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Staff Development in the O.R.
STAFF DEVELOPMENT IN THE O.R. Myra K . Slauens, R.N. Operating room experience in baccalaureate nursing progrants. The operating room experience included in the baccalaureate nursing programs must be in accordance with the overall philosophy of the school or college of nursing. The philosophy of nursing education is not to graduate skilled practitioners but to graduate individuals with beginning skills in various services who are able to function in first-level nursing positions, Learning experiences should be carefully selected and organized for sequence and continuity which would provide for the broadening and deepening of understanding, skills, and socially desirable attitudes. The philosophy of the School of Nursing of Indiana University (1960) states: “The curriculum is designed for the acquisition and application of knowledge from academic and professional courses for the cumulative and progressive learning in the establishment of interpersonal relationships, communication skills, problem solving, discriminative judgments and beginning skills in team and group processes.” The subject area of this course is optimum care for the surgical patient. Experiences are selected to assist the student to acquire understanding and knowledge of the immediate postoperative areas; and the relationship of these areas to the total hospiMyra K. Slavms, K.N., is educational director of AORN. Miss Slavens graduated with a Bachelor’s degree from Indiana llniversity Schonl of Nursing and a Master‘s degree from East Texas State University. Shr served as staff niirne and assistant head niirsr at Raylor University hlrdical Center, Texas, private scrub nurse for a nriirosurgron, and stnff nursr at Dallas County Hospital District, Parkland Menlorial Hospital. Miss Slavrnk was also an instructor at Texas Women’s University, L)a!las Clinical Center.
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talization of the patient. Emphasis is placed upon: 1) Meeting the needs of patients anticipating, experiencing and recovering from surgical intervention : 2 ) The application of aseptic technique and the transfer of these principles to other nursing experiences; 3 1 Interpersonal and intradepartmental relationships ; and 4) Medicallegal responsibilities.
GENERAL OB’JECTIVES Knowledge. a ) Understands the role of the nurse (teacher, supervisor, active participator ) in the care of the surgical patient, b ) Understands the different roles of the various members of the nursing team and the importanc*e of each role, c) Understands the significance of the patients’ response to surgical intervention. Skill. a ) Utilizes opportunities effectively in teaching the manifestations of surgical intervention to the patient and their families, b ) Applies principles of aseptic technique to the care of patients and their environments, c ) Functions as a member of the interdisciplinary team, d ) Is motivated to learn the necessity of regimentation and self discipline in all nursing techniques. Attitudes. a ) Appreciates the functions of each member of the interdiscliplinary team, b ) Appreciates the concepts that have influenced health practices from ancient times to present, c ) Appreciates the use of problem solving in promoting better patient care. SPECIFIC OBJECTIVES This course is planned so that learning experiences are selected to enable the student
AORN Journul
to: 1) Recognize and meet the individual needs of patients during the immediate preoperative and postoperative periods. 2) Gain understanding of the significance of surgical intervention to the patient and his family. 3) Reinforce her understanding of anatomy and physiology and correlating it with the reasons for and methods of operating procedures (pathophysiology) . 4) Gain knowledge and understanding of the principles basic to aseptic technique. 5) Apply aseptic technique in this area, correlate it with previous learning experiences and transfer it to future nursing experiences. 6) Gain insight into the interpersonal relationships of team members and ability to function effectively as a member of the team. 7) Gain an understanding of the relationships between the operating room, recovery room and other hospital departments. The operating room experience varies in different baccalaureate programs. In the program with which I am most familiar, the students’ operating room rotation consisted of eighteen hours a week for a period of four weeks. This rotation was an integral part of Medical-Surgical Nursing, sections I-IV, during the sophomore year (either fall or spring semester). In the clinical area, approximately three hours per week were utilized for lecture and group conferences. Each student, in addition, spent one morning with an assigned anesthesiologist and was expected to make preoperative rounds with the physician the evening prior to the experience. Operating room nursing was taught on the basis of scientific principles-pathophysiologic and psycho-sociologic-with specific reference as to the application of these principles and practices in the operating room and in other nursing areas. The students actively participated in the presentation of certain classes and in the discussion of problem-solving situations. The examinations covered factual data and applied principles to structured situations. In clinical practice, every effort was
December 1967
