Complications After Surgery
ContentsCommon Types Of Surgery What To Expect The Day Of Surgery Elective Surgery vs. Emergency Surgery Selecting A Surgeon And Specialists Complications After Surgery Signs And Symptoms Of Surgical Complications Preventing Complications The Caregiver’s Role Identifying Individual Care Needs After Surgery Common Care Needs After Surgery Making The Home Safe Selecting Caregivers And Skilled Personnel Paying For At-Home Care Residential Long-Term Care Options Selecting A Long-Term Care Facility Paying For Long-Term Care Legal And Financial Considerations FAQs About Complications After Surgery
Many individuals and families are nervous when a doctor recommends surgery. While the prospect of undergoing surgery may be intimidating, surgery is a highly effective method of treatment for many illnesses and disorders. By reading this guide, you will learn about some common types of surgery and how to help a family member or other individual avoid and deal with post-operative complications.
However, no surgery is without risks. A variety of surgical complications may occur, both in the hospital and after an individual returns home. A research study in 2012 discovered that over 40% of patients who developed post-surgical complications experienced complications after returning home.
Family members and caregivers can help improve an individual’s prognosis by understanding why surgery is performed as well as recognizing and helping prevent complications after surgery.
Common Types Of Surgery
With improvements in technology and surgical techniques, doctors are able to perform a variety of different surgeries for people with different needs. Some of the more common types of surgery currently being performed include:
- Abdominal surgery
- Bariatric surgery (also known as weight loss surgery)
- Cataract surgery
- Carpal tunnel surgery (also known as carpal tunnel release)
- Gastric bypass
- Hip replacement
- Knee replacement
- Laparoscopic surgery (a type of minimally invasive surgery)
- Sinus surgery
- Spine surgery
What To Expect The Day Of Surgery
Surgery is usually performed in a hospital setting. In rare cases, certain outpatient procedures may be performed in a doctor’s office or special clinic. However, major surgical procedures are always performed at a hospital.
Individuals undergoing surgery are usually asked to arrive at the hospital a few hours before their surgery is scheduled to take place. The person undergoing surgery will remove their clothing and jewelry and change into a hospital gown. A nurse will take their vital signs and prepare an intravenous (IV) line.
The surgeon and anesthesiologist will typically visit the person undergoing surgery to explain the procedure and answer any questions. At this time, anesthesia will be administered and the individual will be taken to the operating room. Family members will often be directed to a special waiting room while the surgery takes place.
After the surgery, the individual will be taken to a recovery room where their post-operative care will be closely monitored by hospital staff. With outpatient surgery, the person may be permitted to return home once their vital signs are stable and medical staff is satisfied that they are recovering as expected.
Elective Surgery vs. Emergency Surgery
When considering an individual’s prognosis, future care needs, and the risk of post-operative complications, it is important to identify the difference between elective surgery and emergency surgery.
Elective surgery is surgery that an individual chooses to undergo. Elective surgery typically takes place only after a person has discussed all other treatment options with their doctor. Elective surgery may be scheduled weeks or months in advance. This allows plenty of time to make arrangements for any post-operative care needs.
Some common types of elective surgery include:
- Bariatric surgery or weight loss surgery
- Cataract surgery
- Carpal tunnel surgery
- Gastric bypass
- Hip replacement
- Knee replacement
- Laparoscopic surgery (may also be done in emergency surgery)
- Sinus surgery
- Spine surgery
Emergency surgery is often performed suddenly and in response to an unexpected health crisis. The individual and their family may not have time to make extensive care plans. In some cases, the person’s future care needs may be more complex since they have experienced a serious health emergency.
Selecting A Surgeon And Specialists
If an individual’s doctor determines that they require surgery, the doctor will often arrange for a referral to an appropriate surgeon. If the person has been seeing a specialist, the specialist may perform the surgery themselves. In some cases, an individual may need to choose a healthcare provider to perform their surgery.
Choosing a surgeon requires careful consideration. If surgery has been recommended, an individual and their family will likely have many questions for a prospective surgeon.
Some questions may include:
- How many times have you performed this procedure?
- What type of outcome do you expect from this procedure?
- How will this surgery improve the person’s overall health and wellbeing?
- What are the potential risks?
