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Full Time Clinical Component

29 min read

Description #

The full-time clinical component of the Perioperative Nursing Program includes required readings, assignments and post-tests pertaining to lectures about the surgical specialties and areas of clinical practice encountered during the clinical experience. Yhe clinical component of the course helps students to achieve entry-level requirements to practice in the perioperative setting.

Learning Objectives #

At the end of the session the nurse will:

  • 1. Review relevant reading materials related to the lecture topics on surgical specialties.
  • 2. Complete the post-tests related to specified lecture material (Pass mark 75%).

Full-time Clinical Program Information #

Prior to the first day of the Perioperative Nursing Program full-time clinical experience, download the following:

Instructor Contact Information

You will receive the contact information for your clinical instructor on, or before, the first day of the full-time clinical program. Instructors will provide information regarding clinical hours, and what to do if a student is unable to attend due to sickness.

Clinical Rotation

The Daily Clinical Rotation schedule will be provided on, or before, the first day of the full-time clinical program. Refer to the Daily Clinical Rotation schedule to determine the classroom days (and locations) you are required to attend, and how to prepare for post-conferences on each clinical day. There may be unavoidable changes to the clinical schedule, but students will be informed about changes with as much notice as possible. Post conference topics may vary and are subject to change, based on each group’s clinical learning needs.

Student Workbook

Each student has a copy of the Student Workbook on a USB that they will receive on the first day of class. Students will need to download and print a copy of the workbook, (students may wish to have the workbook professionally bound) and bring it with them on the first clinical day. The workbook will provide information and exercises on the topics covered (information covered in post conference that is located in the workbook is denoted by a (W) on the clinical rotation). Students will also be directed to refer to required readings and lecture notes in preparation for post conference and the hands on experiences. STUDENTS ARE EXPECTED TO BRING THEIR WORKBOOK TO EVERY POST CONFERENCE.

Required Readings

Prior to attending the classroom days, students are expected to read the required material in the textbook. Students will be expected to bring questions to class and to participate in discussions. Post-test questions are based on information from the classroom day presentation, presentation notes, required readings, online units, and the workbook.

Readings are listed on the navigational link (in the right hand column) for each classroom day topic. Alexander’s Care of the Surgical Patient is the main textbook resource for the lectures. Read the chapters up to the section entitled “Surgical Interventions” (unless otherwise specified), to prepare for the classroom day. Students are expected to do a brief overview (read the descriptions) of the Surgical Interventions section to obtain a general knowledge of the surgeries, but it is not necessary to read the actual surgical steps as these will be individually reviewed prior to clinical assignment of that surgery.

Note: The website is continuously being updated and it is important for students to check for any content changes prior to each classroom day.

Post-tests

Complete the post-test related to each classroom day topic. The post-test consists of short answer and multiple-choice questions. The post-test will usually be due the Friday after the specific classroom day. (Check the Full-Time Clinical Component schedule for the due dates for each post-test). Post-tests that are not submitted by the end of the clinical day (due date) will not be marked. Your instructor will make post tests available at the end of the classroom day. A total mark of 75% must be achieved on all post-tests. If the post-test is submitted prior to the due date, marks will not be released until after the due date and the instructor has marked all post-tests.

Assignments

The information and marking criteria for both assignments (Assignments #1 and #2) can be downloaded from the Materials to Download page. A mark of 75% must be achieved for both assignments, in order to pass. Assignment #2 is a group activity; the same mark will be given to each member of the group. Check the Clinical Rotation Day-by-Day Schedule for the exact due date of each assignment.

Clinical Skills Checklist

The Clinical Skills Checklist (included in your Student Workbook – given the first day of class) is provided for students to keep a record of the required skills that have been achieved. Students will have the opportunity to practice the clinical skills on the list during the clinical experience. Students will be required to demonstrate the skill to the instructor either in the clinical setting (OR) or the lab (if there is no opportunity to do so in the OR). Instructors will evaluate the students according to specified criteria and subsequently “sign off” the student as competent to complete the skill. If a student is unsuccessful in demonstrating mastery of the skill during the first attempt, one other opportunity to demonstrate the skill will be permitted. Students may not practice the skill independently, in the OR, until the clinical instructor has deemed the student competent to do so.

