ORNAC Notice: These guidelines are currently under review by the Education Committee and may be subject to change without notice.

RULES AND REGULATIONS MANUAL

Perioperative Programs for Registered Nurses
Program Review and Approval Process: Recommended Core Curriculum

1. Perioperative nursing programs will include theory content from nursing, sciences and the humanities.
   The focus of the program shall be on the provision of individualized, patient-centered care.
2. The current edition of the Standards, Guidelines, and Position Statements for Perioperative Nursing Practice by ORNAC will be a required textbook.
3. The Code of Ethics of Canadian Nurses Association, Perioperative Nursing Data Set and Provincial Nursing Standards of Practice will be included in curriculum.
4. Teaching and learning methodologies will reflect principles of adult learning and may include self-instructional units, independent learning opportunities, challenge exams and research projects or presentations.
5. Clinical assignments will be designed to provide opportunities for the learner to apply theory to practice. Adequate clinical practice time will be allowed for the learner to achieve predetermined objectives.
6. Learner outcome evaluation will be ongoing and based on the achievement of program objectives. Evaluation will include objective measurements (e.g., examinations), competence to perform selected skills, and evidence of clinical decision making and critical thinking.
7. A passing grade 75% (minimum) must be achieved.
8. A plan will be developed for process evaluation, and should include: the learning climate; timing of events; levels and quality of instruction; appropriateness of teaching methods; and, the quality of supporting materials.
9. Provision will be made for records and reports to be maintained by the program.
10. Methods for the storage and retrieval of individual records will be developed.

COMPETENCIES TO BE ACHIEVED BY THE LEARNER UPON COMPLETION OF THE PROGRAM

The Perioperative Registered Nurse Practices Professionally:

1. 1. Is committed to continual improvement of knowledge and skills required to respond to the needs of the perioperative patient throughout the continuum of care; 2. Understands and applies ORNAC’s Standards, Guidelines, and Position Statements for Perioperative Nursing Practice (current edition) and the Canadian Nurses Association Code of Ethics; 3. Utilizes self-evaluation and reflective practice as a method to continually improve practice; 4. Collaborates with patient and patient’s support systems as well other providers to assist the patient in achieving optimal health status; 5. Articulates the role of the perioperative nurse using the Perioperative Nursing Data Set; 6. Has an understanding of ORNAC and the role/contribution that ORNAC makes to professional perioperative nursing; 7. Understands professional accountability for active membership in professional nursing bodies (provincial and national e.g. ORNAC); 8. Advocates for the role of perioperative registered nurse; 9. Advocates for changes to institutional policies and practices that meet evidence based practice.

The Registered Nurse Provides Patient Care in the Circulating Role:

1. 1. Reviews, identifies, and assesses the physiological and psychological status of the patient, focusing on the individual needs of each patient; 2. Uses the nursing process to develop a nursing care plan to meet the specific needs of the patient; 3. Establishes priorities of patient care specific to the patient’s needs and the surgical procedure; 4. Provides resources required for the surgical team to function efficiently; 5. Provides emotional support to each surgical patient; 6. Provides appropriate care during the surgical procedure; 7. Demonstrates knowledge and supports the role of the anesthesia care provider during both routine and emergency situations; 8. Demonstrates a surgical conscience; 9. Coordinates care requirements and liases with interprofessional team; 10. Communicates effectively with interprofessional team members contributing to positive patient outcomes; 11. Monitors patient safety throughout the experience; 12. Performs the count procedure with the scrub person according to ORNAC Standards, facility policy, and documents appropriately; 13. Maintains the integrity of the sterile field; 14. Provides focused, astute observation of the surgical team throughout the operative procedure; 15. Anticipates and meets the team’s needs with minimal delays; 16. Acts as the patient’s advocate during the surgical procedure; 17. Monitors and evaluates the physiological status of the patient throughout the operative procedure; 18. Responds appropriately to complications and unexpected events; 19. Assists with patient transfer and positioning pre, intra and postoperatively; and 20. Documents nursing and surgical activities during the perioperative period.

The Registered Nurse Provides Patient Care in the Scrub Role:

1. Sets priorities and expedites an efficient set-up for each surgical procedure;
2. Demonstrates a surgical conscience;
3. Maintains a sterile field;
4. Labels medication on the sterile field;
5. Advocates for use of smoke evacuation devices;
6. Tracks instruments throughout the surgical experience;
7. Communicates effectively with an interprofessional team contributing to positive patient outcomes;
8. Monitors patient safety throughout the care experience;
9. Applies knowledge and skills to the techniques and procedural steps of the surgical procedure;
10. Demonstrates the ability to respond appropriately to complications and unexpected events during the surgical procedure;
11. Performs the count procedure with the circulator according to ORNAC Standards and facility policy;
12. Demonstrates knowledge of instruments and equipment; and
13. Acts as the patient’s advocate throughout the surgical experience.

