Ruthie Leubovitz, Chief Nurse, Dept. of Cardiothoracic Surgery
The aim of this paper is to describe as simply as possible the process of admission, preparation for surgery and recovery after surgery, up to discharge from the department. In-depth and comprehensive information can be found in the instruction pamphlet "Together with you and for you", published by the Dept. of Cardiothoracic Surgery, which can be obtained in the Department.
Admission and preparation for surgery
The surgical candidate admitted to the Dept. of Cardiothoracic Surgery at the Tel Aviv Sourasky Medical Center goes through a unique circular process from admission up to discharge. Upon admission to the Department and completion of the bureaucratic procedures, a medical admission is made by a physician and a nursing admission by a nurse, who instructs the patient and his/her family and prepares them both physically and mentally for what should be expected postoperatively. The patient is admitted to the department's regular rooms from which he/she will be taken at a later stage down to the operating room.
During the framework of preparation for surgery, the patient will be examined by departmental physicians, will undergo a series of tests including ECG, chest X-ray, blood tests and other vital examinations. On the day prior to surgery, a nurse, departmental physician and anesthesiologist (each one separately) will examine the patient, will collect significant details for the duration of the operation and hospitalization, and will instruct him/her, each one in his/her field. It is really desirable that a family member be present during this instruction.
On the morning of the operation the patient will receive medications for sedation and may possibly feel drowsy. Family members will be allowed to remain with the patient at this time and can accompany the patient to the operating room. When the patient arrives at the operating room, he/she will be received by an anesthesiologist, who will check the patient's identity and will perform all the pre-operative procedures. The operation usually takes between 4-5 hours and during this time, the family members will wait in the special waiting room assigned to them. It should be stressed that about six hours will pass (of course, depending on the type of surgery and its duration) from the time the patient enters the OR until he/she comes out of the OR, due to the pre-operative preparations.
After Surgery
When the patient returns to the department from the OR, he will be admitted to the Intensive Care Unit in the Department. When the patient comes out of the anesthetic, he/she will find that he/she is attached to various instruments and tubes. Not to worry: this is a temporary measure.
Respiratory physiotherapy: during surgery, excretions build up in the respiratory tract. It is important to breathe deeply and to cough in order to be rid of these excretions and to ensure good ventilation of the lungs. A special instrument and a physiotherapist will help with this process.
In most cases, after one or two nights, the patient is transferred to the Intermediate Unit and after a short recuperation, will return to one of the regular rooms in the Department, where he/she began his/her admission. From here, the patient will be discharged from the hospital.
Getting out of bed: generally, patients are assisted out of bed the first post-operative day to sit in an armchair. On the second post-operative day, the patient will start walking in the department, under supervision.
Preparation for discharge: The patient will generally be informed a day or two before the proposed discharge, and the physician's examination on the planned discharge day will be the final decision if discharge is possible. If this will be decided, the patient will be given instructions during the morning by a nurse and will receive a discharge summary.
There is no need to return home in an ambulance. It is possible to go by car/taxi. The patient should wear clothes, not pyjamas. On the day of discharge the patient is in a general condition that allows him/her to return to being independent at home, with a small amount of help.
Important!
All the rooms, intensive and intermediate care units are situated within the Department itself and are manned by the same staff. The patient and his/her family become acquainted with the staff from the start of the course and they will meet familiar, smiling faces at every location and at any time. Continuity of treatment affords the patients and their families more security, strengthens the faith in the staff and eases for them the transit between the units and the department.
The nursing staff's aim is to achieve a high standard of satisfaction, both of the patient and his/her family, and allocates great effort into providing professional treatment of a high standard, incorporating also compassion and warmth that are so important during the hospitalization, which places a physical and emotional burden on the patient and his/her family alike. One of the exclusive customs in our Department is "mid-day rest" - every day, at 2 PM, the department "calms down" and is darkened. The visitors leave the department and our patients enjoy a period of rest and relaxation in an island of peace and quiet. Once a week, a support group gets together in the department. Patients and their families meet with the head nurse of the department and, together with the guidance of a social worker, the patients present their problems, and share the rather difficult experience of cardiothoracic surgery. They receive support that enables them to go through the week of hospitalization in an easier manner.
On behalf of the departmental staff, I wish everybody good health and a long life and, as the saying goes, "you shouldn't need our services" but it's important that you know that we are here.
Dept. of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center |
