Health promotion question

[Karis]

I work in the OR at an ambulatory surgery center. I have noticed in the past that the pre-op nurses document that they've encouraged some sort of health promotion, for example - routine gyne exams, stop smoking, handwashing, etc. For my part, after setting up for my case, I meet the pt in preop. I do a quick chart review and interview to verify the usual things such as pt, consents, procedure, site markings, etc. I then get a brief rept from pre-op nurse and the CRNA and I take the pt to the OR and follow the usual routine. The other day, my boss (who has no OR experience) came into my room and asked me if I had encouraged the pt to follow some sort of health promotion such as the examples listed above. I told her that the pre-op nurse has always done that. My manager then told me that JCAHO requires ALL nurses who come in contact with a patient to discuss health promotion. She wanted me to do so after the procedure on the way to PACU. When I mentioned that my pt was heavily sedated and would not be fully alert to such teaching from me, I was told that I need to start doing health promotion in the pre-op area. When I come out to pre-op and tell the pt I'm here to take them into surgery does not seem like an appropriate time for this either. I find this very aggravating. I also find it hard to believe that this is an actual JCAHO requirement for ME as the OR nurse. I've tried looking on JCAHO's website and can't seem to find any info at all related to this. Could someone PLEASE direct me to a resource that will help me either prove or disprove what my manager is telling me? Thank you so much in advance.

[canesdukegirl, BSN, RN]

I think your manager is nuts. You can't very well do health promotion when you are prepping your pt for surgery. It is inappropriate to do so when they are already terrified. Ask your manager for the literature from JCAHO stating what she is asking you to do. If you feel uncomfortable doing that, ask your nurse educator for the info. Have you looked at AORN for the info?

[canesdukegirl, BSN, RN]

OP, I just read something from ANA and the verbiage of the "health promotion" does not include specifics, but requires that TEACHING must be done with every patient that you encounter. You do teaching when you are asking the patient to verify their understanding of the surgical procedure during your pre-op interview. You also do teaching when they ask questions such as "when can I eat again", or when you tell them what to expect when they enter the OR (I always tell my pts that the room will be cold and loud, but that warm blankets will be provided, that they will probably not remember coming into the OR because of the amnesia that Versed induces). So, your teaching is done, and your NM can go take a hike!

[GHGoonette, BSN, RN]

In fact, it makes little sense to give any kind of teaching in the pre-op area! If there is a proper system in place for pre-or post-operative visits on the ward, that is when teaching takes place.

If the patient has had a premed, especially midazolam, they're not going to remember it anyway.

I think your UM is in dire need of education regarding premedication and anaesthesia....

[daVinciNurse]

When I see a pt pre op, I usually make mention of the importance of incentive spirometry and/or deep breathing post-op, as well as the reasons why we put intermittent compression stockings on and that they will be taken off once they are up and walking...to encourage them to get out of bed post op (when appropriate). Also discuss pre-op antibiotic even though it will be given by our anesthesia provider. I know the pre-op nurses are supposed to do this, but we all know surgical patients usually are very anxious...hearing it a second time can't hurt.

[ShannonRN2010, BSN, RN]

I think that trying to do teaching before a surgery is...kinda...crazy. I mean to facilitate learning, the conditions have to be right. Like a willingness to learn ect. I had surgery yesterday....I have NO CLUE what we talked about before hand because my nerves were on end and I really needed something to calm me down a bit.

I know they gave me a bunch of hand outs on handwashing....LoL....