- How will we know if the surgery has been successful?
- What actions will be taken if complications arise?
- Where will the surgery be performed?
- How long will the surgery take?
- How long will the recovery process be?
- Will the person make a full recovery or should we expect some chronic health issues after the surgery?
Deciding to have surgery is a major medical decision that may have permanent effects on a person’s health. Individuals and their family members should feel free to discuss all treatment options with the doctor. If surgery is recommended but the person still has some doubts or concerns about whether the procedure is needed, it may be advisable to seek a second opinion.
Complications After Surgery
While surgeons, nurses, and other hospital staff work hard to ensure their patients’ safety and full recovery, any surgery may result in complications. A variety of common post-operative complications may occur.
Pulmonary complications or difficulties with breathing may affect some individuals who have recently undergone surgery. Some people may develop pneumonia following surgery.
Hemorrhaging or heavy bleeding may occur during or shortly after surgery. This bleeding may occur as a result of the surgery itself or due to an underlying health condition such as a bleeding disorder.
Surgical site infections are one of the most common post-surgical complications. An individual who has recently undergone surgery may develop an infection around the area where the incision was made.
Adverse or negative reactions to anesthesia may sometimes occur. Most adverse reactions are minor and resolve soon after the individual regains consciousness. However, in rare cases, serious complications may occur.
Blood clots may sometimes develop after surgery. These clots may travel through veins and arteries to different parts of the body including the lungs causing pulmonary complications. In some cases, these blood clots may block blood flow to organs causing serious problems. Blood clots may even be fatal.
Signs And Symptoms Of Surgical Complications
Individuals who undergo surgery will usually consult with their doctor or surgeon to discuss potential post-operative complications that may arise. Certain people may be more likely to develop post-operative complications based on their weight, medical history, and the type of surgery they are scheduled to have.
Once it is considered safe for the individual to return home from the hospital after their surgery, they should be carefully monitored by family members and caregivers. Any symptoms of surgical site infection should be promptly reported to the individual’s doctor.
Symptoms of an infection may include:
- Fever or temperature of 100.4 F or higher
- Inflammation, redness, or warmth at the surgical site
- Swelling around the surgical site
- Pus or discharge from the incision area
Some people feel very dizzy or ill after surgery due to the effects of anesthesia. In many cases, this dizziness passes after the first few days. However, if a person continues to feel faint, weak, or disoriented after surgery, they should contact their doctor.
A person who has recently had surgery may be at a heightened risk of falling. Falls are very dangerous and may lead to serious injury. Consult a doctor promptly if a person who has had surgery falls, slips, or accidentally injures their surgical site.
Family members may help reduce the risk of post-operative complications by gathering information from medical providers about what type of care a person will need before and after surgery.
Some family members may wish to bring a notepad to the hospital on the day of the surgery. This will be helpful for documenting all instructions given by the doctor, surgeon, or nurses. Family members may also wish to bring any relevant legal paperwork and a list of the individual’s medications.
It is important to ensure that the doctor or surgeon has all the necessary information about a person’s health and daily habits. If a person drinks heavily or uses illegal substances, this may have a serious impact on their ability to safely undergo surgery. Family members should encourage an individual to disclose their use of alcohol, tobacco, marijuana, or other illegal drugs to their surgeon or medical team before having surgery.
Ensuring the person who has had surgery takes their pain medications and any anti-inflammatory drugs they were prescribed will help an individual recover more quickly as well.
The Caregiver’s Role
Most individuals who undergo surgery will require some type of care after their procedure. At the very least, an individual will require a ride home from the hospital and may require supervision while they recover from the effects of anesthesia. Further care may be required in the weeks following the surgery.
The type of care required after surgery will depend on the person’s health needs and the surgical procedure had performed. Family members and caregivers may need to provide support with mobilizing, meal preparation, household chores, transportation, or bathing. Some individuals may also require professional medical care such as help administering medication, monitoring vital signs, and changing surgical dressings among other needs.
Family members can help a person recover more quickly by monitoring them closely for potential complications, keeping the home clean and sanitary, and arranging for professional care it becomes necessary.
Identifying Individual Care Needs After Surgery
The length of time needed for recovery will vary depending on which procedure the individual has undergone and whether they have experienced any post-surgical complications.
