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Unit Name:
Nursing 6
Unite Number:
Perioperative Elective
Semester:
Semester 2 2007
Lecturers: Astrid Frotjold, Margaret Butler
Faculty of Health Sciences
School of Nursing (NSW)
Clinical Workbook
Nursing 6: Perioperative Elective
This workbook is designed to assist your learning during your clinical experience in the
Operating Theatre Suite and in the perioperative component of Nursing 6.
You must take this workbook with you to clinical. You should read the questions in the
workbook and access some of the readings prior to your clinical experience. You will be
able to acquire a lot of the answers to the questions in the workbook by directly observing
patient care in the operating theatre environment and by asking questions of the relevant
staff working there. You are required to complete your workbook as part of the
requirements of the perioperative component. A lot of the answers will be found in the
readings allocated to each section of the workbook.
Workbook:
Due Date:
Allocation of marks:
Friday 28th September
10%
Clinical Experience
You are going to experience operating room nursing first hand at two different operating
suites as part of your workshop requirements for the perioperative elective. You will
each spend two sessions of four hours duration observing the entire perioperative
environment. This clinical experience is compulsory and details are set out below. This
experience should be really exciting and will add significantly to your understanding of
perioperative nursing.
Time:
Wednesday 0800 - 1200
Hospital
Prince of Wales Hospital
St George Hospital
St Vincent’s Hospital
St Vincent’s Private
St Vincent’s Clinic
Facilitator/Educator
Menna Davies
Leonie Robertson
Marianne McGhee
Trish Keating
Margaret Butler
Kelly Sinclair
Bob Moore
Vanessa Simpson
Margot Shearer
Celia O’Keefe
Jacqui Bayliss
Contact details
9382 2222 page 43634
9382 2222 page 43632
9350 3247
9350 3200 (OR reception)
8382 2653 page 6133
8382 3440 (OR reception)
8382 7516
8382 7550 page 0520
Sydney Hospital /
Sydney Eye Hospital
The Mater Hospital
Russell Hewitt
Michelle Hignett
8382 6320 page 0552
8382 6300 (reception)
9382 7043
9382 7109 (OR reception)
9900 7577 (OR reception)
The Sutherland Hospital
Fiona Lendon
9540 7621 page 864
9540 7600 (OR Reception)
You are required to meet at a designated area at 0800 on the day of your visit. Directions
and details of where to meet for each of the operating suites are found in the Appendix of
this Clinical Workbook.
If you are late or unable to attend please call the Facilitator/Educator and let them know.
If you can’t find the meeting area go to the hospitals main reception and ask them to page
the Facilitator/Educator listed.
Theatre Attire
According to Operating Suite Standards the following information regarding theatre attire
must be followed.
Theatre attire must be worn within the operating suite. Theatre attire should not be worn
outside the operating suite.
Dress
Remove all outer clothes (leave underwear on) and change into
Males:
blue pyjama suit and socks
Females:
blue dress and stockings or blue pyjama suit and socks
Sizes:
are colour coded from smallest to largest; white, blue, green, yellow,
purple
Headwear
All hair must be covered.
Disposable caps are available.
Balaclavas (a special type of head cover) must be worn in orthopaedic theatres.
Footwear
You must wear closed in, hard soled shoes.
Overboots are available to wear over your shoes to protect them. In some operating
suites wearing these are a compulsory infection control practice and you will be informed
if this is the case.
Jewellery
Jewellery is not to be worn with the exception of:
1. wedding ring
2. one neckchain
3. sleepers or stud earrings which are secure
What to Bring
1. This workbook
2. Paper and pens
3. Morning tea (Tea and coffee available free in theatres; drink machine also
available)
4. Student ID
Note 1: Students are advised to eat a substantial breakfast.
Note 2: Students may not be given the use of a locker for valuables during this clinical
experience therefore you are asked to bring as little as possible that needs locking up.
Etiquette
1. all mobile phones to be turned off
2. always introduce yourself to manager and those in OR
3. follow local sign in procedure and ensure wearing “visitor” or appropriate
identification.
Question
1. Why was it important that you changed into correct theatre attire?
Observations Required By Each Student
Tick off each observation when complete
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The layout of the operating theatre suite
Checking the patient into theatre
Induction of the patient
Gowning and gloving
Preparing the theatre for the surgical procedure
Surgical procedure
Cleaning the theatre between cases
Patient recovering from anaesthesia
Central sterilizing department
Specimen transport
Surgeon’s preference sheets
Section: Perioperative Nursing
The NSW Operating Theatre Association is a useful professional body for nurses
working in the area of perioperative nursing. Using the following link, answer the
following questions.
www.nsw-ota.asn.au
1. Describe the objectives of the NSW Operating Theatre Association.
2. What continuing education courses are available for registered nurse?
3. Access the “Patient Information” button on the above link and describe each of the
following nursing roles in the operating room.
