Inez E Tenzer, RN
Nursing students learn OR skills As a firm believer that operating room nurses have a responsibility toward reinstating the OR experience in the nursing curriculum, I decided to contribute to this goal by devising a program for nursing students at San Jose State University, San Jose, Calif. The proposal was first presented to the chairman of the university’s nursing department. Her responsiveness and cooperation resulted in a pilot program offering an OR experience for third- and fourth-year nursing students, which began in January. Three area hospitals cooperate in the program, comprised of 16 hours of lecture and 15 weeks of clinical experience for a minimum total of 210 hours. The clinical experience includes one week in the recovery room. Although many community colleges and teaching institutions are responding to the need to provide training in the operating room, their programs Inez E Tenzer, R N , is supervisor, OR-PAR, OConnor Hospital, Sun Jose, Calif. A graduate of the Bellevue School of Nursing, New York City, she received an associate of arts degree from Sun Jose City College. She is president of the AORN Sun Jose chapter.
62
are usually available only to registered nurses who want to work in surgery. In our program, the goal is to offer nursing students the special skills used in the OR so they can incorporate them into their basic nursing skills as a foundation for whatever field they choose. Once we established this as our direction, I prepared goals and objectives and a course outline, dividing our attention into four phases of emphasis. Phase 1 . This consisted of preparing an audiovisual program for students and a tour of an operating room. I had no knowledge of audiovisual techniques and found creating a slide-tape show an interesting experience. I was fortunate to have enthusiastic staff members at our hospital-the director of education and training and medical photographer-team together to produce a low-budget overview of an operating room and the people who contribute to its functioning. In September 1976, we offered the program on a voluntary basis to thirdand fourth-year students. Twenty-one attended. After viewing the slides and listening to a summary of the goals and objectives, 20 students signed to tour an OR on one of three days. Thirteen students enrolled in the courseeight seniors and five juniors.
AORN Journal, July 1977,Vol26, No I
Goals and objectives Course title: Basic OR nursing Duration: Semester Hours: Minimum-1 6 hrdwk Lecture: two consecutive days-7 am to 4 Pm Clinical experience: Remainder of semester Goal A: To provide the nursing student with exposure to nursing in the operating room Objective 1. To present an audiovisual presentation to third- and fourth-year nursing students, demonstrating an overview of the OR department Objective 2. To provide those nursing students who have viewed the audiovisual program, a tour of an OR suite Objective 3. To receive a list of nursing students interested in selecting the OR as an elective Objective 4. To initiate a semester course in operating room nursing for selected nursing students in conjunction with the department of nursing of San Jose State University Goal 8: To provide the nursing student with the concepts and application of nursing in the operating room, including postanesthesia room (PAR), to contribute to the basic skills of the student in preparation to practice as a registered nurse Objective 1. By the end of the first day of lecture, the student a. will be able to identify responsibilities of OR and PAR personnel b. will learn the principles of basic aseptic technique and be able to apply the concepts within the clinical setting c. will learn the basic concepts of electrosafety and be able to apply them in the clinical setting d. will be able to identify basic instrumentation, supplies and equipment utilized in surgery, and learn basic table set and room setup e. will learn the care and handling of instruments and standard equipment f . will be able to identify and apply the principles of circulating and scrubbing for surgical procedures including 1 . admission and discharge of patient in surgery 2. positioning 3. prepping 4. draping 5 . basic intraoperative procedure 6. sponge and needle count
7. anesthesia assistance 8. application of accessory devices (EKG-grounds) will learn the technique and procedure for hand scrubbing, gowning and gloving will be able to identify the pertinent observation required in the postsurgical patient in PAR will be able to demonstrate the clinical application of the principles of recovery room nursing
Objective 2. By the end of the second day of lecture, the student will practice and return demonstrate the following: a. hand scrubbing, gowning and gloving b. techniques of asepsis c. care and handling of instruments and standard equipment d. techniques employed to ensure electrosafety e. r m m setup 1. basic instrument setup g. sponge and needle count h. circulating and scrubbing procedure as outlined in Goal B, Objective 1, f i. admission and discharge of patient in surgery Goal C: To provide psychological and clinical support to students Objective 1. a. assign a preceptor to remain with the student throughout his/her clinical OR experience b. implement student conferences weekly with preceptor, OR supervisor to discuss surgical experience c. implement student evaluatory conferences two times a semester with preceptor, instructor, and OR supervisor d. prepare a written evaluation of student's performance in surgery and PAR Goal D: To continually review the course content's method of presentation and clinical experience and revise when necessary Objective 1. Provide the student with a form at the conclusion of the course so he/she may evaluate those areas specified in Goal B, Objectives 1 and 2 Objective 2. Submit a written report to the assistant administrator of nursing and department chairperson at the conclusion of the course, summarizing the evaluation and presenting appropriate recommendations
