My name is Nethravathy Seenappa and I am a registered nurse from India.
After obtaining my diploma in nursing in 2004, I started working at a dedicated nephro-urology hospital, the NU Hospitals in Bangalore, India. In 2016, I completed my bachelor’s degree in nursing, followed by a master’s degree (MSN – urology).
The level of work was vastly different from my training as a nursing student. Our Chairman, an eminent urologist, opened my eyes to the need to grow further in the field of urology nursing. I have been in the urology operating room for the last 16 years. The motivation for an enhanced work profile comes from the institution I work at and the constant encouragement from the urology consultants. It is also a teaching hospital for urology and nephrology postgraduates. As an operating room nurse, I participate in teaching urology residents about instrumentation and operative procedures. Recently, I had the opportunity to train and assist in robotic surgeries.
NU Hospitals has five branches. Four of them are located in different parts of India, and one in the Maldives. Today, I oversee functioning of operating rooms in all these branches.
I was delighted when I received the email confirming about the EAUN fellowship. It was a great opportunity to visit a hospital in a European country for two weeks to enrich my knowledge on general urology nursing, as well as in urology operating room.
I chose UZ Leuven as it is one of the largest university hospitals in Belgium. Its surgical department has 46 operating rooms (ORs) with dedicated urology and robotic units. Around 1,600 surgeries per year are performed at the hospital.
On 7 July 2022, which was my first day, I was welcomed and introduced to the OR complex by Ms. Julie Veryser. I was amazed by the welcoming environment and friendly staff. They took pains to make me feel like a part of their very competent team. Every day the procedures commenced at 7:30 AM. This meant that the nurses started their day on the dot at 7:00 AM The punctuality and time management were commendable.
On the second day, I was posted in the urology OR. In the first half of the day, I observed urethroplasty with penile flap for urethral stricture and endourology procedures (e.g. ureterorenoscopy, cystoscopy, TURBT [trans urethral resection of bladder tumour] and percutaneous nephrolithotomy [PCNL]) in the second half. PCNL was done in the supine position, and the initial puncture was done using ultrasound and fluoroscopy guidance.
Nurses were posted in two shifts. In each shift, there were two nurses and they were completely responsible for the respective OR. Their responsibilities included transferring the patient from the pre-op, positioning the patient for anaesthesia, and surgery, scrubbing, circulating for surgery, assisting the anaesthesia team with intubation and extubation, and finally transferring the patient to the recovery room. After each case, the OR was quickly cleaned/disinfected and kept ready for the next patient.
When a patient was wheeled inside the OR, their barcode was scanned to confirm the patient’s identity and to ensure that it was the right patient for the right surgery. Similarly, consumables were scanned once given to the scrub nurse. This scanning system also helped automatically send bills to patients and identify the expiry date of the consumables. Using technology to minimise human errors was amazing.
Ms. Kele Hoogeveen and Ms. Veryser, who are dedicated robotic urology nurses, helped me to understand critical processes in the OR. While I am familiar with our CMR robotic system, the introduction to the Da Vinci was very interesting.
On day five, I was at a nurse-led prostate clinic. The experience opened my eyes to the possibility of nurses taking up similar responsibilities in India. I was with Ms. Veryser at the prostate clinic. Patients diagnosed with prostate cancer report to the clinic and she counsels the patients pre-operatively. She visits them during their admission and follows them up after discharge at defined intervals.
Ms. Veryser was very patient and professional during her counselling. I was very inspired by the nurse-led clinic. Such nurse-led clinics are still in their infancy in India. This fellowship helped me realise the potential role that nurses could play in augmenting health care delivery in our resource-constrained environment.
On day six, the urology outpatient department had a separate room for different activities. There was a cystoscopy clinic where cystoscopy and stent removals were done on an outpatient basis. Flexible cysto-nephroscopes were used for both procedures. Then there were separate rooms for outpatient procedures where various procedures like suprapubic catheter insertions, per-urethral Foley catheterisation, and teaching of clean intermittent catheterisation took place. It was great learning to see a single nurse competently handling sterile procedures.
