a project alpha program for smaller chapters

MAY 1995, VOL 61, NO 5 Henderson Davis

A Project Alpha Program for Smaller Chapters

or a small chapter like ours, other chapters’ pro- with this system. First, none of the students knew the jects and programs at the national level some- perioperative staff members well enough to approach times seem like shoes we will never be able to them as possible preceptors, and the environment wear-they are just too big! In answer to this intimidated them. They wanted perioperative precep- problem, our chapter developed a program that tors but could not or did not approach us. Second,

can be used by smaller chapters to interest student when we finally did get two students into the OR, they nurses in and educate them about perioperative nurs- could only stand and observe because of their lack of ing. All it requires is four volunteers, a telephone, less knowledge. They were not as prepared to participate

in the OR as they were in other areas. This made their than $50 for expenses, and a little time and effort. The Coosa Valley chapter of AORN, Rome, Ga, OR preceptorships disappointing experiences.

is a small, rural chapter with less than 25 members. We decided to take action. The first year, we Our community has two hospitals with a combined approached the nursing faculty with a list of willing bed capacity of slightly more than 500. Our surgical preceptors and asked that they assign interested stu- services are, however, very sophisticated for our size. dents to these nurses. Although this approach We can do everything from trauma care to coronary brought more students into the OR, they still could artery bypass surgery. only stand and watch. There also

was the problem of students and INITIAL EXPERIENCE A B S T R A C T preceptors being mismatched and

Two years ago, we realized Smaller chapters cannot preceptors being unprepared for there was a lack of perioperative easily adapt to their groups the their role and unable to translate experience for the nursing students projects of larger chapters or their responsibilities into nursing at Rome’s Floyd College, which is programs at the national level. process forms and care plans. part of Georgia’s university system TO address this problem, the The second year, the college and graduates more than 100 asso- COOSa Valley chapter Of AORN, prepared o u r preceptors more ciate degree nurses each year. Our Rome, Ga, developed a program thoroughly, and we tried bringing chapter made changing this situa- that Offers periOperatiVe eXperi- the students into the OR for orien- tion a priority, and we encouraged ence to nursing students at a tation before they began their pre- our members to act as preceptors local college. Members Of the ceptorships. This gave them more for some of the students. We made chapter act as preceptors for the exposure, but they still were use of the students’ existing pre- students and educate them somewhat intimidated by the OR, ceptorships, which consisted of before the students‘ preceptor- and they still stood and watched. two 80-hour sessions during their ships in the OR. This education They had never been taught the last quarter of school. At the time seems to relieve some Of the skills needed to participate in a we launched our project, the stu- intimidation and fear related to surgical procedure and did not dents chose their own preceptors the OR, and students in the pro- know when to apply the knowl- and selected two different areas of gram are more Willing tO partici- edge they did have (eg, inserting a nursing in which to work. We pate in the program. AORN J 61 Foley catheter, positioning pa- immediately found two problems (May 1995) 845-851. tient, prepping skin).

F

L E S L E Y H E N D E R S O N , R N ; L I S A D A V f S , R N

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CHAPTER PROGRAM We decided we had to develop our own pro-

gram for preparing the students. Our first step was to contact the nursing faculty. They were eager to work with us in identifying interested students, as they also had recognized the need for more exposure. The curriculum was predetermined, however, and they could offer us very little classroom time.

We talked to recent graduates who had completed preceptorships in the OR and asked what changes they would recommend. All the students responded that they had felt like outsiders and had wanted to participate more during their preceptorships. We then talked to our OR supervisors, ambulatory surgery directors, and directors of the postanesthesia care units (PACUs). They specified the number of students we could accommodate and the scope of their involvement in direct patient care.

Armed with this information, we contacted the students’ clinical faculty instructor and told her of our desire to broaden the students’ roles. Although she was enthusiastic about our goals and our efforts, she still could offer us little classroom time.

Program design. Our challenge now was to design a program that would be sufficiently complete to give students the knowledge and confidence to participate, yet short enough to be completed in a reasonable time period. With the information from our preliminary project, we identified six goals that we thought were overriding and attainable. We wanted the students to be able to

define perioperative nursing, describe the various phases of perioperative nursing and their functions, identify medications commonly used in the phases of perioperative care, identify personnel in each perioperative phase and list their duties, describe and demonstrate the techniques of gowning and gloving, and demonstrate setting up and maintaining a sterile field.

Using the Project Alpha Handbook and the AORN Standards and Recommended Practices, we started working o n a course outline for the presenta- tion itself. We settled on a combination of lecture and laboratory time because, although time was critical, we believed the lecture would be meaningless with- out hands-on practice of the techniques under direct supervision. We contacted prospective lecturers and asked them to review the parts of the outline related

to their areas of expertise and make revisions or addi- tions.

