- Email: [email protected]
OR experience teaches continuity of care
Patricia A Hercules, RN
OR experience teaches continuity of care
t Houston Baptist University, the nursing process has always been emphasized in teaching intraoperative nursing care. With development of the Standards of Nursing Practice: OR and the perioperative role, this aspect of care has been more readily understood by both faculty and students. Now it is seen as a valuable part of the curriculum. With the standards as the foundation for student learning, the nursing process provides a structure for emphasizing continuity of care. A nursing diagnosis from the patient unit can be transferred to the operating room. Likewise, patient problems identified intraoperatively can become a basis for nursing care in other settings. The philosophy of the nursing curriculum at the university is to prepare graduates at a high level of competency for beginning positions in a variety of settings. That is, the program prepares generalists. The curriculum evolves from five major concepts: man, society, health, nursing, and the teaching-learning process. Man is seen as a unique, integrated, open system with changing biological, psychological, sociocultural, and spiritual needs. As a system, he evolves through stages of growth and development. He deserves access to a health care system that helps him reach his optimum level of wellness. Society, the framework in which man lives, contains groups with distinct ethnic origins, cultural patterns, and religious and social backgrounds. Health is man’s adaption to stress throughout his life and may have degrees of wellness and illness. Nursing is believed to be an art and science, using human creativity to perform skills based on scientific principles from physical and behavioral sciences. The practice of nursing is an interaction based on the nursing process, t o assist persons maintain or reach equilibrium. The teaching-learning process is an active, ongoing interchange among teacher, student, and c1ient.l
A
Patricia Hercules, RN
AORN Journal, November 1980, V o l 3 2 , No 5
799
Using this philosophy and the conceptual framework for implementing the theory that developed from it, the faculty designed the curriculum on the modular system wth integrated concepts. A module is a learning package consisting of entry behaviors, behavioral objectives, learning activities, and learning resources. Integrated concepts are aspects of patient care that relate to all modules and are taught as part of each module. Examples include growth and development, nutrition, and pharmacology. Three courses, entitled Care of the Adult, award 18credit hours in nursing. Each course contains modules, called GUIDES, that focus on patient problems or needs (GUIDE is an acronym for Grouped Units of Individualized Directed Education for students.) The first course focuses on introductory content and patient problems relating t o digestion, metabolism, and elimination. The second covers patient problems with respiration, skeletal structure, skin and surgery; and the third deals with patient problems with circulation, hormonal imbalances, and neurological disturbances. In the second course, a module or GUIDE entitled Patient Needs Relating to Surgical Intervention includes the Standards of Nursing Practice: OR and the perioperative role. The needs of the patient revolve around the five basic curriculum concepts and are the same kinds found in other clinical areas. InPatricia A Hercules, R N , MS, is assistant director, OR, Methodist Hospital, Houston. Formerly, she was assistant professor of nursing at Houston Baptist University.A baccalaureate graduate of Baylor University, Dallas, she received a master’s degree from Texas Woman’s University, Houston. This article is adapted from a speech she presented at the Invitational Conference for Nurse Educators June 20 in Denver.
800
Table 7
Standard Ill: Goals for nursing care are formulated The individual is free from infection. The individual’s skin integrity is maintained. The individual is free of adverse effects from lack of or improper use of safety measures: - improper positioning - extraneous objects - chemical, physical, and electrical hazards. 0 The individual’s fluid and electrolyte balance is maintained. The individual and/or responsible party demonstrate knowledge of the individual’s physiological and psychological responses to surgical intervention. 0 The individual participates in the rehabilitation process. From the “Standardsof Nursing Practice: OR” in AORN Standards of Practice (Denver: AORN, Inc, 1978).
