Trustee for

The Pennsylvania Association of Nurse Anesthetists

(PANA)

Is your family prepared to deliver your elderly parent to surgical care?

Whether a surgery is routine or complex, it is not uncommon for patients and their families to experience some degree of anxiety and stress in the weeks and days leading up to it.

Dealing with the surgery of a loved one is not easy—particularly if the patient is an elderly parent. But there are steps that can be taken to relieve anxiety and stress on both the patient and the family’s part. There are considerations leading up to the surgery as well as post-operative plans that need to be made. Addressing these considerations in an organized fashion will significantly reduce stress and anxiety.

Preoperative Activities: Get the Facts, Learn the Terrain

Learn the nature of the surgery and why it is required. Know what to expect before, during, and after the surgery. Will the procedure be quick? Will it involve an extended stay? Will it alter the lifestyle of the elderly parent temporarily or permanently? What special needs will occur after the surgery?

An initial consideration you need to make is: who will take mom to the hospital? Will it be dad? If so, does he know the route well enough? Will dad be emotionally stable enough to drive? If that is in doubt, then who will drive and does that person know the route well?

Become Oriented with the Facilities

Some hospitals offer a preadmission program for patients and families. Hospitals that do not have such programs might allow patients to tour the facilities to become familiar with the surgical and recovery environment. Becoming familiar with the hospital will relieve some anxiety and stress for both the patient and the family.

There are many questions that need to be addressed leading up to the day of the surgery. The Certified Registered Nurse Anesthetist (CRNA) who will be assigned to the surgery will be happy to help you prepare for the event. Here are some general pre-operative concerns you will need to address:

· Medication: Does the elderly parent use medication? If so, the surgical team needs to be advised so that they may prepare with your parent accordingly.

· Food intake: as a general rule, solid foods and water should not be consumed during eight hours prior to the surgery.

· Does the parent take natural dietary supplements? It is critical to disclose this information to the surgical team.

· Have there been any physical or emotional changes since the surgery has been scheduled? If so, report the changes to the CRNA.

Intra-Operative Stage: During the Surgery

Decide how you will monitor the surgery. Though you know that your parent will be in highly skilled and caring hands, you will naturally want to be kept posted on the progress. Will you be the primary point of contact? Will you be there in the waiting room as the operation takes place? If not, will anyone?

Establish a chain of communication. If you will wait in the waiting room, determine who you will first call to report your parent’s progress and how the word will be spread to the rest of the family.

Equally important, establish a chain of support. It is natural to have concerns during the operation. Having someone to call to express these concerns or just talk to can be a great emotional support during the day of surgery.

One important note: Prior to the day of surgery, determine the hospital’s policy regarding cell phone usage. Also, determine if you are able to obtain a signal in the hospital’s vicinity. If not, you may wish to consider bringing a calling card for the payphone.

Finally, know when mom is expected to be released. Will it be the same day? If not when? Who will bring her home?

Post-Operative Stage: After the Surgery

Depending on the type of surgery performed, lifestyle adjustments, whether temporary or long term, may need to be considered. Questions you will need to answer include:

· Will mom require assistance after the surgery? Such assistance may include the need for visiting nurses, nurse assistants, and homemakers. Do not assume that dad will be able to handle mom’s bathing needs, dressing changes needs, medication needs, meal preparations, etc.

· If such assistance is necessary, will there be family members who are willing and able to participate in the care?

· Will mom require durable medical equipment such as specialized furniture or breathing apparatuses?

You will also need to be familiar with what mom’s insurance will and will not cover. Typically, Medicare provides for only ten Visiting Nurse visits. Be aware of what will be financially available to help mom has she recovers.

Family Matters in Preparing for the Surgery

Involve the Entire Family

When planning for surgery for a elderly parent, try to involve as much of the family as possible. While surgery is a far cry from a birthday celebration, it is in its own regard a family event. Bear in mind, there may naturally be some who will contribute little or nothing to the event. Do not take offense to this, as not being involved is simply the only way some people know how to cope with uncomfortable circumstances. Let them withdraw if need be—pushing them into the situation through guilt will not help at all.

There are typically three layers of family that need to be included in very different ways:

· The elderly parent/patient and his or her spouse

· The children of the elderly parent

· The grandchildren of the elderly parent

Here are some general tips that may help prepare the entire family for the elderly parent’s surgery. Remember, these tips will not work for everyone as no two families are exactly alike. However, the tips will serve as a model to help you and your family prepare.

Preparing the Elderly Parent/Patient

Keeping an open line of communication with the parent who is scheduled for surgery is crucial. These parents need to know that their family cares and is committed to participating in the surgery. Participation includes talking to the parent about what is about to happen and assuring the parent that all will be well and everything will be taken care of during his or her absence. Assuring the parent that you will be there for him or her before, during, and after the surgery is a critically meaningful step.

Preparing the Spouse of the Elderly Parent

Often the greatest challenge is preparing dad for mom’s surgery or vice versa. Surrendering a spouse of many years to surgery is never an easy event. Many emotions are stirred and memories of years gone by race to the forefront of the spouse’s mind. Some people deal with the situation more strongly than others, but no one is immune from the fear of the unknown. These tips will help prepare dad for mom’s surgery:

· Have a family meeting with just the adults—you, your siblings, mom and dad: Discuss how the family feels, but be positive. This is an opportunity to reassure the parent who will undergo surgery that everything will be all right and that he or she will be cared for by highly skilled and caring professionals. Yet, at the same time, it is OK to express your human emotions of concern.

· Have a meeting alone with dad: Let him know ahead of time that you want to talk to him alone about what’s about to happen. This is a time to bond in a new and necessary way—somebody you both love is about to undergo surgery. You will be a source of strength to each other. Express your concerns, but also reassure your father that mom is going to be taken care of by highly skilled professionals.

· Don’t neglect dad—while it is natural that most of the attention will be on mom, don’t let dad feel forgotten.

Meet with the Siblings

· Have a family meeting with the siblings: If you have siblings, be a mini-support group. This is a chance for everyone to let their feelings and concerns out and to serve as a source of strength for each other.

· Talk about preoperative, intra-operative, and postoperative precautions and how you will monitor those precautions.

Bring the Children into the Situation

Communicating with children about their grandparent’s surgery is a delicate situation that should be approached carefully. Try to remain calm when giving your child an account about what is about to happen. You need to be honest, but not overly detailed. Keep the information both age and developmentally appropriate. If you need help in finding a balance to the conversation, talk to the nurse anesthetist who will care for your elderly parent. The nurse anesthetist should be able to offer an accurate yet simplified explanation of the surgery that is suitable for the child(ren). Your display of emotions and behavior can impact your child’s perception of the event.

Remember, surgery is in fact a family event. Having this in mind will substantially lessen the stress and the anxiety involved for everyone one.

Keep in mind that your nurse anesthetist is there for your parent, your family, and you during every phase of the surgery: before, during, and after.

Thomas Kelly is Trustee for The Pennsylvania Association of Nurse Anesthetists, an organization that promotes responsible, ethical, and prudent health care practices to benefit Pennsylvania patients in matters of anesthesia. The hallmark of nurse anesthesia is patient safety. Over 2,300 CRNAs practice in the state of Pennsylvania, consistently administering safe, high quality anesthesia care. For more information on PANA and issues related to anesthesia, visit the association’s web site at www.pana.org.

Editor’s Note: To schedule an interview with a certified registered nurse anesthetist or PANA representative in your area, contact the PANA at 1-800-495-PANA(7262)