We estimated there would be approximately 20 students for the orientation course and decided that four presenters would be adequate (ie, OR staff nurse, OR supervisor, ambulatory surgery supervisor, PACU supervisor). The entire group of students would receive an overview of perioperative nursing and its phases and functions and participate in a question-and-answer period. This overview would include our expectations for the students and also would allow us to hear their expectations for the time they would spend in the perioperative setting. For the laboratory portion, we decided to split the class into two groups to give as much supervision as possible. Two instructors and half the students would go to the laboratory while the other instructors and students remained in the classroom. This would give us an anticipated student:teacher ratio of 5: 1.

Resources. We condensed the entire program into three hours. This program exposed the students to a great deal of information in a short time frame, but we thought this was necessary. We provided the students with two publications on wound closure and patient care in the OR that they could refer to during their preceptorships.? These publications would give the students broad, general knowledge in a simply written, well-illustrated format and could be provided at no cost to the chapter. In addition to these publications, we created some overhead and handout materials for use in the course.

We showed the program to the faculty liaison and discovered that the only three-hour time slot available was on the last day of the students’ vaca- tion just before the preceptorship period. There was some question about the students’ willingness to participate on their own time, but the college liaison decided that the three-hour course would be required for any student wishing to complete a perioperative preceptorship. We proceeded on the assumption that the students who attended the program would be serious about perioperative nursing.

PRESENTING THE COURSE Fifteen students attended the initial class. They

arrived with an interest in the subject but felt inadequate, as most of them thought that they might not be able to meet the course goals.

Classroom. During the first hour, we gave a general overview of the perioperative environment. The students received a course outline, both perioperative

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MAY 1995, VOL 61, NO 5 Henderson Davis -

Figure 1 publications, and AORN’s definitions of perioperative nursing and the recipients of perioperative care.3 We talked about some general rules of behavior, described activities in the OR, and suggested the students read through the publications they had been given. We explained that the documentation in the OR comprises the patient’s care plan and that this plan of care would look different from the care plans on the inpatient units. We told the students that a surgical case is dynamic and that some- times they would have to anticipate potential changes in a patient while simultaneously adjusting nursing care based on the patient’s condi- tion, needs, pathology test results, and new laboratory test results.

W e advised the students to put their personal problems aside as they entered the OR, place the patient first while there, and leave any stress in the room when they left. We described briefly the types of behaviors they would observe in the surgeons and OR staff members and the behaviors expected of the students. We emphasized the fact that the relaxed atmosphere in the OR could change suddenly and that any humor they might observe was designed to relieve stress.

W e wanted the s tudents to know that they would not feel completely comfortable with their skills after being in the OR for such a limited time and that this was acceptable. We encouraged them to be curious and ask questions and told them that although we might not be able to respond immediately, we would answer their questions. We emphasized that what they observed on one procedure might be their information resource for the next. The “see one, d o one, teach one” rule was explained; although in practice this could not be applied, it gave the students the incentive to observe what went on around them. The students were told to be prepared to take call with their preceptor a t least one night during their preceptorship. For most of the students, this was their first experience wearing a beeper and

planning to be available at a moment’s notice. We spent time discussing patient advocacy and patient confidentiality and informed them that whatever thcy might see or hear in the O R was not to be discussed outside the OR.4

After this overview, we asked the students to tell us what they expected from their preceptorships, and we answered their questions. We reassured the students that we would not put them in situations they were not prepared to handle. We wanted this time to be interesting and challenging and to provide them with information they could use in any aspect of nursing.

During the second hour, we described procedures, equipment, and patient routes in greater detail and discussed the nurses’ roles in the preoperative, intraoperative, and postoperative phases (Figure 1). We tried to give the students information about the

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Table 1 COURSE OlcrulyE FOR THE SECOND HOUR OF THE PROJECT U P H A PROGRAM

Phases of Deriooerative nursina

Preoperative holding: patients come from ambulatory surgery, emergency room, or hospital room to preoperative area.

Intraoperative: beyond red line, patient in actual OR.

Postoperative: called postanesthesia care unit. Patient assessed and watched while effects of anesthetic wear off. Post- operative orders initiated; patients discharged to hospital room or ambulatory surgery.

Ambulatory surgery: patients come from home. Preoperative tests performed here. Patients discharged to homes post- operatively. Handles smaller cases; generally more patient friendly. May be located in hospital or in separate building.

Preoperative responsibilities

Patient teaching: answer questions, allay fears.

Assessment patient's preparedness for surgery, preoperative orders followed, all laboratory work/x-rays available to OR.

Continue patient preparation: start IV lines, draw blood for laboratory work. If necessary, give preoperative medications, provide patient comfort, deal with family members.

lntraoperative responsibilities

Staff: scrub person, circulating nurse, anesthesia care provider, surgeon, and assistant.

What is sterile: sterile versus clean versus contaminated, steam sterilization, ethylene oxide sterilization.

Patient positioning and safely: knowledge of anatomy, proper alignment, safely straps and padding, proper use of

Types of anesthesia: local, local with standby, spinal, epidural, general, arm block, and the nurse's role in each type.

Skin preps: areas for various procedures, shaving, agents used, Foley catheters.

Patient advocacy, privacy, and confidentiality.

