the plastic surgery office nurse...

Running head: THE PLASTIC SURGERY OFFICE NURSE EDUCATOR 1

The Plastic Surgery Office Nurse Educator

Georgia Elmassian

Ferris State University

THE PLASTIC SURGERY OFFICE NURSE EDUCATOR 2

Abstract


The Plastic Surgery Office Nurse Educator

A patient educator is an individual who works in the healthcare industry. Often, the

educator is a registered nurse or an allied health professional who communicates directly with

patients and families regarding health and illness across the continuum of care. The patient

educator is a intermediary and or connection between the physician and patient. This paper will

focus on the specialized role of the plastic surgery nurse educator.

Current Practice

As a current nurse educator in the plastic surgery field, my role encompasses many facets

of responsibility. Not only am I a teacher of information, I am the liaison between the patient

and the surgeon; the multidisciplinary medical team; the hospital; community services; and

family members. I define, inform, demonstrate, execute, coordinate, mentor, encourage, and

support the patient who is contemplating, as well as engaging in plastic surgery, whether

aesthetic or reconstructive. I also help to create a plan; objectives; and achievable goals for the

patient from the initial consult all the way through and including post-operative recovery care.

To further appoint my role as a plastic surgery nurse educator, the following sections will detail

the knowledge, skills, and attitudes one needs to be a successful educationalist.

Knowledge

In accordance with the standards of nursing practice, the American Nurses

Association (2010) states “the registered nurse employs strategies to promote health and a safe

environment.” (p. 41) Keeping in alignment with this standard, my current position as a nurse

educator in the plastic surgery office does subscribe to this criterion of practice. I venture to

identify and employ teaching tactics that need to be cognizant of sound, clear, and empathetic

communications which are necessary to ensure a healthy and trusted environment that is vital to


effective patient education. As a nurse educator, I need to know the phases of life span growth

and development, and utilize learning approaches both physically and psychologically when

educating patients for surgical procedures and optimum recovery care. I fully utilize methods of

personal nursing knowledge, where I am aware of the patient’s situation, and I quickly build a

trusting and working relationship with the patient, and patient’s family.

I readily engage my patient in a comprehensive perioperative education that is not merely

a rhetorical question and answer guidance. Rather, I employ effective constructivist concepts for

patient education whereby I advise the patient to build upon his or her earlier knowledge of the

procedure and surgery. I then expand their foundation, and prompt them for effective plastic

surgical expectations and outcomes. In fact, according to nursing research, “when patients are

adequately prepared psychologically and physically, and policies and guidelines have been

followed, the risk of postoperative complications should be low, leading to a quick recovery.”

(Liddle, 2012, para. 21) Hence, plastic surgery patients who engage in a learning connection

with a nurse educator end up with better surgical outcomes than those patients who did not have

any instruction.

Equally significant for the nurse educator to keep in mind is that each member of the

family is at a different developmental and emotional time in the road of life. Therefore, all

family members are influenced by one another either simultaneously or independently, as well as

positively or negatively. With this in mind, it would be relevant for the nurse educator to

understand human growth and development, as well as identify family and ecology systems

when preparing patients and their families emotionally and physically for surgery. In fact,

Bronfenbrenner’s ecology system theory contends families are not isolated systems; rather


families and individuals within one system are influenced by, or themselves, influencing another,

sometimes much larger system of life (Lewthwaite, 2011). Therefore, the plastic surgery

nurse educator, when preparing a patient for a surgical event, should respect the concept families

are part of a much larger body.

Skills

As an existing nurse educator in the plastic surgeon’s office, it is my primary

responsibility to surgical patients, to instill a trusted environment dedicated to providing valuable

perioperative information and implementation. This is accomplished by collecting appropriate

health and assessment data from the patient during the consultation phase, analyzing the data,

identifying outcomes, and executing a plan of action. In so doing, the first five standards of

nursing practice, assessment, diagnosis, outcomes identification, planning and implementation

(American Nurses Association, [ANA], 2010) have been clearly instituted, and the strength of

my practice elevated.

