Tips for caring for older surgical patients
Knowing the physiological differences between your older patients and your younger patients is a good start to providing care that addresses their needs, but some of the things you can do to help the patient don't involve clinical skills, says Jim B. Wilkerson, RN, BSN, CCRN, outpatient surgery supervisor at Pomerado Hospital in Poway, CA.
Don't just assess the patient. Consider the caregiver's health and ability to provide post-surgical care as well, Wilkerson says. Sometimes the surgical patient is actually the caregiver for a spouse who may be medically fragile, he explains. "Ask about the current home situation, and make sure that needs such as transportation to a physician's office for follow-up visits are possible," Wilkerson says. If there is a concern, help the patient find home care services or another family member who can help, he suggests.
Discuss financial issues
During the preoperative visits and assessments, be sure that patients understand their insurance, their responsibilities for copayments, and any other financial obligations. "Older patients live on a fixed income, so they are more concerned about being able to make payments," says Wilkerson. "It's not like a younger patient who might just work overtime or take a part-time job to cover extra expenses." Have resources in the community or within your hospital that you can call upon to provide extra help for the patient, he suggests.
Because it is likely that the patient is on a variety of medications, tell the patient to bring in the bottles so that an accurate list of them can be made at the preoperative visit, suggests Patricia Stein, RN, MAOL, CNOR, nurse education specialist for perioperative services at Palomar Pomerado Health System in Escondido, CA. "Determine which ones are to be taken preoperatively and which ones should be withheld, especially medications that affect clotting, glucose control, or blood pressure," she says.
Use 'Mr.' and 'Mrs.'
You should respect the dignity of the patient, using proper pronouns when addressing him or her, she says. "For example, use 'Mrs. Smith' rather than 'Hazel' when speaking to the patient," Stein says. Make eye contact when talking to the patient but with sensitivity to cultural differences for which eye contact may not be positively received, she says. "Allow the patient to speak for him or herself rather than depend upon a relative or friend for answers," Stein adds.
"It will be difficult for the patient to tolerate a vigorous bowel prep if you are performing an endoscopic or bowel procedure or to be NPO for an extensive length of time," points out Stein. If possible, schedule an elderly patient's surgery or procedure so that it is completed early in the day, she suggests. At the same time, recognize that getting to the hospital at 5:30 in the morning for a first case may be difficult, Stein adds.
Secure all prostheses especially hearing aids, false teeth, and glasses prior to surgery, but make them available to the patient as soon as is safe, says Stein. Making sure that the patient can see and hear and look normal makes them more comfortable as they recover and prepare for discharge, she adds.
"Allow the patient to hug and kiss their loved ones goodbye prior to the move into the operating room," says Stein. Although surgery is a routine procedure for the busy staff of an outpatient program, undergoing a surgical procedure is not easy for the patient or family, she adds.
Increase staff sensitivity
Helping your staff members develop sensitivity to an older patient's needs is a matter of education, says Stein. "Invite a clinical nurse specialist or other nurse professional who is knowledgeable about caring for the older patient speak to the staff at an inservice," she suggests.
Help staff members develop empathy for older patients by letting them experience the same challenges, recommends Stein. For example, have a staff member put on earmuffs to simulate difficulty with hearing, remove glasses or put them on to simulate difficulty seeing, and add an ice pack to bring down the temperature of the body, she says. Other ideas include hobbling on one leg to help with understanding impaired mobility and then having that person obtain several instructions at once in quick consecutive order from many caregivers, she adds.
"It is important that we show genuine concern and empathy for our older patients," says Wilkerson. "Outpatient surgery is so technical and fast-paced that we get used to an assembly-line pace of work, but when we are dealing with older patients who have faced a life full of challenges, we need to slow down and ask them, 'How can I make this better for you?'"
Knowing the physiological differences between your older patients and your younger patients is a good start to providing care that addresses their needs, but some of the things you can do to help the patient don't involve clinical skills, says Jim B. Wilkerson, RN, BSN, CCRN, outpatient surgery supervisor at Pomerado Hospital in Poway, CA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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