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Perioperative Study for Nurses
AORN JOURNAL
SEPTEMBER 198X. VOL. 48. NO 3
Perioperative Study for Nurses AN ON-SITE, INDEPENDENT STUDYPROGRAM Jane C . Rothrock, RN; Claire A. Baldwin, RN In a metaphoric mode, American nursing can be thought of rn a seedling that took root, struggled, thrust itself upward, and at some point above ground level split,forming two trunks. The trunks continued to grow separate&, and though they sprung from a common root, and though they reared toward a common goal, a gap exists between them embers of the nursing profession use diverse and varied ways to describe the split between nursing service and nursing education. Those in nursing service want a graduate who is technically competent and who can be immediately assimilated into the work environment; those in nursing education want a graduate who has the scientific knowledge of nursing and is capable of analyzing and synthesizing nursing information. Although seemingly
M
different, both have the common goal of providing nursing care that contributes to the safety and welfare of the recipient. This article describes a partnership between nursing education and nursing service that had the common goal of designing and implementing an independent study program for perioperative nurses.
Course Design
T
he collaborative effort was prompted by the shortage of perioperative nurses. At Delaware County Community College, Media, Pa, the faculty members responded to this need by developing an independent study program in perioperative nursing that registered nurses could complete at their hospital instead of
nursing, Delaware County Community College, Media, Pa, She received her diploma in nursing from the Bryn Mawr (Pa) Hospital School of Nursing, both her bachelor of science and master of science degrees in nursing from the University of Pennsylvania, Philadelphia, and her doctorate of nursing science from Widener University, Chester. Pa.
Jane C. Rothrock
chire A. Baldwin
Jane C. Rothrock, RN, DNSc, CNOR, is professor and curriculum director of perioperative 490
ClaireA . Baldwin, fW, MSN, CNOR, is apalieni care manager,postanesthesia care unit, Bryn Mawr (Pa) Hospital She received a bachelor of science degree in nursing .from Boston College, Chestnut Hill, M a s , and a masler of science degree in nursing from Villanova (Pa) Universiv.
AORN JOURNAL
SEPTEMBER 1988. VOL. 48, N O 3
The study program includes textbook reading assignments, audiotapes of classroom lectures, videotapes, and computer-assisted instruction.
attending the college. The program offers academic credits, has easily transported materials, and can be tailored to the institution. To date, it has been offered at five institutions in three states. The on-site independent study program was modeled after the perioperative nursing course offered at the college. Normally, an o n a m p u s perioperative nursing student attends 15 three-hour didactic sessions (three credit hours) and spends 15 clinical days in an OR setting (three credit hours). Because the program offers academic credit, it was necessary to include similar content, learning resources, and examinations as provided in the classroom. From this modeling, there emerged a generic perioperative nursing course with textbook reading assignments, audiotapes of classroom lectures, videotapes with learner guides, and selected computer-assisted instructional materials. The course data base has been computerized. When a proposal is generated for an institution, the generic course is printed and sent to the institution for review. Perioperative nursing faculty then visit the health care facility to consult with the nursing administrators. In this meeting, the faculty and administrators review the practice of perioperative nursing in that facility. If possible, course materials and learning resources are tailored to prepare nurses to work in that particular facility. Although some changes are made, the curriculum itself is not altered-all students have to complete the same academic requirements. Nonetheless, just as a faculty member might change the focus of the content from semester to semester, the focus of an on-site perioperative nursing course might change. To adapt the content, supplementary readings and learning resources such as audiotapes and videotapes are provided to support and enhance the perioperative role as it is practiced in the individual setting. For example, an institution may 492
not evaluate the perioperative nursing care plan through a postoperative visit. They may, instead, use an audit. In such an instance, the evaluation process will focus on audits rather than on postoperative visits. To make changes, the educator goes into the computer data base and revises the generic program. The revised program gives details of the reading, listening, viewing, and computer activities for the learners on a weekly basis. The nurse administrators than select a preceptor for each learner from the perioperative nursing staff. Although the perioperative nurse preceptors need to be models of clinical competence, that competence does not ensure teaching competence. To help the preceptor, the college faculty wrote a preceptor guideline booklet detailing clinical content, suggested clinical assignments, and a resource and reference list. The preceptor booklet addresses some adult education concepts and suggests strategies for using the operating room as a clinical learning laboratory. It includes an empathy exercise to help the preceptor establish a learning climate (Table I). Audiotapes and a videotape on the responsibilities of a preceptor are also provided. After preceptors and students have been selected, the date is set for the start of the course. The institution needs to have an on-site classroom/ learning laboratory for course participants complete with equipment for viewing and listening to materials. At the first meeting, college faculty members present a two-hour session to explain the learning packets and activities. During the remaining 15 weeks, faculty members make three more visits to the facility. In sessions lasting three to four hours, they review exams, identify and solve problems, and present lectures or other educational exercises. Between visits, faculty members contact the onsite facilitator to track progress, answer questions, and provide any special needs. Otherwise, students
SEPTEMBER 1988. VOL. 48. NO 3
AORN JOURNAL
Table 1
Empathy Exercise Directionr to the preceptor. Please complete this empathy exercise. When you have finished it, review with the nurse the important features you value in teaching-learning. Ask the nurse to share with you his or her learning style, and find out what will be needed to make the teaching-learning process work for both of you.
