Preop visits- for l ittle people

Christine Peterson, RN Lois Bullerman, RN

Once upon a time, in the land of race cars, there was a town Indianapolis. In this town there was a big medical center with a hospital specializing in children’s diseases. This was James Whitcomb Riley Hospital, part of the Indiana University Medical Center.

In this hospital was a beautiful, modern, operating suite with ceramic walls and big stainless steel doors and autoclaves making hissing noises in every room. There were big round lights that moved in so many direc- tions, and these lights had little

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Christine Peterson, RN, i s assistant head nurse, neurology and orthopedics, James Whitcomb Riley Hospital for Children, Indianapolis, Ind. She re- ceived her bachelor’s degree in nursing from Indiana University, Bloomington.

Lois Bullerman, RN, is supervisor nurse, Bethany Hospital, Merriam, Kansas. She received her RN degree from Ball Memorial Hospital School of nursing, and completed a postgraduate course in OR management and technic at the University of Pennsylvania, Philadelphia.

Both authors are A O R N members; Miss Peterson of the Indianapolis chapter and Miss Bullerman of the Greater Kansas City chapter.

lights inside of them. There was a kind of monster-like machine there with dials, and glass cylinders on it, and white gravel in it. Boy, I bet that was dirty!

There were all kinds of tentacles coming off that machine, like an oc- topus. Everybody wore green clothes and covered their hair and covered their faces so all you could see were their eyes. All of these people talked a lot and laughed and clanged around big pots and pans and all kinds of tools. They kept running around and doing things all the time.

They stuck metal plates with some cold wet goo on them under the little people. They put big needles in little veins after they put a rubber band around their arms. “Ouch! That hurt!” They taped cold little metal plates on their arms and legs and if that weren’t enough they put smelly black masks on the little peoples’ faces. The little people couldn’t breathe and they tried to get away

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but somebody was on top of them and their legs were strapped in and it turned dark and the little people were asleep.

And then when they awoke they hurt and they had bottles hanging around them and some were in plas- tic tents and their mommies weren’t there. Oh, if only mommy could have been there!

A bad dream? Maybe. But this is how some children perceive their ex- perience in the OR. Older children who’ve stopped fantasizing, see it in a different, but no less frightening light.

Doing something to prevent this psychological trauma was discussed as long as four or five years ago. It was talked about and hoped for, but that’s about all, for it is difficult to implement revolutionary ideas in a big bureaucratic organization which, typically of this monster, surrounds itself with red tape.

A group of senior nursing students was interested in doing a study on the effect of the preoperative visita- tion a n d postoperative recovery. Time available for these students to conduct their study was insufficient to provide them with a broad exten- sive sample. However, from their sample of some 30 cases, they found that the anxiety, fear and resulting pain experienced by children visited preoperatively was significantly lower than in those who did not receive this service.

When possible, the children were taken to look into the OR through the windows available for this pur- pose. When visiting, the students wore scrub suits and brought masks with them for the children to see.

The children and their parents were encouraged to ask questions.

Since the time of that study, more than two years had elapsed, and in January 1970, the Riley OR staff was given the go-ahead from the OR supervisor. to start regular preop- erative visits on a routine basis. Word was filtered down to the head nurses of all the pediatric units, and to the head of the pediatric division of the medical center. All were happy to hear of the practice and have been most cooperative in assisting the OR nurse to make her patient visits.

How is it done, you ask. Only RNs are permitted to make preoperative visits to the patients and their fam- ilies. It was reasoned that their ed- ucational background might better enable them to answer some of the touchy and technical questions some- times asked.

There is one nurse assigned to PVs per week. (The RN on duty on Sun- day sees Monday’s patients.) This provides for continuity of care. She visits the patients scheduled for the next day’s surgeries. During the visit she uses her discretion as to the best approach for the particular patient.

She is responsible for filling out a report sheet complete with pertinent information from the chart, such as past medical history, social history, weight, religion, and information ob- tained during the interview. Informa- tion such as size, weight, may be sig- nificant when it comes to picking instruments. The OR schedule has the age of the child; however, we know that a 15 year old can weigh as lit- tle as 30 lbrs if he’s severely deformed or retarded; or he can weigh as much as any adult.

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Particulars about the family are also i m p o r t a n t. You certainly wouldn't want to ask a youngster what his daddy did if you knew that his father just died several months ago in an automobile accident. The PV nurse relays all pertinent infor- mation-including the child's pre- ferred nickname-to the OR staff the next morning. She spends the rest of the morning greeting patients as they arrive staying with them through in- duction if possible. The report sheets given each circulator in the morning are placed by her in the chart for the benefit of the recovery room staff.

Since these reports are not part of the official records, they are dis- carded before the child leaves the recovery room. In the afternoon as she's seeing patients for the next day, the PV nurse has a chance to do post- operative visits.

We've had a lot of success with these visits. Evidence of that is a 13- year-old girl who had had numerous

operative procedures because of se- vere burns in early childhood.

I had visited her the day before surgery. Since she knew, from past experiences, about the surgical pro- cedure, I served only to remind her and refresh her memory.

Sensing her apprehension I made sure to be with her from the time she arrived until she was fully anesthetized. During that time we talked and I explained to her every- thing that was going to happen be- fore it happened. I talked to her in a calm, low-toned voice during induc- tion to anesthesia-this to assure her that she wasn't alone as she might have felt.

The next day, during my post- operative visits, she called me over and, looking me straight in the eyes, and said, "thank you for being with me yesterday." To know from the child herself that she needed the sup- port offered by the OR nurse is more than enough to make our ef- forts worthwhile. El

Health care reorganizafion The American Hosp i ta l Association's house o f delegates gave its approval t o the proposal that would reorganize the nation's health care system and i t s f inancing.

The AHA proposal, now in b i l l form and ready t o be introduced in Congress, was developed from the report of a special commit tee on the provision o f health services. Known as Ameriplan, the proposal would create a network of nonprof i t health care corporations ( H C C ' s ) that would span the nation and provide comprehensive health services fo r all who wished t o part ic ipate.

Ac t ion by the House, accordinq t o A H A president Jack A. L. Hahn, w i l l speed introduct ion of t he b i l l before the end of this year. I n addi t ion, he said, the House authorized the officers of AHA t o make "necessary adjustments in legislative action," in order t o reach agreement wi th prospective sponsors.

M r . Hahn said that A H A ' S officers are authorized t o seek prompt sponsorship of the Ameriplan proposal. Hea l th care corporations, which he described as the "keystones" of Ameriplan. would be responsible fo r the care of def ined populat ion groups in specified geo- graphic areos. Every geographic area in each state would be served by one or more HCC's , he said, and these corporations would be similar in many respects t o the health maintenance or- ganizations proposed by President Nixon, bu t would be required t o have the approval of a stute health commission in order t o provide services.

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