Clinical Skills Exam Guidelines

The Clinical Skills Exam Guidelines will help students to prepare for the Clinical Skills Exam that will be held during the last week prior to the midterm break. The Clinical Skills Exam will test your performance in the clinical area and give your instructor feedback on the level of your clinical skills at this point in time.

VCH Perioperative Nursing Program Student Clinical Evaluation Form

Download the Student Clinical Evaluation Form. This evaluation is to be completed by the student at the mid-point of the clinical program and again, during the final week. Clinical evaluations provide an opportunity to highlight a student’s strengths and for students to discuss their clinical performance with the instructor. (Instructors will fill out the same clinical evaluation formto discuss with each student.)

Midterm and Final Examinations

The midterm exam covers material from both the online portion of the course as well as all lecture topics covered up until midterm. Material is based on online content, required readings and lecture notes. A passing mark of 75% is required to continue on in the program.

The final exam is comprised of 40% of the material from the online portion of the program and lecture topics covered prior to midterm. The remaining 60% of the exam will cover material from after the midterm break. A passing mark of 75% is required to complete the course.

VCH Perioperative Nursing Program Evaluation

Student feedback is important. Students may complete the Program Evaluation for submission to the clinical instructor PRIOR TO GRADUATION. Students will be contacted approximately three months after completion of the program and will be asked to complete the Three-month Post-graduate Evaluation.

Graduate Transfer Form

The Graduate Transfer Form enables the student to track their progress throughout the clinical portion of the program. This form helps the student to keep track of the surgical experiences they have participated in during the program. After graduation the Graduate Transfer Form assists your site educator to customize an orientation to the OR where you will be working and that can be tailored to meet individual learning needs. Students should update this form on a weekly basis and it must be fully completed prior to the end of the course and submitted (in electronic from) PRIOR TO OR ON THE FINAL EVALUATION.

Hernia Surgery #

Learning Objectives #

By the end of the Hernia Surgery classroom day, the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery:
  • Chapter 12: Repair of Hernias
  • Chapter 25: Section entitled: General Surgery – Hernias.

Breast Surgery #

Learning Objectives #

By the end of the Breast Surgery classroom day, the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery:

Biliary System #

Learning Objectives #

By the end of the Biliary System classroom day, the nurse will have a basic understanding of: 

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations 
  1. Alexander’s Care of the Patient in Surgery: Read the chapters up to the section entitled “Surgical Interventions” 
  • Chapter 11: Surgery of the Liver, Biliary Tract, Pancreas, and Spleen
  • Chapter 25: Section entitled: Correction of Biliary Atresia 
  • Chapter 27: Trauma Surgery: Section entitled: Organ & Tissue Procurement

   2. ORNAC: Section Five –  Exceptional Clinical Events: Organ and Tissue Procurement Protocol

   3. Review the link entitled Medical Terminology from PN-007: Perioperative Anatomy & Medical Terminology

GastroIntestinal System Surgery #

Learning Objectives #

By the end of the Gastrointestinal system classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapters 10 – Gastrointestinal Surgery and Chapter 25 – sections titled: Minimally Invasive Surgery to Repair of Hernias and Chapter 27 Trauma Surgery – section titled: Injuries of the Abdomen.
  6. Review PN005 – Intraoperative Stapler section.

Urology Surgery #

Learning Objectives #

By the end of the Urology (open and closed urology) classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapter 14 – Genitourinary Surgery and Chapter 25 – section titled: Genitourinary Surgery and Chapter 27 Trauma Surgery – section titled: Injuries of the Genitourinary System.
  6. Review ORNAC: Section Five – Exceptional Clinical Events: Organ and Tissue Procurement Protocol.

