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Surgical Liaison Nurse

John Hunter Hospital
Project Added:
4 December 2012
Last updated:
17 October 2014

By Hunter New England Local Health District

Summary

The role of the Surgical Liaison Nurse (SLN) is to provide intraoperative progress reports to family members and significant others whilst surgery is being undertaken. This role is imperative in proving holistic care not only to the patients themselves but also to the entire family unit. Results show reduction in distress for patients and families prior to surgery, as well as positive feedback from staff.

Jenny Muir and Michelle Stubbs

Background

Anxiety in patients and families is an issue for a number of reasons. Firstly, anxiety is unnecessary when we can reduce it. Secondly, the need for the patient’s family, carers and loved ones seeking information about their wellbeing and progress became apparent as part of 'Improving the Patient and Staff Experience in 2011' during the roll out of the New South Wales Health Excellence Program.

Limited efforts were attempted by the Post Anaesthetic Care Unit (PARU) nursing staff to provide this information. These efforts proved to be unsuccessful.

Recent studies conclude that clinical manifestations appear in the PARU that directly relate to anxiety and stress experienced by the patients' family members. 

Initially anxiety may be diagnosed in the Anaesthetic Bay. Investigation will report dyspnea, diaphoresis, chest pain, nausea and diarrhea. Additionally, anxiety is clinically observed in PARU as tachycardia, hypertension and increase in pain scores.

Diminution of these symptoms could include drug therapy however communication is a simple yet exceedingly effective management tool.

Communication

The SLN utilises the communication protocol ISBAR. ISBAR is an acronym. It stands for:

I – Introduction
S – Situation
B – Background
A – Assessment
R – Recommendation

ISBAR is an initiative of the Hunter New England Local Health District.

It should be noted that information related by the Surgical Liaison Nurse is of a general nature and does not include specific medical details related to the surgery (e.g. Diagnosis); these details are given to the family members directly by the surgeon.

The SLN distributes and discusses the pamphlet with family members and circulates a business card with the SLN’s phone number. An example of the SLN script is:

 

I will be the nurse that keeps you updated on (patient's name) progress during surgery. I would like to review our pamphlet with you that describes options for locating close amenities (toilets, gift shop and diners) and where my name and contact number is located. Please call me with any questions or concerns that you have. I will give you an update approximately every hour.

Implementation

Aims

Derived aims of the SLN include to:

  • improve the process of communication and the level of patient and family satisfaction as well as to reduce the feelings of anxiety felt by many patients and their family members, throughout the perioperative phase of hospitalisation
  • establish a perioperative philosophy that has a multidisciplinary approach to the management of the surgical patient, their families and significant others.

Goals

The goals of the SLN are to:

  • include family in the care of their loved one during the perioperative phase of treatment
  • improve communication with families through regular updates on loved ones status thereby facilitating a positive experience at John Hunter Hopsital
  • facilitate emotional support
  • offer information about the hospital and surgical procedure being undertaken
  • promote family and surgeon communication

Role

The SLN nurtures the patients and families connected with the operating suite. The role is centered on:

S - Surgical
L - Liaison
N - Nurse
=
N - Nurturing patients
L - Looking after loved ones
S - Satisfying journey

Peri-Operative Surgical Liaison Nurse job description (Word File docx - 32 KB)

The SLN is an incredible addition to the services provided within the operating suite. The role injects a much needed non-clinical approach to caring for patients and families.

Quantitative Outcomes

The pilot study used the ‘Units of Distress Scale’ to gauge the level of anxiety and stress in patients and family members prior to surgery. This scale is a convenient way of communicating to other people how much distress you are experiencing at any given time. There are eleven points on the scale, ranging from zero (absolutely complete relaxation) up to eleven (extreme distress). The results are tabled below.

Pre service graph showing a peak of distress 8-10

Staff feedback included fewer phone calls, staff fulfillment plus noticeable less crowding outside the theatre complex. Positive feedback from families and patients was overwhelming. Written feedback included how important it was for the family to meet the Surgical Liaison Nurse. It was also described as a "brilliant service".

Post service chart showing distress peak at 2-4

The Surgical Liaison Nurse was praised for their appropriate progress updates outlining travels from the operating suite into recovery and return to the ward. Results display a major reduction in anxiety levels.

Qualitative Outcomes

Results of the 6-month trial period display promising and extremely encouraging outcomes. The Surgical Liaison Nurse has a focus of developing a culture of service and person-centred care that includes needs of
families and carers. All consumers experienced a heightened satisfaction within their hospital stay.

Quotes illustrating positive outcomes

"My family would like to give recognition to the Surgical Liaison Nurse."

"Full marks for her lovely manner and helpfulness to us."

"It’s wonderful to see the hospital implementing positive strategies."

 

Outcomes from the trial period illustrate that a positive approach to the role is paramount in nurturing a holistic approach to patient care and family support.

 

Nursing evaluation quotes

"Families are happy with the service and wishing for the service to continue."

"I found families were very thankful to have access to a phone number knowing they can call and get up to date information when they need it most."

Sustaining Change

The Surgical Liaison Nurse shows admirable ethical standards and accountability for representing our shared core values of Hunter New England Local Health District. The main component in sustaining the improvement of the Surgical Liaison Nurse is delivered in everyday practice. The environment and culture of the Operating Suite must reflect support and promote acknowledgement of the position. Daily allocation of a nurse to the role will ensure continuance and will establish an effective patient centered focus.

Distribution of the pamphlet will ingrain the daily operation of the service. Placement of the pamphlet on hospital wards will produce unquestionable sustainability of the service. Embedding this change within the Operating Suite will ensure continual increased gratification of care provided by the Surgical Liaison Nurse and its vial role. Provision of care at John Hunter Hospital is exceeding the ‘gold standard’ we pride ourselves in supplying. The impact of this imperative service is felt throughout the entire hospital campus and local health districts respectively.

The impression that nursing staff care and encourage interaction with families is key in nourishing this sensational person centered approach to intraoperative care of the surgical patient and their families. The Surgical Liaison Nurse plans and invests for the future holistic needs of healthcare consumers within Hunter New England Health by virtue of encouraging a multidisciplinary innovative service.

Family Testimony

“Last month my mother underwent surgery for a cerebral aneurysm which is where I first heard of, and encountered the Surgical Liaison Nurse. I just wanted to let you know that we were very grateful to have her available to us during that period. She eased our minds about waiting times etc. and called me at home before she finished her shift to let me know of the operations progress. She also rushed my sisters’ into the anaesthetic bay so they could wish mum luck. It was wonderful to have one person to contact and liaise with instead of all different staff from different shifts. I found the service extremely valuable and rewarding and that’s me as a Registered Nurse, so I can only imagine how the general public must appreciate it”.

Contact


Registered Nurse, Anaesthetics and Recovery
John Hunter Hospital
Hunter New England Local Health District
Phone: 02 4921 4222


Nursing Unit Manager, Operating Suite
John Hunter Hospital
Hunter New England Local Health District
Phone: 02 4921 4300

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