- Email: [email protected]
Preop visits for eye patients
Preop visits for eye patients Wilhelmina Fernsebner,
RN
Wilhelmina Fernsebner, RN, is a graduate of NewtonWellesley Hospital School of Nursing, Newton, Mass. Ehe was an OR staff nurse at the Massachusetts Eye and Ear Infirmary, Boston. 980
magine going through life without sight or having such poor vision you can only count fingers at five feet. Even more frightening, imagine facing eye surgery not knowing whether the surgery will provide better vision or no vision at all. These are some of the problems eye patients face that operating room nurses should be aware of. The Massachusetts Eye and Ear Infirmary is one of the oldest specialty hospitals in the country. Although the bed capacity is only 170 beds, 99% of all inpatients require surgery, making the operating room suite one of the busiest centers in the hospital. Ten rooms have surgery scheduled from 7:30 am until 5:30 pm, five days a week with a half schedule on Saturday. About 50 operations are performed daily, and more than half are eye procedures for cataracts, glaucoma, retina and vitreous disease, strabismus, plastic repair to lids, and corneal disease. While many of our patients are children, the average patient age is over 65, and many have serious medical problems (the most common, diabetes). On most days, emergency surgery such as corneal transplants, repair of lacerations, removal of foreign bodies, and peripheral iridectomy for glaucoma is scheduled to follow the elective surgery. Ninety people, including RNs, LPNs, scrub technicians, instrument technicians, orderlies, secretaries, and housekeeping personnel staff the department. The specialty nature of the hospital produces a backlog of patients waiting for admission. Many operations last an hour or less, with only five minutes allowed to clean a room before setting up for the next operation. Patients are wheeled in and out in a blur of right eyes and left eyes, and often there is hardly time to say hello and no time for adequate explanation of procedures and alleviation of fears. Much eye surgery is done with local anesthesia with or without an anesthetist standby. These patients are awake and want to know what is happening. Many arrive in the operating room with questions such as, “Will
AORN Journal, December 1974, Vol20, No 6
you have to remove my eye to fix it?” “Will I be asleep during the operation?” Others arrive with special needs that should be known to the operating room staff. After working several months with eye surgery patients, I felt the need to make the patient care more personal in the operating room. I believed some of the patients’ fear and anxiety could be relieved if someone visited preoperatively. By conducting preoperative visits, I believed I could answer their questions and provide a much needed link between floor nursing care and operating room nursing care. I would not explain the actual surgery, but would focus on “going to the operating room” and what was to be expected. I obtained permission from the OR director to spend three months seeing patients in preoperative visits to ascertain what information was needed by, and from, the patient to provide continuity of care. I hoped to see all patients postoperatively but was unable to complete many visits due to the busy operating schedule and the short stay of most patients. Conducting the visit. After obtaining information from the patient’s chart and the floor staff, I entered the patient’s room and introduced myself. I learned after a few visits to touch the patient and offer my hand. Patients with poor vision want to know where you are, and they prefer to have you close. Touch shows that you care and that you are a comforting person. Many of my patients held my hand throughout the visit, communicating to me that they trusted me to care for them. Ignoring everything I was taught in nursing arts, I frequently sat on the bed so I could be close to the patient. I believed that
if the patient could not see me he was not going to have a meaningful conversation with me. Our discussions covered such points as: 1. Time and length of surgery. The patient and his family want to know the time surgery is scheduled and, in general, how long he will be away from his room. Patients are taken to the operating room about 45 minutes to an hour before surgery and wait in the holding area before actually going into the operating room. Many physicians tell the patient that the surgery will take an hour, but they fail to tell the family that the patient could be away from his room for three hours. 2. Preoperative medications. I tell the patient when they are given and why. 3. Holding area. I explain the function of the area, transportation to and from the area, and what will be done there. 4. Operating room. I wear OR clothing so the attire will be familiar on the day of surgery. I also describe the bright lights, the people who will be in the room, and equipment the patient might see. I explain procedures that will be done prior to surgery such as starting an infusion, applying a blood pressure cuff, and applying monitor leads. I also tell the patient about the wrist bracelets which prevent him from touching his face by mistake while the physician is operating. 5. Recovery room. If the patient is to be taken to the recovery room, T explain what the room is for, that nurses will be with him, and that when he wakes up he will find his eye patched. 6. Returning to room. I explain
