ORBIS - training nurses worldwide in ophthalmic care

AORN Journal, Oct, 1998 by Karen Watts, Helen Taylor, Kevin Taylor

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In the OR, the two local nurses are exposed to a variety of ophthalmic procedures, with the exception of refractive surgeries, which are not performed by ORBIS. Each week there are three visiting faculty members representing three ophthalmic subspecialties. A variety of techniques and equipment may be used as the local doctors are being taught. Working with an ORBIS nurse, local nurses alternate between scrubbing and circulating duties. Areas emphasized in the OR training are the practices of aseptic technique and standard precautions and how to effectively and safely handle and pass microsurgical instruments.

Surgical procedures taking place at local hospitals are an excellent opportunity to demonstrate to the host physicians and nurses that the same surgery performed on the plane often can be performed in their facilities, using their equipment (Figure 6). A technologically advanced OR is not always necessary. The surgical procedures completed in hospitals also provide an opportunity to suggest ways to implement change (Figure 7). The ORBIS float nurse assisting in a local hospital surgical procedure can observe firsthand the practices of the hospital OR and make suggestions. This may be something as simple as suggesting OR staff members use a puncture resistant, leak-proof plastic bottle for the safe disposal of sharps. The standards learned on the plane that are directly applicable to the host country's OR environment are not always easy for the local nurses to implement for several reasons (eg, a lack of basic supplies, nurses believing that they do not have the power or authority to change practices).

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It is the float nurse's responsibility to maintain ORBIS standards while working in the local hospital. Recognizing that more than one surgery being performed concurrently may be the norm, the ORBIS nurse can use this opportunity to discuss methods for ensuring that the principles of aseptic technique and standard precautions are adapted in the most beneficial way. The ORBIS nurse must work within and be sensitive to the limitations in the host country hospitals. As on the plane, a local nurse is encouraged to scrub alongside an ORBIS nurse. Some of the best teaching can take place in the hospital setting. The ORBIS organization realizes the importance of working more within the host hospital's environment and is increasing the number of surgeries performed in the local hospitals.

Many of the countries where ORBIS has held programs have had very skilled, knowledgeable nurses. When questioned as to how they are benefiting from the ORBIS program, the nurses often answer that they are learning a great deal just from observing. Local nurses can observe how the ORBIS nurses interact with surgeons, work with the biomedical engineers when there are equipment problems, interact with the patients, and handle other everyday actions (eg, organizational skills, decision-making skills). It is necessary for ORBIS nurses to be aware that they may be continuously placed in a leadership role by the local nurses and other health care professionals participating in the ORBIS training program.