I want my baby to come with me to the hospital when I have surgery, and I also want m y daughter to care for the baby.
Home visits give continuity of care Nancy J Girard, RN
Nancy J Girard, R N , is a graduate student and teaching assistant at the University of Texas School of Nursing, S a n Antonio. She received her diploma from Salem City Hospital School of Nursing, Salem, Ohio, and her B S N degree from the University of Nebraska School of Nursing, Omaha.
Family hospitalization? We listened as our patient described her goals. Was it advisable? Was i t possible? Would it work? These were some of the questions going through our minds as we, an OR nurse and graduate student nurse, sat in Mrs P’s living room. Mrs P had initiated contact with us by calling the hospital when she was informed by her physician that she would need a cholecystectomy. The mother of seven children, Mrs P wanted her 2-month-old baby with her a t the hospital because he was nursing and refused to take a bottle from anyone except her or her 12-year-old daughter. She wanted her daughter to care for the baby in the hospital while she was incapacitated. Since this request was a dramatic departure from our standard hospital routine, we believed this patient would be best served by a home visit. Preoperative and postoperative home visits are a controversial concept. Although there are differing opinions about the techniques and results, the majority of those involved believe that such visits are important to the patient, the family, and the nurse. In preoperative home visits, the major goals are to improve the quality of professional nursing care for the patient and to expand the role of the operating room nurse. These goals are reached by providing contact with the patient before and after surgery, giving needed continuity of care.’ The patient has many needs at the time of surgery. His anxiety level is already high, and his physical needs are usually greater than normal. The most effective place for the first preop-
AORN Journal, December 1976, Vol 24, No 6
1057
erative interview is in the home. The patient feels secure and in control of the situation when in his own territory and he is less anxious. In the hospital, the situation is reversed. The hospital is the nurse’s domain, and it appears cold and hostile to the patient.2 Although the type of surgery somewhat affects the degree of anxiety, anxiety is high for any surgical procedure. One study suggests that preoperative interviews relieve fear and anxiety when minor surgery is indicated, but do not lessen anxiety for moderate or major procedure^.^ Other studies show that information given preoperatively lessens fear of the unknown and gives a bond of trust and confidence between the patient and the nurses4A study on preoperative visit effectiveness showed instructions given before surgery speed and improve the recovery period. Patients awakened easier, made a better effort to ventilate, required less sedation in the first 24 hours postoperatively, and ambulated better the first day.5 Studies on the values of preoperative interviews have been done in the hospital setting. More positive results may emerge from research on home visits. Preoperative instruction done during a 30-minute period in the patient’s home should be more effective than a 10-minute interview .in the hospital the night before surgery when the patient’s anxiety level is higher. The family of the patient also profits from the home visit. It makes family members feel more capable and better equipped to handle the needs of the patient and to provide the necessary mental and physical care. In the case of the spouse and parent, it helps them feel needed by enabling them to participate in their family’s health care. This in turn promotes a calmer home atmosphere. Better patient care is
1058
given at home after surgery and can be maintained by knowing in advance the limitations and amount of care the patient will need. At Archbishop Bergan Mercy Hospital, Omaha, under the guidance of Barba Edwards, home visits have been successful for four years. Before visiting any patients, nurses study videotapes on communication techniques with a patient and family. These tapes were made with a portable videotape recorder during actual home visits as part of a project by Edwards to explore the use of the videotape for communication analysis. Videotapes can also be used for immediate indepth review of a situation.s They were extremely helpful to me in identifying the effects of body language, voice intonation, and wording used during communication. While I was a nursing student, I participated in these home visits and did a case study on Mrs P’s suggestion. On our initial visit, Mrs P was friendly and cooperative. A threeyear-old child was present and the baby was sleeping. Her husband was not at home. We wore street clothes and did not take any videotaping equipment because we felt it might inhibit the responses and communication even though the component is small and inconspicuous. It was easy to converse with Mrs P, and she told us she had carefully thought out everything she wanted to do. Her other children would stay with the neighbors until her mother arrived to care for them while her husband worked. The eldest daughter would care for the baby during surgery and the first day postoperatively. Mrs P planned to take baby food, baby clothes, and disposable diapers to the hospital. After listening to her, we asked if there was anything about the actual surgery she would like t o know.
