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• W2912127946 abstract "Efficiency, safety, and competency are all important aspects of perioperative care, but patients have come to expect them in the care delivered by perioperative team members. The factors that seem to set patient care encounters apart and make them memorable are the personal connections and the provision of comforting behaviors. Recently, I reviewed letters written by patients that highlighted the care provided by the perioperative nursing team. One of the patients remarked on a perioperative nurse who went out of her way to create a calming environment in a stressful situation by staying at the patient's side. While the providers were inserting an epidural catheter, which was causing the patient some discomfort, this nurse began to sing. According to the patient, this immediately put her at ease and allowed her to focus on the beautiful voice. The nurse's singing was the last thing that the patient remembered of being in the OR—what a gift! In another letter, a patient who underwent surgery to remove cancer recalled that the nurse provided him with warm blankets without his having to ask for them. He also indicated that he had not been left unattended for any extended period of time, which put him at ease and gave him the impression that the perioperative nursing staff members truly care about the comfort of their patients. When it was time to go home, the technician who wheeled him to his car remembered that his father had parked on a different floor, and he took the time to be sure that his father found his car in the parking garage. This patient referred to these acts as the so-called little things. These “little things” are small acts of kindness and caring, but they are important ones that seem to have a major effect on the overall impression of a health care facility and the care provided there. We did not learn these in our educational programs; these are part of who we are as perioperative nurses, what is at the core of our values, and what is important to our patients. We must not lose sight of these things as we are pressured to become more efficient and to do more with less. These acts of kindness cannot be minimized. Although the surgical procedure is an important component of the treatment plan, it is the caring actions–looking a patient in the eye, holding a hand to show support, and providing caring, supportive words–that make an otherwise stressful and anxiety-provoking experience extraordinary. As I reviewed additional letters that I had received earlier in the year, I again found descriptions of perioperative nurses who stayed by the patient's side from the time the stretcher was wheeled into the OR until the time the anesthetic was administered. These actions left patients feeling comforted in the OR environment. One patient commented on a technique that a perioperative nursing staff member used to remove tape painlessly from his skin. He shared that the atmosphere and culture seemed to empower the nurse to take the time to do this. These comments from patients and family members should not be surprising; there is research that supports the positive effects of these caring behaviors on patients. Surgical patients often experience high levels of anxiety.1 It has been estimated that 80% of adult surgical patients experience anxiety.2 Anxiety triggers a physical response, stimulating the release of epinephrine and norepinephrine, which in turn raises blood pressure and increases heart rate, cardiac output, and blood glucose levels.3 Anxiety can have negative effects on postoperative pain, risk of infection, and postoperative healing.4, 5 Stress and anxiety can affect the surgical outcome and have been shown to be the most common predictors of postoperative pain.6 Preoperative waiting also has been cited as a cause of anxiety.4 Long wait times with little information increase anxiety levels. A study by Gilmartin and Wright7 found that patients felt abandoned in the preoperative stage and that they were not treated as individuals while waiting for surgery. In a study by Jangland et al,8 patients and their families who complained about increased anxiety complained specifically about insufficient information, insufficient respect, and insufficient empathy. Perioperative nursing entails recognizing and managing patient anxiety, which in turn support positive patient outcomes and patients’ satisfaction with their experience. In a study of patients undergoing cataract surgery under a local anesthetic, the act of a nurse holding the patient's hand significantly reduced the patient’s epinephrine levels as well as self-reported levels of anxiety.9 In another study, hand massage was shown to reduce the anxiety of patients in the preoperative area without affecting the timing or workflow of the procedure.10 Yellen and Davis11 found that a strong predictor of patient satisfaction is when patients feel personally valued and attain a high level of comfort. Lastly, keeping patients and their families updated in the preoperative area can help to decrease anxiety and promote the feeling that perioperative team members care about them. As I reflected on the comments of these patients and their families and the imprint our perioperative nurses made on their experience, I was reminded of Jean Watson's human caring theory and the idea that caring is the essence of nursing and is at the core of our profession.12 It is through our acts of caring that we are able to establish nurse-patient relationships that can promote healing and decrease anxiety. In summary, the “little things” do matter, and as perioperative nurses, we must take the time needed to connect and establish a caring relationship with patients and their families. Laurie Saletnik, DNP, RN, CNOR, is the Editor-in-Chief of the AORN Journal and the senior director of Nursing, Perioperative Services, at the Johns Hopkins Hospital, Baltimore, MD. Dr Saletnik has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article." @default.
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• W2912127946 date "2019-01-29" @default.
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• W2912127946 title "Patients Remember the Little Things" @default.
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• W2912127946 doi "https://doi.org/10.1002/aorn.12600" @default.
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