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What can students learn in the OR?
What can students learn in the OR? Nursing students usually see patients on the surgical units preoperatively and postoperatively, but often they have no opportunity to learn what happens to the patient in the operating room. That is the missing link. The intraoperative experience is the piece that is missing from their education. The lack of intraoperative experience for nursing students has been a long-time concern of AORN. One reason is self-serving. If student nurses have no opportunity to learn about operating room nursing, they are not likely to select it as an area to practice in after graduation. The result is a lack of operating room nurses. Educators may be sympathetic, but they are concerned with educating generalists, not specialists for a specific area. Moreover, they have seen operating room nursing as technical rather than professional nursing. The development of the perioperative role has given OR nurses a new selling point. Here is strong evidence that OR nursing is more than handling instruments. Based on the nursing process, the perioperative role covers nursing activities in all three phases of the patient's surgical experience-the preoperative, intraoperative, and postoperative periods. The perioperative role is causing educators to take a second look at OR nursing. To give educators an opportunity to learn about perioperative nursing and to find out more about how educators see OR nursing, AORN has held two conferences for deans and faculty members. The first, in June 1979,
was for a selected group of deans. Based on these discusssions, a second, larger conference was held in June 1980. This conference included faculty members as well as deans, since faculty determine the curriculum. From the two conferences, a critical question emerged: How can perioperative nursing achieve general curriculum goals? What can students learn in the OR, not about OR nursing specifically, but knowledge that can be applied to nursing in general? This Journal looks at that question. It includes some of the material from the June Invitational Conference of Nurse Educators. As did the conference, this issue looks at the benefits of perioperative nursing to the student, to the nursing curriculum, and to the patient. If there was one surprise at the conference, it was the strong and enthusiastic support of so many of the deans and faculty members. Hoping to convert many to the cause, AORN was delighted to discover that many already were, as one dean put it, "true believers." The articles in this Journal reflect the perspectives of both educators and OR nurses. In an Opinions column, both respond to one of the problems brought up at the conference. "They simply drop the students at our door," complained an OR nurse. "The OR staff makes us feel anything but welcome," retorted an educator. Nurse educators feel uncomfortable in the operating room, an area in which they are often unskilled. On the other side, OR nurses have not always gone out of their way to accommodate students or faculty. The double doors have been a psychological as well as a physical barrier. We asked the OR nurses and the educators to suggest some ways to bridge this barrier.
AORN Journal, Nouember 1980, V o l 3 2 , N o Fi
755
Many chapter and individual members have expressed interest in “doing something” about getting students back in the OR. But they weren’t quite sure what to do. To give them some help, the National Committee on Education developed Project Alpha, guidelines for chapters to use in reaching schools of nursing in their community. A summary of Project Alpha is included in the Journal, and Phyllis Wells, RN, describes the success of the Wilmington, Del, chapter in implementing such a project. It can be done. For those of you whose minds are boggled by the very thought of nursing theories and conceptual models, Julia A Kneedler, RN, AORN assistant director of education, offers in
the education column a brief introduction to what these terms mean. She discusses how the perioperative role fits into current nursing theories. We hope this issue will be used by nurse educators and practicing nurses who are interested in including a perioperative experience for nursing students. It should provide some ideas, some thought-provoking comments, and some how-to-do its. It also gives a new perspective on the question, “What can they learn in the OR”?
Elinor S Schrader Editor
Pacemaker insertions: Are they a// needed? Are unnecessary pacemaker insertions becoming routine? A dramatic leap in the number of demand pacemakers implanted at Brooklyn (NY) Hospital led a group of physicians there to form a committee to review all pacemaker implantations. In the two years following formation of the committee, the rate of pacemaker insertions dropped by more than one half, even though total hospital admissions grew. Howard S Friedman, MD, chief of cardiology at the hospital, described the effects of the committee’s review at the recent meeting of the American Federation for Clinical Research in Washington, DC. According to a news story in the June 20 Journal of the American Medical Association, the physicians became concerned when they realized the number of demand pacemaker implantations at the hospital had increased by 600% between 1972 and 1976, from 8 to 48 per year. During that time, hospital admissions and admissions to the critical care unit increased by less than 15%. A related report in the June 9 Medical World News quoted Friedman as saying he set up a committee of four cardiologists and a cardiovascular surgeon to review the circumstances under which new pacemakers were being installed. “In no instance did we interfere in the decision to
756
put one in,” he said. In addition to its review of cases, the committee also distributed a list of what it considered legitimate indications for pacemaker insertion. The influence of the committee appears to have been impressive: In the next two years, insertions fell from 48 to 22. Friedman said the review process led to improved patient selection for such procedures. According to the JAMA report, before the committee was set up, 30 patients received pacemakers while they were taking medication that might have contributed to their bradycardia. During the review period, only eight such patients received pacemakers. The number of pacemakers inserted because of complete heart block was not affected by the review, but there was almost a 50% reduction in implantation for sick sinus syndrome and an 84% reduction in insertions for intraventricular conduction defects. The financial impact of cutting down on unnecessary pacemaker implantations through such a review process could be great. Using a total first-year cost for pacemaker implantation of approximately $5,000, Friedman said several hundred million dollars per year might be saved.