AORN Journal, December 1976, Vol24, No 6
I
n the security of her home, Mrs P confided her fears.
She was interested in all the routines, so we explained about admission, laboratory tests, physical layout of the operating room, and the visits by other hospital personnel after her admission. We also explained the postoperative routine, including recovery room coughing, deep breathing, and possible discomfort. At no time did we use the word pain. When we asked what her husband thought of the plans, she informed us that he approved but was sure the hospital would reject the idea. During the preoperative period, the only contact we had with her husband was by telephone. Although her physician considered Mrs P to be a n extremely stoic woman because she had had seven children with a minimum of fuss and medication, we found that she did have strong fears. When we were explaining sedations and medications she stated she reacted strongly to any type medication. She said she also had two great fears. One was a fear of needles. She knew some injections were necessary and not too painful, but she said she would do anything not to have one even to the point of suffering severe discomfort. The other fear was of face masks. She told of having her tonsils out years ago and being very afraid of masks including oxygen masks. This impressed on us the need to investigate carefully each patient’s real needs and not to take appearances a t face
value. We wondered if this information would have come out in a hospital visit or was it only in the security of her own home that Mrs P could confide these fears. After the visit, a conference was arranged to review the case with the director of nursing, the surgical supervisor, the unit supervisor, the anesthesiologist, and the surgeon. At Archbishop Bergan Mercy Hospital, there is close cooperation among all areas and the director of nursing helps coordinate the floor and surgical departments. In these undertakings, she listens to reports of the home visits and talks to the patient, her husband, and the physician. Concern about the possibility of psychological trauma for the 12-year-old daughter on seeing her mother incapacitated postoperatively led to telephone consultations among the physician, patient, husband, director of nurses, and surgical supervisor. The patient and her husband expressed such strong confidence in the maturity of the child that permission was granted to continue the project. Where to room the patient and her children posed the next problem. It was decided to use a two-room suite a t the far end of a surgical floor. A crib was set up near the mother’s bed and a studio couch in the other room was available for the daughter. Mrs P was admitted to the hospital in the evening accompanied by her
AORN Journal, December 1976, V o l 2 4 , N o 6
1059
family. A preoperative interview was made by the operating room staff nurse involved with the case. She further explained and reclarified the information the patient had been given a t home. In the morning before the preoperative medication was administered, the patient nursed her baby and the daughter then took over the care of the infant. The unit staff cooperated by avoiding unnecessary contact with the baby and every precaution was taken to avoid transmitting any nosocomial infection to the infant or child. The surgeon decided to use a “button hole” incision to remove the gallbladder, and the anesthesiologist felt he could use agents that would not be transmitted, via the mother’s milk, to the baby after three hours postanesthesia. The morning of surgery the baby was fed early. The father and daughter then took him home until after surgery which was scheduled for 7: 15 am. The procedure took about 40 minutes, skin to skin, and Mrs P spent a n hour in the recovery room. We visited Mrs P the first day postoperatively to reiterate details that might be remembered immediately but could later be forgotten. The baby was sleeping and the daughter was quietly reading. Mrs P said she had had nothing for discomfort since surgery, so we stressed that she should have medication if she needed it. She had been able to urinate without catheterization. She had gone about 15 hours without nursing the baby, but i t had not bothered either of them. During this time, the baby took fluids offered by the daughter. The patient stated she felt it had definitely helped her to have us visit a t home, because knowing what to expect had eliminated most of the fear of the unknown.