Some individuals recover quickly after surgery and are able to care for themselves after a few days. Others may need care for weeks or months following their surgery. In some cases, an individual may require some type of care for the rest of their lives. The individual’s doctor will be able to provide more information about their prognosis and future care needs.
Family members may be able to provide a certain amount of care after a person returns home from surgery. However, some individuals may require care from a skilled medical provider. In these situations, hiring a professional at-home care provider may be the best option.
When determining what kind of care is needed, it is important to evaluate whether an individual is able to independently perform the activities of daily living (ADLs). ADLs include bathing, dressing, eating, mobilizing, and toileting. Determining which ADLs a person struggles will help identify the type of care they need.
Common Care Needs After Surgery
Depending on the type of surgery an individual has, they may need some assistance performing ADLs and caring for themselves as they recover and heal. Some common care needs that people have after surgery are discussed below.
Individuals who have recently undergone surgery are often advised not to bathe or shower for the first few days following their procedure. Keeping the incision clean and dry may help prevent post-surgical infections.
If a person has been told to keep the incision area dry, their doctor will explain which forms of bathing are safe. Many individuals are instructed to take sponge baths or bed baths after surgery. Others are permitted to take a shower as long as they use waterproof dressings or cover the affected area with a plastic bag.
Following surgery, many individuals need help getting dressed. Depending on which type of surgery was performed, a person may have limited mobility. They may have difficulty standing, raising their arms, or moving their legs.
These individuals may be more comfortable wearing light, loose-fitting garments that do not restrict movement or apply pressure to the incision site. Tight belts, bras, and girdles should be avoided unless a doctor directs otherwise.
An individual’s doctor or surgeon may advise them to avoid certain foods or beverages during their recovery. Consult the hospital discharge instructions for more advice in this area.
Many people feel nauseated after surgery or experience a sore throat due to the anesthesia. Light meals that can be easily swallowed (such as broth, mashed potatoes, applesauce, yogurt) are often advised. Popsicles, tea, or smoothies may help ease a sore throat but this should be checked by the doctor or a nurse first.
Prior to surgery, a person may be given a special soap or body wash to use. These products help reduce the risk of post-surgical infections so it is important that they are used exactly as prescribed.
After surgery, an individual should follow hospital discharge instructions regarding when it is safe to bathe/shower and which personal care items may be used. Avoid using sunscreen, creams, or other personal care products near the incision site unless a doctor directs otherwise.
If a person has had surgery on their arm, shoulder, or chest, they may be advised to use an arm sling or to avoid lifting their arms over their head. These individuals may need help with grooming tasks such as brushing, styling, or washing their hair.
Some individuals may be advised not to shave or apply lotion around the incision site after their surgery. Consult the hospital discharge instructions for more information on which grooming products or activities are safe during the recovery process.
People who have recently undergone surgery may feel dizzy or faint once they return home. Depending on which type of procedure was performed and what medications a person was given, the dizziness may persist for several days or weeks. A person who is dizzy or has difficulty mobilizing should not attempt to use the toilet on their own.
Some individuals who are taking prescription pain medications may become constipated. If this happens, encourage the person to drink plenty of water (unless advised not to by medical staff) and ask their doctor which over-the-counter products may help provide some relief.
Transfer From Bed To Chair
If a person feels weak or faint after surgery, they should not attempt to rise or walk on their own until they feel stronger. If an individual is using a mobility aid, they may require a caregiver’s help as they learn to use it.
Regardless of whether or not a person is able to get up independently or requires a caregiver’s assistance, they should move slowly and carefully to avoid slipping or injuring the surgical area.
A person’s mobility following surgery will depend upon their overall health and the type of surgery they had. Individuals who had surgery performed on their legs or feet may be unable to walk unassisted. In these situations, a mobility aid may be helpful.
A person who has recently had surgery should not attempt to mobilize if their surgeon has advised them to remain still. In some situations, a surgeon may instruct an individual not to put any pressure on certain limbs or to avoid strenuous activity following their surgery. Failure to follow these directions may result in serious complications including injury to the surgical site or a dangerous fall.
Following surgery, an individual may be prescribed several medications including medication for pain and anti-inflammatory drugs. These medications should be taken according to the doctor’s instructions.
