Perioperative Nursing Education

Given that most nursing programs offer limited or no operating

room experience in their curricula, nurses initiating a career in
the OR get their perioperative education either at the hiring institution or by
enrolling in a postgraduate or fellowship perioperative program. It is estimated that
a minimum of 3 to 6
months of instruction is required to adequately educate nurses
with no previous OR experience depending on the ORs activities (AORN, 2007a).
Programs may include the surgical environment, aseptic technique, perioperative
assessment,
anesthesia, positioning the surgical patient, sterilization and disinfection, surgical
instruments, safety considerations, patient
teaching, teamwork, scrubbing and circulating, and wound
healing and hemostasis (AORN, 2007a). In addition to didactic
modules, nurses are often instructed through a cognitive apprenticeship model in
the OR in which they take on increasingly
complex responsibilities over time.
Health Promotion
Patient teaching for the intraoperativepatient is usually done in
a preadmission testing clinic or the day before the surgery in a
patient general surgical unit. Once in the preoperative area, the
patient is normally anxious and stressed and assumes a passive
role as the recipient of technical care. The perioperative nurse
performs the preoperative assessment of patients in the holding
area. The responsibilities of the perioperative nurse in this setting are to verify the
appropriate data have been obtained, assess
the patient for readiness both physically and emotionally, and
reinforce teaching as needed. This information is the basis for
planning the patients individualized perioperative care.

The use of the nursing process emphasizes a patient-centered

approach; health promotion in the perioperative arena has become more evident as
perioperative nurses have gained great
satisfaction from knowing that they are part of a team committed to an individual
patient with an individualized outcome. As
illustrated through the PNDS (p. 624), this framework enables
perioperative nurses to shift from a task-oriented role to that of
providing a holistic view of the patient. Therefore, even if the
nurses main role is still to ensure patient safety throughout a patients surgical
experience, the nurse is now able to demonstrate
the caring aspect of perioperative nursing by participating in a
preoperative assessment of the patient.
Surgical Areas
Patients needing surgery go to the operating room for a surgical
procedure after having been admitted to the hospital on the same
day as surgery, unless an extensive work-up or in-hospital treatments or tests are
required prior to surgery. Patients also access the
operating room emergently through the emergency department.
The practice of same-day admission has become popular for both
financial reasons and because evidence suggests that surgical-site
infection rates are reduced when the preoperative stay is reduced
(Nichols, 2001).
Prior to being admitted to the surgical setting, the patient dons
a gown and cap. Surgical-site skin preparation includes a baseline
assessment, cleaning of the surgical site and surrounding area,
hair removal, and application of an antiseptic agent when required. Traditionally hair
removal was extensive and often performed the day prior to surgery. Research
studies have revealed
that hair removal does not reduce the incidence of surgical-site

infections (SSIs). In fact, today, hair removal is instead performed

to improve access to surgical site, improve the field of view, or per
the institutions policy or surgeons preference (Evidence-based
practice information sheets, 2003; Niel-Weise, Willie, & van den
Broek, 2005). Should hair removal be indicated, care needs to be
taken to maintain skin integrity and minimize injury. The removal is ideally done
outside of the surgical suite as close to the
surgery time as possible (AORN, 2007b). There is some evidence
that use of hair clippers is superior to use of a razor, but more research is needed
(Niel-Weise et al., 2005).