AORN Journal, November 1980, V o l 3 2 , N o 5
was for a selected group of deans. Based on these discusssions, a second, larger conference was held in June 1980. This conference included faculty members as well as deans, since faculty determine the curriculum. From the two conferences, a critical question emerged: How can perioperative nursing achieve general curriculum goals? What can students learn in the OR, not about OR nursing specifically, but knowledge that can be applied to nursing in general? This Journal looks at that question. It includes some of the material from the June Invitational Conference of Nurse Educators. As did the conference, this issue looks at the benefits of perioperative nursing to the student, to the nursing curriculum, and to the patient. If there was one surprise at the conference, it was the strong and enthusiastic support of so many of the deans and faculty members. Hoping to convert many to the cause, AORN was delighted to discover that many already were, as one dean put it, "true believers." The articles in this Journal reflect the perspectives of both educators and OR nurses. In an Opinions column, both respond to one of the problems brought up at the conference. "They simply drop the students at our door," complained an OR nurse. "The OR staff makes us feel anything but welcome," retorted an educator. Nurse educators feel uncomfortable in the operating room, an area in which they are often unskilled. On the other side, OR nurses have not always gone out of their way to accommodate students or faculty. The double doors have been a psychological as well as a physical barrier. We asked the OR nurses and the educators to suggest some ways to bridge this barrier.
AORN Journal, Nouember 1980, V o l 3 2 , N o Fi
755
Many chapter and individual members have expressed interest in “doing something” about getting students back in the OR. But they weren’t quite sure what to do. To give them some help, the National Committee on Education developed Project Alpha, guidelines for chapters to use in reaching schools of nursing in their community. A summary of Project Alpha is included in the Journal, and Phyllis Wells, RN, describes the success of the Wilmington, Del, chapter in implementing such a project. It can be done. For those of you whose minds are boggled by the very thought of nursing theories and conceptual models, Julia A Kneedler, RN, AORN assistant director of education, offers in
the education column a brief introduction to what these terms mean. She discusses how the perioperative role fits into current nursing theories. We hope this issue will be used by nurse educators and practicing nurses who are interested in including a perioperative experience for nursing students. It should provide some ideas, some thought-provoking comments, and some how-to-do its. It also gives a new perspective on the question, “What can they learn in the OR”?
Elinor S Schrader Editor
Pacemaker insertions: Are they a// needed? Are unnecessary pacemaker insertions becoming routine? A dramatic leap in the number of demand pacemakers implanted at Brooklyn (NY) Hospital led a group of physicians there to form a committee to review all pacemaker implantations. In the two years following formation of the committee, the rate of pacemaker insertions dropped by more than one half, even though total hospital admissions grew. Howard S Friedman, MD, chief of cardiology at the hospital, described the effects of the committee’s review at the recent meeting of the American Federation for Clinical Research in Washington, DC. According to a news story in the June 20 Journal of the American Medical Association, the physicians became concerned when they realized the number of demand pacemaker implantations at the hospital had increased by 600% between 1972 and 1976, from 8 to 48 per year. During that time, hospital admissions and admissions to the critical care unit increased by less than 15%. A related report in the June 9 Medical World News quoted Friedman as saying he set up a committee of four cardiologists and a cardiovascular surgeon to review the circumstances under which new pacemakers were being installed. “In no instance did we interfere in the decision to
756
put one in,” he said. In addition to its review of cases, the committee also distributed a list of what it considered legitimate indications for pacemaker insertion. The influence of the committee appears to have been impressive: In the next two years, insertions fell from 48 to 22. Friedman said the review process led to improved patient selection for such procedures. According to the JAMA report, before the committee was set up, 30 patients received pacemakers while they were taking medication that might have contributed to their bradycardia. During the review period, only eight such patients received pacemakers. The number of pacemakers inserted because of complete heart block was not affected by the review, but there was almost a 50% reduction in implantation for sick sinus syndrome and an 84% reduction in insertions for intraventricular conduction defects. The financial impact of cutting down on unnecessary pacemaker implantations through such a review process could be great. Using a total first-year cost for pacemaker implantation of approximately $5,000, Friedman said several hundred million dollars per year might be saved.
AORN Journal, November 1980, V o l 3 2 , N o 5