- Email: [email protected]
Competency-Based Education
AORN JOURNAL
-~_____
FEBKUARY 1987. VOL. 45. NO 2
Competency-Based Education ITS IMPLEMENTATION IN THE OR
Diane C. Schmaus, RN
I
n this era of costcontainment, budget cuts, and staff layoffs, it is becoming more difficult for the OR educator to validate and retain his or her position. One way the OR educator can prove to administratorsthat his or her position is necessary and cost-effective is by implementing competency-basededucation for staff development and orientation. The increasing complexities involved in working in the OR pose difficulties for the seasoned perioperative nurse as well as the beginning practitioner. It has been estimated that the turnover rate for nurses in critical care areas, including the OR, ranges from 18%to 35% a year.' The expense of orienting and developing a new OR nurse is estimated to be $8,000 to $12,000 per nurse? A great portion of this expense is attributed to the number of hours new recruits spend in classrooms with an instr~ctor.~ If the number of classroom hours could be shortened during orientation while achieving the same results, the cost of orientation could be reduced. If staff development programs could meet the need-to-know rather than the nice-to-know
needs of the staff, the staff members would be more competent to complete their assignments. Also, expenses associated with knowledge deficits (ie, care and handling of expensive equipment) would be reduced.
Basic Concepts
C
ompetency-based (performance-based) education originated in adult education theory. Therefore, when designing a competency-based program, the educator should consider the following four primary assumptions that exist about adult learners: Adult learners view themselves as selfdirected and responsible for their learning. They will learn at different rates, depending on their perceived need-to-know. Adults have accumulated a vast wealth of knowledge that can be used as a learning resource. Because adults attach more meaning to what they learn from experience than what they learn passively, experiential learning techniques should be used.
Diane C.schmaus, RN,MS,fi the AORN nurse system anabst and was an AORN continuing education specialist when this article was written. She received her nursing diploma from Piedmont Hospital School of Nursing, Atlanta; her bachelor of science degree in nursing from Armstrong College, Savannah, GG and her master of science degree in nursing administration from the University of Hawaii, Honolulu.
FEBRbAKY 1987. VOL. 4.5. NO 2 _____
_____--
-__
AORN JOURNAL
Differences in Educational Methods Traditional
Cornpetency-based
Teacher
decides what the learner needs to know, how he or she will learn, and at what pace
presents material based on learner’s identified needs
Learner
assumes passive role
assumes active role; identities learning needs, how he or she can best learn, and at what pace; takes initiative and responsibility for learning
Focus
on the subject; learning is removed from where application will occur
on learning outcomes; learning takes place in the work environment
I I
3. Adults are motivated to learn when they realize the experience will help them with real-life tasks or problems. Information given to them should be need-to-know rather than nice-to-know. 4. Adult learners view education as a lifelong process that will help them achieve their full potential. Knowledge gained needs to be immediately applicable to the situation at hand. Learning is viewed as performancebased rather than subject-centered. Traditional education methods are instructorbased: the instructor decides what the learner needs to know, how learning will take place, and at what pace. Usually, learning takes place via lectures in a place that is removed from where the application of knowledge will occur. Also, traditional learning is subject-centered. Rather than being instructor-centered, competency-based education is self-directed. The learner identifies his or her own learning needs and how that education will best be obtained. The focus of the competency-based education process is on learning outcomes. The learner advances at his or her own pace, and takes the initiative and responsibility for meeting the educational outcomes. These outcomes are directly applicable to job performance, and the learning
often takes place within the work setting. (See “Differences in Educational Methods.”) The O R educator can structure competencybased education by developing learning modules, which can be kept in individual notebooks for staff members. Each staff member can then demonstrate acquisition of a new skill to the head nurse, educator, or supervisor. After the O R educator develops the module, he or she is free to develop more modules or to give individualized instruction. Thus,the OR educator’s time is more wisely and economically spent. Modules also allow staff members to verify learning at their own pace, rather than spending an hour in a formal in-service education session that may not address their needs. Formal in-service sessions will be necessary from time to time, though, for topics that need discussion or problemsolving. Learning modules are best adapted to situations that require individual instruction time, programs that are repeated, or orientation.
