Perioperative Nursing Program PONP-RN. Part Time Program. Program Manual

Transcription

1 Perioperative Nursing Program PONP-RN Part Time Program Program Manual Registered Nurses Professional Development Centre & Nova Scotia Department of Health Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 1

2 Copyright 2002 Registered Nurses Professional Development Centre and Department of Health Nova Scotia Government. No part of this manual may be reproduced or transmitted in any form by any means, electronic or mechanical, without permission in writing from the: Registered Nurses Professional Development Centre Room 231, Bethune Building 1276 South Park Street Halifax, Nova Scotia B3H 2Y9 Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 2

3 Disclaimer Registered Nurses Professional Development Centre The faculty of the Registered Nurses Professional Development Centre and program reviewers have exerted every effort to ensure that the information in the lessons are consistent with evidence-based research and standards of practice at the time of publication. However, in view of ongoing research, changes in governmental regulations and the constant flow of information relating to practice, the reader is urged to check additional practice reference sources. The curriculum is designed to prepare individuals in their intended program of study, based on a performance-based certification model and a specified proficiency level. These lessons are designed for the continuing education of health professionals and are not intended for the care of individual patients. The print based lessons should never replace specific decisions for individual patients, and do not substitute for the shared decision-making between patients and physicians/other health care professionals. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 3

4 Table of Contents Section 1: Perioperative Nursing Program Perioperative Faculty 6 Contact Information 7 Program Description 8 Performance-based Certification 9 Program Competencies 10 Proficiency Level 11 Section 2: Program Delivery Program Delivery/ Required Textbook 12 Basis and Evidence of Proficiency 13 Perioperative Knowledge Assessment Points 15 Examinations 16 Proctors 16 Assignments 17 Assignment #1 Surgical Plan of Care 18 Assignment #2 Evidence Based Practice 21 Online Discussion Forum 24 Perioperative Skill Assessment 27 Skill Development Sessions 27 Skill Practice and Assessment 27 Perioperative Performance Assessment 28 Clinical Guidelines 28 Surgical Case Logs 32 Clinical Plan 33 Section 3: Additional Perioperative Experiences SPD 35 OR Observation Days 36 Sameday 36 Preadmission Clinic 37 Anesthesia 37 PACU 38 Section 4: Appendices Competencies and Performance Criteria 39 Proficiency Levels 43 Proctored Examination Policy and Approval Form 49 Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 4

5 Perioperative Nursing Program Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 5

6 Perioperative Faculty Trudy Hebb, RN, BScN, MHI, CPN(C) Faculty, Perioperative Nursing Program Trudy graduated from Dalhousie University with her Baccalaureate of Science in Nursing in 1995 and a Master of Health Information in She has worked for five years in the operating room both in Canada and the United States, and her operating room experiences cover a variety of services. Trudy is also certified nationally in the perioperative nursing specialty. Jocelyne Granger, RN, CPN(C) Faculty, Perioperative Nursing Program Jocelyne graduated from Dawson College in Montreal with a Diploma in Nursing. She is presently enrolled in the Baccalaureate of Nursing program at Athabasca University. She completed the critical care program in Montreal and then the perioperative nursing program in Halifax. Jocelyne has worked in the operating room at the Halifax Infirmary. She also has experience in many areas of nursing including critical care and emergency nursing. Suzanne Betts, RN, BN, CPN(C) Faculty, Perioperative Nursing Program Suzanne graduated from the AJ MacMaster School of Nursing in Moncton in In 2006, she received her Nursing Degree from the University of New Brunswick. She has spent the last 17 years working in perioperative nursing in Moncton, Kentville, Middleton and Dartmouth. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 6

7 Contact Information Faculty: Trudy Hebb Room 214, Bethune Office Phone Number Fax Jocelyne Granger Room 234, Bethune Office Phone Number Fax Suzanne Betts Room 234, Bethune Office Phone Number Fax Administrative Support: Dee Mason Room 231, Bethune Office Phone Number Fax Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 7

8 Program Description The Perioperative Nursing Program (PONP) is designed to prepare registered nurses to work in the operating room. The program uses a competency-based methodology to achieve its performance-based certification. Shifting from a focus of presenting learners with an abundance of theoretical content, the PONP has adopted a conceptual learning approach that organizes knowledge and skills into concepts that are illustrated using real-life perioperative situations. Learners study a concept, actively apply the concept to a surgical scenario, and then learn a new concept. Each concept is then integrated with others so, by the end of the program, graduates can apply all concepts to a variety of surgical experiences. This is an active, learner-centered approach that fosters critical thinking and a deeper understanding of clinical knowledge by building on previous knowledge. In turn, learners are better prepared to meet the dynamic and complex needs of patients in the perioperative setting. Program content is structured under four key concepts, each presented in a separate unit. The four concepts that will be discussed in detail are: surgical experience, protection, surgery, and homeostasis. Surgical experience, although a concept in and of itself, is the overarching or surrounding concept that is threaded throughout and considered in all the subsequent concepts. Visually the concepts can be imagined this way: Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 8

