Experiences of operating room staff about the role of theatre technicians in peri-operative nursing

Viszolai, Loraine (2016-03)

Thesis (MCur)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: Background Unregulated theatre technicians allocated in scrub, circulating or anaesthetic assistant roles challenge traditional nursing roles in the operating room. No evidence could be found on the role of theatre technicians within the South African context, whilst such changes have an unknown effect on peri-operative patient care. Research question The study was guided by the question: “What are the experiences of operating room staff about the role of theatre technicians within peri-operative nursing?” Aim The aim of this study was to explore the experiences of operating room staff about the role of theatre technicians in peri-operative nursing. Objectives The objectives of this study were to gain an understanding of the experiences of operating room staff about the role of theatre technicians in peri-operative nursing with specific reference to: 1. Pre-operative nursing 2. Intra-operative nursing 3. Post-operative nursing 4. The supervision by professional nursing practitioners when theatre technicians are allocated to peri-operative nursing roles. Research process A descriptive qualitative research design was applied in this study. Ethics approval was obtained from the Health Research Ethics Committee of Stellenbosch University and three private healthcare organisations in the Cape Metropolitan area prior to the study. A pilot interview was conducted after which data was collected during semi-structured, audio recorded interviews with fourteen purposefully selected participants to whom pseudonyms were allocated to ensure anonymity. The interviews were transcribed, themes were induced and data was coded and elaborated upon whilst applying Lincoln and Guba’s criteria of credibility, transferability, dependability and conformability to enhance the trustworthiness of the study. Results The study found that theatre staff experienced overlapping roles between the roles of theatre technicians and that of operating room (OR) qualified professional nurses (PNs), as well as diverse views on comprehensive peri-operative care. Vague role boundaries were demonstrated through similar role expectations of staff in the scrub, circulator and anaesthetic assistant roles: “I don’t think there is a scope of practice for us… that says...this is what you do, this is what you don’t do” (Participant 12). However, within these roles, theatre technicians’ technical focus opposed the holistic patient care approach by OR qualified PNs. Holistic care, which necessitates an understanding of existing patient conditions, was associated with the anticipation and prevention of peri-operative risks. Surgical team composition seems undirected by standards and unguided by a required level of supervision. In the high risk OR environment, staff shortages and vague role expectations are linked to unclear responsibility. Coupled with limited information about team members’ credentials and their role boundaries, OR staff report conflict and leadership uncertainty, highlighted by theatre technicians’ educational backgrounds: “I (surgeon) think their training must be done differently to give them insight into what they do” (Participant 5). Conclusion The study emphasised unclear supervision requirements and questionable accountability of theatre technicians, although theatre staff experienced theatre technicians’ role as similar to that of OR qualified PNs. As voiced by participant 7: “If there is a real emergency…I (theatre technician) will be worried”. Thus, theatre technicians’ ambiguous role expectations require clarification as peri-operative risk prevention is fundamental to safe surgical care.

AFRIKAANSE OPSOMMING: Agtergrond Die ongereguleerde aanwys van teatertegnici om te skrop, te sirkuleer of as narkose-assistent rolle te vervul, is ‘n uitdaging vir tradisionele verpleegrolle in die operasie-saal. Geen bewys kon gevind word oor die rol van teatertegnici binne die Suid-Afrikaanse konteks nie, terwyl sulke benaderinge ‘n ongekende effek op operatiewe pasiëntsorg het. Navorsingsvraag Hierdie studie is gelei deur die vraag: “Wat is die ervaringe van personeel in die operasie-saal oor die rol van teatertegnici binne peri-operatiewe verpleging?” Doel Die doel van hierdie studie is om die ervaringe van personeel in die operasie-saal oor die rol van teatertegnici in peri-operatiewe verpleging te ondersoek. Doelwitte Die doelwitte van hierdie studie is om ‘n begrip te verkry van die ervaringe van die personeel in die operasie-saal oor die rol van teatertegnici in peri-operatiewe verpleging met spesifieke verwysing na: 1. Pre-operatiewe verpleging 2. Intra-operatiewe verpleging 3. Post-operatiewe verpleging 4. Die toesighouding deur professionele verpleegkundiges wanneer peri-operatiewe verpleegrolle aan teatertegnici toegeken word. Navorsingsproses ’n Beskrywende kwalitatiewe navorsingsontwerp is in hierdie studie toegepas. Etiese goedkeuring is van die Gesondheidsnavorsingsetiekkomitee aan die Universiteit van Stellenbosch en drie private gesondheidsinstellings in die Kaapse Metropolitaanse area, voor die studie verkry. ’n Loodsprojek was na die insameling van data gedurende semi-gestruktureerde, oudioopnames met veertien doelbewus geselekteerde deelnemers aan wie skuilname toegeken is om anonimiteit te verseker, gedoen. Die onderhoude is getranskribeer, temas bepaal, data gekodeer en uitgebrei, terwyl Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid om die betroubaarheid van die studie te versterk, toegepas is. Resultate Die studie het getoon dat teaterpersoneel oorkoepelende rolle het wat die rol van teatertegnici, asook die van operasie-saal gekwalifiseerde professionele verpleegsters behels, met uiteenlopende sieninge oor komprehensiewe peri-operatiewesorg. Vae rolgrense is gedemonstreer deurdat personeel wat skrop, sirkuleer en narkose-assistent is, dieselfde rolverwagtinge het: “Ek dink nie dat daar ‘n bestek van praktyk vir ons in die praktyk is nie.. ....wat sê dis wat jy doen, dis wat jy nie doen nie” (Deelnemer 12). Nietemin, binne hierdie rolle is die teatertegnici met hul tegniese fokus in teenstelling met die holistiese benadering vir pasiëntsorg van operasie-saal professionele verpleegsters. Holistiesesorg waarvoor daar ‘n begrip van bestaande pasiënttoestande moet wees, word geassosieer met die antisipering en voorkoming van peri-operatiewe risiko’s. Die samestelling van chirurgiese spanne kom voor asof dit nie deur standaarde of ‘n vereiste vlak van toesighouding bepaal word nie. In die hoë risiko operasie-saal omgewing, word personeeltekorte en vae rolverwagtinge gekoppel aan onduidelike verantwoordelikhede. Gekoppel aan beperkte inligting oor spanwerkers se gekwalifiseerdhede en hulle rolgrense, rapporteer operasie-saal personeel konflik en leierskap onsekerhede, wat deur teatertegnici se opvoekundige agtergronde aan die lig gebring word: “Ek (chirurg) dink hulle opleiding moet verskillend wees om hulle die insig te gee oor wat hulle doen.” (Deelnemer 5) Gevolgtrekking Die studie beklemtoon onduidelike toesigvereistes en bevraagteken aanspreeklikheid van teatertegnici, alhoewel teaterpersoneel die rol van teatertegnici dieselfde as die van operasiesaal professionele verpleegkundiges ervaar. Soos aangehoor deur deelnemer 7: “As daar ‘n werklike noodgeval.... sal ek (teatertegnikus) bekommerd wees”. Dus, teatertegnici se onduidelike rolverwagtings noodsaak duidelikheid, omdat peri-operatiewe risiko-voorkoming fundamenteel vir veilige chirurgiese sorg is.

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