Getting Started. A Needs Assessment
T
he first step in forming a learning module is a needs assessment. An assessment will identify immediate learning needs, validate 475
AORN JOURNAL
FEBRUARY 1987. VOL. 45. N O 2
Table 1
Perwperative Nursing Skills Checklist
I Experience
~
Circulating: Procedure
None
Some/ Need Review
Experienced/ No Review
Could Teach
Abdominal hysterectomy Abdominoperineal resection Amputation Anterior-posterior repair Arthroscopy Arthrotomy Breast biopsy Blepharoplasty Bunionectomy Burr holes Bypass: femoral-popliteal gastric Caldwell-Luc antrostomy Carotid endarterectomy Carpal tunnel release Cataract extraction previously identified needs, and identify performance expectations for various positions within the OR. The educator should start by asking the staff members what information they need to perform competently on the job. As adults, it is important for them to recognize their own learning needs, rather than having someone else decide what they 416
need to know. Formats for the needs assessments may be by survey, questionnaire, individual interviews, group discussions, direct observation (ie, of incorrect aseptic technique or improper positioning), or by reviewing incident reports. A skills checklist offers an array of information in a concise manner that is easy to retrieve (Table 1).
AORN JOURNAL
Purpose Statement
T
he differences in competency-based and traditional education will emerge in the program planning. Therefore, during the program planning, the four assumptions about adult learners should be kept in mind. Program planning includes identifying learning needs and developing a purpose for the program (ie, why it is necessary for a learner to complete the module). Purposes may include job requirements, safety reasons, or improving patient care. The purpose statement should be stated in a few sentences. It will be a focus for developing the learner objectives. The purpose should state: what the offering is about, why it is being offered, and for whom (target audience) the offering has been designed. If, for example, patients in your OR are experiencing ulnar nerve damage postoperatively from improper positioning techniques, you have identified a learning need. This need could have been identified through postoperative patient assessments, quality assurance/risk management reports, physician comments, or by observing incorrect positioning techniques. You may then decide to design a module on correct positioning techniques. The purpose statement may read: This learning module is an introductionfor the perioperative nurse orientee and a refresher for the experienced perioperative nurse (whom) to basic principles in positioning and how they appb to the patient in the OR (what). All nurses in the OR should recognize the importance of positioning in relation to patient safety and legal liability of the hospital and OR team (why).
Writing Objectives
FEBRUARY 1987. VOL. 45. NO 2
number of objectives will depend on content and time needed to complete the program. The educator should not offer more objectives than the participant will have time to master. Objectives for the purpose statement for a positioning module may be: At the completion of this module, the nurse will be able to: I. Demonstrate the following patient positions according to the written procedures: supine, Trendelenburg,sitting, and lithotomy. 2. Identifv the peripheral nerves of the upper extremity. 3. Locate the peripheral nerves of the a m
Content Development
C
ontent is developed from the objectives. The educator should base the content on need-to-know information that is directly related to the objectives. Mastery of the content validates competency. Because most learners will have only small amounts of time to devote to learning or reviewing a procedure or skill, the content should be concise and to the point. The educator should organize the content so that the learner can skim over material he or she already knows and concentrate on the new material. Many educators use an outline for content development. Content for the positioning module might include the policies and procedures for positioning patients because they were identified in the objectives. Also included might be neuroanatomy and physiology of the arm. Nerves of the leg should not be included unless there is an objective to validate that content. The OR educator will consider the audience in determining how much detail the module will contain. If inexperienced RNs will be using the module, more detail will be needed than if the module is used as a refresher for experienced perioperative nurses.