1. When I took my first position as a perioperative nurse, the way I felt about going to work in the OR was
2. The most traumatic things experienced as a new perioperative nurse were
3. The most effective characteristics of the person who oriented me to the OR were
4. The things I wish my orienter/preceptor had done more often were
5. The things I wished my orienter/preceptor had not done were
6. The things that are now important to me as a preceptor for a new perioperative nurse are
493
Sk P l t M H k K I Y X X . VOL JX. NO-3
- -
AORN J O U R N A L
~~
After completing the 15-week learning period, the student will have the skills to begin practicing perioperative nursing. work independently with course materials reviewing results with each other, their preceptor, and the on-site facilitator. The on-site facilitator can be the perioperative manager, a staff development person, or the OR in-service instructor. Educators have selected a system that reflects their philosophy and resources and best provides guidance to the learners. For 15 weeks, students engage in classroom learning at the hospital and develop clinical skills based on that learning. At the end of the learning period, the student will have the skills and conceptual basis needed to begin practicing perioperative nursing. Although those skills will reflect perioperative nursing as practiced at the facility, the students could practice at any hospital.
Program Benefits
T
he on-site course is perceived as an opportunity for the nursing service department to enhance employee benefits by offering college credits for a competency-based orientation program. When the course is offered at the hospital, students can schedule time in the on-site learning laboratory during their free time, such as in the evenings or on their days off. In addition, when skill sessions are scheduled in the evening, ORs are usually more available. By providing an extended learning environment that is not as locked into prescribed schedules on a college campus, nurses may find it more suitable to their schedules, and thus easier to learn. Considering recruitment and retention problems with nurses, administrators need to offer creative, worthwhile, and mutually beneficial programs. An educational program that makes the transition to new practice areas easy, such as the one described in this article, is one such program. The on-site independent study program has become, for our institutions, a prototype that
exemplifies accessible adult education. The school and hospital have worked together to develop an educational curriculum that makes perioperative nursing education available both to main- and off-campus learners, and one that incorporates the principles of adult education. Another institutional benefit is that personnel familiar with the nursing philosophy of the facility are involved in presenting and applying the didactic content of the program. The college has built flexibility into the program wherever possible, which enables the preceptor to work with and around patient care assignments. Initiating a learning laboratory in the facility enables nurses to continue their employment while earning college credits. As an added enticement, program administrators at the college allow the nurses to register by mail. Because the health care facility pays the tuition, billing for our course was handled through the nursing service department. As a result, the independent study program has produced educated, satisfied employees who can practice within the philosophical and theoretical framework of the employer and who have abroadbased knowledge of perioperative nursing. Offering educational opportunity within the institution can be a positive marketing tool to attract and retain nurses. The Bryn Mawr (Pa) Hospital and the Delaware County Community College have collaborated twice in offering the on-site perioperative nursing course to current and new OR nursing staff.
Conclusion e believe that today, more than ever before, nursing program faculty members and nursing service administrators need to take steps to accommodate adult learners. The success of our partnership shows that it can be done. Through our partnership, we have created a sense of unity regarding our commitment 495
SEPTEMBER 19x8.VOL. 4X. NO 3
to perioperative nursing and have given meaning, purpose, and direction to the educational preparations of perioperative nurses. Making the independent study program a reality requires mutual goals, collaboration, and open communication between college faculty and nursing administrators. As colleagues, educators and nursing administrators can provide educational opportunities and enhance patient care, 0 which is our mutual goal. Note 1. K 0 Rosenlieb, ‘‘Nursing service and education collaborate to enhance students’ learning,” in Living With Change and Choice in Health: Proceedings of the 1st Sigma Theta Tau. Alpha Rho chapler, National Research Conference, ed. J F Wang, C L Nath, P S Simoni (Morgantown, WV: Sigma Theta Tau. 1986) 21.
