Orientation / Objectives
Package for Student Nurses in
the Perioperative Environment
December 2003
YOUR ORIENTATION/BASIC LEARNING PACKAGE
This package has been designed in such a way that it will allow the student nurse on
placement to the operating theatre environment a structured orientation and basic learning
period.
The main objectives are: 1. To provide a Trust-wide structure for the perioperative placement of student nurses.
2. To identify and address the practical aspects of beginning work in the exciting field of
perioperative nursing.
3. To identify the process and underline the structure of your orientation, including
identification of your preceptors and an outline of the activities to be carried out.
4. To introduce you to the full range of practice and practitioners involved in the
delivery and support of perioperative care.
5. To ensure that the efforts of everyone involved in your training and education are
maximised through a common Trust wide objective based structure.
We hope the package will achieve these objectives, but in the interests of
continual improvement, if there is anything that you feel should be modified, included or
omitted to make it more effective, then please let us know. We can only improve what
we do, when we know where we are going wrong.
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THE OPERATING THEATRE AS A LEARNING ENVIRONMENT
“Nursing education in the United Kingdom has as its foundation, the premise that
student nurses learn in the clinical setting…”
Gerrish (1990)
The National Association of Theatre Nurses (1995) believe that the operating
department with its high qualified staff / learner ratio is an ideal environment in which
learner nurses can take advantage of a wide range of learning opportunities related to
perioperative nursing care within a multi-disciplinary team setting. They also establish
that an effective learning environment is one in which the educational needs of learners
are met and facilitated by: 
The availability of qualified nurses to supervise practice

Staff who are anti- hierarchical, democratic and patient focused

Good teamwork

Effective communication and negotiation skills

A conscious decision to make learning a reality
PRECEPTORSHIP ISSUES
The National Association of Theatre Nurses (NATN) (1995) identifies that “learner
support” should encompass the ability to:

Be an innovator in negotiating a learning contract.

Act as a catalyst for learning by guiding and facilitating learning.

Become a moderator of learning by active participation and interactive discussion.

Sustain learning through critical appraisal, creative expression and positive reenforcement.
To do this, they tell us, the preceptor must understand where the learner has come from,
why they are there and where they want to go.
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In order to achieve these optimum conditions for learning, your preceptorship will
involve a number of different people, whose ultimate aim is to ensure that your learning
experience in the operating department environment is maximised. They will include: Your Main Preceptor.
Your main preceptor will be a suitably experienced and qualified individual. He / she
will be your main point of contact through your placement and will be the person who
you will spend the most time with.
Area Specific Preceptors.
If it is deemed appropriate “area specific” preceptors will also be identified who will
work with you as you visit their “fields of expertise” in order to address those objectives
which have been identified as being required from your placement. These individuals
will be identified before you visit their clinical areas and you will be introduced to them
by your main preceptor.
Dependent upon the perioperative setting that your placement takes place in, you may
find that this process differs slightly. This is a reflection of the fact that each of the
different operating theatre areas across Tayside function in slightly different ways,
because they have identified what is the most effective for them. In some clinical areas
you may be mentored by the same member of staff throughout your placement, whilst in
others, “area specific” associate preceptors may be involved to assist your learning
process as you work with staff who are functioning in specific roles such as scrub,
anaesthetic or recovery nurses.
YOUR NOMINATED PRECEPTORS ARE AS FOLLOWS: Your Main Preceptor is:
He/she can be contacted by:
Your Area Specific Preceptors (If required) in each area of practice are:
Anaesthetics-
Scrub-
Recovery-
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OUTLINE PLAN
Each period of time spent in different clinical areas will follow the same basic format.
You should note that your first morning will involve activities that do not need to be
repeated in each clinical area. This time can be spent either in pre-arranged meetings
with your preceptor(s) or on other activities as agreed with your preceptor.
Day 1. Morning- (On first working Day only)

Meet and be introduced to your main preceptor. Discuss with him / her the process
and structure of training planned for the period of placement and what each party
should expect both during and at the end of this period.

Discuss this orientation programme and how it could help your development.

Compile a brief learning contract if this would be useful to either you or your
preceptor.