AORN Journal, J u l y 1977, Val 26, N o 1
63
Two-day lecture schedule Day 1 7 am: Introductions 7:30 to 8 am: Review of OR responsibilities of OWPAR personnel 8 to 8:30 am:Basic principles of aseptic techniques 8:30 to 9 am: Hand scrubbing, gowning and gloving 9 to 9:15 am: Coffee 9:15 to 10 am: Electrosafety 10 to 11:30 am: Basic instruments, supplies and equipment, room setup, table setup 11:30 to 12:15 pm: Lunch 12:15 to 3:30 pm: Circulatinglscrubbing 12:15 to 2 pm: 12:15 to 12:30 pm: room preparedness 12:30 to 12:40 pm: admission of patient to surgery 12:40 to 12:50 pm: patient positioning 12:50 to 1 pm: patient monitoring 1:05 to 1:30 pm: prepping 1:30 to 1:40pm: anesthesia induction 1:40 to 2 pm: care and handling of standard equipment and supplies, electrostatic unit (ESU)-suction 2 to 2:15 pm: Coffee 2:15 to 2:30 pm: Preparation of sterile field 2:30 to 2:45 pm: Draping 2:45 to 255 pm: Setting up accessories, Bovie-suction 2:55 to 3:15 pm: lntraoperative routine 3:15 to 3:30 pm: Dressing 3:30 to 3:45 pm: Sponge and needle count 3:45 to 4 pm: Local patient Day 2 7 to 7:30 am: Review hand scrub, gowning and gloving
To participate, students must meet certain criteria, including the ability to spend a minimum of 16 hours a week in the clinical setting. They are required to attend the audiovisual program, tour an OR, submit goals and objectives for taking the course, submit a commitment for time and days, indicate hospital preference, and
64
7:30 to 8 am: Return demonstration of hand scrub, gowning and gloving 8 to 8:30 am: Return demonstration of techniques reflecting comprehension of asepsis: a. opening packs and supplies b. passing supplies onto a sterile field c. pouring solutions d. establishing perimeters of a sterile field 8:30 to 9:15 am: Retum demonstration of preparing a room for surgery 9:15 to 9:30 am: Coffee 9:30 to 10 am: Retum demonstration in application of monitoring devices and anesthesia preparation 10 to 10:30 am: Return demonstration in utilization of EUS and applying the principles of electrosafety 10:30 to 11 am: Return demonstration, sponge and needle count 11 to 11:30am: Retum demonstration in admitting and transferring of patient 11:30 to noon: Lunch Noon to 1 pm: Return demonstration in setting up a Mayo stand and back table 1 to 2 pm: Demonstration of the procedures that are the responsibilities of the circulating nurse 2 to 2:15 pm: Coffee 2:15 to 3:15 pm: Demonstration of procedures that are the responsibilities of the scrub nurse 3:15 to 3:45 pm: Local patients 3:45 pm: Questions
attend the introductory conference with the preceptor liaison and clinical coordinator. Their responsibilities also include attending a one-day lecture and one-day return demonstration, maintaining up-to-date work experience records, submitting midsemester evaluations of goals and objectives, participating in preceptor-student and
AORN Journal, July 1977, Vol26, No 1
end-of-semester conferences, and submitting evaluations of the course. Of the 13 enrolled, approximately one-half planned to work in surgery after graduation. The remainder were interested in the unknown experience, having been aroused by the brief exposure to a n OR or the audiovisual program or both. Phase 2. This required developing the course, “Basic OR nursing,” and its practicum. Before entering surgery, students attend one day of lectures and one day return demonstration, scheduled shortly before the start of the semester. Eight hours hardly seem adequate to include all the pertinent information, but we decided to evaluate its effectiveness before rearrangmg the schedule. Many OR supervisors were interested in providing the clinical experience, but only two were selected so we could maintain adequate contact and eliminate problems likely to arise with a new venture. To provide a smooth transition from the university setting to the clinical setting and t o alleviate apprehensions, we make a concerted effort to ensure cohesive communication among students, the university, and the hospitals. Preceptors, who are voluntary staff members meeting specific criteria, are assigned to the students and keep in close contact with them throughout their practicum. Meetings orient the preceptors to the requirements of the positions, the resource material to be used, and the course outline. Thus, they are aware of the preparation of the students entering their departments. Preceptors also are required to attend meetings where they meet the students and plan the orientation for the clinical experience, covering such subjects as where to go, attire, protocol, and the first day’s schedule .