Gynecology and Obstetrics Surgery #

Learning Objectives #

By the end of the Gynecological and Obstetrics classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations

Gynecology & Obstetrics

  1. Alexander’s Care of the Patient in Surgery: Chapter 13 – Gynecologic Surgery and Obstetric Surgery.

Anesthesia Review #

Please go to the PN 003 – Anesthesia to review the objectives for the classroomday and to review all readings and content completed during the online portion of the program.

Plastic Surgery #

Learning Objectives #

By the end of the Plastic surgery classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapter 21 – Plastic & Reconstructive Surgery and Chapter 25 – section titled: Plastic & Reconstructive Surgery and Chapter 27 Trauma Surgery – sections titled: Injuries of the Face and Thermal Injuries.
  6. Review ORNAC: Section Three: Surgical Equipment – Pneumatic Tourniquet.
  7. Review PN002 – Pneumatic Tourniquet Safety and PN003 – under the Anesthesia section: Regional Anesthesia: Intravenous Bier Block

ENT (Ear, Nose & Throat) and Neck Surgery #

Learning Objectives #

By the end of the ENT and Neck classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations

ENT

  1. Alexander’s Care of the Patient in Surgery: Chapter 18 Otorhinolarygologic Surgery – sections titled: Otologic Surgery and Rhinologic & Sinus Surgery and Chapter 25 – section titled: Otorhinolarygologic Procedures.

Ophthalmology Surgery #

Learning Objectives #

By the end of the Ophthalmology classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapter 17 – Ophthalmic Surgery and Chapter 27 Trauma Surgery – section titled: Injuries of the Eye.

Orthopedic Surgery #

Learning Objectives #

By the end of the Orthopedic surgery classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations

Note: the Orthopedic classroom days occur at different times in the program.

Ortho Day 1

  1. Alexander’s Care of the Patient in Surgery: Chapter 19 – Orthopedic Surgery and Chapter 25 – section titled: Orthopedic Procedures and Chapter 27 Trauma Surgery – section titled: Skeletal Injuries.
  2. Review the links titled: Anatomical Locations & Regions and Body Movements from PN 007 – Perioperative Anatomy & Medical Terminology.
  3. Synthes website: http://www.skeletalsimulation.com It is necessary to register in order to receive a password. The site is intended for health professionals and so a password may be issued faster if a hospital email address is provided.

Please do the following courses (go through them quickly, as we will be practicing the techniques discussed) – it will be beneficial to have an understanding prior to class):

  • Fundamentals of Orthopedic Plates and Screws I
  • Fundamentals of Orthopedic Plates and Screws II (only do sections titled DCP and LCDCP)

Bring to class emailed handout:

  • Classroom day notes
  • Orthopedic Pretest
  • Lag Screw Fixation

Ortho Day 2

Bring to class emailed handouts:

  • Total Knee Replacement
  • Total Hip Replacement

Vascular Surgery (& Cardiac Arrest) #

Learning Objectives #

By the end of the Vascular surgery classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. The procedure for conducting a cardiac arrest in the perioperative setting – roles and responsibilities
  6. Alexander’s Care of the Patient in Surgery: Chapter 23 – Vascular Surgery and Chapter 25 – sections titled: Vascular Access and Central Venous Catheter Placement and Chapter 27 Trauma Surgery – section titled: Damage Control Surgery and Chapter 28 – Interventional Radiology.
  7. Download Methods to Minimize Bleeding (hemostatic agents) – review the different hemostatic agents. Bring document to class. Most of the hemostatic agents described – will be shown in lecture and/or during post conference.
  8. Review unit PN 003 – cardiac arrest

Recommended readings:

  1. Alexander’s Care of the Patient in Surgery: Chapter 24 – Cardiac Surgery and Chapter 25 – section titled: Surgery for Congenital Heart Disease.

Neurosurgery (Brain & Spine) Surgery #

Learning Objectives #

By the end of the two Neurosurgery classroom days the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapter 20 – Neurosurgery and Chapter 25 – section titled Neurosurgical Procedures and Chapter 27 Trauma Surgery – section titled: Injuries of the Head and Spinal Column.