terventions that the students learn, however, are specific to surgery. Within this GUIDE are three sub-GUIDES: Need for Perioperative Nursing Care, including preoperative assessment, identification of patient problems, intraoperative nursing care, and some initial components of postoperative evaluation. 0 Need for Surgical Relaxation, including intraoperative problems relating to anesthesia and facts about anesthetic agents. Need for Postoperative Surveillance and Evaluation, including problems in the postanesthetic care and evaluation techniques. Each sub-GUIDE emphasizes basic and specialized nursing interventions crucial for meeting patient goals. Six primary goals, which are discussed in
AORN Journal, November 1980, V o l 3 2 , N o 5
Table 2
Sample of objectives for a goal Goal: The individual is free from infection. Objectives : 1. Explain the meaning of a controlled physical environment. 2. Discuss the characteristics of the following physical aspects of the surgical suite: lights, windows, floors, and design. 3. Explain the principles of surgical asepsis by discussing the Standards for Basic Aseptic Technique. 4. Discuss the various types and methods for cleaning and sterilization. 5. Discuss sanitization as a contributing factor to asepsis by reviewing the Standards for OR Sanitation. 6. Discuss OR attire as a contributing factor to asepsis by reviewing the Standards for OR Wearing Apparel. 7. Relate the surgical hand scrub to the prevention of infection as discussed in the Standards for Surgical Hand Scrubs. 8. Describe how preoperative skin preparation decreases the incidence of postoperative infection by reviewing the Standards for Preoperative Skin Preparation of Patients. 9. Identify patient problems resulting from infection.
depth, a r e f r o m Standard 111 o f Standards o f N u r s i n g Practice: OR (Table 1). A d d i t i o n a l goals are i d e n t i f i e d and discussed as students adapt t h e n u r s i n g process t o individual patients. E a c h o f these goals i s t h e basis f o r a series of c o g n i t i v e objectives f o r t h e s t u dents (Table 2). It i s i m p o r t a n t f o r students t o u n d e r s t a n d these c o g n i t i v e objectives so t h e y c a n assist p a t i e n t s in m e e t i n g goals. A f t e r t h e y m a s t e r t h e c o g n i t i v e objectives, t h e y i m p l e m e n t n u r s i n g actions u s i n g psychomotor objectives such as those i n v o l v i n g t r a n s f e r and positioning. These objectives a r e
Students conduct preoperative interviews and assessments. They are exposed to patients in all stages of growth and development, so they have an opportunity to apply concepts learned about all age groups.
AORN Journal, November 1980, V a l 32, No 5
801
Table
How students patient goals Patient problems/ needs
Examples
Goal ~~
Inability to protect self from bodily harm due to administration of pharmacological agents, resulting in the need for safety and protection.
Specific potential problems:
Causes:
Skin and tissue damage
Preoperative medications
Circulatory impairments
Intraoperative anesthesia
Respiratory impairments
Postoperative analgesics, antiemetics, sedatives, etc
Chemical burns
Structural damage
-__
The individual IS free of adverse effectsfrom lack of or improper use of safety measures. - improper positioning
Nerve and muscle damage
- extraneous objects - chemical, physical, and
Electrical burns
also based on the nursing process, and evaluation is based on the student’s ability to transfer them into practice. As they correlate this, they implement perioperative nursing care (Table 3). Students conduct preoperative interviews for detailed assessments and actively carry out intraoperative patient care with the assistance of a staff nurse and their instructor. They apply nursing skills in the postanesthesia care unit and evaluate patient goals in the postoperative setting. Because concepts of community health are integrating threads in the curriculum, students are encouraged to (and do) visit their patients at home or in the clinic for evaluation and discharge care. Patients, students, and OR team members benefit from teaching and learning about the perioperative role.
802
electrical hazards
Patients benefit most, because they receive individualized nursing care, with a follow-through on problems from preoperative to postoperative phases. This reinforces to them that nurses are concerned and will provide them both emotional and physical support during a time when they are unable t o care for themselves. There are many benefits to students as well. First, they have an opportunity to study man as a holistic being in a situation of rapidly changing physiological and psychological needs. Surgery involves changes in anatomical structure and body image, sometimes predictable before surgery and sometimes not. This requires the student t o adapt knowledge of anatomy and physiology to the changes and correlate them with emotional and psychological alterations in
AORN Journal, November 1980, V o l 3 2 , No 5
3
can see achieved Nursing interventions/ psychomotor skills
Knowledge needed
Transfer patients using safety and protection techniques.