Preceptor qualifications Purpose: To provide an individual clinical instructor for the nursing student in the OR to maintain a consistent, structured learning experience. Qualifications: 1. For OR and PAR, a minimum of one year appropriate experience 2. Ability to teach (as demonstrated by effective verbal and written communication skills), determined by the individual and evaluated by the OR supervisor or designated person 3. Patient, understanding, tolerant. Responsibilities: 1. Attend preceptor meeting prior to beginning of course 2. Attend introduction meeting to meet students 3. Review student goals and objectives 4. Review course goals and objectives and course content 5. Prepare written handouts for students to use as a resource, utilizing course content but adapting procedures to specific hospitals 6. Develop the OR experience with the student prior to higher beginning in surgery 7. Maintain work experience record (student responsibility) 8. Meet with student and OR supervisor or designated person weekly for three weeks to discuss experience, feelings, progress, and plans; after three weeks, meetings can be as necessary 9. Submit student’s new goals and objectives with old ones to clinical coordinator 10. Give written midsemester evaluation in triplicate (one each to student, preceptor, clinical coordinator) 11. Attend midsemester conference of all preceptors, students, preceptor liaison, and clinical coordinator to evaluate the course and share feelings, progress, etc 12. Submit workshop records to clinical coordinator 13. Attend end-of-semester conference 14. Present certificate of completion. PAR preceptor is requested to participate in all preceptor meetings.
AORN Journal, July 1977, Val 26, No 1
65
Pilot program calendar Dec 15: Student meeting to discuss course, review goals and objectives, requirements, calendar, establish specific dates and times for experience and hospital Second week of January: OR supervisor of each participating hospital will receive list of names of students, dates and times for preceptors to determine schedules Jan 24: Preceptor meeting; hand out packets, discuss course, etc Jan 27: Lecture Jan 28: Return demonstration 4:15 pm-Introduction of preceptors
A calendar is distributed to the OR supervisors, preceptors, and students as part of a packet containing the goals and objectives, student criteria, preceptor qualifications, and course outline. For use during the course, additional tools include a return demonstration card that is signed and kept on file in the department of nursing. Students are responsible for maintaining daily work experience records listing the date, type of procedure, name of physician, and whether they “scrubbed” or circulated. They also summarize their clinical experiences on work summary sheets a t midsemester and end of semester. At the same time, preceptors complete student evaluations, which are placed in the students’ files. Students are evaluated on their attitude, adaptability, dexterity, organization, setting priorities, aseptic technique, verbal and written communication, preparation, attire, rapport with others, and attendance. At midsemester, students submit new goals and objectives comparing them with their original reasons for taking the course. At the end of the semester, they complete course eval-
66
uations to assist in determining the effectiveness of the program, the teaching methods, and the clinical experience. Phase 3. Perhaps the most important step is providing a n atmosphere conducive to learning. Two of the participating hospitals are community institutions staffed by private physicians. The third is the county teaching facility. The student is assigned to the hospital of hidher choice, based on location and previous exposure. In our hospital, the response to the program is extremely positive. Many physicians and nurses expressed interest in having students learn to scrub and circulate on their cases. We must always remember, however, that we are offering our expertise and knowledge to future nurses so they can become skillful practitioners. We do not want students to assume staff work when illness and vacation deplete personnel. Their experience must be structured to meet their needs and the goals of the course while permitting flexibility so they have the opportunity to accept more responsibility as their abilities increase. We also need to remember that the manner in which we receive students and the friendliness and warmth projected by staff members are invaluable supports for those groping in unfamiliar territory. We believe that a pleasant and worthwhile experience is retained and stimulates further interest. Phase 4 . A t the conclusion of the second day of lecture, preceptors and students meet and prepare for the first week in the OR. For the first three weeks, the preceptor, student, and OR supervisor or her designee hold weekly meetings to discuss feelings, experience, progress, and the following week’s schedule. These meetings also
AORN Journal, Ju1.y 1977, V o l 2 6 , N o 1
~
-~