1060
Her major complaint was that her back hurt more than the incision, a fact she felt we should have warned her about. All in all, she looked remarkably well for the first day postoperatively. We visited again the fifth day after surgery since the patient expected to go home the next day. Her husband was there and explained that before the surgery he had been called numerous times by different people in the hospital questioning whether it was a wise decision to allow his daughter to accompany her mother. I apologized for the lack of coordination in communication that had prompted so many calls but explained that everyone was only concerned about the child. When asked about her reaction to the experience, the patient replied that on the whole it was quite good. Her only negative comments did not concern the operating room staff. One criticism was that one night nurse awakened her three times to ask if she could take the baby to the nurses’ station, and the other incident was the nurses were slow in changing her gown and linen when they became saturated with breast milk. The daughter had stayed two nights and 1%days and then resumed her regular school routine. She had enjoyed feeling needed, and it seemed to have given her a great deal of self-confidence and maturity. The baby was content and ate and slept well during hospitalization. Our final contact with the patient was at her home 19 days postoperatively. We were welcomed warmly like old friends. On the whole, her recovery was excellent. She was eating well, and the incision was already fading. When we asked her her recollections of the surgery, she could not remember
AORN Journal, December 1976, Vol24, N o 6
anything of the recovery room and memories of the first few hours in the hospital room were hazy. This supports the idea that visits immediately postoperatively show needed areas of improvement that would later be forgotten by a patient, a t least consciously. Mrs P could only think of two items we had overlooked mentioning preoperatively that concerned her. One was the fact she had to roll from side to side, and she had been unprepared to do that. The other item was the back discomfort. Actually, we had anticipated many more problems than had happened. The baby and the daughter had done well and showed no signs of nosocomial infection. The husband was pleased and impressed that everything went so smoothly and well. Mrs P was asked if she thought it would be feasible to offer the family hospitalization to others in the same situation. She agreed it would work but suggested that someone like her daughter should care for the baby rather than add to the floor nurse’s load. She definitely liked the family involvement, for she had no worries of the baby and could concentrate on recuperating. Archbishop Bergan Mercy Hospital has done about 50 home visits using the OR staff and nursing students from three local universities and colleges. It also has a Home Health Care Nurse Department that is involved in visiting patients referred from surgery or the physician. The average length of time spent with a patient is approximately 30 minutes, although time varies depending on the patient and the situation. The hospital feels the cost is justified because it benefits the patients, their families, and the professional nurses. The hospital has 1.7 RNs per OR shift, and this allows for
the visits and family teaching. Morale seems to be high among the staff. Everyone interested has an opportunity to do home visits, depending on the patient diagnosis and the procedure to be done. There are some problems that have arisen with home visits. Resistance has come from both physicians and nurses. Some professional OR nurses who for years have worked only in the operating room feel insecure and afraid of patient contact in the home. At times unit nurses see the visits as usurping their power and territory. A few physicians would prefer that no visits were made to their patients, either due to patient misconceptions or a lack of knowledge of the expanded role of the operating room nurse.? It is difficult to decide which patients to visit. Often it is hard to arrange a convenient time for all parties to meet. Although postoperative visits were made in this case study, these are sometimes difficult to do. As a substitute, the telephone can be used for continuing communication. Coordination could also be done by an OR clinical nurse specialist or with the discharge planning nurse. In the future, home visits may be used in the growing field of outpatient surgery. Because this patient is not hospitalized, it is important that he gets information needed either from the physician or the coordinating nurse. Home visits provide the operating room nurse with a n opportunity to expand her role and her professional growth. Increased contact with patients helps her to be better prepared for any situation that may occur relating to the patient’s mental or physics1 well-being. Most important, home visits improve the health care of the pa-
AORN Journal, December 1976, V o l 2 4 , N o 6
1061
t i e n t through patient participation, an important trend in health care.
0
Notes 1. Carol Lindeman, “The effects of preoperative visits by operating room nurses,’’ Nursing lntervention with the PresurgicalPatient Phase Ill,Nursing Research Paper (Eau Claire, Wis: Lutheran Hospital, 1972) 1. 2. Barba Edwards, “How to talk to patients,” AORN Journal 16 (November 1971) 45.
3. Lindeman, “The effects of preoperative visits,” 3. 4. Mary Ann Bruegel, “Relationship of preoperative anxiety to perception of postoperative pain,” Nursing Research (January-February 1971) 20-26. 5. Barba Edwards, “Preoperative home visits: Patient perception and nurse self-image,” AORN Journal 19 (February 1974) 419. 6. Edwards, “Preoperative home visits,” 420. 7. Carol Alexander, Elinor Schrader, Julie Kneedler, “Preoperative visits: The OR nurse unmasks,” AORN Journal 19 (February 1974) 401.
