Cerfification Council
Assessment of nursing practice for certification The operatingroom nurse pursuingAORN certification engages in a four-step process: determining eligibility, making application, validating practice, and finally, taking the examination. The applicant must meet predeterminedcriteria for each step to be certified.This column describes how applicants can meet the requirement of validating practice through self-assessment and peer assessments. The CertificationCouncil believes validating practice is an important part of certification. This is reinforced in the definition of AORN certification: “The documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing patient care before, during and after surgery.” In other words, the nurse seeking certification must be able to document that he or she is using standards of practice in patient care. This is a means of verifying, substantiating, and confirming the validity of practice. The assessment mechanism developed by the CertificationCouncil for validating practice incorporates AORN’s concept of peer review. This concept, as well as guidelines and suggestions for setting up a peer review program, were published in 1977 in the manual, Peer Review for Nursing Practice: Operating Room, by the AORN ad hoc Committee on Peer Review. The guidelines present a model that can be analyzed, synthesized, and applied in many settings. They were based on standards of nursing practice specific to the
a
operating room. Consistent with this concept of peer review, the Certification Council believes the individual nurse practicing in the operating room not only should carry the major responsibility for implementing standards of practicebut also should be involved in appraising his or her practice, as well as that of professionalpeers. Evaluating the practice of other practitionersis calledpeerreview. Peer is defined by Webster as a person of the same rank, value, and quality; a person who is equal to another in abilities and qualifications. Review means to view or see again; to examine or study again; to look back on; to go over or examine critically or deliberately. The method established by the Certification Council for validating practice includes two aspects of the peer review concept. Each applicant will be required to perform a self-assessment and to invite two registered nurse peers to do peer assessments. After the applicant has completed the application and mailed it to AORN Headquarters with the fee, he or she will receivethree copies of a tool entitled “Assessment of Professional Practice.” The applicant will complete the answer sheet accompanying the self-assessment tool and give the other tools and answer sheets to the same two RNs listed on the application for completing assessments of professional practice. These nurses must be knowledgeable about the applicant’s practice. For nurses who work in hospitals, these two nurses would probably be others who are employed in the operating room. For nurses in private practice situations, they would have to be registered nurses who have observed the applicant’s practice and can evaluate how the applicant provides patient care based on
AORN Journal, March 1979,V o l 2 9 , No 4
675
AORN certification process Eligibility
1 1
Application
Validation
1
Examination
1
Certification standards of practice. The assessorsmay also be other nurses in the community, in the operating room, or in another hospital specialty service. Nursesfrom small hospitalswho do not have a peer with the same job description may ask a registered nurseon the surgical unit or in the recovery room to evaluate the applicant’s practice and do the assessment. Assessment by a peer means assessment by a registered nurse who “is equal to another in abilities and qualifications” and can “examine and/or review“ the practice of nursing based on predetermined standards. A peer is not a physician,technician, or nonnurse;therefore, these individuals do not qualify to assess the professional practice of the applicant. The assessment tool includes four categories plus demographic information. The first category is skills: the nurse’s ability to use knowledge in clinical performance by applying technical, interpersonal, teaching, leadership, and communication concepts. Professional characteristics, the second category, focuses on attributes of a nurse that have an impact on the patient experiencing surgical intervention. The physiological and psychosocial category assesses nursing actions directed toward the physical, emotional, social, and spiritual needs of the patient experiencing surgical interven-
678
tion. The last category, accountability, deals with the nurse being responsible and answerable to self, patient, profession,and agency for nursing care of the patient experiencing surgical intervention. The assessment tool, similar to a multiplechoice examination, has approximately 50 questions plus the demographic items. The answer sheets, with spaces for marking responses, are computer-scannable. When all three assessments are received at AORN Headquarters, the data will be computerized.The applicant will receivethe following information: 1. his or her self-assessment score on a scale of 1 to 4 for each item in the four categories (1 being the lowest score and 4 the highest) 2. an average of the two nurse peer assessments or raters’ scores on a scale of 1 to4 3. a statement interpreting and explaining what the scores mean individually. It is importantthat applicants realize they are not being compared to other operating room nurses. Rather, their computerized score reflects how they individually ranked the criteria on the tool. The score reflects howthey met the criteria, not a comparisonwith other nurses. In other words, this is a criterion-referenced score, not a norm-referenced score. The Council hopes this feedback will be one way for the applicant to identify strengths and weaknesses in his or her practice. It is also a way to identify practice patterns indicating the need for more knowledge. The results become a diagnostic tool, pointing out specific areas where continued learning or study is recommended before attempting the certification examination. Based on data from the three assessments, applicants can systematically pursue avenues to assist them in implementing, maintaining, and upgrading standards of nursing practice. The end product should be selfeducation by mature, motivated nurses who can objectively determine their own needs and seek appropriate solutions, resulting in enhancedquality of patient care and assistingthe applicant obtain certification. The Certification Council believes that validating practice through assessment is an essential step in the certification process, but the results of the assessments will not be used to
AORN Journal, March 1979,V o l 2 9 , No 4
Peer assessment Who can
Who can not
Registered nurse practicing in OR
Physician Technician
Registered nurse knowledgeable about applicant’s practice
Nonnurse
keep an applicant from taking the examination. All applicants are strongly encouraged to be critical when completing the self-assessment. It is also strongly recommended that nurses chosen to do the assessments spend time thinking about all aspects of the applicant’s practice and responding accurately. Measuring the extent to which established standards are met is in itself a valuable educational en-
deavor that applicants can use to correct shortcomings and narrow the gap between established standards and actual performance. If you are fully implementingstandards of practice, including all the technical standards plus standards of nursingpractice,you will have the knowledge and experience to answer questions on the examination. Remember that the certification process is based on practice and how you, the applicant, applies knowledge and skills necessary to practice nursing in the operating room. The CertificationCouncil firmly believes that validating practice through assessment by self and peers demonstrates a commitment to evaluating nursing practice. This is one of the highest forms of professionalism, based on honesty and trust.