Evaluation form Course title: Basic OR nursing Dates: 1. Did the course meet its goals and objectives? If not, why not? 2. Did the course meet your goals and objectives? If not, why not? 3. Were the preparatory classes conducted in an organized, informed manner? If not, in what way could they be improved? 4. Did the preparatory classes offer sufficient information? If not, what would you suggest be included? Did they help to make the OR experience more comfortable? 5. Were communications, written and verbal, sufficient throughout the planning and during the course? If not, why not? 6. Did the instructors present the material in an organized, knowledgeable, effective manner? If not, what was the least effective, and why? 7. Did you work well with your preceptor? If not, what difficulties did you encounter? 8. Did you feel comfortable in your OR? Did you encounter difficulties from surgeonsanesthesiologists-other personnel? If yes, please explain in detail and indude any suggestions for preventing or resolving the conflicts. 9. Did you feel you were exposed to sufficient experience in the responsibilities of the RN in surgery? If not, please explain what you think could be done to expand the experience. 10. Are you able to relate the nursing skills you learned in the OR to other fields of nursing after this course? List at least five of these skills. If not, please explain in what ways you benefited from taking this course. 11. What suggestions do you have for improving the course? Audiovisual program: Lectures: Return demonstration: Instructors: Preceptors: Clinical experience: Conferences: 12. Do you think the course should be continued? 13. Do you think “Basic OR nursing” should be a mandatory course in the nursing curriculum?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes Yes
No No
Student (optional)
AORN Journal, July 1977, Vol26, No 1
67
provide an opportunity for both the preceptor and student to feel comfortable with one another, knowing that assignments can be changed; students and staff members should enjoy their experience together. At San Jose State University, fourth-level students have time allotted for practice for which “Basic OR nursing” is substituted. The majority of academic classes are completed by this time, and seniors can expend a minimum of 16 hours and up to 24 hours a week in their practicum. Third-level students, on the other hand, are burdened with heavy schedules and have little free time. Therefore, they can request to attend the course during the summer with the approval of the department chairman. By having one faculty member at the school as resource, we meet the requirements of the university for the continuation of the course. During the regular session, we eliminate the need for three university instructors to cover the operating room by having the chairman of the department of nursing serve as preceptor liaison, the academic resource person for students. As clinical coordinator, a title created to distinguish responsibility, I integrate the OR experience, lectures, and course development. Within time, I hope the OR experience will resume its rightful place in the curriculum. We will not have to organize pilot programs and special projects to teach OR skills to nursing students. In the meantime, we must find ways to afford students prolonged experience in our specialty so they enter nursing with a diversified prep;ration including the operating room.
0
68
NLN establishes doctoral fell0 wships The National League for Nursing (NLN) has established a fellowship for doctoral study in nursing with funds from a $10,000 biennial grant from the F A Davis Company and Clarence Wilbur Taber, Jr. The first fellowship will be awarded at the NLN convention April 29 to May 2, 1979, in Atlanta. The Davis Company, publishers of nursing texts, will present the funds in memory of Elizabeth Irene Craven Davis, head of the company from 1917 to 1960. Taber’s gift will be in memory of his father, creator of Taber’s Cyclopedic Medical Dictionary. The award will be given in $5,000 annual installments for two years. To qualify, candidates must be accepted into a doctoral program and have published articles in professional journals or books. Selection will be by a committee established by the Council of Baccalaureate and Higher Degree Programs of NLN, which will administer the program. Further information may be obtained by writing to NLN, 10 Columbus Cir, New York, NY 10019.
LA medical director named JCAH head John Ellsworth Affeldt, MD, has been appointed director of the Joint Commission on Accreditation of Hospitals (JCAH) by the JCAH Board of Commissioners. He will succeed John D Porterfield Ill, MD, JCAH director since in 1965, who is retiring in August. Dr Affeldt has been medical director of the
Los Angeles County Department of Health Services since 1972. He received a bachelor of arts degree from Emmanuel Missionary College (now Andrews University),Berrien Springs, Mich, and his MD from Loma Linda University, Los Angeles. Dr Affeldt is a fellow of the American College of Physicians and a diplomate of the American Board of Internal Medicine.