Accordingly, sound and basic foundational skills, and understanding in general and

plastic surgical nursing, patient communication, critical thinking skills, pathophysiology, and

pharmacology are employed by the nurse educator. For a consultation to be successful, it is

necessary for the educator to have an understanding of psychosocial, communication, and

interpersonal skills. These are needed, to adequately assess and respect a patient’s body

dysmorphia or perceived body image, and promote reasonable expectations/outcomes of

aesthetic or reconstructive surgical procedures such as face-lifts and liposuction.

Moreover, as a nurse educator in a busy plastic surgery office, it is necessary to create a

constructivist environment for learning in which patients become engaged in activities that build

around their previous experience ("Constructivism," 2004). This entails encouraging patients to


problem solves and acquire more awareness surrounding their surgical procedure. Subsequently,

we will discuss their pending surgery and how their understanding of the procedure has

modified. These building blocks of information will ultimately develop an optimal peri-surgical

experience.

Attitude

The plastic surgery office where I now serve as patient educator is a practice that is quite

unique in the plastic surgery field. The current trend in the medical-business subspecialty market

is to have separate reconstructive and aesthetic practices. However, this surgeon’s practice

model welcomes diverse individuals across the entire life span and provides services for both the

aesthetic and reconstructive patient. We see a plethora of patients all across the spectrum for

something as simple as in-office Botox treatments, to office based surgery mommy-makeovers

("Mommy Makeover," 2013) and facelifts, to the complex staged-surgical procedures for the

cleft lip/cleft palate patient, to the multifaceted hospital in-patient bilateral breast reconstruction

and flap surgery. Thus, it is necessary for the plastic surgery nurse educator to use thoughtful,

therapeutic, and effective communication. As well as, culturally appropriate and practical

instruction, utilizing constructivist teaching methods across the continuum of care for the

aesthetic and reconstructive patient.

Reflection

In summary, a successful plastic surgery nurse educator who works with individuals and

patients across the human growth life cycle, will have an understanding of the foundations of

human growth and development and will successfully engage the surgical patient both

psychologically and physically (through demonstration). Furthermore, the educator will have the

ability to explain the pending surgery, assess the patient’s needs, and identify expected outcomes


plan and implement patient care, and evaluate the patient’s overall perception regarding

procedure, potential complications, and recovery care, all to ensure patient satisfaction and rapid

therapeutic recuperation after surgery.

Philosophy

My philosophy of nursing is strongly linked to my philosophy of being a nurse educator.

As a plastic surgery nurse educator, my mind long since merged nursing practice with nursing

education. As a nurse educator, I consider the patient teaching role to be an extension of my

nursing practice where I look at the whole person in order to assess, evaluate, and plan for their

needs. Plastic surgery nursing is an increasingly challenging and changing environment. Nurses

in this subspecialty are assuming more responsibility and expanded roles. Comprehensive

assessment, intervention, and therapeutic communication skills are essential to plastic surgery

education, and promoting optimal surgical outcomes. Therefore, the role of the plastic surgery

nurse educator encompasses more than a nurse-patient relationship. It combines the science of

education with the art of nursing. The following sections will provide the reader with a succinct

overview of my understanding of the nursing metaparadigm’s: person, health, environment, and

nursing concepts that I find helpful for the patient, and their relationship to plastic surgery.

Person

The person metaparadigm concept in nursing, as I believe it, refers to a vast interrelated

system much like the aforementioned Bronfenbrenner ecology system. The person

metaparadigm includes the human system, or layer, which includes family, peers, friends and

neighbors, faith, and community, and interconnects with that of the nurse. The groundwork of

the person metaparadigm is the basis of the larger system that is continually interacting and

benefiting from the nurse and nursing care.


Betty Neuman, a nursing theorist of the Systems Model, believes the person

metaparadigm refers to all aspects of the person interconnecting with other larger systems.

