- Email: [email protected]
Developing Laser Competencies: A Process to Ensure Safe Practice
FEBRUARY 1994,VOL 59, NO 2
-
AORN JOURNAL
Developing Laser Competencies A PROCESS TO ENSURE SAFE PRACTICE Caroline Buszta, RN; Brenda S. Sovero, RN ince 1960, when the first laser used in a health care setting was developed, lasers have had a positive effect on nursing. Today, laser nursing, one of the newest and fastest growing departments in the OR, is a subspecialty of perioperative nursing that demands technologically safe and appropriate practice. The development of the prospective payment system based on diagnosis related groups in 1983 and the fact that laser technology reduces patients' hospital stays have contributed to the popularity of lasers in the OR. As a result, the types of lasers available and the possible surgical applications still are increasing. Although lasers are successful operating tools, they also are potentially dangerous. Laser plume can be hazardous, and lasers increase the risk of fire in the OR and the risk of eye damage. Consequently, nurses must ensure the proper use of lasers and exercise precautions to protect patients and staff members. This process requires continuous education. The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) now mandates that competency of nurses who provide care in the surgical settings is verified, and hospitals are expected to document the competency levels of their health care providers.' Therefore, OR nurse managers must review and record competency levels of their staff members. Competency documentation has been a major aspect of vocational training for years. The educational literature has several publications that feature competency-based education in specialized care units such as critical care, psychiatry, and cardiovascular surgery.2 This article addresses the development of competencies for laser nursing.
Caroline Buszta, RN, MSN, CNA, CS, C , is clinical coordinator at the Department of Veterans Affairs, Brecksville, Ohio. She received her associate of applied science degree in nursing from Tri C West, Parma, Ohio, her bachelor of arts degree in social science from Ursuline College, Pepper Pike, Ohio, and her master of science degree in nursing f r o m Case W e ste rn Re se rv e , Cleveland.
Brenda S. Sovero, RN, MPA, is nurse manager of the OR and postanesthesia care unit at Veterans Affairs Medical Center, Cleveland. She received her bachelor of science degree in psychology f r o m Mount Union College, Alliance, Ohio, her bachelor of science degree in nursing f r o m Case Western Reserve University, Cleveland, and her master of science degree in public administration from Cleveland State University.
S
Competency Development Program
C
reating and implementing a program to monitor and support the documentation/evaluation process is labor intensive and costly. Developing workable and meaningful competency statements requires
467
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 1
Laser Knowledge Demonstrates an understanding of types, uses, and biophysical aspects of laser therapy.
Describes the basic biophysics of laser technology. Identifies the types of lasers used. Identifies the appropriate laser for each procedure. Identifies safety issues relevant to each type of laser. Lists the benefits of laser therapy. Lists the safety measures for patients undergoing laser therapy. Lists the safety measures for staff members during laser therapy.
Table 2
Equipment Set Up Sets up equipment properly to ensure safe care to the patient undergoing laser therapy.
Reviews policies, procedures for laser use. Sets up, takes down equipment per manual instructions. Assesses conditions of attachments. Calibrates equipment. Verifies laser beam alignment. Checks for biomedical engineering seal of safety. Maintains equipment as appropriate.
468
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 3
Safety Provides safe care to the patient undergoing laser therapy.
Identifies potential hazards with every laser procedure. Ensures that equipment is operating properly. Monitors window coverings, posts warning signs. Removes potentially flammable, combustible supplies. Checks fire extinguisher to ensure it functions. Prepares the surgical field considering the reflective equipment, the risk of fire. Provides protective eye wear for patients, staff members. Complies with safety measures for laser plume, laser masks, smoke evacuation. Ensures safe ventilation for patient, staff members.
communication, clinical, and administrative skills. One also must gain staff members’ support to ensure cooperation during the implementation phase of the program. Those charged with creating a competency program must identify and select staff nurses who demonstrate clinical excellence so that they may function as preceptors or mentors for those seeking competence verification. Program planners also must write detailed policies and procedures that include topics such as the levels of competency, qualifications for each level of competency, frequency of measuring competency, record keeping, and administrative details. The first step in creating a competency program is to have nursing staff members write and implement care standards specific to the use of lasers. Based on the nurses’ recommendations, competency statements and quality
improvement/quality assurance monitors may be established.
