regulation, you identified several other “areas of interest.” I would like to call attention to an additional proposal that is of significance to nurses.

The proposal would delete the requirement for “hospitals to maintain a medical library in or adjacent to the facility, containing modern textbooks, journals, and periodicals.“ (Federal Register, Jan 4, 1983, page 305.) I believe it is more important today than at any previous time that the changing scientific base of prac- tice be disseminated. Cost containment efforts should be aimed at increasing the efficiency with which information is disseminated, not at deleting required access to information.

I also believe it is more cost efficient to provide a central repository of information all health care providers can use than for each individual to create his own reference system.

Winifred Lauder, RN Downers Grove, 111

Study’s parameters are questioned

Regarding the study “The impact of preopera- tive assessment on intraoperative nurse per- formance“ in the January 1983 Journal, we would like to voice the following concerns:

There appeared to be no evidence of staff level involvement in tool development. None of the information about the re- searchers addressed present or recent OR experience. Many of the parameters listed in the cir- culator performance evaluation were as- pects of performance one would not ex- pect to alter (improve) through preopera- tive assessment: patient identification, observation of sterile field for breaks in technique, regulation of traffic flow, and sponge and needle counts to name a few. We think these activities would have iden- tical scores regardless of the extent of a preoperative assessment. Perhaps the study would have shown a significant statistical difference in performance if the data had not been diluted by these activities. The researchers felt their study differed from previous research because it fo-

cused on nurse performance rather than patient outcome. We feel the goal of in- depth preoperative assessment should be improved patient outcome through im- proved nurse performance. Improved nurse performance alone should not be the goal.

While we agree with the researcher’s view that studies of this nature are valuable and necessary, we think some of the tools in this particular study did not focus on the most ap- propriate parameters. Our suggestion would be to study OR nurse preparation for individual patient needs with respect to positioning, equipment, instrumentation, and supplies.

Pam Dwyre, RN, CNOR Teresa Logue, RN, BSN

Cindy Taft, RN, BSN, CNOR Portland, Ore

Author’s response. 0 While the article only alludes to staff in- volvement in tool development, there actually was extensive participation in the entire proj- ect. The assessment tool was the result of nearly a year of development and refinement by the staff nurse committee. The nurse per- formance tool partially evolved from guidelines for the circulator nurse coming out of the operating room’s policy committee. The tool was refined by staff nurses who served as a “panel of experts.” Staff nurses also partici- pated as research assistants. 0 I had overall responsibility for operating room nursing for five years at Rush-Presbyte- rian-St Luke’s Medical Center (RPSLMC) in Chicago.

Gerald Biala has practiced as an OR nurse for several years and has had a variety of administrative roles in this setting.

Wendy Pollack practiced widely as an OR nurse and was head nurse for several years at RPSLMC before assuming her present duties. 0 Without any baseline data, we could not assume that certain nurse performance be- haviors would not become altered through preoperative assessment. In retrospect, a scale that rated degree of performance might have provided more opportunity to demon- strate differences in performance. 0 Operationalizing patient outcome in such a way that the impact of the nurses can be mea-

1146 AORN Journal, May 1983, Vo l37 , No 6