Perioperative education—perspective from the think tank

AORN Journal, Nov, 2004 by Nancy J. Girard

The lack of perioperative experiences in nursing program curricula limits the number of new graduates who have exposure to perioperative nursing practice and likely limits the number of new graduates who will choose to pursue a career in this specialty. This situation, combined with the reality that perioperative nurses are retiring in greater numbers, creates serious concern about the ability to staff perioperative arenas in the future.

In February 2004, the AORN Foundation and the National League for Nursing (NLN) cosponsored a think tank to address this problem. Sixteen individuals representing perioperative clinical practice and all types of nursing education programs (ie, associate degree, diploma, baccalaureate, graduate), many of whom had expertise in nursing education and curriculum development, were invited to participate in the think tank to share their ideas. The Think Tank on Perioperative Learning Experiences in the Nursing Curriculum was underwritten by donations from Alliance Medical Corp, Phoenix, and the Certification Board Perioperative Nursing.

OBJECTIVES OF THE THINK TANK

The objectives of the think tank were to

* examine the knowledge, skills, and values associated with caring for perioperative patients and their family members that are appropriate to generalist preparation for the RN role;

* explore how students can most efficiently and effectively develop that knowledge and those skills and values; and

* propose strategies to help faculty members whose specialty focus is perioperative nursing provide leadership in curriculum development and innovative teaching, learning, and evaluation efforts that will help students attain defined knowledge, skills, and values.

As the think tank progressed, participants agreed on the following goals.

* Increase faculty members' awareness of the full range of clinical nursing opportunities available to students. Perioperative nursing practice takes place in many clinical settings, in many types of surgical centers, and in many areas throughout a hospital.

* Share information with faculty members about ways in which much of the knowledge and many of the skills and values identified as essential for twenty-first century nursing practice can be achieved through perioperative learning experiences.

* Propose strategies to be shared with faculty members on how to expose more students to perioperative nursing practice without increasing content hours in an already overloaded curriculum.

* Re-educate faculty members and the nursing community in general that perioperative nursing is real nursing--it just is practiced in specialty settings, such as the OR and postanesthesia care units, which are not unlike other specialty settings, such as critical care units and emergency departments.

THINK TANK

To begin the session, the group viewed a film titled Joel Barker's The New Business Paradigm (1) on leadership, change, and paradigm shifts. This presentation stimulated discussion on traditions and existing paradigms in nursing and nursing education, including

* "lock-step" curricula that allow for little, if any, student choice or opportunities to explore areas of interest;

* content-driven curricula, which emphasize covering content more than student learning, student excitement about learning, processes, and values development;

* concurrent teaching of theory and practice, which may inhibit rather than enhance student learning;

* expert faculty members who may have difficulty conveying knowledge at the beginner level;

* faculty member concerns about promotion and tenure that can inhibit willingness to try innovative approaches to teaching, learning, evaluation, or curriculum development;

* the individual nature of teaching and learning, which is in sharp contrast to perioperative practice settings that expect teamwork and collaborative, cooperative functioning;

* the pressure faculty members feel to prepare students to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) so that learning and evaluation methods are designed to align with the examination;

* frequent repetition of material in a nursing curriculum;

* students' reports of being overwhelmed with work but not intellectually challenged in some nursing programs;

* faculty members who are expert clinicians but who have not been prepared for the faculty role and, therefore, do not have the theoretical base on which to design innovative curricula and student-centered teaching practices;

* pressure placed on faculty members and schools to meet revenue and enrollment expectations; and

* the way clinical experiences are provided in nursing programs, which has not changed significantly over the years.

Nursing program curricula, student leaning experiences, and teaching and evaluation strategies must change significantly for schools to prepare nurses so they can function effectively in current and future practice arenas.

KNOWLEDGE, SKILLS, AND VALUES

With a general framework in mind, think tank participants explored factors that influence nursing education and practice (Table 1). These and other factors also affect the design of education programs, teaching methods and strategies, evaluation of student learning, teaching of clinical skills, clinical practicum, and provision of education that will prepare a diverse, talented body of nurses.