W
hen formulating objectives, the educator decides what the learner should be able to do after completing the learning module. These outcomes become the objectives for the program. Objectives should be stated in behavioral terms and based on standards of performance or standards of patient care.5 The 478
Teaching Methods and Materiah
T
he module may consist of a variety of learning materials. Because adults learn better from experience, learning techniques
A O R N JOURNAL F E U K L A K k 19x7 VOL 35. NO 2
may include presentation of case studies, short lectures with demonstrations/return demonstrations, simulation or training laboratories, or small group discussions. The educator should actively involve the learner in the learning process. Short lectures may be tape-recorded or typed so that information given to each learner is consistent. This also frees the educator from delivering the same lecture two or three times, which also contributes to cost containment. Photographs can be taken of how to assemble, operate, trouble-shoot, and clean new instruments. These could be used as a quick reference, particularly for power equipment or microscopes that are used infrequently by some staff members. For the module on positioning, the educator could include pictures of proper and improper techniques, and then have the learners identify what is wrong with the picture. The educator can also show anatomical charts of nerves and the positioning techniques that can be used to prevent trauma to those nerves. The educator should investigate resources in the hospital. A staff member may have written a paper on some aspect of perioperative nursing that would be beneficial in a learning module. Or, a staff member might be an expert on a particular topic, and he or she might like to assist in developing a module. Including staff members in educational programs gives them recognition among their peers and helps raise morale. The educator should search for available books or periodicals and try to borrow audiovisual equipment through the hospital education department or other hospital libraries in the area. Films are loaned by many libraries. The educator should also talk with other educators in the area and form a network. There may be many sources of expertise that are not being tapped. Also, small group discussions can be used to reinforce learning after several people have completed the module.
Writing Module Instructions
A
s the content is developed, instructions must also be developed to assist the learner. Instructions should be direct and
self-explanatory because the educator may not be immediately available to answer questions. Instructions for the sample positioning module might include the following. Directions: Read the policy and procedure for positioning patients in the supine position. (Have these materials available so the learner can refer to them.) Read the article, “Proper positioning to prevent ulnar nerve damage” by Mary Jones, RN. (Have the article immediately available.) Study the figure in drawing #3. Answer the following questions. After completing the questions, compare your answers to those provided in the “Learner feedback” section of this module. Learner Activity: Please answer the following questions on the paper provided. What are the pressure areas associated with the supine position? What precautions should be taken to minimize pressure at each of these areas?
Learner Feedback
L
earner feedback helps the learner to assess how well he or she answered the questions. In this section, the educator should include all possible answers; a rating scale may also be included. For example, if the learner identfied four out of five pressure areas, the module does not have to be reviewed again for six months. If the learner has difficulty identifyingat least three areas, the information under “Section one” should be reviewed again. Suggestions for further reading can also be given. Learners should have the option to complete the module as many times as necessary to master the information. The educator may also ask orientees to submit written answers for formal evaluation. Learners should be given every opportunity to have a successful outcome. After the module has been completed, nurses may be observed for demonstration of competency. (See Table 2 for an example of a competency checklist.) 479
AORN J O U R N A L
Table 2
Perioperative Nursing Competency Checklist ~~ ~~
~
Circulating: Patient Positioning
Observed
Not
Date/
Observed
Initials
I. Supine A. patient transferred to O R bed safely B. safety belt placed at least 2 inches above knee C. arms positioned 1. on armboards a. abducted 90-degrees b. no pressure on olecranon process c. palms up d. secured in place 2. at sides a. no pressure on bony prominences (1) olecranon process (2) styloid processes b. palms down or facing patient c. secured in place D. bony prominences checked for pressure 1. occiput 2. spinous processes 3. scapulae 4. medial and lateral epicondyles of humerus 5. olecranon process 6. styloid processes 7. sacral promontory 8. calcaneus
Evaluation and Benefits
A
fter the educator completes the module, he or she should give it to a learner as a pilot test. This learner's feedback can be used to improve the module. After the module has been tested, the educator implements it. Learning modules may meet with resistance at first, simply because they are new, but the educator should try to educate the staff on its advantages. Once the benefits are realized, new modules will meet with acceptance and gain popularity. Completion of the learning modules should be recorded and placed in the employees personnel file or entered into a computer system for recording staff development and credentialing such as the
AORN O R Credentialing'" software. Successful completion is equivalent to mastering the objectives that document competency for practice. And documentation of competency is becoming more important as nurses are named in litigation, and as they prove their worth in providing quality patient care in the operating room.