Note: This is a two part lecture – Neuro Brain will be held on a day prior to the Neuro Spine classroom day – review the appropriate subject material prior to the designated classroom day.

Thoracic Surgery #

Learning Objectives #

By the end of the Thoracic surgery classroom day the nurse will have a basic understanding of:

  1. Relevant system anatomy
  2. Related pathology
  3. Associated surgical procedures
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia, positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Alexander’s Care of the Patient in Surgery: Chapter 22 – Thoracic Surgery and Chapter 25 – sections titled: Thoracic Procedures, Correction of Pectus Excavatum & Trauma and Chapter 27 Trauma Surgery – section titled: Injuries of the Chest & Heart.

Leadership/ Ethics & Legal Issues / Risk Management #

Learning Objectives #

By the end of the Ethics and Legal, Leadership and Risk Management classroom day the nurse will be able to:

  1. Distinguish the difference between ethics and morals
  2. Engage in ethical reflection and ethical decision making
  3. Classify the 5 principles of ethics
  4. Discuss the principles of privacy and confidentiality
  5. Discuss the implications of “Do not resuscitate” orders in the OR
  6. Examine nursing law including tort, negligence, and liability in the OR
  7. Discuss the purpose of and appropriate use of incident reports
  8. Examine harassment and bullying in the workplace
  9. Understand critical incident debriefing and professional dilemmas
  10. Compare and contrast Leadership styles and debate leadership issues in Perioperative nursing (i.e. mentors, preceptors)
  11. Understand the institution’s client relations and risk management policy and procedures (i.e. documentation, right to refuse visit, consent forms, advance directives, legal resources, complaint management, risk assessment , incident and critical incidents, release of information, and ethical-decision making )

Leadership, Ethicolegal and Risk Management:

  1. Review the Ethics and Legal Pre-read in the content in the navigational links in the right hand column.
  2. Canadian Nurses Association Code of Ethics for Registered Nurses
  3. Review from PN002 – Occupational Safety – Physical and Psychosocial Stressors
  4. ORNAC: Section One: Professional Standards and Competences (all), Review Section Three: Immediate Pre-Operative Phase – Consent and Section Five: Exceptional Clinical Events – Adverse Events/Sentinel Events/Near Misses; Disclosure of Events to Patients; and Gathering Medicolegal Evidence in the Surgical Suite.

Ethics & Legal Pre-read #

Ethics #

Ethics is defined as:

  • The systematic inquiry into the principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct 
  • It refers to standards of conduct for “right” behaviour
  • It addresses questions of what one ought to do, not what one does
  • Professional ethics incorporated into a code of professional conduct such as the Canadian Nurses Association’s (CNA) Code of Ethics Morals
  • Ethics addresses three types of moral problems with “Moral” meaning “concerned with goodness or badness”. 

Moral refers to personal standards of right and wrong.

Moral uncertainty is being unsure of what moral principles apply or the nature of the ethical problem itself 

Moral dilemma is a conflict of moral principles that support two different actions

Moral distress is knowing what action to take but being prevented by institutional constraints. 

  • It is important to distinguish ethics from religion, law, custom and institutional practices. Just because an action is legal or customary does not in itself make the action morally right. (Canadian Nurses Association Code of Ethics, June 2008) 

Values #

A value is something that is prized or held dear; something that is deeply cared about. This code is organized around eight primary values that are central to ethical nursing practice:

  • Safe, competent and ethical care – nurses value the ability to provide safe, competent and ethical care that allows them to fulfill their ethical and professional obligations to the people they serve
  • Health and well-being – nurses value health promotion and well being and assisting persons to achieve their optimum level of health in situations of normal health, illness, injury, and disability or at the end of life 
  • Choice – nurses respect and promote the autonomy of persons and help them to express their health needs and values, and also to obtain desired information and services so they can make informed decisions
  • Dignity – nurses recognize and respect the inherent worth of each person and advocate for respectful treatment of all persons
  • Confidentiality – nurses safeguard information learned in the context of a professional relationship, and ensure it is shared outside the health care team only with the person’s informed consent, or as may be legally required, or where the failure to disclose would cause significant harm
  • Justice – nurses uphold principles of equity and fairness to assist persons in receiving a share of health services and resources proportionate to their needs and in promoting social justice
  • Accountability – nurses are answerable for their practice, and they act in a manner consistent with their professional responsibilities and standards of practice
  • Quality Practice Environments – nurses value and advocate for practice environments that have the organizational structures and resources necessary to ensure safety, support and respect for all persons in the work setting. 