AORN Journal, July 1977, V o l 2 6 , No 1
Nursing students learn OR skills As a firm believer that operating room nurses have a responsibility toward reinstating the OR experience in the nursing curriculum, I decided to contribute to this goal by devising a program for nursing students at San Jose State University, San Jose, Calif. The proposal was first presented to the chairman of the university’s nursing department. Her responsiveness and cooperation resulted in a pilot program offering an OR experience for third- and fourth-year nursing students, which began in January. Three area hospitals cooperate in the program, comprised of 16 hours of lecture and 15 weeks of clinical experience for a minimum total of 210 hours. The clinical experience includes one week in the recovery room. Although many community colleges and teaching institutions are responding to the need to provide training in the operating room, their programs Inez E Tenzer, R N , is supervisor, OR-PAR, OConnor Hospital, Sun Jose, Calif. A graduate of the Bellevue School of Nursing, New York City, she received an associate of arts degree from Sun Jose City College. She is president of the AORN Sun Jose chapter.
62
are usually available only to registered nurses who want to work in surgery. In our program, the goal is to offer nursing students the special skills used in the OR so they can incorporate them into their basic nursing skills as a foundation for whatever field they choose. Once we established this as our direction, I prepared goals and objectives and a course outline, dividing our attention into four phases of emphasis. Phase 1 . This consisted of preparing an audiovisual program for students and a tour of an operating room. I had no knowledge of audiovisual techniques and found creating a slide-tape show an interesting experience. I was fortunate to have enthusiastic staff members at our hospital-the director of education and training and medical photographer-team together to produce a low-budget overview of an operating room and the people who contribute to its functioning. In September 1976, we offered the program on a voluntary basis to thirdand fourth-year students. Twenty-one attended. After viewing the slides and listening to a summary of the goals and objectives, 20 students signed to tour an OR on one of three days. Thirteen students enrolled in the courseeight seniors and five juniors.
AORN Journal, July 1977,Vol26, No I
Goals and objectives Course title: Basic OR nursing Duration: Semester Hours: Minimum-1 6 hrdwk Lecture: two consecutive days-7 am to 4 Pm Clinical experience: Remainder of semester Goal A: To provide the nursing student with exposure to nursing in the operating room Objective 1. To present an audiovisual presentation to third- and fourth-year nursing students, demonstrating an overview of the OR department Objective 2. To provide those nursing students who have viewed the audiovisual program, a tour of an OR suite Objective 3. To receive a list of nursing students interested in selecting the OR as an elective Objective 4. To initiate a semester course in operating room nursing for selected nursing students in conjunction with the department of nursing of San Jose State University Goal 8: To provide the nursing student with the concepts and application of nursing in the operating room, including postanesthesia room (PAR), to contribute to the basic skills of the student in preparation to practice as a registered nurse Objective 1. By the end of the first day of lecture, the student a. will be able to identify responsibilities of OR and PAR personnel b. will learn the principles of basic aseptic technique and be able to apply the concepts within the clinical setting c. will learn the basic concepts of electrosafety and be able to apply them in the clinical setting d. will be able to identify basic instrumentation, supplies and equipment utilized in surgery, and learn basic table set and room setup e. will learn the care and handling of instruments and standard equipment f . will be able to identify and apply the principles of circulating and scrubbing for surgical procedures including 1 . admission and discharge of patient in surgery 2. positioning 3. prepping 4. draping 5 . basic intraoperative procedure 6. sponge and needle count
7. anesthesia assistance 8. application of accessory devices (EKG-grounds) will learn the technique and procedure for hand scrubbing, gowning and gloving will be able to identify the pertinent observation required in the postsurgical patient in PAR will be able to demonstrate the clinical application of the principles of recovery room nursing