Summary
B
ecause the amount of time that an educator can spend educating staff is slowly being taken away in the name of cost containment, the time that is left is valuable. For many educators, this may be only a few minutes a day or week. Making the most effective use 481
AORN J O U R N A L
of that time is essential. Devising programs that meet the need-to-know rather than nice-to-know learning needs of staff members contributes to staff competency and thereby to quality patient care, and does so in a cost-effective manner. 0
FEBRUARY 1987, VOL. 45, NO 2
The cost-effective alternative,” Nurse Educator 6 (September/October 1981) 12. Suggested reading Bergsma, S; Martin, S; Bergsma, L. “Make your in-
service education department revenue producing.” HosptaZ Topics 63 (November/December 1985)
Notes 1. D del Bueno, “New venture: Boosting staff performance,” Aspen’s Adviror for Nurse Executives
1 (December 1985) 6. 2. Zbid 3. D del Bueno, F Barker, C Christmyer, “Implementing a competency-based orientation program,” Nurse Educator 5 (May-June 1980) 19; C K b i t e r , M R Kearney, R Fell, “Competency-based orientation: An idea that works,” Journal of Nursing Staff Development 1 (Summer 1985) 70. 4. M Knowles, The Modern Practice of Adult Educatiorc Andragogy Versus Pedagogy (New York City: Association Press,1970) 37-55. 5. C Boyer, “Performance-based staff development:
10-15.
Brunt, B; Scott, A. “Factors to consider in the development of self-instructional materials.” Journal of Continuing Education in Nursing 17 (May/June 1986) 87-93. Cooper, S. “Self-directed learning.” Journal of Continuing Education in Nursing 17 (May/June 1986) 104. Daniels, L. “Transfer of new skillsfrom classroom setting to the work place: Whose responsibility is it?” Hospital Topics 64 (January/February 1986) 2736. Mast, M Van Atta, M. “Applying adult learning principles in instructional module design,” Nurse Educator 1 1 (January/February 1986) 35-39.
Skin Cryopreservation Technique Simplified Researchers at Yale University School of Medicine, New Haven, Conn, are developing a simple and economical method for cryopreservation of skin. This study was reported at the 72nd annual American College of Surgeons Clinical Congress Oct 19 to 24. The technique involves incubating human donor skin strips for one hour at 4 OC (39.2 O F ) in a balanced electrolyte and salt solution. For the study, 0.015-inch strips were rolled in a jellyroll fashion or folded in a fanlike manner and packaged separately. The packages were placed upright in the slots of a perforated stainless steel carousel, and that was placed in a mechanical freezer that had been cooled to -72 “C (-161.6 OF). After being equilibrated overnight, the skin samples were transferred to liquid nitrogen for storage. The samples were later thawed in their packets by immersion and agitation under 20 “C (68 OF) running water. In comparing the folded skin and the rolled skin, researchers found that less damage had occurred to the folded skin 482
because the cooling rate was more predictable and uniform. The folded skin samples also remained alive after being kept in frozen storage for as long as eight months. Keratinocytes, the major cell type in epidermis, and adenosine triphosphate, which exists only in nonliving systems, were detected on the folded skin. When the skin was used as a graft, the patient accepted it. This study contradicts the belief that the rate of freezing had to be precisely controlled (ie, a freezing rate of 1 “C [33.8 O F ] per minute from room temperature down to -70 “C [-158 OF]) which makes cryopreserved skin expensive to prepare.
