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Building Perioperative Nursing Research TeamPart I n the current health care environment, perioperative principles and appreciate the contributions of sound nurses are expected to be competent technically research to improved surgical patient outcomes. The and to demonstrate independent judgment and model of cyclical, experiential learning developed by skilled decision making. To fulfill this role, periop- David A. Kolb, PhD,can be used to help perioperative erative nurses must be able to analyze research data nurses acquire this knowledge and build nursing and to use research findings to promote positive patient research teams (Table 1). The four steps in this model 0utcomes.l In essence, they need to be scholars who (ie, reflecting, connecting, deciding, doing) are inteknow and use research principles in clinical practice.2 gral to adult learning because they focus on learners’ To create research-based practices, perioperative immediate feelings, opinions, and values4 As adult nurses must understand the research process and the learners, perioperative nurses need the realism of systematic investigation of clinical practice problems. experiential learning rather than rote memorization. In a recent study, 58% of perioperative nurses who Reflecting. The first step in building a perioperaresponded to a survey about clinical nursing research tive nursing research team is to provide a forum for expressed interest in research; however, less than half interested nurses to reflect on actual or potential clinithe resuondents had taken research classes or read cal problems and to consider participating in nursing published nursing r e ~ e a r c h Par.~ research. Throughout the teamticipating in research, reading and building process, reflection concritiquing published research, A B S T R A C T tributes to individual and group applying research findings to nursPerioperative nurses can use learning. Reflecting may take the ing practice, and conducting for- nursing research to acquire skills form of team members keeping mal studies are ways in which and knowledge to formulate inde- journals about clinical issues that perioperative nurses can use pendent judgments, make critical could be studied. They can record research to become scholars and decisions, and become nurse their personal learning and discuss to improve their clinical decision- scholars. This article, which is the the influence of this learning on making skills. first in a two-part series, de- their clinical practices. Team memCreating research-based peri- scribes the use of the model of bers can use reflection to recall operative practice models can be experiential learning developed incidents in perioperative patient challenging in an era of downsiz- by David A. Kolb, PhD, to facili- care that led to undesirable outing and restructuring. This article tate a team approach to perioper- comes. Clinical nurse specialists or presents strategies to promote ative nursing research. The sec- nursing faculty members can serve perioperative nursing research and ond article in the series will focus as consultants or facilitators for ideas for building nursing research on constraints and enablers to these discussions, guiding team teams in perioperative settings. conducting and using nursing members’ reflection process by research in perioperative care set- asking questions such as “What TEAM APPROACH TO RESEARCH tings and will provide suggestions went wrong?” “Why did this hapPerioperative nurses who are for perioperative nurse managers pen?” “What could you have done motivated to participate in research to facilitate clinical research. differently?” and “What guided must understand basic research AORN J 65 (Feb 1997) 396-401. your thinking during the incident?” ,lUDITH A . CSOKASY. RN
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tive solutions or responses and think about implementing their new ideas, while learning to value different opinions. To encourage broader thinking by team members, the group facilitator can expand critical incident analysis beyond the context of perioperative nursing and encompass general nursing knowledge and clinical experience. As the facilitator introduces questions about knowledge generation and information sources, team members can use research principles to seek solutions to clinical practice questions. Team members may decide to form journal clubs during the connecting step of the research team-building process. Journal clubs help nurses become familiar with the wide array of peerreviewed professional journals and the databases (eg, Cumulative Index to Nursing and Allied Health Literature, Index Medicus) available for searching the literature. During journal club meetings, the research team facilitator helps nurses learn to critique studies and identify sound, rigorous research. Deciding. Step three in the team-building process occurs when research team members decide on a course of action. At this stage, they may decide on priority research questions or reach consensus about needing to learn more about the research process. They discuss options for continuing their research education and meeting individual learning needs, and they explore collaborative research opportunities in the community. Doing. The last step in the team-building process is the development of a collaborative action plan. Team members may work independently during this step, but they have a sense of support and shared meaning as they undertake their separate research activities. The research team facilitator continues to provide opportunities for reflection. and