Deep cooling infants for heart surgery Fears that small infants undergoing deep cooling for surgical repair of congenital heart disease may incur brain damage from the procedure were reduced by a study reported at the annual meeting of the American Society of Anesthesiologists. Margaret J A Blackwood, MB, of Toronto said no significant neurological findings were found among a group of patients tested for learning ability and verbal, social, and motor skills at least six months after surgery when compared to their brothers and sisters. Although development was normal, it was a bit slower than among the controls. The strong relationship was found between the developmental outcome and the type of congenital heart disease the child had. Those children with uncomplicated ventricular septa1 defect had the best prognosis while those with more complex lesions did not develop as well. There also was an association between developmental outcome and social class. Those in the lower socioeconomic families had the lowest developmental quotient. Dr Blackwood is a member of the departments of anesthesia and pediatrics, University of Toronto Medical School and The Hospital for Sick Children. Her colleagues in the study were Katerina-Haka-lkse,MD, and David J Steward, MB. In babies and small infants, surgery using the conventional heart-lung bypass procedure is more difficult. In the past, palliative procedures have been used to
1062
keep these children alive until they are old enough for another operation to correct their defect. The simpler procedure of profound hypothermia is used to make complex total correction possible in infancy. The technique of deep cooling reduces the amount of oxygen needed by the brain. The baby is cooled by using the heart-lung machine for a short time only. Then all the large tubes are removed from the tiny chest, and the surgeon is able to repair the heart speedily and with good access. The repair is usually completed in less than an hour. The patient is then reattached to the heart-lung machine and rewarmed to normal temperature. Seventeen children, ages 12 to 54 months, were examined by the same person and compared with seven sibling controls. The examiner was not aware of the condition of the children before surgery nor of the kind of heart problem they had. “The results of the study proved that the children who had surgery under cooling did not have abnormal neurological signs,” said Dr Blackwood. “Their learning skills, their ability to speak, to move, and to relate to people were normal, although slower than that of their siblings. It is known, however, that children with congenital heart problems tend to be a little slower than healthy children. In that respect, there was no difference between children who had surgery under cooling and children with heart problems who did not have surgery.”
AORN Journal, December 1976, V o l 2 4 . No 6
Home visits give continuity of care Nancy J Girard, RN
Nancy J Girard, R N , is a graduate student and teaching assistant at the University of Texas School of Nursing, S a n Antonio. She received her diploma from Salem City Hospital School of Nursing, Salem, Ohio, and her B S N degree from the University of Nebraska School of Nursing, Omaha.
Family hospitalization? We listened as our patient described her goals. Was it advisable? Was i t possible? Would it work? These were some of the questions going through our minds as we, an OR nurse and graduate student nurse, sat in Mrs P’s living room. Mrs P had initiated contact with us by calling the hospital when she was informed by her physician that she would need a cholecystectomy. The mother of seven children, Mrs P wanted her 2-month-old baby with her a t the hospital because he was nursing and refused to take a bottle from anyone except her or her 12-year-old daughter. She wanted her daughter to care for the baby in the hospital while she was incapacitated. Since this request was a dramatic departure from our standard hospital routine, we believed this patient would be best served by a home visit. Preoperative and postoperative home visits are a controversial concept. Although there are differing opinions about the techniques and results, the majority of those involved believe that such visits are important to the patient, the family, and the nurse. In preoperative home visits, the major goals are to improve the quality of professional nursing care for the patient and to expand the role of the operating room nurse. These goals are reached by providing contact with the patient before and after surgery, giving needed continuity of care.’ The patient has many needs at the time of surgery. His anxiety level is already high, and his physical needs are usually greater than normal. The most effective place for the first preop-
AORN Journal, December 1976, Vol 24, No 6
1057
erative interview is in the home. The patient feels secure and in control of the situation when in his own territory and he is less anxious. In the hospital, the situation is reversed. The hospital is the nurse’s domain, and it appears cold and hostile to the patient.2 Although the type of surgery somewhat affects the degree of anxiety, anxiety is high for any surgical procedure. One study suggests that preoperative interviews relieve fear and anxiety when minor surgery is indicated, but do not lessen anxiety for moderate or major procedure^.^ Other studies show that information given preoperatively lessens fear of the unknown and gives a bond of trust and confidence between the patient and the nurses4A study on preoperative visit effectiveness showed instructions given before surgery speed and improve the recovery period. Patients awakened easier, made a better effort to ventilate, required less sedation in the first 24 hours postoperatively, and ambulated better the first day.5 Studies on the values of preoperative interviews have been done in the hospital setting. More positive results may emerge from research on home visits. Preoperative instruction done during a 30-minute period in the patient’s home should be more effective than a 10-minute interview .in the hospital the night before surgery when the patient’s anxiety level is higher. The family of the patient also profits from the home visit. It makes family members feel more capable and better equipped to handle the needs of the patient and to provide the necessary mental and physical care. In the case of the spouse and parent, it helps them feel needed by enabling them to participate in their family’s health care. This in turn promotes a calmer home atmosphere. Better patient care is