Julia A Kneedler, RN, EdD Assistant director of education
Film review: Fundamentals of Aseptic Technique This 22-minute film, authored by Phyllis Wells, RN, demonstrates the creation and maintenance of a sterile environment. Through the use of color coding (red-unsterile, bluesterile), Fundamentals of Aseptic Technique visually impresses eight principles of surgical asepsis: All items used within a sterile field must be sterile. 0 The edges of sterile containers are not considered sterile once the package is opened. Gowns are considered sterile in front, chest to table level; the sleeves are also sterile to two inches above the elbow. 0 Draped tables are sterile only at table level. 0 Sterile persons and items contact only sterile areas; unsterile persons and items contact unsterile areas. 0 Movement within and around a sterile field must be such as not to cause contamination of that sterile field.
Whenever bacterial barriers are permeated, contamination occurs. 0 Articles of doubtful sterility are considered unsterile. Fundamentals of Aseptic Technique is a suitable film for students and beginning practitioners and may be used as a review for experienced staff. The film is designed to present basic skills in such a way to encourage behavioral change or reinforcement on the part of the learner. Although the operating room was used as the setting for this film, aseptic technique as employed in other areas of the hospital is also demonstrated. A comprehensive instructor’s guide, which is an excellent teaching tool, is included with the film. Fundamentals of Aseptic Technique is available from the Surgical Film Library, Davis + Geck, One Casper St, Danbury, Conn 06810. The rental charge for 16 mm films is $10; 3/4 inch videocassettes may be purchased for $100. Alicia C Arvidson, RN Audiovisual Committee 0
AORN Journal, March 1979,Vol29, N o 4
679
Assessment of nursing practice for certification The operatingroom nurse pursuingAORN certification engages in a four-step process: determining eligibility, making application, validating practice, and finally, taking the examination. The applicant must meet predeterminedcriteria for each step to be certified.This column describes how applicants can meet the requirement of validating practice through self-assessment and peer assessments. The CertificationCouncil believes validating practice is an important part of certification. This is reinforced in the definition of AORN certification: “The documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing patient care before, during and after surgery.” In other words, the nurse seeking certification must be able to document that he or she is using standards of practice in patient care. This is a means of verifying, substantiating, and confirming the validity of practice. The assessment mechanism developed by the CertificationCouncil for validating practice incorporates AORN’s concept of peer review. This concept, as well as guidelines and suggestions for setting up a peer review program, were published in 1977 in the manual, Peer Review for Nursing Practice: Operating Room, by the AORN ad hoc Committee on Peer Review. The guidelines present a model that can be analyzed, synthesized, and applied in many settings. They were based on standards of nursing practice specific to the
a
operating room. Consistent with this concept of peer review, the Certification Council believes the individual nurse practicing in the operating room not only should carry the major responsibility for implementing standards of practicebut also should be involved in appraising his or her practice, as well as that of professionalpeers. Evaluating the practice of other practitionersis calledpeerreview. Peer is defined by Webster as a person of the same rank, value, and quality; a person who is equal to another in abilities and qualifications. Review means to view or see again; to examine or study again; to look back on; to go over or examine critically or deliberately. The method established by the Certification Council for validating practice includes two aspects of the peer review concept. Each applicant will be required to perform a self-assessment and to invite two registered nurse peers to do peer assessments. After the applicant has completed the application and mailed it to AORN Headquarters with the fee, he or she will receivethree copies of a tool entitled “Assessment of Professional Practice.” The applicant will complete the answer sheet accompanying the self-assessment tool and give the other tools and answer sheets to the same two RNs listed on the application for completing assessments of professional practice. These nurses must be knowledgeable about the applicant’s practice. For nurses who work in hospitals, these two nurses would probably be others who are employed in the operating room. For nurses in private practice situations, they would have to be registered nurses who have observed the applicant’s practice and can evaluate how the applicant provides patient care based on
AORN Journal, March 1979,V o l 2 9 , No 4
675
AORN certification process Eligibility
1 1
Application
Validation
1
Examination
1
Certification standards of practice. The assessorsmay also be other nurses in the community, in the operating room, or in another hospital specialty service. Nursesfrom small hospitalswho do not have a peer with the same job description may ask a registered nurseon the surgical unit or in the recovery room to evaluate the applicant’s practice and do the assessment. Assessment by a peer means assessment by a registered nurse who “is equal to another in abilities and qualifications” and can “examine and/or review“ the practice of nursing based on predetermined standards. A peer is not a physician,technician, or nonnurse;therefore, these individuals do not qualify to assess the professional practice of the applicant. The assessment tool includes four categories plus demographic information. The first category is skills: the nurse’s ability to use knowledge in clinical performance by applying technical, interpersonal, teaching, leadership, and communication concepts. Professional characteristics, the second category, focuses on attributes of a nurse that have an impact on the patient experiencing surgical intervention. The physiological and psychosocial category assesses nursing actions directed toward the physical, emotional, social, and spiritual needs of the patient experiencing surgical interven-