AORN Journal, December 1974, Vol20, No 6
981
Nursing care plan for patients in OR and Name:
RR Age:
Date of surgery:
Surgeon:
Family:
Room: Procedure:
Occupation:
Medical condition: Previous hospitalization and/or Previous surgery Action, if any
Patient concern Allergies
Tape
Dentures Vision without glasses Hearing PhysicaI limitations Language Summary of interview and instructions, if any, to the circulating nurse
that he will return to his room from either the recovery room or the holding area but not until he is awake and able to call for assistance. From these visits, I devised a care plan sheet to fill out and give to the nurse circulating in that patient’s room the next day. Most of the areas are appropriate for any surgical patient, but a few are especially pertinent to eye patients and need explanation. Occupation or home responsibilities. A father, who does not know whether he will have enough vision to return to his job or who wonders where he will get money to pay the bills, will be anxious and worried. A mother, faced with a relatively long convalescence when she will not be able to care for her home and children, will be worried and concerned. A person, facing loss of vision which
982
will mean rehabilitation before working again, will be depressed. The OR nurse is not the first person to discuss these problems with the patient, but they will affect the patient’s reaction to surgery and his response to the nurse’s visit. If the nurse is aware of these emotional responses, she understands that a patient may respond to her visit with indifference or hostility. Most hospitals have a social service department to arrange for job and family counseling. The Massachusetts Eye and Ear Infirmary has an excellent department that usually knows of the patient’s needs before I see the patient. Family. Many of our patients are from other areas (or other countries) and frequently have no friends and family to visit them. Social service arranges for visits for these patients.
AORN Journal, December 1974, Vol20, N o 6
Even when someone lives close to the hospital, he may be too elderly to travel alone to visit. Several volunteer agencies help arrange transportation. Many older patients, who live alone, are reluctant to go to one of their children’s homes for their recovery period because they interpret such a move as a threat to their independence. These patients need reassurance that their recovery will be relatively short, and they can then return to their own home or apartment and resume normal activities. Language. This is an important problem at the Infirmary because the hospital is located in a large city with many ethnic communities and because of referrals from other countries. Interpreters for the most common foreign languages are available. Allergies. This is a routine question asked when the patient is admitted, but frequently people think of allergies as pertaining only to food or drugs. I ask the patient specifically about adhesive tape allergy because tape is used to hold the monitor leads and eye patches in place. Vision without glasses. Almost all our patients wear glasses, and many see poorly without them. If a patient can only see shadows, he cannot move easily to the operating room table without having someone guide him. He also cannot see the nurse preparing for surgery; therefore, procedures should be explained before rather than as they are performed. Summary of some visits during three-month program. Many patients have had surgery before at the Infirmary and know what to expect. A Iarge number have been well prepared by their doctor, while others
have routine questions (pertaining to visiting hours for example) that could be answered by anyone, but the preoperative visits provided the vital link necessary for continuity of care. Sometimes I have helped the family as much as the patient, particularly when the family was from out-of-town. By telling them specific places to go and how to get there (and places to avoid) and further explaining that I come to the city every day with no fear, I have allayed some anxieties. I have summarized several preoperative visits which show some of the problems of eye patients. Mrs B did not seem at all apprehensive, perhaps because she did not grasp why she was in the hospital or what was to be done. My first reaction was that she could not profit from my visit. On reevaluation I realized that the OR staff could profit, as I did, from knowing her limitations and how much cooperation they could expect. I suggested they explain every procedure as it was performed in hopes that she could understand some of what they told her. She cooperated well in surgery although she still did not seem to know what was being done. Mrs A was an 83-year-old lady with absolute glaucoma (final state of glaucoma when there is no vision due to extensive damage and atrophy to the optic nerve resulting from continual increased intraocular pressure). She was to have her eye enucleated which would relieve the constant pain she experienced. As the result of a cerebral vascular accident or stroke, she was disoriented as to time and location and had hemiplegia. While I was not able to convey information to the patient, I
AORN Journal, December 1974, VoE20, N o 6
983
G
ary’s cool facade crumbled when he got on the operating room-table.