I also had the opportunity to witness video-urodynamics done by a nurse. While I was familiar with urodynamics, I had not witnessed video-urodynamics earlier. The unit nurses were very professional and helpful, and went out of their way to explain and share their knowledge on every step of the procedure.
During the 7th day, the focus was on robotic urology procedures. I observed the robotic ureteric reimplantation performed by Prof. Frank Van Der Aa, head of the urology department. The unit has the Da Vinci Xi Robot system which translates the surgeon’s hand movements to the console in real-time. The highly-magnified, 3D high-definition cameras provided extremely clear images of the surgical area. Two surgeons and one nurse handled the bedside units. Compared to the CMR surgical robot (the one which I have trained in India), the Da Vinci has a single bedside unit with four arms and extra-long instruments.
To observe OR arrangements, surgical trolley setting, assembling and docking/undocking instruments, etc. was a great opportunity. I felt privileged when Prof. Van Der Aa explained the surgery steps patiently.
In the next two days, I observed complex robotic surgeries such as partial nephrectomy, cystectomy with ileal conduit, and total abdominal hysterectomy with colporrhaphy and mesh.
On 18 July, the day was dedicated to the Central Sterile Supply Department (CSSD) process and practice. I was accompanied by Mr. Wouter Meert, who is in charge of CSSD. It is a massive CSSD which supplies sterile sets and consumables for 46 operating rooms, in-patient area and out-patient areas. The entire CSSD was automated for cleaning, disinfection and drying. ISO 13485 standard was followed in CSSD.
Mr. Meert was very professional and knew the processes of the CSSD as per ISO 13485. I was privileged to be able to discuss about the training process, define job roles and the clinical audits done in the CSSD.
The next day, I met with the infection control team where I acquainted myself with Ms. Nele Stroobants and the team to know about the infection control practices followed in the OR complex. We had a very interactive meeting to understand the processes followed during and after the infectious cases (especially air-born transmission). A caution board was displayed on the OR door which helps the teams to minimise the traffic and take precaution. We also discussed cleaning, disinfection, the process after every procedure, and the end of the day in detail. It was a great opportunity to know and discuss protocols followed to minimize the OR traffic and to maintain the AHU’s (Air Handling Units) in the OR.
On 20 July, the focus was on OR process and maintaining OR standards. I met Ms. Anneleen Jeanquart, the assistant head nurse who explained the process in the operating room in detail. This included planning for the nurses’ duties, shift allotment, preparation of the theatre, inventory management, nurses training and privileges, and documentation followed in the OR.
I understand that in Belgium, the basic nursing training focuses more on clinical posting, and because of dedicated operating room nursing training, they are aware of the basic OR process which makes the on-the-job training easier. This is lacking in India, and it takes tremendous time and effort for us to train the general nurses for specialty care.
OR shift in-charge took responsibility for all OR nurses for their coffee and lunch breaks. People seemed to genuinely get on well together.
Overall, the nursing communication skills were commendable and definitely contributed to the effective and speedy manner in which they perform their tasks. It has been a great pleasure to meet nurses who work with great pride in their profession and are also dedicated to their patients. I hope I can replicate the effective communication and enthusiasm that I observed among the surgical team members in my own setup.
The whole experience has given me a tremendous impetus to enhance my knowledge. It also helped me to improve my performance as a speciality nurse and a team player.
In weekends, I explored Brussels, Liege and Antwerp, and it was wonderful to see the historical places in Belgium.
I thank each and every colleague I met at UV Leuven for their patience in mentoring and sharing their knowledge. My thanks to the EAUN for providing me with a great opportunity. A special thanks goes to Ms. Hanneke Lurvink and Ms. Marie Rose Aangeveld for coordinating my fellowship. I would also like to express my appreciation to our management Dr. Venkatesh Krishnamoorthy and Dr. Prasanna Venkatesh for their constant support and guidance and permitting me to participate in the fellowship programme.