-~_____
FEBKUARY 1987. VOL. 45. NO 2
Competency-Based Education ITS IMPLEMENTATION IN THE OR
Diane C. Schmaus, RN
I
n this era of costcontainment, budget cuts, and staff layoffs, it is becoming more difficult for the OR educator to validate and retain his or her position. One way the OR educator can prove to administratorsthat his or her position is necessary and cost-effective is by implementing competency-basededucation for staff development and orientation. The increasing complexities involved in working in the OR pose difficulties for the seasoned perioperative nurse as well as the beginning practitioner. It has been estimated that the turnover rate for nurses in critical care areas, including the OR, ranges from 18%to 35% a year.' The expense of orienting and developing a new OR nurse is estimated to be $8,000 to $12,000 per nurse? A great portion of this expense is attributed to the number of hours new recruits spend in classrooms with an instr~ctor.~ If the number of classroom hours could be shortened during orientation while achieving the same results, the cost of orientation could be reduced. If staff development programs could meet the need-to-know rather than the nice-to-know
needs of the staff, the staff members would be more competent to complete their assignments. Also, expenses associated with knowledge deficits (ie, care and handling of expensive equipment) would be reduced.
Basic Concepts
C
ompetency-based (performance-based) education originated in adult education theory. Therefore, when designing a competency-based program, the educator should consider the following four primary assumptions that exist about adult learners: Adult learners view themselves as selfdirected and responsible for their learning. They will learn at different rates, depending on their perceived need-to-know. Adults have accumulated a vast wealth of knowledge that can be used as a learning resource. Because adults attach more meaning to what they learn from experience than what they learn passively, experiential learning techniques should be used.
Diane C.schmaus, RN,MS,fi the AORN nurse system anabst and was an AORN continuing education specialist when this article was written. She received her nursing diploma from Piedmont Hospital School of Nursing, Atlanta; her bachelor of science degree in nursing from Armstrong College, Savannah, GG and her master of science degree in nursing administration from the University of Hawaii, Honolulu.
FEBRbAKY 1987. VOL. 4.5. NO 2 _____
_____--
-__
AORN JOURNAL
Differences in Educational Methods Traditional
Cornpetency-based
Teacher
decides what the learner needs to know, how he or she will learn, and at what pace
presents material based on learner’s identified needs
Learner
assumes passive role
assumes active role; identities learning needs, how he or she can best learn, and at what pace; takes initiative and responsibility for learning
Focus
on the subject; learning is removed from where application will occur
on learning outcomes; learning takes place in the work environment
I I
3. Adults are motivated to learn when they realize the experience will help them with real-life tasks or problems. Information given to them should be need-to-know rather than nice-to-know. 4. Adult learners view education as a lifelong process that will help them achieve their full potential. Knowledge gained needs to be immediately applicable to the situation at hand. Learning is viewed as performancebased rather than subject-centered. Traditional education methods are instructorbased: the instructor decides what the learner needs to know, how learning will take place, and at what pace. Usually, learning takes place via lectures in a place that is removed from where the application of knowledge will occur. Also, traditional learning is subject-centered. Rather than being instructor-centered, competency-based education is self-directed. The learner identifies his or her own learning needs and how that education will best be obtained. The focus of the competency-based education process is on learning outcomes. The learner advances at his or her own pace, and takes the initiative and responsibility for meeting the educational outcomes. These outcomes are directly applicable to job performance, and the learning
often takes place within the work setting. (See “Differences in Educational Methods.”) The O R educator can structure competencybased education by developing learning modules, which can be kept in individual notebooks for staff members. Each staff member can then demonstrate acquisition of a new skill to the head nurse, educator, or supervisor. After the O R educator develops the module, he or she is free to develop more modules or to give individualized instruction. Thus,the OR educator’s time is more wisely and economically spent. Modules also allow staff members to verify learning at their own pace, rather than spending an hour in a formal in-service education session that may not address their needs. Formal in-service sessions will be necessary from time to time, though, for topics that need discussion or problemsolving. Learning modules are best adapted to situations that require individual instruction time, programs that are repeated, or orientation.