9 Each unit presents a concept in detail in relation to the perioperative patient factors, perioperative nurse factors, and perioperative environment factors that come together to provide for an optimal and safe surgical experience. The focus is on providing learners with a framework that enables them to: recognize the concept that is represented in a perioperative scenario, and respond appropriately given the patient characteristics and the dynamics of the perioperative environment. PONP is a performance-based certification program. Performance-based certification attests that graduates have met a defined set of requirements that have been validated through consistent application of concepts and procedures under real work conditions. This program utilizes a competency-based methodology (Alspach, 1996) to achieve its performance-based certification. This methodology emphasizes the performance of competencies that are central to the role of the nurse in the specialty practice setting while recognizing that knowledge and skills are implicit in this performance. The following diagram depicts that certification can be knowledge-based, skill-based or performance-based, and that knowledge and skills are encompassed in a performance-based certification. Performance-based Certification Skill-based Knowledge-based Permission given to reproduce by Fourth Wave Strategy Inc., Halifax, NS. As a learner, you are required to demonstrate consistently under real work conditions that you are able to perform in your new role. This requires both the application of knowledge and the performance of skills in the perioperative setting. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 9

10 Program Competencies The program competencies (outcomes) the learner must achieve by the end of the program are: Patient Centered Care 1. Provides compassionate, coordinated and competent care while respecting the patient as a full partner. Teamwork and Collaboration 2. Functions as a member of a collaborative team to promote integrated, continuous and reliable care. Evidence Informed Practice 3. Uses current evidence coupled with clinical expertise and consideration of patient s preferences, experience and values to make best practice decisions. Quality Improvement 4. Integrates improvement strategies into practice to improve the quality and safety of health care systems. Safety 5. Integrates strategies to reduce the risk of harm to patients and providers by being accountable for individual performance and promoting a culture of safety within the health care system. Informatics 6. Uses information and communication technologies to communicate, manage knowledge, mitigate error and support decision making to enhance patient, provider and system outcomes. Refer to the Appendix section for PONP Competencies, which includes expected performance criteria and behavioral indicators for each competency. These competencies are used to assess the learner s knowledge, skill, and performance while in the program. Some of these behavioral indicators will be achieved upon completion of lessons, assignments and examinations, while others will be achieved in the clinical setting. As a learner in the program, you will be required to successfully demonstrate each of these competencies. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 10

11 Proficiency Level Upon completion of this certification program, you will be able to provide safe and effective nursing care to patients and their families at the level of an advanced beginner. The advanced beginner compares to Benner s (1984) definition and is defined as follows: The advanced beginner enters a specialty setting with specialized knowledge and skills, and prior exposure/experience with patient situations in the specialty setting. The advanced beginner can relate previous experiences while consistently applying knowledge and skills to predictable patient situations with minimal guidance from a preceptor following an individualized orientation to the practice setting. When confronted with rapidly changing patient situations, the advanced beginner requires supervision from a preceptor. By identifying the advanced beginner as the proficiency level outcome for this program, you will graduate with a clear set of expectations regarding your performance abilities that will help to define your orientation needs to your new practice setting. For further explanation of the proficiency levels, see Appendix. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 11

12 Program Delivery The Perioperative Nursing Program has been designed to provide a logical and motivating sequence of study. The lessons in the program build on each other as concepts and theories are introduced. A calendar has been developed by faculty to guide your progression through the program. Required Textbook & ORNAC Standards 1. Rothrock, J.C. (2015). Alexander s care of the patient in surgery (15th ed.). Toronto: Mosby. 2. Tighe, S.M. (2012) Instrumentation for the Operating Room (8 th ed.) Elsevier Mosby These textbooks are required for the Perioperative Nursing Program. The textbooks are available at the Dalhousie Carleton Campus Bookstore, 5981 University Ave., Halifax, Phone (902) Operating Room Nurses Association of Canada. (2013). ORNAC Standards for Perioperative Registered Nursing Practice (11th ed.). Toronto. Canadian Standards Association Note: The ORNAC Standards (2013) will be distributed as part of the Program Materials during Orientation on the first day of class or mailed out to you with the rest of the program materials from the Registered Nurses Professional Development Centre (cost $ which will be invoiced with your academic fees). Optional Textbook Phillips, N. F. (2013). Berry & Kohn s operating room technique (12th ed.). Toronto: Mosby. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 12

