Running head: SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE

Self-Assessment of Nursing Standards of Practice Shannon Sheffer Ferris State University

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE Abstract The mission of the Association of periOperative Registered Nurses is simple; promote safety to patients undergoing an operation or invasive procedure by supporting the professional growth and development of the perioperative nurse. This organization completes this by setting forth standards and scopes of practice for the nurses to abide by. These standards help protect both patient and health care worker before, during, and after procedures. One standard includes

aseptic practice in the forms of proper hand hygiene and proper surgical attire. Another standard sheds light on the prevention of retained surgical items in the techniques of a proper count. These are just a few of the many different standards the Association of periOperative Registered Nurses sets forth as professional practices.

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE Self-Assessment of Nursing Standards of Practice Scopes and standards of practice are designed to describe the basic skills necessary to

care for a patient within an institution or facility. According to the American Nurses Association (2014), standards of practice serve as the professional method to conduct and guide nurses throughout the country. An operating room nurse specializes in providing a sterile environment for the patient as well as maintaining and ensuring safety to all. The Association of periOperative Registered Nurses (AORN) has developed a scope and standard of practice to guide the development of the professional nurse. Description of Current Behavior I am employed as a registered nurse clinical coordinator in the operating room (OR). As a registered nurse in the OR for the last nine years, the specialty practices set forth by the AORN are ever changing to stay ahead of new strands of infections that could possible injure the patients. The AORN is a non-profit membership association that provides nursing education, standards, and clinical practice resources for the ORs around the country (AORN, 2014a). This organization serves over 160,000 perioperative nurses in the United States and is growing more every year (AORN, 2014a). The mission, vision, and values of AORN are to provide resources of evidence-based practice as well as promoting safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses (AORN, 2014a). This organization creates the standards of care and practice as well as oversees potential training recommendations for intraoperative nurses. All standards of AORN center on cleanliness and sterility which all reducing the spread of bacteria and germs. This all starts with proper hand hygiene and how it is so important in the global picture of the surgical environment.

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE Hand Hygiene

Hand hygiene is recommended multiple times throughout the day for nurses dealing with patient care. There are two methods of proper hand hygiene for the nurse to choose from; alcohol based hand scrubs or soap and water scrub. The AORN recommends hand hygiene be done when entering or exiting an operative suite, before or after having contact with a patient, any time the nurse has been in contact with blood or other potentially infectious materials, before and after the use of personal protective equipment such as gloves and gowns, or any time when ones hands are dirty or unclean (AORN, 2014b). I believe that I abide by this recommendation set by AORN on a daily bases. At the start of everyday in the OR, I am required to perform a mechanical scrub with hospital approved soap and water prior to starting in the operative suites. Once this task is complete, one may begin to open the rooms with sterile products and instruments. Throughout the day, I use hospital approved alcohol based sanitizer when removing gloves within the operative suites, as well as when transferring care of patients to post anesthesia care nurses after the procedure is complete. In addition, I also wash my hands with soap and water when exiting an operative suite when I leave the OR for breaks, lunch, and at the end of the day. One area that I think I can improve upon is when Im entering and exiting a patients room in the perianesthesia holding area. Recommendations from AORN are that hands need to be washed before and after every patient contact (AORN, 2014b). AORN defines patient contact as exposure to patient and not each time you touch a patient (AORN, 2014b). Surgical Attire Appropriate surgical attire is a very important part of sterility standards set forth by the AORN. According to a journal in AORN by Braswell & Spruce (2012), proper surgical attire is

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE to safeguard the surgical patient against contaminates and infection and also to protect the intraoperative employee. AORN standards go on to say that surgical attire should be made of low-linting material, contain shed skin squames, provide comfort, and promote a professional appearance (Braswell & Spruce, 2012). They continue to say any jewelry worn by intraoperative personnel should be confined within the surgical attire as well as if personnel who are not scrubbed in at the sterile field should be wearing long sleeved jackets to prevent contamination from skin cells flaking off the employees body (Braswell & Spruce, 2012). Braswell & Spruce also state that all individuals entering the restricted areas should wear a

surgical mask when open sterile supplies and equipment are present (Braswell & Spruce, 2012). I believe that I follow these recommendations of practice in the intraoperative setting. Currently, the OR provides cotton low-linting tightly woven stain resistant surgical scrubs for all the perioperative employees including preoperative staff, intraoperative staff, post anesthesia staff, surgeons, surgical assistance, and anesthesia providers. By everyone wearing the same scrubs, a professional unified front is projected to the patient and their families. These scrubs are kept at the hospital were, after use, get laundered in off-site health care-accredited facility where they are ensured to be sterilized, pressed, and starched to remove any microbes or organisms. I no longer wear any jewelry to work and also wear the long sleeved jacket at all times while in the OR. I also wear a bouffant cap to conceal my hair while in the OR as well as wear a surgical mask when entering an operative suite when sterile products are opened or during a surgical procedure. Prevention of Retained Surgical Items The prevention of retained surgical items is very simple; at the end of procedures or surgical interventions make sure a complete and proper count of instruments and soft countable