AORN JOURNAL
Suggested reading Dexter, P A; Laidig, J. “Breaking the education/service harrier.’’ Nursing Outlook 28 (March 1980) 179182. Nayer. D D. “Unification: Bringing nursing service and nursing education together.” American Journal of Nursing 80 (June 1980) 1 1 10-1114. Rothrock, J C. “Perioperative nursing goes to college.” AORN Journal 40 (December 1984) 873-876. Styles, M M. “Reflections on collaboration and unification.” Imagt. 16 (Winter 1984) 21-23. Westcot, L B. “Nursing education and nursing service: A collaborative model.” Nursing and Health Care 2 (September 1981) 376-379. Yarcheski, A; Mahon. N E. “The unification model in nursing: A study of receptivity among nurse educators in the United States.” Nursing Research 34 (March/April 1985) 120-125.
Computer Programs May Diagnose Strokes Computer programs designed as diagnostic and teaching aids may be available for use by physicians in the near future. One such program, developed by German researchers at the University of Hamburg, is currently being used to train residents at Tufts University, Medford, Mass, according to the April 1 I , 1988 issue of Medical World News. The program asks the physician a series of questions related to his or her patient’s age, sex, signs of heart disease, history of heart disease and hypertension, and state of consciousness. The program then gives probabilities for the diagnosis of certain types of strokes, including thrombosis, embolus, lacuna, intracerebral hemorrhage, and subarachnoid hemorrhage. The program also has a warning system that alerts the physician when symptom patterns indicate that the patient may have intracranial bleeding. The system stores all of the case data, including the physician’s final diagnosis. A similar program developed at Michael Reese Hospital and Medical Center, Chicago, contains modules that indicate the anatomic location and mechanism of stroke. Three
modules under development will provide information on patient testing, treatment, and prognosis.
New Products Developed for Alternate Care Sites Manufacturers’ research and development staffs are developing new products for use in the alternate care marketplace, according to the June 5, 1988, issue of Hospitals. Diagnostic products (eg, home diagnostic tests for consumers, rapid test kits for physicians) are promising options for many manufacturers. In 1986, consumers spent $668 million on home diagnostic tests. To help generate ideas, manufacturers are sending their staffs to alternate care sites to learn how health care is practiced and delivered in nonhospital settings.
497
SEPTEMBER 198X. VOL. 48. NO 3
Perioperative Study for Nurses AN ON-SITE, INDEPENDENT STUDYPROGRAM Jane C . Rothrock, RN; Claire A. Baldwin, RN In a metaphoric mode, American nursing can be thought of rn a seedling that took root, struggled, thrust itself upward, and at some point above ground level split,forming two trunks. The trunks continued to grow separate&, and though they sprung from a common root, and though they reared toward a common goal, a gap exists between them embers of the nursing profession use diverse and varied ways to describe the split between nursing service and nursing education. Those in nursing service want a graduate who is technically competent and who can be immediately assimilated into the work environment; those in nursing education want a graduate who has the scientific knowledge of nursing and is capable of analyzing and synthesizing nursing information. Although seemingly
M
different, both have the common goal of providing nursing care that contributes to the safety and welfare of the recipient. This article describes a partnership between nursing education and nursing service that had the common goal of designing and implementing an independent study program for perioperative nurses.
Course Design
T
he collaborative effort was prompted by the shortage of perioperative nurses. At Delaware County Community College, Media, Pa, the faculty members responded to this need by developing an independent study program in perioperative nursing that registered nurses could complete at their hospital instead of
nursing, Delaware County Community College, Media, Pa, She received her diploma in nursing from the Bryn Mawr (Pa) Hospital School of Nursing, both her bachelor of science and master of science degrees in nursing from the University of Pennsylvania, Philadelphia, and her doctorate of nursing science from Widener University, Chester. Pa.
Jane C. Rothrock
chire A. Baldwin
Jane C. Rothrock, RN, DNSc, CNOR, is professor and curriculum director of perioperative 490
ClaireA . Baldwin, fW, MSN, CNOR, is apalieni care manager,postanesthesia care unit, Bryn Mawr (Pa) Hospital She received a bachelor of science degree in nursing .from Boston College, Chestnut Hill, M a s , and a masler of science degree in nursing from Villanova (Pa) Universiv.
