September 23, 2019

Seminar eases nurses’ discomfort with sudden patient declines

By: Judith M. Mathias, MA, RN

A patient’s condition can change in the blink of an eye. Are you prepared to respond? And what happens if the patient dies?

This is the focus of an annual seminar at Houston Methodist Hospital that was developed to increase the comfort level of perioperative nurses caring for a patient whose condition changes or an unexpected death occurs during the pre-, intra-, and postoperative phases of surgical care.

Karen Y. White-Edwards, MBA, BSN, RN, CNOR

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“The reason we hold this seminar is because some nurses don’t know what to do or know what to expect when a patient’s condition changes suddenly,” Karen Y. White-Edwards, MBA, BSN, RN, CNOR, nurse education specialist II, Perioperative Center for Nursing Research, Education, and Practice, Houston Methodist Hospital, told OR Manager.

Edwards, who has led the seminar the past 3 of the 5 years it has been given, decided in February 2018 to survey the seminar participants to see if there was a change in their comfort levels before and after the seminar.

Edwards sent the survey to the 98 nurses who were registered before the seminar, and 45 responded. The same survey was sent to those 45 after the seminar at 30, 60, and 90 days.

The comfort level of nurses when a patient dies in the OR also was measured in the same group of participants after the seminar.


Condition change/comfort level survey

The eight topics listed on the survey Edwards sent to the participants are the same topics presented at the seminar:

• conducting a perioperative physical assessment with anesthesia criteria

• hypothermia

• changes in ECG rhythm

• code in the OR

• stroke and sepsis recognition

• pressure injuries

• hemorrhage

• surgical emergencies.

“You would have thought that the nurses would experience the most discomfort with changes in ECG rhythm or code in the OR,” says Edwards, “but those were second to conducting a perioperative physical assessment with anesthesia criteria, followed by stroke and sepsis recognition, hemorrhage, surgical emergencies, pressure injuries, and hypothermia” (sidebar at right).

Familiarizing nurses with important lab values and comorbidities that could affect a patient’s condition lessened their discomfort with performing a physical assessment. After the seminar, the number of nurses with discomfort dropped from 15 to 4 at 30 and 60 days, and to 2 at 90 days.

“In the seminar, they learn how to connect what they find in the preoperative assessment to what happens during the surgical procedure. And then when they hand off their patients to the PACU [postanesthesia care unit] or ICU nurses, they are better able to articulate what needs to be done for the patient,” says Joanne Muyco, BSN, RN, CNOR, manager of the cardiovascular OR, Houston Methodist Hospital.

“Oftentimes perioperative nursing is siloed into the three phases of care, and nurses don’t always know what happens in each phase. This allows them to see what each phase of care does and how their work plays a role in the overall care of the patient,” notes Muyco.

Codes in the OR also caused a lot of discomfort, with 12 nurses citing this before the seminar and four nurses admitting that they still had discomfort at 90 days afterward.


Patient death survey

After the seminar, the same group of nurses was asked about their comfort level when a patient dies in the OR.

Questions asked included:

• How many years have you worked in perioperative services?

• Have you ever had a patient who died in the OR?

• When a patient dies during a surgical procedure, what is your comfort level on a scale from 1 to 5 (with 5 meaning the greatest comfort and 1 the least comfort)?

Of 29 respondents, there were 14 whose comfort was scored at 1 or 2, and there were 8 nurses whose comfort score was greater than 3 (sidebar below).

“The reason we added the death component to the survey was because the respondents to the patient change in condition survey recommended it,” says Edwards.

“We are adding a death component to the future seminars also,” notes Muyco.

Going forward

About 100 nurses attend the seminar each year from the whole Methodist system, which includes seven hospitals. At the end of the 2018 seminar, when asked if they intended to make any changes in their professional practice or performance, 65 (71.43%) attendees said yes.

In the past, each of the eight topics has been presented by different educators and managers from various perioperative services, such as preoperative holding, PACU, ICU, and the cath lab, as well as the OR, but, in the future, Edwards says, they are going to put more focus on how each of these topics applies to the intraoperative nurse.

“We believe, and the survey shows, that just by bringing attention to potential changes in a patient’s condition and death in the OR, the attendees’ comfort levels in caring for their patients increase,” says Edwards. ✥



Edwards K, Muyco J. A patient’s condition can change in a blink of an eye. Are you prepared to respond? And what happens if death occurs? Poster. 2019 AORN Global Surgical Conference & Expo.

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