Clinical: Surgical

Regarding surgical patients, the ophthalmic RN can perform many duties the ophthalmologist previously performed. For example, after the work-up by the technician and examination by the physician, who diagnoses and prescribes treatment, the nurse can complete the patient visit while the ophthalmologist moves to the next patient.

The RN can also be an asset in patient education, including all aspects of medical and surgical care:

1. The nature of the disorder;

2. What treatment is planned and why;

3. The alternatives, risks, and benefits;

For the surgical patient, education also includes the potential for visual recovery in the presence of coexisting ocular or systemic pathology, as well as the usual preoperative routine and the responsibilities for self-care postoperatively.

Informed consent is another aspect of patient education. To obtain a truly informed consent, both patients and their families must be given complete information. Although some physicians may like to be the one to fully inform patients about proposed treatments and procedures, it is time- consuming. As obtaining such consent is an appropriate nursing function, this task can be properly, safely, and legally delegated to an appropriately experienced RN.

The ophthalmic nurse can also ensure that the medical, surgical, allergy, and anesthesia history is complete. This requires more than simply writing down information. The data must also be evaluated to prevent adverse effects on the course or outcome of surgery. This can involve:

- Review of current medications. The nurse recognizes generic and trade names and instructs the patient on which medications (e.g., beta-blockers, bronchodilators) to take the morning of the surgery, depending on the type of anesthesia. Some patients are told when an insulin dose should be held or a half dose taken preoperatively.

- Review of anticoagulant therapy. The nurse ascertains why the anticoagulant is being used and whether it should be interrupted. The nurse contacts the physician for orders.

- Evaluation of preoperative lab and electrocardiogram results. The nurse looks for unexpected abnormal values. If there are any, the nurse calls the primary care physician for follow-up purposes and obtains medical clearance as needed. This prevents surgery from being canceled at the last minute.

An important aspect of surgical care is the emotional and psychosocial support all patients and families need. Fear and anxiety respond to comfort, reassurance, and active listening. If previous surgical approval is required by the primary care physician, insurance, or managed care plan, the nurse can speak or write to the nurse employed by the third-party payer in a language that both understand.

This team-care concept continues postoperatively with discharge planning. Patients today must be told how to take care of themselves at home after surgery. They must be given the knowledge and skills required to promote healing and prevent complications. As part of discharge planning, patients can be told to call the nurse with questions or concerns, even after hours.

Role of the ophthalmic registered nurse (RN) in the practice/clinic (part 2)