Competency Format
C
are standards and competency statements should address no less than five basic domains for laser therapy (eg, laser knowledge, equipment set up, safety, patient education, documentation). The nurses who develop the laser therapy care standards can establish each domain’s basic criteria based on their hospital’s policies and procedures. Examples of nonspecific basic criteria for each domain are detailed in Tables 1, 2, 3, 4, and 5. After the basic competency statements are completed, specialty-specific statements may be developed. The criteria for each domain may be individualized for each specialty (eg, vascular, 469
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 4
Laser Competencies Provides appropriate education to the patient undergoing laser therapy.
Assesses the patient’s educational needs. Provides preoperative instruction. Provides intraoperative explanations. Provides postoperative teaching that summarizes pain, dressings, medications, precautions, complications, follow-up requirements. Reviews the patient’s understanding of instructions. Documents all patient teaching.
Table 5
Laser Competencies Documents that safe and appropriate care is given to the patient undergoing laser therapy.
Documents type of procedure performed, types of lasers used. Lists laser powerhime settings, laser start/stop times. Documents patient’s condition for each operative stage, records vital signs. Documents anesthesia type. Checks administered medications. Records intravenous fluids, blood placement. Completes the laser log per policy guidelines.
470
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
urology, dermatology). It is important that each component of the competency statement be validated by clinical experts. Establishing thresholds for each level of competency may be as simple or as complex as necessary to ensure safe patient care. As few as three levels may be developed; criteria for measuring competency levels for the laser nurse may be minimally competent-adheres to care standards with assistanceiguidance, competent-independently complies with the care standards throughout each operative stage/demonstrates trouble shooting abilities for the use and storage of laser equipment/identifies need for biomedical intervention, and advanced competency-reviews and monitors care standards/establishes and updates standards as needediprovides and monitors educational needs of the OR staffiis proactive during each operative stage/anticipates identifying and resolving potential and actual problems. Staff members attain each level of competency independent of other staff members. Theoretically, this process allows every perioperative nurse the opportunity to achieve the advanced competency level. Clinical specialists, educators, or an assigned preceptor should evaluate each level of competency.
Conclusions
A
dvancing technology requires that surgical nurses meet new challenges by updating their knowledge bases. Continuing education must be encouraged to attain and maintain the expertise required of this surgical subspecialty. The advantages of a competency-based approach to measuring proficiency include increased safety, shorter hospital stays, decreased morbidity, fewer readmissions due to complications for patients, and reduced costs for the OR. Each nurse also may experience an increased level of self-satisfaction as his or her clinical experience is acknowledged officially. Measuring competency levels and identifying
staff members’ learning needs and practice issues may identify topics worthy of further nursing research. As laser technology advances, the perioperative nurse must be prepared to assume greater accountability and responsibili0 ty to ensure safe practice.’ Notes 1. Joint Commission on Accreditation of Healthcare Organizations, AMHI92 Accreditation Manual for Hospitals (Oakbrook Terrace, 111: Joint Commission on Accreditation of Healthcare Organizations, 1991) 80. 2. J C Alspach, “Designing a competency-based orientation for critical care nurses,” Heart & Lung 13 (November 1984) 665-62; J C del Bueno, “Competency based education,” Nurse Educator 3 (May/June 1978) 10-14; K J Peterson, “Competency-based orientation program for a cardiovascular surgery unit - part I,”Critical Care Nurse 11 (February 1991) 32-33,42-44;S L Stewart, J M Vitello-Cicciu, “Designing a competency-based orientation program for the care of cardiac surgical patients,” Journal of Cardiovascular Nursing 3 (May 1989) 31-34.
AORN Discontinues Use of Annual Transcripts In August 1994, AORN will stop sending annual transcripts, which indicate individual contact hours, to people who attend continuing education seminars. AORN is doing this because the transcripts, unlike certificates of attendance, are unofficial. Certificates of attendance with the accreditation statement are the official documents that prove seminar participation. Course participants should keep all their certificates of attendance as documentation for certification or licensure purposes.