Principles of transferring
Evaluations ~
Did the patient demonstrate evidence of bodily harm?
Principles of positioning Position patients in correct body alignment.
Anatomy and physiology
Count sponges, needles, and instruments.
"Standards for Sponge, Needle, and Instrument Procedures '
Skin or tissue damage?
Determine patient allergies to chemicals, solutions, and medications.
Assessment techniques
Problems with circulation7
Electrical equipment and potential hazards
Problems with respiration?
Structural damage? Nerve or muscle damage?
Manipulate electrical equipment properly.
Chemical burns? Disinfectants and other chemicals Electrical burns? Preoperative medications Anesthetic agents Postoperative medications
the patient following surgery. Students can visualize anatomy and apply it to preoperative, intraoperative, and postoperative nursing care. They apply anatomy and physiology to medical diagnosis and directives and their related nursing care. For example, they can see how and where drains are placed in patients following a cholecystectomy or mastectomy. They can visualize the rationale for arteriograms prior to vascular procedures. Dealing with patients in crisis, students can apply the theory of crisis intervention to them, their families, and friends. Surgery elicits a variety of emotional responses in patients preoperatively and postoperatively. If the patient is under local anesthesia, he may have intraoperative emotional responses as well. This emphasizes holis-
tic patient care. Students can study and apply nursing interventions based on sociocultural and religious differences in patients. This makes them aware that surgical intervention is not selective for any cultural, social, or religious background. For example, students will encounter persons from the Mexican-American, Indian, and Chinese cultures and religious groups such as Jehovah's Witnesses, Roman Catholics, and Christian Scientists. Surgery is an opportunity to provide nursing care for man at all points on the wellness-illness continuum and to evaluate realistically the progress of the patient according to his own needs. This is fully emphasized in the preoperative assessment, intraoperative interventions, and postoperative evaluation.
AORN Journal, November 1980, V o l 3 2 , No 5
803
Having students in the operating room stimulates staff to workat their highest level, because they are role models. Bradley J Manuel, RN, MSN, one of the course instructors, helps a student gown during AORN’s pilot postbasic course in Denver this summer. Nurses with little or no operating room experience had an opportunity to learn about the perioperative role.
804
In the OR, students are exposed to patients in all stages of growth and development, giving them the opportunity to integrate learned concepts to needs of various age groups. For example, diet, medication dosage, positioning needs, and fluid and electrolyte administration all vary with the age of the patient. In the operating room, students have increased opportunity to learn safety and protection techniques such a s transferring, positioning, skin preparation, catheterization, suctioning, irrigating drainage tubes, hanging intravenous lines, sterilization, and practice in principles of asepsis. The controlled OR environment lends itself particularly well to teaching which can then be transferred to other areas of the hospital. The operating room is a unique setting where students can apply a variety of self-care concepts described by Dorothea Orem. In the wholly compensatory nursing system, decision making is centered in the nurse. Clients are unable to make decisions about their physical and psychological status. They are in life-threatening situations requiring therapeutic intervention. The partly compensatory system is one in which the nurse and client share decision making. The client is able to exercise partial control. In the supportive-educative stage, decision making centers in clients. They can manage their health care needs independently .2 Nurses practicing in the perioperative role see patients i n all three categories. Depending on the type of surgery, they may see more of one type than the others. Most anesthetized patients fall in the first category, where decisions are made by OR team members. Patients depend totally on care given by others, including the nurse. Preoperatively and postoperatively, students see patients in the other two states, where they can share decisions
AORN Journal, November 1980, V o l 3 2 , N o 5
or make their own. This opportunity to learn about selfcare is important. The new State Board Test Pool Examination for registered nurses, to be implemented in 1982, will be based on the nursing process, with no specialized areas. The test plan emphasizes nursing behaviors (assessing, analyzing, planning, implementing, and evaluating) and the decisionmaking systems. By visualizing what actually happens to patients during surgery, students can form more realistic objectives and rationale for their preoperative and postoperative patient teaching plans. They can learn more about patients’ needs for teaching and learning and apply them appropriately to assist patients in achieving their goals. In general in perioperative settings, students can learn about empathy for patients, family, and friends. They can participate in continuity of care and develop skills in organizing, communicating, and functioning as team members. Students attest to the value of the experience in their informal comments. One said: I feel that because of my experience in the OR, I am better able to care for my patients in a competent and caring way. I can explain and answer questions about surgery for the patients who are awaiting surgery to be performed. I can prepare the patient with full understanding of why it needs t o be done. When the patient returns to the floor, I can truly appreciate why he is in pain, why he is nauseated, and why turning, coughing, and deep breathing are important. The operating room team benefits, too. In any clinical setting where there are students, the staff responds with enthusiasm. They are stimulated to work at their highest level, because they are role models who are being watched and emulated. Students challenge the staff