13 Basis and Evidence of Proficiency To attest that a learner has met the program s competencies (see Appendices) at the required proficiency level and thus be certified, the learner must meet all the program s assessment criteria for knowledge, skills and performance at predetermined assessment points. This program has multiple assessment points that are communicated to the learner in advance. The following policies support the learner s assessment for specialty certification: 1. Knowledge is a prerequisite for skills and performance. a. Examinations and assignments are used to assess a learner s knowledge base prior to performance assessment. b. A learner must achieve a 75% grade at each designated knowledge assessment point. 2. Skills are a prerequisite for performance. a. Assessment of skills may occur in a learning lab or the actual practice setting. b. Opportunities for the learner to practice skills will occur prior to assessment of the skills. c. A learner must achieve a satisfactory on all skills prior to performance assessment. 3. Performance is assessed through consistent demonstration of the competencies in the practice setting. a. Opportunities for the learner to demonstrate the competencies will occur prior to assessment of the competencies. b. A learner must achieve a satisfactory on all competencies at each performance assessment point. 4. Failure at an assessment point can result in disqualification, or continuation in the program with remedial instruction and reassessment. 5. Repeat assessment will occur following remedial instruction. a. Repeat knowledge assessment will be a supplemental exam or assignment. Only one knowledge reassessment is permitted during the course of a program. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 13

14 b. Repeat skill assessment will be a re-assessment of the skill. Only one reassessment per skill is permitted during the course of a program. c. Repeat performance assessment will be a re-assessment of the competency. Only one reassessment per competency is permitted during the course of a program. If the learner requires reassessment on more than 50% of the competencies, they will be ineligible for reassessment. 6. Learners must achieve a satisfactory for their skill and performance levels at each designated assessment point. This is assessed by the learner s ability to perform the required skills and competencies. Learners unable to achieve a skill or competency will receive faculty-guided instruction and are eligible for re-assessment. Failure to achieve a satisfactory reassessment of the skill or competency will result in remedial instruction and reassessment or program disqualification. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 14

15 Perioperative Knowledge Components Perioperative Knowledge Assessment Points There are four knowledge-based assessment points. Each area will be weighted according to weights below. Protection Unit: 1. Exam 70% 2. Participation /Online Discussion Forum 30% Total 100% Surgery Unit: 1. Exam 70% 2. Participation /Online Discussion Forum 30% Total 100% Surgery Specialties Unit: 1. Exam 70% 2. Assignment #1 Surgical Plan of Care 20% 3. Participation /Online Discussion Forum 10% Total 100% Homeostasis Unit: 1. Exam 70% 2. Assignment #2 Evidence Based Practice 20% 3. Participation /Online Discussion Forum 10% Total 100% After all opportunities for reassessment have occurred, a final grade of less than 75% at any of the four assessment points results in disqualification. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 15

16 Examinations The pass mark for each exam is 75%. Examinations consist of multiple choice questions and short answer questions. Learners are required to write all examinations. Failure on an exam results in the opportunity for one rewrite. However, only one knowledge reassessment (e.g., exam rewrite) is permitted during the course of a program. Failure to write an examination will result in program disqualification. Therefore, if a learner is unable to write the examination on the specified date, faculty must be contacted. Learners will write onsite according to the date scheduled in your program calendar. Learners will have to obtain approval from faculty to write in their own district (outside CDHA). Please refer to Proctored Examination Policy in the Appendices. Note: If the Perioperative Nursing Program should receive an unsealed examination envelope, the examination will not be graded. Proctors To reduce the number of proctors required by learners, groups of learners are encouraged to write the examinations at the same time and place. Once a proctor has been selected, this individual must be given the Proctored Examination Policy and Form (see appendix). The Proctor Approval Form must be received two (2) weeks prior to the examination deadline date. This time frame will ensure delivery of examination material to the proctor by the examination date. The examination materials will be forwarded by Priority Post to the proctor one week prior to the examination date. It is the responsibility of the proctor to monitor the writing of the examination and to return the completed examination to the Perioperative Nursing Program. Learners will be notified of examination marks as soon as all examinations have been graded. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 16

17 Assignments 1. Surgical Plan of Care 2. Evaluating the Evidence Learners are required to complete and submit all assignments to faculty. The purpose of assignments is to assist learners in the application of perioperative concepts. Failure to submit an assignment on time will result in loss of marks toward the grade. Points (.5) will be deducted for each business day that the assignment is late. Therefore, if you are unable to meet the assignment deadline date, the faculty should be contacted. The pass mark for each assignment is 75%. Failure on the assignment assessment point results in the opportunity for one remedial assignment. This remediation can occur at the time of the assignment failure or at the completion of all of the assignments when a final grade is calculated. All assignments should include the learner's name and address. Once assignments are complete, it is recommended that they be saved electronically or in print. Assignments are to be ed, faxed, or postmarked by the deadline date as outlined in the program calendar. The mailing address is: Perioperative Nursing Program Registered Nurses Professional Development Centre Room 231, Bethune Building 1276 South Park Street, Halifax, NS B3H 2Y9 Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 17