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Anaesthetic nurse
Instrument nurse
Scout nurse
Recovery room nurse
Aseptic Technique in the Operating Suite
Read your handout on the Australian Standards for Perioperative Nursing prior to your
clinical experience.
Operating Theatre Layout
Read: Rothrock, J. C. (2002). Alexander’s Care of the Patient in Surgery (12th edition).
Mosby: St. Louis
1. Describe the layout of the two operating theatres you have visited.
2. Highlight the differences between the two.
Access the following site:
http://www.johnsonmedical.com/articles.htm
Open the above link. Read the article titled “Ventilation Systems in Operating Theatres”.
1. Why are airflow systems important in the operating room environment?
2. Describe the “Guided Airflow Ventilation System”.
For interest, look at the highly innovative ergonomically structured theatre environment
at the Mater Hospital in Sydney.
Access the Mater Hospital at:
http://www.matersydney.com.au/0100/0104/0104.asp?id=0104
and go to the Interactive Telesurgical Centre (ITC) link on the right of screen.
You can also do a virtual tour of an operating suite by going to:
http://www.fsregional.com/fsrmc-ipix-surgery-b.cfm
Note that different titles are used when referring to the personnel in this operating suite.
The ‘Circulation’ RN is the ‘scout nurse’ as described on the N.S.W. OTA website and
the ‘surgical technician’ is the ‘instrument nurse’. In Australia the instrument nurse is
always an RN or EN however in many other countries this role is undertaken by specially
educated technicians.
Checking the patient into theatre
Read: Rothrock, J. C. (2002). Alexander’s Care of the Patient in Surgery (12th edition).
Mosby: St. Louis
1. Who sends for the patient to be brought to theatre?
2. What requirements are needed in the operating theatre before sending for a
patient?
3. Describe the patient check in procedure to theatre.
Anaesthetics
Read: Rothrock, J. C. (2002). Alexander’s Care of the Patient in Surgery (12th edition).
Mosby: St. Louis
Read: Read: Rothrock, J. C. (2002). Alexander’s Care of the Patient in Surgery (12th
edition). Mosby: St. Louis
1. Describe the nursing preparation of the patient in the anesthetic room.
Read:
http://www.anzca.edu.au/publications/profdocs/profstandards/index.htm
and
http://www.surgical-tutor.org.uk/core/preop1/premed_&_induction.htm
2. What is the function of the following?
 Preop fasting
 The premedication
 What are the 3 areas that need to be monitored during anaesthetic?
3. Describe any safety measures implemented in the anaesthetic room.
4. Name two artificial airways used by the anaesthetist.
5. Identify two drugs used by the anaesthetist. For each one, investigate its action, dose
and any side effects.
Read http://www.surgical-tutor.org.uk/core/preop1/perioperative_injuries.htm
6. What is the nurse’s role in the following?
 Positioning the patient for surgery
 Caring for the unconscious patient
 Acting as the patient’s advocate
Operating Theatre
Read: Rothrock, J. C. (2002). Alexander’s Care of the Patient in Surgery (12th edition).
Mosby: St. Louis
1. Briefly describe the documentation necessary in the operating theatre.
2. Why is sterile equipment used by the scrub nurse?
Read www.surgical-tutor.org.uk/core/preop1/sterilisation.htm
3. Identify 3 techniques used to sterilize theatre equipment.
4. How are the principles of asepsis maintained in the operating theatre?
5. What purpose did the sterile drapes serve?
6. What preparations were used on the patient’s skin?
7. What infection control measures are adhered to in the operating theatre?
8. Name the items that are counted in the surgical procedure and describe how and
when the count or counts are done?
9. What instruments were used?
Read www.surgical-tutor.org.uk/core/preop1/diathermy.htm
10. Was diathermy used?
11. Name three different types of sutures. For each suture indicate its use.
12. What type of dressings was used on the patient at the end of the surgical
procedure?
13. How are specimens handled in the operating theatre?
Recovery Room
Read:
Hartfield, A. & Tronson, M. (1996) The Complete Recovery Room Book (2nd ed) Oxford
University Press.
and
http://www.anzca.edu.au/publications/profdocs/profstandards/PS4_2000.htm
1. Describe the procedure for transferring the patient to recovery.
2. Describe the equipment that is needed for each patient in the recovery room?
3. Describe the most important nursing assessments done when the patient is
received into recovery? Provide a rationale for each assessment. Use the table
below.
