Perioperative Unfolding Case Study
Author: Gerry Altmiller, EdD, APRN, ACNS-BC, ANEF, FAAN
For use in: Pre-licensure Nursing Education, New Graduates/Transition to Practice, Continuing Education, Staff Development
Setting: Didactic lecture; skills laboratory
- Examine how the safety and quality of health care can be improved through the active involvement of patients and families in the perioperative setting.
- Describe strategies to empower patients or families in all aspects of the health care processes.
- Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds and dangerous abbreviations).
- Discuss potential and actual impact of national patient safety resources, initiatives, and regulations.
- Demonstrate effective use of strategies to reduce risk of harm to self or others.
- Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists).
- Use national patient safety resources for own professional development and to focus attention on safety in care settings.
- Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care.
- Value the contributions of standardization/reliability to patient safety.
- Value own role in preventing errors.
- Value relationship between national safety campaigns and implementation in local practices and practice settings.
The Perioperative Unfolding Case Study can be used for classroom or lab experiences. The presentation slides follow a patient through the preoperative, intraoperative, and postoperative setting, allowing learners to gather information and react to changing situations. Theory bursts throughout the unfolding case, provide perioperative content that learners need to support clinical reasoning. A worksheet is provided to learners so they may record significant information to enable safe and effective decision making while moving through the case. Quality and safety competencies are emphasized throughout the learning experience.
To implement, learners should be given preparatory work to read about OR safety prior to class. Learners should also be assigned the chapter on perioperative nursing care in their course textbook to read as preparation. The unfolding case study powerpoint presentation should not be made available to students prior to class as the answers are always on the next slide. Students should be encouraged to record information on the accompanying student worksheet and brainstorm to answer the questions as the case study unfolds. Three volunteers should be recruited prior to beginning. These volunteers will deliver reports and call physicians with updates using SBAR communication as the case study progresses. Theory bursts are woven throughout the case study. Following the class session, the case study file will be posted for the class to retrieve so that theory content is available to them.
Evaluation strategies related to student learning included separate measurement of a cohort of questions on the final exam that focus on the decision-making skills of the nurse caring for the perioperative patient. Questions included content related to implementation of national patient safety standards for the surgical patient, appropriate and effective strategies to use to reduce risk of harm, and recognition of the role of the patient as well as the role of the nurse in preventing errors.
Student satisfaction with this teaching strategy was evaluated following the presentation of this unfolding case study using a questionnaire with the five following statements followed by a 5 point Likert scale: (1) This presentation provided the information needed to care for the peri-operative patient. (2) I found myself actively thinking about the patient’s care during this presentation. (3) I recognize the value of my role in preventing errors and promoting safety for the surgical patient. (4) I would like to have more course content presented as unfolding case studies. (5) I found my mind wandering during this presentation. In addition, an area for comments was be provided. Evaluations demonstrated students gained knowledge and valued the learning experience.
Altmiller, G. (August 2020). Perioperative unfolding case study: A lesson in quality and safety. AORN Journal, 112(2), 104-111.
Altmiller, G. (September 2020). Perioperative nursing unfolding case study: Bringing the OR experience to the classroom. Nurse Educator, 45(5), 231-232. Link to Publication in Nurse Educator