Nursing Story

A Story about Professional Nursing in Day Surgery
by Nancy T. Johnson, BSN, RN

SONY DSCAs a nurse in day surgery Nancy prepares patient for surgery and/or a procedure requiring anesthesia or sedation as well as caring for patients post-operatively until they can be discharged to their homes.

On this particular day, Nancy received a patient from the Post Anesthesia Care Unit (PACU) that had just undergone a left extracorporeal shockwave lithotripsy (ESWL) related to a kidney stone. After Nancy received report, she continued with her nursing assessment as she does at any given day. The patient scores his pain at a level of “8” on a scale of 0-10, with ‘0’ being no pain and ‘10’ representing the highest pain imaginable. The established comfort goal for this specific patient was ‘5’. Nancy obtained orders to address her patient’s acute pain. After a series of medications as well application of an icepack and repositioning, the desired relief was not attained.

Nancy describes this as follows “The patient’s facial expressions and body language conveyed that the patient was experiencing acute pain. The patient’s family (wife and brother) stated that they had never seen the patient in this amount or kind of pain and that the patient did not complain of pain unless it was serve pain “. Nancy reassessed the patient and noted a 10-point elevation in his systolic and a 5-point elevation in his diastolic blood pressure. The patient’s heart rate was also slightly elevated from the baseline earlier in the day and the pain was scored at an ‘8’ out of 10. After yet another call to the anesthesiologist, Nancy receives an order for IV Morphine. She promptly administered the medication, which appeared to decrease the pain to a level of ‘4-5’.

Nancy encouraged the patient to try to relax for 10 minutes, and they would then talk about the patient going home. Nancy recollects:

“The patient’s wife followed me to the Nurses’ desk an asked me if I thought he would be OK going home and what would she do if his pain returned and the Vicodin did not help the pain. I told her she would need to call the physician on call for the physician that did the procedure. The wife stated she was not comfortable taking the patient home with the possibility of the pain returning and not being controlled by the Vicodin and could he stay overnight? I told her I understood her concerns and would call the physician. I called the physician and informed of the wife’s concerns and patient’s pain experience and requested for the patient to stay overnight. The physician stated the patient would be alright going home and the Vicodin should take care of the pain. I informed the wife of the physician statement.

The patient rested quietly with eyes closed for 15 minutes and at this time I reassessed the patient. VS were within 20percent of pre-op and pain level was ‘5’. I asked the patient if he would like to go home. He voiced the same concerns as his wife. I told the patient I had called the physician and he said that he would be alright going home and the Vicodin should take care of the pain. I told the patient and his wife to talk it over and if they thought he needed to stay overnight, I would call the physician again.

After 10 minutes I returned to the patient’s room. The patient stated his pain level was now a ‘6 or 7’ and the patient and his wife thought he should stay overnight. It was now after office hours, so I called the physician on call which was not the physician that did the procedure. I informed the on-call physician of the procedure, the patient’s pain experience, and the request to stay in the hospital overnight. I received orders to admit patient to observation with orders for a PCA pump with Morphine for pain. I informed the patient and his family of the physician’s orders. The patient thanked me and his wife hugged me and thanked me for understanding her concerns and taking care of her husband.”

In order to illustrate how Nancy utilized CVMC’s Professional Nursing Practice Model to educate and coordinate the care given to this particular patient using the Science of Nursing, the Art of Nursing, as well as the Patient’s Perspective, Nancy states:

“The Professional Nursing Practice Model was utilized in the care of this patient. Through the Science of Nursing, I collaborated with other healthcare providers to provide pain treatment for this patient and nursing practice standards were used as a guide for the patient’s plan of care. By means of the Art of Nursing, I made use of my experience, critical thinking skills, and knowledge to provide care for this patient. I demonstrated nursing professionalism by being an advocate for the patient and his family and by being sensitive of their concerns. I utilized the Patient Perspective by providing holistic care for the patient and the patient’s stated experience of pain.”

About two weeks later, Nancy cared for this patient again after receiving treatment for a left kidney stone. Nancy recollects, “I received the patient from PACU and the patient’s pain level was ‘3’. The patient informed me that the stone was not completely crushed with the previous treatment and that was the reason for his severe pain”.

Thanks to Nancy T. Johnson, BSN, RN for sharing her nursing story and using the Science of Nursing, the Art of Nursing, and the Patient Perspective to care for you patients!