Getting Started. A Needs Assessment
T
he first step in forming a learning module is a needs assessment. An assessment will identify immediate learning needs, validate 475
AORN JOURNAL
FEBRUARY 1987. VOL. 45. N O 2
Table 1
Perwperative Nursing Skills Checklist
I Experience
~
Circulating: Procedure
None
Some/ Need Review
Experienced/ No Review
Could Teach
Abdominal hysterectomy Abdominoperineal resection Amputation Anterior-posterior repair Arthroscopy Arthrotomy Breast biopsy Blepharoplasty Bunionectomy Burr holes Bypass: femoral-popliteal gastric Caldwell-Luc antrostomy Carotid endarterectomy Carpal tunnel release Cataract extraction previously identified needs, and identify performance expectations for various positions within the OR. The educator should start by asking the staff members what information they need to perform competently on the job. As adults, it is important for them to recognize their own learning needs, rather than having someone else decide what they 416
need to know. Formats for the needs assessments may be by survey, questionnaire, individual interviews, group discussions, direct observation (ie, of incorrect aseptic technique or improper positioning), or by reviewing incident reports. A skills checklist offers an array of information in a concise manner that is easy to retrieve (Table 1).
AORN JOURNAL
Purpose Statement
T
he differences in competency-based and traditional education will emerge in the program planning. Therefore, during the program planning, the four assumptions about adult learners should be kept in mind. Program planning includes identifying learning needs and developing a purpose for the program (ie, why it is necessary for a learner to complete the module). Purposes may include job requirements, safety reasons, or improving patient care. The purpose statement should be stated in a few sentences. It will be a focus for developing the learner objectives. The purpose should state: what the offering is about, why it is being offered, and for whom (target audience) the offering has been designed. If, for example, patients in your OR are experiencing ulnar nerve damage postoperatively from improper positioning techniques, you have identified a learning need. This need could have been identified through postoperative patient assessments, quality assurance/risk management reports, physician comments, or by observing incorrect positioning techniques. You may then decide to design a module on correct positioning techniques. The purpose statement may read: This learning module is an introductionfor the perioperative nurse orientee and a refresher for the experienced perioperative nurse (whom) to basic principles in positioning and how they appb to the patient in the OR (what). All nurses in the OR should recognize the importance of positioning in relation to patient safety and legal liability of the hospital and OR team (why).
Writing Objectives
FEBRUARY 1987. VOL. 45. NO 2
number of objectives will depend on content and time needed to complete the program. The educator should not offer more objectives than the participant will have time to master. Objectives for the purpose statement for a positioning module may be: At the completion of this module, the nurse will be able to: I. Demonstrate the following patient positions according to the written procedures: supine, Trendelenburg,sitting, and lithotomy. 2. Identifv the peripheral nerves of the upper extremity. 3. Locate the peripheral nerves of the a m
Content Development
C
ontent is developed from the objectives. The educator should base the content on need-to-know information that is directly related to the objectives. Mastery of the content validates competency. Because most learners will have only small amounts of time to devote to learning or reviewing a procedure or skill, the content should be concise and to the point. The educator should organize the content so that the learner can skim over material he or she already knows and concentrate on the new material. Many educators use an outline for content development. Content for the positioning module might include the policies and procedures for positioning patients because they were identified in the objectives. Also included might be neuroanatomy and physiology of the arm. Nerves of the leg should not be included unless there is an objective to validate that content. The OR educator will consider the audience in determining how much detail the module will contain. If inexperienced RNs will be using the module, more detail will be needed than if the module is used as a refresher for experienced perioperative nurses.