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE items are visualized and accounted for on the surgical table. AORN emphasizes the role of the entire surgical team in preventing retained surgical items (Goldberg & Feldman, 2012). AORN highlights the roles of the entire surgical team in preventing retained surgical items (Goldberg & Feldman, 2012). AORNs counting process requires a preliminary count that should be a baseline and identify manufacturing packaging errors prior to the start of any and all procedures (AORN, 2014c). Additional counts should be done whenever instruments or countable items are added to the sterile field, as well as at the time of permanent relief of either the scrub person or the registered nurse circulator (AORN, 2014c). A count must also be

performed at three intervals during a procedure. First count is before closure of a cavity within a cavity and when wound closure begins (AORN, 2014c). Lastly, the final count must be completed at skin closure at the end of the procedure (AORN, 2014c). In my practice, I follow these counting standards of procedure, but can see some room for improvement. The area of improvement I can work on is completing my final count when the skin is closed. The surgical technologist and I always perform a baseline count before the start of the procedure and then again as items are added or taken away. We also complete a count as a cavity is being closed and then again as a surgical site is being closed. I tend to perform another count, which we refer to as a final count, as the skin or final layer is being closed instead of after closure is complete. I also will perform a count before my relief or the surgical technologists relief staff takes over. Professional Development Goals While composing this paper and reflecting upon both my educational goals and professional practice, I have identified areas in my practice that can and should be improved upon. One professional goal I would like to achieve is continuing my education and completing

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE my masters in nursing degree. In addition to my educational goal, there are two other professional goals that I would like to achieve within the year 2014. One of these goals I have identified through this paper is improving hand hygiene, not only for me, but for my peers and staff I work with in the OR. I currently use the hospital approved soap and water method at the beginning of my day, at break times, and at the end of my work shift. During the day I use the alcohol based hand sanitizer after removing my gloves after patient contact, but need to improve my practice of using the hand sanitizer when entering and exiting a patient perianesthesia room. In accordance to AORN recommendation of hand hygiene being the most effective way to prevent and control infections, and help keep our work environment germ free (AORN, 2014d). My final goal will be to adhere to the counting standards set by the AORN. The AORN has definite guidelines and practice standards that are clearly outlined. By complying with these

standards, I can ensure my patient is safe from any retained surgical items as well as ensuring the safety of the surgical team I am working with in the OR. Professional Development Action Plan The first goal I have of earning my masters in nursing has begun by finishing my bachelors in nursing (BSN) last year. I plan on finishing my BSN in December of this year and then will continue onto the masters program in January 2015. I plan to also expand my knowledge in clinical and critical thinking skills in the realm of the OR setting and new standards and recommendations set by the AORN. I will begin in March 2014 to review all of the AORN standards and begin encompassing them into my daily practice. By becoming more familiar with these standards of practice, it will enable me to improve my current nursing practices for the benefit of myself as well as my patients.

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE

My second goal of having a more effective and consistent hand hygiene habits will begin immediately. I will remind myself to use the alcohol based hand sanitizers that are outside every patient holding room before entering and upon exiting. I will give myself three weeks to become compliant with this standard of nursing. I believe that within those three weeks I will be able effectively and efficiently ascertain the necessary skills to intergrade hand sanitization into my daily nursing routine. As for my final goal, I plan to abide by the standards and recommendations set by the AORN to conduct my final procedure count at skin closure. I will start to implement this recommendation this month by leading by example in the operating suite. I will dictate to the surgical technologist when we need to perform our counts and how often. I will complete all counts recommended in order to keep my patient safe from harm. I would anticipate being capable in my counting compliance by April 2014. I believe by giving myself this time, I will adequately obtain the knowledge, engage in the proper training, and execute with proficiency without back sliding into old habits. Evaluating the Plan To evaluate myself on carrying through with my goals, I will develop daily check-ins with myself and peers. These will help me become accountable to not only myself, but to my teammates as well. The daily check-ins will help me identify areas that I am doing well and areas that I need to improve upon. Another way to evaluate my progress is by tracking my goals on a self-evaluation check off sheet. I will develop a sheet that will focus in on my top goals and what I need to do to perform and maintain these specific improvements in my practice. These sheets along with daily check-ins with a peer will help keep me accountable and on track to successfully achieve my goals.

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE Conclusion This review of the AORN standards for aseptic technique has been enlightening. As an OR nurse, refreshing my knowledge of existing standards, as well as discovering new recommendations to incorporate into my practice will be beneficial to my professional growth. I have gained the ability to think critically and evolve my practice which will not only benefit me but my patients as well. In reflection, I recognized areas of my practice that mirror the standards set by nursings governing organization as well as areas that I can improve upon to provide my patients with the safest possible care.

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE Reference

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American Nurses Association [ANA]. (2014). Professional standards. Nursing World. Retrieved from http://www.nursingworld.org/nursingstandards Association of periOperative Registered Nurses [AORN]. (2014a). About AORN. Retrieved from http://www.aorn.org/AboutAORN/ Association of periOperative Registered Nurses [AORN]. (2014b). Hand antisepsis. Retrieved from http://www.aorn.org/Secondary.aspx?id=20976 Association of periOperative Registered Nurses [AORN]. (2014c). Counts/retained surgical items. Retrieved from http://www.aorn.org/Clincal_Practice/Clinical_FAQs/Counts/Retained_Surgical_Items. aspx Association of periOperative Registered Nurses [AORN]. (2014d). Hand hygiene in the perioperative setting. Retrieved from http://www.aorn.org/Secondary.aspx?id=23929&terms=Hand%20antiseptic Braswell, M.L. & Spruce, L. (2012). Recommended practices: Implementing AORN recommended practices for surgical attire. AORN Journal, 95(1), 122-140. Retrieved from http://www.isgweb.aorn.org/ISGWeb/downloads/CEA12503-0001.pdf Goldberg, J.L. & Feldman, D.L. (2012). Recommended practices: Implementing AORN recommended practices for prevention of retained surgical items. AORN Journal, 95(2), 205-219. Retrieved from http://www.isgweb.aorn.org/ISGWeb/downloads/CEA125060001.pdf