Tom Sharon Focusing on what the staff members will need to do


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A Conversation with a Pre-Op Nurse

The nurse may start to focus on what Bob will need to do to enhance his recovery and minimize complications such as deep breathing and coughing after surgery. But Bob should turn the conversation around to first focus on what the staff members will need to do to ensure his safety. Here is how the dialogue should go:

NURSE: Hello, I am here to provide you with pre-op teaching. Can you describe the operation you are going to have?
BOB: Yes. It's a hernia repair.
NURSE: There are a few things you will need to do to give yourself the best chance for a successful outcome.
BOB: I would rather talk first about what the staff will need to do to give me the best chance for survival.
NURSE: All right. What are your concerns?
BOB: How can I be certain that the staff will not drop me on the floor while transferring me from the bed to the stretcher, from the stretcher to the operating table, and vice versa?
NURSE: Oh, they won't drop you. They are very careful with transferring.
BOB: Are you going to personally guarantee that and be accountable if I fall and get hurt during transfer?
NURSE: No, I cannot agree to that. I do not directly supervise the doctors and nurses in the operating room.
BOB: Then how can you assure me of safe transfers in your hospital?
NURSE: We have strict policies and procedures for safe transfers.
BOB: Good. Would you elaborate on them please?
NURSE: First, transferring from the bed to the stretcher, the transfer person will come to your hospital room with an operating room stretcher. He and your nurse will place the stretcher next to your bed with no space in between, and he will lock all four wheels. Then they will ask you to slide over onto the stretcher.
BOB: Good. Now I know to make sure that they lock the wheels, and I can test the stretcher with my hand before I move. What is the next step?
NURSE: The transporter will bring you to the pre-op holding area, where a nurse will greet you.
BOB: How do I make sure that I don't end up getting one of my kidneys removed instead of getting the hernia repair that I came for?
NURSE: The nurse who greets you will ask you to state your name and then check your identification bracelet and your chart to make sure they all match.
BOB: So if she doesn't do that, I can ask her who she thinks I am?
NURSE: That's a good idea. Correctly identifying the patient is necessary to avoid operating on the wrong person. All surgical patients wear the same gowns and head covers, so even males and females look alike.
BOB: How do I know they will not operate on the wrong side of my abdomen?
NURSE: The procedure and anatomical location of the surgery is supposed to be on the consent form. The circulating nurse has the responsibility to make sure that the surgeon is aware of whom the patient is and that he is aware of the proper location of the initial cut.
BOB: What happens next?
NURSE: The anesthesiologist or nurse anesthetist will come to you and start an intravenous line.
BOB: What if I still have to wait for a long time and I feel scared and nervous?
NURSE: You can ask for some pre-op sedation.
BOB: What happens when the operating room is ready for me?
NURSE: The anesthesiologist or one of his staff will walk you into the room or bring you on the stretcher.
BOB: What about transferring to the table?
NURSE: If you are on a stretcher, they will ask you to slide over after locking the wheels and holding the stretcher against the operating table. If you are walking, you will just sit and then lie down while swinging your legs up. The table height is adjustable.
BOB: How will the surgical team keep me safe during the surgery?
NURSE: The circulating nurse has the duty of keeping you safe in the operating room. She will perform certain routine tasks that will ensure your safety.
BOB: What does she have to guard against?
NURSE: She has to keep track of blood loss, watch for breaks in sterility to avoid infection, make certain that your body is grounded to prevent electrical burns, and make certain that the surgeon doesn't leave any sponges or instruments inside your body.
BOB: Now, what are the things I will need to do to give myself the best chance for a successful outcome?
NURSE: After abdominal surgery, you will experience some pain with deep breathing and coughing, and this may cause you to not want to do it. That will increase the risk of pneumonia.
BOB: What can I do about it?
NURSE: The floor nurses will keep you as pain-free as possible with medications that the doctor orders. They will also give you this incentive spirometer, also known as a lung expander. [The nurse shows Bob a clear plastic device made up of three cylinders with a Ping-Pong ball in each one.] Place the mouthpiece between your lips and inhale through it, causing all three Ping-Pong balls to rise to the top of each cylinder. After doing this for about five minutes, take a deep breath and cough, but first make sure that you have an abdominal binder. That is a wide elastic belt that wraps around your abdomen with a Velcro fastener.

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