Assessments
Rationale
4. Why is the patient given oxygen in the recovery room?
5. What type of analgesia is given to the patient in the recovery room?
6. Name 2 analgesics and indicate the action, dose and side effects of each.
7. How is the patient’s airway maintained in the recovery room?
8. Describe the procedure when transferring a patient from recovery to the ward
9. What information must be given to the ward nurse?
(You must use APA referencing throughout your workbook)
Overall Experience
Placement 1:
Reflect on your experience in the operating theatre environment. What were the positive
aspects of the nurses’ role in the operating theatre and were there any negatives? What
did you learn during this experience? Describe what was good about the experience and
what impact did it have on you?
Appendix 1
Directions for Clinical Experience Visits
Prince of Wales Hospital
Operating Suite
Directions to Operating Suite Reception, Level 1, Campus
Building.
Entering via main entrance, Barker Street, Randwick.
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Enter via the main entrance and turn right. Walk past the staff cafeteria.
Turn left and you will immediately see four lifts. Take the lift to level one.
Exist the lift at level one and proceed north along the main corridor.
Turn left into the corridor signed Operating Suite.
Half way along the corridor a sign indicates theatre reception, please go to the
reception desk and inform them you are there to meet the OR Educators.
Entering via High Street, Randwick.
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Enter via the High Street entrance. Immediately after the entrance turn right, walk
approximately five meters, on your left are a set of stairs and two lifts.
Take the lift down one level or the stairs down one level.
Exit and turn right and right again. Walk south down a long corridor.
Turn right into the corridor signed Operating Suite.
Half way along the corridor a sign indicates theatre reception, continue along the
corridor.
On your left you will see blue entrance doors after the entrance to theatre reception
please go to the reception desk and inform them you are there to meet the OR
Educators.
Getting there
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The State Transport Authority has bus stops on High Street and Belmore Road,
Randwick.
Car Parking
 Unrestricted car parking is available on some of the surrounding streets of the
hospital. Please note you may need to walk some distance to the hospital.
 The hospital visitor’s car park is reached via the main entrance, which is located off
the roundabout in Barker Street, Randwick.
 Car park fees are a maximum of $15.00 for a period between two and one halfhours to twenty-four hours.
If you get lost please ring extension 20500 or 20501 (hospital phone) or 9382 0500 or
9382 0501 (mobile phone) and request additional instructions for the location of the
Conference Room.
How to find the Operating Suite at St George Hospital
Operating Suite,
Level 2
Clinical Services Block
St George Hospital,
Gray Street, Kogarah
Getting there:
Trains
The Kogarah train station is on the Illawarra – Bondi Junction line.
Look for the signs to St George Hospital and beware of signs directing you to the private
hospital (although you wont be too far away of you end up there!). The hospital is about
500m walk from the train station through the shopping precinct (Kogarah coffee is
getting better all the time, so pick one up on the way). Continue walking until you reach
signs directing you to the Main Entrance.
St George Hospital Parking
On-site parking facilities are available (either in Gray Street or South Street). The All-day
rate is about $14, but please check rates and conditions on your way into the station, as
things may have changed. There is un-timed street parking available in Kogarah several
blocks away from the hospital, if you have time to find the spots and walk to the hospital
(say about 10 minutes).
Directions from the Main Entrance (from Gray Street)
From the Main Entrance, take the lifts to the 1st Floor - as you exit the lifts you will see a
sign directing you towards Delivery Suite follow this direction continue past Delivery
Suite until you reach the lifts in the alcove on your Right hand side take theses lifts to the
2nd Floor upon exiting the lifts the entrance for the Operating Suite is on your left hand
side. There are 2 large doors with intercom outside. Please use the intercom, to gain
access into the suite the reception is through the doorway to your right please wait at
reception where the OR Educator will meet you.
The number for the St George Operating Suite is 9350 3200 (from outside) or 3200
(internal extension). Please call and ask for the educator if you are lost and need
directions or unable if you are to attend.
Directions for St Vincent’s Hospital Operating Suite visit.
Getting there:
Buses from Circular Quay and the City
The 389 bus travels along Burton Streets, stopping beside the DeLacy Building.
The 380 bus travels along Oxford Street.
Buses from Central Station
The 378 and the 311 buses travel along Oxford Street.
Trains
The closest train station is at Kings Cross, which is on the Bondi Junction line.
