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ASSISTANCE EDUCATION AND TRAINING

Operating department assistance curriculum development and redesigning have over the last two decades embraced contemporary issues which resemble the barriers ODAs originally had to overcome on their journey to a profession (cf. Ch. 2, sect. 2.4.3). The recent humanistic approach to patient care, development of multi-skilled practitioners and interprofessional and simulated training have had the most significant impact on breaking down current barriers (Steevenson, 2006:553).

2.6.1. Humanism

The purpose of healthcare practice is to care for the sick and promote health and well-being. It goes beyond technical or clinical experience. Patients’ needs include expertise as well as humanity from all those who take care of their health. McQuoid-Mason and Dhai (2011:59) aptly state humanism is essential as healthcare encompasses understanding and acknowledging that patients are not merely bodies that receive care, but are human beings who have feelings like fear and anxiety, experience pain and suffering and who need tenderness and compassionate care. Such humane caring attributes were not initially envisaged as part of the ODA profession. The role of the ODA was purely seen as an equipment managing function perceived as technically inclined and uncaring (Robinson & Straughan, 2014:352-354; Steevenson, 2006:550; Timmons & Tanner, 2004:663). At the outset the general assumption was that ODAs are unable to provide holistic perioperative care (Davey & Ince, 2000:29; Hauxwell, 2002:483) which caused strain between ODAs and nurses (cf. Ch. 2, sect. 2.4.3). Technology was the central feature of the divide (Timmons & Tanner, 2004:655-659) with ODA education and training described as lacking the humanistic component – the component which fosters compassionate and empathetic relationships and is described as healthcare embracing elements of caring, excellence, compassion, integrity, respect, service, empathy and altruism (Schiffman, 2017:246). Humanism also demonstrates actions and attitude sensitive to patients’ autonomy, values and cultural and ethnic backgrounds. A shift occurred in the ODA profession from fulfilling a distant technical role towards a more holistic, patient-centred approach to produce healthcare professionals capable of multi-functioning in the operating department. Topics such as holistic patient-centred care; legal and ethical issues; communication; knowledge, attitude and ethics associated with professionalism as well as the caring element were included in ODA programmes (Montgomery, Loue & Stange, 2017:378-379;

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Steevenson, 2006:551). Furthermore, Schiffman (2017:247) states accountability, commitment to excellence and learning as well as dealing with complexity and uncertainty enhance core humanistic values. On the other hand, Davey and Ince (2000:29) perceive the caring process as the continuous cycle of assessing, planning, implementing and evaluating the patient’s perioperative care. Consequently, the specific selection criteria for undergraduate students became based on caring and teamwork instead of pure technical skills (Hind, Galvin, Jackson & Platt-Mellor, 2001:82).

2.6.2. Multi-skilled practitioner training

The Lewin (1970s) and the Brevan (1980s) reports were instrumental in the development of a flexible, responsible workforce and the ODA curriculum of the modern era. The vision was for ODAs to have appropriate knowledge, skills and attitudes to move between different theatre disciplines and work in teams alongside the anaesthetist, surgeon and RN. The aim was to foster multi-skilled practitioners able to function in all areas of the operating department, including the anaesthesia and recovery room departments (Hauxwell, 2002:481; Ministry of Health and Family Welfare Allied Health Section, 2015:15; Smith, 2010:2-4; Smith & Wicker, 2007:4) to combat the staff shortages in the operating department (Hauxwell, 2002:487). This was consistent with the findings of Hind et al. (2001:78) that some senior operating department staff preferred multi-skilled ODAs to ODAs specialising in technical pre-operational activities. This versatility gave ODAs the incentive of being promoted (Hauxwell, 2002:493) if they embraced their professional development by updating their knowledge and skills to that of ODPs. It resulted in the positive outcome of nurses and non-nurses sharing roles and responsibilities which finally broke the mould of ODAs/ODPs being trained solely as technicians (Hauxwell, 2002:486).

2.6.3. Interprofessional education

Because all theatre cases are addressed and managed by a team consisting of more than one healthcare professional, Keijsers, Dreher, Tanner, Forde-Johnston and Thompson (2016:306) assert adopting a patient- centred interprofessional approach is essential and best for safe perioperative patient care. The WHO indicates interprofessional education (IPE) as an innovative solution to produce practice-ready healthcare professionals (WHO, 2010:12). Although many definitions exist for IPE, the following definition formulated by the Centre for the Advancement of Interprofessional Education (CAIPE) (2016:24) is best known and most widely used: “Interprofessional education occurs when students from various professions learn from and about each other to improve collaboration and the quality of care.” (CAIPE, 2016:24).

Interprofessional education differs from multi-professional education as students learn side by side without any interactions (Brown & Bostic, 2016:237). The former is perceived as a method to enhance teamwork, increase job satisfaction, reduce patient safety errors, use resources economically (Hind et al., 2001:75 & 81) and assist students to make the transition to competent healthcare professionals (Boyce, Moran, Nissen, Chenery & Brooks, 2009:433). This viewpoint relates to the Brevan Report’s (1980) recommendation that nurses and non-nurses should work and train together to enhance role coverage between the two groups. The IPE superseded the traditional roles of nurses assisting the surgeons and taking care of patients in recovery

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room and ODAs/ODPs assisting the anaesthetists which mainly emerged as a result of the Lewin Report published in the 1970s (Hind et al., 2001:75 & 81).