Objective 2. By the end of the second day of lecture, the student will practice and return demonstrate the following: a. hand scrubbing, gowning and gloving b. techniques of asepsis c. care and handling of instruments and standard equipment d. techniques employed to ensure electrosafety e. r m m setup 1. basic instrument setup g. sponge and needle count h. circulating and scrubbing procedure as outlined in Goal B, Objective 1, f i. admission and discharge of patient in surgery Goal C: To provide psychological and clinical support to students Objective 1. a. assign a preceptor to remain with the student throughout his/her clinical OR experience b. implement student conferences weekly with preceptor, OR supervisor to discuss surgical experience c. implement student evaluatory conferences two times a semester with preceptor, instructor, and OR supervisor d. prepare a written evaluation of student's performance in surgery and PAR Goal D: To continually review the course content's method of presentation and clinical experience and revise when necessary Objective 1. Provide the student with a form at the conclusion of the course so he/she may evaluate those areas specified in Goal B, Objectives 1 and 2 Objective 2. Submit a written report to the assistant administrator of nursing and department chairperson at the conclusion of the course, summarizing the evaluation and presenting appropriate recommendations
AORN Journal, J u l y 1977, Val 26, N o 1
63
Two-day lecture schedule Day 1 7 am: Introductions 7:30 to 8 am: Review of OR responsibilities of OWPAR personnel 8 to 8:30 am:Basic principles of aseptic techniques 8:30 to 9 am: Hand scrubbing, gowning and gloving 9 to 9:15 am: Coffee 9:15 to 10 am: Electrosafety 10 to 11:30 am: Basic instruments, supplies and equipment, room setup, table setup 11:30 to 12:15 pm: Lunch 12:15 to 3:30 pm: Circulatinglscrubbing 12:15 to 2 pm: 12:15 to 12:30 pm: room preparedness 12:30 to 12:40 pm: admission of patient to surgery 12:40 to 12:50 pm: patient positioning 12:50 to 1 pm: patient monitoring 1:05 to 1:30 pm: prepping 1:30 to 1:40pm: anesthesia induction 1:40 to 2 pm: care and handling of standard equipment and supplies, electrostatic unit (ESU)-suction 2 to 2:15 pm: Coffee 2:15 to 2:30 pm: Preparation of sterile field 2:30 to 2:45 pm: Draping 2:45 to 255 pm: Setting up accessories, Bovie-suction 2:55 to 3:15 pm: lntraoperative routine 3:15 to 3:30 pm: Dressing 3:30 to 3:45 pm: Sponge and needle count 3:45 to 4 pm: Local patient Day 2 7 to 7:30 am: Review hand scrub, gowning and gloving
To participate, students must meet certain criteria, including the ability to spend a minimum of 16 hours a week in the clinical setting. They are required to attend the audiovisual program, tour an OR, submit goals and objectives for taking the course, submit a commitment for time and days, indicate hospital preference, and
64
7:30 to 8 am: Return demonstration of hand scrub, gowning and gloving 8 to 8:30 am: Return demonstration of techniques reflecting comprehension of asepsis: a. opening packs and supplies b. passing supplies onto a sterile field c. pouring solutions d. establishing perimeters of a sterile field 8:30 to 9:15 am: Retum demonstration of preparing a room for surgery 9:15 to 9:30 am: Coffee 9:30 to 10 am: Retum demonstration in application of monitoring devices and anesthesia preparation 10 to 10:30 am: Return demonstration in utilization of EUS and applying the principles of electrosafety 10:30 to 11 am: Return demonstration, sponge and needle count 11 to 11:30am: Retum demonstration in admitting and transferring of patient 11:30 to noon: Lunch Noon to 1 pm: Return demonstration in setting up a Mayo stand and back table 1 to 2 pm: Demonstration of the procedures that are the responsibilities of the circulating nurse 2 to 2:15 pm: Coffee 2:15 to 3:15 pm: Demonstration of procedures that are the responsibilities of the scrub nurse 3:15 to 3:45 pm: Local patients 3:45 pm: Questions
attend the introductory conference with the preceptor liaison and clinical coordinator. Their responsibilities also include attending a one-day lecture and one-day return demonstration, maintaining up-to-date work experience records, submitting midsemester evaluations of goals and objectives, participating in preceptor-student and
AORN Journal, July 1977, Vol26, No 1
end-of-semester conferences, and submitting evaluations of the course. Of the 13 enrolled, approximately one-half planned to work in surgery after graduation. The remainder were interested in the unknown experience, having been aroused by the brief exposure to a n OR or the audiovisual program or both. Phase 2. This required developing the course, “Basic OR nursing,” and its practicum. Before entering surgery, students attend one day of lectures and one day return demonstration, scheduled shortly before the start of the semester. Eight hours hardly seem adequate to include all the pertinent information, but we decided to evaluate its effectiveness before rearrangmg the schedule. Many OR supervisors were interested in providing the clinical experience, but only two were selected so we could maintain adequate contact and eliminate problems likely to arise with a new venture. To provide a smooth transition from the university setting to the clinical setting and t o alleviate apprehensions, we make a concerted effort to ensure cohesive communication among students, the university, and the hospitals. Preceptors, who are voluntary staff members meeting specific criteria, are assigned to the students and keep in close contact with them throughout their practicum. Meetings orient the preceptors to the requirements of the positions, the resource material to be used, and the course outline. Thus, they are aware of the preparation of the students entering their departments. Preceptors also are required to attend meetings where they meet the students and plan the orientation for the clinical experience, covering such subjects as where to go, attire, protocol, and the first day’s schedule .