informed the circulating nurse of Mrs B’s needs. She was able to look at my care plan and realize that Mrs B would not be able to move by herself and would probably not understand procedures. Gary, a 21-year-old parking lot manager, entered with a detached retina in his left eye. He was to have a scleral buckle procedure the next day. I anticipated that Gary would be frightened and have many questions. I entered the room and introduced myself to Gary and his father, who was visiting. I told Gary that I was from the operating room and after some opening conversation asked him what he knew about his surgery and whether he had any questions. He said he didn’t know much and asked how long it took to get a telephone. After a few rapid changes in conversation, all away from his surgery, I thought that Gary’s father might be an intimidating factor. I also felt that Gary’s age was the cause of his nonchalant attitude. It was too late for me to ask Gary’s father to leave, so I closed the visit by telling Gary that I would t r y to see him the next day prior to surgery. I told the evening charge nurse that Gary might have some questions once his father left, and maybe it would help if he could talk to Gary later in the evening. On Gary’s care
984
plan, I suggested that the circulating nurse explain everything as she did it and, if possible, t r y to talk with him prior to surgery to see if she could answer any questions. Gary’s cool facade crumbled when he got on the operating room table and asked the circulating nurse questions such as, “Will they cut my eye? Will they take my eye out? Will I lose my sight?” She tried to answer all his questions in the little time available, but felt that Gary was apprehensive when given his anesthesia. During induction, his monitor pattern was abnormal, and this might have been related to his level of anxiety as his pattern returned to normal as his level of anesthesia deepened. Mrs G was an asthmatic who became “wheezy” when upset. She had a bad experience with an inaccurate diagnosis before changing doctors and was quite apprehensive and upset on her admission. Although she had great confidence in her physician, who had explained the surgery in detail, she still had many questions for me to answer. She was concerned that she would not receive the diazepam she took at home as her medication could not be kept by her bedside. I advised her to tell her physician of her need for the medication so he would order it for her to receive during her hospitalization. I was able to tell Mrs G that I would
AORN Journal, December 1974, Vol20, N o 6
be with her during surgery, something I don’t always know when visiting. During the visit, I found that Mr G worked odd hours that coincided with visiting hours. I was able to have the head nurse make special arrangements for an exception to the regular visiting hours. I also noticed that the day of admission was Mrs G’s birthday and was able to arrange for a birthday cake from the kitchen. On the day of surgery, Mrs G commented how good it was to see a familiar face. She was still very tense but was able to relax with intravenous diazepam. Later that day, when she was in her room, Mrs G told me she did not realize how pleasant surgery could be. Her recovery was uneventful, and she spent her entire hospital stay without an asthmatic attack. Mr P was in a double room with Mr M. They were both having the same surgery by the same doctor, and I thought I would experiment with visiting the two of them together. Mr M had had the same surgery on his other eye several months before and was aware of what was going to happen. He had explained some procedures to Mr P, and they were discussing surgery when I arrived. We all talked about his surgery, but M r P did not seem to hear what was being said. His chart stated that he had many other problems including alcoholism which started when his daughter died in an automobile accident in which M r P had been the driver. He told me he had been to many hospitals but did not know what for. (His chart stated that he had had both psychiatric care and “drying out” a t VA hospitals.) When I mentioned visiting hours, he said he didn’t think his family cared.
If this interview had been conducted with Mr P alone, I might have been able to help him more. Summary. When I worked in general surgery, eye surgery was performed in one room one or two days a week. As the surgery was almost always performed under local anesthesia, it was thought of as minor surgery. Most of us did not give much thought, if any, to the needs of the patient. Now that I am working at a specialty hospital, I realize I had been remiss. The eye patient has needs. He may be frightened, anxious, depressed as are many patients facing surgery, but his potential loss, vision, is greater than almost any other surgical patient. By conducting a preoperative visit, I could reassure the patient. Realistic hope should be offered, but the seriousness of the surgery should not be minimized. A care plan can be developed for each patient so that the best possible care can be given in the operating room.
0
References Berger, Peter. Introduction to Sociology. New York: Anchor Books, 1963. Berne, Eric. Games Peeople Play. New York: Grove Press, 1967. Bird, Brian. Talking With Patients. Philadelphia, Toronto: J P Lippincott, 1973. Carlson, Carolyn, coordinator. Behavioral Concepts and Nursing fntervention. Philadelphia, Toronto: J B Lippincott, 1970. Garrett, Annette. Interviewing, 2nd ed. New York: Family Service Association, 1972. Harris, Thomas. I’m OK-You’re OK. New York: Harper & Row, 1967. Jourard, Sidney M. The Transparent Self. New York: Van Nostrand Co. 1971. Lair, Jess. “Hey, God, What Should I Do Now?” New York: Doubleday, 1973. Lair, Jess. “I Ain‘t Much, Baby-But I‘m All I’ve Got.” New York: Doubleday, 1969. Ross, Elisabeth Kubler. On Deatth and Dying. New York: MacMillan, 1969.
