Program integrates OR, professional nurses’ needs Joan M Weintraub, RN

perating room nursing exists as a specialty because of its task orientation and the need for physical isolation of the patient intraoperatively. As these needs were recognized in the mid-to-late nineteenth century, operating room nurses gradually moved away from general nursing practice t o develop a highly specialized and relatively isolated area of practice. Other members of the surgical nursing care team have tended to relegate the OR nurse to an “out-of-sight, out-of-mind” existence. Operating room nurses have become equally limited in their understanding of the functions and problems of other medical-surgicalnurses. As OR nurses, we need to change these images and attitudes if we want our nurse colleagues to support our role in professional nursing and to cooperate with us in the care of the surgical patient. At Beth Israel Hospital in Boston, we believe operating room nurses can move toward the interrelated goals of professional understanding and continuous quality patient care by encouraging an exchange of information between OR and other professional nurses, especially those caring for surgical patients. Despite the needs for specializationand physical separation, we believe this ex: change can take place through integrating education programs for OR nurses with professional nursing education programs throughout the hospital. This article describes how we have begun to implement this idea. The surgery suite at Beth Israel Hospital includes 11operating rooms and a cystoscopy room and is staffed by apJoan M Weintraub, RN, is instructional coordinator for operating room practice at Beth Israel Hospital, Boston. She is a graduate of Barnes Hospital School of Nursing, St Louis.

Weintraub holds a BA in nursing from Sirnrnons College, Boston.

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proximately 40 registered nurses. These nurses range in OR experience from none to 15 years and have been educated in associate, baccalaureate, and diploma programs. The educational needs of the staff a r e cooperatively evaluated by the instructional coordinator for operating room practice and others in leadership positions in the OR. The instructional coordinator also assists the staff in meeting these needs by developing and coordinating OR orientation and in-service programs. The coordinator is accountable to the clinical director of nursing for the OR and allied areas (OR, recovery room, special procedures, and ambulatory surgery). Staff nurses, assistant head nurses, and head nurses assist in the planning and presentation of OR educational programs. It is expected that staff will a t some time volunteer to present or help prepare a program on some topic of interest. The director of nursing services, the OR clinical nursing director, and the associate director for nursing education and research provide the time, space, materials, and specialized nursing personnel necessary for the operating room staff’s educational efforts. This support reflects the nursing service’s philosophy, which states, “We are concerned with creating and preserving an environment for patients and staff that will ensure excellence of care and will support continuing research and education in nursing practice .” In most areas of the hospital, the educational needs of professional nurses are met by educational coordinators, clinical specialists, an in-service instructor, and a research coordinator who work within the Department of Nursing Education and Research. The OR instructional coordinator meets regularly with members of this department to keep the OR staff involved in educational activities throughout the


Table 1

Core orientation topics Introduction to the nursing process Philosophy of primary nursing Principles of infection transmission and preventing of nosocomical infection Religious needs of patients and family Introduction to quality assurance procedure Cardiopulmonary resuscitation (CPR) Procedure and equipment review Principles of cardiac monitoring Chest physical therapy Respiratory therapy Introduction to gerontology nursing hospital. This includes identifying programs appropriate for OR personnel to attend or help present and publicizing OR programs that may interest nurses from other areas. In our OR, all educational programs fall into one of three categories: clinical excellence, professional growth, or personal growth. These categories provide convenient headings that help describe our efforts to integrate OR and other hospital nursing education programs. Clinical excellence. Education for clinical excellence begins in OR orientation. We have a traditional orientation program with content that may vary according to the orientee’s level of experience. The instructional coordinator presents a one- to two-week introductory segment in the classroom, followed by clinical teaching by senior staff nurse preceptors for the next several weeks. The length of clinical teaching depends on the individual orientee, the amount and type of his or her experience, and the unit’s circumstances. Length of clinical teaching can range from 6 to 16weeks. In addition, monthly hospital-wide core orientation for new nursing personnel, offered by the Department of Nursing Education and Research, is mandatory for OR orientees.

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These sessions include topics relevant to the ORnurse (Table 1).Attendance a t core orientation allows OR orientees to meet with other nurses who are also new, and they become familiar with the resource personnel who conduct the sessions and learn about the role of the Department of Nursing Education and Research. Surgical nursing service orientation is a segment of the general hospital core orientation that is particularly important for the OR orientee. This is a sixhour session presented by the educational coordinator for surgical nursing on the care of the preoperative and postoperative patient. I t provides t h e operating room orientee with a n overview of non-OR surgical nursing and the surgical patient’s experience a t Beth Israel Hospital. In addition, information incorporated into these sessions by the OR instructional coordinator enables staff nurses from the surgical units to become more aware of the patient’s experience in the OR and how it influences his preoperative and postoperative care. Education for clinical experience continues throughout the OR nurse’s employment, primarily through weekly participation i n one-hour in-service programs. Most of the subject matter is specific to OR practice and may arise from staff requests or from the need to introduce or review equipment, policy, or procedures. Personnel from other departments, such as anesthesia or nursing education and research, may be invited to speak, but generally, these sessions are presented by our OR staff. Some in-service offerings are repeated frequently t o assure attendance by every staff member t h e required number of times per year. This number is determined by the head nurse. Topics presented repetitively are those that every staff nurse must be familiar with to practice a t a minimum level of com-