18 Assignment #1 Surgical Plan of Care Grade = 20% The purpose of this Surgical Plan of Care assignment is to facilitate the learner's understanding of the experiences of the patient throughout the surgical experience. The assignment will focus on the surgical plan of care developed by the perioperative registered nurse during the immediate preoperative phase, and will then follow the patient through the intraoperative phase, and the immediate postoperative phase and any modifications to the plan of care. This assignment will assess the learner s ability to critically analyze patient assessment data and identify actual and potential surgical health issues for the planned surgical procedure. This in turn will help develop an individual surgical plan of care for the patient. As the patient moves through the different phases, the learner can monitor the patient s reaction to care and adjust the plan of care accordingly to advocate for a safe surgical procedure. Requirements Pick a surgical case from your OR list that is interesting to you. It is probably better if you circulate for this case to better understand the patient flow through the different phases, and the patient s reactions to the care provided. Follow outlined headings when developing the surgical plan of care. This written assignment should be typed. APA format is not required, however please reference throughout your paper and provide a reference list at the end of your assignment. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 18

19 1. Immediate Preoperative Phase Present an analysis of the patient assessment data (e.g., complete a focused assessment). Biographical Data: age, gender, etc. (no patient names please) Surgical Procedure: consent, markings History: present illness, serious or chronic illnesses, previous operations, significant family history, etc. Current Physical Condition: o Vital Signs, height, weight o Allergies o Current medications -including prescription, over-the counter medications, and complementary alternative medications o Physical status-cardiopulmonary, respiratory, GI, genitourinary, endocrine, immunological, extreme underweight/overweight, etc. o Substance abuse-smoking, alcohol, drugs, etc. o Mental condition- confused, alert, etc. o Physical limitations-disabilities, restrictions, assistive devices, etc. o Implants Tests: laboratory, radiology, blood bank, etc. Psychosocial data: cultural/spirituality, health literacy, coping, support, etc. Anesthesia: ASA status, difficult intubation, etc. Overall patient complexity, predictability, and risk for negative outcomes for the surgical procedure. Identification of Concerns: Using the significant data from your patient assessment listed above; identify the priority concerns/issues that are pertinent to the patient for developing your surgical plan of care. Support your clinical judgements with appropriate assessment data to illustrate the relationships between the assessment data and the health issues for this patient. Please outline any nursing concerns using the following headings: Actual Perioperative Nursing Concerns (and supportive assessment data) High Risk Perioperative Nursing Concerns (and supportive assessment data) Anesthesia Concerns Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 19

20 2. Intraoperative Phase Identify the type of anaesthesia used during the case and what medications/gases were used. Describe the patient's position during surgery and any positioning devices used. Describe the surgical procedure briefly with identification of surgical instruments and the goal of the intervention. Identify the type of incision and tissue layers dissected, explored, and excised. Describe how hemostasis was maintained during the surgical procedure. Identify the types of closure material used for each tissue layer. Identify the wound classification (CDC guidelines) for this procedure and its rationale. 3. Immediate Postoperative Phase Identify how the care coordination (patient needs) of the plan of care are managed during this transition phase, both from the circulating nurse s role and the scrub nurse s role. 4. Reflection Share your thoughts and reflections regarding the surgical plan of care for your patient. It may be helpful to include: Did the patient achieve the expected outcomes? Provide rationale. Identify any modifications to the surgical plan of care, based on the patient s reaction to care, and the rationale behind the modifications. Describe any initiatives taken during the case that highlight any patient and/or staff safety concerns related to the surgical plan of care. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 20

21 Assignment #2 Evidence Based Practice Grade = 20% The purpose of this assignment is to facilitate the learner s application of research findings to areas of practice that could be improved in the perioperative setting, thereby promoting evidence-based practice. Scenario: As a perioperative nurse, you feel it is important for your OR to integrate improvement strategies into perioperative practice to improve the quality and safety of patient care in your OR. Please chose one of the following topics (or one of your choosing) where you see the opportunity for improvement in perioperative practice in your OR: World Health Organization Surgical Safety Checklists Marking the Surgical Site Sharps Safety Double Gloving Preoperative Anxiety Verbal Abuse in the OR Anesthesia Awareness Recycling in the OR (Waste Management) Reuse of Disposable Supplies Medication Safety Surgical Counts Use of Photography in OR with Smartphones Outline your topic using the following headings: Brief description of the topic area and why improvement is needed Patient safety issues Surgical team safety issues, if applicable Obstacles you may encounter in presenting this topic area to the remaining perioperative team (e.g., manager, staff, surgeons, anesthesia, support staff, etc.) Relate the topic to at least one ORNAC Standard (e.g., if choosing a topic related to flipping of perioperative items, an example of one ORNAC Standard related to this would be on page 114) Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 21

