OR NURSING’S HUMANE FRONTIER Bette Clemons, RN

Many of our world’s gravest problems stem from inadequate human relationships. Bor- ders, barriers, and gaps which separate people now warrant rejoining efforts as never before. The universal question is “how?”

The discovery of bacteria once made aseptic practice relevant. This forever influenced the nature of patient care in operating rooms. What we call “hideous practices” were common, prior to understanding of the germ theory; and the people involved were quite unaware of their wrong-doing.

Today’s scientific frontier concerns human behavior study and the development of good human relationships. The elements, and their implications for change, may be just as difficult for us to see as bacteria once were.

Yet today’s pioneering challenge effects operating room nurses just as surely as before.

Each operating room nurse today is challenged to individualize her entire patient approach. But before nursing care can become truly patient-centered, the patient’s individual- ity must be known.

Some people maintain it is unnecessary for the OR nurse to visit patients preoperatively;

Bette Clemons, RN, is a member of the Association of Operating Room Nurses and has recently com- pleted work on a book on the history of nursing in the operating room. A graduate of West Suburban Hospital School of Nursing, Oak Park, 111, she has had several years experience in emergency room nursing, and as an OR staff nurse and private scrub nurse. She has been published previously in Amen- can Journal of Nursing and the AORN Journal (vol 10, no. 2, p 61, “On Being General Chairman of a Regional Institute”).

that pertinent information about the patient can be forwarded in writing. By this method, however, only a small measure of existing need is served.

Patients do look upon surgery differently. Some individuals facing an operation need more supportive help than others.

Patients have many worries when they enter a hospital. Psychologists tell us the basis of most anxiety is fear of entering alone into a hostile world.

We may not think of the operating room a being hostile world, but it is. Children, if not adequately prepared for the experience, are vulnerable to trauma just undergoing a tonsillectomy and adn0idectomy.l

A child of seven recently underwent a T&A. While her recollections were fresh, and her throat still scratchy, she described what her operating room experience was like. She said, “I saw utensils like pliers . . . you know, sharp ruggedy things. The voices sounded strict. A boy said to me, ‘are you afraid?’ I didn’t answer.

“A big machine was put on me, gates and gates of water kept opening, blue kept pouring in until it turned black.””

This child did not seem frightened by what she experienced. The child’s mother, a nurse, had thoughtfully prepared her daughter. (The child willingly admitted, however, being frightened upon awakening to the sight of blood on the sheet under her nose.)

Being employed at one time by a group of surgeons gave me the opportunity to hear

*Conversation with a neighbor’s daughter, age seven.

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initial surgeon-patient conversations. I was constantly amazed by the calm way people accepted the news when the need for surgery was first confirmed.

People would ask mature questions of the surgeon-where, when, for how long, and “how much.”

Childlike questions were saved. The tone of “Nurse, will you be there?” revealed how many people really felt about their anticipated operation.

The basis of a patient’s fear can be quite unimaginable to us-fear, on our part can be easily overlooked.

Anna Boersma, presently of Doetinchem, Netherlands, once served as a nurse mission- ary in a remote area of New Guinea. Among primitive natives, fear of surgery was ac- cepted and matter of fact. Miss Boersma would begin each day by checking with the ward nurse to learn how many of the day’s scheduled operative patients still remained in the hospital, and how many had run away during the night.

She recalls the natives were frightened of the sight of the operating room.

Puzzled by this, Miss Boersma asked one patient why he took one look inside and ran. He was accustomed to hut dwellings, each of which had a visible roof support. The operating room ceiling, having no visible logs or trees in sight, surely meant the roof would topple down. Miss Boersma learned that indeed a curious reassurance was needed.2

A UNESCO (public health) report briefly mentions different ways people in various world cultures perceive surgery. “People to whom it is important that their body remain whole find surgery insu~portable.”~

Spanish Americans of New Mexico are said to resist cuts being made upon their body, which they compare to pottery-once dam- aged the appearance remains forever, no matter how careful the mending.

