Re-Enforcement Counseling as a Key Way to Ease Apprehension on the Pending Surgery – Care Example

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"Re-Enforcement Counseling as a Key Way to Ease Apprehension on the Pending Surgery" is a remarkable example of a paper on care. During their duties, doctors and nurses meet patients who after undertaking a diagnosis require surgery in order to address their health issues. To ensure that the patients have a positive attitude towards the operation and that they are ready, it is imperative to undertake an extensive counseling process. Re-enforcement counseling is vital in addressing the psychological problems that may occur after surgery. There are various cases where re-enforcement counseling is necessary.

First, if the surgery can affect the self-esteem of a patient for example the removal of the breast or erectile dysfunction. Secondly, patients suffering from life-threatening illnesses for example cancer may seek the guidance of a counselor. Thirdly, patients who have had a bad experience in earlier surgery may need to undergo re-enforcement counseling. This paper seeks to discuss some of the major aspects of re-enforcement counseling as a key way to ease apprehension on the pending surgery. Change Model Overview One of the models that have been adopted by nurses is the one that was proposed by Rosswurm and Larrabee.

The model, which aims at guiding nurses through a methodical process for the change to evidence-based practice, came to a conclusion that for effective translation of research into practice there must exist research utilization, change theory, standardized nomenclature as well as research utilization. Nurses should use this model in order to be guided in their processes of developing and establishing an evidence-based practice change. The model depicts that nurses with clinical expertise, contextual evidence, quantitative as well as qualitative data will achieve evidence-based practice changes.

The section below discusses the six steps of the Rosswurm and Larrabee model and their link to the re-enforcement counseling by the nurse to ease apprehension on a pending surgery. Step 1: Assess the Need for Change Rosswurm and Larrabee's model indicate that nurses should examine the past practice and compare it with the current practice. Most importantly, communication among all the stakeholders including the staff nurse should be adopted. Additionally, literature research should be adopted to check the need for change. Due to the impact that surgery can have on the patients, there is a need to undertake counsel prior to the operation.

Basically, the question is for patients who require surgery after diagnosis, would re-enforcement counseling by the nurse ease apprehension on the pending surgery? Currently, nurses do not undertake extensive counseling but with evidence-based re-enforcement counseling, nurses will be in a position to make a change in the way patients are assisted before and after surgery. Step 2: Link the problem, Interventions, and Outcomes The model supports the use of standardized nursing systems in order to identify a problem as well as prevention of clinical deterioration.

As indicated earlier, re-enforcement counseling is essential for cases where the self-esteem of a patient may be affected as well as in life-threatening illnesses. If not properly addressed, medical-surgical patients may experience serious problems after surgery (Douglas and Anna, 2006).   Thus, during operations right interventions need to be put in place to ensure that proper outcome is attained. The key intervention is therefore to undertake re-enforcement counseling by the nurse prior to surgery. As a result of undertaking the change, the desired outcome will be to ease apprehension thus mitigating the whole post-surgery problems. Step 3: Synthesize the best evidence Rosswurm and Larrabee's model supports the use of critical review of the literature as well as weighing the evidence.

In his article Pre-Op Counseling for Laryngectomy Jason (2014), indicates that presenting the patients with after and before pictures during the counseling process is a major step during Laryngectomy. Adequate communication that allows patients to ask questions and get clarification is also a major way of providing proper counseling (Jill and Kristina, 2003).

As indicated by Megan (2002), counseling should not only focus on inpatients but also the outpatients. In his article Patient Anxiety and Conscious Surgery, Mitchell (2009) argues that patient education and counseling are two major components that cannot be overlooked prior to and after surgery. This implies that nurses should be empowered through training on matters relating to counseling (Tarja et al, 2001). Step 4: Design a change in practice Rosswurm and Larrabee model are for a roundtable discussion in order to come up with the best design for a change.

During the re-enforcement counseling, various stakeholders will be included. First, the nurses will undertake a training session that will enhance their counseling skills thus allowing them to significantly contribute to the change process. Professional counselors will also be involved as well as surgeons who have specialized in various parts of the body. In order to ensure that ethics is maintained during the process, patients will be involved in filling the feedback forms that will be maintained by the customer's care department. Step 5: Implement and evaluate the practice Step five of Rosswurm and Larrabee's model indicates that early identification of the patient problem is vital in order to effectively implement the change.

If nurses are faced with a patient who is anxious or has suffered a post-surgery problem in the past, he or she immediately initiate re-enforcement counseling to ease apprehension. The counseling should be done in a quiet room where the patient is able to concentrate and secrecy is guaranteed. By creating a friendly environment where the patient and the counselor freely intermingle, the desired outcome will be attained. To evaluate the change, the nurse will need to discuss with the patient the psychological impact of the entire process.

In this way, the nurse will identify the level of success for the change an aspect that will make him or her attain adequate skills to be applied in the future. Step 6: Integrate and maintain the practice change This step indicates that further evaluation and consideration should be undertaken as well as how to maintain the change. Based on the evaluation that will be undertaken in step 5, regular training of nurses and doctors on counseling will need to be undertaken.

As a result, the culture of re-enforcement counseling will be adopted during surgery. In this way, cases of problems after surgery will be effectively addressed among the patients regardless of their illnesses. Summary As indicated by the discussion above, it is clear that for patients who require surgery after diagnosis, re-enforcement counseling by the nurse will ease apprehension on the pending surgery. According to Rosswurm and Larrabee's model, nurses should identify the need for change which in this case is providing the patient with a counseling process prior to surgery.

This is followed up by linking the problem, interventions, and outcomes, synthesizing the best evidence, designing a change in practice, implementing and evaluating the practice, and finally integrating and maintaining the practice change.


Douglas, M, and Anna, H. (2006). Preoperative Counseling in Laryngectomy Available from;year=2012;volume=2;issue=1;spage=10;epage=20;aulast=Ward

Jason, M. (2014). Pre-Op Counseling for Laryngectomy. Available from

Jill, H, and Kristina, G. 2003. Client-Provider Communication in Postabortion Care Available from

Megan, T. (2002). Counseling the Outpatient Bariatric Client. Available from

MJ Mitchell. (2009). Patient Anxiety and Conscious Surgery. Patient Education and Counseling available from

Tarja, K, Marita, P and Leena, L. (2001). Empowering counseling—a case study: nurse-patient encounter in a hospital. Available from

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