Do not increase or decrease the dosage without consulting a doctor. It may also be dangerous to mix prescription medications with certain over-the-counter drugs. Consult with a doctor or pharmacist before using over-the-counter medications.
If a person is prescribed antibiotics, it is extremely important that they finish all their medication. Failure to do so may result in a surgical site infection. If a person has difficulty tolerating their antibiotics, they should consult their doctor.
It is normal to experience some pain following a surgery. Pain medication and anti-inflammatory drugs may be prescribed to help ease a person’s discomfort. Individuals taking pain medication may feel tired and weak and may be at a high risk of falls. People taking prescription pain medications should not attempt to drive.
Many individuals feel nauseated following surgery and some may experience vomiting. A person should contact their doctor if these symptoms do not pass after the first few days or if they begin to have symptoms of dehydration.
Special Medical Equipment
Some people may require special medical equipment following surgery. Many individuals find it helpful to use a mobility aid during their recovery. Mobility aids include items such as wheelchairs, walkers, canes, and knee scooters.
Some individuals may also be advised to use special orthopedic pillows, slings, oxygen delivery devices, or supplemental equipment which may accompany an implanted medical device. Medicare Part B may provide coverage for many of these items.
In some cases, these devices are needed only for a short period of time and may be rented from a local medical supply store. Other individuals may require the device for the rest of their life.
Equipment designed to prevent falls (such as handrails, grab bars, etc.) may also be helpful for individuals who are unsteady on their feet. In situations where a person’s mobility is extremely limited, items such as patient lifts may also be necessary.
Medicare may provide coverage for many of these items as durable medical equipment. However, it will be necessary to obtain documentation from an individual’s doctor stating that these items are medically necessary for use in the home in order to receive Medicare coverage.
Managing Medical Appointments
Managing a person’s medical care in the weeks following a surgery may be a challenge. Family members and caregivers can help an individual remain organized by documenting all information in a central area. Medical appointments may be recorded on a Google calendar or a physical calendar kept in the individual’s home.
If a person needs help taking medications, family members should create a system for documenting when each dose of medication is taken. This will help prevent missed doses or accidental overdoses.
Because anesthesia may temporarily affect a person’s cognitive abilities, people who have undergone surgery are usually not allowed to drive themselves home from the hospital. After all surgeries, individuals must be taken home by a friend, family member, or caregiver.
Depending on the type of surgery performed and a person’s overall health status, they may be told to avoid driving for several weeks or months. It is important that an individual follows the doctor’s instructions regarding driving. Failure to do so may result in a serious accident.
If a person has chronic health issues, they may qualify for a handicap permit which will allow them (or their caregiver) to park in designated handicapped parking spots or wait beside certain curbs. Contact the state’s Department of Motor Vehicles for more information on how to apply for this type of permit.
A person who has recently undergone surgery may not be able to safely perform their usual household chores. It is important that an individual carefully follow their doctor’s instructions regarding their physical limitations while they recover.
Household tasks that involve lifting, pushing, or pulling heavy objects may be too strenuous and could result in injuries. Family members or caregivers may need to take over these jobs temporarily or it may be necessary to hire a professional house cleaning service while the person recovers.
Many individuals are able to manage their own finances following surgery. However, some people may need help performing tasks such as writing checks, filling out forms, or going to the bank.
A person who plans to undergo surgery in the near future should begin making plans for how these tasks will be performed in the weeks after their surgery. It may be necessary for a person to make special arrangements with their bank to allow a family member to manage their finances during their recovery.
In some cases, a person may wish to arrange for a power of attorney which will allow a family member or other appointed individual to make decisions on a person’s behalf if they become incapacitated.
Making The Home Safe
A person who has recently undergone surgery may need several home modifications in order to ensure their safety once they return home as well.
Falls often present the greatest risk to an elderly person’s health and safety. Individuals who have recently had surgery or who have mobility issues are at a high risk of falling. A person who has difficulties walking or balancing may benefit from the use of a mobility aid, particularly if they are home alone at times.