678
tion. The last category, accountability, deals with the nurse being responsible and answerable to self, patient, profession,and agency for nursing care of the patient experiencing surgical intervention. The assessment tool, similar to a multiplechoice examination, has approximately 50 questions plus the demographic items. The answer sheets, with spaces for marking responses, are computer-scannable. When all three assessments are received at AORN Headquarters, the data will be computerized.The applicant will receivethe following information: 1. his or her self-assessment score on a scale of 1 to 4 for each item in the four categories (1 being the lowest score and 4 the highest) 2. an average of the two nurse peer assessments or raters’ scores on a scale of 1 to4 3. a statement interpreting and explaining what the scores mean individually. It is importantthat applicants realize they are not being compared to other operating room nurses. Rather, their computerized score reflects how they individually ranked the criteria on the tool. The score reflects howthey met the criteria, not a comparisonwith other nurses. In other words, this is a criterion-referenced score, not a norm-referenced score. The Council hopes this feedback will be one way for the applicant to identify strengths and weaknesses in his or her practice. It is also a way to identify practice patterns indicating the need for more knowledge. The results become a diagnostic tool, pointing out specific areas where continued learning or study is recommended before attempting the certification examination. Based on data from the three assessments, applicants can systematically pursue avenues to assist them in implementing, maintaining, and upgrading standards of nursing practice. The end product should be selfeducation by mature, motivated nurses who can objectively determine their own needs and seek appropriate solutions, resulting in enhancedquality of patient care and assistingthe applicant obtain certification. The Certification Council believes that validating practice through assessment is an essential step in the certification process, but the results of the assessments will not be used to
AORN Journal, March 1979,V o l 2 9 , No 4
Peer assessment Who can
Who can not
Registered nurse practicing in OR
Physician Technician
Registered nurse knowledgeable about applicant’s practice
Nonnurse
keep an applicant from taking the examination. All applicants are strongly encouraged to be critical when completing the self-assessment. It is also strongly recommended that nurses chosen to do the assessments spend time thinking about all aspects of the applicant’s practice and responding accurately. Measuring the extent to which established standards are met is in itself a valuable educational en-
deavor that applicants can use to correct shortcomings and narrow the gap between established standards and actual performance. If you are fully implementingstandards of practice, including all the technical standards plus standards of nursingpractice,you will have the knowledge and experience to answer questions on the examination. Remember that the certification process is based on practice and how you, the applicant, applies knowledge and skills necessary to practice nursing in the operating room. The CertificationCouncil firmly believes that validating practice through assessment by self and peers demonstrates a commitment to evaluating nursing practice. This is one of the highest forms of professionalism, based on honesty and trust.
Julia A Kneedler, RN, EdD Assistant director of education
Film review: Fundamentals of Aseptic Technique This 22-minute film, authored by Phyllis Wells, RN, demonstrates the creation and maintenance of a sterile environment. Through the use of color coding (red-unsterile, bluesterile), Fundamentals of Aseptic Technique visually impresses eight principles of surgical asepsis: All items used within a sterile field must be sterile. 0 The edges of sterile containers are not considered sterile once the package is opened. Gowns are considered sterile in front, chest to table level; the sleeves are also sterile to two inches above the elbow. 0 Draped tables are sterile only at table level. 0 Sterile persons and items contact only sterile areas; unsterile persons and items contact unsterile areas. 0 Movement within and around a sterile field must be such as not to cause contamination of that sterile field.
Whenever bacterial barriers are permeated, contamination occurs. 0 Articles of doubtful sterility are considered unsterile. Fundamentals of Aseptic Technique is a suitable film for students and beginning practitioners and may be used as a review for experienced staff. The film is designed to present basic skills in such a way to encourage behavioral change or reinforcement on the part of the learner. Although the operating room was used as the setting for this film, aseptic technique as employed in other areas of the hospital is also demonstrated. A comprehensive instructor’s guide, which is an excellent teaching tool, is included with the film. Fundamentals of Aseptic Technique is available from the Surgical Film Library, Davis + Geck, One Casper St, Danbury, Conn 06810. The rental charge for 16 mm films is $10; 3/4 inch videocassettes may be purchased for $100. Alicia C Arvidson, RN Audiovisual Committee 0
AORN Journal, March 1979,Vol29, N o 4
679
