Re-exploring the anaesthetic and recovery room component of the Diploma in Operating Department Assistance curriculum at a private higher education institution in South Africa

van Zyl, Ann Elizabeth (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT : The provision of high quality education and training is paramount in healthcare contexts to ensure graduates are trained according to the needs of stakeholders and are competent to enter the 21st century workforce. Healthcare education and training predicates the provision of high quality surgical and medical training which enable healthcare professionals to respond effectively and flexibly to the demands in the healthcare environment − of which the operating department forms a major part. This technological high-impact, fastmoving perioperative environment is staffed by nurses and operating department assistants (ODAs) who deliver patient care with the anaesthetic assistance functions historically provided by nurses. However, due to a shortage of nurses and changes in the higher education landscape in South Africa, anaesthetic and recovery room assistance as an exit-level outcome was added to the training of ODAs. This was mainly done to enable ODAs to fulfil these roles and functions. Thus, the anaesthetic and recovery room assistance course was included in the three-year Diploma in Operating Department Assistance to develop competent ODAs to assist anaesthetists and recovery room registered nurses. Due to critique from different sources it was deemed necessary to revisit and re-explore the anaesthetic and recovery room curriculum. It became clear that the anaesthetic and recovery room module in use was not effective to equip ODAs with the appropriate cognitive, affective and psychomotor skills. These skills are critical to contribute to an effective and competent team approach to address the skills shortage in the operating department. The aim of this study was therefore to inquire how an existing undergraduate curriculum in anaesthetic and recovery room practices could be reconstructed to fit the needs of a private hospital group in South Africa. This aim was pursued against the background of wider theoretical and healthcare education issues which influence curricula in health training environments. The development of theoretical perspectives relevant to the study was based on exploring the following concepts and models: competency-based education, curriculum-mapping, Kerns’ six-step approach to curriculum development and Fishbein’s Integrated Behavior Model (IBM). These key concepts and models guided the investigation in the search for possible curriculum changes. A programmatic case study design using a mixed method of data collection was used to obtain qualitative data through individual, pair and focus group interviews. Quantitative data were gathered via a selfadministered paper-based questionnaire. Data were generated from samples of clinical environment managers, anaesthetists, ODAs, students and educators. An inductive approach through an interpretivist lens of knowledge production was employed to investigate the understanding and needs of the stakeholders. A total of 35 interviews were conducted which involved 71 participants. It included 24 nursing and operating department managers, seven anaesthetists, seven ODAs, 22 students and 11 educators. Sixty-two respondents completed the paper-based questionnaires and the results served to compile a questionnaire on the possible knowledge, technical skills, attitudes and non-technical skills to be included in the anaesthetic and recovery room course. These learning-identified outcomes were verified by means of an online modified Delphi exercise. To obtain consensus a panel of 17 experts (of whom each held either a Diploma in Operating Room Nursing Science or a Diploma in Operating Department Assistance) participated. The study findings indicated that a few of the essential cognitive, psychomotor, affective and non-technical skills ODAs require to assist anaesthetists and registered nurses were lacking. It emerged this was mainly due to the lack of ODAs’ psychomotor skills. The study further confirmed that a number of factors suggested by Fishbein’s Integrated Behavior Model (IBM) impacted on the teaching and learning of anaesthetic and recovery room assistance. Of these factors, mediocre clinical assessments and environmental constraints were found to contribute substantially. Some of the constraints related to the training environment were unclear work profiles and nursing staff shortages. From the factual and conceptual conclusions drawn, a framework for a redesigned undergraduate needs-based anaesthetic and recovery room curriculum within a private higher education institution was proposed. The proposed curriculum aims at contributing towards dealing with the criticisms levelled against the previous curriculum – which was largely the product of a nonparticipative and non-verified curriculum process – in several ways.

