Perioperative nursing in nursing school curricula

AORN Journal,  Feb, 2006  by Sharon A. McNamara

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Where in the world is Project Alpha? I have had many members ask me this question. Project Alpha, a program implemented by AORN in the 1980s, identified activities that AORN chapters could use to "implement recognition and acceptance of the scope of perioperative nursing practice for student nurses" (1(p2)) and provided "guidelines for fostering meaningful dialogue between faculty members and perioperative nurses about perioperative nursing practice and its relevance to nursing curriculum." (1(p2)) Some nurses believe we have given up on the goal of Project Alpha (ie, pursuing the inclusion of perioperative nursing in nursing school curricula). This is certainly not the case.

AORN believes that the perioperative areas can be used to provide a wide variety of experiences through which student nurses can acquire medical/surgical skills and knowledge of the nursing process. We also believe that we need to educate college administrators and nursing faculty members about the benefits that a clinical experience in the perioperative areas can offer nursing students. We need a collaborative partnership in which we can understand each others' needs and abilities and develop ways we can work together to provide nursing students with quality experiences that prepare them for the future of health care. (2)

NEW PROPOSED POSITION STATEMENT

In 2005, the National Committee on Education (NCE) was charged with revising the "Position statement on inclusion of perioperative nursing learning activities in undergraduate nursing curricula," which was to sunset in March 2006. As part of the process, the NCE members assembled a distinguished panel of reviewers from academia to comment on their first revision. The reviewers' input steered the committee in a different direction that resulted in complete rewrite of the statement and a new title.

From the review panel's comments, the NCE members came to the realization that the current position statement mandated the inclusion of perioperative learning activities in basic nursing curricula. With the amount of mandatory content currently included in nursing curricula, there is no method or time frame for implementing separate perioperative content, unless a course can be offered as an elective.

The new statement, "Proposed position statement on the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula," advocates "the inclusion of learning activities in the perioperative setting in all undergraduate professional nursing curricula in order to assist in meeting end-of-program outcomes" (2) (Table 1). The committee members believe that "the perioperative setting has the potential to provide opportunities in which the principles of the art and science of professional nursing can be applied and, therefore, that these settings should be used during the formal education for nurses." (2) We hope the delegates at the 2006 Congress will approve the position statement and the new approach.

WHAT THE PERIOPERATIVE AREAS CAN OFFER

Think about what we have to offer. In the preoperative unit, students can learn assessment skills and how to take a patient's history; perform IV insertions, urinary catheterizations, and electrocardiograms; experience day of surgery point-of-care laboratory testing and evaluation; and witness the emotional impact of surgery on a patient and the patient's significant others. The preoperative unit offers a variety of opportunities for students to use therapeutic communication skills and experience the spiritual side of nursing when patients face their fear of the unknown. A multitude of cultural competencies can be met by learning to address a patient's specific cultural needs.

In the OR, students will use and become grounded hi aseptic technique. Patient safety principles for patient prepping and positioning, electrosurgery use, sharps handling, and correct site surgery can be applied to other patient care areas. Students will work with living human anatomy and participate in the proper use of personal protective equipment. Students also will learn to provide humanistic care in a high-tech environment.

In the postanesthesia care unit (PACU), students will focus on the continuum of care and enhance and reinforce their assessment skills. Evaluating, assessing, and reevaluating a patient's level of consciousness, pain level, and treatment needs are invaluable experiences. Skills that can be learned in the PACU include airway management; maintenance of normothermia; and neurological, musculoskeletal, and vascular assessment.

I have identified a few of the skills that students in a perioperative rotation could practice many times in a few days compared to weeks on a medical/surgical unit. In addition, there are few areas that offer the team-building skills that students will experience in the perioperative environment.

Organizational, prioritization, and critical thinking skills can be honed in every aspect of a perioperative patient's care. The tremendous emphasis on patient and staff member safety can provide numerous opportunities to learn about human factors and communication theories. Most important to student nurses is the ability to share in the surgical experience and the nursing care planned for the patient. It will open up new ways of thinking and provide knowledge that can be applied to the care of all patients. Understanding the planned trauma a patient will undergo during surgery can enhance the student nurses' ability to understand postoperative sequelae that individual patients may experience.