22 Requirements: Use 2 peer reviewed research perioperative nursing articles (evidence based) to support your topic for improvement that were written in the past 5 years. See additional information below on peer review if you are unfamiliar with this term. Reference throughout your paper. APA format is not required. Please include a title page and a reference page. This written assignment should be typed. Maximum page is 3 pages (this does not include the title page or reference page). Additional Info: Peer review is a process of self-regulation by a profession or a process of evaluation involving qualified individuals within the relevant field. Peer review methods are employed to maintain standards, improve performance and provide credibility. As a peer-reviewed journal will not publish articles that fail to meet the standards established for a given discipline, peer-reviewed articles that are accepted for publication exemplify the best research practices in a field. For perioperative, the journals that you have seen in your lessons, such as ORNAC Journal, AORN, Journal of Infection Control, etc., all have experts that review the articles before they ever get published. They are all peerreviewed. This is a more stringent process than just writing a blog, or giving an opinion on a certain perioperative topic. There is usually some research (e.g., trials, data-either qualitative or quantitative, previous literature search, etc.) done on the particular topic and it is submitted to experts for review. Sometimes it is hard to tell now as more information being available online. What you want to avoid is things like blogs, some forums, etc. as they are sometimes just peoples opinions. Nurse One is an excellent resource for research articles. To access articles go to nurseone.ca o If you have not already registered, you need to complete an account first. o To register, click Register in upper tab. You will need you RN license from CRNNS to set up account. Finish setting up account with a current and a password. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 22

23 o Then continue to left hand menu and click Library, then Library Resources. o Select any of the EBSCO databases to search for a topic of interest for the assignment. Usually the CINAHL or Cochrane are excellent for nursing articles. Then enter Search criteria. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 23

24 Content Marking Rubric for Assignment #2 Fair 1 pts Good 2 pts Exceptional 3 pts Description/ Background of Topic -Does not provide a clear description of topic or background information -No relevance to Operating Room -Provides some description of topic or background information -Provides a clear description of topic or background information -Relevance to Operating Room clearly articulated Patient /Team Safety -Relevance to patient /team safety not clearly outlined -Some relevance to patient/team safety clearly outlined -Relevance to patient /team safety clearly outlined Obstacles -Obstacles/barriers not stated -Some obstacles/barriers were addressed -Clearly outlined barriers/obstacles to topic Overall Assignment Content Graded out of /9 pts Fair 0 pts Good 1 pts Exceptional 2 pts ORNAC Standard -Does not relate chosen topic to ORNAC Standards -Some relevance to ORNAC Standards -Clearly relates topic to ORNAC Standards Overall Presentation of Paper - Paper contains numerous grammatical, punctuation, and spelling errors - Paper does not flow -Difficult to read - Paper contains some errors in grammar, punctuation or spelling - Language is somewhat clear - Paper contains less than 1-2 errors in grammar, punctuation or spelling - Language is clear and precise -Paper flows consistently -Easy Read Current References -No references -References with questionable relevance and validity -All sources are recent and relevant and 2 are from current nursing journals Overall Assignment Graded out of /6 pts Total out of /15 pts Converted to /20% Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 24

25 Online Discussion Forum An online discussion forum has been setup for interactive discussion between learners and faculty. Online discussion activities (e.g., discussion topics, announcements, changes in schedule, etc.) will be posted online by faculty throughout the program. It is important to actively participate in the learning process. The purpose of the discussion area is to have an online area where we can have interactive discussions. It will function like a virtual classroom, especially for distance learners. This group is private and only seen by those who are on the membership list. Faculty members are Managers of the area and will moderate the group s conversations. Participation in the discussion area will be evaluated on the quality of the postings. Avoid repeating what has already been said and be constructive in building the discussion. The quality of the posting is assessed by the participant s ability to incorporate points raised and also apply alternatives that have yet to be identified. Cite relevant personal examples and ask key questions that lead to dynamic discussions. Postings will be assessed on knowledge, comprehension, application, analysis, synthesis and evaluation. Marks for participating on the forum will be awarded to the learner. Detailed information about the online discussion area will be given at orientation. The marking scheme/rubric can be found below. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 25

26 Online Discussion Participation Rubric Points Participation and Timeliness Does not post Late posting No response Creates an initial post. Responds not in time for others to respond Creates and posts early and responds in a timely fashion References and Support None Uses personal experience but no readings or lessons Uses personal experience and some reference from lessons Supports comments with personal experience, research and readings. Contribution to the Learning Does not make effort to respond to others Occasional signs of insight. Not always relevant to discussion Constructive but too general to topic of discussion. Mostly insightful Insightful and constructive. Sparks further discussion. Demonstrates applicability to professional practice None Not applicable to professional practice Some aspects are applicable to professional practice Applicable to professional practice Demonstrates knowledge and understanding of content None Demonstrat es little understanding of course content Demonstrate s some understanding of course content Demonstrates clear understanding of course content Graded out of /20 pts Converted to / % Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 26