W
hen formulating objectives, the educator decides what the learner should be able to do after completing the learning module. These outcomes become the objectives for the program. Objectives should be stated in behavioral terms and based on standards of performance or standards of patient care.5 The 478
Teaching Methods and Materiah
T
he module may consist of a variety of learning materials. Because adults learn better from experience, learning techniques
A O R N JOURNAL F E U K L A K k 19x7 VOL 35. NO 2
may include presentation of case studies, short lectures with demonstrations/return demonstrations, simulation or training laboratories, or small group discussions. The educator should actively involve the learner in the learning process. Short lectures may be tape-recorded or typed so that information given to each learner is consistent. This also frees the educator from delivering the same lecture two or three times, which also contributes to cost containment. Photographs can be taken of how to assemble, operate, trouble-shoot, and clean new instruments. These could be used as a quick reference, particularly for power equipment or microscopes that are used infrequently by some staff members. For the module on positioning, the educator could include pictures of proper and improper techniques, and then have the learners identify what is wrong with the picture. The educator can also show anatomical charts of nerves and the positioning techniques that can be used to prevent trauma to those nerves. The educator should investigate resources in the hospital. A staff member may have written a paper on some aspect of perioperative nursing that would be beneficial in a learning module. Or, a staff member might be an expert on a particular topic, and he or she might like to assist in developing a module. Including staff members in educational programs gives them recognition among their peers and helps raise morale. The educator should search for available books or periodicals and try to borrow audiovisual equipment through the hospital education department or other hospital libraries in the area. Films are loaned by many libraries. The educator should also talk with other educators in the area and form a network. There may be many sources of expertise that are not being tapped. Also, small group discussions can be used to reinforce learning after several people have completed the module.
Writing Module Instructions
A
s the content is developed, instructions must also be developed to assist the learner. Instructions should be direct and
self-explanatory because the educator may not be immediately available to answer questions. Instructions for the sample positioning module might include the following. Directions: Read the policy and procedure for positioning patients in the supine position. (Have these materials available so the learner can refer to them.) Read the article, “Proper positioning to prevent ulnar nerve damage” by Mary Jones, RN. (Have the article immediately available.) Study the figure in drawing #3. Answer the following questions. After completing the questions, compare your answers to those provided in the “Learner feedback” section of this module. Learner Activity: Please answer the following questions on the paper provided. What are the pressure areas associated with the supine position? What precautions should be taken to minimize pressure at each of these areas?
Learner Feedback
L
earner feedback helps the learner to assess how well he or she answered the questions. In this section, the educator should include all possible answers; a rating scale may also be included. For example, if the learner identfied four out of five pressure areas, the module does not have to be reviewed again for six months. If the learner has difficulty identifyingat least three areas, the information under “Section one” should be reviewed again. Suggestions for further reading can also be given. Learners should have the option to complete the module as many times as necessary to master the information. The educator may also ask orientees to submit written answers for formal evaluation. Learners should be given every opportunity to have a successful outcome. After the module has been completed, nurses may be observed for demonstration of competency. (See Table 2 for an example of a competency checklist.) 479
AORN J O U R N A L
Table 2
Perioperative Nursing Competency Checklist ~~ ~~
~
Circulating: Patient Positioning
Observed
Not
Date/
Observed
Initials
I. Supine A. patient transferred to O R bed safely B. safety belt placed at least 2 inches above knee C. arms positioned 1. on armboards a. abducted 90-degrees b. no pressure on olecranon process c. palms up d. secured in place 2. at sides a. no pressure on bony prominences (1) olecranon process (2) styloid processes b. palms down or facing patient c. secured in place D. bony prominences checked for pressure 1. occiput 2. spinous processes 3. scapulae 4. medial and lateral epicondyles of humerus 5. olecranon process 6. styloid processes 7. sacral promontory 8. calcaneus
Evaluation and Benefits
A
fter the educator completes the module, he or she should give it to a learner as a pilot test. This learner's feedback can be used to improve the module. After the module has been tested, the educator implements it. Learning modules may meet with resistance at first, simply because they are new, but the educator should try to educate the staff on its advantages. Once the benefits are realized, new modules will meet with acceptance and gain popularity. Completion of the learning modules should be recorded and placed in the employees personnel file or entered into a computer system for recording staff development and credentialing such as the
AORN O R Credentialing'" software. Successful completion is equivalent to mastering the objectives that document competency for practice. And documentation of competency is becoming more important as nurses are named in litigation, and as they prove their worth in providing quality patient care in the operating room.
