A O R N J O U R N A L APRIL 1989. VOL. 49. NO 4

Presidenth Message

Surgical conscience, intuitive skills are essential for perioperative nurses

s AORN President, I have the unique o p A portunity to convey my personal beliefsabout perioperative nursing in the monthy “President’s Message” column. One of my strongest beliefs is that perioperative nurses must have a “surgical conscience.” By surgical conscience, 1 mean an unmeasurable, almost automatic sense of whether strict aseptic technique is being followed during the entire intraoperative period. It demands that nurses monitor their practice and the practice of others to provide safe, aseptic environments for their patients.

Confidence and the ability to continuously evaluate oneself are paramount to the development of the surgical conscience. Perioperative nurses constantly build upon the skills and knowledge acquired in their basic nursing education. They learn to see themselves as professionals, and they evaluate their practice accordingly. They value their contribution to patient care, and they respect their patients right to a safe surgical environment. If they have the slightest suspicion of contam- ination while opening sterile supplies, they assume the item is unsterile and proceed to provide another setup.

The surgical conscience includes anticipating equipment and supply needs for each patient, procuring those necessary items, arranging them in logical order, and establishing a sterile field in a clean operating room.

How do perioperative nurses develop surgical consciences? Some nurses never do, and good perioperative nurses will recognize those nurses’ limitations almost immediately. Some nurses recognize this limitation in themselves and choose

not to work in the operating room. Inherent in the surgical conscience are intuitive

skills. When I watch an experienced OR nurse in practice, I see the intuitive process unfold as she or he completes the patient assessment and implements the plan of care. Intuitive skills are demonstrated by the OR nurse who can tell by the pitch of the cautery that the surgeon is on “cut” instead of ‘bag.” The scrub nurse who passes the correct instruments without requests from the surgeon, and the circulator who provides additional sterile supplies to the team members before they request them, are putting their intuitive skills to work. Occasionally, experienced OR nurses’ intuition can signal that a patient is a poor risk for surgery.

Some nurses possess a natural instinct for perioperative nursing. They move from basic competency to excellence in practice quickly. They take every opportunity to learn from others; they watch and listen. They are developing their surgical consciences and intuitive skills. But they need help along the way.

Experienced perioperative nurses must take new recruits under their wings and teach them all that they know, both cognitively and intuitively. They must demonstrate, coach, and counsel others. And in doing so, they serve as leaders, advisors, guardians, and friends.

As novice nurses begin to gain competency and become self-confident, they communicate and collaborate with the surgical team, thus enhancing their contribution to the staff. They become leaders and friends as well as skilled clinicians. Eventually, they become mentors for other novices.

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A O R N J O U R N A L APRIL 1989, VOL. 49, NO 4

I believe in the surgical conscience and in the value of intuitive skills in the OR, even though they cannot be quantified. I have seen them demonstrated repeatedly every day in the operating room. I learned these perioperative nursing skills at the hands of experts, and hopefully, I have taught them to others. Experienced nurses have a responsibility to teach them to others. The surgical conscience is what separates a gifted O R nurse from a mediocre OR nurse. It is what makes leaders. It enhances our care, promotes quality, and makes us proud at the end of each workday.

If you are an experienced OR nurse, I hope you know the thrill of watching the surgical conscience develop in someone. If you are a novice, I hope you have the opportunity to observe and learn the intuitive skills so necessary in perioperative nursing.

Surgical conscience is intuition, knowledge, gut reactions, experience, and a fine-tuned sense of perception. Without it, our patients would surely suffer. CAROL J.APPLEGEET, RN, MSN, CNOR, CNAA

PRESIDENT

Otolaryngologists Fight Sore Throats

Patients May Recuperate in Nonhospital Environment

Most sore throats, which are often bred in winter weather, smoke-filled offices, and school class- rooms, are nuisances that last only a few days. Some, however, cause serious pain and difficulty in swallowing and breathing. If these symptoms persist, the American Academy of Otolaryngol- ogy-Head and Neck Surgery (AAO-HNS) recommends that patients see a physician.

measles, chicken pox, whooping cough, croup, and mononucleosis, are highly contagious and can cause epidemics. This is particularly true in close living conditions common in winter, according to a news release from the AAO-HNS.

Bacterial infections that cause sore throats include Streptococcus, tonsillitis, and tonsillar abscess. The most dangerous bacterial throat infection is epiglottitis, which infects the larynx and causes swelling that closes the airway. Pain- ful swallowing, drooling, muffled speech, and labored breathing signal epiglottitis.

Because immediate medical evaluation is necessary in cases of epiglottitis, the AAO-HNS recommends seeing an otolaryngologist when- ever the followings signs and symptoms are present: difficulty breathing, swallowing, or open- ing mouth; severe, prolonged, or recurrent sore throat; joint pains; earache; lump in neck; rash; fever above 101 O F (38 "C); or hoarseness lasting two weeks or longer.

Viral infections that cause sore throats, such as

The Rhode Island Hospital and the Women and Infants Hospital of Rhode Island, both located in Providence, are jointly building a 900-bed facility that will enable patients to recuperate under phy- sician supervision in a nonhospital environment, according to the November/December 1988 issue of the Healthcare Forum Journal.

The facility is designed for two types of patients: (1) medical and surgical hospital patients who no longer have acute-care needs but are not ready to be discharged, and (2) patients undergoing surgical procedures in an outpatient setting who would otherwise have the procedure performed in an inpatient setting. Likewise, the facility will benefit ambulatory surgery patients because they will be able to be monitored with- out being admitted to the hospital.

Island, will be built on the same campus as the other two facilities, and it will be linked to both hospitals by an enclosed skyway. It is scheduled to open in 1990.

Patients will be admitted to the Medical Inn only by physician referral and after a rigorous screening test. In addition, physician supervision of care is required, and physicians will be able to see their patients at the facility.

Administrators from both hospitals and third- party payers are developing a reimbursement system.

The facility, dubbed the Medical Inn of Rhode

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