AORN Journal, December 1974, Vol20, N o 6
985
RN
Wilhelmina Fernsebner, RN, is a graduate of NewtonWellesley Hospital School of Nursing, Newton, Mass. Ehe was an OR staff nurse at the Massachusetts Eye and Ear Infirmary, Boston. 980
magine going through life without sight or having such poor vision you can only count fingers at five feet. Even more frightening, imagine facing eye surgery not knowing whether the surgery will provide better vision or no vision at all. These are some of the problems eye patients face that operating room nurses should be aware of. The Massachusetts Eye and Ear Infirmary is one of the oldest specialty hospitals in the country. Although the bed capacity is only 170 beds, 99% of all inpatients require surgery, making the operating room suite one of the busiest centers in the hospital. Ten rooms have surgery scheduled from 7:30 am until 5:30 pm, five days a week with a half schedule on Saturday. About 50 operations are performed daily, and more than half are eye procedures for cataracts, glaucoma, retina and vitreous disease, strabismus, plastic repair to lids, and corneal disease. While many of our patients are children, the average patient age is over 65, and many have serious medical problems (the most common, diabetes). On most days, emergency surgery such as corneal transplants, repair of lacerations, removal of foreign bodies, and peripheral iridectomy for glaucoma is scheduled to follow the elective surgery. Ninety people, including RNs, LPNs, scrub technicians, instrument technicians, orderlies, secretaries, and housekeeping personnel staff the department. The specialty nature of the hospital produces a backlog of patients waiting for admission. Many operations last an hour or less, with only five minutes allowed to clean a room before setting up for the next operation. Patients are wheeled in and out in a blur of right eyes and left eyes, and often there is hardly time to say hello and no time for adequate explanation of procedures and alleviation of fears. Much eye surgery is done with local anesthesia with or without an anesthetist standby. These patients are awake and want to know what is happening. Many arrive in the operating room with questions such as, “Will
AORN Journal, December 1974, Vol20, No 6
you have to remove my eye to fix it?” “Will I be asleep during the operation?” Others arrive with special needs that should be known to the operating room staff. After working several months with eye surgery patients, I felt the need to make the patient care more personal in the operating room. I believed some of the patients’ fear and anxiety could be relieved if someone visited preoperatively. By conducting preoperative visits, I believed I could answer their questions and provide a much needed link between floor nursing care and operating room nursing care. I would not explain the actual surgery, but would focus on “going to the operating room” and what was to be expected. I obtained permission from the OR director to spend three months seeing patients in preoperative visits to ascertain what information was needed by, and from, the patient to provide continuity of care. I hoped to see all patients postoperatively but was unable to complete many visits due to the busy operating schedule and the short stay of most patients. Conducting the visit. After obtaining information from the patient’s chart and the floor staff, I entered the patient’s room and introduced myself. I learned after a few visits to touch the patient and offer my hand. Patients with poor vision want to know where you are, and they prefer to have you close. Touch shows that you care and that you are a comforting person. Many of my patients held my hand throughout the visit, communicating to me that they trusted me to care for them. Ignoring everything I was taught in nursing arts, I frequently sat on the bed so I could be close to the patient. I believed that
if the patient could not see me he was not going to have a meaningful conversation with me. Our discussions covered such points as: 1. Time and length of surgery. The patient and his family want to know the time surgery is scheduled and, in general, how long he will be away from his room. Patients are taken to the operating room about 45 minutes to an hour before surgery and wait in the holding area before actually going into the operating room. Many physicians tell the patient that the surgery will take an hour, but they fail to tell the family that the patient could be away from his room for three hours. 2. Preoperative medications. I tell the patient when they are given and why. 3. Holding area. I explain the function of the area, transportation to and from the area, and what will be done there. 4. Operating room. I wear OR clothing so the attire will be familiar on the day of surgery. I also describe the bright lights, the people who will be in the room, and equipment the patient might see. I explain procedures that will be done prior to surgery such as starting an infusion, applying a blood pressure cuff, and applying monitor leads. I also tell the patient about the wrist bracelets which prevent him from touching his face by mistake while the physician is operating. 5. Recovery room. If the patient is to be taken to the recovery room, T explain what the room is for, that nurses will be with him, and that when he wakes up he will find his eye patched. 6. Returning to room. I explain