27 Skills Components Perioperative Skill Assessment Skill Development Sessions There is skill development sessions scheduled in the perioperative nursing program (e.g., Skills Week Intensive). The purpose of the sessions is to provide the opportunity for learners to reinforce the content presented in the lessons, to develop skills, and to consult with faculty. Skill development sessions are mandatory and clearly outlined in the program calendar. If a learner will be absent from a scheduled skill development session, they are required to contact faculty (see Student Handbook for Attendance Policy). Learners receiving credit for the knowledge/skill presented in a skills session may attend at their discretion after consultation with faculty. Please remember to bring your copy of pertinent lessons and the skills checklist with you to each skills session. Skill Practice and Skills Assessment Skill practice and assessment will occur during Skills Week. Please refer to your Skills Checklist for the Levels of Psychomotor Skill Acquisition and the required levels at the different assessment points in the program. Failure on any skill assessment will result in remedial instruction and reassessment. The specifics of this reassessment will be determined by the learner progression committee. Failure of a skill at the re-assessment point will result in disqualification. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 27

28 Clinical Components Clinical Clinical learning is instructional until the performance assessment which occurs at the end of the program. The preceptor completes the scrub and circulating assessments from direct observation of the learner s performance (see forms in Operating Room Skills booklet). Faculty will keep in contact with all preceptors and students during their final clinical performance to ensure they are meeting the programs competencies. Nurses currently employed in the perioperative setting or who have previous perioperative nursing experience may receive credit for their prior clinical learning and potentially reduce their clinical learning requirements based on a portfolio assessment (please see faculty if you are requesting PLAR for any of the required program requirements). Perioperative Performance Assessment Points A. OR Clinical 1 & 2 : Skills Development in the Scrub Role Preceptor to provide review (if required) on: locker room/hours of work/breaks unit daily reports/in-services unit layout unit polices pertinent to learner experience: dress code, consents, documentation, routine practices, cardiac arrest, malignant hyperthermia, latex sensitivity, fire, etc. Review the responsibilities of the scrub role. Focus on developing the following skills inherent in the scrub role: Scrubbing, gowning, and gloving. Creating a sterile field Instrument preparation, passing and care during surgery (including laparoscopic instruments) Draping Surgical counts Medication preparation Specimen handling Surgical Safety Checklist Surgical Conscience Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 28

29 Seek opportunities to act as first scrub for basic surgical cases. Due to unpredictable nature of the case lists, patient condition, and OR staffing models (RNs and LPNs), this may not always be possible to be in the first scrub role. In this situation, the preceptor will use his/her discretion in determining the appropriate learning for the perioperative learner (e.g., second scrub with preceptor in first scrub role, move to circulating role, etc.). Observe the circulating role. Preceptor (and/or faculty) to complete a Scrub Role Assessment. B. Final OR Clinical: Clinical Performance Integration of the Scrub and Circulating Roles Continue to scrub for basic and more complex cases. Review the responsibilities of the circulating role noting the following: The RN's approach to the patient/family. The data included in the focused assessment of the patient and developing the surgical plan of care. Participation in the Surgical Safety Checklist. The patient records for which the OR nurse is responsible for documentation. Team members with whom the operating room nurses shares pertinent information (e.g., allergies, lab values, etc.). The responsibilities of the RN in the circulating role in care coordination of the patient. The operating room nurse s report (details) to the PACU registered nurse (e.g., handoff report). Perform aspects of the circulating role as determined by the preceptor: Surgical Safety Checklist Focused patient health assessments Creating a sterile field Surgical counts Positioning Prepping Assistance with draping Assistance with anesthesia (e.g., induction of patients) Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 29

30 Implement thermoregulation measures (e.g., Bair hugger) Catherization if required Medication delivery to the sterile field Specimen preparation Completion of perioperative records Transfer of patients Preceptor (and/or faculty) to complete Final Scrub and Circulating Assessments. Clinical Guidelines During the perioperative clinical experiences the following guidelines apply: 1. The clinical settings are used throughout the perioperative program to develop skills and apply perioperative knowledge. 2. It is an expectation that learners should review the surgical caselists and read information related to surgical procedure prior to their participation in the surgery. 3. Learners should identify themselves as a perioperative nursing program (PONP) student on all legal documentation (i.e., student name, RN, PONP). 4. Learners are expected to bring their Skills Checklists with them each day. The checklist is the basis on which the daily progression of the learner is assessed. 5. Each week while in the clinical setting you will be required to log your cases in a Surgical Case Log. Please refer to the next page for a more detailed description of what is expected. At the end of each week (or daily), you will be required to send your faculty advisor a copy of your surgical case log either by , or fax. Please refer to your program calendar for outlined dates for submitting the surgical case log. 6. Learners are responsible for informing the perioperative faculty, clinical sites (if in clinical rotation), and their supervisors (place of employment if being sponsored) of any scheduling changes or illness on the part of the learner or preceptor. 7. Absenteeism for any reason will be reviewed by faculty to determine whether the missed time will be rescheduled. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 30