Work through the “discussion topics” listed below with your preceptor.
TEAM WORK- How does the team function and interact and how can we promote
team spirit?
THEATRE AREAS- Traffic flow. Clean and dirty zones. Uniforms and dress code.
Policies on jewellery and smoking.
DUTY ROSTERS- Planning and publication. Process to request duty changes.
Annual leave requests. Reporting absence.
COMMUNICATION- Links and processes. Use of telephones, pagers and other
communication hardware.
HEALTH & SAFETY- Safety checks. Fire awareness. Reporting process for
accidents and untoward incidents. (Review of sample documents)
RAISING CONCERNS- The process and importance of raising concerns.
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Day 1. (Afternoon) …and on commencement in each new clinical area.
Be introduced to your area specific preceptor (if they are different from your main
preceptor) who will support your learning experience in the relevant designated clinical
area.

Be orientated to this area.

Be introduced to the various team members.

Discuss your objectives for this part of your placement.

Identify and negotiate learning opportunities.
References
Gerrish, C. (1990) An analysis of the educational role of the ward sister. Nurse Education
Today. 1990 (10) pp198- 205.
Keyzer, Dirk (1986) Using Learning Contracts to Support Change In Nursing
Organisations. Nurse Education Today. 1986 (6) pp 103- 108.
NATN (1995) Supporting Learner Nurses in the Operating Department. Harrogate:
NATN.
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Record of Structured Meetings Between Preceptor and Learner.
These tables should be used to document that regular meetings have taken place between
yourself, your main preceptor and any area specific preceptors.
Generic Objectives.
Date/Time Arranged
For.
Preceptor’s
Signature
Learner’s
Signature
Date/Time Arranged
For.
Preceptor’s
Signature
Learner’s
Signature
Date/Time Arranged
For.
Preceptor’s
Signature
Learner’s
Signature
Date/Time Arranged
For.
Preceptor’s
Signature
Learner’s
Signature
Meeting with preceptor.
Comments from preceptor.
Comments from learner.
Anaesthetic Objectives.
Meeting with preceptor.
Comments from preceptor.
Comments from learner.
Scrub Objectives.
Meeting with preceptor.
Comments from preceptor.
Comments from learner.
Recovery Objectives.
Meeting with preceptor.
Comments from preceptor.
Comments from learner.
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Final Review.
Date/Time Arranged
For.
Supervisor’s
Signature
Preceptor’s Learner’s
Signature
Signature
Final
placement
review with
main
preceptor.
Comments from preceptor.
Comments from learner.
It is important that communication between you and your preceptor remains open and
free and that continuous feedback is provided by you both.
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Basic Perioperative Objectives
The following pages list a number of objectives, which will help to guide you throughout
your perioperative placement and maximise your learning opportunities.
The first section, entitled “Generic Perioperative Orientation” identifies objectives that
are necessary to all clinical areas that you may visit during your placement.
Three different columns run beside each of these generic objectives, representing each
different clinical area. Both you and your preceptor should initial these columns, when
you both agree that you have achieved the objective.
The remaining three sections contain anaesthesia, scrub and recovery objectives that will
guide you through your perioperative learning experience. In these sections, only one
column runs down the side of the page. When you are both happy with your level of
achievement, we would ask both you and your preceptor to sign next to the appropriate
objectives.
We will strive to make your learning experiences within theatres as beneficial as possible
and will welcome your feedback or comments during any stage of your placement.
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GENERIC PERIOPERATIVE OBJECTIVES & ORIENTATION
Become orientated to the theatre environment, with specific
reference to:

Fire Equipment, exits, etc.

Store areas.

Staff facilities including security of property.

Patient facilities.

Location of all relevant policies and procedures.

Emergency equipment / Arrest Trolley / Difficult Intubation
Trolley
Area
1
Area
2
Area
3
Discuss the appropriate action to be taken in the event of:

Cardiac/respiratory arrest.

Fire.

Chemical Spillage

A designated major incident.
Discuss the importance of effective communication strategies
within the perioperative multi-professional team: 
Verbal communication

Written communication
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Have a knowledge of legal issues and be able to demonstrate
safe, effective patient focused care pre, intra and postoperatively including specific reference to: 
Consent forms.