471
-
AORN JOURNAL
Developing Laser Competencies A PROCESS TO ENSURE SAFE PRACTICE Caroline Buszta, RN; Brenda S. Sovero, RN ince 1960, when the first laser used in a health care setting was developed, lasers have had a positive effect on nursing. Today, laser nursing, one of the newest and fastest growing departments in the OR, is a subspecialty of perioperative nursing that demands technologically safe and appropriate practice. The development of the prospective payment system based on diagnosis related groups in 1983 and the fact that laser technology reduces patients' hospital stays have contributed to the popularity of lasers in the OR. As a result, the types of lasers available and the possible surgical applications still are increasing. Although lasers are successful operating tools, they also are potentially dangerous. Laser plume can be hazardous, and lasers increase the risk of fire in the OR and the risk of eye damage. Consequently, nurses must ensure the proper use of lasers and exercise precautions to protect patients and staff members. This process requires continuous education. The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) now mandates that competency of nurses who provide care in the surgical settings is verified, and hospitals are expected to document the competency levels of their health care providers.' Therefore, OR nurse managers must review and record competency levels of their staff members. Competency documentation has been a major aspect of vocational training for years. The educational literature has several publications that feature competency-based education in specialized care units such as critical care, psychiatry, and cardiovascular surgery.2 This article addresses the development of competencies for laser nursing.
Caroline Buszta, RN, MSN, CNA, CS, C , is clinical coordinator at the Department of Veterans Affairs, Brecksville, Ohio. She received her associate of applied science degree in nursing from Tri C West, Parma, Ohio, her bachelor of arts degree in social science from Ursuline College, Pepper Pike, Ohio, and her master of science degree in nursing f r o m Case W e ste rn Re se rv e , Cleveland.
Brenda S. Sovero, RN, MPA, is nurse manager of the OR and postanesthesia care unit at Veterans Affairs Medical Center, Cleveland. She received her bachelor of science degree in psychology f r o m Mount Union College, Alliance, Ohio, her bachelor of science degree in nursing f r o m Case Western Reserve University, Cleveland, and her master of science degree in public administration from Cleveland State University.
S
Competency Development Program
C
reating and implementing a program to monitor and support the documentation/evaluation process is labor intensive and costly. Developing workable and meaningful competency statements requires
467
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 1
Laser Knowledge Demonstrates an understanding of types, uses, and biophysical aspects of laser therapy.
Describes the basic biophysics of laser technology. Identifies the types of lasers used. Identifies the appropriate laser for each procedure. Identifies safety issues relevant to each type of laser. Lists the benefits of laser therapy. Lists the safety measures for patients undergoing laser therapy. Lists the safety measures for staff members during laser therapy.
Table 2
Equipment Set Up Sets up equipment properly to ensure safe care to the patient undergoing laser therapy.
Reviews policies, procedures for laser use. Sets up, takes down equipment per manual instructions. Assesses conditions of attachments. Calibrates equipment. Verifies laser beam alignment. Checks for biomedical engineering seal of safety. Maintains equipment as appropriate.
468
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 3
Safety Provides safe care to the patient undergoing laser therapy.
Identifies potential hazards with every laser procedure. Ensures that equipment is operating properly. Monitors window coverings, posts warning signs. Removes potentially flammable, combustible supplies. Checks fire extinguisher to ensure it functions. Prepares the surgical field considering the reflective equipment, the risk of fire. Provides protective eye wear for patients, staff members. Complies with safety measures for laser plume, laser masks, smoke evacuation. Ensures safe ventilation for patient, staff members.
communication, clinical, and administrative skills. One also must gain staff members’ support to ensure cooperation during the implementation phase of the program. Those charged with creating a competency program must identify and select staff nurses who demonstrate clinical excellence so that they may function as preceptors or mentors for those seeking competence verification. Program planners also must write detailed policies and procedures that include topics such as the levels of competency, qualifications for each level of competency, frequency of measuring competency, record keeping, and administrative details. The first step in creating a competency program is to have nursing staff members write and implement care standards specific to the use of lasers. Based on the nurses’ recommendations, competency statements and quality
improvement/quality assurance monitors may be established.
