The knowledge and skills described in this competency unit are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements

Enrolled/Division 2 nursing work is to be carried out in consultation/collaboration with registered nurses and under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements

ELEMENT

PERFORMANCE CRITERIA

1. Work as part of the multi-disciplinary health care team in the perioperative environment

1.1 Contribute appropriately to support the role of the multi-disciplinary health care team in managing care needs of clients in the perioperative environment

1.2 Contribute to achieving effective team work and supportive group dynamics when working with health care colleagues

1.3 Establish appropriate relationships with other members of the health care team

1.4 Incorporate into practice the philosophical framework for managing care for the client in the perioperative environment

1.5 Recognise the role of emergency service personnel, referring agencies and other hospital department staff as contributors to the initial/emergency care needs of the client in the perioperative environment

1.6 Maintain professional communication with all members of the perioperative team

2. Contribute to assessment of client undergoing surgical intervention

2.1 Perform a holistic assessment of the client within the perioperative environment in conjunction with registered nurse/midwife, taking into account the client's physical, emotional, spiritual and cultural needs

2.2 Recognise significant findings in physiological and/or psychological variables promptly and report to appropriate health team members

2.3 Use contemporary perioperative assessment tools accurately

2.4 Communicate effectively with clients, their significant others and other health team members

2.5 Provide holistic client centred care in the perioperative environment

2.6 Document perioperative assessment including any special needs identified for the client

3. Contribute to planning care for perioperative client

3.1 Develop an individualised plan of care for client in the perioperative environment in conjunction with registered nurse/midwife and in consultation/collaboration with the client and the health care team

3.2 Participate with registered nurse/midwife to ensure nursing care plan reflects specific nursing care requirements in accordance with health unit policy

3.3 Participate with registered nurse/ midwife to ensure care plan reflects client's current nursing needs and nursing actions designed to maximise physical function and minimise potential complications

3.4 Demonstrate understanding of risk management principles in planning client care

3.5 Confirm that planned care and therapeutic interventions aim to assist client/s to achieve optimal health outcomes

3.6 Identify requirements of client (and identified significant other/s) for health promotion and education to enhance implementation of nursing care plan

3.7 Carry out regular review of plan of care and, in conjunction with registered nurse/ midwife, modify to reflect changes in client condition

3.8 Identify and report any potential for adverse client outcome, using information gained through perioperative assessment

3.9 In consultation/collaboration with the registered nurse, ensure health teaching and discharge planning is incorporated into practice, in line with established policies and procedures for discharge/transfer

4. Perform clinical nursing actions appropriate to care of perioperative clients

4.1 Prioritise nursing interventions according to client needs, in conjunction with registered nurse/ midwife

4.2 Modify nursing interventions using critical thinking and problem solving approaches, to reflect changes in client condition

4.3 Perform nursing interventions to assist client (and significant other/s) to meet expected outcomes of nursing care plan, including health promotion and/or education

4.4 Maintain a safe environment appropriate for the age specific population

4.5 Monitor nursing interventions, identify any that fail to address client needs and revise them in consultation/collaboration with the health care team

4.6 Perform contemporary nursing interventions for the client within the perioperative environment as part of the health care team

4.7 In conjunction with registered nurse/ midwife, implement an individualised plan of care for the client within the perioperative environment

4.8 Recognise environmental hazards and take advantage of every opportunity to reduce risk and promote safety

4.9 Check equipment according to manufacturer recommendations, ensure proper functioning and take corrective action and report when faulty equipment and/or environmental hazards are detected

4.10 Apply the principles of infection control to all activities within the perioperative environment, applying a surgical conscience at all times in line with ACORN standards

4.11 Ensure appropriate perioperative diagnostic procedures are undertaken in line with organisation policies and procedures

4.12 Implement appropriate perioperative surgical procedures in line with organisation policies and procedures

4.13 Ensure medication administration is based on sound knowledge of principles of drug actions and side effects in accordance with health unit policies and procedures

5. Evaluate effectiveness of nursing interventions and planned care in the perioperative environment

5.1 Evaluate responses of client/s and identified significant other/s to nursing interventions, and modify and document in accordance with health unit policy and in conjunction with registered nurse/ midwife

5.2 Assess client understanding of their condition, medications and therapeutic regimes prior to discharge/transfer

5.3 Evaluate client acceptance of specific health promotion initiatives prior to discharge/transfer

5.4 Assess and review understanding of identified significant other/s in relation to current condition of client and their ongoing management

5.5 Monitor client's response to nursing interventions and progress toward planned goals, and document and report to the appropriate members of the health care team

5.6 Identify appropriate emergency response to adverse reactions or perioperative complications and initiate as required

5.7 Report and document any emergency treatment and the client's response to the treatment

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

Australian Standards relating to electrical hazards, radiation hazards, and sharps disposal

Client advocacy

Client rights and responsibilities

Complications of surgical procedures and their management

Confidentiality and privacy

Critical thinking and problem solving

Cultural and spiritual beliefs and practices

Emergency and first aid treatment of surgical procedures

Factors influencing growth and development

Factors influencing self esteem

Grief and loss

Health teaching

Health-illness continuum

Infection control policies and procedures specific to perioperative environment

Legislative requirements for practice, including Nurses Act, Organ and Tissue Transplantation Act, Freedom of Information Act&Occupational Health&Safety Act

Literature and professional bodies associated with perioperative care and management