AORN JOURNAL
SEPTEMBER 1988. VOL. 48, N O 3
The study program includes textbook reading assignments, audiotapes of classroom lectures, videotapes, and computer-assisted instruction.
attending the college. The program offers academic credits, has easily transported materials, and can be tailored to the institution. To date, it has been offered at five institutions in three states. The on-site independent study program was modeled after the perioperative nursing course offered at the college. Normally, an o n a m p u s perioperative nursing student attends 15 three-hour didactic sessions (three credit hours) and spends 15 clinical days in an OR setting (three credit hours). Because the program offers academic credit, it was necessary to include similar content, learning resources, and examinations as provided in the classroom. From this modeling, there emerged a generic perioperative nursing course with textbook reading assignments, audiotapes of classroom lectures, videotapes with learner guides, and selected computer-assisted instructional materials. The course data base has been computerized. When a proposal is generated for an institution, the generic course is printed and sent to the institution for review. Perioperative nursing faculty then visit the health care facility to consult with the nursing administrators. In this meeting, the faculty and administrators review the practice of perioperative nursing in that facility. If possible, course materials and learning resources are tailored to prepare nurses to work in that particular facility. Although some changes are made, the curriculum itself is not altered-all students have to complete the same academic requirements. Nonetheless, just as a faculty member might change the focus of the content from semester to semester, the focus of an on-site perioperative nursing course might change. To adapt the content, supplementary readings and learning resources such as audiotapes and videotapes are provided to support and enhance the perioperative role as it is practiced in the individual setting. For example, an institution may 492
not evaluate the perioperative nursing care plan through a postoperative visit. They may, instead, use an audit. In such an instance, the evaluation process will focus on audits rather than on postoperative visits. To make changes, the educator goes into the computer data base and revises the generic program. The revised program gives details of the reading, listening, viewing, and computer activities for the learners on a weekly basis. The nurse administrators than select a preceptor for each learner from the perioperative nursing staff. Although the perioperative nurse preceptors need to be models of clinical competence, that competence does not ensure teaching competence. To help the preceptor, the college faculty wrote a preceptor guideline booklet detailing clinical content, suggested clinical assignments, and a resource and reference list. The preceptor booklet addresses some adult education concepts and suggests strategies for using the operating room as a clinical learning laboratory. It includes an empathy exercise to help the preceptor establish a learning climate (Table I). Audiotapes and a videotape on the responsibilities of a preceptor are also provided. After preceptors and students have been selected, the date is set for the start of the course. The institution needs to have an on-site classroom/ learning laboratory for course participants complete with equipment for viewing and listening to materials. At the first meeting, college faculty members present a two-hour session to explain the learning packets and activities. During the remaining 15 weeks, faculty members make three more visits to the facility. In sessions lasting three to four hours, they review exams, identify and solve problems, and present lectures or other educational exercises. Between visits, faculty members contact the onsite facilitator to track progress, answer questions, and provide any special needs. Otherwise, students
SEPTEMBER 1988. VOL. 48. NO 3
AORN JOURNAL
Table 1
Empathy Exercise Directionr to the preceptor. Please complete this empathy exercise. When you have finished it, review with the nurse the important features you value in teaching-learning. Ask the nurse to share with you his or her learning style, and find out what will be needed to make the teaching-learning process work for both of you.
1. When I took my first position as a perioperative nurse, the way I felt about going to work in the OR was
2. The most traumatic things experienced as a new perioperative nurse were
3. The most effective characteristics of the person who oriented me to the OR were
4. The things I wish my orienter/preceptor had done more often were
5. The things I wished my orienter/preceptor had not done were
6. The things that are now important to me as a preceptor for a new perioperative nurse are
493
Sk P l t M H k K I Y X X . VOL JX. NO-3
- -
AORN J O U R N A L
~~
After completing the 15-week learning period, the student will have the skills to begin practicing perioperative nursing. work independently with course materials reviewing results with each other, their preceptor, and the on-site facilitator. The on-site facilitator can be the perioperative manager, a staff development person, or the OR in-service instructor. Educators have selected a system that reflects their philosophy and resources and best provides guidance to the learners. For 15 weeks, students engage in classroom learning at the hospital and develop clinical skills based on that learning. At the end of the learning period, the student will have the skills and conceptual basis needed to begin practicing perioperative nursing. Although those skills will reflect perioperative nursing as practiced at the facility, the students could practice at any hospital.