Family members may help reduce the risk of falls by taking the following precautions:
- Secure or remove rugs
- Tape down or move electrical cords
- Keep rooms and staircases well-lit
- Place a non-skid mat, bath chair, or stool in the bath or shower
- Install grab-bars in showers and beside baths and toilets
- Install rails along staircases
- Remove clutter from floors
- Remove small pieces of furniture such as footstools
- Clear away ice from porches, sidewalks, and driveways
Selecting Caregivers And Skilled Personnel
If an individual needs more care than family members can provide, it may be necessary to hire a home care services provider.
Custodial caregivers provide assistance with many ADLs including:
- Meal preparation
Skilled personnel are able to provide medical supervision and assistance with medical tasks such as:
- Taking medications
- Monitoring vital signs
- Changing wound dressings
- Performing physical therapy
- Supervising individuals with complex medical needs
Skilled personnel include the following healthcare professionals:
- Registered nurse (RN)
- Licensed practical nurse (LPN)
- Certified nursing assistant (CNA)
- Home health aide (HHA)
Paying For At-Home Care
If a professional caregiver is needed, an individual and their family will need to determine how they plan to pay for this type of care.
Some private insurance policies may offer coverage, particularly if an individual has a long-term care policy.
Medicare provides some coverage for skilled at-home care if the following criteria are met:
- Skilled nursing care is required.
- The individual is under a doctor’s care.
- The individual is homebound.
- The individual does not require 24/7 care.
While Medicare does not provide coverage for custodial care, low-income individuals may qualify for custodial care through Medicaid. Each state has different Medicaid eligibility requirements. The Medicaid website offers valuable information regarding who qualifies and how to apply to coverage.
Residential Long-Term Care Options
If a person is no longer able to safely live at home or if their care needs have exceeded what at-home caregivers are able to provide, it may be necessary to consider long-term care options.
Long-term care facilities are an excellent option for individuals who need a greater level of support than what home health care agencies can offer. However, different facilities offer different levels of support. To choose the appropriate long-term care facility, an individual and their family will need to determine what type of care is needed.
Care facilities are often grouped into the following categories:
- Independent living
- Assisted living
- Nursing homes
Independent living facilities are an excellent option for individuals who are able to care for themselves on a day-to-day basis but need help with light housekeeping or other tasks related to home maintenance. Many independent living facilities offer assistance with meal preparation. Some facilities offer help with transportation as well. Independent living facilities may be a good fit for those who need a little extra support with daily tasks. However, they are not usually appropriate for a person who requires a great deal of medical supervision.
Assisted living facilities (ALFs) are a good option for individuals who need help performing some ADLs such as bathing or dressing. ALFs also offer some medical support such as help taking medications. Meals, housekeeping, and transportation services are often provided as well. Medical staff is on-site to assist with any emergencies. However, ALFs do not offer round-the-clock medical care.
Nursing homes provide the greatest level of medical support. Trained medical staff will supervise and assess an individual as needed, administer medications, and monitor vital signs. Nursing homes also provide care for individuals who have difficulty mobilizing independently and need help bathing, dressing, or toileting. If a person is no longer able to care for themselves in any capacity, a nursing home may be the best option for long-term care.
Selecting A Long-Term Care Facility
If an individual experiences serious complications following surgery or their overall health deteriorates, it may be time to consider long-term care.
Choosing a long-term care facility may be a difficult process for an individual and their family. Selecting an affordable facility is often a primary concern. However, family is often equally concerned about choosing a high-quality facility that will also be safe and comfortable.
Individuals and families who need to select a long-term care facility may wish to follow these steps when making their decision:
- Determine how to pay for a facility - If an individual will be using a certain type of insurance such as Medicare or Medicaid, they will need to learn which facilities accept this insurance. If an individual or family will be paying for the facility out-of-pocket, they may need to choose a facility that fits their overall budget.
- Find out whether a facility is licensed - Care facilities should be licensed by the appropriate state agency. To determine whether a facility is licensed, contact the state’s Department of Social Services.
- Visit the facility and meet the staff - Individuals and their family should ask to meet staff members who will be interacting with the individual on a daily basis.
- Learn which services and amenities are provided - Different facilities offer different services. Some facilities offer help with laundry, meal preparation, or other tasks. Other facilities may offer group activities, special outings, or other opportunities for socialization.
