PAs Assist Post-Surgical Patients with Goal Setting

When I first graduated from PA school, my first job was working as a civilian PA with military surgeons in general and trauma surgery at Landstuhl Regional Medical Center. Most of our patients were injured U.S. soldiers stationed in Iraq and Afghanistan.

I worked with a patient who had been severely injured by an improvised explosive device (IED). He had burns over 70 percent of his body and had to have an above-the-knee amputation. He required many skin grafts and eventually was fitted for a prosthetic leg. That patient was in the hospital over six months dealing with continual, intense pain, but we set small goals every day for walking and recovering and longer term goals to ready him for discharge.

The day he walked out of the hospital to the outpatient clinic with a huge smile on his face reminded me how important these goals are to recovery.

Today, as a certified physician assistant in cardiovascular and thoracic surgery, I still see patients during life-defining moments. Certified PAs are well-suited to working as members of surgical teams because we are highly educated, well-trained, and retain certification throughout our careers by passing rigorous national exams and fulfilling ongoing CME requirements.

Our patients have serious cardiac conditions. Many are senior citizens with multiple comorbidities who are facing their own mortality for the first time. I treat and manage these patients post operatively from the time they go into the recovery room, throughout their hospital course, and until they are discharged from the hospital. Often, they are afraid, tired and in pain. They have a lot to take in, so I educate them on the process of recovery and what they need to do to participate in healing. I believe in setting short-term and long-term goals during their path to recovery and celebrating the achievement of each goal along the way.

I prepare patients for their at-home journey by discussing their long-term goals and what they need to work on after discharge. Although they will be followed by their primary-care physician, I want to help support his efforts by helping patients understand that life as they know it has to change. I talk in terms of what they now have to do, not what they should do.

Long-term goals for patients after cardiac surgery:

• Follow your prescription regimen. Even though a nurse will follow up with them multiple times a week for several weeks, I stress the importance of compliance to prevent clots, strokes, and other complications.

• Lose weight. We introduce the discussion of healing wounds by eating lean protein, reducing sodium, and avoiding alcohol. A dietitian talks to them about the Heart Healthy diet.

• Quit Smoking. For those who smoke, the critical takeaway message is that the coronary grafts that are used in surgery will become stenotic again if they continue smoking. I tell them they have been in the hospital 7-10 days without a cigarette, so just keep going. If they can't do that, I ask them if they can reduce the number of cigarettes a day or agree to a tobacco cessation program. I ask them to commit to manageable steps to encourage progress.

• Exercise. I encourage moderate walking. If their activity level in the past included walking from the couch to the refrigerator that has to change. Walk one block slowly, then two blocks, and then walk at a moderate pace.

My goal is to empower patients by explaining that their future is in their own hands, and if they don't make significant changes, their life choices will be more limited. The goals are ones they have heard before, but hopefully undergoing heart surgery has made them want to pay more attention and make a change.

As a PA we are taught communication skills and how to educate patients. I take that part of my job very seriously. This is a teachable time in patients' lives, and I explain this is their opportunity to seize the moment.

Kelly Calero, PA-C,has been a certified PA for 11 years. She spent 10 years in general and trauma surgery in Landstuhl, Germany, and at the Alaska Native Medical Center in Anchorage, Alaska. Currently she works in cardiovascular and thoracic surgery at the Medical Center of the Rockies, part of the University of Colorado Health system.

This blog was provided in partnership with the National Commission on Certification of Physician Assistants.