The Registered Nurse Provides Supportive Care to Patients and Their Families

1. Remains attentive to the needs of the patient throughout the perioperative period;
2. Provides explanations when providing care;
3. Demonstrates caring behavior;
4. Provides a safe environment for the patient;
5. Offers information and support to patients and families;
6. Acts as a patient advocate; and
7. Provides culturally sensitive care to patients.

The Registered Nurse Provides Support to Team Members

1. Contributes to and encourages collaborative working relationships;
2. Shares knowledge and skills, including teaching other staff members;
3. Manages stressful situations in a focused and calm positive manner;
4. Communicates effectively both verbally and in writing;
5. Demonstrates effective conflict resolution;
6. Functions as an effective member of the multidisciplinary team; and
7. Is aware of and actively works to stop horizontal violence in the workplace.

The Registered Nurse Provides a Safe Environment

1. Practices effective aseptic technique, routine precautions and other infection control practices;
2. Provides timely, appropriate corrective action when injury or contamination occurs to self or team members;
3. Verifies sterility of all equipment;
4. Demonstrates a surgical conscience;
5. Identifies and safely manages hazardous materials and equipment;
6. Complies with Workplace Hazardous Materials Information System (WHMIS) regulations;
7. Practices according to CSA standards when radiation or laser devices are being used;
8. Adheres to policy when handling or recording controlled drugs;
9. Labels all medications on the sterile field;
10. Demonstrates knowledge of Safer Healthcare Now! Initiatives;
11. Provides interventions to assist with normothermia;
12. Ensures that equipment and instruments are in safe working condition;
13. Manages surgical specimens according to policy;
14. Conducts surgical counts according to ORNAC Standards and policy;
15. Demonstrates safe management of electrosurgical units, and pneumatic tourniquets;
16. Provides a latex-free environment for the patient when necessary;
17. Demonstrates the use of the Surgical Safety Checklist and participates in the completion of this checklist; and
18. Utilizes waste management practices in accordance with government legislation and organizational policy.

The Registered Nurse Responds to Emergency Situations

1. Demonstrates the ability to recognize and respond effectively to urgent and emergency situations; and
2. Anticipates, sets priorities, and prepares for the management of urgent and emergent situations.

The Registered Nurse Manages Resources

1. Plans, organizes and priorizes resources to meet the needs of the patient;
2. Assembles, prepares for use, and disassembles equipment for each surgical procedure;
3. Reduces waste, is cost effective, and respects environmental concerns;
4. Organizes patient care with team members to maximize efficient use of resources, energy and time;
5. Evaluates the process of activities, delegated duties, and patient outcomes; and,
6. Participates in evaluations of products and equipment.

PROGRAM CONTENT
to include but not limited to the following:

1. Introduction to Perioperative Nursing Practice
   1. Patient-centered care in the perioperative setting
   2. Perioperative nursing roles
   3. Standards of perioperative nursing practice
   4. Perioperative Nursing Data Set
2. Legal and Ethical Issues in Perioperative Nursing
   1. Ethical decision making
   2. Confidentiality
   3. Informed consent
   4. Documentation
   5. Organ retrieval and transplants
   6. Do Not Resuscitate orders & advanced directives
   7. Dealing with death in the OR
3. Preoperative Nursing Care
   1. Patient preparation
   2. Patient assessment and admission to the OR
   3. Age specific care: geriatric, pediatric
   4. Caring for patients with specific needs: pregnancy, latex allergy, high BMI, diabetes, etc.
   5. Culturally sensitive care in the OR
4. Anaesthesia
   1. Types of anaesthesia: general, regional, local, etc
   2. Perioperative nursing responsibilities related to the provision of anaesthesia, including during induction and emergence
   3. Pharmacological agents
   4. Anaesthetic emergencies:
      • cardiac arrest
      • malignant hyperthermia
      • hypovolemic shock
      • latex allergy
   5. Use of blood, blood products and alternatives
   6. Monitoring the patient receiving procedural sedation and/or local anesthesia.
5. Environmental Safety Issues
   1. Surgical Safety Checklist
   2. Fire safety protocols and procedures
   3. Use of lasers and electrosurgery devices
   4. General safety in the OR; and
      • OR table basics and safety
      • transferring patients
      • waste management and
   5. Surgical smoke evacuation
6. Immediate Postoperative Nursing Practice
   1. Preparation and transfer of patient to post anaesthesia care unit, or other nursing unit for post operative care
   2. Perioperative nursing care documentation