31 8. Learners are expected to maintain complete and accurate patient care records in compliance with hospital policy. 9. Learners are responsible for ensuring that the scrub and circulating assessments are completed and submitted to faculty at the end of the final clinical. Faculty members will visit the clinical sites as required during clinical and will observe the learner in the clinical area and meet with learners and preceptors. Faculty will consult with the learner s preceptor(s) regarding the performance however, faculty are responsible for the final decision regarding the learner s performance assessment. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 31

32 Surgical Case Log Purpose: The surgical case log is used to assist you in your learning/reflecting, as well as to assist faculty/preceptors in performance assessment. The surgical case log combines information, emotion, and experience, giving the learner a clearer understanding of what she/he has learned and how it has impacted on her/his practice. Instructions: Please keep a log of all cases during clinical placements in the operating room. Please indicate whether you were in an observatory, circulator, or scrub role. Please update your surgical case log daily. At the end of each week in the clinical setting, you will be required to send faculty a copy of your surgical case log either by . Please refer to your program calendar for outlined dates for submitting the surgical case log. Reflection: Reflect in whatever way you choose (e.g., thinking, writing, in dialogue with a colleague) on events that may have represented significant learning opportunities for you (e.g., what have you learned from the situation? What went well- what didn t? What would you do differently, or the same, next time? What feedback did you get, if any? How might you grow and learn from this experience? What would help you manage similar situations in the future? What skill set might enhance your abilities?) (CRNNS, 2008). Examples: March 10, 2011: Right Inguinal Hernia Repair Scrub with Mary Smith: Felt more comfortable with sterile technique. Need to review instruments and counting procedures. March 10, 2011: Lap chole Scrub with Tom Mason: Handed off wrong end of light cord. Circulating nurse opened new cord. Need to check ends before passing off sterile field. Feeling more comfortable with laparoscopic instruments. CRNNS. (2008). Building you profile. Retrieved from Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 32

33 Clinical Plan The purpose of the Clinical Plan is to help faculty and learners establish a plan for the learner s time in the clinical setting. It is the learner s responsibility to provide faculty with a plan of how their clinical time will be arranged. It is also the learner s responsibility to inform faculty of any scheduling change once the plan has been established. The learner cannot be in the clinical setting without faculty being aware. Absenteeism for any reason will be reviewed by faculty to determine whether the missed time will be rescheduled. Please submit your clinical plan on date indicated in your calendar for faculty approval. The following is a list of the requirements for the Clinical Plan: Clinical site and contact information for the OR (e.g. OR phone number, staff lounge, etc.) OR Manager and/or preceptor(s) names Dates and timeframe for clinical (25 days) in operating room: o Fulltime (5 days/week) o Parttime (3 days/week) o or some combination of fulltime and parttime Submitted to faculty as outlined in calendar Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 33

34 Additional Perioperative Experiences In addition to the learner s clinical time, there are also additional perioperative learning experiences. These experiences provide the perioperative learner with the opportunity to operationalize the coordination of patient care required in caring for patients throughout all phases of the surgical experience. Every effort is made to provide learners with the required experiences at a clinical site close to their home. All scheduled perioperative learning experiences are mandatory. Specific learning outcomes are outlined for each clinical experience. Please take the learning outcomes with you when observing in these clinical areas so that your preceptor/assigned staff person will have an understanding of your objectives during your time. The following are the observation days that will be required in the perioperative nursing program: Sterile Processing Department OR Observation Days Same Day Surgery Preadmission Clinic Post Anesthesia Care Unit Anesthesia Note: These perioperative learning experiences provide the learner with the opportunity to apply knowledge in the workplace setting. It is the expectation of the perioperative program that the learner follow ethical, legal, and professional standards during each of these learning experiences. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 34

35 Sterile Processing Department (SPD) Learning Outcome: The purpose of this experience is to reinforce the theoretical content (e.g., sterilization lesson) through clinical observation. The following is a list of learning outcomes for the day that you are assigned in the Sterile Processing Department (SPD). Based on ~ 5-7 hour observation day Decontamination ~ 1 hour What is need for PPE, when working around chemicals and contaminated items Decontamination process - cleaning and disinfection Spaulding classification and handling contaminated supplies. Understand how the pre-cleaning effects assist SPD s ability to turn around their items in a timely manner. Processing/ Sterilization ~ 3-5 hours Learn how to inspect supplies/instruments for cleanliness and functionality. Learn different packaging used for sterilization Learn what chemical indicators are and what they indicate (external and internal indicators). Daily testing required for sterilization Understanding the turn-around time of an item that entering decontamination to the time it can be release. Review basic instrumentation tray o instrumentation identification (instrument binders/catalogues) o stringing of instruments Storage ~ 1 hour Even Related Sterility Stock rotation Recognize if the item is sterile or compromised and how to handle sterile items. Case cart system, if applicable Process for instruments to get back to OR Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 35

