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How we should teach Operating room staff members learn OR prac- tice and principles primarily through on-the-job training. Many programs use lectures and reading material to prepare students for the OR clinical experience, but the most concrete learning comes from hands-on experience. Unfortunately, there are few programs to teach our OR staff members how to be effective in- stmors.

Teachers should serve as role models and inspire their students. They are in a position to inspire respect or disregard for patients’ rights to quality care. Sound OR theory and principle can be undone by poor example.

Too often, OR staff take the observe and absorb approach and don’t explain their actions. It is unrealistic and potentially danger- ous to expect already overwhelmed students to learn by osmosis in a new and strange envi-

Liisa J Nenonen, RN, is an OR nurse at Harry S Truman Memorial Veterans Administration Hospital, Columbia, Mo. She is a graduate of the Walter Reed A n y Institute of Nursing Pro- gram, University of Maryland, Baltimore.

& Speak out

ronment. If you explain the importance of specific actions and methods, you are more likely to ensure that learners perform the task correctly. Instructors should help the novice build a knowledge base and an “aseptic con- science” he or she can apply to other situa- tions.

If you are responsible for instruction, teach sound practices the first time around. Don’t worry about making a student too cautious; there are always people who will try to undo your effoorts. They’ll say, for example, “We al- ways did it in Vietnam and never got infec- tions;” or “You don’t worry about sterile tech- nique when the patient‘s bleeding;” and “Don’t bother to count those-the incision will only be 2 inches long.” If the learner has a sound knowledge base and firm principles of sterile technique and safe practice, he or she will be able to make appropriate judgments.

Personnel and assignment continuity help reduce unnecessary stress on the student. Ideally, a scrub and circulator team should be assigned to each student to teach basic princi- ples. A few days circulating are a good way for students to learn department layout, patient interaction, sterile presentation of items, and spatial relationships of sterile and nonsterile areas in the OR. Scrubbing allows the student to observe closely, get the feel of the instru- ments, learn the needs of the scrubbed per- son, and develop an *‘aseptic body image.” If just two people teach, much unnecessary rep- etition can be avoided, and students don’t have to adjust to new teaching styles and per- sonalities.

Assignment continuity is also important. Cir- culating neurosurgery Monday, scrubbing vascular on Tuesday, and rubbing the cystos- copy room Wednesday don’t allow a student to

756 AORN Journal, November 1983, Vol38, No 5

progress through increasingly complicated, yet related, cases. Ideally, a student should be instructed, allowed to observe and then to per- form. Following this exposure, he or she should scrub and circulate on similar cases within a reasonably short time period. The stu- dent can then build on his or her knowledge and develop a deeper understanding of the procedure.

Any teacher in the OR should be consistent in behavior and practice. Tell the student how you’re going to do something, why, and do it that way during each demonstration. If you must alter your practice, explain how and why. When the phrase, “do as I say, not as I do” applies to your teaching, you need to evaluate the safety of your practice.

A student must be able to rely on the teacher for dependable, accurate answers. Questions should be encouraged and answered con- scientiously, not flippantly. If you don’t know the answer, don’t pretend you do or you could destroy your credibility. If neither you nor any- one present knows the answer, look it up or ask the student to look it up; then be sure to discuss it later.

Students should not be sent out alone to fend for themselves. They need feedback and counseling on their performance, both infor- mally in the operating room and in scheduled, private sessions. Except for immediate tech- nique corrections in the OR, negative com- ments should be made as privately as possi- ble. The student should realize everyone accidentally contaminates sterile items and themselves, and the important thing is to per- ceive the break in technique and quickly take corrective measures. Harsh and severe criti- cism of a student’s mistakes could be intimidat- ing and cause him or her to hide or deny mis- takes.

Positive reinforcement is by far the most important way to establish pride in perfor- mance. The student must enjoy confidence and competency to be able to build upon those feelings when confronted with more compli- cated procedures and specialties. If there is no reward or recognition for a job well done, it won’t be long before the quality of work de- clines. Some students have more drive to suc- ceed than others, but most, given proper moti- vation and guidance, can determine their learning needs and priorities. Having avoice in

Definitions OR students should know As a teacher, you will want these three ideas foremost in your OR student’s consciousness: Aseptic conscience-awareness that develops from knowledge of basic technique and its importance. This conscience determines how strictly you will enforce sterile technique. Aseptic body image-an awareness of your body, hair, makeup, clothes, jewelry, and placement. When you are scrubbed, how much of you is considered sterile and how close are you to nonsterile areas? When part of you is considered contaminated, how close is that part to sterile areas? When you are circulating, how close are you to sterile areas? Spatial relationships-an awareness of how a field can become progressively contaminated. The student should understand the arrangement of the OR- what is sterile, clean, and contaminated, the height of people in relation to each other and to table level, the proximity of sterile to nonsterile areas, and segregation of sterile from wet and/or contaminated areas.

decisions increases students’ commitment. When you teach another person your job,

you often gain an increased understanding and appreciation of your profession’s require- ments. Teaching can awaken your values and stimulate you to reassess your own perfor- mance. Students ask questions you never thought of before and offer a new perspective on OR nursing and your department. Whether you find this challenging or threatening de- pends on your personal security and con- fidence. Their enthusiasm should not be squelched, even when you don’t have much energy left. Effective on-the-job training re- quires planning, organization, staff coopera- tion, and patience. Your goal is to produce skilled, qualified OR professionals, happy in their jobs and proud of their profession.

Liisa J Nenonen, RN

758 AORN Journal, November 1983, Vol38, No 5