Standards fundamental to certification, perioperative role The speaker asked how many nurses believed they were practicing the perioperative role. No one raised a hand. Then she explained in detail what the

perioperative role is-that it is a continuum from a basic level of competency to an ad- vanced level of practice.

She asked the question again. “How many of you are practicing in the perioperative role?”

All hands went up. The speaker was Barba Edwards, RN, talk-

ing about the perioperative role to the Lincoln area and Central Nebraska Chapters of AORN. A former AORN President, Edwards has been a member of both the Project 25 and 26 Task Forces. The Project 25 Task Force last year defined the perioperative role, which was approved at the 1978 House of Delegates. The Project 26 Task Force is charged with helping nurses to implement that role.

After talking with these and other OR nurses, Edwards believes that although most OR nurses are practicing in the perioperative role, they don’t realize it. If OR nurses are seeing patients at all, whether it ison the unit or even for a few minutes in the OR before induc- tion, they are functioning in the perioperative role.

“Nurses don’t realize the scope of the perioperative role,” Edwards commented to me as well as to the Project 26 Task Force. She believes the perioperative role encour- ages the OR nurse to grow from a beginning competency level to excellence in practice. For

Editorial

example, in the preoperative phase, the be- ginning level is an assessment performed in the surgical suite; the advanced level is a preoperative assessment in the home or clinic. The OR nurse moves along the continuum as she gains experience and knowledge in OR nursing .

To demonstrate to operating room nurses that they are functioning in the perioperative role even though they may not realize it, the Project 26Task Force has asked theJournal to talk with staff nurses about what they do as they give nursing care. The Task Force will then analyze these job functions in terms of the perioperative role. The Journal plans to pub- lish articles based on these interviews in the next several months.

At its recent meeting, Project 26 Task Force members discussed many different ap- proaches to implementing the perioperative role. Putting up large sheets of paper in the AORN Board room, Task Force members listed such activities as courses to be offered in the new Education Center, seminars, learning modules, and films. They proposed not only articles for the Journal, but also articles in other publications. They considered research projects that would examine the cost- effectiveness of the perioperative role as well as its social and economic implications.

Fundamental to the perioperative role are standards of nursing practice. (Standards of Nursing Practice: Operating Room, published jointly by the American Nurses’ Association and AORN.) If you haven’t already noticed, a major portion of this Journal is devoted to a lengthy article on how to use these standards in the practice setting. This article,, from the ad hoc Committee on Standards of Nursing Prac- tice, is a response to members’ requests for

AORN Journal, October 1978, Vol28, N o 4 581

help in implementing the standards. We are enthusiastic about this article because we think it shows clearly and simply how to use the standards in practice.

In performing the perioperative role, the operating room nurse uses the standards of practice. She can implement these standards as various levels from a beginning compe- tency to an advanced practice as in the perioperative role. For example, at a beginning competency level, the nurse may perform an immediate postoperative evaluation in the re- covery room: at an advanced level of practice, she might do postoperative follow-up in the home or clinic. When the OR nurse has im- plemented the standards of practice, she is practicing in the perioperative role.

After you have read the article “From Stand- ards into practice,” you might want to go back to the May 1978 Journaf and look again at the perioperative role as described in the report of the Project 25 Task Force.

The standards are also fundamental to the certification program. Certification is defined as the documented validation of professional achievement of identified standards of prac- tice. The examination and other certification requirements will be based on the standards of practice. In the next few months, the Certifica- tion Council is planning to pilot test its peer review tool. The Project 26 Task Force then plans to analyze the data collected to deter- mine the current level of practice to find out where the majority of operating room nurses are on the continuum.

Have I convinced you the standards of prac- tice are fundamental to some of the important developments taking place in operating room nursing? If you want to learn more about using the standards in your own practice, consider attending the national AORN seminar on im- plementing standards. This seminar will be of- fered eight times between September and June in cities across the nation-from Duluth to New Orleans, from New York City to Pasco, Wash. Julia Kneedler, RN, assistant director of education, is the seminar leader.

Are you practicing in the perioperative role? Are you using standards in your practice?

Probably more than you think.

Elinor S Schrader Editor

artificial sweetener zancer link disputed Artificial sweeteners in the amounts :urrently consumed do not cause cancer in humans, says a research report from Johns Hopkins University in the Journal of the American Medical Association (July 28).

After interviewing 519 individuals in Baltimore who had confirmed cases of bladder cancer and an equal number of matching controls, researchers concluded those who used artificial sweeteners, including diet soft drinks, were no more likely to develop bladder cancer than those who did not.

Cyclamate was banned as an artificial sweetener in 1970 on the basis of cancer-causing effects in laboratory animals. Saccharin, the other artificial sweetener in general use, was withdrawn in 1972 from the list of safe products and was later proposed for an outright ban by the Food and Drug Administration. Congress stepped in last year to order an 18-month postponement of the ban. Saccharin is now sold with a warning label stating that the product may be hazardous to health.

Irving I Kessler, MD, and J Page Clark conducted the study. Dr Kessler has since moved to the University of Maryland School of Medicine.

Dr Kessler concluded, “Neither saccharin nor cyclamate is likely to be carcinogenic in man, at least at the moderate dietary ingestion levels reported by the patient sample.” One of the criticisms of earlier animal studies had been that the rats were given huge doses of the sweeteners, much more than a human could possibly consume in diet soft drinks and from other sources.

residents with bladder cancer in I9 participating hospitals between 1972 and 1975. Surviving patients who could be contacted for interviews were questioned carefully regarding their intake of table sweeteners, diet beverages, diet foods, and total intake in all forms.

The study involved Baltimore-area

582 AORN Journal, October 1978, Vol28, No 4