to develop teaching skills and increase their own knowledge. Students’ inquisitiveness encourages the staff to keep current in their practice, improving the quality of care. Because students may have more flexibility and more time t o make preliminary assessments, the surgical team has more preoperative data about patient problems such as visual deficiencies, altered laboratory test values, and anxiety. Job satisfaction and recognition increase as staff receive positive feedback from students who have had positive experiences in the OR. In addition, student experience in the operating room can aid future staffing. Orientation time will be less for nurses who have had an intraoperative experience in their basic education. OR staff positions may be easier to fill when students have been welcomed and encouraged to implement perioperative nursing. Finally, all team members may have better understanding of their roles when they are explained t o students during the perioperative experience. Schools of nursing, faculty, and curriculum committee members also benefit from the perioperative experience. The program can help them meet parts of the National League for Nursing’s criteria for accreditation (see related article). The quality of intraoperative nursing care by students has significantly increased since Houston Baptist University has been using the Standards of Nursing Practice: OR in teaching and learning about the perioperative role. Students understand more readily that perioperative nursing is important as part of a continuum of care. Notes 1. Department of Nursing Philosophy (Houston: Houston Baptist University, 1980). 2. Dorothea E Orem, Nursing: Concepts of Practice (New York: McGraw-Hill, 1980) 96-103.
AORN Journal, November 1980, Vol32, No 5
805
OR experience teaches continuity of care
t Houston Baptist University, the nursing process has always been emphasized in teaching intraoperative nursing care. With development of the Standards of Nursing Practice: OR and the perioperative role, this aspect of care has been more readily understood by both faculty and students. Now it is seen as a valuable part of the curriculum. With the standards as the foundation for student learning, the nursing process provides a structure for emphasizing continuity of care. A nursing diagnosis from the patient unit can be transferred to the operating room. Likewise, patient problems identified intraoperatively can become a basis for nursing care in other settings. The philosophy of the nursing curriculum at the university is to prepare graduates at a high level of competency for beginning positions in a variety of settings. That is, the program prepares generalists. The curriculum evolves from five major concepts: man, society, health, nursing, and the teaching-learning process. Man is seen as a unique, integrated, open system with changing biological, psychological, sociocultural, and spiritual needs. As a system, he evolves through stages of growth and development. He deserves access to a health care system that helps him reach his optimum level of wellness. Society, the framework in which man lives, contains groups with distinct ethnic origins, cultural patterns, and religious and social backgrounds. Health is man’s adaption to stress throughout his life and may have degrees of wellness and illness. Nursing is believed to be an art and science, using human creativity to perform skills based on scientific principles from physical and behavioral sciences. The practice of nursing is an interaction based on the nursing process, t o assist persons maintain or reach equilibrium. The teaching-learning process is an active, ongoing interchange among teacher, student, and c1ient.l
A
Patricia Hercules, RN
AORN Journal, November 1980, V o l 3 2 , No 5
799
Using this philosophy and the conceptual framework for implementing the theory that developed from it, the faculty designed the curriculum on the modular system wth integrated concepts. A module is a learning package consisting of entry behaviors, behavioral objectives, learning activities, and learning resources. Integrated concepts are aspects of patient care that relate to all modules and are taught as part of each module. Examples include growth and development, nutrition, and pharmacology. Three courses, entitled Care of the Adult, award 18credit hours in nursing. Each course contains modules, called GUIDES, that focus on patient problems or needs (GUIDE is an acronym for Grouped Units of Individualized Directed Education for students.) The first course focuses on introductory content and patient problems relating t o digestion, metabolism, and elimination. The second covers patient problems with respiration, skeletal structure, skin and surgery; and the third deals with patient problems with circulation, hormonal imbalances, and neurological disturbances. In the second course, a module or GUIDE entitled Patient Needs Relating to Surgical Intervention includes the Standards of Nursing Practice: OR and the perioperative role. The needs of the patient revolve around the five basic curriculum concepts and are the same kinds found in other clinical areas. InPatricia A Hercules, R N , MS, is assistant director, OR, Methodist Hospital, Houston. Formerly, she was assistant professor of nursing at Houston Baptist University.A baccalaureate graduate of Baylor University, Dallas, she received a master’s degree from Texas Woman’s University, Houston. This article is adapted from a speech she presented at the Invitational Conference for Nurse Educators June 20 in Denver.