Summary
B
ecause the amount of time that an educator can spend educating staff is slowly being taken away in the name of cost containment, the time that is left is valuable. For many educators, this may be only a few minutes a day or week. Making the most effective use 481
AORN J O U R N A L
of that time is essential. Devising programs that meet the need-to-know rather than nice-to-know learning needs of staff members contributes to staff competency and thereby to quality patient care, and does so in a cost-effective manner. 0
FEBRUARY 1987, VOL. 45, NO 2
The cost-effective alternative,” Nurse Educator 6 (September/October 1981) 12. Suggested reading Bergsma, S; Martin, S; Bergsma, L. “Make your in-
service education department revenue producing.” HosptaZ Topics 63 (November/December 1985)
Notes 1. D del Bueno, “New venture: Boosting staff performance,” Aspen’s Adviror for Nurse Executives
1 (December 1985) 6. 2. Zbid 3. D del Bueno, F Barker, C Christmyer, “Implementing a competency-based orientation program,” Nurse Educator 5 (May-June 1980) 19; C K b i t e r , M R Kearney, R Fell, “Competency-based orientation: An idea that works,” Journal of Nursing Staff Development 1 (Summer 1985) 70. 4. M Knowles, The Modern Practice of Adult Educatiorc Andragogy Versus Pedagogy (New York City: Association Press,1970) 37-55. 5. C Boyer, “Performance-based staff development:
10-15.
Brunt, B; Scott, A. “Factors to consider in the development of self-instructional materials.” Journal of Continuing Education in Nursing 17 (May/June 1986) 87-93. Cooper, S. “Self-directed learning.” Journal of Continuing Education in Nursing 17 (May/June 1986) 104. Daniels, L. “Transfer of new skillsfrom classroom setting to the work place: Whose responsibility is it?” Hospital Topics 64 (January/February 1986) 2736. Mast, M Van Atta, M. “Applying adult learning principles in instructional module design,” Nurse Educator 1 1 (January/February 1986) 35-39.
Skin Cryopreservation Technique Simplified Researchers at Yale University School of Medicine, New Haven, Conn, are developing a simple and economical method for cryopreservation of skin. This study was reported at the 72nd annual American College of Surgeons Clinical Congress Oct 19 to 24. The technique involves incubating human donor skin strips for one hour at 4 OC (39.2 O F ) in a balanced electrolyte and salt solution. For the study, 0.015-inch strips were rolled in a jellyroll fashion or folded in a fanlike manner and packaged separately. The packages were placed upright in the slots of a perforated stainless steel carousel, and that was placed in a mechanical freezer that had been cooled to -72 “C (-161.6 OF). After being equilibrated overnight, the skin samples were transferred to liquid nitrogen for storage. The samples were later thawed in their packets by immersion and agitation under 20 “C (68 OF) running water. In comparing the folded skin and the rolled skin, researchers found that less damage had occurred to the folded skin 482
because the cooling rate was more predictable and uniform. The folded skin samples also remained alive after being kept in frozen storage for as long as eight months. Keratinocytes, the major cell type in epidermis, and adenosine triphosphate, which exists only in nonliving systems, were detected on the folded skin. When the skin was used as a graft, the patient accepted it. This study contradicts the belief that the rate of freezing had to be precisely controlled (ie, a freezing rate of 1 “C [33.8 O F ] per minute from room temperature down to -70 “C [-158 OF]) which makes cryopreserved skin expensive to prepare.