Competency Format
C
are standards and competency statements should address no less than five basic domains for laser therapy (eg, laser knowledge, equipment set up, safety, patient education, documentation). The nurses who develop the laser therapy care standards can establish each domain’s basic criteria based on their hospital’s policies and procedures. Examples of nonspecific basic criteria for each domain are detailed in Tables 1, 2, 3, 4, and 5. After the basic competency statements are completed, specialty-specific statements may be developed. The criteria for each domain may be individualized for each specialty (eg, vascular, 469
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
Table 4
Laser Competencies Provides appropriate education to the patient undergoing laser therapy.
Assesses the patient’s educational needs. Provides preoperative instruction. Provides intraoperative explanations. Provides postoperative teaching that summarizes pain, dressings, medications, precautions, complications, follow-up requirements. Reviews the patient’s understanding of instructions. Documents all patient teaching.
Table 5
Laser Competencies Documents that safe and appropriate care is given to the patient undergoing laser therapy.
Documents type of procedure performed, types of lasers used. Lists laser powerhime settings, laser start/stop times. Documents patient’s condition for each operative stage, records vital signs. Documents anesthesia type. Checks administered medications. Records intravenous fluids, blood placement. Completes the laser log per policy guidelines.
470
AORN JOURNAL
FEBRUARY 1994, VOL 59, NO 2
urology, dermatology). It is important that each component of the competency statement be validated by clinical experts. Establishing thresholds for each level of competency may be as simple or as complex as necessary to ensure safe patient care. As few as three levels may be developed; criteria for measuring competency levels for the laser nurse may be minimally competent-adheres to care standards with assistanceiguidance, competent-independently complies with the care standards throughout each operative stage/demonstrates trouble shooting abilities for the use and storage of laser equipment/identifies need for biomedical intervention, and advanced competency-reviews and monitors care standards/establishes and updates standards as needediprovides and monitors educational needs of the OR staffiis proactive during each operative stage/anticipates identifying and resolving potential and actual problems. Staff members attain each level of competency independent of other staff members. Theoretically, this process allows every perioperative nurse the opportunity to achieve the advanced competency level. Clinical specialists, educators, or an assigned preceptor should evaluate each level of competency.
Conclusions
A
dvancing technology requires that surgical nurses meet new challenges by updating their knowledge bases. Continuing education must be encouraged to attain and maintain the expertise required of this surgical subspecialty. The advantages of a competency-based approach to measuring proficiency include increased safety, shorter hospital stays, decreased morbidity, fewer readmissions due to complications for patients, and reduced costs for the OR. Each nurse also may experience an increased level of self-satisfaction as his or her clinical experience is acknowledged officially. Measuring competency levels and identifying
staff members’ learning needs and practice issues may identify topics worthy of further nursing research. As laser technology advances, the perioperative nurse must be prepared to assume greater accountability and responsibili0 ty to ensure safe practice.’ Notes 1. Joint Commission on Accreditation of Healthcare Organizations, AMHI92 Accreditation Manual for Hospitals (Oakbrook Terrace, 111: Joint Commission on Accreditation of Healthcare Organizations, 1991) 80. 2. J C Alspach, “Designing a competency-based orientation for critical care nurses,” Heart & Lung 13 (November 1984) 665-62; J C del Bueno, “Competency based education,” Nurse Educator 3 (May/June 1978) 10-14; K J Peterson, “Competency-based orientation program for a cardiovascular surgery unit - part I,”Critical Care Nurse 11 (February 1991) 32-33,42-44;S L Stewart, J M Vitello-Cicciu, “Designing a competency-based orientation program for the care of cardiac surgical patients,” Journal of Cardiovascular Nursing 3 (May 1989) 31-34.
AORN Discontinues Use of Annual Transcripts In August 1994, AORN will stop sending annual transcripts, which indicate individual contact hours, to people who attend continuing education seminars. AORN is doing this because the transcripts, unlike certificates of attendance, are unofficial. Certificates of attendance with the accreditation statement are the official documents that prove seminar participation. Course participants should keep all their certificates of attendance as documentation for certification or licensure purposes.
471