On the other side of the OR doors
Article Outline
DONNA S. WATSON
I had entered those double doors into the OR many times before, but this time it was different because I was not in my usual role as a perioperative RN. Instead, I was the patient, and I was scheduled to undergo a diagnostic laparoscopy.
SELECTING MY CARE
When I realized that surgery was inevitable, I did what any informed consumer should do. I sought out the best providers and care facilities available. I was very familiar with my surgeon. As a perioperative manager, I had firsthand knowledge of her skills, superior expertise, caring bedside manner, and expectations of excellence from every member on her surgical team.
I also selected the institution where the procedure would be conducted. I was careful to select one of the best facilities in the Tacoma, Wash, area, St Joseph Medical Center. I had worked at St Joseph as a perioperative nurse in the past and was aware of its philosophy of quality patient care, as well as the skills of the nursing and medical staff members.
Selecting my anesthesia care provider proved to be a challenge. It is interesting that as a patient I could participate in the selection of my surgeon, but my influence on who provided anesthesia care was limited to a request in the schedule book. Although my requested anesthesia care provider was not available, the one chosen appeared to be very caring.
Of course, I also wanted the best providers on my surgical team. I was certain that any of the staff members at St Joseph's would provide excellent care, but the selection of the surgical team members was left to the surgery coordinator.
PREPARING FOR SURGERY
During the preoperative visit with my surgeon. I was offered medication for any anxiety I may have had related to the impending surgery. I initially declined the prescription, but I eventually accepted it, just in case. After all, I was fully aware of what I would be experiencing—right?
Although I did not take the medication, I was surprised at the amount of anxiety I had before surgery. My thoughts revolved around my knowledge of what could go wrong. I worried about issues of sterilization, time of surgery, anesthesia complications, infection, and many other things. My imagination was getting the best of me—or was it? The anxiety got worse the closer I got to surgery, and it peaked on the morning of the scheduled diagnostic laparoscopy.
The day arrived, and I was off for another life experience, one that I had hoped would come later rather than sooner. My husband commented on the valet parking at the hospital, but this proved to be a nice benefit, especially after surgery. At this point, if I had not had any presurgery anxiety, the wait in the surgical admitting area would have caused it. The area clearly was understaffed for the number of patients being admitted, and it lacked adequate seating, although staff members were very courteous. Privacy was an issue, and I could not avoid hearing confidential issues being discussed between staff members and patients as they were being admitted. I was hoping when it was my turn the discussion would be kept to a minimum, and it was.
I do not like wasting time, so I tried to conduct business on my cellular telephone while waiting, until a nice volunteer gently reminded me to turn it off because it can interfere with monitors in critical care areas. He also talked about how noncomplying nurses and physicians use cellular telephones all the time in the hospital and ignore the warnings. I confess I did not see the signage—perhaps my anxiety was greater than I thought—but after the lecture on nurses and physicians, I kept the fact that I am an RN a secret.
This was my only distraction, and, in some way, I felt like a child whose toy had been taken away as the anxiety continued to reach new heights; however, I maintained my exterior composure for the sake of the profession. After all, what would the other surgical patients think if a perioperative nurse with more than 22 years of experience had a meltdown? They would wonder, “What does she know that we don't?”
THE SURGERY
The short-stay surgery area was very inviting and aesthetically pleasing. Upon arrival, I asked staff members to page Beverly Walker, RN, CNOR, who is an educator in the surgical services area and a friend of mine, because I wanted to give her some materials. Seeing the familiar face of a colleague I respect was very therapeutic. My anxiety was reduced greatly when she reassured me that I had a great team to care for me.
The nurse who assessed me shared her name but not her title, and her name badge was turned so that all I could see was information about the Joint Commission on Accreditation of Healthcare Organizations. She conducted a very thorough nursing assessment with skill and expertise, however. The laboratory technician was very polite as he introduced himself and used correct technique. Then I met my anesthesia care provider for the first time. He was courteous, polite, and answered my questions for more details, such as what medications would be used. Although I really wanted to know more about his competence, training, and experience, we proceeded with information about my care. Everything was moving much too quickly for me, and every minute seemed to go by in a second.
Then the circulating nurse came in and introduced herself. I knew what this meant—the schedule was running early, and the time had arrived too soon. I wanted to say, “Stop! It is too early to take me in. I'm not ready for this. I really want to go back home. Can we do it at a better date and time?” My cool exterior was in control of my now panicked and out-of-control emotions as we entered the OR. I scanned the room as I had done so many times before, just as if I was returning from lunch or if my procedure had been set up by a colleague. Only this time, I had a different focus, and questions were running through my mind like ticker tape on Wall Street. “Is all the equipment present? How was the scope processed? Is the room set up? Are the staff members experienced?” The required equipment was in place, and the scrub person was setting up the back table and was introduced to me.
As I scanned the room, I wondered whether the back table was too close to the wall or if the drop box was hanging over the sterile field. My anxiety was getting the best of me, but was it just my perception or reality? I had to stop myself; I was getting worse. “Trust the system and the process,” and “you have competent caregivers,” I told myself. My attention was refocused on me as I was positioned and the medication was administered. It most likely was midazolam, because my next recollection was in the postanesthesia care unit (PACU) where I was asking if I could leave.
My PACU nurse was very through, knowledgeable, and caring, and the discharge went smoothly. I arrived home and had my prescriptions filled for pain and nausea. These went unused, and I determined that my anesthesia care provider was excellent in all regards. The only episode of nausea was that of my 12-year-old son as he watched the videotape of the procedure. Although I greatly anticipated and looked forward to the next few days of rest and relaxation with my family members waiting on my every wish, this was short lived; within two hours I was back on the telephone taking care of business as usual.
LESSONS LEARNED
Although I do not recommend having surgery, it was an experience that has changed my perspective. I am thankful to every provider who had contact with me and the care they provided that resulted in a safe surgical experience. Acting in a caring manner in the surgical setting, an environment that is considered high tech, is a challenge for every provider. There are many issues and variables that we as individual providers have no control over, but caring is something we can control; it is our responsibility to act in a caring manner with each of our patients. The surgical patient is the focal point of all care in a setting that includes the latest technology, equipment, and a team of dedicated, qualified individuals. Team members must work together to provide safe, quality patient care.
Team unity takes many forms, including effective communication and collaboration among team members. Communication allows views to be expressed, ensures the availability of necessary supplies and equipment, and allows for specifies related to comprehensive care. One example of poor communication is the failure to communicate a patient's medication allergy. This failure could have a devastating effect on the patient. Each team member has a responsibility to provide the best care to the patient, and communication is key in the delivery of that care. Collaboration among team members also is essential to provide safe, quality patient care. On behalf of surgical patients across the country, I want to thank each member of the surgical team for his or her daily efforts to ensure safe, quality care.
PII: S0001-2092(06)60928-9
doi:10.1016/S0001-2092(06)60928-9
© 2002 AORN, Inc. Published by Elsevier Inc All rights reserved.
