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Let's Open the Door
LET’S OPEN THE DOOR Sister Rose Mary, D.C., R.N. What is to be the true role of the operating room supervisor of the future? Will she be free to coordinate and collaborate with all areas of nursing in her hospital? If so, she will need experience in all phases of regular so-called “hall” duty and all it involves such as team participation, in-service education and bedside conferences. For all these and many more activities now regarded as sidelines should be routine for this nurse who wants to see the patient through an operation from start to finish. Unfortunately, hozo this can be done is the dilemma of the day. Orders, schedules, bookkeeping, statistics and housekeeping duties retard and hide the gold mine behind “the green door” of the operating room suite. True, great things are being done behind this door: real team nursing, the concept of which can never be realized in other departments; a learning environment, not available in any other nursing situation ; tremendous in-service programs presented by staff nurses with intimate knowledge of a specialty which should be shared with nurses caring for these patients postoperatively. So much of the above could be shared but is not because of inadequate coordination between departments. The only way to solve this problem, I believe, is through revising the role of the operating room supervisor. In two areas, for example, the sharing of responsibilities could play a significant role in freeing the operating room supervisor to look beyond her own portals, nursing-wise.
One area is housekeeping, where inspection and supervision of general cleaning of the OR area falls at the present time into the jurisdiction of the operating room supervisor. Could the possibility be explored whereby the housekeeping department would inspect and supervise the general cleaning of the operating room area? Should not supervisory personnel from the hospital’s central housekeeping department regularly mask and gown and go through the operating room department, appraising and praising the work being done there by individuals who, under the present arrangement, must feel “special” and thus set apart in their own department?
Sister Rose Mary, D.C., R.N., operating ronni supervisor of Saint Joseph Hospital, Chicago, received her B.S. from DePaul University, Chicago; her R.N. from DePaul Hospital, St. Louis. She has been operating room supervisor at Providence Hospital, Mobile, Ala. and has done psychiatric nursing at DePaul Hospital, New Orleans. Sister is Chairman of the Operating Room Conference Group, Chicago Nursing Group of ANA and a member of AORN.
While in many places unit secretaries are trained to handle specific OR scheduling during daytime hours, the advent of DP machines can be especially beneficial in freeing the evening operating room nursing staff who do not have the services of a unit secretary. In this way, the evening staff will also be af-
May 1968
Secondly, what utilization can be made in surgery of the unit manager who, as in other departments, could supervise the ordering of all supplies, coordinate secretarial work, control inventory, and perform a myriad of other non-nursing tasks? By functioning in those areas, the unit manager would relieve not only the operating room supervisor, but other operating room personnel heretofore assisting her. Furthermore, with the advent of data processing, even scheduling of surgical procedures may well become minimal for the operating room supervisor if her DP machines can be fed with the proper information such as specific information for certain operations or surgeons. For example, when Dr. Jones schedules thoracic surgery, a suite must be reserved for four hours. But, when Dr. Smith schedules the same procedure, he will need an operating room for only three hours.
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forded time to visit many more preop patients, especially on the eve of surgery. Hopefully, these and other potentially shared responsibilities would then enable the operating room supervisor and her staff to utilize their time to participate as:
1) Nursing team consultants or members of the team;
2 ) Leaders and service programs bring regular staff they can expect in
participants in hospital in(the objective being to nurses up-to-date on what postoperative care) ;
3 ) Specialists in initiating and conducting patient information sessions throughout the hospital, and
4) Assistants with difficult pre and postoperative patients. As a nursing team consultant, the operating room supervisor would then be available to provide special information surrounding the “what’’ and “why” of patient care.
As in-service education participants, the operating room supervisor and her staff could assist with overall understanding of today’s constantly evolving operating room proceedings, thus anticipating and alleviating many of the fears and tensions of both the patient and his family-and the attending nurse. For instance, operating room staff could, at regular monthly continuing education sessions, demonstrate specific operating room proceedings and techniques used in new concepts of surgical treatment-such as peritoneoscopy. The general duty nurse exposed to such a session could attain a better understanding of why such a patient suffers certain postop pain (as from carbon dioxide insufflation). She, in turn, could explain the “whys” of this temporary discomfort to the patient. In many instances, we have found the postoperative progress of patients to be retarded in the majority of cases in which these patients have suffered from apprehension and tension, due to poor understanding of their problems and the procedures to be performed.
48
Here, too, the OR nurse can establish rapport with the patient and often fill an information void left by the busy physician. After patient has been told that she is suffering from cancer, for example, the OR nurse can assist her to understand the diagnosis and to accept the fact by answering her questions, dispelling fears, encouraging her and telling her of the considerable knowledge the medical profession has gleaned in treatment of this disease and of the use which can be made of modern surgical techniques. In the Patient Information Sessions, conducted preoperatively as part of preparation of the patient for surgery, the operating room supervisor and others conducting these sessions form a close bond with the patient, doctor, and hospital, thus providing a genuine atmosphere geared toward graceful postoperative recuperation of the patient. We found Patient Information Sessions most gratifying, both to the patient, who generally appears to progress much more rapidly after surgery because he can anticipate various pains or conditions, and to the operating room staff member who is thus afforded an opportunity to individualize her contact with the patient both before and after surgery. (Figure 1Patient Information Session.) It has been our experience that the Patient Information Session outlined herein works best on a specialty wing where a group of patients anticipating similar surgery within the next 48 hours or so can be brought together in a classroom setting.