Neuman’s philosophy states “nurses should not only view the individual holistically, but should

also take the family, friends, and the community into consideration.” (Mercer University College

of Nursing [Mercer, CON], n.d.) Neuman’s theory also believes the person and nurse

interconnect to regain balance amidst the physiological, psychological, socio-cultural, spiritual

and developmental subsystems (Tourville & Ingalls, 2003).

The plastic surgery educator fully utilizes the person metaparadigm concept on a daily

basis with patients. Promoting optimal surgery outcomes is one of the primary challenges of

aesthetic and reconstructive education. Therefore, the educator recalls the psychosocial outcome

of surgery is contingent on the patient’s developmental stage and influence of family and

resource support; thus integrating Neuman’s principles into practice. Additionally, knowledge of

the patient’s emotional and psychological characteristics, and body image perceptions is essential

to providing compassionate care for the plastic surgery patient from the first pre-operative

consult and assessment through the postoperative recovery period (Hotta, 2007; Carper, 1978).

Health

Succinctly defined, the health metaparadigm concept in nursing is the measure of

physical, emotional, and social wellness or illness that is experienced by an individual. Tourville

& Ingalls (2003) finds as nursing has evolved; the profession looks at the patient’s position on a

health spectrum and simply defines health as “the absence of disease.” (p. 22) Sister Callista

Roy, another theorist of the systems model, further finds “health is a process of becoming

integrated and able to meet goals of survival, growth, reproduction, and mastery.” ("Roy," 2013,


para. 25) Clearly, internal and external factors within the patient’s larger system shape the

nurse’s assessment of, and plan for, the patient’s comprehensive continuum of health.

The plastic surgery nurse educator, unmistakably understands that aesthetic and

reconstructive patients are in need of education regarding wellness and disease throughout the

range of plastic surgical care. Therefore, the patient educator provides patients with the skills

needed to contribute to improving health, as well as enhancing recovery.

Environment

The environment metaparadigm concept in nursing, as I believe it, refers to everything

that surrounds, influences, and affects the person whether internal or external in nature. The

environment system of a person is continually changing and is constantly interconnecting and

interrelating with other larger systems. The environment as it relates to nursing includes any

factors that would indicate a physical or psychosocial need, or would be beneficial in nature.

Callista Roy, nurse theorist, as mentioned previously, bases her nursing theory on the

open systems model. Her adaptation model “focuses on the constant interaction between the

person and the environment, and how the person adapts to his/her environment.” (Tourville &

Ingalls, 2003, p. 27) Her theory includes developmental stages, family, and culture; as well as,

three types of systems influencers- focal, which are individual needs, contextual, as in resources

and support, and, residual, which comprises the family. All of which are not conclusive, but

continually interact with the patient, nurse, and environment (Boston College William F. Connell

School of Nursing [Boston College SON], 2013). Thus, the nurse, patient, and the environment

are all interconnecting and affecting behaviors.

As a nursing educator in plastic surgery, the patient’s environment as described by Roy,

must be taken into consideration at all times, and factor into the strategy in which to establish


goals for perioperative and recovery care. Thus, the education plan that the nurse educator puts

forth for the surgical patient is contingent upon the surgical procedure, access of caregivers, the

patient and family’s interpretation of the perioperative teaching and post procedure care, as well

as, the preparedness and compliance of the patient to be involved in their treatment.

Nursing

The metaparadigm concept of nursing encompasses the nurse-patient relationship, the art

of care, and the meeting of needs. Moreover, in accordance with the six American Nurses

Association Standards of Practice, nursing is the assessment, diagnosis, outcomes, plan of action,

intervention, evaluation, education, and empathetic interaction between the nurse and patient

(ANA, 2010). The nursing concept not only refers to the delivery of care and health, it is

meeting the psychosocial needs of the person, family, and community. Nursing is a

particularized art where the needs of the individual is met and provided in a professional and

effective manner (Carper, 1978).

Nurse theorist Dorothea Orem, also a uses a systems model for her Self-Care Theory.