- Ask about facility policies - Individuals and their families should ask how medical emergencies will be dealt with. A facility should have a procedure in place for what to do if a resident must be transferred to hospital.
Paying For Long-Term Care
If an individual’s healthcare needs become more complex, it is best for the family to begin planning for long-term care as soon as possible. Paying for long-term care is a challenge for many people and their families. Making plans well in advance offers the best opportunity for finding affordable options.
Medicare provides coverage for certain long-term care options such as care in a skilled nursing facility (SNF) immediately following a hospitalization. Medicare also offers coverage for hospice care. However, Medicare does not cover most other long-term care options including custodial care.
Medicaid offers more extensive coverage for long-term care options. However, only low-income individuals may qualify for this type of coverage. Eligibility requirements also vary by state so an individual and their family will need to determine if the person qualifies for Medicaid benefits.
Legal And Financial Considerations
In some cases, an individual who is planning to undergo surgery may be advised to prepare an advance directive beforehand. An advance directive states an individual's wishes in the event that they become incapacitated and unable to make their own medical or legal decisions.
A living will is one form of advance directive. This type of document explains what medical interventions (if any) an individual would like to receive in the event that they experience life-threatening medical issues. In most cases, a living will only contains information about issues related to an individual’s end-of-life care physical and medical care.
A power of attorney is a document that gives a person the authority to make medical or financial decisions on behalf of another person. A durable healthcare power of attorney allows a family member or other trusted person to make long-term medical decisions on an individual’s behalf.
If a person is experiencing health problems or undergoing a high-risk surgery, it may be a good idea to prepare these documents as soon as possible. This will help ensure that a person’s wishes are respected in the event of an emergency.
FAQs About Complications After Surgery
1. When can a person leave the hospital after their surgery?
An individual may or may not be allowed to leave the hospital the day of their surgery. If complications arise, the surgeon may arrange for a person to be admitted to the hospital overnight.
After outpatient surgery, a person will usually be able to return home the day of their surgery. However, the length of time they must spend at the hospital will depend on several factors including how long the surgery takes and whether post-surgical complications occur. In some cases, a person may be kept at the hospital for several hours after their surgery.
Hospital staff will provide more information about when an individual will be allowed to return home. However, family should be prepared for possible delays the day of the surgery.
2. What rights do family members have during and after surgery?
In many cases, family members will be permitted to stay with an individual until they are taken for surgery. Family is often allowed to rejoin the individual in the recovery room after their surgery. Space may be limited so family should decide in advance who will accompany the patient.
It may be best to have an individual’s spouse or the person with power of attorney present at all times. In the event of an emergency, hospital staff will consult the family to determine who has the authority to make medical decisions on the person’s behalf.
3. What should family members expect during and after surgery?
Family members are often allowed to wait with an individual prior to surgery. They may be able to consult with the surgeon and anesthesiologist. Once a person is taken into surgery, family will be directed to a waiting room. Hospital staff will notify the family when the individual is out of surgery or if any complications have arisen.
In some cases, surgery may take much longer than expected. Family should be prepared for delays and may wish to decide in advance what they would like to do if the person must stay at the hospital longer than anticipated.
4. Who should be notified if complications are suspected once a person returns home after surgery?
A surgeon or discharge nurse will often give specific instructions about who to contact if an individual experiences complications following a procedure. Many individuals will have a follow-up appointment scheduled with their doctor a few days after surgery. If a person’s symptoms are minor, it may be safe to wait until the follow-up appointment to notify the doctor of these concerns.
However, if an individual experiences any symptoms that may indicate a life-threatening emergency such as symptoms of infection, chest pain, pulmonary complications such as difficulty breathing, or unexpected confusion/disorientation, they should seek medical help immediately.
5. What preparations should a person and their family make prior to surgery?
Certain aspects of an individual’s care may need to be for prepared in advance. If an individual is scheduled to have surgery soon, it is a good idea to begin making the following arrangements:
- Decide who will take the person home from the hospital.
- Determine who will care for the person immediately after they return home.
- Fill prescriptions for medications that must be taken after surgery, such as antibiotics or pain medications.
- Prepare over-the-counter medications that may be required after surgery.
- Acquire mobility aids, if needed.
- Install grab bars, handrails, and other safety equipment in the home.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.