1058
given at home after surgery and can be maintained by knowing in advance the limitations and amount of care the patient will need. At Archbishop Bergan Mercy Hospital, Omaha, under the guidance of Barba Edwards, home visits have been successful for four years. Before visiting any patients, nurses study videotapes on communication techniques with a patient and family. These tapes were made with a portable videotape recorder during actual home visits as part of a project by Edwards to explore the use of the videotape for communication analysis. Videotapes can also be used for immediate indepth review of a situation.s They were extremely helpful to me in identifying the effects of body language, voice intonation, and wording used during communication. While I was a nursing student, I participated in these home visits and did a case study on Mrs P’s suggestion. On our initial visit, Mrs P was friendly and cooperative. A threeyear-old child was present and the baby was sleeping. Her husband was not at home. We wore street clothes and did not take any videotaping equipment because we felt it might inhibit the responses and communication even though the component is small and inconspicuous. It was easy to converse with Mrs P, and she told us she had carefully thought out everything she wanted to do. Her other children would stay with the neighbors until her mother arrived to care for them while her husband worked. The eldest daughter would care for the baby during surgery and the first day postoperatively. Mrs P planned to take baby food, baby clothes, and disposable diapers to the hospital. After listening to her, we asked if there was anything about the actual surgery she would like t o know.
AORN Journal, December 1976, Vol24, No 6
I
n the security of her home, Mrs P confided her fears.
She was interested in all the routines, so we explained about admission, laboratory tests, physical layout of the operating room, and the visits by other hospital personnel after her admission. We also explained the postoperative routine, including recovery room coughing, deep breathing, and possible discomfort. At no time did we use the word pain. When we asked what her husband thought of the plans, she informed us that he approved but was sure the hospital would reject the idea. During the preoperative period, the only contact we had with her husband was by telephone. Although her physician considered Mrs P to be a n extremely stoic woman because she had had seven children with a minimum of fuss and medication, we found that she did have strong fears. When we were explaining sedations and medications she stated she reacted strongly to any type medication. She said she also had two great fears. One was a fear of needles. She knew some injections were necessary and not too painful, but she said she would do anything not to have one even to the point of suffering severe discomfort. The other fear was of face masks. She told of having her tonsils out years ago and being very afraid of masks including oxygen masks. This impressed on us the need to investigate carefully each patient’s real needs and not to take appearances a t face
value. We wondered if this information would have come out in a hospital visit or was it only in the security of her own home that Mrs P could confide these fears. After the visit, a conference was arranged to review the case with the director of nursing, the surgical supervisor, the unit supervisor, the anesthesiologist, and the surgeon. At Archbishop Bergan Mercy Hospital, there is close cooperation among all areas and the director of nursing helps coordinate the floor and surgical departments. In these undertakings, she listens to reports of the home visits and talks to the patient, her husband, and the physician. Concern about the possibility of psychological trauma for the 12-year-old daughter on seeing her mother incapacitated postoperatively led to telephone consultations among the physician, patient, husband, director of nurses, and surgical supervisor. The patient and her husband expressed such strong confidence in the maturity of the child that permission was granted to continue the project. Where to room the patient and her children posed the next problem. It was decided to use a two-room suite a t the far end of a surgical floor. A crib was set up near the mother’s bed and a studio couch in the other room was available for the daughter. Mrs P was admitted to the hospital in the evening accompanied by her
AORN Journal, December 1976, V o l 2 4 , N o 6
1059
family. A preoperative interview was made by the operating room staff nurse involved with the case. She further explained and reclarified the information the patient had been given a t home. In the morning before the preoperative medication was administered, the patient nursed her baby and the daughter then took over the care of the infant. The unit staff cooperated by avoiding unnecessary contact with the baby and every precaution was taken to avoid transmitting any nosocomial infection to the infant or child. The surgeon decided to use a “button hole” incision to remove the gallbladder, and the anesthesiologist felt he could use agents that would not be transmitted, via the mother’s milk, to the baby after three hours postanesthesia. The morning of surgery the baby was fed early. The father and daughter then took him home until after surgery which was scheduled for 7: 15 am. The procedure took about 40 minutes, skin to skin, and Mrs P spent a n hour in the recovery room. We visited Mrs P the first day postoperatively to reiterate details that might be remembered immediately but could later be forgotten. The baby was sleeping and the daughter was quietly reading. Mrs P said she had had nothing for discomfort since surgery, so we stressed that she should have medication if she needed it. She had been able to urinate without catheterization. She had gone about 15 hours without nursing the baby, but i t had not bothered either of them. During this time, the baby took fluids offered by the daughter. The patient stated she felt it had definitely helped her to have us visit a t home, because knowing what to expect had eliminated most of the fear of the unknown.
