Phoenix seminar: keynote speech

Caroline Rogers, RN

As members of the nursing profession we hold our heads high and proud. Nursing in this year of 1972 is truly professional.

Strangely enough, only during the past 100 years has nursing been acclaimed as a profession, even though recorded ac- counts of nursing appear in the Bible. For centuries, nursing was ridiculed and was socially rejected.

Change can be beautiful. Just think for a few moments about what change has done for nursing. During the Civil War, good intentioned women helped ease the pain of the wounded in army hospitals and on the battlefield. Despite their dedi- cation to their cause, they were pictured by the army's Surgeon General as meddle- some, interfering women. Patient care was strictly in the realm of the physicians and they allowed no trespassing.

Caroline Rogers, RN, is director of membership,

A O R N National Headquarters. She graduated from

Mary Immaculate Hospital School of Nursing, Ja- maica, NY, and did postgraduate study at Belle-

view Hospital, N e w York City.

Without going further into the history of nursing, suffice it to say the battlegrounds of the Civil War precipitated the opening of schools for the express purpose of train- ing women to nurse the sick. Numerous changes have occurred between then and now. The effect of socio-economic condi- tions, as well as the steady improvement in educational goals, has changed the pic- ture from "training women" to educationally preparing people to become members of a health care team.

That i s where you are today. As students in the nursing profession you are at a crossroad in this educationat preparation. Most crossroads in life are met only once. We rarely get the chance to go back and make another choice; that luxury of time i s usually not ours to take.

Today the responsibilities of nurses are tremendous. Better care for the patient is our ultimate goal. We want to provide better care not only for the patient already the victim of trauma or disease but also better preventive care. We are called on to iriform the community of ways and means

October 1972 165

of maintaining health as well as being ex- pected to aid in repairing health. To achieve that performance we must constanly look toward better techniques and share our knowledge with students and co-workers.

The crossroad each one of you i s fast approaching is the one in which the sign- posts offer alternate routes to your desti- nation of a career filled with satisfaction. As I picture a signpost, there is always a choice to be made. Take one road and the path leads straight to mental health nursing. Another offers a non-detour to pediatrics. Many others offer a smooth ride to ObGyn; teaching, research, medsurg nursing and on and on.

There is one more road, though, as I mentally contemplate that signpost. Of late it has not been overly crowded. That i s surprising to me because I have been down that road and I know it well. In my opinion, that particular road offers all the benefits to be gained from each of the other roads.

I invite you to take a mental excursion with me. Let's take the road that says "Operating Room Nursing". I can guar- antee you will encounter all kinds of pa- tients. Infants, children, the aged, the men- tally ill, drug addicts, the man next door, famous and infamous, rich and poor; you'll meet them all. All those people will be in their respective groups clustered at the end of the other roads you might have taken. Yes, you'll meet them all and the meeting will be under conditions that chal- lenge you.

This route of operating room nursing makes demands on you. You are forced to supplant yourself in the patient's being, to be his conscience and carry on the thought process he is now unable to ac- complish because of anesthesia. He de- pends on "you" to guarantee his safety by ensuring correct positioning to avoid injury to nerves. You must maintain sterility For considerable periods of time to prevent dangerous infection complications. You must

know how to be the surgeon's third hand so that surgical time can be shortened to the barest minimum. And, you must per- form efficiently all the while knowing that you probably will not get a verbal thank you or clasp of the hand from the patient. Why do I say this road offers the combined benefits of all other roads? it i s this road that puts together all the fundamentals and principles of nursing and puts them to the test.

This training ground is essential no mat- ter what your final destination. Granted that OR nursing i s not the goal of every one of you, but the experience very defi- nitely must be included. Without this experi- ence, you are, in the opinion of many sur- geons and nurses, a deprived student.

Nursing education has gone through a cycle in which the educators told us there is nothing to be learned in the OR that cannot be taught in the classroom or in the nursing unit, including aseptic tech- nique, anatomy, psychology, team work and other pertinent information. When educators eliminated those items and looked at the curriculum they saw in the OR block only trauma to the student's psyche and an exercise in mechanical functions. They reasoned then that rotation through the OR could safely be removed.

Passage of time has underlined the fal- lacy of that theory. Today more and more educators realize the importance of the inclusion of the OR in the students' total learning experience, and some are attempt- ing to gradually reinstate it.

A pilot study of expanded OR experience for the nursing student led to a dramatic report from one school of nursing in south- eastern US. By changing a four week course of observation to a five week course of supervised participation, the pilot study class averaged 570.7 on the surgical nurs- ing state bwrd exam. This was 121.1 points higher than the previous class' score of 449.8. In addition, the report showed that

I

& t o 169

166 AORN Journal

the pilot class scored 61.2 points above the state mean average and 47.1 points above the national mean average.

Based upon recommendations by the graduates of the pilot study class, the school now has expanded the OR experi- ence to an eight week course.

This trend of getting back to having the student put his learned theory to practical applications as part of the educational process i s followed not only in nursing but in other fields of education as well. Just this past year, the Colorado legislature has worked closely with state universities. The schools are now awarding degree credits to law students for on-the-job training in connection with their established classroom curriculum. They spend several hours a week doing actual work for and with the legis- lators. Both students and legislators have agreed that the work program has proven to be a most valuable experience.