Equipment electrosurgical unit, anesthesia, video camera, insufflation device, lasers, Doppler, oximeter, and

9 Adaptability: cases are dynamic, ongoing assessments of needs based on changes in patient, findings, pathology results.

equipment in the OR.

temperature regulating blanket.

PostoDerative resoonsibilities

Assessment.

Knowledge of procedure: used to troubleshoot for complications, knowledge of anesthetic agents and medications.

Equipment: ventilator, Doppler, oximeter.

Use of visual observation, listening, and touch: bedside nursing.

Patient teaching.

Discharge and transfer of patients.

Laboratory: Mock OR

What is sterile?

Traffic patterns.

Gowning, gloving, and scrubbing.

Basic instrumentation.

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Figure 2 Dia- gram used on the overhead projector that shows equipment posi- tioned for use during an OR procedure. The shaded area within the bro- ken line indi- cates the sterile field.

urpose of each phase, what they would see, what equipment they would use, the role of each person in the OR, and what the students’ roles would be (Table 1). Patient safety, positioning, and prepping also were covered. The handouts for this portion were a list of medications coininonly used in perioperative care, a list of the duties of the scrub person and circulating nurse (ie. as taken from the policy and procedure manual of our facility), and a list of patients’ rights. Thc instructors used an overhead projector to display diagrams that showed equipment placement and the sterile field before and during a procedure (Figure 2) .

We gave a brief overview of the PACU’s physi- cal layout, including monitoring equipment, supple- mental oxygen devices, and emergency equipment, and discussed the purpose and goals of PACU nursing care. We reviewed discharge criteria, emphasiz- ing that the anesthesia care provider ultimately is responsible for release of the patient from the PACU. We used handouts of anesthesia, preoperative, intraoperative, and postoperative records to explain the continuity of care in the perioperative environment as well as how this information might affect the patient’s care before or after surgery. We

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stressed the importance of thorough and accurate documentation in all phases of perioperative care.

Laboratory. After the classroom session, the students participated in hands-on instruction in the laboratory. Using supplies that we had collected in the OR, the students were able to scrub, gown, and glove with direct supervision. We had set up the laboratory in advance with a basic tray of instruments, a back table, a basin, and even a mock patient (ie, the school’s mannequin). The students learned how to prep a patient, drape a surgical area, and move within a sterile field. They also learned about observing traffic patterns and monitoring their fields for breaks in sterile technique. The students enjoyed being able to handle the instruments and learning how each is used.

Evaluation. At the completion of the course, each student completed an exit survey, which was patterned after the Georgia State Nursing Associa- tion’s exit surveys for educational offerings. We believed this survey would provide important information for making changes in future programs and improving the course.

The feedback from the exit surveys, the nursing faculty, and the students has been positive. One of the 15 students who attended the course was hired into the OR as a new graduate. The total cost to the chapter was less than $50 for overhead transparen- cies. The college provided the classroom and the audiovisual equipment. We spent considerable time planning the program; however, we believe a committee of two or three people could produce a similar product in about two months.

NOTES I . National Committee on Educa-

tion, Project Alpha Handbook (Den- ver: Association of Operating Room Nurses, Inc, 1992) 4- 12, 18-20; AORN Stundurds and Kecwnmended Practices (Denver: Association of Operating Room Nurses, Inc, 1992).

2. Nursing Care oj‘the Patient in

SUMMARV This program does not replace the preceptor-

ships that new graduates complete when hired by employers, but it does expose students to a previous- ly unknown area of nursing, and it increases their interest in perioperative nursing. It also appears to relieve some of the intimidation and fear associated with the OR-students rotating through the OR after the program are more willing to participate. They use the program’s publications for reference, and they are more comfortable with OR terminology and procedures. The students also apply this information when caring for patients on postsurgical units and believe it gives them a better understanding of what their patients have been through in surgery.

This program has helped increase communication between the hospital’s various perioperative depart- ments. It also has been valuable for our chapter members, some of whom never thought of themselves as teachers or mentors. They are rethinking their roles and are taking pride in their own skills and talents. A

Lesley Henderson, RN, CNOR, is an OR stajfnurse, Redmond Regional Medical Center, Rome, Ga.

Lisa Davis, RN, CPAN, is director ofthe post anesthesia care unit, Redmond Regional Medial Center. Rome, Gu.

The authors wish to thank Peter Dahm, sales representa- tive, Ethicon, Inc, Somei-ville, NJ, for his enthusiastic sup- port and for providing the publications to their students.

the OR, second ed (Somerville, NJ: Ethicon, Inc, 1987); Wound Closure Manual (Somerville, NJ: Ethicon, Inc, 1994).

3. M P Wells, “Changes in health care result in new definitions,” (Pro- ject 2000) AORN Journal 58 (Octo- ber 1993) 680; L H Avery, “Business proceedings: Bylaws amendments,

member at large delegates, redetini- tion of perioperative nursing top business issues this year,” AORN Journal 59 (June 1994) 1 190- 1 19 1.

4. P C Seifert et al, “ANA code for nurses with interpretive state- ments: Explications for perioperative nursing,” AORN Journal 58 (August 1993) 369-388.

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a project alpha program for smaller chapters

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