Look for the signs to Victoria Street and walk south towards Oxford Street. The
hospital is about 700 meters on the left-hand (eastern) side of Victoria Street. The
first building you reach is the DeLacy Building.
St Vincent’s Hospital Parking
On-site parking facilities are available BUT it is very expensive by the hourly rate.
There is un-timed street parking available in Paddington (mostly back lanes between
garages!) between Boundary Road and Brown Street (walking distance, about 10
minutes).
Meeting Spot:
We will be meeting at the Mezzanine Lounge, Level 4, Aikenhead building.
To find this:
 Enter via Victoria Street to St Vincent’s Hospital. This is the building off the
street, to the right of the old heritage building and to the left of St Vincent’s
Private Hospital. You need to take the steps down from the street to the main
entrance.
 Enter via main entrance.
 Proceed past reception, past the flower shop to the escalators.
 Take escalator up one level to Level 4.
 Turn left at top of escalator, you will see a lounge area. Please be waiting here at
0800 and OR Educator will come and collect you.
Contact:
Margaret Butler, OR Educator or Kelly Sinclair. Phone 8382 2653 or 8382 3440 page
6133 (you can also return to the main hospital reception and ask them to page her)
Directions to St Vincent’s Private Hospital Operating Suite.
Getting there:
As for St Vincent’s Hospital above.
To find the Operating Suite at St Vincent's Private Hospital:
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Enter via Victoria Street to St Vincent's Private Hospital (note this is the building
between the Clinic on right and SVH on left).
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Go to the staff lifts which are on the right near the pharmacy and take lifts to level 5.
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Report to OR reception and ask for the OR Educator.
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SVPH OR reception phone number is 8382 7550.
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Directions to St Vincent’s Clinic Day Surgery Unit.
Getting there:
As for St Vincent’s Hospital above.
To find the Day Surgery Unit at St Vincent’s Clinic:
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Enter via Victoria Street to St Vincent's Clinic (note this is the building between
the left of St Vincent’s Private and closest to Oxford Street).
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Go to the lifts which are on the right and take lifts down to level 3.
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Report to Day Surgery Reception (you may need to ring bell) and ask for the OR
Educator.
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St Vincent’s Day Surgery reception phone number is 8382 6300.
Directions to
Sydney Hospital/Sydney Eye Hospital Operating Suite.
Entry via Macquarie Street.
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Go to Main Hospital Entrance (next to Emergency Department), and enter
through the glass doors.
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Take lift to level 3 and report to OR Reception.
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OR Educators are Russell Hewitt, (and Molly for some of the days)
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Contact details: OR phone number is 9382 7109; Russell’s page number is 21538.
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Directions for Mater Hospital Operating Suite Visit
Getting There:
The Mater Hospital is on Rocklands Road about 100 metres from the intersection of
Pacific Highway.
It is centrally located between train services from North Sydney Station and St Leonards
Station and is approximately 5 minutes by car from the North Sydney business district
and railway station.
Bus services running on Pacific Highway are frequent and stop only a short walk from
the Hospital.
Meet at the main, ground floor foyer of the hospital. The Facilitator will meet you here
and take you up to theatres.
Contact Details: Michelle Hignett Mater OR Reception: 9900 7577
Directions to The Sutherland Hospital Operating Suite
Getting there:
Car
The Hospital entrance is via the Kingsway. Parking is available here for $4. Un-timed
street parking is available in Kareena road and on the opposite side of the Kingsway from
the Hospital (watch out for clearways)
Trains
The closest train station to Sutherland Hospital is Caringbah station. Trains run roughly
every half hour on the Cronulla to Bondi train line. Travel time from central is roughly 1
hour. When exiting the station you turn right and head up the Kingsway for about 500
meters and then you should see the hospital.
Operating Suite Reception
The main entrance to the Hospital is open through the front foyer. Take the stairs up to
level three and follow the corridor to the right until you see the glass doors. Operating
Suite reception is just to the left. For entrance via the back of the hospital (level 1).
Follow the corridor along to you reach a set of lifts. Take these lifts to level 3. You
should from here exit in front of the admissions unit. Turn right then immediately left up
the corridor towards intensive care. Follow this along until you see a small glass window
on the left which is reception. Once here ask the staff to page Fiona Lendon.
There are two other entrances to the hospital. One near emergency (level 2) and one near
the rehab gym (level 1). If entering via these entrances follow the corridor till you reach a
set of lifts and follow directions as above.
Contacts:
Fiona Lendon: 9540 7600
If lost in the hospital at all, find a phone and dial 5 OT reception and ask for directions.