PREOPERATIVE VISITING

Preoperative Visiting

Preoperative Visiting

Introduction

Preoperative visiting has been debated and discussed since Hayward's widely cited research (1975). Authors have mostly looked at relationships between information-giving, stress and anxiety (Boore 1978, Salmon 1993), and modulation of the patients' pain experience (Melzack & Wall 1965).

Preoperative visiting can be broadly defined as a visit conducted by theatre nurses to surgical patients prior to the patients coming to theatre for an invasive procedure. In recent years a similar practice has been adopted by intensive care nurses (Watts & Brooks 1997).

Preoperative visiting is either performed in an informal ad hoc manner or as part of a formal system with agreed policies and documentation (Wicker 1995). Even in formal programmes the purpose of the visit is not uniform; the nature of the visit depends largely on the nurses who carry them out, but it normally falls within one or more of the following areas:

Patient anxiety reduction, which is achieved through giving procedural information, offering patients the opportunity to ask questions and providing a recognisable `friendly face' that will be there on the day of surgery (Johnston & Vogeles 1993, Martin 1996).

Patient education, including such things as discussing postoperative pain management and dealing with psychological distress (Devine 1992).

Patient assessment, to improve the effectiveness of the patient's care through the theatre department (Carter & Evans 1996).

There has been some debate about the ideal timing of a visit, particularly in the light of increasing numbers of patients being cared for through day surgery units. However, Lepczyk et al (1990), following a study of 72 patients, found that it made little difference whether patients received information up to a week before surgery or the day before.

Caring for paediatric cases has the added dimension of dealing with parental anxiety. A number of hospitals now offer Saturday clubs and interactive play sessions well before surgery to ensure that both parent and child feels prepared for the surgical experience (Brown 1997).

Although preoperative visiting has been practised since the 1970s there still appear to be problems and restrictions that prevent it becoming a mainstream activity for theatre nurses. Wicker (1995) identified a number of constraints that are regularly cited as reasons for the lack of preoperative visiting. These include: lack of time; lack of staff; patients not being available; no set list; lack of interest by staff and managers; and lack of support by the theatre team. Both Wicker (1995) and Kalideen (1991) felt that nurses are missing an opportunity to demonstrate their nursing role by not ensuring that they surmount the constraints on this practice. This comes at a time when theatre nurses are increasingly feeling threatened in their role and are having to justify their existence.

Fyfe (1999a) citing Hayward (1975) reminds us that pain and anxiety are closely related phenomena. Further to this, the well-cited gate control theory of pain (Melzack & Wall 1965) indicates that cognitive control can modulate pain postoperatively. Therefore, lack of information can have a direct bearing upon the patient's level of stress and anxiety before and after ...