Principles of Ethics #

  • Autonomy – self-determination; allow and enable people to make their own decisions
  • Respect – for individuals and their decisions
  • Beneficence/Non-Maleficence – doing good/doing no harm
  • Veracity – telling the truth
  • Justice – everyone should be treated equally
  • Fidelity – keeping promises made 

Three Levels of Professional Responsibility  #

In relation to ethics:

  1. Micro is the level of individual professional responsibility for patients and families under our care.
  2. Meso is the level of institutional responsibility for programs of care.
  3. Macro is the level of societal responsibility for the health of the whole population.

Ethical Decision-Making Theories and Models #

Deontologic

Look at formally established rules and principles (e.g., CNA code of ethics, nurse practice act) The nurse would base his/her decision on policies, rules, and laws rather than on personal preferences or consequences of the action

Teleological (Utilitarian)

Focus on the consequences of the action The goal is to ensure that the decision provides the greatest amount of good, or the least amount of harm, to the greatest number of people

Ethical Egoism

The patient becomes a secondary consideration; The nurse seeks the solution that is best for him/herself, the solution that makes him/her the most comfortable Defensive health care practice is perhaps based on this theory.

Oberle & Raffin Model

  1. Understanding the ethics of the situation: Relationships, goals, beliefs, and values.
  2. Reflecting on the range of available choices
  3. Maximizing the good
  4. Taking ethical action
  5. Reflecting on and reviewing an ethical action

Do Not Attempt Cardiopulmonary Resuscitation #

The decision not to attempt resuscitation means the acceptance, without intervention, of death if and when it occurs and does not imply a restriction of any other potential form of treatment unless specified (VCH patient care guidelines). Please read the VCH Patient Care Guidelines: Cardiopulmonary Resuscitative Intervention.

Confidentiality #

Confidentiality pertains to the treatment of information that an individual has disclosed in a relationship of trust and with the expectation that it will not be divulged to others in ways that are inconsistent with the understanding of the original disclosure without permission. It is understood by all parties that the property (whether data or information) is not made available or disclosed to unauthorized persons or processes.

Excerpts from the Principles of Privacy and Confidentiality (CRNBC, October 2010):

  • Nurses collect personal and health information on a need-to-know basis.
  • Nurses ensure that clients are aware of their rights concerning their personal and health information and have consented to the collection, use, and disclosure of this information.
  • Nurses will safeguard health and person information learned in the context of the nurse-client relationship and disclose this information (outside of the health care team) only with client consent or when there is specific ethical or legal obligation to do so.
  • Nurses have an ethical obligation to disclose in situations what involve a substantial risk of significant harm to the health or safety of the client or others. In these situations, nurses use the process of ethical decision-making before disclosing confidential information. Whenever possible, this process involves consulting with knowledgeable colleagues.
  • Nurses comply with any legal obligation to disclose confidential information that is imposed by legislation (i.e. communicable disease regulation) or required under a warrant, court order or subpoena.

Professional Conduct Review Process

Reporting unsafe or inappropriate nursing practice is an ethical and legal issue protected by the “Health Protection Act”. First priority is given to the public interest and public protection. A CRNBC Nursing Concerns Coordinator will work with you to assist in resolving your concerns. There are legal ramifications of not reporting any unsafe or inappropriate care (or lack of care) by any health care professional.

Informed Consent #

An agreement to do something or to allow something to happen made with complete knowledge of all relevant facts, such as the risks involved or any available alternatives. For example, a patient may give informed consent to medical treatment only after the healthcare professional has disclosed all possible risks involved in accepting or rejecting the treatment. A healthcare provider or facility may be held responsible for an injury caused by an undisclosed risk.

