INTERRELATED SURGICAL PATIENT CARE The following papers were presented as part o f a panel discussion on Interrelated Surgical PG tient Care which was held during the AORN Phoenix Regional Institute. The discussion cov-

ered all aspects of care from the role of the nurse in the operating room to the special duties and responsibilities of the nurse in the recovery room, as well as the particular feelings and emotions of the patient who is the recipient of this specialized care.

THE NEED TO COMMUNICATE

Phyllis Wells, R.N.

As the world around us becomes faster paced and more complex, the necessity to communi- cate becomes more acute. The hospital situation is a good ex- ample of modern day acceleration. As hos- pitals have expanded

and new techniques of care have developed, it has been necessary to form special care areas. The hospital is no longer “one big happy family,” but is instead, many families grouped together. There has been a tendency for communication to break down between the various groups that constitute a hospital. The area with which we are especially con- cerned is that involving the relationship be- tween the OR and general nursing personnel.

To begin the study with a definition, most people would agree that communication is an interchange of ideas between two people. It is

I I

essentially something that is sent and some- thing that is received. The intention to send and the intention to receive must both be pres- ent to some degree.

Communication is one of the three require- ments necessary for a meaningful association. These three ingredients form a triangle which some educators call the A.R.C. triangle:

A-At one corner we see affinity or degree of liking. The more emotional the affinity between two parties, the better the communica- tion. This point is easily demonstrated by stopping to think how hard it is to talk to someone who is angry and belligerent.

R-The second corner of the triangle is reality. Reality can be defined as that which appears to be. It is fundamentally an agree- ment. What we agree upon is real.

C-The third corner of the triangle is communication.

It is easy to see that each of these corners is dependent on the other. Desiring any one corner of the triangle must include the other

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two. If you desire a strong and able communication with someone, there must be some basis of agreement. There must be some liking for the person. Think of some recent encounter with another person. Was there an experience of communication? Was the other person as eager to receive as you were to give? Was there an d n i t y between you?

Let us come to an agreement. If we are realistic, we must agree that there is a barrier between the operating room and the remainder of the hospital. The operating room, of neces- sity, must be protected from external invasion. It must be kept as aseptic as possible; therefore, human traffic is limited to OR personnel. There must be a tranquil, uninter- rupted atmosphere in which the surgeon can work. Thus, there is no interaction between the doctor and other hospital staff or the patient’s family. Even phone messages are sifted, sorted, and detoured to avoid bothering a doctor during surgery.

Another aspect of surgery that tends to iso- late the operating room nurse from the rest of the hospital is the crisis dimension of the job. When the OR nurse gives directions or makes requests of other hospital groups, she expects them to comply without question. There are no counter proposals, no rejections, no reasons why it cannot be done and no suggestions as to how surgery ought to be run. Thus, the com- munication pattern between OR nurses and other groups is one-sided.

The team atmosphere in the operating room, while a secure and pleasant working environment, tends to build resentment among the nurses on the floor. Working closely with the surgeon, the OR nurse identifies with him. There is a greater social acceptance of the operating room nurse by the surgeon. Theirs is an easy relaxed relationship. Nurses on the floor do not have the benefit of this close asso- ciation. To them, the doctor is usually a die- tant figure and the nurses tend to relate or identify with each other.

This brief examination of the position of

the operating room nurse should indicate that there does exist an obstacle to communciation with other personnel. With so many well estab- lished barriers, it is tempting to take the easy way out, to remain in our secure, isolated area. It is easy for bad habits to form. We do not know the floor nurse, so there is no reason to talk to her. We are not involved in general nursing problems so there is no reason to go to regular staff meetings. Any information we need about the patient we will get from the doctor. Certainly none of these bad habits is conducive to good communication.

The best way to break a bad habit is to replace it with a good one. Using better communication as our motive, let us confront our opposition.

We can start by letting these other groups know that we are interested in them. Going back to our triangle, we are developing an afiinity: we like them; we are concerned; we are willing to listen to them.

We shall seize every opportunity in our conversation with others to do more listening than talking. We should not let a day go by without some attempt to communicate beyond the double doors. As we work toward this goal, many new ways of sharing our time, our interest, and our talents with other hospital personnel will become obvious.

We will see the second corner of the triangle developing: agreement. For when the barriers are removed, I think all nurses will agree that our main reason for existence is the care of the patient. With this strong, common goal we cannot help but communicate!

BIBLIOGRAPHY

Young, Stanley, Ph.D., “Conimunications,” AORN Journal, January, 1967. Hubbard, L. Ron, “The Fundamentals of Thought,” Department of Publications, World Wide.

Phyllis Wells, R.N., is a graduate of Good Samaritan Hospital, Phoenix, Arizona. Presently an Operating Room Staff Nurse at Good Samaritan Hospital, Mrs. Wells has been a member of the open heart team for the past three years.

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