made to provide continuity and progression in experiences and the attainment of individual student’s goals. Following the rotation in the operating room, the student had a one week experience in the recovery room. As soon as possible following these experiences, the student was assigned a patient for surgical follow-up case study. In this experience it was hoped that the student would be able to correlate previously learned knowledge and skills in caring for a patient preoperatively, operatively, and postoperatively. In determining the nature of this assignment, the operating room instructor conferred with the individual student, her clinical instructor, and the surgeons with regard to the availability of patients with multiple nursing care needs and teaching potential. This study was to be presented in writing. At various times during the year, if other students were caring for preoperative patients, the students were encouraged to come with the patient into the operative suite. The students who had completed their operating room rotation could assist in the operative area with permission from the nursing instructors involved. The student at this time was allowed to determine the extent of involvement in the operative area with guidance from the operating room instructor. Frequently, the operating room instructor was utilized by the students and others with regard to the teaching and rehabilitative aspects of surgical intervention to individual patients. Similar situations occurred with students and instructors from the areas of pediatric, public health, and psychiatry. These types of experiences provide the student an opportunity to utilize knowledge and skills learned from other areas as well as the operating room in planning the care of the patient undergoing surgical intervention. In this experience, as in others throughout the educational process, the instructor must instill within the student an understanding of the importance of operating room nursing in
65
the total care of the patient. Furthermore, the student should be able to relate this experience to other areas. In other words, the instructor promotes within the student enthusiasm regarding this specialized nursing area in order that the student will use the instructor’s competence, integrity, and discipline as a guideline. The respect from surgeons and nursing staff that this instructor has gained will become an effective working relationship that is transmitted to the student. The relationship of the student to the nursing staff is one of student and practitioner to teacher. As the student progresses in discriminative performance, the professional nurse assists the student in more complex nursing situations commensurate with her experience and ability to adjust to new experiences. The student nurse’s relationship with non-professional nursing personnel is one of a practitioner and in some instances a teacher, as she gains knowledge and understands the functions and duties of various roles in the operating room. She should become adept at recognizing sub-standard performances at all levels, have insight into ways of correcting such difficulties, and begin to develop an understanding of the various roles assumed by each student nurse. The student should be allowed to assume an active role in the operative team so that she becomes acutely aware of various interactions between team members and sources of conflict which may later ensue from this interaction. By these repeated interactions, the student should become actively aware of the necessity of harmonious relationships between various team members in providing optimum care for the patient. This may be the only period in which the student feels that she is an integral and important part of the surgical team. As an undergraduate, the student should have been provided with a program of general education which would promote cultural, emotional, and professional growth leading to individual maturity. The hospital staff
66
should be aware of the educational experiences of the new graduate and work to foster and promote the individual capabilities of the graduate to his or her highest potential. An active and progressive inservice program is necessary for the new graduate’s growth and development in the operating room. The level of technical skills will vary according to the individuals’ capacity; however, the new graduate should have a firm foundation in the principles of operating room nursing care. The new graduate should be able to apply the scientific principles involved in nursing care with relation to the operative patient. The technical portions of operating room nursing vary from institution to institution, but the basic principles involved in patient care are universal. The goals to be achieved in the baccalaureate program cannot be accomplished without the assistance and understanding of nursing service. It is an absolute necessity that the nursing education and nursing service departments communicate with each other. The nursing instructor for the baccalaureate program must communicate to the staff the principles, practices, and objectives of this educational experience for the student and foster the means whereby these goals may be achieved. Periodic conferences with supervisory and staff personnel is mandatory. The instructor for this program is obligated to provide the type of experience which will be meaning ful to the student. This can only be accomplished through the cooperative efforts and understanding of all persons involved, whether it be the administration itself, nursing service, nursing education, or the medical and surgical staff. Utilization of the services and explicit capabilities of all members of the surgical team provides a learning experience which will endow the student with an awareness of the importance of operating room nursing in the total patient care plan.
AORN Journal
64
talization of the patient. Emphasis is placed upon: 1) Meeting the needs of patients anticipating, experiencing and recovering from surgical intervention : 2 ) The application of aseptic technique and the transfer of these principles to other nursing experiences; 3 1 Interpersonal and intradepartmental relationships ; and 4) Medicallegal responsibilities.