Orem’s support for the nursing metaparadigm positions that individuals should be independent

for their own care and the care of their family members. Masters (2014), states the nursing

metaparadigm as defined by Orem as “therapeutic self-care designed to supplement self-care

requisites. Nursing actions fall into one of three categories: wholly compensatory, partly

compensatory, or supportive-educative.” (p. 60) Therefore, in alignment with Orem, the plastic

surgery nurse educator’s goal should be to increase the patient’s self-care ability in the best way

possible.

Much in correlation with Orem’s metaparadigm of nursing, not only does the nurse

educator support the plastics patient; but the patient has an obligation to contribute to their own


care decisions, pre and post-surgical instruction, and treatment plan. Therefore, it is essential for

the plastic surgery nurse educator to disseminate relevant knowledge in which to teach patients

how to care for themselves, have an understanding of their surgical procedure, and be

comfortable in handling their own care. Thus, patient education is a key component of nursing

practice.

Nursing Theory

Florence Nightingale, a statistician, and social reformer was the founder of the

profession of nursing and the first nursing theorist (Tourville & Ingalls, 2003). Her teachings on

care were based on statistical evidence and the principles of caring for, and about the patient.

Continually evolving from Nightingale’s basic philosophy, three classifications of behavioral

theories-interactive, system, and development have been expanded over the years and integrated

into current nursing theories and practice today (Tourville & Ingalls, 2003).

When we consider the concepts and assessments of the leading nursing theorists as

described above and add them to the metaparadigm’s of nursing, we get a more narrow view and

understanding of the larger range of nursing as science. Therefore, if we combine nursing

knowledge with theory, evidence based research, and the insight of nursing we have the

necessary components of art and science that identify the discipline of nursing (Carper, 1978;

Dudley-Brown, 1997; Tourville & Ingalls, 2003).

Conclusion

As we can conclude from this discussion, nursing focuses on the whole of the

person/patient, the environment, and health experiences. It is through the utilization of nursing

theories and metaparadigm’s that the nurse-patient relationship, systems, and developmental

theories and concepts merge. Plastic surgery educators involve both the science and art of


nursing in that we combine principles, research, and art/care into the domain of practice on a

daily basis.


References

American Nurses Association. (2010). Standards of professional nursing practice. In Scope and

standards of practice: Nursing (2nd ed., pp. 31-62). Silver Spring, MD: Nursesbooks.org.

Boston College William F. Connell School of Nursing. (2013). The Roy adaptation model.

Retrieved from

http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model.html

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. ANS Advances in Nursing

Science, 1(1), 13-23. Retrieved from http://ferris.libguides.com

Constructivism as a paradigm for teaching and learning: What is constructivism? (2004).

Retrieved from http://www.thirteen.org/edonline/concept2class/constructivism/

Dudley-Brown, S. L. (1997). The evaluation of nursing theory: a method for our madness.

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Hotta, T. (Ed.). (2007). Core curriculum for plastic surgical nursing (3rd ed.). Pensacola, FL:

American Society of Plastic Surgical Nurses.

Lewthwaite, B. (2011). Applications and utility of Urie Bronfenbrenner’s bio-ecological theory.

Retrieved from Manitoba Education Research Network website:

http://www.mern.ca/monographs/Bio-Ecological.pdf

Liddle, C. (2012). Preparing patients to undergo surgery. Retrieved from

http://www.nursingtimes.net/nursing-practice/clinical-zones/critical-care/preparing-

patients-to-undergo-surgery/5052645.article


Mercer University College of Nursing (n.d.). Betty Neuman PowerPoint [Lecture notes].

Retrieved from faculty.mercer.edu/ray_jk/NUR210/.../Betty%20Neuman.ppt

Northern Virginia mommy makeover. (2013). Retrieved from

http://www.austin-weston.com/procedures/mommy-makeovers/

Roy’s adaption model. (2013). Retrieved from

http://currentnursing.com/nursing_theory/Roy_adaptation_model.html

Tourville, C., & Ingalls, K. (2003, July-September). The living tree of nursing theories. Nursing

Forum, 38(3), 21-30. Retrieved from http://ferris.libguides.com/loader.php?

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