AFRIKAANSE OPSOMMING : Die voorsiening van kwaliteit onderwys en opleiding is uiters belangrik in gesondheidsorgomgewings om te verseker dat gegradueerdes behoeftegerig opgelei word ten einde die werksmag van die 21ste eeu te betree. Gesondheidsorg-onderwys en -opleiding voorsien hoë gehalte chirurgiese en mediese opleiding wat professionele gesondheidswerkers in staat stel om effektief en aanpasbaar te reageer op die eise van die gesondheidsorgomgewing. In hierdie opsig speel die operasiesaalafdeling 'n groot rol. Die gesondheidsorg personeel moet in staat wees om midde ʼn tegnologies gevorderde en vinnig bewegende perioperatiewe omgewing pasiëntsorg te lewer; veral verpleegkundiges en operasiesaal departement assistente (ODAe). Histories is die narkotiseur in hierdie omgewings bygestaan deur 'n verpleegkundige. As gevolg van 'n tekort aan verpleegkundiges en veranderinge in die hoër onderwys landskap in Suid-Afrika, is narkose en herstelkamerbystand as 'n uittreevlakuitkoms in die opleiding van ODAe geïnkorpereer. Dit was hoofsaaklik om die ODAe in staat te stel om hierdie ondersteunende rolle en funksies te vervul. Die narkose- en herstelkamerbystandskursus is dus ingesluit in die driejaar ‘Diploma in Operating Department Assistance’ om bevoegde ODAe op te lei ten einde narkotiseurs en geregistreerde verpleegkundiges te assisteer. As gevolg van kritiek uit verskillende oorde op die opleiding van ODAe was dit nodig om die narkose- en herstelkamerkurrikulum te hersien. Dit het duidelik geword dat die huidige narkose- en herstelkamermodule nie effektief genoeg was om ODAe met die toepaslike kognitiewe, affektiewe en psigomotoriese vaardighede toe te rus nie. Hierdie vaardighede is krities ten einde by te dra tot 'n effektiewe en bekwame spanbenadering en om vaardigheidstekorte in die operasiesaal departement aan te spreek. Die doel van hierdie studie was dus om ondersoek in te stel na hoe 'n bestaande voorgraadse kurrikulum in narkose- en herstelkamerpraktyk ondersoek en aangepas kon word om aan die behoeftes van 'n privaat hospitaalgroep in Suid-Afrika te voldoen. Hierdie doelwit is nagestreef teen die agtergrond van wyer teoretiese en gesondheidsorgonderwyskwessies wat leergange in gesondheidsopleidingsomgewings beïnvloed. Die ontwikkeling van teoretiese perspektiewe relevant tot die studie is gebaseer op die ondersoek van die volgende begrippe en modelle: bevoegdheidsgebaseerde onderwys, kurrikulum kartering, Kerns se ses-stap benadering tot kurrikulum ontwikkeling en Fishbein se geïntegreerde gedragsmodel. Hierdie sleutelkonsepte en -modelle was prominent in die ondersoek na moontlike kurrikulum veranderinge. 'n Programmatiese gevallestudie ontwerp met verskillende metodes van data insameling is gebruik om kwalitatiewe data met behulp van individuele en fokusgroeponderhoude asook kwantitatiewe data deur middel van ‘n vraelysondersoek, te verkry. Die deelnemers het bestaan uit geselekteerde groepe vanuit praktiserende kliniese praktykbestuurders, ODAe, ODA studente, narkotiseurs en dosente. 'n Induktiewe benadering deur middel van 'n interpretatiewe lens van kennisverwerwing is gebruik om die leer- en onderrigbehoeftes van die relevante belanghebbendes te ondersoek. Vyf-en-dertig onderhoude is gevoer met 71 deelnemers wat bestaan het uit 24 verpleeg- en teaterbestuurders, sewe narkotiseurs, sewe ODAe, 22 ODA studente en 11 ODA dosente. Twee-en-sestig respondente het die vraelys voltooi. Die resultate van die onderhoude en vraelyste is gebruik om 'n vraelys oor die moontlike vaardighede wat in die narkose en herstelkamerkursus ingesluit kon word, op te stel. Die geïdentifiseerde leeruitkomste is geverifieer deur middel van 'n aanlyn gemodifiseerde Delphi-oefening. Konsensus is verkry van 'n paneel bestaande uit 17 kundiges met 'n Diploma in Operasiesaalverpleegkunde of ‘n Diploma in Operasie Departement Assistering. Die studie het getoon dat enkele noodsaaklike kognitiewe, psigomotoriese, affektiewe en nie-tegniese vaardighede wat die ODA benodig om die narkotiseur en geregistreerde verpleegkundige te assisteer, kortkom. Die meeste van hierdie vaardighede is geidentfiseer as psigomotoriese vaardighede. Die studie het ook getoon dat ‘n aantal faktore, soos aangedui deur Fishbein se geïntegreerde gedragsmodel, die leer van narkose en herstelkamer assistensie beïnvloed. Veral ondoeltreffende kliniese assesserings en omgewingsbeperkings was bydraende faktore; laasgenoemde het ingesluit ongedefinieerde werksprofiele en 'n tekort aan verpleegpersoneel. Op grond van die feitelike en konseptuele gevolgtrekkings vanuit die studie is 'n raamwerk vir 'n herontwerpte voorgraadse behoefte-gebaseerde narkose- en herstelkamerkurrikulum in 'n private hoër onderwysinstelling voorgestel. Die voorgestelde kurrikulum kan ‘n bydrae lewer om die kritiek op die huidige kurrikulum − hoofsaaklik die produk van 'n nie-deelnemende en nie-geverifieerde kurrikulumproses − aan te spreek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106149
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