Amputations present quite a separate prob- lem. According to the report, in many

societies cripples are despised, or at least a source of uneasiness. The Navajo Indians feel a cripple is out of harmony with his universe. Therefore, close contact with him might bring disharmony into another life.

In Melanesia, people prefer to die of gangrene rather than have an amputation. They most strongly wish to enter the after-life complete.

By marked contrast, Dr. Schweitzer found people in Africa impressed with the dramatic cure effects of surgery, even amputation. Surgery is willingly accepted, even to the extreme example of one African walking 300 miles just to be operated upon.4

Amputation can become a welcome alterna- tive to a person who has long endured the painful agony of an extremity slowly dying of arterial insufficiency. In civilian practice in this country, “More limbs are removed for chronic occlusive arterial disease than for any other c a ~ s e . ” ~

People the world over understand and accept surgery differently. Is this worldly variable relevant to us in the United States?

Today we watch our mass communication media convey more surgical information to the public than ever before in history. This sophisticated array of facts does not answer the simple things people want and need to know when their own moment arrives.

The fact is, misconceptions are common. Understanding the patient’s attitude toward surgery can help the operating room nurse approach each patient more helpfully. Aware- ness of his overall general condition can help the nurse assemble the right things to guide in the selection of personnel best suited to member each team.

Many blessings result from patient visiting, not the least of which is personal enrichment for the nurse. Yet, despite all of the potential good, persons in authority (in a given setting) have been known to deny approval for operating room nurses to begin preopera- tive visits. Pioneering efforts have been hastily

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manacled for a variety of reasons. The question in return to the negative

opinions might be “How satisfied are we that prior to surgery, the sole ambassador from the operating room is the person assigned to do the prep?”

Why not inquire into the nature of questions which the attendant is asked to field every day?

Nothing is ever quite so convincing as fact. What one person or group has accomplished, seeming however small, could prove vitally important to another. Nurses in the Associa- tion of Operating Room Nurses could con- vince with their own facts. They could make an effort to share their own preoperative visiting experiences with Journal readers, describing (for example) :

1. how the visiting program began, the opposition which was encountered and how it was surmounted;

2. the size hospital and amount of surgery

done;

arranged ;

including the sticky ones; and

3. how time for preoperative visiting is

4. the nature of questions patients ask

5. the advantages of preoperative visiting. Any innovation which breaks an established

habit pattern is bound to stir up objection in some quarter. Anticipating this, we can’t really expect other people to be convinced in a few minutes of a new value. It may take years.

“Would you go to Room 8 please and start Dr. Smith‘s gall bladder right away?” In accustomed OR parlance, the nurse now has her assignment. In order to fill it us stated,

she must know: where Room 8 is, where the gall bladder is, where Dr. Smith is, assuming she already knows where the tools are.

Whose responsibility is it to wonder about-indeed, to insist upon knowing-who each patient really is?

REFERENCES

1. Hughes, Robert B.: “Children’s Fears of Sur- 3. Meade, Margaret: Cu ..sral Patterns and Tech- gery,” Hospital Topics, 45:9, 116-117, September nical Change, a manual prepared by the World 1967. Federation for Mental Health, Margaret Meade, Ed,

2. Boersma, Anna (former exchange nurse in the UNESCO, 1953, 250. US), information obtained from a tape recording 4. Ibid. made per author’s request, for possible publication use.

5. Hershey, Falls B.; Calman, Carl H., Atlas of Vascular Surgery, CV Mosby, 1%3, 255.

TO COPE WITH AN O R DANGER . . . Use of flammable anesthetics, of interest to those involved with operating room work, is outlined in a booklet Code for the Use of Flammable Anesthetics 1968. The paperback is available at a cost of $1.25 from the National Fire Protection Association, 60 Batterymarch St, Boston, Mass 02110.

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