When I said the educators had deleted a very meaningful chunk of the student's OR experience, I did not mean to place the educators in the position of "whipping boy". We as OR nurses must share a portion of that blame. In trying to assess the situation, we as a group did some soul searching. Had we treated students in the OR fairly? Did we see ourselves as teachers or merely policemen making sure that the novices did not get in the way or contaminate the area? Did we use them for service only, without trying to significantly add to their learning process? Unfortunately we had to admit to those shortcomings to some extent. We had indeed contributed to the formulation of the theory that OR experience could be shaved down or eliminated from the cur- riculum. This contribution was unwittingly given and most unintentional.

There was then and is now no doubt in our minds that students musf have OR ex- perience. Take anatomy for example. Your instructor, by means of charts and books, helps you grasp the picture and enables

you to place the issues, structures and or- gans in their proper place. We know how much stronger the impact, how much deeper the meaning, when you can actually see and feel the structure in both normal and abnormal situations,

We know the direct relationship opera- tive manipulation of tissue has to postop pain. We understand why one patient may experience much more postop discomfort than others. We've seen times when the tissues are extremely friable and to do an efficient hernia repair meant using many more sutures than usual and involved much more undermining of surrounding tissue than usual. We live with sterile technique for eight hours a day. The principles of asepsis become second nature to us in all of our actions.

It i s not my intent or purpose to detail all the advantages of OR nursing. The pro- gram being presented to you today does that admirably. M y function here is to give you a point of reference, to open your minds, to the information being made avail- able to you.

As I mentioned earlier, not every one of you will choose OR nursing as a career, but I sincerely ask each of you to consider quite seriously the road you will take and ponder the advantages to be gained by travelling the OR nursing road on the way to your destination of a fulfilling career.

To those inclined toward OR nursing, I say "welcome aboard". You have chosen well. I have no qualms about that unquali- fied statement, "You have chosen well." For me personally, it has been rewarding, self gratifying and truly productive career.

I first realized the importance of OR nurs- ing when I was in nursing school. My room- mate and I were chosen to go to the OR to fill a vacancy. Normally, the students did not get to the OR until their senior year. A whole new world opened up to us. Sud- denly the long memorized list of bones, muscles, nerves and other terms came to

October 2972 169

life in full living color. We went back to the OR in our senior year for the routine assignment and then on to postgraduate study in the specialty.

In the following years, as my career un- folded, I've worked with many well known surgeons and have been personally en- riched by them.

Don't let anyone tell you there i s no patient contact. What little I know of psy- chology, I learned in the OR. Believe i t or not, back when I was in nursing school our psychology course consisted of two trips to the state hospital and a few lec- tures. Recognizing emotional needs and knowing how to cope with them i s possible for me because of the patient contact I've experienced. This patient contact comes at a time when the patient is no longer guarded by social mores and the bravado of self sustenance.

Surgery has been defined by psychol- ogists as a crisis in the patient's hospitaliza- tion. What better time to really communi- cate with another human being than during crisis stress situations? I might compare this to a mother-child relationship. A child runs

to the mother for understanding and love during a crisis and just so do patients relate with an OR nurse. She is the one who i s on the scene, who has all the answers about that little known area behind the closed doors. She i s the one who holds their hand in hers and by this gesture alone says: "I love you and I will take care of you." This kind of love that I have been able to give patients over the years has made a better person of me.

Next month when I am in Italy, at the meeting of the International College of Surgeons in Rome, acting as a representa- tive of the nurses of the world, I shall have the opportunity to compare, discuss and ex- change ideas about OR nursing with nurses from various foreign countries. Methods and techniques may differ greatly but one thing you can be sure of: The dedication of OR nurses i s universal. The program you are going to get into right now i s a perfect example of that dedication. AORN of Phoenix has worked very hard to put this program together and it will, I know, tell you the story of the OR scene far better than I have been able to tell it.

Neck fracfures respond well to immobilization A neck fracture that involves the jo in t concerned w i th moving the head in "no" and "yes" fashions responds we l l t o immobilization in a cast or jackets, according t o a report presented before the American Academy o f Or thopaed ic Surgeons at their annual meeting in Washing- ton , DC.

Twenty-eight o f the 32 fractures achieving union healed w i th this conservative t reatment in 20 weeks or less. Twenty percent fa i led t o unite.

The author, A lan Roberts, MD, c l in ica l instructor in orthopaedic surgery at the UCLA School of Medicine, Lor Angeles, and co-author, Jack K. Wickstrom, MD, chairman o f t he di- vision of orthopaedic surgery, Tulane University Med ica l School, New Orleans, recommended that immobilization continue fo r 20 weeks and i f union has not been achieved by then, that surgery be carried out.

Au tomobi le accidents accounted fo r most o f the fractures, bu t 49 of the patients studied report d i rec t t rauma t o the head or face instead of the neck as in "whip-lash."

The fracture occurs in the odontoid bone which i s the body of the atlas, a r ing on which the head rests. I n the area of the odontoid, the spinal cord i s about 10 mi l l ime ten in diameter and the spinal canal about 25 mill imeters. A blow t o the back o f the head or to the face can cause an odontoid fracture. I n 14 o f the 50 fractures studied, the odontoid bone was disp1ac.d.

170 AORN Journal