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Coping with the wait

A surgical liaison nurse can help families and friends cope with a very worrying time and assist with the smooth running of a hospital. By Michelle Stubbs

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The day starts with your alarm sounding and daily routines undertaken. The phone rings! You are instructed to present to the hospital immediately. One of your family members has been involved in an accident and is currently being transferred via ambulance to the emergency room.

You arrive at the hospital noting the absence of your family member in the room. They have been taken straight into the operating suite for an emergency laparotomy. You are ushered out of the emergency room and into the corridor.

What do you do now? Where is the operating suite located in this enormous, strange and unfamiliar building? Should I go there and seek information? Do I go home to pack clothes and retrieve toiletries? Does my family member even know I have arrived in the hospital? So many unanswered questions and noted increasing level of anxiety and stress.

This scenario is all too common among family members and significant others of patients admitted to the operating suite via the emergency room. Evident is a lack of communication and support for the waiting family. Fear of the unknown can be unsettling for anyone but for families of patients undergoing surgery, that fear is often compounded. This level of anxiety and stress could be better addressed through the implementation of a surgical liaison nurse (SLN).

Addressing this issue introduces an imperative service. The SLN networks with families, surgeons and associated hospital units to provide information and support during the most anxious times endured in a hospital stay. A nurse that gives information not a diagnosis is a simple measure yet essentially fundamental in providing holistic care to both the patient and family.

Caring historically has been considered as the essence of nursing. The innovation of introducing the SLN comes in recognition of the number of hospitals within Australia not connecting the need for patient and family support in this difficult time.

Not only limited to family members, patients themselves once in the recovery phase of their surgical journey may show signs and symptoms of anxiety. Altered clinical observations including an increase in blood pressure, heart rate and pain are detected. Furthermore, an increase in the patients' length of stay in the Post Anaesthetic Recovery Unit is associated with the lack of communication and heightened anxiety.

This gap in communication and observed elevation in anxiety prompted the pilot study currently implemented at the John Hunter Hospital (JHH) operating suite, where Jenny Muir (NUM) and I set out to bridge the gap.

The JHH emergency department treats in excess of 65,000 patients a year. With the total amount of cases performed within the operating suite from October 2010 to October 2011 reported as approximately 16,000 cases.

This monumental figure represents the vast number of families experiencing anxiety and strain within the perimeter of the operating suite. The SLN will prevent these fears with quality of care and communication.

Initially, the primary role of SLNs is to introduce themselves and provide a pamphlet detailing all necessary hospital information. A map of the hospital and business card with the surgical liaison nurse's phone number is also provided and discussed. The nurse then gauges the level of anxiety experienced by family members at this point in time.

Within this meeting, the nurse informs family members of the progress regarding their loved one and allocates the appropriately timed additional progress reports to be undertaken. This gives the family a chance to leave the hospital if they wish, grab a coffee or make necessary phone calls to inform other family members not within the hospital.

Once the SLN has communicated with the family they do the documentation; taking down the time, family member spoken to, place of occurrence and supplemental information in legal format within patient notes. This provides core information and an "interdisciplinary team communication framework". This framework and documentation will benefit the complex nature and demands of the healthcare environment.

Given the opportunity to visit non-urgent or scheduled surgery patients on hospital wards proves advantageous. Particularly on the day-stay unit and paediatric wards, the SLN welcomes patients and families and informs them of what they may encounter.

"This pre-operative visit most often is the element that eliminates the clinical jargon and untravelled surgical road. Gentle explanations and a warm heart works wonders for patients and families in reducing the fear of the unknown," says Muir.

Prior to commencement of the trial, program developers acted in the SLN role. One particular family remains forefront in their minds. The family had experienced a true emergency being airlifted to John Hunter Hospital from the far west of NSW.

The father had arrived with his son who was rushed into the operating suite. With only the clothes he stood in, no phone or wallet, the father was destitute and obviously troubled. Through conversation with the SLN, accommodation, a shower, meal and telephone was made available whilst his son was undergoing surgery. The father, who was able to then concentrate on his son's recovery, voiced appreciation.

Likewise, Muir says, "within day three of the trial implementation the effect of the surgical liaison nurse was substantial. Positive feedback from families and patients was overwhelming." Written feedback included how important it was for the family to meet the SLN. It was also described as a brilliant service. The SLN was praised for their progress updates outlining travels from the operating suite into recovery and return to the ward.

The individual attention given to waiting families is wonderful. The use of the SLN's phone number not only reduced the workload placed on post anaesthetic recovery unit staff but reassured waiting families that at any stage the SLN would be there to help and answer any questions or queries they have.

The main goal of the SLN trial is to establish a perioperative philosophy that has a multidisciplinary approach to the management of the surgical patient, their families and significant others.

Aims of the trial include facilitating a positive experience, improving communication, providing emotional support and offering information.

Apprehensions that patients and families maintain are strikingly narrowed via the direct link of communication the SLN provides. The impression that nursing staff care and encourage interaction with families is key in nourishing this sensational person centered approach to intraoperative care of the surgical patient and their families.

The SLN overall nurtures the patients and families connected with the operating suite. Its fundamentals are centered on:

S - Surgical
L - Liaison
N - Nurse
N - Nurturing patients
L - Looking after loved ones
S - Satisfying journey

The SLN is an incredible addition to the services provided within the operating suite. It injects a much-needed non-clinical approach to caring for patients and families. One can only imagine how it would feel to be on the receiving end of the initial phone call as described above.

If it arises that a family member is admitted to the John Hunter Hospital for surgery the SLN will deliver this gold service for you and your significant others.

Michelle Stubbs is a registered nurse in anesthetics and PARU at John Hunter, and clinical educator for Newcastle University school of nursing.

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