Medical terminology

Medication management - pharmaco-dynamics and pharmaco-kinetics

Occupational health and safety legislation

Organisation policy and procedure

Participating as a member of the health care team

Philosophy of perioperative nursing

Principles of effective documentation

Principles of health assessment

Reflective practice

Specialised in-depth knowledge in anatomy, physiology and pathophysiology related to a diverse range of conditions

Specialised knowledge and execution relating to emergency care

Specialised knowledge in the clinical manifestations of disease states

Surgical asepsis

Use of complex technologies, such as anaesthetic machines, lasers, CUSA and endoscopic equipment

Essential skills:

It is critical that the candidate demonstrate the ability to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

Apply relevant admission and discharge tools according to organisation policy

Apply relevant health unit assessment tools according to organisation policy

Apply cognitive processes to reflect problem solving and analysis in the planning implementation and evaluation of care to clients

Apply clinical nursing skills, including:

administration of oxygen

administration of pre operative, post operative medications

admission and discharge procedures

application of anti-embolism stockings

care of the unconscious client

collection of specimens for pathology studies

deep breathing and coughing

electrocardiography

emergency management of post operative complications

facilitation of activities of daily living

incentive spirometry

incentive spirometry

insertion of indwelling catheter

intra operative observations

maintenance of fluid balance

maintenance of patent airway

management of intravenous therapy including blood replacement

management of skin integrity

management of surgical drains

material resource monitoring

monitoring of blood glucose level

oral suctioning

pain management

post operative observations including neurovascular and neurological

preparation of the client for a surgical procedure

pre-procedure baseline observations

recovery of client post anaesthetic

support scrub nurse

wound management

continued ...

Essential skills (contd):

Apply professional standards of practice:

ANMC code of conduct

ANMC code of ethics

ANMC national Enrolled/Division 2 nurse competency standards

state/territory Nurse Regulatory Nurses Act

state/territory Nursing and Midwifery Regulatory Authority standards of practice

scope of nursing practice decision making framework

ACORN Policy statements and guidelines

Diligent application of infection control procedures in the perioperative environment

Demonstrate accountability for personal outputs and broad client group outcomes

Use Information technology systems

Use language, literacy and numeracy competence required to communicate effectively with client, group, colleagues and to record or report client outcomes

Use advanced communication skills

Use education and teaching strategies relating to health promotion and practical task applications

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit:

The individual being assessed must provide evidence of specified essential knowledge as well as skills

Observation of performance in a work context is essential for assessment of this unit

Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion and be assessed by a registered nurse

Context of and specific resources for assessment:

This unit is most appropriately assessed in the clinical workplace or in a simulated clinical work environment and under the normal range of clinical environment conditions

Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible

Method of assessment

Observation of clinical performance in the work place

Written assignments/projects

Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice

Questioning - verbal or written

Role play in the clinical perioperative setting

Simulation in the clinical perioperative setting

Surgical Workbook

Experience Log

Access and equity considerations:

All workers in the health industry should be aware of access and equity issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Clients may include:

Inpatients

Outpatients

ranging from neonates to the frail aged client

Health care setting may include:

Perioperative

Hospital setting

Free standing Day Surgery/Ambulatory Care facility

Multidisciplinary health care team members may include:

Nurses

Surgeons

Anaesthetists

Support Staff including, SSD Technical Aids, Wardsmen, Porters, Stockroom Assistants, Clerical Support.

Allied health staff including, radiographers and physiotherapists

Client assessment may include:

Performance of activities of daily living

Loss of physical function

Perceptions of pain

Accompanying trauma or injury

Self image and body image concerns

Impact on family or significant others

Expectations of surgical procedure

Expectations of post operative procedures

Levels of mobility

Presence of co-morbidities and previous medical history

Skin integrity

Previous surgical intervention

Fear and anxiety associated with surgical intervention

Psycho social considerations

Physiological alterations associated with surgical intervention

Preoperative, Intraoperative and Postoperative complications

Accompanying trauma or injury

Level of client knowledge regarding their surgical experience

Planning appropriate care may include:

Perioperative nursing records

Nursing care plans

Observation sheets

Anaesthetic records

Medical record

Computerized operation notes

Clinical pathways

Treatment plans

Discharge plans

Community referrals

Health teaching

Rehabilitation plans

Theatre booking processes

Evaluation of planned outcomes may include:

Monitoring of clients response to surgical procedure

Clarification of client understanding of health teaching, discharge planning or return appointment schedule

Client understanding of care needs post discharge

Actual and potential problems may include but are not limited to:

Electrolyte imbalance

Fluid overload

Reduced CO2

Hypoxia/Hypoxaemia

Sepsis

Haemorrhage

Neurovascular damage

Cerebral Vascular Accident

Arrhythmia

Clinical nursing skills may include but are not limited to::

Airway management

Use of suction equipment

Maintenance of normothermia

Preoperative nursing assessment

Preparing the client for anaesthesia and surgical intervention

Practice in the various roles of the perioperative nurse under the supervision of the Registered Nurse

Positioning of the client for surgical intervention

Medication management

Urinary catheterisation (female clients)

Physiological monitoring equipment

Role in transfusion / fluid management

Assessment and monitoring of haemo dynamic status and fluid replacement therapies

Handover to post anaesthesia care unit

Principles of decontamination and sterilization

Material resource management

Aseptic technique

Management of the client in the post anaesthetic care unit

Caring for the immediate post-operative client Post-operative monitoring(delete)

Airway management in the post anaesthesia care unit

Preparation of the perioperative environment

Discharge planning considerations

Handover&documentation

Client education

This unit contains Employability Skills