Many preoperative and postoperative patient problems can be understood by personnel living in close contact to the source of these intimate happenings to the patients. I believe the operating room supervisor and staff are equipped to render valuable assistance in a patient problem-solving session. Psychiatric nursing consultations are available to personnel on regular medical-surgical units. During these consultations, nurses from the hospital’s mental health unit meet
AORN Journal
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PATlEN’I’ INFORMATION SESSION ---who he is -what he wants to know (usually stimulates many questions regartling type of anesthesia, rtc.) 2) Resident and Intern 3) Sister visitor --spiritual needs -chaplain or minister -Holy Commiinion --Mass f) Morning of surgery l i Hypo or “shot” 2 ) Cart to the operating room 3 ) Assignment to nurse in operating room 4 ) Recovery room -identity of something patient sees when awakening -special care g ) Rrturn to room 1) Patient cooperation streised -deep breathing -miiving freely -pain felt only by patieninurse should b e notified 2 ) Side rails 3 ) Dressings and tuhes EKG 4) Ambulation Preparation of skin 5 ) Questions by patients ale answeied as the) Fingernail polisli arise and/or referred to the doctor. Valuables, Dentures, C o s m e t i c s 4 t h e r RESULTS: prosthesis 1. Nurses on unit are relieved of many questions Evening diet 2. Patients more receptive to preop nursing care 3. Patients mnre relaxed and cooperative 4. More informed relatives 5. Patients ask for medications as needed
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k’igure 1
with unit personnel to plan and coordinate therapy for patients experiencing psychological difficulties. Could not the OR supervisor and her staff who evaluated the patient before surgery also serve as a valuable team member in alleviating his postoperative problems? As clinical specialists serving actively as consultants to the whole hospital, the operating room nursing staff is potentially able to perform a significant role in recruiting nurses and other personnel to their own depita1 as well as without. The fact that most nursing students spend relatively little time in surgery, principally observing a few operations, is often overlooked. So is the fact that there is relatively little cross-over from regu-
M a y 1968
lar floor nursing to operating room nursing in the typical general hospital today. Certainly, then, the image of the OR department can be significantly enhanced by the OR staffs presence in all phases of patient care.
But, here again, how can the operating room supervisor and her staff make their unique contribution to integrated patient care if they seldom are allowed to step beyond “the green door?” Certainly, it is the primary responsibility of the operating room supervisor to pave the way for herself and her staff by correct utilization of non-nursing personnel and encouragement of her own staff to include these new hospital-wide roles in their daily routine.
49
One area is housekeeping, where inspection and supervision of general cleaning of the OR area falls at the present time into the jurisdiction of the operating room supervisor. Could the possibility be explored whereby the housekeeping department would inspect and supervise the general cleaning of the operating room area? Should not supervisory personnel from the hospital’s central housekeeping department regularly mask and gown and go through the operating room department, appraising and praising the work being done there by individuals who, under the present arrangement, must feel “special” and thus set apart in their own department?
Sister Rose Mary, D.C., R.N., operating ronni supervisor of Saint Joseph Hospital, Chicago, received her B.S. from DePaul University, Chicago; her R.N. from DePaul Hospital, St. Louis. She has been operating room supervisor at Providence Hospital, Mobile, Ala. and has done psychiatric nursing at DePaul Hospital, New Orleans. Sister is Chairman of the Operating Room Conference Group, Chicago Nursing Group of ANA and a member of AORN.
While in many places unit secretaries are trained to handle specific OR scheduling during daytime hours, the advent of DP machines can be especially beneficial in freeing the evening operating room nursing staff who do not have the services of a unit secretary. In this way, the evening staff will also be af-
May 1968
Secondly, what utilization can be made in surgery of the unit manager who, as in other departments, could supervise the ordering of all supplies, coordinate secretarial work, control inventory, and perform a myriad of other non-nursing tasks? By functioning in those areas, the unit manager would relieve not only the operating room supervisor, but other operating room personnel heretofore assisting her. Furthermore, with the advent of data processing, even scheduling of surgical procedures may well become minimal for the operating room supervisor if her DP machines can be fed with the proper information such as specific information for certain operations or surgeons. For example, when Dr. Jones schedules thoracic surgery, a suite must be reserved for four hours. But, when Dr. Smith schedules the same procedure, he will need an operating room for only three hours.