Program Benefits
T
he on-site course is perceived as an opportunity for the nursing service department to enhance employee benefits by offering college credits for a competency-based orientation program. When the course is offered at the hospital, students can schedule time in the on-site learning laboratory during their free time, such as in the evenings or on their days off. In addition, when skill sessions are scheduled in the evening, ORs are usually more available. By providing an extended learning environment that is not as locked into prescribed schedules on a college campus, nurses may find it more suitable to their schedules, and thus easier to learn. Considering recruitment and retention problems with nurses, administrators need to offer creative, worthwhile, and mutually beneficial programs. An educational program that makes the transition to new practice areas easy, such as the one described in this article, is one such program. The on-site independent study program has become, for our institutions, a prototype that
exemplifies accessible adult education. The school and hospital have worked together to develop an educational curriculum that makes perioperative nursing education available both to main- and off-campus learners, and one that incorporates the principles of adult education. Another institutional benefit is that personnel familiar with the nursing philosophy of the facility are involved in presenting and applying the didactic content of the program. The college has built flexibility into the program wherever possible, which enables the preceptor to work with and around patient care assignments. Initiating a learning laboratory in the facility enables nurses to continue their employment while earning college credits. As an added enticement, program administrators at the college allow the nurses to register by mail. Because the health care facility pays the tuition, billing for our course was handled through the nursing service department. As a result, the independent study program has produced educated, satisfied employees who can practice within the philosophical and theoretical framework of the employer and who have abroadbased knowledge of perioperative nursing. Offering educational opportunity within the institution can be a positive marketing tool to attract and retain nurses. The Bryn Mawr (Pa) Hospital and the Delaware County Community College have collaborated twice in offering the on-site perioperative nursing course to current and new OR nursing staff.
Conclusion e believe that today, more than ever before, nursing program faculty members and nursing service administrators need to take steps to accommodate adult learners. The success of our partnership shows that it can be done. Through our partnership, we have created a sense of unity regarding our commitment 495
SEPTEMBER 19x8.VOL. 4X. NO 3
to perioperative nursing and have given meaning, purpose, and direction to the educational preparations of perioperative nurses. Making the independent study program a reality requires mutual goals, collaboration, and open communication between college faculty and nursing administrators. As colleagues, educators and nursing administrators can provide educational opportunities and enhance patient care, 0 which is our mutual goal. Note 1. K 0 Rosenlieb, ‘‘Nursing service and education collaborate to enhance students’ learning,” in Living With Change and Choice in Health: Proceedings of the 1st Sigma Theta Tau. Alpha Rho chapler, National Research Conference, ed. J F Wang, C L Nath, P S Simoni (Morgantown, WV: Sigma Theta Tau. 1986) 21.
AORN JOURNAL
Suggested reading Dexter, P A; Laidig, J. “Breaking the education/service harrier.’’ Nursing Outlook 28 (March 1980) 179182. Nayer. D D. “Unification: Bringing nursing service and nursing education together.” American Journal of Nursing 80 (June 1980) 1 1 10-1114. Rothrock, J C. “Perioperative nursing goes to college.” AORN Journal 40 (December 1984) 873-876. Styles, M M. “Reflections on collaboration and unification.” Imagt. 16 (Winter 1984) 21-23. Westcot, L B. “Nursing education and nursing service: A collaborative model.” Nursing and Health Care 2 (September 1981) 376-379. Yarcheski, A; Mahon. N E. “The unification model in nursing: A study of receptivity among nurse educators in the United States.” Nursing Research 34 (March/April 1985) 120-125.
Computer Programs May Diagnose Strokes Computer programs designed as diagnostic and teaching aids may be available for use by physicians in the near future. One such program, developed by German researchers at the University of Hamburg, is currently being used to train residents at Tufts University, Medford, Mass, according to the April 1 I , 1988 issue of Medical World News. The program asks the physician a series of questions related to his or her patient’s age, sex, signs of heart disease, history of heart disease and hypertension, and state of consciousness. The program then gives probabilities for the diagnosis of certain types of strokes, including thrombosis, embolus, lacuna, intracerebral hemorrhage, and subarachnoid hemorrhage. The program also has a warning system that alerts the physician when symptom patterns indicate that the patient may have intracranial bleeding. The system stores all of the case data, including the physician’s final diagnosis. A similar program developed at Michael Reese Hospital and Medical Center, Chicago, contains modules that indicate the anatomic location and mechanism of stroke. Three
modules under development will provide information on patient testing, treatment, and prognosis.
New Products Developed for Alternate Care Sites Manufacturers’ research and development staffs are developing new products for use in the alternate care marketplace, according to the June 5, 1988, issue of Hospitals. Diagnostic products (eg, home diagnostic tests for consumers, rapid test kits for physicians) are promising options for many manufacturers. In 1986, consumers spent $668 million on home diagnostic tests. To help generate ideas, manufacturers are sending their staffs to alternate care sites to learn how health care is practiced and delivered in nonhospital settings.
497