team members’ activities generate creativity and ongoing introspection. Regardless of the role that each team Table 1 member chooses, he or she is EXPERIENTIAL LEARNING AND RESEARCH TEAM DEVELOPMENT aware of the overall research Nursina research team activities ExDeriential learnina stew process, and all team members Envision the role of research in Reflecting meet periodically in a collegial, clinical practice. supportive environment to discuss their learning experiences. Hold discussions, do critical incident Connecting analyses, form journal clubs. During the reflecting step, team members begin to listen and speak honestly about their clinical care concerns. They share knowledge, analyze problems, and generate possible solutions. Reflection also helps team members broaden their thinking, which helps them meet the demands of increasingly complex work settings. As their self-awareness and confidence in discussing clinical problems and the research process increase, team members may decide to develop a brief vision statement and goals to provide structure to their experiential learning. Connecting, The second step in building a nursing research team consists of team members connecting ideas and creative solutions to clinical questions and concerns. This step may reinforce existing clinical standards or protocols, or it may lead team members to question the status quo and formulate new approaches to patient care. During this phase of team development, members may begin to identify their research roles. All perioperative nurses can be consumers of research, and the consumer role offers a nonthreatening, effective way for nurses to become familiar with the research literature and with the relationship between research and clinical practice. Team members with appropriate education and experience may decide to participate in research problem identification and data collection or to become principal investigators of their own studies. Team members may conduct critical incident analyses to identify issues for research. This type of analysis begins with asking team members to identify incidents or situations that they view as significant (eg, surgical patients developing hypothermia). After describing the incidents and OR personnel’s responses to the incidents, team members can generate alterna-
Identify and develop a plan for team members to learn about nursing research.
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WTEWIAL RESEARCH TOPICS
One source of research topics is the “recommendations for future research” sections that appear in published research articles. In these
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sections, authors list unanswered research questions This group of nurses agreed to begin collecting infor(eg, “Does the temperature of uterine distention fluid mation about surgical smoke plume and to meet in influence the incidence or extent of intravasation?” one month for further discussion. “When, where, and how is preoperative teaching most One month later, the group of nurses met and effective for ambulatory surgery patient^?")^ that can shared journal articles about surgical smoke plume. The group facilitator, who was a perioperative cliniserve as the impetus for future studies. The report published by the Pew Health Profes- cal nurse specialist, led the nurses through a critical sions Commission Task Force on Health Care Work- incident analysis in which they identified a problem force Regulation6 identifies several topics for poten- situation (ie, surgical smoke plume); described why this problem was important (ie, exposure of patients tial nursing research. For example, studies of strategies to document health care and OR personnel to potentially harmful subproviders’ competencies could include competen- stances); and identified potential solutions to the cy evaluation through continuing education pro- problem (eg, routine use of smoke plume evacuagrams, simulations, or computer-generated teach- tors), who would be affected by the solution (eg, ing methodologies; patients, OR personnel), and whether this solution nurse researchers could investigate the ethical was the best from a list of alternatives (eg, improvissues of identifying and implementing different ing room ventilation systems). This discussion replevels of competency in the nursing profession; resented the connecting step in building a perioperative nursing research team. and nurses could study total quality management After completing the critical incident analysis, issues related to competency and patient care the nurses decided (ie, step three) that they needed delivery. to learn more about the research process before they Many penoperative nurses have participated in could investigate this clinical problem. They the AORN multisite clinical study of bloodborne requested assistance from a nursing faculty member exposures among OR personnel? This is an excellent who was interested in research and met with their example of a professional organizations providing perioperative nurse manager to discuss available leadership in research that will have a significant resources and to decide on a course of action. Based impact on clinical practice. on their critical incident analysis, the nurses knew that they were more concerned than the surgeons about the negative impact of surgical smoke plume CASE STUDY This hypothetical case study illustrates the use of on patients and OR personnel. They also knew that the experiential learning model in building a perioper- to achieve improved air quality in the ORs, they ative nursing research team. The team members iden- would need to submit data