25/04/2015
PSYCHOLOGICAL SUPPORT OF THE PATIENT IN SURGERY
When surgery is recommended to an individual, the proposed operation,
regardless of its extent, is perceived by the patient to be a “major”
procedure. The patient’s emotional support begins with the referring
physician who recommends a surgeon qualified to perform the surgery.
The surgeon explains the indications for surgery, the course of
events prior to and following the surgical procedure, and the medical
terminology used. During the discussion, the surgeon, in a supportive
manner, will outline a favorable course of events, but will not make
any guarantees regarding the outcome of the surgical procedure. In
addition, the surgeon must inform the patient of the possibility of poor
results and the potential complications or injuries related to the procedure
or the anesthetic, including death, even though the likelihood
may be remote.The surgeon then clarifies any information pertaining
to the surgery until the patient (or legal representative) indicates that
he/she understands and is satisfied with the explanation. If there are
alternative treatments or therapies, these must be disclosed prior to
asking the patient to sign the “informed consent.” The surgeon may
comfort the patient by stating that the chosen hospital or surgicenter
is an accredited facility that has a capable and dedicated staff and that
every measure will be taken to assure a successful outcome.
In some facilities, when time permits, a perioperative nurse telephones
the patient prior to the day of surgery to verify the patient’s
name, date of birth, height and weight, and other personal data, as necessary.
He/she answers the patient’s questions and tries to help the
patient feel more comfortable about the impending surgical procedure.
This initial patient contact optimally is made prior to the date of surgery,
but may not take place until immediately before the surgical procedure.
The patient usually arrives at the hospital or surgicenter the day
before or the day of the scheduled surgery, according to the surgeon’s
orders. Following admission to a unit, as time permits, the patient may be
offered a perioperative teaching session and/or a teaching video.When-
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ever possible, the patient is afforded an opportunity to express anxieties
and/or ask questions.The nurse preparing the patient for surgery completes
the Surgical Assessment and Preoperative Checklist (Form 1-1).
Prior to transporting the patient to the surgical suite, operating
room personnel must use at least two sources of identification to verify
the identity of the patient.This may include any two of the following
methods:
1. ask the patient to state his/her name
2. compare the name on the chart to the patient’s stated name
3. compare the name on the patient’s armband to the name on the
chart
4. compare the name on the addressograph plate to the name on
the chart.
In addition, as a safety measure, personnel should check the front
of the chart to obtain a list of the patient’s allergies and current medications.
Once the patient arrives in the surgical holding area preoperatively,
the circulator, a perioperative practitioner, will implement the
Joint Commission (JC) (formerly the Joint Commission on Accreditation
of Healthcare Organizations) 2004 Universal Protocol to identify
the patient by asking the patient to state his/her name and by using
another identifier from the list above. (Note that by asking for the
patient’s name, rather than by asking directly, “Are you Mary Jones,”
one minimizes the possibility of misidentification.) The patient’s name,
date of birth, the name of the admitting doctor or surgeon, and other
identifiers on the patient’s hospital armband must match those identi-
fiers on the chart.The patient is asked to state the proposed procedure;
the perioperative practitioner records the patient’s response in the
patient’s own words on the record. Obtaining and confirming important
information from the patient and the patient’s chart helps to
ensure the patient’s safety in the operating room. For patients who are
unable to communicate effectively (e.g., a young or shy child, a patient
with a language barrier, or a patient who is physically or emotionally
impaired or otherwise unable to speak coherently or obtunded), the
above information is verified with the patient’s legal representative.
In the surgical suite, the circulator again asks the patient to state his/
her name. (Note that the patient’s name and identifiers are verified a number of times by different personnel.) The circulator compares the patient’s name and identification number with the armband, chart, and addressograph plate. The procedure to be performed, the appropriately marked site/side (or laterality) of the body as applicable, and the name of the surgeon are reconfirmed with the patient or the patient’s representative (Goldman, 2008).