36 OR Observation Day # 1 Learning Outcomes: 1. Describe the different perioperative surgical team members apparel. 2. Outline the personal protective equipment (PPE) the different perioperative team members wore. 3. Describe the roles of the scrub and circulating nurse play in gowning and gloving. 4. Determine sterile versus unsterile supplies and when used during surgical procedure. 5. Describe the movement of sterile surgical team members. Learning Outcomes: OR Observation Day # 2 1. Observe how and when the patient is positioned for a surgical procedure. 2. Observe who is involved in patient positioning. 3. Describe what safety precautions are taken. 4. Describe the positioning devices used. 5. Outline the purpose of the skin prep of the operative site, who does the skin prep, when during the surgical procedure and how. 6. Describe the type of drape(s) that were used in the surgical procedures and who is involved in the draping. Learning Outcomes: Same Day Surgery 1. Observes the role of the registered nurse related to: Patient Assessment Development of the Surgical Plan of Care, if applicable Support (managing patient/family anxiety) Teaching Coordination of patient care and setting priorities 2. Gains an appreciation of the patient s perioperative experience in sameday surgery/preop. 3. Observe a nursing assessment completed by your preceptor which includes the pre-operative checklist. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 36

37 Preadmission Clinic Learning Outcomes: 1. Observes the role of the registered nurse in relation to: Patient Assessment Development of the Surgical Plan of Care, if applicable Helping/support Teaching Organization and setting priorities 2. Gains an appreciation of the patient s perioperative experience in the preadmission setting. 3. Observe a comprehensive preadmission nursing assessment in the clinical setting by preceptor/assigned staff. Anesthesia Day The following is a list of learning outcomes for the day that you are assigned with an anesthetist. Learning Outcomes: 1. Observe the anesthetist in managing the patient in the preoperative, intraoperative, and postoperative phase of the surgical experience. 2. Observe the role of the anesthetist in his/her interactions with other team members. In particular, observe the coordination of patient care through all stages of surgery. 3. Identify the items on the anesthesia machine that are changed between cases. 4. Observe the role of anesthesia with regards to patient positioning. 5. Observe any anesthesia equipment/supplies that were used during the case (e.g., endotracheal tube, LMA, suction, etc). 6. Observe the vocal cords of a patient (if possible). 7. Discuss the medications and inhalation gases used for induction, maintenance and emergence in general anesthesia. 8. Identify what monitoring equipment was used during the case (e.g., pulse oximetry, BP, capnography, ECG, etc.). Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 37

38 Post Anesthesia Care Unit Learning Outcomes: 1. Observes the role of the registered nurse related to: Assessment o Admission o Discharge o Other assessments Types of monitoring equipment used Medications (including oxygen) o Type o Indications o Mode of administration o Therapeutic effect of the medication Stir-up regimen Management/adjustments to the Surgical Plan of Care (e.g., rapidly changing patient situations) Documentation 2. Observes patients recovering from various types of anesthetics (e.g., general, regional, etc.), if possible. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 38

39 Appendices Appendix A - Competencies and Performance Criteria B - Proficiency Levels C - Proctored Examination Policy D - Proctor Approval Form Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 39

40 Appendix A Competencies and Performance Criteria Perioperative Nursing Program Patient Centered Care: Provides compassionate, coordinated and competent care while respecting the patient as a full partner. 1. Develops a therapeutic relationship with patients and families. Respects patient and families values, perceptions, views and diversity. Demonstrates caring attitude while maintaining professional boundaries. Uses appropriate communication tools and techniques to explore patient s health care needs. 2. Engages patient (or designee) in decision-making and the management of own health. Recognizes the influence of patient differences, preferences, values and needs on decision-making. Considers patient s capacity and/or willingness to be the source of control in all aspects of care. 3. Performs an individualized, holistic health assessment. Completes health assessments that are individualized to the patient and their situation. Integrates assessment data from other sources. Validates assessment findings with patient and other members of the health care team. Identifies patient problems (actual/potential) based on interpretation of assessment findings (abnormal/normal). 4. Develops an individualized shared plan of care. Collaborates with patient and other members of health care team to identify goals, interventions and expected outcomes reflective of the patient s needs and the surgical procedure (e.g., surgical team management). Identifies resources required for the surgical team to function efficiently. Incorporates teaching and learning into plan of care. 5. Provides priority based nursing care to patients through independent and collaborative implementation of the plan of care. Implements the established plan of care. Coordinates the delivery of individual care. Recognizes and responds effectively to urgent and emergency situations. Revised June 2014 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 40