Advanced Directives #

In health care law, all people are considered capable of making a health care decision unless they are found incapable. Advanced health care directives are being promoted by some health authorities as a way for people to ensure their wishes about health care are followed in situations where they are not capable of making their own health care decisions. Advanced health care directives provide a written set of instructions and guidelines for a person’s family members and health care providers about the level and type of medical treatment they want if they are injured or ill and are unable to express their wishes. While intended to ensure that a person’s wishes are followed, advanced health care directives pose some fundamental problems. Advanced health care directives are often written long before a health care situation occurs. They can only reflect a person’s intentions at a specific time, they are rarely updated, and they cannot anticipate people changing their minds. These documents are usually written down and then entrusted to family members, physicians and lawyers for safekeeping until they are needed. As time passes, people’s circumstances change and new technology and treatment options become available, with the result that the advance directives may no longer apply to the person’s wishes or circumstances. There is widespread misunderstanding about advanced health care directives and who can make them. The legal authority to make an advanced health care directive belongs to the individual. While a legally appointed substitute decision-maker can make a health care decision on behalf of an individual, they do not have the authority to make decisions about what type of health care will be provided sometime in the future. In various care facilities across British Columbia, the current practice is to require an individual or a substitute decision-maker to make an advanced health care directive by signing a Levels of Intervention form upon admission. By signing this form, an individual or substitute decision-maker is agreeing to treatment that will (or will not) be provided sometime in the future, without full knowledge of the specific health care issue and treatment options that will be available. The Levels of Intervention form becomes the basis for future health care decisions and may or may not reflect the adult’s wishes, values or beliefs at the time a health care decision is required. In British Columbia, the Representation Agreement Act (RAA) and the Health Care (Consent) and Care Facility (Admission) Act (HCCFAA) include provisions for individuals to communicate their values, beliefs and wishes, which become the basis for making health care decisions on their behalf. BC does not have specific legislation on advance health care directives. However, the existing legislation provides a framework that ensures substitute decision-makers are ethically making health care decisions that reflect the values, beliefs and wishes of the individual for whom the decision is being made.

Harassment #

Any improper conduct by an individual, that is directed at and offensive to another person or persons in the workplace, and which the individual knew or ought reasonably to have known would cause offence or harm. It comprises any objectionable act, comment or display that demeans, belittles, or causes personal humiliation or embarrassment, and any act of intimidation or threat. It includes harassment within the meaning of the Canadian Human Rights Act; and based on the grounds set out in that Act, namely race, national or ethnic origin, color, religion, age, sex, sexual orientation, marital status, family status, disability and pardoned conviction.

Perioperative Nursing Law #

Torts

Torts are a civil wrong for which a remedy may be obtained, usually in the form of damages, a breach of a duty that the law imposes on everyone in the same relation to one another as those involved in a given transaction. This area of private law is concerned with compensating those who have been injured by the wrongdoing of others. Society, through its judicial and legislative systems imposes everyone to act in the consideration of the rights of others. Tort law provides damages to victims as compensation. It rarely punishes.

  • Intentional torts
  • Battery
  • Unintentional torts
  • Negligence
  • Retained foreign objects
  • Incorrect counts
  • Burns
  • Electrical, chemical, thermal
  • Injuries due to positioning
  • Including falls
  • Surgery on the “wrong side”
  • Faulty equipment – Trocars, tourniquets, etc.
  • Improper scheduling of breaks.

It is important to note that nurses may find themselves involved in lawsuits even if they were not part of the incident that resulted in an alleged patient injury. Access to legal counsel may be necessary to prove the nurse’s lack of involvement.

