How a Perioperative Nurse Educator Carries Out Provision 4 of the Code of Ethics
A perioperative nurse educator fulfills Provision 4 (authority, accountability, and responsibility for nursing practice) by developing and delivering comprehensive education programs that ensure the perioperative team can identify risks, implement evidence-based protocols, and maintain patient safety through standardized practices—while simultaneously modeling ethical decision-making and holding themselves and others accountable to professional standards.
Educational Program Development and Implementation
A perioperative nurse educator carries out Provision 4 by creating structured, multidisciplinary education programs that address the full spectrum of perioperative care:
Core Educational Responsibilities
Develop training programs that support identification of risk factors for complications including delirium, surgical site infections, and other perioperative neurocognitive disorders, working in partnership with anaesthetists, surgeons, pharmacists, and geriatricians 1
Create interactive educational content that covers all aspects of screening, risk factor identification, and both non-pharmacologic and pharmacologic prevention and management—ensuring programs include leadership, use champions and peer support to be effective 1
Design education in multiple formats (oral, written, and pictorial) to accommodate different learning styles and health literacy levels, ensuring information is delivered in plain, non-medical language 1, 2
Implement evidence-based protocols for critical interventions including preoperative skin antisepsis, hair removal, surgical safety checklists, and postoperative monitoring 3
Authority and Accountability in Practice
The nurse educator demonstrates authority and accountability by:
Setting Standards and Expectations
Establish clear protocols for maintaining patient dignity through privacy preservation, respectful communication, use of preferred names and pronouns, and appropriate draping to limit unnecessary exposure 4
Mandate baseline cognitive screening using validated tools like the Mini-Cog for at-risk patients, and ensure delirium screening occurs before discharge from recovery and ideally twice daily until Day 5 or discharge using tools like the 4AT or CAM 1
Require documentation of baseline cognitive status before surgery to facilitate identification of postoperative neurocognitive disorders, raising awareness among the perioperative team 1
Ensuring Competency and Compliance
Train staff to manage patients with delirium and other complications, ensuring the team can recognize ethical dilemmas and take action based on professional codes 1, 5
Implement the WHO Surgical Safety Checklist with its 19 items and three pause points as routine practice, standardizing safety protocols across the perioperative setting 1, 3
Educate on multimodal pain management strategies including opioid-sparing techniques, local and regional blocks, and proper opioid education regarding adverse effects, storage, and disposal 3, 2
Responsibility for Patient and Family Education
The educator ensures the team can effectively educate patients and families:
Preoperative Education Standards
Train staff to discuss risks for delirium, techniques to minimize its development, and potential delayed return to baseline thinking and memory with patients and families, as patients want to be informed about risks to their brain health 1
Ensure comprehensive preoperative counseling that includes detailed information about surgical procedures, expected recovery timelines, self-care techniques, and the patient's active role in successful recovery 1, 3, 2
Teach specific techniques like abdominal breathing and coughing to reduce postoperative complications such as pneumonia and arrhythmia 3
Discharge Planning and Continuity
Establish discharge plans preoperatively that are tailored to individual patient needs, ensuring patients and caregivers feel safe with clear emergency contact details and transport plans—particularly important when patients face long travel distances 1
Provide written and verbal instructions about pain control methods before surgery and reinforce them at discharge, including explicit education about opioid adverse effects and when to hold medication 2
Modeling Ethical Decision-Making
Professional Accountability
Recognize and address ethical dilemmas in perioperative practice, preparing staff to take action based on ethical codes that emphasize respect for people and patient advocacy 5, 6
Maintain confidentiality standards by ensuring patient personal information (including transgender status or other sensitive details) is not shared beyond those directly involved in care 4
Advocate for adequate time allocation for patient interaction, particularly with elderly patients who may require additional preparation time 4
Quality Improvement and Evidence Integration
Continuous Professional Development
Use GRADE methodology to determine quality of published evidence and grade recommendations as low, moderate, or high through assessment of risk of bias, publication bias, precision, and consistency 1
Adapt recommendations based on current evidence while considering feasibility of implementation in specific practice settings 1
Monitor implementation of evidence-based practices including early mobilization (30 minutes on day of surgery, 6 hours/day thereafter), urinary catheter removal within 24 hours, and maintenance of normothermia 3
Common Pitfalls to Avoid
Do not assume that simply providing information fulfills educational responsibilities—the educator must ensure comprehension and competency through interactive methods and validation 1
Avoid focusing solely on technical skills without addressing the ethical dimensions of care, including dignity preservation and patient advocacy 4, 5
Do not neglect vulnerable populations including elderly patients who require specialized protocols for delirium prevention and cognitively impaired patients who may not effectively communicate pain 3
Never allow staff to screen less than required—current evidence shows anaesthetists screen less than 10% of patients postoperatively, which is inadequate 1