Perioperative Nurse Week: recognition of excellence

AORN Journal,  Nov, 2005  by Nancy J. Girard

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Perioperative Nurse Week is Nov 13 to 19, 2005. It is a time in which perioperative nurses are recognized and lauded for their professional nursing qualities, dedication to patient care, and excellence in perioperative practice.

Excellence generally is defined as being superior or exceptionally good (1) at what one does. AORN promotes excellence by supporting

   the highest professional standards of
   perioperative nursing practice for
   the optimum care of the patient
   before, during, and after surgery. (2(p9)

Optimum care implies incorporating the "physiological, psychological, sociocultural, and spiritual responses of surgical patients" (3(p15) into daily practice. Excellence in nursing care is evident in self-motivation and regulation, a nurse's competence in performing all required roles, and ultimately, in patient satisfaction.

Excellence in perioperative nursing practice can be seen every day in every setting. There are a million stories in the perioperative arena. The following four scenarios provide examples of excellence in perioperative nursing that occur every day in a variety of perioperative settings.

SCENARIO ONE

In a busy, nonprofit hospital with many ORs, a small Hispanic girl has been scheduled for surgery to correct a genetic deformity. The perioperative nurse first sees the patient and her parents in the noisy holding area. Many other family members are in the waiting room. The parents look more scared than the child, and it is apparent that the child feels her parents' fear.

The perioperative nurse performs a brief assessment. The nurse recognizes the emotional situation and uses excellent communication skills to minimize the psychological trauma to the family. The nurse introduces himself to the patient and her family members, telling them that he is their child's special nurse and that he will be with their child the entire time she is in surgery. He will keep the parents and family members informed on the progress of the surgery and will come to tell them when it is over.

The perioperative nurse tells the child he will be with her and will hold her hand until she falls asleep. The child will not let go of her blanket and refuses to part with it. The nurse allows her to have the security of the blanket until she is asleep, then he has the blanket taken to the parents for safekeeping until the child is awake.

The nurse's actions demonstrate caring, expertise in understanding both the patient's and parents' needs, and skill in helping make the procedure go as smoothly as possible. After the procedure, the parents thank the nurse, saying he made their child's surgery bearable.

SCENARIO TWO

At a small for-profit ambulatory surgery center, a woman is waiting for a breast biopsy to determine if a lump is cancerous. She is quiet and withdrawn.

The perioperative nurse enters as the anesthesia care provider and surgeon are leaving. She introduces herself and notes the woman's body posture and lack of emotion. The perioperative nurse tells the woman that she will be with her during the procedure and asks if she has any questions. The patient retorts impatiently that everyone has told her more than she has ever wanted to know about breast biopsies, and she just wants it to be over. The nurse replies that she understands and asks if the patient has any requests she can help with. The patient replies that she would like to see her pastor. He is there but no one will let him in.

The nurse finds the pastor and arranges for him to see the patient briefly before the procedure. After a few minutes, the nurse returns to complete the preparations for the patient. She notes that the patient is now calm but shivering. She puts a warm blanket on her and asks if she wants some warm booties.

After the procedure, the patient reports that the little things the nurse did for her, including giving her personal attention, expressing concern for her fears and needs, and providing for her physical comfort, were important. These actions meant a lot to the patient during a period of extreme worry. The patient later tells the nurse that the biopsy was negative. The nurse demonstrated excellence in all aspects of this patient's perioperative care.

SCENARIO THREE

An older adult patient is scheduled for a gastroenteroscopy and colonoscopy at a minimally invasive gastrointestinal laboratory. The patient has no relatives and is being transported from a nursing home via ambulance. The perioperative nurse performs a comprehensive preoperative assessment because all records have not been transferred with the patient. The assessment results show a well-nourished, 82-year-old white male with apparent abdominal discomfort. His mobility is impaired because of arthritis. He wears glasses for vision problems. The nurse allows the man to wear his glasses as long as possible and minimizes the bright lights around him. He is cognitively intact and knows where he is and why he is there. The nurse assures the patient she will help him change positions so his arthritis pain will be minimized. She promises to be with him to prevent any sudden motions to his head because the arthritis in his neck is worrisome to him.