800
Table 7
Standard Ill: Goals for nursing care are formulated The individual is free from infection. The individual’s skin integrity is maintained. The individual is free of adverse effects from lack of or improper use of safety measures: - improper positioning - extraneous objects - chemical, physical, and electrical hazards. 0 The individual’s fluid and electrolyte balance is maintained. The individual and/or responsible party demonstrate knowledge of the individual’s physiological and psychological responses to surgical intervention. 0 The individual participates in the rehabilitation process. From the “Standardsof Nursing Practice: OR” in AORN Standards of Practice (Denver: AORN, Inc, 1978).
terventions that the students learn, however, are specific to surgery. Within this GUIDE are three sub-GUIDES: Need for Perioperative Nursing Care, including preoperative assessment, identification of patient problems, intraoperative nursing care, and some initial components of postoperative evaluation. 0 Need for Surgical Relaxation, including intraoperative problems relating to anesthesia and facts about anesthetic agents. Need for Postoperative Surveillance and Evaluation, including problems in the postanesthetic care and evaluation techniques. Each sub-GUIDE emphasizes basic and specialized nursing interventions crucial for meeting patient goals. Six primary goals, which are discussed in
AORN Journal, November 1980, V o l 3 2 , N o 5
Table 2
Sample of objectives for a goal Goal: The individual is free from infection. Objectives : 1. Explain the meaning of a controlled physical environment. 2. Discuss the characteristics of the following physical aspects of the surgical suite: lights, windows, floors, and design. 3. Explain the principles of surgical asepsis by discussing the Standards for Basic Aseptic Technique. 4. Discuss the various types and methods for cleaning and sterilization. 5. Discuss sanitization as a contributing factor to asepsis by reviewing the Standards for OR Sanitation. 6. Discuss OR attire as a contributing factor to asepsis by reviewing the Standards for OR Wearing Apparel. 7. Relate the surgical hand scrub to the prevention of infection as discussed in the Standards for Surgical Hand Scrubs. 8. Describe how preoperative skin preparation decreases the incidence of postoperative infection by reviewing the Standards for Preoperative Skin Preparation of Patients. 9. Identify patient problems resulting from infection.
depth, a r e f r o m Standard 111 o f Standards o f N u r s i n g Practice: OR (Table 1). A d d i t i o n a l goals are i d e n t i f i e d and discussed as students adapt t h e n u r s i n g process t o individual patients. E a c h o f these goals i s t h e basis f o r a series of c o g n i t i v e objectives f o r t h e s t u dents (Table 2). It i s i m p o r t a n t f o r students t o u n d e r s t a n d these c o g n i t i v e objectives so t h e y c a n assist p a t i e n t s in m e e t i n g goals. A f t e r t h e y m a s t e r t h e c o g n i t i v e objectives, t h e y i m p l e m e n t n u r s i n g actions u s i n g psychomotor objectives such as those i n v o l v i n g t r a n s f e r and positioning. These objectives a r e
Students conduct preoperative interviews and assessments. They are exposed to patients in all stages of growth and development, so they have an opportunity to apply concepts learned about all age groups.
