Perioperative clinical learning experiences

AORN Journal, Sept, 2004 by Linda M. Sigsby

Educators and perioperative nurses interested in education should forge strong ties and establish relationships with nursing students that facilitate perioperative experience and emphasize patient care. Students may find it exciting to see a surgical procedure, but the relationship of perioperative activities to the curriculum and patient care is what matters and what students need to learn about.

Nurses often think the OR is so specialized and unique that the care practiced there may not apply to other types of nursing. On the contrary, the perioperative experience may provide nursing students with an opportunity to apply their knowledge about patient care, such as aseptic technique, skin integrity, patient positioning, infection control, informed consent, and thermal and fluid balance. These skills are practiced daily in perioperative settings. Patient care learned in the perioperative setting can and should be applied to patients in other clinical units as well It is critical that content learned in one setting be applicable to other clinical settings.

The dynamics of health care today make the perioperative clinical environment a viable setting for student learning. Perioperative settlings require critical thinking and application of nursing skills, but these settings often are underused by nursing programs, despite the increasing need for personnel in ORs. In addition, the trend toward same day surgery means fewer students are exposed to patients preoperatively and postoperatively; thus, students have less opportunity to learn about and practice issues central to perioperative nursing. These factors have important implications for student learning and surgical patient care because the perioperative environment provides students with learning opportunities that are congruent with academic accreditation goals.

THE CURRICULUM PLAN

According to nursing accreditation standards, perioperative didactic and clinical course content must relate to objectives in a course syllabus. Content is introduced in a didactic course and applied to patient care in clinical courses. Faculty members are responsible for the curriculum, so they must be able to articulate how curricular content can be integrated in any clinical site, including in perioperative practice areas. (1) The curriculum should consist of logically ordered course content and course objectives that indicate students' increasing responsibilities and mastery of more complex concepts (Table 1).

COURSE CONTENT. Courses in most nursing programs begin with simple content and move to complex content. Early didactic courses often are titled "Essentials of Nursing" or "Foundation of the Nursing Profession" to emphasize their basic content. If a course is scheduled very early in the curriculum plan, the clinical component, which may take place in a hospital or nursing home setting, might focus on learning basic skills, such as communicating with the patient, gathering a health history, performing a health assessment, and practicing psychomotor skills. Course objectives should include these expectations of achievement, and faculty members in a clinical setting must determine how these activities can best be learned at their site. Faculty members in a perioperative environment also need to design learning activities that will help students achieve learning objectives that are specific to the perioperative setting.

COURSE OBJECTIVES, A course scheduled for later in the curriculum plan may address more advanced cognitive, affective, and psychomotor skills. Cognitive domain includes descriptions of learner behavior related to intellectual abilities and skills. Affective domain includes descriptions of learner behavior related to attitudes and values. Psychomotor domain includes descriptions of learner behavior related to movement and motor skills. Words used to describe the course objectives usually signify a higher level of expectation and indicate increasing levels of performance, from knowledge to comprehension, application, analysis, synthesis, and evaluation (Table 2). (2) For instance, rather than focusing on knowledge of anatomy and insertion of a urinary catheter, a later course might require more complex thought processes, such as critical thinking related to fluid balance.

One of the last courses in a nursing curriculum often is one that promotes a transition from the student role to the clinical role of the practicing nurse. Again, course objectives usually reflect this emphasis.

RELATING PERIOPERATIVE LEARNING TO COURSE CONTENT

One day of observation experience in the OR usually is insufficient for nursing students to learn anything, because they seldom have clear objectives for that one-day experience. Students may be in the OR expecting only to see a surgical procedure, but if that is the only course objective, it can be achieved by watching a surgical procedure on television. Faculty members usually do not assign students to see a particular surgical procedure; they assign students to learn about patient care in the perioperative setting. Areas that are vital to quality patient care include