AORN Journal, December 1974, Vol20, No 6
981
Nursing care plan for patients in OR and Name:
RR Age:
Date of surgery:
Surgeon:
Family:
Room: Procedure:
Occupation:
Medical condition: Previous hospitalization and/or Previous surgery Action, if any
Patient concern Allergies
Tape
Dentures Vision without glasses Hearing PhysicaI limitations Language Summary of interview and instructions, if any, to the circulating nurse
that he will return to his room from either the recovery room or the holding area but not until he is awake and able to call for assistance. From these visits, I devised a care plan sheet to fill out and give to the nurse circulating in that patient’s room the next day. Most of the areas are appropriate for any surgical patient, but a few are especially pertinent to eye patients and need explanation. Occupation or home responsibilities. A father, who does not know whether he will have enough vision to return to his job or who wonders where he will get money to pay the bills, will be anxious and worried. A mother, faced with a relatively long convalescence when she will not be able to care for her home and children, will be worried and concerned. A person, facing loss of vision which
982
will mean rehabilitation before working again, will be depressed. The OR nurse is not the first person to discuss these problems with the patient, but they will affect the patient’s reaction to surgery and his response to the nurse’s visit. If the nurse is aware of these emotional responses, she understands that a patient may respond to her visit with indifference or hostility. Most hospitals have a social service department to arrange for job and family counseling. The Massachusetts Eye and Ear Infirmary has an excellent department that usually knows of the patient’s needs before I see the patient. Family. Many of our patients are from other areas (or other countries) and frequently have no friends and family to visit them. Social service arranges for visits for these patients.
AORN Journal, December 1974, Vol20, N o 6
Even when someone lives close to the hospital, he may be too elderly to travel alone to visit. Several volunteer agencies help arrange transportation. Many older patients, who live alone, are reluctant to go to one of their children’s homes for their recovery period because they interpret such a move as a threat to their independence. These patients need reassurance that their recovery will be relatively short, and they can then return to their own home or apartment and resume normal activities. Language. This is an important problem at the Infirmary because the hospital is located in a large city with many ethnic communities and because of referrals from other countries. Interpreters for the most common foreign languages are available. Allergies. This is a routine question asked when the patient is admitted, but frequently people think of allergies as pertaining only to food or drugs. I ask the patient specifically about adhesive tape allergy because tape is used to hold the monitor leads and eye patches in place. Vision without glasses. Almost all our patients wear glasses, and many see poorly without them. If a patient can only see shadows, he cannot move easily to the operating room table without having someone guide him. He also cannot see the nurse preparing for surgery; therefore, procedures should be explained before rather than as they are performed. Summary of some visits during three-month program. Many patients have had surgery before at the Infirmary and know what to expect. A Iarge number have been well prepared by their doctor, while others
have routine questions (pertaining to visiting hours for example) that could be answered by anyone, but the preoperative visits provided the vital link necessary for continuity of care. Sometimes I have helped the family as much as the patient, particularly when the family was from out-of-town. By telling them specific places to go and how to get there (and places to avoid) and further explaining that I come to the city every day with no fear, I have allayed some anxieties. I have summarized several preoperative visits which show some of the problems of eye patients. Mrs B did not seem at all apprehensive, perhaps because she did not grasp why she was in the hospital or what was to be done. My first reaction was that she could not profit from my visit. On reevaluation I realized that the OR staff could profit, as I did, from knowing her limitations and how much cooperation they could expect. I suggested they explain every procedure as it was performed in hopes that she could understand some of what they told her. She cooperated well in surgery although she still did not seem to know what was being done. Mrs A was an 83-year-old lady with absolute glaucoma (final state of glaucoma when there is no vision due to extensive damage and atrophy to the optic nerve resulting from continual increased intraocular pressure). She was to have her eye enucleated which would relieve the constant pain she experienced. As the result of a cerebral vascular accident or stroke, she was disoriented as to time and location and had hemiplegia. While I was not able to convey information to the patient, I
AORN Journal, December 1974, VoE20, N o 6
983
G
ary’s cool facade crumbled when he got on the operating room-table.