AORN Journal, November 1980, V a l 32, No 5
801
Table
How students patient goals Patient problems/ needs
Examples
Goal ~~
Inability to protect self from bodily harm due to administration of pharmacological agents, resulting in the need for safety and protection.
Specific potential problems:
Causes:
Skin and tissue damage
Preoperative medications
Circulatory impairments
Intraoperative anesthesia
Respiratory impairments
Postoperative analgesics, antiemetics, sedatives, etc
Chemical burns
Structural damage
-__
The individual IS free of adverse effectsfrom lack of or improper use of safety measures. - improper positioning
Nerve and muscle damage
- extraneous objects - chemical, physical, and
Electrical burns
also based on the nursing process, and evaluation is based on the student’s ability to transfer them into practice. As they correlate this, they implement perioperative nursing care (Table 3). Students conduct preoperative interviews for detailed assessments and actively carry out intraoperative patient care with the assistance of a staff nurse and their instructor. They apply nursing skills in the postanesthesia care unit and evaluate patient goals in the postoperative setting. Because concepts of community health are integrating threads in the curriculum, students are encouraged to (and do) visit their patients at home or in the clinic for evaluation and discharge care. Patients, students, and OR team members benefit from teaching and learning about the perioperative role.
802
electrical hazards
Patients benefit most, because they receive individualized nursing care, with a follow-through on problems from preoperative to postoperative phases. This reinforces to them that nurses are concerned and will provide them both emotional and physical support during a time when they are unable t o care for themselves. There are many benefits to students as well. First, they have an opportunity to study man as a holistic being in a situation of rapidly changing physiological and psychological needs. Surgery involves changes in anatomical structure and body image, sometimes predictable before surgery and sometimes not. This requires the student t o adapt knowledge of anatomy and physiology to the changes and correlate them with emotional and psychological alterations in
AORN Journal, November 1980, V o l 3 2 , No 5
3
can see achieved Nursing interventions/ psychomotor skills
Knowledge needed
Transfer patients using safety and protection techniques.
Principles of transferring
Evaluations ~
Did the patient demonstrate evidence of bodily harm?
Principles of positioning Position patients in correct body alignment.
Anatomy and physiology
Count sponges, needles, and instruments.
"Standards for Sponge, Needle, and Instrument Procedures '
Skin or tissue damage?
Determine patient allergies to chemicals, solutions, and medications.
Assessment techniques
Problems with circulation7
Electrical equipment and potential hazards
Problems with respiration?
Structural damage? Nerve or muscle damage?
Manipulate electrical equipment properly.
Chemical burns? Disinfectants and other chemicals Electrical burns? Preoperative medications Anesthetic agents Postoperative medications
the patient following surgery. Students can visualize anatomy and apply it to preoperative, intraoperative, and postoperative nursing care. They apply anatomy and physiology to medical diagnosis and directives and their related nursing care. For example, they can see how and where drains are placed in patients following a cholecystectomy or mastectomy. They can visualize the rationale for arteriograms prior to vascular procedures. Dealing with patients in crisis, students can apply the theory of crisis intervention to them, their families, and friends. Surgery elicits a variety of emotional responses in patients preoperatively and postoperatively. If the patient is under local anesthesia, he may have intraoperative emotional responses as well. This emphasizes holis-
tic patient care. Students can study and apply nursing interventions based on sociocultural and religious differences in patients. This makes them aware that surgical intervention is not selective for any cultural, social, or religious background. For example, students will encounter persons from the Mexican-American, Indian, and Chinese cultures and religious groups such as Jehovah's Witnesses, Roman Catholics, and Christian Scientists. Surgery is an opportunity to provide nursing care for man at all points on the wellness-illness continuum and to evaluate realistically the progress of the patient according to his own needs. This is fully emphasized in the preoperative assessment, intraoperative interventions, and postoperative evaluation.
AORN Journal, November 1980, V o l 3 2 , No 5
803
Having students in the operating room stimulates staff to workat their highest level, because they are role models. Bradley J Manuel, RN, MSN, one of the course instructors, helps a student gown during AORN’s pilot postbasic course in Denver this summer. Nurses with little or no operating room experience had an opportunity to learn about the perioperative role.