1060
Her major complaint was that her back hurt more than the incision, a fact she felt we should have warned her about. All in all, she looked remarkably well for the first day postoperatively. We visited again the fifth day after surgery since the patient expected to go home the next day. Her husband was there and explained that before the surgery he had been called numerous times by different people in the hospital questioning whether it was a wise decision to allow his daughter to accompany her mother. I apologized for the lack of coordination in communication that had prompted so many calls but explained that everyone was only concerned about the child. When asked about her reaction to the experience, the patient replied that on the whole it was quite good. Her only negative comments did not concern the operating room staff. One criticism was that one night nurse awakened her three times to ask if she could take the baby to the nurses’ station, and the other incident was the nurses were slow in changing her gown and linen when they became saturated with breast milk. The daughter had stayed two nights and 1%days and then resumed her regular school routine. She had enjoyed feeling needed, and it seemed to have given her a great deal of self-confidence and maturity. The baby was content and ate and slept well during hospitalization. Our final contact with the patient was at her home 19 days postoperatively. We were welcomed warmly like old friends. On the whole, her recovery was excellent. She was eating well, and the incision was already fading. When we asked her her recollections of the surgery, she could not remember
AORN Journal, December 1976, Vol24, N o 6
anything of the recovery room and memories of the first few hours in the hospital room were hazy. This supports the idea that visits immediately postoperatively show needed areas of improvement that would later be forgotten by a patient, a t least consciously. Mrs P could only think of two items we had overlooked mentioning preoperatively that concerned her. One was the fact she had to roll from side to side, and she had been unprepared to do that. The other item was the back discomfort. Actually, we had anticipated many more problems than had happened. The baby and the daughter had done well and showed no signs of nosocomial infection. The husband was pleased and impressed that everything went so smoothly and well. Mrs P was asked if she thought it would be feasible to offer the family hospitalization to others in the same situation. She agreed it would work but suggested that someone like her daughter should care for the baby rather than add to the floor nurse’s load. She definitely liked the family involvement, for she had no worries of the baby and could concentrate on recuperating. Archbishop Bergan Mercy Hospital has done about 50 home visits using the OR staff and nursing students from three local universities and colleges. It also has a Home Health Care Nurse Department that is involved in visiting patients referred from surgery or the physician. The average length of time spent with a patient is approximately 30 minutes, although time varies depending on the patient and the situation. The hospital feels the cost is justified because it benefits the patients, their families, and the professional nurses. The hospital has 1.7 RNs per OR shift, and this allows for
the visits and family teaching. Morale seems to be high among the staff. Everyone interested has an opportunity to do home visits, depending on the patient diagnosis and the procedure to be done. There are some problems that have arisen with home visits. Resistance has come from both physicians and nurses. Some professional OR nurses who for years have worked only in the operating room feel insecure and afraid of patient contact in the home. At times unit nurses see the visits as usurping their power and territory. A few physicians would prefer that no visits were made to their patients, either due to patient misconceptions or a lack of knowledge of the expanded role of the operating room nurse.? It is difficult to decide which patients to visit. Often it is hard to arrange a convenient time for all parties to meet. Although postoperative visits were made in this case study, these are sometimes difficult to do. As a substitute, the telephone can be used for continuing communication. Coordination could also be done by an OR clinical nurse specialist or with the discharge planning nurse. In the future, home visits may be used in the growing field of outpatient surgery. Because this patient is not hospitalized, it is important that he gets information needed either from the physician or the coordinating nurse. Home visits provide the operating room nurse with a n opportunity to expand her role and her professional growth. Increased contact with patients helps her to be better prepared for any situation that may occur relating to the patient’s mental or physics1 well-being. Most important, home visits improve the health care of the pa-
AORN Journal, December 1976, V o l 2 4 , N o 6
1061
t i e n t through patient participation, an important trend in health care.