Negligence #

The omission to do something which a reasonable man guided upon those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do. Critical Elements Constituting Actionable Negligence

  1. Duty of Care (include a discussion about the implications of undertaking care in a non-work setting)
  2. Breach of the Duty of Care

The court analyzes the following:

  • Standard of care (includes the institution’s policies and procedures, national standards)
  • Res ipsa loquitur (“the thing speaks for itself”)
  • Custom
  • Error in judgment and/or nursing misadventures
  • Presence of Material Injury
  • Causation
  • Cause in fact
  • Proximate cause
  • Absence of Contributory Negligence or Voluntary Assumption of Risk
  • Foreseeability – A key issue in determining a person’s liability. If a defendant could not reasonably have foreseen that someone might be hurt by his or her actions, then there may be no liability.

Direct and Vicarious Liability #

As the employer, a physician or institution may be held directly or vicariously liable for the employee’s work. The greater concern of many physicians is vicarious liability, under which they may be held responsible for the negligent acts of a third party, or employee. Incident Reports Incident reports are privileged information and the property of the hospital. The purpose of an incident report is to initiate a process that leads to an investigation and possible action. It is not a part of chart, nor recorded for slate data. They are the responsibilities of the hospital/unit administration. Management is responsible for providing adequate numbers of qualified staff, adequate equipment and sufficient supplies, policies and procedures.

Incident

An incident is an event, process or practice that creates hazard, or leads to harm.

Near Miss

A near miss is an event that would likely have been an incident (i.e. actual hazard or harm), but was not because of luck or timely intervention.

Critical Incident

A Critical Incident is defined as an incident resulting in serious harm (loss of life, limb, or vital organ) to the patient, or the significant risk thereof. Some examples of when incidents are critical incidents:

  • Situation has caused – or has the potential to cause – an unexpected death or serious deterioration in the state of health of a patient/client.
  • Equipment malfunction has caused, or has the potential to cause, compromised patient/client well being
  • Implications for the safety and care of patient/clients in general
  • Process or protocol failure potentially resulting in untoward or unexpected complication or outcome

Professionalism and Postoperative Care #

By the end of the Professionalism presentation the nurse will have an appreciation and understanding of: 

  1. The CRNBC Professional Standards – be able to list all 6 standards and how they relate to daily practice
  2. Review selected Practice Standards and Scope of Practice for registered nurses
  3. Discuss responsibilities and issues regarding documentation, informed consent, confidentiality, privacy and social media
  4. Be cognizant of global, national and provinicial Perioperative practice associatons and how they foster professional development
  5. Be aware of different perioperative nursing opportunities that are available

By the end of the Postoperative Nursing Care presentation the nurse will:

  1. Be able to describe the process of safe patient transfer from the operating room table to the postoperative stretcher/bed
  2. Be able to identify potential immediate postoperative complications and concerns as the patient emerges from anesthesia
  3. Be able to identify potential immediate postoperative complications and concerns as the patient is transferred from the operating room to the postanesthesia recovery room (PACU), ICU, CCU, CSICU, ward, or surgical daycare areas.
  4. Demonstrate a comprehensive patient handover to the PACU nurse
  5. Have an understanding of the postoperative recovery phase of nursing care in terms of assessment and intervention for the patient emerging from a variety of anesthetics
  6. Have an understanding of the discharge criteria from the PACU to the ward

readings_icon.jpgProfessionalism:

  1. Review the CRNBC:

Postoperative Care

  1. Alexander’s Care of the Patient in Surgery: Chapter 9 Postoperative Patient Care and Pain Management

Pediatric Surgery #

Learning Objectives #

By the end of the Pediatric surgery presentation the nurse will have a basic understanding of how the pediatric population differs from adults in terms of:

  1. Related or differing anatomy
  2. Related or differing pathology
  3. Common pediatric surgical procedures (that have not been included in other body system lectures)
  4. Nursing considerations and required actions in relation to: patient specific considerations, anesthesia (and anesthesia complications), positioning, skin preparation, draping, instrumentation, equipment and supplies, specimens, documentation, and any special surgery specific considerations
  5. Special considerations such as presence of the parent during induction, emotional support to the family, and consent of a minor

Alexander’s Care of the Patient in Surgery: Review Chapter 25 – up until Surgical Interventions Section (you have been or will be reviewing this information for each of the appropriate surgical specialties).