The participants (nurses, ODAs and medical staff) in the study conducted by Hind et al. (2001:81) agreed with the concept of interprofessional education to improve teamwork and the quality of patient care. Hammick, Freeth, Koppel, Reeves and Barr’s (2007:735 & 748) review of IPE showed similar results. They found IPE has a positive impact on students’ ability to work together and improve patient satisfaction which is confirmed by the findings in the study Keijsers et al. (2016:306) did with regard to interprofessional education. Keijsers et al. (2016:307) and Thistlethwaite (2012:65) state the most important theories underpinning IPE are adult learning, student-centredness, self-determination and social constructivism. Community of practice (CoP) based on the social learning theory and linked to the situated learning is also relevant (Thistlethwaite, 2012:65). According to the situated learning theory, which also underpins IPE, an authentic context and social interaction in practice situations improves learning (Keijsers et al., 2016:308).

In South Africa, Treadwell and Havenga (2013:1-7) conducted a simulation study involving four groups of healthcare students (medicine, nursing, physiotherapy and occupational therapy) at the Sefako Makgatho Health Sciences University. They concluded that IPE provided students with an opportunity to develop collaborative skills and an awareness of each other’s profession. These findings support Thistlethwaite’s (2012:67) statement that educators and healthcare professionals need to collaborate to provide authentic learning experiences such as simulated training.

Regardless of all the advantages of IPE, Zanotti, Sartor and Canova (2015:2) reported that knowledge of the effectiveness of IPE is lacking. Thistlethwaite (2012:59 & 62) states that the IPE community still needs to prove empirically whether IPE is more effective before or after obtaining a qualification; whether it should be facilitated in the classroom or clinical setting and how it should be structured. A study by Hammick et al. (2007:736), which consisted of a review of 107 IPE studies, showed both positive and negative responses to IPE. This was due to the ineffective facilitation of IPE; undergraduate students’ prior negative attitude towards IPE; students not reflecting on current or future practices; educators’ not utilising adult-learning principles and the absence of or mediocre assessments during IPE (Thistlethwaite, 2012:65).

The lack of a clear understanding of what is meant by collaborative practice in the clinical environment, as well as the lack of creating an authentic learning experience for students who are learning to work together, were mentioned as barriers to effective IPE (Thistlethwaite, 2012:67). Hammick et al. (2007:748) are of the opinion that the unique nature of IPE demands adult-learning principles paired with authentic learning experiences in the clinical environment (workplace) and/or in simulation. To conclude, Freeth (2014:85) is of the opinion that poor-quality IPE could be detrimental if it results in reinforcing negative stereotypes and creates reluctance amongst students to engage in IPE sessions.

2.6.4. Simulated training

Dr Aaron Motsoaledi, SA’s Minister of Health stated: “The importance of providing quality health services is non-negotiable.” (National Department of Health (NDoH), 2011:5). However, the profound national and

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international changes in healthcare challenge the delivery of safe, quality healthcare services. For example, reports based on studies done in the UK, USA and Australia highlight adverse events and human errors where one in 10 patients suffered due to some blunder or oversight during their hospital stay (Sevdalis, Hull & Birnbach, 2012:i3). To counteract such adverse outcomes, the education and training of a uniquely capable, knowledgeable and accountable new nurse workforce was pivotal. Numerous changes to education and training curricula have been made to improve patient safety. One such change was simulated training. The aim of simulated training is to improve teamwork (cf. Ch. 2, sect. 2.8.7), competence (Sevdalis et al., 1012:i13) and communication (Hughes, 2013:167; Weller, Cumin, Torrie, Boyd, Civil, Madell et al., 2015:40). Simulated training is also seen by Hughes (2013:167) as a method to reduce staff anxiety in real anaesthetic emergency situations because staff gets the opportunity to practise vital skills not commonly available in the workplace.

Simulated training is not a new concept. Del Bueno (1978:11) reported it long ago as a useful method for students to acquire the required knowledge, skills and attitudes imbedded in a CBE/T programme. In fact, the original simulation training model as found in the aviation industry was adopted for healthcare training to assess competence of healthcare practitioners (Cumin, Weller, Henderson & Merry, 2010:45; Weller, Merry, Robinson, Warman & Janssen, 2009:126). Anaesthetic training was one of the first health specialties to adopt the aviation model for healthcare training between the late 1980s and mid-1990s (Sevdalis et al., 1012:i6). It is now widely used in anaesthetic training in the UK, Australia and New Zealand with some countries making it a compulsory training requirement (Cumin et al., 2010:45). Unfortunately, this strategy is not well embedded in ODA and whole team training mainly due to costs, the recruitment of participants, scarcity of adequate simulators and the lack of creating an approach which can combine all elements of a team (surgeons, anaesthetists, ODAs and nurses) (Weller et al., 2015:41).

Having discussed curriculum theories, barriers to effective ODA education and training as well as modern determinants in ODA education, the next section provides an overview of the impact of learning theories on ODA learning.