47
forded time to visit many more preop patients, especially on the eve of surgery. Hopefully, these and other potentially shared responsibilities would then enable the operating room supervisor and her staff to utilize their time to participate as:
1) Nursing team consultants or members of the team;
2 ) Leaders and service programs bring regular staff they can expect in
participants in hospital in(the objective being to nurses up-to-date on what postoperative care) ;
3 ) Specialists in initiating and conducting patient information sessions throughout the hospital, and
4) Assistants with difficult pre and postoperative patients. As a nursing team consultant, the operating room supervisor would then be available to provide special information surrounding the “what’’ and “why” of patient care.
As in-service education participants, the operating room supervisor and her staff could assist with overall understanding of today’s constantly evolving operating room proceedings, thus anticipating and alleviating many of the fears and tensions of both the patient and his family-and the attending nurse. For instance, operating room staff could, at regular monthly continuing education sessions, demonstrate specific operating room proceedings and techniques used in new concepts of surgical treatment-such as peritoneoscopy. The general duty nurse exposed to such a session could attain a better understanding of why such a patient suffers certain postop pain (as from carbon dioxide insufflation). She, in turn, could explain the “whys” of this temporary discomfort to the patient. In many instances, we have found the postoperative progress of patients to be retarded in the majority of cases in which these patients have suffered from apprehension and tension, due to poor understanding of their problems and the procedures to be performed.
48
Here, too, the OR nurse can establish rapport with the patient and often fill an information void left by the busy physician. After patient has been told that she is suffering from cancer, for example, the OR nurse can assist her to understand the diagnosis and to accept the fact by answering her questions, dispelling fears, encouraging her and telling her of the considerable knowledge the medical profession has gleaned in treatment of this disease and of the use which can be made of modern surgical techniques. In the Patient Information Sessions, conducted preoperatively as part of preparation of the patient for surgery, the operating room supervisor and others conducting these sessions form a close bond with the patient, doctor, and hospital, thus providing a genuine atmosphere geared toward graceful postoperative recuperation of the patient. We found Patient Information Sessions most gratifying, both to the patient, who generally appears to progress much more rapidly after surgery because he can anticipate various pains or conditions, and to the operating room staff member who is thus afforded an opportunity to individualize her contact with the patient both before and after surgery. (Figure 1Patient Information Session.) It has been our experience that the Patient Information Session outlined herein works best on a specialty wing where a group of patients anticipating similar surgery within the next 48 hours or so can be brought together in a classroom setting.
Many preoperative and postoperative patient problems can be understood by personnel living in close contact to the source of these intimate happenings to the patients. I believe the operating room supervisor and staff are equipped to render valuable assistance in a patient problem-solving session. Psychiatric nursing consultations are available to personnel on regular medical-surgical units. During these consultations, nurses from the hospital’s mental health unit meet
AORN Journal
-~
-
-
- -
I
PATlEN’I’ INFORMATION SESSION ---who he is -what he wants to know (usually stimulates many questions regartling type of anesthesia, rtc.) 2) Resident and Intern 3) Sister visitor --spiritual needs -chaplain or minister -Holy Commiinion --Mass f) Morning of surgery l i Hypo or “shot” 2 ) Cart to the operating room 3 ) Assignment to nurse in operating room 4 ) Recovery room -identity of something patient sees when awakening -special care g ) Rrturn to room 1) Patient cooperation streised -deep breathing -miiving freely -pain felt only by patieninurse should b e notified 2 ) Side rails 3 ) Dressings and tuhes EKG 4) Ambulation Preparation of skin 5 ) Questions by patients ale answeied as the) Fingernail polisli arise and/or referred to the doctor. Valuables, Dentures, C o s m e t i c s 4 t h e r RESULTS: prosthesis 1. Nurses on unit are relieved of many questions Evening diet 2. Patients more receptive to preop nursing care 3. Patients mnre relaxed and cooperative 4. More informed relatives 5. Patients ask for medications as needed
I
1
k’igure 1
with unit personnel to plan and coordinate therapy for patients experiencing psychological difficulties. Could not the OR supervisor and her staff who evaluated the patient before surgery also serve as a valuable team member in alleviating his postoperative problems? As clinical specialists serving actively as consultants to the whole hospital, the operating room nursing staff is potentially able to perform a significant role in recruiting nurses and other personnel to their own depita1 as well as without. The fact that most nursing students spend relatively little time in surgery, principally observing a few operations, is often overlooked. So is the fact that there is relatively little cross-over from regu-
M a y 1968
lar floor nursing to operating room nursing in the typical general hospital today. Certainly, then, the image of the OR department can be significantly enhanced by the OR staffs presence in all phases of patient care.
But, here again, how can the operating room supervisor and her staff make their unique contribution to integrated patient care if they seldom are allowed to step beyond “the green door?” Certainly, it is the primary responsibility of the operating room supervisor to pave the way for herself and her staff by correct utilization of non-nursing personnel and encouragement of her own staff to include these new hospital-wide roles in their daily routine.
49