A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses.

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.

Competency Skills Assessment: Successes and Areas for Improvement Identified During Collaboration Between Informaticists and a National Organization.

The Association of periOperative Registered Nurses (AORN) approached the Nursing Informatics Research Team (NIRT) with a request to collaborate and conduct a competency assessment for their organization. An online tool was developed to determine current technology in perioperative settings. This presentation shares the process used to conduct research that led to a method for assessing perioperative nurses' competencies skills in their practice as well as identified gaps in curricula that faculty could address. Both successes and areas for improvement are detailed. The outcome of the process demonstrated a need to understand what skills are being assessed as AORN did not know what technology existed or how existing equipment was being used.

Comparison of nursing interventions performed by medical-surgical nurses in Korea and the United States.

PURPOSE: To compare the Nursing Interventions Classification (NIC) interventions used in two countries, Korea and the United States. METHODS: Data were collected from 167 nurses working in eight hospitals in Korea and analyzed with descriptive statistics. FINDINGS: Korean nurses selected 202 interventions, nine of which were used by more than 50% of nurses surveyed. In comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United States identified 68 interventions as core interventions. Among the top ranked 68 interventions selected by Korean nurses, 29 (43%) matched those selected by U.S. nurses. CONCLUSIONS: The nursing interventions selected by Korean nurses were more heavily focused on the physiologic domain than those selected by the U.S. nurses. PRACTICE IMPLICATIONS: The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and educational curricula for nursing students.

Developing terminology for documenting perioperative nursing interventions.

OBJECTIVE: To develop terminology for documenting perioperative nursing interventions. METHOD: Nursing documentation of 250 patients was explored by content analysis. The study was conducted to validate further the Perioperative Nursing Data Set (PNDS) in Finland. The data included 3442 terms that were clustered into 104 nursing interventions. A Delphi-panel (N=5) evaluated the relevance of each term on a scale from 1 to 4. The structure of each nursing intervention was checked to meet the minimum requirements of the ISO reference terminology model for nursing action concepts. Finally, the nursing interventions were compared with the original PNDS-interventions. RESULTS: The Delphi-panel accepted 98 nursing interventions with Content Validity Index from 0.88 to 1.0. Of the 133 nursing interventions in the PNDS, 60% (n=80) were covered by nursing interventions identified in this study. A notable portion of the nursing interventions related to preventive aspects of perioperative care and the patients' coping with perioperative experience. CONCLUSION: The findings supported the need for cross-cultural validation of a nursing language prior to clinical implementation. The ISO reference terminology model is recommended as framework in constructing concepts for nursing interventions in a regular form.

Perioperative data elements: interventions and outcomes.

In 1999, the American Nurses Association's committee on nursing practice recognized AORN's Perioperative Nursing Data Set (PNDS) as a data set useful in the practice of nursing. The PNDS is a standardized nursing language specific to perioperative settings that is both clinically relevant and empirically validated. This data set is the culmination of six years of effort by AORN and AORN staff members to develop a standardized language that is clearly defined, common to all cases, and consistent across time.

Structural data elements--standardized terms and definitions.

Perioperative nurses must have an organized approach to collect, organize, classify, and capture clinical nursing data to communicate nursing practice. Standardized nursing language provides a systematic method of collecting basic elements of perioperative nursing care. This article examines how structural elements were developed and validated for this standardized language.

Standardized language--making nursing practice count.

Language in nursing has never communicated the same clinical problems in a clear, precise, or consistent manner. Clinical information systems require standardized terms and definitions to help clinicians with electronic documentation. The future of nursing depends on systematic efforts to label and define nursing contributions to health care. Standardized nursing languages provide a structure to manage nursing data in a computerized patient record. Learning about and working with standardized nursing languages will ensure that nursing contributions are an integral component of any medical record. This article defines standardized language, explores standardized languages in nursing, and outlines the various nursing languages for clinical practice that have been recognized by the American Nurses Association.

Development of the Perioperative Nursing Data Set.

Nursing practice is a major component of health care. Yet, it remains undervalued and essentially invisible because little data exist to substantiate the influence of nurses on patient outcomes. The research-based Perioperative Nursing Data Set (PNDS), with an easily automated nomenclature capable of describing the specialty practice of perioperative nursing, was designed to fill this gap. Four domains (i.e., safety, physiologic response to surgery, patient and family behavioral response to surgery, health system) form the foundation of the PNDS. Each domain, with accompanying desired outcomes, nursing interventions, and nursing diagnoses, has reliability, content validity, and evidence of construct validity. The purpose of this article is to introduce the conceptual framework, taxonomy, and potential clinical applications of the PNDS.

Building a successful risk-based competency assessment model.

The requirement to verify and ensure the competency of staff members to perform their assigned duties is here to stay. This article describes a model for decision making about competency assessment frequency. Implementation of the model should be accompanied by a systematic review of learning needs and performance improvement data. Education sessions designed to address identified learning needs or to support performance improvement activities should occur before or concurrent with competency assessment. The result is a cost-effective, efficient use of resources to accomplish the goal of ongoing assessment and improvement of staff competency. When staff member competency improves, the likelihood of a positive patient outcome increases. Our model provides a structured, defensible mechanism to link competency assessment with improvements in patient care quality.

The prevalence of perioperative nurse clinical judgments.

A clinical judgement about a patient situation precedes the selection of appropriate nursing actions and the identification of patient outcomes. The North American Nursing Diagnosis Association nomenclature (i.e., nursing diagnoses) is the accepted language for naming nurse's clinical judgements. Two hundred thirty-nine members of the Association of Operating Room Nurses, Inc, rated the frequency and treatment priority of 60 nursing diagnoses. They rated two diagnostic labels (i.e., risk for perioperative positioning injury, risk for infections occurring in more than 50% of the clinical judgments they make about perioperative patient situations that require immediate nursing action. These data reinforce perioperative nurses' primary role in protecting surgical patients from harm.

A patient classification system for ambulatory surgery centers.

A well-developed and operational patient classification system can lessen problems associated with determining and allocating nursing personnel. This article discusses the development of such a tool in a free-standing ambulatory surgery center and includes a tool for facilities that want to develop similar classification systems.

Developing behavioral objectives for perioperative staff development.

Behavioral objectives (i.e., clear statements that describe intended instructional outcomes) are a crucial component of educational planning for perioperative staff development. Properly written objectives promote positive learning outcomes such as increased motivation, better retention of information, and improved instructional accountability. This article describes the advantages of using behavioral objectives, gives a historical perspective of their development, presents a practical "how-to" approach to formulating them, and delineates their link to the selection of appropriate evaluation methods.