GENERAL OB’JECTIVES Knowledge. a ) Understands the role of the nurse (teacher, supervisor, active participator ) in the care of the surgical patient, b ) Understands the different roles of the various members of the nursing team and the importanc*e of each role, c) Understands the significance of the patients’ response to surgical intervention. Skill. a ) Utilizes opportunities effectively in teaching the manifestations of surgical intervention to the patient and their families, b ) Applies principles of aseptic technique to the care of patients and their environments, c ) Functions as a member of the interdisciplinary team, d ) Is motivated to learn the necessity of regimentation and self discipline in all nursing techniques. Attitudes. a ) Appreciates the functions of each member of the interdiscliplinary team, b ) Appreciates the concepts that have influenced health practices from ancient times to present, c ) Appreciates the use of problem solving in promoting better patient care. SPECIFIC OBJECTIVES This course is planned so that learning experiences are selected to enable the student
AORN Journul
to: 1) Recognize and meet the individual needs of patients during the immediate preoperative and postoperative periods. 2) Gain understanding of the significance of surgical intervention to the patient and his family. 3) Reinforce her understanding of anatomy and physiology and correlating it with the reasons for and methods of operating procedures (pathophysiology) . 4) Gain knowledge and understanding of the principles basic to aseptic technique. 5) Apply aseptic technique in this area, correlate it with previous learning experiences and transfer it to future nursing experiences. 6) Gain insight into the interpersonal relationships of team members and ability to function effectively as a member of the team. 7) Gain an understanding of the relationships between the operating room, recovery room and other hospital departments. The operating room experience varies in different baccalaureate programs. In the program with which I am most familiar, the students’ operating room rotation consisted of eighteen hours a week for a period of four weeks. This rotation was an integral part of Medical-Surgical Nursing, sections I-IV, during the sophomore year (either fall or spring semester). In the clinical area, approximately three hours per week were utilized for lecture and group conferences. Each student, in addition, spent one morning with an assigned anesthesiologist and was expected to make preoperative rounds with the physician the evening prior to the experience. Operating room nursing was taught on the basis of scientific principles-pathophysiologic and psycho-sociologic-with specific reference as to the application of these principles and practices in the operating room and in other nursing areas. The students actively participated in the presentation of certain classes and in the discussion of problem-solving situations. The examinations covered factual data and applied principles to structured situations. In clinical practice, every effort was
December 1967
made to provide continuity and progression in experiences and the attainment of individual student’s goals. Following the rotation in the operating room, the student had a one week experience in the recovery room. As soon as possible following these experiences, the student was assigned a patient for surgical follow-up case study. In this experience it was hoped that the student would be able to correlate previously learned knowledge and skills in caring for a patient preoperatively, operatively, and postoperatively. In determining the nature of this assignment, the operating room instructor conferred with the individual student, her clinical instructor, and the surgeons with regard to the availability of patients with multiple nursing care needs and teaching potential. This study was to be presented in writing. At various times during the year, if other students were caring for preoperative patients, the students were encouraged to come with the patient into the operative suite. The students who had completed their operating room rotation could assist in the operative area with permission from the nursing instructors involved. The student at this time was allowed to determine the extent of involvement in the operative area with guidance from the operating room instructor. Frequently, the operating room instructor was utilized by the students and others with regard to the teaching and rehabilitative aspects of surgical intervention to individual patients. Similar situations occurred with students and instructors from the areas of pediatric, public health, and psychiatry. These types of experiences provide the student an opportunity to utilize knowledge and skills learned from other areas as well as the operating room in planning the care of the patient undergoing surgical intervention. In this experience, as in others throughout the educational process, the instructor must instill within the student an understanding of the importance of operating room nursing in
65
the total care of the patient. Furthermore, the student should be able to relate this experience to other areas. In other words, the instructor promotes within the student enthusiasm regarding this specialized nursing area in order that the student will use the instructor’s competence, integrity, and discipline as a guideline. The respect from surgeons and nursing staff that this instructor has gained will become an effective working relationship that is transmitted to the student. The relationship of the student to the nursing staff is one of student and practitioner to teacher. As the student progresses in discriminative performance, the professional nurse assists the student in more complex nursing situations commensurate with her experience and ability to adjust to new experiences. The student nurse’s relationship with non-professional nursing personnel is one of a practitioner and in some instances a teacher, as she gains knowledge and understands the functions and duties of various roles in the operating room. She should become adept at recognizing sub-standard performances at all levels, have insight into ways of correcting such difficulties, and begin to develop an understanding of the various roles assumed by each student nurse. The student should be allowed to assume an active role in the operative team so that she becomes acutely aware of various interactions between team members and sources of conflict which may later ensue from this interaction. By these repeated interactions, the student should become actively aware of the necessity of harmonious relationships between various team members in providing optimum care for the patient. This may be the only period in which the student feels that she is an integral and important part of the surgical team. As an undergraduate, the student should have been provided with a program of general education which would promote cultural, emotional, and professional growth leading to individual maturity. The hospital staff
66
should be aware of the educational experiences of the new graduate and work to foster and promote the individual capabilities of the graduate to his or her highest potential. An active and progressive inservice program is necessary for the new graduate’s growth and development in the operating room. The level of technical skills will vary according to the individuals’ capacity; however, the new graduate should have a firm foundation in the principles of operating room nursing care. The new graduate should be able to apply the scientific principles involved in nursing care with relation to the operative patient. The technical portions of operating room nursing vary from institution to institution, but the basic principles involved in patient care are universal. The goals to be achieved in the baccalaureate program cannot be accomplished without the assistance and understanding of nursing service. It is an absolute necessity that the nursing education and nursing service departments communicate with each other. The nursing instructor for the baccalaureate program must communicate to the staff the principles, practices, and objectives of this educational experience for the student and foster the means whereby these goals may be achieved. Periodic conferences with supervisory and staff personnel is mandatory. The instructor for this program is obligated to provide the type of experience which will be meaning ful to the student. This can only be accomplished through the cooperative efforts and understanding of all persons involved, whether it be the administration itself, nursing service, nursing education, or the medical and surgical staff. Utilization of the services and explicit capabilities of all members of the surgical team provides a learning experience which will endow the student with an awareness of the importance of operating room nursing in the total patient care plan.
AORN Journal