informed the circulating nurse of Mrs B’s needs. She was able to look at my care plan and realize that Mrs B would not be able to move by herself and would probably not understand procedures. Gary, a 21-year-old parking lot manager, entered with a detached retina in his left eye. He was to have a scleral buckle procedure the next day. I anticipated that Gary would be frightened and have many questions. I entered the room and introduced myself to Gary and his father, who was visiting. I told Gary that I was from the operating room and after some opening conversation asked him what he knew about his surgery and whether he had any questions. He said he didn’t know much and asked how long it took to get a telephone. After a few rapid changes in conversation, all away from his surgery, I thought that Gary’s father might be an intimidating factor. I also felt that Gary’s age was the cause of his nonchalant attitude. It was too late for me to ask Gary’s father to leave, so I closed the visit by telling Gary that I would t r y to see him the next day prior to surgery. I told the evening charge nurse that Gary might have some questions once his father left, and maybe it would help if he could talk to Gary later in the evening. On Gary’s care
984
plan, I suggested that the circulating nurse explain everything as she did it and, if possible, t r y to talk with him prior to surgery to see if she could answer any questions. Gary’s cool facade crumbled when he got on the operating room table and asked the circulating nurse questions such as, “Will they cut my eye? Will they take my eye out? Will I lose my sight?” She tried to answer all his questions in the little time available, but felt that Gary was apprehensive when given his anesthesia. During induction, his monitor pattern was abnormal, and this might have been related to his level of anxiety as his pattern returned to normal as his level of anesthesia deepened. Mrs G was an asthmatic who became “wheezy” when upset. She had a bad experience with an inaccurate diagnosis before changing doctors and was quite apprehensive and upset on her admission. Although she had great confidence in her physician, who had explained the surgery in detail, she still had many questions for me to answer. She was concerned that she would not receive the diazepam she took at home as her medication could not be kept by her bedside. I advised her to tell her physician of her need for the medication so he would order it for her to receive during her hospitalization. I was able to tell Mrs G that I would
AORN Journal, December 1974, Vol20, N o 6
be with her during surgery, something I don’t always know when visiting. During the visit, I found that Mr G worked odd hours that coincided with visiting hours. I was able to have the head nurse make special arrangements for an exception to the regular visiting hours. I also noticed that the day of admission was Mrs G’s birthday and was able to arrange for a birthday cake from the kitchen. On the day of surgery, Mrs G commented how good it was to see a familiar face. She was still very tense but was able to relax with intravenous diazepam. Later that day, when she was in her room, Mrs G told me she did not realize how pleasant surgery could be. Her recovery was uneventful, and she spent her entire hospital stay without an asthmatic attack. Mr P was in a double room with Mr M. They were both having the same surgery by the same doctor, and I thought I would experiment with visiting the two of them together. Mr M had had the same surgery on his other eye several months before and was aware of what was going to happen. He had explained some procedures to Mr P, and they were discussing surgery when I arrived. We all talked about his surgery, but M r P did not seem to hear what was being said. His chart stated that he had many other problems including alcoholism which started when his daughter died in an automobile accident in which M r P had been the driver. He told me he had been to many hospitals but did not know what for. (His chart stated that he had had both psychiatric care and “drying out” a t VA hospitals.) When I mentioned visiting hours, he said he didn’t think his family cared.
If this interview had been conducted with Mr P alone, I might have been able to help him more. Summary. When I worked in general surgery, eye surgery was performed in one room one or two days a week. As the surgery was almost always performed under local anesthesia, it was thought of as minor surgery. Most of us did not give much thought, if any, to the needs of the patient. Now that I am working at a specialty hospital, I realize I had been remiss. The eye patient has needs. He may be frightened, anxious, depressed as are many patients facing surgery, but his potential loss, vision, is greater than almost any other surgical patient. By conducting a preoperative visit, I could reassure the patient. Realistic hope should be offered, but the seriousness of the surgery should not be minimized. A care plan can be developed for each patient so that the best possible care can be given in the operating room.
0
References Berger, Peter. Introduction to Sociology. New York: Anchor Books, 1963. Berne, Eric. Games Peeople Play. New York: Grove Press, 1967. Bird, Brian. Talking With Patients. Philadelphia, Toronto: J P Lippincott, 1973. Carlson, Carolyn, coordinator. Behavioral Concepts and Nursing fntervention. Philadelphia, Toronto: J B Lippincott, 1970. Garrett, Annette. Interviewing, 2nd ed. New York: Family Service Association, 1972. Harris, Thomas. I’m OK-You’re OK. New York: Harper & Row, 1967. Jourard, Sidney M. The Transparent Self. New York: Van Nostrand Co. 1971. Lair, Jess. “Hey, God, What Should I Do Now?” New York: Doubleday, 1973. Lair, Jess. “I Ain‘t Much, Baby-But I‘m All I’ve Got.” New York: Doubleday, 1969. Ross, Elisabeth Kubler. On Deatth and Dying. New York: MacMillan, 1969.
AORN Journal, December 1974, Vol20, N o 6
985