The Vital Role of Nurses

An advocate, educator and carer all rolled into one.

One thing that makes Cape Hip and Knee unique is that we offer a comprehensive service from a team of health professionals. A vital part of that team is our nurses. While many practices focus primarily on the Orthopaedic Surgeon’s role in surgery, we know that nurses play an integral part and come alongside our patients as an incredible support system. In writing this article, we caught up with a couple of our nurses to gain more insight into their “day-to-day” and asked them to help us unpack the vital role they play.

 

The Many Facets of a Nurse

Something that is immediately striking is the number of roles nurses end up fulfilling! It is so easy to fall into the trap of thinking nurses assist “only” with the aftercare treatment of a patient and to consider just their “caring role”.  As Sister Nell Browne shares:

“We often provide emotional support, information and liaise with the Surgeon and/or family as is needed. The nurse is the patient’s advocate to ensure they receive the best possible experience and care.”

Nurses are Carers, Listeners, Educators and Advocates for the patient. The caring aspect is mainly clinical, such as attending to dressings (wound care), pain management, nutrition, exercise and rehabilitation. As Carers, there can even be an aspect of ‘counselling’ that is sometimes needed – lending an ear and providing wise counsel. This leads us to their next role as Listeners, where they help to translate all the “medicalese” (fancy technical, medical terms that so often go over all our heads!) and help to evaluate the patient’s needs to advise, treat, and refer them accordingly.

 

“It is so important that patients feel understood, adequately informed and not alone on their journey.”

 

It is so important that patients feel understood, adequately informed and not alone on their journey. As an Advocate, nurses stand in the gap. They are a link between patients, health professionals (the Surgeon, physician, ward staff and physio) and their families, acting as a fantastic intermediary with everyone’s best interests at heart. They answer questions, triage problems and fix what they can, referring to others when they cannot. They provide information on what needs to be done preoperatively so that the patient’s surgery can proceed from a low-risk perspective. They also explain the peri-operative complications and how they can be prevented so that the patient is prepared and can feel more confident going into the procedure. And as Educators, they provide correct and practical information to help motivate and empower patients to take responsibility for their health, the surgical process and their rehabilitation.

And then there is the patient’s return home! Nurses also advise patients about what they will need in their home environment for safe and effective post-op recovery and to embrace personal independence appropriate to their age and health status.

 

The Character Traits of a Nurse

Keeping all the above in mind, it is hardly surprising that nurses are made of strong stuff! The top character traits our nurses mentioned are empathy, a caring nature, adaptability to work in ever-changing circumstances, good communication skills, being inclined to truly listen to patients and staff, a desire to serve, lots of patience, tolerance and a willingness to understand differences in cultures, to name just a few.

 

The Availability of Our Nurses

The hours the nurses at Cape Hip and Knee work are variable, depending on the Surgeons’ workload. In general, our unique offering includes:

• The availability of our nurses for two home or room visits and a ward visit – the timing of this is flexible. It depends on the patient’s availability in a 30km radius from Vincent Pallotti Hospital.
• A 45-minute pre-op visit – either at home, the office, the Surgeon’s rooms or as a remote telephone, WhatsApp video/call or Zoom call. This is such a valuable visit as it also helps nurses identify any issue that may cause additional risk during the surgery. With this insight, the team can pre-empt any potential problems and notify the relevant person, (the Anaesthetist, Surgeon or Unit Manager). A win all around!
• A brief hospital visit to arrange the two-week follow-up dressing and progress assessment.
• A 30-45 minute post-op visit – either at home or at the Surgeon’s or physiotherapist’s rooms. This includes a dressing change, suture/ clip/ mesh removal, scar management advice, and evaluation of progress after surgery. The nurses will check aspects such as pain control, anticoagulant compliance/ deep vein thrombosis prevention, mobility, how rehab and exercise are going, how the patient is sleeping, their diet and fluid intake, bowel and bladder function, general mood and motivation. They will also highlight anything the Surgeon may want to follow up on to ensure the best post-operative care and support.

 

DID YOU KNOW? CHK nurses ensure out of town patients have the appropriate dressing pack for their post-op dressing and an instruction letter for their local health professional attending to them.

• CHK Sisters are also available for telephonic support (via WhatsApp, Signal, Telegram, or call) with joint replacement patients, during working hours as far as possible.
• If the clinical need necessitates a visit, our Sisters do call-outs at night/ on weekends and public holidays. This is most often a dressing change for a bleeding or oozing wound and is always discussed and agreed to ahead of time with the Surgeon.
• Some patients may be referred for negative pressure wound therapy/ vacuum dressing or be re-admitted on the Surgeon’s instructions, and if indicated, this may include pain management. Our Sisters do this triage with the patient and their Surgeon or Physician.

Note: It is important to note that the CHK nursing staff are not an emergency service. For emergencies such a hip dislocation, patients must go to the Trauma Unit wherever the surgery took place for treatment. And if a patient reports possible deep vein thrombosis (DVT) symptoms, they will be referred for an ultrasound. This is because a DVT cannot be seen at a home visit. 

 

Tips From Nurses to Prepare You For Surgery

There is almost no one better to ask for tips to help you think about and prepare for surgery than from our nurses! Here is some of their feedback:

• If you are unsure if you should have the surgery, or are delaying for whatever reason, ask yourself the following questions: If you answer YES to two of these questions and the problem can be resolved or improved with surgery, go ahead and get it done. Don’t delay! Unfortunately, often the longer you wait, the longer the rehabilitation process and recovery can be.

1. Is the current problem affecting your quality of life?
2. Does pain disrupt your sleep?
3. If you are going away for the weekend and count how many pain pills you have, will you have enough to make it through, or will you need to get more to take with you?

• In this process, you will be given a lot of information to read. Take advantage of this and read all the information provided. This will help you set realistic expectations and plan well.
• Hand in hand with the above point is to get organised. Use the information given to you to organise your hospital stay, medical aid, plan your time off from work (if applicable), communicate with loved ones, obtain medical accessories you might need (like crutches) and make short-term adaptations to your home if required.
• Arrange help at home. It is impossible to do this alone. Make plans for assistance, or speak to your medical team about available options if you don’t have an adequate support network in place or nearby.
• Ask questions. Never be scared to ask questions to ensure you have the clarity and peace of mind you need. Know what to expect before the operation, on admission, during the surgery, in hospital, and for the weeks following as you recover.
• Get into the best space possible to set you up for success – this is threefold: mentally, physically, and nutritionally.

There is a lot of information and many helpful articles available on our website to assist you as you contemplate or prepare for joint surgery. Please don’t hesitate to book a consult with us to discuss your injury and take the next step on your road to recovery.

*Acknowledgement: Many thanks go to Sister Kathie Troost and Sister Nell Browne, whose valuable insights and knowledge made this article possible.