and a proposal for the tified a specific clinical concern and worked through upcoming year’s budget. the four steps of the model to arrive at a solution. As the group embarked on the fourth step in the A group of perioperative nurses at a community model (ie, doing), they developed this research queshospital were talking during a break about their mutu- tion: “Does the use of smoke evacuators result in al interest in clinically focused research. As they decreased physical symptoms and absenteeism reflected (ie, step one) on the current concerns in their among perioperative staff members who are exposed department, they realized that their absenteeism rate to surgical smoke plume?” They designed a data colhad increased during the past six months. One nurse lection tool that would capture information about recalled an article in the AORN Journal about the specific signs and symptoms (ie, nausea, headaches, potential negative effects of surgical smoke plume on myalgia, respiratory distress), number of days absent patients and OR personnel, and she remembered that from work, number of physician visits, cost of treatthe article discussed the interaction of surgical smoke ment and medications, and the adequacy of the plume with body tissues and advocated the use of department’s investment in smoke evacuation equipsmoke plume evacuation devices.* Another nurse ment. They distributed the data collection tool to all recalled that she experienced respiratory problems department employees. The nurse manager obtained after she participated in a surgical procedure in which funding to expand the study and mailed copies of the an electrosurgical device was used, and she remem- data collection tool to randomly selected perioperabered that two other nurses had the same symptoms. tive nurse managers across the country. 400 AORN JOURNAL
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Learning about and participating in research is an excellent way to socialize perioperative nurses to the contemporary nurse scholar role and to improve nurses’ clinical decision-making skills. To achieve the goal of providing research-based patient care, perioperative nurses must be educated consumers of research, participate in research projects, and be principal investigators in major studies. Developing a perioperative nursing research team is not a short-term activity. The experiential NOTES 1. American Organization of Nurse Executives, “A call for nursing reform of our nursing education system,” Nursing Management 24 (March 1993) 33. 2. C Lindemann, “New mandate for educational research,” speech presented at the annual meeting of the National League for Nursing, Orlando, Fla, 20 Jan 1994. 3. D Fawcett, C Lainof, “A pilot study appraising the climate for perioperative nursing research,” AORN Journal 63 (January 1996) 205-208.
learning model can be used to implement a team approach to nursing research. Support from perioperative nurse managers is a key element in empowering staff nurses to undertake research, and the second article in this series will discuss ways in which nurse mangers can facilitate perioperative nursing research. A
Judith A. Csokasy, RN,PhD, is an associate professor, division of nursing, at Indiana University-Kokomo.
4. D A Kolb, Experiential Learning: Experience as the Source of Learning and Development (Englewood Cliffs, NJ: PrenticeHall, lnc, 1984); P N Senge, The Fifh Discipline Fieldbook: Tools, Techniques, and Reflections for Building a Learning Organization (New York: Doubleday and Co,
Inc, 1994) 67-69. 5. K L Bennett, C Ohrmundt, J A Maloni, “Preventing intravasation in women undergoing hysteroscopic procedures,” AORN Journal 64 (November 1996) 792-799; V C Brumfield, C D Kee, J Y Johnson, “Preoperative patient teaching in
ambulatory surgery settings,” AORN Journal 64 (December
1996) 941-952. 6. L J Finocchio et al and the Task Force on Health Care workforce Regulation, Reforming Health Care Worworce Regulation: Policy Considerationsfor the 21st Century
(San Francisco: Pew Health Professions Commission, 1995). 7. J Thompson, “AORN’s multisite clinical study of bloodbome exposures in OR personne1,”AORN Journal 63 (February 1996)428-433. 8. B P Giordano, “Don’t be a victim of surgical smoke,” AORN Journal 63 (March 1996) 520-522.
Bring Journal Article Ideas to Congress Perioperative nurses interested in publishing articles in the AORN Journal will have an opportunity to talk with members of the editorial staff in the Communications section of the AORN Booth during exhibit hours at Congress. The Journal welcomes manuscripts on perioperative clinical
nursing, management, education, ethics, and research. In addition to these manuscripts, shorter submissions are needed for several columns. Potential authors are encouraged to stop by the AORN Booth to talk with an editor about article ideas and to pick up author guidelines.
Shuttle Bus Information for Congress Attendees who wear Congress badges may ride the AORN shuttle buses. Shuttle bus service will run every 15 minutes between official AORN hotels and the Anaheim Convention Center. Bus route information and schedules will be available at the registration counters in the convention center and at all official AOFW hotels. Bus service is not provided for meetings arranged by state councils, chapters, or other groups.
The shuttle schedule is as follows: Saturday, April5 10:30 AM to 6 PM Sunday, April 6 6:30 AM to 8 PM Monday, April 7 6:30 AM to 8 PM Tuesday, April 8 6:30 AM to 8 PM Wednesday, April 9 6:30AM to 8 PM 6:30 AM to 8 PM Thursday, April 10 Friday, April 11 630 to 11 AM
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