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Practice comment

Good postoperative care means setting personal goals for patients

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Information for elective surgery is too heavily focused on the admission process. Nurses must work proactively with patients to aid postoperative recovery, says Liz Lees

My recent experience as a patient was generally positive. My first impression was that the ward was clean, the nurses were polite and the admission process was organised. Although I was determined to focus on my recovery rather than judging any aspects of care, my intention was thwarted when listening to my fellow patients’ discussions about what they “were allowed” to do.

I was one of six patients in a bay who were all shown to their bed on the same day, at the same time, for elective operations. Admission to the ward was rather like being processed on a conveyor belt and the care was delivered using a distinctly perfunctory approach. We were all nervous and after admission, we all duly settled into a mentality of “wait to see what we have to do next”. I learnt that we had all been seen in preoperative assessment clinics and had booklets about what to expect after our operations. Despite this we all remained apprehensive.

By comparison, I work in emergency care and had felt that my area was the “Cinderella” of planning and preparation for procedures. We are only able to give limited information at the point of emergency presentation, as we often do not know patients’ exact diagnosis. But I now question whether this is really the case?

By the nature of the questions patients in my bay were asking each other, it struck me that something had gone wrong. Patients simply did not know whether they were “allowed to get out of bed”, “could go to the toilet with this tube in” or “could take a shower”, and before ward rounds the emphasis shifted to whether they “would be able to go home”.

Patients also appeared to rely on what any friends who had previously undergone surgery had been able to do. While this is not a completely unreliable indicator of what to expect, it is not personal and specific to them. Moreover, this type of care process forces deeply private matters into a public forum, reduced to “old wives’ tales”. Leaving such questions unanswered reinforces the idea of patients as passive recipients of care rather than proactive participants in care.

I understand that preoperative assessments aim to prepare and inform patients before surgery and reduce morbidity and mortality, which cannot be faulted. Nevertheless, booklets and preoperative assessments are surely only one part of a patient pathway rather than a replacement for patient support and information while in hospital? However well intentioned, there is a missing link between preoperative preparation and individual patients’ postoperative anxieties. This balance needs to be redressed.

Instead of the seemingly laissez faire approach to postoperative recovery and discharge planning, I believe the nurses should have been working proactively with their patients to set personal goals which encourage and empower them (depending on the procedure), perhaps reducing perceived dependence on nursing and nursing interventions.

So, I believe that in order to successfully deliver care across the whole pathway, the preoperative assessment, admission process and attendant patient information must be “reactivated” throughout patients’ stay, because it is currently too heavily focused on preadmission and admission processes.

In addition, the focus of patient satisfaction as a measure of success of preoperative assessment clinics needs to change, as this can only measure satisfaction about the service at the time and not its impact on patient experience and recovery.

LIZ LEESis consultant nurse (acute medicine), Heart of England Foundation Trust, Birmingham

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