AORN guidance statement: the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula

AORN Journal, August, 2007

INTRODUCTION

The nature and quality of undergraduate education is key to the future of the profession of nursing. However, nursing faculties face many barriers, existing or potential, when they take on the challenge of designing and implementing innovative curricula. Yet, if they are to prepare graduates who can function effectively in current and future practice arenas, nursing curricula and their component teaching-learning activities and evaluation methods must undergo constant revision, updating, and change. (1)

To facilitate this complex work of faculty, this document has been developed to serve as a guide to help faculties plan clinical learning opportunities in perioperative patient care that develop competencies essential for all undergraduate nursing students. The term clinical learning activity or opportunity refers to a planned instructional activity designed to facilitate the achievement of a desired learning outcome or competency. Perioperative patient care refers to the preoperative, intraoperative, and postoperative care of patients undergoing surgery and other invasive procedures.

In 2006, the AORN House of Delegates ratified a revised position statement on the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula. That position statement reaffirmed that "all clinical settings, including the perioperative setting, have the potential to provide opportunities in which the principles of the art and science of professional nursing can be applied; therefore, these settings should be used during the formal education of nurses. The incorporation of perioperative learning activities into existing undergraduate curricula will assist in meeting end-of-program outcomes." (2) Also in 2006, the National Student Nurses Association (NSNA) House of Delegates passed a resolution submitted by the Florida Nursing Student Association encouraging support for including theoretical and clinical perioperative nursing experiences into nursing curricula. (3)

While the faculty has primary responsibility for curriculum planning and implementation, partnerships with perioperative clinical nurse educators, nurse managers, and staff nurses are essential for successful coordination of these clinical activities. Nursing students also are expected to be active participants in their learning; as such, they have an important role in setting their own individual learning goals. Nursing students can use these guidelines to help design self-directed learning activities in perioperative clinical settings.

BACKGROUND

Operative or other invasive procedures are a primary treatment for patients admitted to hospitals, accounting for 29% of all admissions. (4) An even greater percentage of surgeries are performed in the ambulatory/outpatient setting. According to the most recent data of the American Hospital Association affiliate Health Forum, 27,401,836 surgeries were performed in the United States in 2004; of these, 37% (10,050,346) were inpatient surgeries, and 63% (17,351,490) were outpatient surgeries) With the forecasted growth of free-standing outpatient surgical settings (5) and other ambulatory care facilities (eg, mobile interventional suites, physicians' offices), an increasingly wide variety of learning sites is available to nursing students.

This rich array of opportunities for planned clinical learning activities throughout the undergraduate nursing curriculum can alleviate some of the problems currently faced by educators:

* increasing enrollments in nursing education programs leading to competition among nursing education programs for the same clinical sites;

* emergence of competition between nursing and other health care professional programs for clinical placements; and

* shortage of nursing faculty members for teaching in clinical settings.

The provision of safe care to these most vulnerable of patients is of paramount importance to health care professionals and the health care agencies in which they receive care. Planned clinical learning activities in ambulatory (6) and other perioperative clinical settings are consistent with many of the knowledge, skills, and values promoted by the American Association of Colleges of Nursing (AACN) (7) and the National League for Nursing (NLN). (1) Perioperative clinical sites can provide opportunities to apply

* critical thinking skills to assess patients' readiness for surgery; (8)

* safety principles to patient care; (8)

* patient and family teaching to enhance expected outcomes;

* aseptic and antiseptic practices to promote wound healing;

* care to diverse patient populations;

* principles of human, technical, and fiscal resource utilization; (8)

* legal and ethical guidelines; and

* concepts of teamwork, (8)

Perioperative clinical learning experiences thus can provide benefit to nursing programs, nursing students, and clients undergoing operative and other invasive procedures.

GUIDANCE STATEMENT

Undergraduate nursing education programs are attempting to produce graduates with a common set of competencies that are necessary for safe, effective nursing practice. However, in the early 1990s the primary national nursing associations involved in establishing standards for nursing education--the NLN, the National League for Nursing Accrediting Commission, (9) the AACN, and the Commission on Collegiate Nursing Education--moved from a prescriptive model that dictated specific content and learning activities to an outcomes model that holds schools accountable for achieving their identified outcomes. The specific outcomes, learning activities, and content of programs are no longer directed by these groups. Nevertheless, they continue work to articulate general expectations for performance of nurses and hence provide guidance to schools as the faculty design curricula. Faculties of nursing education programs are expected to identify the national standards they used when identifying their program outcomes, and they are expected to demonstrate the logic of their curricula and learning activities that are implemented to achieve the national standards they selected. In 1998 the AACN produced guidelines in the form of The Essentials of Baccalaureate Nursing Education. (7) The Essentials document identified the following graduate characteristics: liberal education, professional values, core competencies, core knowledge, and role development.