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

[摘要] ENGLISH ABSTRACT : The provision of high quality education and training is paramount in healthcare contexts to ensure graduatesare 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 trainingwhich enable healthcare professionals to respond effectively and flexibly to the demands in the healthcareenvironment − 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) whodeliver patient care with the anaesthetic assistance functions historically provided by nurses. However, due toa shortage of nurses and changes in the higher education landscape in South Africa, anaesthetic and recoveryroom assistance as an exit-level outcome was added to the training of ODAs. This was mainly done to enableODAs to fulfil these roles and functions. Thus, the anaesthetic and recovery room assistance course wasincluded in the three-year Diploma in Operating Department Assistance to develop competent ODAs toassist anaesthetists and recovery room registered nurses.Due to critique from different sources it was deemed necessary to revisit and re-explore the anaesthetic andrecovery room curriculum. It became clear that the anaesthetic and recovery room module in use was noteffective to equip ODAs with the appropriate cognitive, affective and psychomotor skills. These skills arecritical to contribute to an effective and competent team approach to address the skills shortage in theoperating department. The aim of this study was therefore to inquire how an existing undergraduatecurriculum in anaesthetic and recovery room practices could be reconstructed to fit the needs of a privatehospital group in South Africa. This aim was pursued against the background of wider theoretical andhealthcare education issues which influence curricula in health training environments.The development of theoretical perspectives relevant to the study was based on exploring the followingconcepts and models: competency-based education, curriculum-mapping, Kerns' six-step approach tocurriculum development and Fishbein's Integrated Behavior Model (IBM). These key concepts and modelsguided 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 qualitativedata through individual, pair and focus group interviews. Quantitative data were gathered via a selfadministered paper-based questionnaire. Data were generated from samples of clinical environmentmanagers, anaesthetists, ODAs, students and educators. An inductive approach through an interpretivist lensof knowledge production was employed to investigate the understanding and needs of the stakeholders. Atotal of 35 interviews were conducted which involved 71 participants. It included 24 nursing and operatingdepartment managers, seven anaesthetists, seven ODAs, 22 students and 11 educators. Sixty-two respondentscompleted the paper-based questionnaires and the results served to compile a questionnaire on the possibleknowledge, technical skills, attitudes and non-technical skills to be included in the anaesthetic and recoveryroom 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 RoomNursing Science or a Diploma in Operating Department Assistance) participated.The study findings indicated that a few of the essential cognitive, psychomotor, affective and non-technicalskills ODAs require to assist anaesthetists and registered nurses were lacking. It emerged this was mainlydue to the lack of ODAs' psychomotor skills. The study further confirmed that a number of factors suggestedby Fishbein's Integrated Behavior Model (IBM) impacted on the teaching and learning of anaesthetic andrecovery room assistance. Of these factors, mediocre clinical assessments and environmental constraintswere found to contribute substantially. Some of the constraints related to the training environment wereunclear work profiles and nursing staff shortages. From the factual and conceptual conclusions drawn, aframework for a redesigned undergraduate needs-based anaesthetic and recovery room curriculum within aprivate higher education institution was proposed. The proposed curriculum aims at contributing towardsdealing with the criticisms levelled against the previous curriculum – which was largely the product of a nonparticipative and non-verified curriculum process – in several ways.

[发布机构] Stellenbosch University