Informed consent.

Nurse skills and competence.

Theatre information system documentation (blue form).

Nursing documentation.
Area
1
Area
2
Area
3
Utilise knowledge of ethics and professional issues to
demonstrate an understanding of patient advocacy.
Demonstrate knowledge, understanding and control of optimum
environmental factors in the operating theatre:

Design

Ventilation

Humidity

Temperature

Lighting

Water supply
Describe effective traffic flow within the theatre suite.
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Identify how and when to locate and request the assistance of
ancillary staff and the extent of their responsibility.
Discuss and show awareness of the following

Infection control / Universal Precautions

Manual handling

COSHH
Discuss the Decontamination process for equipment & sundries.
Discuss the safe storage, security, handling and administration
of drugs, IV fluids and blood in accordance with UKCC, Trust
and National Policy.
Discuss the specific needs of different types of patient in the
peri-operative setting including:

The neonate.

The child.

Those with sensory / physical deficits.

The elderly.

Those with specific problems affecting the perioperative
nursing care of the patient.
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BASIC ANAESTHETIC OBJECTIVES
Discuss the changing role of the anaesthetic nurse in relation to
changing anaesthetic and peri-operative practice.
Discuss safe, effective preparation of the anaesthetic room with
regards to:

The patient

The environment

Staff
Discuss the rationale behind pre-operative visiting including the
education of patients prior to anaesthesia and for assessment
purposes.
Discuss the importance of emotional support for the patient prior
to the induction of anaesthesia.
Discuss potential hazards during anaesthesia/surgery and the
precautions necessary to prevent them:

Patient screening

Pre-operative checks, policies and protocols

Anaesthetic machine/other equipment checks and policy

Anaphylaxis

Hypovolaemia

Difficult intubation
Discuss monitoring during anaesthesia and the appropriate
course of action in the event of deviation in vital signs.
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Discuss the equipment and techniques available to support and
maintain an airway including:

Facemasks

Airways

Laryngeal mask airways

ET tubes
Practice under supervision the safe & effective maintenance of
the patient’s airway with a mask.
Discuss the reasons and rationale for undertaking rapid sequence
induction and cricoid pressure.
Discuss the rationale behind the “triad of anaesthesia” and be
able to identify the main groups of drugs used in anaesthesia:

Intravenous induction agents

Inhalational agents

Neuromuscular blocking agents

Analgesics
Discuss care of the unconscious patient within the peri-operative
setting with specific regard to:

Pressure area care

Safety

Controlling body temperature

Appropriate positioning for surgery.
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Discuss the principals/procedures/equipment involved in the
administration of:

General anaesthesia

Spinal Anaesthesia

Epidural Anaesthesia

Regional Blocks
Discuss the basic management of patients with invasive
monitoring:

Arterial

CVP
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BASIC SCRUB OBJECTIVES
Discuss the changing role of the perioperative nurse in relation
to perioperative practice.
Differentiate between the duties and responsibilities of the scrub
and circulating roles, pre, intra and post-operatively.
Discuss safe, effective preparation of the operating theatre with
regards to:

The patient

The environment

Staff
Discuss potential hazards during surgery and the precautions
necessary to prevent them where appropriate:

Swab and instrument policy

Handling of specimens

Diathermy

Radiation

Lasers

Power driven instruments

Tables and fitments

Lights




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Discuss the importance of safety checks on all equipment.
Demonstrate an ability to practise effective appropriate
scrubbing, gowning and gloving technique.
Discuss the basic preparation of instrument trays and related
equipment.
Discuss the principals of theatre etiquette.
Discuss and demonstrate the delivery of sterile items to the
surgical field to maintain sterility and integrity.
Discuss effective skin preparation.
Establish and maintain a sterile field as per individual
requirements.
Discuss different methods of decontamination and define the
terminology of:

Cleaning

Disinfection

Sterilisation
Discuss and be able to identify basic instrumentation, trays,
sutures, dressings, drains, etc.