petence, such a s cardiopulmonary resuscitation review, care of bronchoscopy o r laparoscopy equipment, patient safety in transfer, emergency drugs and equipment, instrument care, or other topics common to OR in-service. Some programs have potential interest for employee groups smaller t h a n t h e operating room staff, such as personnel in labor and delivery, special procedures (invasive radiography), transportation, central processing, or pharmacy. Staff in these departments may have similar needs and concerns, but lack the resources t o develop t h e i r own inservice programs. Including these personnel in operating room in-service programs can decrease wasteful duplication and improve communication and patient care. Technical in-service programs are being standardized so they are almost self-perpetuating. This is done by developing a format that allows for thorough coverage of each in-service topic. Once written, the in-service program can be presented by any senior staff nurse. Most programs will need only periodic content review and updating as techniques or procedures change. Under t h i s system, t h e OR nurse educator is relieved of constant procedure and equipment review and is free to develop other topics for continuing education programs. The dates and times of OR in-service meetings are published by the Department of Nursing Education and Research in an educational calendar, which is circulated throughout the hospital. Any member of the hospital staff may call the OR for more specific information. While in-service programs generally cover information technical or basic to a n employee’s performance, OR continuing education programs a t Beth Israel Hospital focus on more advanced technical and theoretical knowledge pertinent to the operating room nurse’s

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ersonal growth topics are most difficult to justify as relevant or cost effective.


continued professional development. These hour-long continuing education offerings are presented to the entire OR staff each week. Subject matter is usually organized in clusters of two to six one-hour talks that relate to a particular specialty such as orthopedics, general surgery, and others. The continuing education programs are planned several months in advance and are also publicized throughout the hospital on the educational calendar. We strongly encourage our staff to present programs whenever possible. We also request speakers from the large number of nurses, physicians, and other professionals at the hospital who are qualified as resource persons on particular subjects. Professional growth. To encourage the professional growth of our staff, OR nurses attend and help present continuing education programs in other areas of the hospital. They are kept informed of these opportunities through the liason activities of the OR instructional coordinator with the Department of Nursing Education and Research. They also learn of continuing education possibilities through contact with other nurses with whom they serve as members of nursing committees. Recently, operating room nurses have contributed to workshops on “Endocrine Problems in Nursing” and “The Nursing Care of the Patient Having a Mastectomy.” They also planned and presented “The

Role of the Professional Nurse in the OR” a t nursing grand rounds, a monthly 1%-hourprogram for all hospital nursing staff. When OR staff nurses present programs or act as resources for their professional nurse colleagues, they become more aware of their area of expertise and the unique contribution they can make to nursing in other areas. We believe this self-awareness and the validation of expertise by others promote a positive professional self-image and lead t o professional growth. The desire of some OR staff nurses to keep abreast of the rapid changes in nursing in general, and OR nursing in particular, has prompted attendance at programs both within and outside the hospital on nursing research, nursing and the law, standards of nursing practice, professional writing, nursing audit, and other current topics. Whenever possible, nurses attending these programs are asked to present a summary of the content at a staff meeting. This is also done for any program a staff member has prepared and presented. All staff members, but particularly the OR instructional coordinator, are responsible for posting announcements to remind others of the many available programs that can help them improve their nursing practice, meet mandatory continuing education requirements, or pursue an interest in some area of nursing that they have little contact with. Personal growth. There is little doubt

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that personal maturity aids professional growth and achievement of clinical excellence. Perhaps more noticeable, personal maturity may make the OR nurse more pleasant and effective in her daily relationships with staff and patients. Since the amount of time the OR nurse spends with the awake patient is relatively limited, she may unfavorably compare the impact of her behavior with that of other nurses caring for surgical patients. Her behavior is, however, important. The patient coming for surgery is generally anxious and hypersensitive, and the OR nurse's behavior may significantly influence his perception of his experience in the OR. The OR nurse who is busy meeting her own emotional needs is not free to give supportive care to her patients, nor is she likely to be perceived as a rational, competent professional. If, in the performance of her job, the OR nurse exhibits immature behavior in the form of dependence, preoccupation, disorganization, or inability to admit mistakes, it can have a serious, deleterious effect on team performance and subsequent patient outcome. Behavior is determined in part by an individual's value and self-image, and both can be influenced through education. However, education for personal growth is not as easy to plan or integrate as education for clinical excellence or professional growth. Perhaps this is because personal growth topics are the most difficult to justify as relevant or cost effective. Also, study of the self is an activity that most of us prefer t o undertake voluntarily at our own pace, rather than within a regularly scheduled time slot, such as from 7 to 8 am on Wednesday morning. Navertheless, we t r y to keep our OR staff informed of programs dea€ing with techniques of self-discovery, especially when the technique is relevant to the health care professional. For example,


when having a conference on patient care, we try to have a psychiatric resource person come t o lead discussions on the feelings and responses of the OR team as well as those ofthe patient. This is useful when discussing care of patients undergoing procedures that are controversial or ethically problematic. We have also tried short presentations on personal growth topics, such as communications skills and values clarification. These have been reasonably well-received, and we look forward to the possiblity of presenting longer programs in which participation would be voluntary and that could be reinforced through follow-up. Conclusion. Progress toward our goal of integrating OR education programs with nursing education programs throughout the hospital is unsteady and is affected by many variables, such as staffing and periodically heavy workloads. We are nevertheless encouraged in our efforts by the increased numbers of OR nurses interested in participating in hospital educational programs and by the interest expressed in OR programs by nurses from other units. One expected, pragmatic outcome of our current and future attempts at educational integration is to increase the pool of educational resources so that operating room and non-OR surgical nurses at Beth Israel Hospital can meet their professional learning needs. We plan to build on these efforts by developing programs on intraoperative documentation, preoperative assessments, and communicating and applying OR nursing research findings. We will not be satisfied until increased expertise and improved communication among surgical nursing services result in true con0 tinuity of patient care.

AORN Journal, September 1978, Vol28, No 3

Program integrates OR, professional nurses' needs.

0 Program integrates OR, professional nurses’ needs Joan M Weintraub, RN perating room nursing exists as a specialty because of its task orientation...
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