Preceptor qualifications Purpose: To provide an individual clinical instructor for the nursing student in the OR to maintain a consistent, structured learning experience. Qualifications: 1. For OR and PAR, a minimum of one year appropriate experience 2. Ability to teach (as demonstrated by effective verbal and written communication skills), determined by the individual and evaluated by the OR supervisor or designated person 3. Patient, understanding, tolerant. Responsibilities: 1. Attend preceptor meeting prior to beginning of course 2. Attend introduction meeting to meet students 3. Review student goals and objectives 4. Review course goals and objectives and course content 5. Prepare written handouts for students to use as a resource, utilizing course content but adapting procedures to specific hospitals 6. Develop the OR experience with the student prior to higher beginning in surgery 7. Maintain work experience record (student responsibility) 8. Meet with student and OR supervisor or designated person weekly for three weeks to discuss experience, feelings, progress, and plans; after three weeks, meetings can be as necessary 9. Submit student’s new goals and objectives with old ones to clinical coordinator 10. Give written midsemester evaluation in triplicate (one each to student, preceptor, clinical coordinator) 11. Attend midsemester conference of all preceptors, students, preceptor liaison, and clinical coordinator to evaluate the course and share feelings, progress, etc 12. Submit workshop records to clinical coordinator 13. Attend end-of-semester conference 14. Present certificate of completion. PAR preceptor is requested to participate in all preceptor meetings.
AORN Journal, July 1977, Val 26, No 1
65
Pilot program calendar Dec 15: Student meeting to discuss course, review goals and objectives, requirements, calendar, establish specific dates and times for experience and hospital Second week of January: OR supervisor of each participating hospital will receive list of names of students, dates and times for preceptors to determine schedules Jan 24: Preceptor meeting; hand out packets, discuss course, etc Jan 27: Lecture Jan 28: Return demonstration 4:15 pm-Introduction of preceptors
A calendar is distributed to the OR supervisors, preceptors, and students as part of a packet containing the goals and objectives, student criteria, preceptor qualifications, and course outline. For use during the course, additional tools include a return demonstration card that is signed and kept on file in the department of nursing. Students are responsible for maintaining daily work experience records listing the date, type of procedure, name of physician, and whether they “scrubbed” or circulated. They also summarize their clinical experiences on work summary sheets a t midsemester and end of semester. At the same time, preceptors complete student evaluations, which are placed in the students’ files. Students are evaluated on their attitude, adaptability, dexterity, organization, setting priorities, aseptic technique, verbal and written communication, preparation, attire, rapport with others, and attendance. At midsemester, students submit new goals and objectives comparing them with their original reasons for taking the course. At the end of the semester, they complete course eval-
66
uations to assist in determining the effectiveness of the program, the teaching methods, and the clinical experience. Phase 3. Perhaps the most important step is providing a n atmosphere conducive to learning. Two of the participating hospitals are community institutions staffed by private physicians. The third is the county teaching facility. The student is assigned to the hospital of hidher choice, based on location and previous exposure. In our hospital, the response to the program is extremely positive. Many physicians and nurses expressed interest in having students learn to scrub and circulate on their cases. We must always remember, however, that we are offering our expertise and knowledge to future nurses so they can become skillful practitioners. We do not want students to assume staff work when illness and vacation deplete personnel. Their experience must be structured to meet their needs and the goals of the course while permitting flexibility so they have the opportunity to accept more responsibility as their abilities increase. We also need to remember that the manner in which we receive students and the friendliness and warmth projected by staff members are invaluable supports for those groping in unfamiliar territory. We believe that a pleasant and worthwhile experience is retained and stimulates further interest. Phase 4 . A t the conclusion of the second day of lecture, preceptors and students meet and prepare for the first week in the OR. For the first three weeks, the preceptor, student, and OR supervisor or her designee hold weekly meetings to discuss feelings, experience, progress, and the following week’s schedule. These meetings also
AORN Journal, Ju1.y 1977, V o l 2 6 , N o 1
~
-~