804
In the OR, students are exposed to patients in all stages of growth and development, giving them the opportunity to integrate learned concepts to needs of various age groups. For example, diet, medication dosage, positioning needs, and fluid and electrolyte administration all vary with the age of the patient. In the operating room, students have increased opportunity to learn safety and protection techniques such a s transferring, positioning, skin preparation, catheterization, suctioning, irrigating drainage tubes, hanging intravenous lines, sterilization, and practice in principles of asepsis. The controlled OR environment lends itself particularly well to teaching which can then be transferred to other areas of the hospital. The operating room is a unique setting where students can apply a variety of self-care concepts described by Dorothea Orem. In the wholly compensatory nursing system, decision making is centered in the nurse. Clients are unable to make decisions about their physical and psychological status. They are in life-threatening situations requiring therapeutic intervention. The partly compensatory system is one in which the nurse and client share decision making. The client is able to exercise partial control. In the supportive-educative stage, decision making centers in clients. They can manage their health care needs independently .2 Nurses practicing in the perioperative role see patients i n all three categories. Depending on the type of surgery, they may see more of one type than the others. Most anesthetized patients fall in the first category, where decisions are made by OR team members. Patients depend totally on care given by others, including the nurse. Preoperatively and postoperatively, students see patients in the other two states, where they can share decisions
AORN Journal, November 1980, V o l 3 2 , N o 5
or make their own. This opportunity to learn about selfcare is important. The new State Board Test Pool Examination for registered nurses, to be implemented in 1982, will be based on the nursing process, with no specialized areas. The test plan emphasizes nursing behaviors (assessing, analyzing, planning, implementing, and evaluating) and the decisionmaking systems. By visualizing what actually happens to patients during surgery, students can form more realistic objectives and rationale for their preoperative and postoperative patient teaching plans. They can learn more about patients’ needs for teaching and learning and apply them appropriately to assist patients in achieving their goals. In general in perioperative settings, students can learn about empathy for patients, family, and friends. They can participate in continuity of care and develop skills in organizing, communicating, and functioning as team members. Students attest to the value of the experience in their informal comments. One said: I feel that because of my experience in the OR, I am better able to care for my patients in a competent and caring way. I can explain and answer questions about surgery for the patients who are awaiting surgery to be performed. I can prepare the patient with full understanding of why it needs t o be done. When the patient returns to the floor, I can truly appreciate why he is in pain, why he is nauseated, and why turning, coughing, and deep breathing are important. The operating room team benefits, too. In any clinical setting where there are students, the staff responds with enthusiasm. They are stimulated to work at their highest level, because they are role models who are being watched and emulated. Students challenge the staff
to develop teaching skills and increase their own knowledge. Students’ inquisitiveness encourages the staff to keep current in their practice, improving the quality of care. Because students may have more flexibility and more time t o make preliminary assessments, the surgical team has more preoperative data about patient problems such as visual deficiencies, altered laboratory test values, and anxiety. Job satisfaction and recognition increase as staff receive positive feedback from students who have had positive experiences in the OR. In addition, student experience in the operating room can aid future staffing. Orientation time will be less for nurses who have had an intraoperative experience in their basic education. OR staff positions may be easier to fill when students have been welcomed and encouraged to implement perioperative nursing. Finally, all team members may have better understanding of their roles when they are explained t o students during the perioperative experience. Schools of nursing, faculty, and curriculum committee members also benefit from the perioperative experience. The program can help them meet parts of the National League for Nursing’s criteria for accreditation (see related article). The quality of intraoperative nursing care by students has significantly increased since Houston Baptist University has been using the Standards of Nursing Practice: OR in teaching and learning about the perioperative role. Students understand more readily that perioperative nursing is important as part of a continuum of care. Notes 1. Department of Nursing Philosophy (Houston: Houston Baptist University, 1980). 2. Dorothea E Orem, Nursing: Concepts of Practice (New York: McGraw-Hill, 1980) 96-103.
AORN Journal, November 1980, Vol32, No 5
805