0
Notes 1. Carol Lindeman, “The effects of preoperative visits by operating room nurses,’’ Nursing lntervention with the PresurgicalPatient Phase Ill,Nursing Research Paper (Eau Claire, Wis: Lutheran Hospital, 1972) 1. 2. Barba Edwards, “How to talk to patients,” AORN Journal 16 (November 1971) 45.
3. Lindeman, “The effects of preoperative visits,” 3. 4. Mary Ann Bruegel, “Relationship of preoperative anxiety to perception of postoperative pain,” Nursing Research (January-February 1971) 20-26. 5. Barba Edwards, “Preoperative home visits: Patient perception and nurse self-image,” AORN Journal 19 (February 1974) 419. 6. Edwards, “Preoperative home visits,” 420. 7. Carol Alexander, Elinor Schrader, Julie Kneedler, “Preoperative visits: The OR nurse unmasks,” AORN Journal 19 (February 1974) 401.
Deep cooling infants for heart surgery Fears that small infants undergoing deep cooling for surgical repair of congenital heart disease may incur brain damage from the procedure were reduced by a study reported at the annual meeting of the American Society of Anesthesiologists. Margaret J A Blackwood, MB, of Toronto said no significant neurological findings were found among a group of patients tested for learning ability and verbal, social, and motor skills at least six months after surgery when compared to their brothers and sisters. Although development was normal, it was a bit slower than among the controls. The strong relationship was found between the developmental outcome and the type of congenital heart disease the child had. Those children with uncomplicated ventricular septa1 defect had the best prognosis while those with more complex lesions did not develop as well. There also was an association between developmental outcome and social class. Those in the lower socioeconomic families had the lowest developmental quotient. Dr Blackwood is a member of the departments of anesthesia and pediatrics, University of Toronto Medical School and The Hospital for Sick Children. Her colleagues in the study were Katerina-Haka-lkse,MD, and David J Steward, MB. In babies and small infants, surgery using the conventional heart-lung bypass procedure is more difficult. In the past, palliative procedures have been used to
1062
keep these children alive until they are old enough for another operation to correct their defect. The simpler procedure of profound hypothermia is used to make complex total correction possible in infancy. The technique of deep cooling reduces the amount of oxygen needed by the brain. The baby is cooled by using the heart-lung machine for a short time only. Then all the large tubes are removed from the tiny chest, and the surgeon is able to repair the heart speedily and with good access. The repair is usually completed in less than an hour. The patient is then reattached to the heart-lung machine and rewarmed to normal temperature. Seventeen children, ages 12 to 54 months, were examined by the same person and compared with seven sibling controls. The examiner was not aware of the condition of the children before surgery nor of the kind of heart problem they had. “The results of the study proved that the children who had surgery under cooling did not have abnormal neurological signs,” said Dr Blackwood. “Their learning skills, their ability to speak, to move, and to relate to people were normal, although slower than that of their siblings. It is known, however, that children with congenital heart problems tend to be a little slower than healthy children. In that respect, there was no difference between children who had surgery under cooling and children with heart problems who did not have surgery.”
AORN Journal, December 1976, V o l 2 4 . No 6