Evaluation form Course title: Basic OR nursing Dates: 1. Did the course meet its goals and objectives? If not, why not? 2. Did the course meet your goals and objectives? If not, why not? 3. Were the preparatory classes conducted in an organized, informed manner? If not, in what way could they be improved? 4. Did the preparatory classes offer sufficient information? If not, what would you suggest be included? Did they help to make the OR experience more comfortable? 5. Were communications, written and verbal, sufficient throughout the planning and during the course? If not, why not? 6. Did the instructors present the material in an organized, knowledgeable, effective manner? If not, what was the least effective, and why? 7. Did you work well with your preceptor? If not, what difficulties did you encounter? 8. Did you feel comfortable in your OR? Did you encounter difficulties from surgeonsanesthesiologists-other personnel? If yes, please explain in detail and indude any suggestions for preventing or resolving the conflicts. 9. Did you feel you were exposed to sufficient experience in the responsibilities of the RN in surgery? If not, please explain what you think could be done to expand the experience. 10. Are you able to relate the nursing skills you learned in the OR to other fields of nursing after this course? List at least five of these skills. If not, please explain in what ways you benefited from taking this course. 11. What suggestions do you have for improving the course? Audiovisual program: Lectures: Return demonstration: Instructors: Preceptors: Clinical experience: Conferences: 12. Do you think the course should be continued? 13. Do you think “Basic OR nursing” should be a mandatory course in the nursing curriculum?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes Yes
No No
Student (optional)
AORN Journal, July 1977, Vol26, No 1
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provide an opportunity for both the preceptor and student to feel comfortable with one another, knowing that assignments can be changed; students and staff members should enjoy their experience together. At San Jose State University, fourth-level students have time allotted for practice for which “Basic OR nursing” is substituted. The majority of academic classes are completed by this time, and seniors can expend a minimum of 16 hours and up to 24 hours a week in their practicum. Third-level students, on the other hand, are burdened with heavy schedules and have little free time. Therefore, they can request to attend the course during the summer with the approval of the department chairman. By having one faculty member at the school as resource, we meet the requirements of the university for the continuation of the course. During the regular session, we eliminate the need for three university instructors to cover the operating room by having the chairman of the department of nursing serve as preceptor liaison, the academic resource person for students. As clinical coordinator, a title created to distinguish responsibility, I integrate the OR experience, lectures, and course development. Within time, I hope the OR experience will resume its rightful place in the curriculum. We will not have to organize pilot programs and special projects to teach OR skills to nursing students. In the meantime, we must find ways to afford students prolonged experience in our specialty so they enter nursing with a diversified prep;ration including the operating room.
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NLN establishes doctoral fell0 wships The National League for Nursing (NLN) has established a fellowship for doctoral study in nursing with funds from a $10,000 biennial grant from the F A Davis Company and Clarence Wilbur Taber, Jr. The first fellowship will be awarded at the NLN convention April 29 to May 2, 1979, in Atlanta. The Davis Company, publishers of nursing texts, will present the funds in memory of Elizabeth Irene Craven Davis, head of the company from 1917 to 1960. Taber’s gift will be in memory of his father, creator of Taber’s Cyclopedic Medical Dictionary. The award will be given in $5,000 annual installments for two years. To qualify, candidates must be accepted into a doctoral program and have published articles in professional journals or books. Selection will be by a committee established by the Council of Baccalaureate and Higher Degree Programs of NLN, which will administer the program. Further information may be obtained by writing to NLN, 10 Columbus Cir, New York, NY 10019.
LA medical director named JCAH head John Ellsworth Affeldt, MD, has been appointed director of the Joint Commission on Accreditation of Hospitals (JCAH) by the JCAH Board of Commissioners. He will succeed John D Porterfield Ill, MD, JCAH director since in 1965, who is retiring in August. Dr Affeldt has been medical director of the
Los Angeles County Department of Health Services since 1972. He received a bachelor of arts degree from Emmanuel Missionary College (now Andrews University),Berrien Springs, Mich, and his MD from Loma Linda University, Los Angeles. Dr Affeldt is a fellow of the American College of Physicians and a diplomate of the American Board of Internal Medicine.
AORN Journal, July 1977, V o l 2 6 , No 1
