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Communication in Healthcare: The Perspective of a Nurse

Pre-operative Advice to Patients Before Surgery

Nurses spend more time with patients than doctors and hence can be very helpful in counselling patients the night before surgery. This helps in relieving the patient's anxiety and apprehension about the surgery. Nurses also play a great role in providing information to the patient's family/relatives before, during and after surgery. Here are a few guidelines which could help them convey the right information to the patient and their family:

• Greet the patient with a smile and inform them that their surgery is scheduled tomorrow.
• Tell them that you have seen many such surgeries and watched how patients recover swiftly. This helps to remove anxiety, and your patient gains confidence in you.
• Ask for an addiction history and advise them not to smoke or consume alcohol the night before the surgery.
• Ask the patient whether he/she is taking any medicines and if so for what illness.
• Ask whether he/she has any history of diabetes, hypertension, bronchial asthma, loose denture or any previous episode of anesthetic complication during surgery.
• Tell your patient to have food, water or medicines after the midnight before surgery. The only exception is antihypertensive medication which has to be taken in on the morning of surgery. Talk to the doctor for further clarification.
• Check his vital signs.
• Don't forget to record all the above information in the case history file.
• Check the case file for documents like: Blood Requisition, Anesthetic Checkup Certificate, Cardiologist Report, Laboratory Investigation Reports, and last but not the least, check whether Consent Form has been signed.
• Convey the patient's family about the surgery schedule and try to make them comfortable without being trivial. For example, there is no risk involved, complications don't occur and the surgeon is god!
• Note down their contact number so that they can be contacted in case of emergency.

Here is a sample of communication between a patient and a nurse on the evening before the patient is scheduled for abdominal surgery for removal of tumors:

Nurse: Good evening, Mrs Sen, Dr Ranjan is going to operate on you next morning.

Mrs Sen: Good evening, sister, when are they going to take me to the Operation Theatre?

Nurse: You've been placed on call from nine in the morning. They'll call you any time after nine. But, we expect it to be around ten o'clock. So, you should not eat anything after dinner. We'll administer a laxative and you might need to use the washroom frequently after that. However, there's nothing to worry. If you feel weak and dizzy, do call for an attendant. Do not try to go to the washroom on your own. After your dinner is over, do not take any water, dessert, snack or even medicines. We'll put you on intravenous fluids (dextrose saline) so that you don't dehydrate. By the way, what are the medicines that you're taking?

Mrs Sen: Sister, I'm on Amlodipine, and I need to take it next morning. I also take a sedative after dinner as I have chronic neuropathy.

Nurse: Please do take Amlodipine. It is advised for hypertension. And, you've been specifically advised against any sedative.

Mrs Sen: Is the surgery going to be painful? Are they going to chloroform me?

Nurse: Well, we do not use chloroform. The anesthetist will probably sedate you by injecting a drug into your spine. It is going to be painless. In fact, the anesthetist will ensure that you recover from sedation once the surgery is over. You may need to be in a High Dependency Unit managed by the Anesthesia department once the surgery is over.

Mrs Sen: This is my first surgery and I am a bit nervous.

Nurse: Mrs Sen, I have seen at least a hundred people go through an abdominal surgery for removing tumors. These are very simple procedures, and since you do not have diabetes and are not a known cardiac, you'll do well. Your lung function is good and after your surgery, you will need to exercise with an incentive spirometer. You will also need to inhale steam. This will expand your lung cells and prevent them from acquiring pneumonia. Since the surgical wound makes breathing difficult, we tend to shorten our breath allowing our lung to become infected. The more you exert your lung, the more you breathe out bad air.

Mrs Sen: The doctor had asked my family to keep two units of blood ready. We've arranged for donor cards.

Nurse: Thanks a ton! The ward attendant will come and collect those cards from you. Have you signed the consent form?

Mrs Sen: Yes, I have. Here you go. But, tell me something: why do you need this?

Nurse: Well, Mrs Sen, every surgery has an element of risk and we need to record the fact that you are aware of this risk. Moreover, we also need to record the fact that you understand the kind of surgery our doctors are going to perform on you. To operate on a patient without informing them about the nature and risk of the surgery is unethical.

Mrs Sen: Am I going to survive the surgery. Do be honest with me, sister.

Nurse: While we do not deny risks, let me assure you that our healthcare facility is fully equipped to manage all kinds of postoperative crises. We have ventilators, dialysis units and intensive cardiac care units. Finally, the benefits outweigh the risks. There is no chance that you are going to live with this tumor. There is every possibility that once your tumor is relieved, you are going to go places without your needing to take painkillers and anti-hypertension pills!

Mrs Sen: Thanks, Sister for taking time to explain all this to me.

Nurse: It was my pleasure and you are most welcome to ask us all sorts of questions. Now that dinner has arrived you must have that soon. After you've had your dinner, do call us for administering the laxative. Thanks for cooperating. May I take your leave?

Mrs Sen: Yes, and thanks once again

Nurse: It was my pleasure.

Vocabulary

1. Counselling: Professional advice
2. Anxiety: Nervousness
3. Apprehension: Fear
4. Addiction: A strong habit
5. Trivial: Unimportant
6. Laxative: Drug to activate bowel movements
7. Sedation: Act of giving a sedative, i.e., a tranquilizer

Reading Comprehension

1. How important is pre-operative counseling for patients by nurses?
2. What details of a patient's history should nurses take from their patients?
3. What documents of a patient should be checked before a surgery?
4. Does Mrs Sen seem to be nervous before her surgery?
5. How does the nurse relieve Mrs Sen of her pre-operative anxiety?

Language: Interrogative Sentence

An interrogative sentence is a type of sentence which usually asks a question and uses a question mark (?). They may ask for information or for confirmation or denial of a statement. They typically begin with a question word such as what, who, or how, or an auxiliary verb such as do/does, can or would, etc. In English an interrogative sentence normally changes the word order so that the verb or part of the verb comes before the subject.

For example:

• What are the medicines that you are taking?
• Is the surgery going to be painful?
• Have you signed the Consent Form?

Pronunciation: Letters ‘r,’ ‘g,’‘t’ and‘s’:

R is silent when it is preceded by a vowel or at the final position but r is pronounced when it follows a vowel. Letter ‘g’ may be pronounced /g/, /dʓ/; ‘t’ may be pronounced as /t/ or /∫/ and ‘s’ is pronounced as /s/, /z/ or /ʓ/:

Writing

Write a conversation between a patient's relative and a nurse discussing the post surgery care to be taken after a successful abdominal surgery.