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Explain the safe and effective management of:

Waste

Sharps

Linen

Trays
Identify, discuss and learn the maintenance / cleaning regime of
the following pieces of equipment (Dependent upon specific
clinical area of experience):





Understand the importance of clear and concise reporting to
anaesthetic / recovery staff on operative procedure performed,
drains, dressings and any special instructions.
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BASIC RECOVERY OBJECTIVES
Discuss the changing role of the reception nurse in relation to
peri-operative practice and changes in anaesthetic techniques.
Discuss safe, effective preparation of the reception/recovery area
before the commencement of planned operative procedures with
regards to:

The patient

The environment

Staff
Identify the functions of the theatre reception area with specific
reference to:

The rational behind and process of pre-operative checklists.

Patient clerking, documentation, etc.

Physical care.

Psychological care.

Effective post-operative management.
Discuss the changing role of the recovery nurse in relation to
peri-operative practice and changes in anaesthetic techniques.
Discuss the main hazards during the recovery phase and the
precautions necessary to prevent them including reference to:

Maintenance of airway. (Including the use of aids e.g.
airways)

O2 Therapy.

Safe transfer of the unconscious patient.

Availability and suitability of necessary post-op
equipment.

Correct patient positioning for the recovery period.
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Discuss and participate in the immediate post-operative care
required by patients who:

Have had General Anaesthesia.

Have had spinal/ epidural anaesthesia.

Have had regional blocks/local anaesthesia.
Discuss the recognition and management of acute problems in
the post-op period including:

Laryngeal spasm / stridor

Respiratory / cardiac arrest

Respiratory depression / obstruction
Discuss the monitoring equipment required by each patient in
the post-operative phase and how this should be applied.
Discuss the rationale and process for regular post-operative
observations and checks and the process for reporting any
problems.
Discuss the appropriate and safe management of drains, wounds,
IV’s, pumps, dressings and other sundry equipment used in the
recovery setting.
Discuss pain scoring, the administration of analgaesia and the
techniques available to ensure a pain-free post-operative phase.
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Discuss the basic management of patients with invasive
monitoring:

Arterial

CVP

Discuss the procedure for removing lines in the recovery
area
Understand the importance of clear and concise reporting to
ward staff and the process and protocols for the safe return of
post surgery patients to the appropriate clinical areas.
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Mr Murdoch
Clinical Group Director
(Critical Care)
Ninewells Hospital
Operating Department
Management Structure
Audrey Warden
Clinical Group Manager
(Critical Care)
Steve McIntosh
Senior Nurse
Educational / H&S Coordinator
SCN Judy Bremner
(General Theatres)
SCN Jane Litchfield
(General Theatres)
SCN Margaret Low
(Obs & Gynae Theatres)
Anne Couser
Senior Theatre Manager
SCN Sandra Hume
(DSU)
SCN Martin McDonald
(Orthopaedic Theatres)
Lorraine Johnstone
Deputy Theatre Manager
SCN Margaret Kennedy
(ENT / P&O Theatres)
SCN Lesley Malcolm
(Opthalmology Theatres)
SCN Geoff Christie
(Anaesthesia)
SCN Christine Yuill
(Recovery)
Mr Murdoch
Clinical Group Director
(Critical Care)
Perth Royal Infirmary /
Stracathro Hospital
Operating Department
Management Structure
Audrey Warden
Clinical Group Manager
(Critical Care)
Anne Couser
Theatre Manager
Laura Miller
Senior Clinical Nurse
(Perth Royal Infirmary
SCN Hazel Scholes
(Main Theatres)
SCN Elma Duthie
Theatres
Stracathro Hospital
SCN Louise Davidson
Day Surgery Ward
Stracathro Hospital
SCN Anne Dunbar
(Day Surgery Unit & Obs/Gynae
University of Dundee
Abertay University
University / Clinical
Link Structure
Link Nurse
Perth Royal Infirmary
SSN Alison Ford
Link Nurses
Stracathro Hospital
SSN Sharon Mulligan
SSN Lorraine Paterson
CN Jaqui Frame
Anaesthetics
Link Nurse
Ninewells Hospital
SCN Judy Bremner
CN Gill Reid
East Block Theatres
SSN Susan Gaffney
West Block Theatres
CN V al Shepherd
Recovery
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