Sunday, October 7, 2012

Comfort theory - a bad example within perioperative nursing

As part of the assignment to explore comfort theory without our clinical practice, we are supposed to write a contrary story of comfort. Again I have no specific story to tell, but can glean a few tidbits from things I have seen or experienced (by doing). Enjoy.

Again, I do not have a good specific story to tell related to what comfort theory in the perioperative setting is not. What I can do is provide examples of behavior by some OR nurses that I believe does not promote comfort.

Bringing a patient to the OR can seem like a production line at times, to the staff and especially for patients. In light of this kind of feedback from patients, I question our push to get the next patient into the room as quickly as possible after completion of the previous case. This push to hurry comes through during our interview with the patient. I see nurses talking to patients rather than talking with patients. I see nurses ignore the questions on patient faces - patients want to ask but they can sense the hurry the nurse is in and don't want to interrupt. I also see nurses do an interview in such a way that they do not provide the patient the opportunity to ask questions during or after.
Being a new nurse, I am sometimes too eager to teach a patient about things. This has, on several occasions, brought about distress in the patient. They don't want to think about the drain, or the reasons for needing such a thing.
Catheters are a huge issue for patients. I must inform a patient if there is a need to place a catheter. It's an unpleasant procedure and a catheter can be very uncomfortable to have in place. Many patients ask "Why do you need to give me a catheter?" and ask if we can just skip that part. This does give me the opportunity to teach them the reasons for why it is needed, but it can still be distressing to patients. (Luckily, they get to be under anesthesia when I place it, that sometimes comforts them.)

At my place of work we are supposed to have the ability to "Stop the line" at any point in the process of getting a patient to surgery or even once a patient is undergoing surgery to make sure that safety is maintained. I once had to stop the line as the patient was rolled into the OR because we had just discovered a contaminated set and our Central Services did not have a ready replacement. I am sure this was distressing to the patient to lie on a stretcher in that cold, noisy room for 15 minutes while we scrambled around to get a replacement.

Sometimes a patient wants to know that you are the expert in that particular surgery. I can't lie to a patient, but telling a patient I am new is not the right answer either. I have to deflect the question, skirt around the answer the patient wants, instead I have to say that "We" do many of those surgeries here every month (or something along those lines). I can tell sometimes this is not what the patient wanted to hear.

Patients in surgery struggle with many emotions, most related to the loss of control of what is going to happen to their body. Nurses who do not keep this in mind while interacting with the patient are doing the wrong thing to provide comfort.

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