Student experience and role of the R N in surgery

Carmella Campbell, RN

It has been said that “the unique function of the nurse is to assist the patient in activities he is unable to do himself .”

Few patients become as totally de- pendent or require as intensive nurs- ing care as the person in surgery. The planning and implementation of this individual’s nursing care must be performed by the person prepared for this “unique function”-the reg- istered nurse.

The purpose of this article is to discuss, from an instructor’s point of view, the need for educational ex- perience and RN staffing in the op- erating room:

1. Does the student of nursing need experience in the operating room? Carmella L. Campbell, RN, is an instructor a t the University of Washington and associate supervisor at Virginia Mason Hospital in Seattle. She received her BS degree from the University of Washington School of Nursing and worked for nine months in the operating room as additional preparation for her current position.

2. Is it mandatory that an RN is teaching both students and surgical personnel ?

To the person admitted into the hospital for surgery, the time spent in the operating room is the focus of his entire hospitalization. All of his preoperative care will be geared toward this point and his postop- erative care will be based on that which has taken place in surgery.

The surgical experience is one situation which we force the indi- vidual to cope with alone. His per- ception of his situation will be dras- tically altered due to preoperative medication, fear of the unknown, anxiety regarding what the surgeon will find, a strange environment and again, most importantly, being alone.

In addition to the technical pro- cedures (enemas, shave preps) being done preoperatively, this individual needs information. The assumption is often made that a description of how

December 1971 45

one’s gallbladder will be removed is the answer the patient is seeking when he asks: “What will happen to me in surgery?”

Preoperative teaching should in- clude such areas as who will transport the individual to the OR; how surgery personnel are dressed; what surgery looks like-the list of so-called “inci- dentals” is endless and can provide the emotional comfort so necessary for the optimum surgical course.

Similar incidences occur postop- eratively: “My back hurts and I had my knee operated on;” “The dressing is so large, the incision must be big;” “My skin has a funny color.”

Only the knowledge which comes through exposure and experience can prepare the RN to answer these ques- tions accurately and thus, provide the necessary reassurance. Neither the student nor the graduate can ef- fectively care for this person without experiential learning in the surgical suite.

The student’s clinical curriculum is aimed at assessing the patient’s condition, then planning and coordi- nating total patient care through un- derstanding of anatomy and physi- ology, principles and procedures, emotional and social components. Gaining an understanding of what happens to the patient in surgery is a primary objective.

For example, students repeatedly discover that the incisional discom- fort individuals experience postop- eratively is a result of the retraction of tissue to expose the operative area, not the cutting of the skin, as they previously thought.

While the patient is attempting to adapt to a situation in which there is

nothing familiar, the student is gathering information - through ex- posure and participation - to ef- fectively assist this individual.

The operating room also provides many specifics involved in prepara- tion of the registered nurse: under- standing and utilization of the princi- ples of aseptic technic; observation and participat.ion in team nursing; assessing the needs and planning the care for the dependent patient; learn- ing to handle personal anxiety, think and act quickly and appropriately.

The essential component of these functions is organization.

The environment in an operating room is dependent yet autonomous, fulfilling yet stressful, magnificent in its accomplishments yet demanding of superior performance. The student becomes a member of a closely-knit team whose effectiveness, in large part, depends upon ability to set pri- orities.

If the student wishes to actively participate in this learning situation, she soon realizes that the organiza- tion of her time and work is of pri- mary importance. She must have the care of the patient uppermost in her mind, recognizing that knowledge, an- ticipation and accuracy result in the optimum care of the individual by the surgical team.

If the patient spends even an extra 15 minutes under anesthesia because the nursing team was unprepared, this is a lack of organization which cannot be easily remedied and may even be life-threatening. The ability to organize, required of the student during her surgical experience, will be valuable in the delivery of quality patient care in whatever field she chooses.

46 AORN Journal

The frame of reference for surgical nursing has shifted from technical duties to surgical patient care based on principles rather than mechanical procedures. Nursing has done a great deal to shift this focus. The increasing number of task-oriented auxillary personnel have allowed the RN time to further develop her role as the in- dividual responsible for assessing and delivering patient care based on knowing the "why" as well as the "how."

To ensure high quality care and continuity of nursing care by all per- sons involved with the surgical pa- tient, the responsibility for teaching OR personnel and students must lie with the RN. That surgery deals with a patient not a procedure constitutes the need for the registered nurse in surgery and also the reason for stu- dent involvement in this area of nursing. n

U

Communicdion systems needed Emergency care for the sick and in jured could be improved i f communications systems were

established between ambulance personnel and hospital medical authorit ies, a nursing consultant said.

" A n interesting commentary an our l i f e in this tachnological age i s that it i s possible to communicate wi th the astronauts on the moon, bu t communication between the lay person or professional administering f i rst a id and the emergency physician at the hospital i s rarely avai l - able," she said.

The speaker was K. M a r y Straub, RN, EdD, o f Rockvil le, Maryland. She is hospital nursa consultant in the O f f i c e o f Consultation on Hosp i ta l Functions, Public Hea l th Service, Depart- ment o f Hea l th , Education, and Welfare.

Miss Straub spoke dur ing a two-day forum on emergency department organization, ad- ministration, and operat ion sponsored by the Commit tee on Injuries o f the American Academy of Orthopaedic Surgeons.

I n her talk Miss Straub also cal led fo r better t ra in ing o f ambulance personnel and lay persons so that better f i rst a id can be administered t o the injured, and she said emergency services in hospitals could be improved if nurses were given author i ty and training to prov ide more medical services.

She noted that the emergency department has become the "way station" in the provision of heal th care. "To many people it i s the po in t o f entry i n to the heal th care system and has rapidly become the community health center,'' she said.

She c i ted surveys which have shown that in many urban areas the emergency department has become a walk-in c l in ic fa r low-income patients and a source o f "a f te r hours" medical service fo r the more affluent.

The surveys have shown, she said, that 40 to 70 percent o f the patients who seek emer- gency service are not actual ly emergencies.

H igh ly skil led personnel are required for the complex care o f " t rue emergencies," Miss Straub pointed out, and this begins at the po in t of f i rst contact w i th the pat ient at the site of an accident.

"It is a t ragedy that in the Uni ted States today, accidents are still the leading cause of death among persons between the ages o f one and thirty-seven and the four th leading cause of death at all ages," she said.

A though there are no figures t o substantiate i t , she said, she considers a greater t ragedy t o be " the number of iniured people who d ie at the site o f the accident or are permanently disabled because o f the lack of proper f i rst aid treatment or lack o f professional treatment."

"The basic and continuing education of ambulance and helicopter attendants and drivers must become the responsibil i ty of someone other than the owners of mortuary establishments," she said.

December 1971