Inter-Professional Education in Nursing

Subject: Nursing
Pages: 24
Words: 6745
Reading time:
26 min


Essentially it is noted that inter-professional training is a crucial approach to teaching healthcare providers, especially in the nursing profession. In this regard, the inter-professional training that takes place in OR becomes of even greater importance since it facilitates observational learning and sharing of ideas. Although there are such great benefits, the coordination of professionals and the cost of training are major challenges that affect the appropriateness of the approach.

This paper focuses on the approach to inter-professional training of nurses in the operating rooms. It focuses on the pros and cons of this approach along with the process of authorization. In addition, the paper seeks to review the literature and collect data from the trainers and nursing students in the OR setting to enable the fulfilment of this objective. Importantly, it seeks the information to develop a course for the nurses concerning the training of ICS and PRP methods.


What We Know

The Operation Room (OR) is referred to as one of the areas that provide an extremely good environment for teaching and training nurses as well as other healthcare providers (Jones & Morris, 2006). It is considered an authentic learning environment where students can easily make observations as the various surgical and clinical activities take place (Kanashiro, Mcaleer & Roff, 2006). In essence, Jones and Morris (2006) established that the trainers can teach every anaesthetic skill from the operating room.

These bodies of knowledge that can be instilled in the operating rooms include anatomical skills, medicine, pharmacological lessons, and statistical methods among other aspects within the healthcare profession (Jones & Morris, 2006). Indeed, the authors also indicated that the operating room can be used effectively to train and instill skills that are non-clinical by nature. Essentially, the authors proceed to establish that the operating room presents the teaching profession with numerous advantages when they are conducting the classes. However, they also appreciate that the venture is bedeviled by some critical challenges.

While focusing on the positive aspects of engaging in inter-professional training within the operating rooms, Brennan et al. (2014) indicated that inter-professionalism is a doctrine based on the creation of a cohesive and collaborative practice among various professionals and disciplines. As such, the authors considered this aspect as a fundamentally vital factor that determines the quality of services provided to the patients in hospitals.

They revealed that inter-professional education (IPE) can be used to instigate collaboration among professionals to ensure that patients are handled safely and proficiently. However, they also explained that inter-professional collaboration has been affected by the strategies used during training because they are less developed in nature. In the same regard, Forse, Bramble, and Mcquillan (2011) expressed the fact that there are new competencies that have been developed to ensure quality patient care and safety when practicing inter-professional collaboration. Following a study conducted by Grould, Drey, and Berridge (2007), it was evident that inter-professional training fosters the spirit of understanding the patients’ problems from a multidimensional perspective.

Essentially, the authors stated that IPE is a platform where professionals prompt each other to think from the perspective of other fields of knowledge (Healey et al, 2006). When inter-professional education is conducted in the operating room, there is a tendency of professionals to over-valuing their fields of specialization and disregarding the others (Hutchings, Scammell & Quinney, 2013). As such, the authors indicated that an effective IPE in the operating room can lead to a scenario where professionals share knowledge in line with patient-oriented goals rather than specialization biases.

Boud & Middleton (2003) focused on the idea of learning from each other, although they did not contextualize their study to the operational room training. Essentially, they specifically focused on how employees and workers learn from each other when conducting their activities. As such, this is a scenario that befits the condition experienced in an operating room inter-professional training because employees from various disciplines merge to share ideas and handle the patients (Leung et al., 2012). The authors indicated that there have been arguments suggesting that informal learning is of more importance than the formal system.

In addition, they observed that workers may prefer learning from each other informally rather than depending on the supervisor. This sentiment is based on the fact that the supervisor’s surveillance forces the employees to act in a manner that portrays them as competent (Lyon, 2004). Objectively, this scenario might hinder the professionals from learning and engaging in show-offs (Diwadkar & Jelovsek, 2010). Further, they raise the issue of how trainers can coordinate the learners to make a focused result that is patient-centered.

What We Do Not Know

Whereas inter-professional learning and training in the operating room have been researched widely, various issues have remained unknown. First, it is indicated by Brennan (2013) that the strategies of inter-professional training are not developed well. As such, this sentiment evokes the question as to whether the training in an operating room can be effective if the teaching strategies are still undeveloped. In essence, it raises the concern of whether teaching professionals in an authentic environment can have any substantial effect in the totality of this scenario.

The second issue of concern is how the trainers should coordinate their students to achieve a common objective. In essence, professionals have different and diverse interests according to their areas of specialization. As a result, it is expected that their perspectives of viewing clinical issues are in line with the areas of specialization. As such, the differences must be imposing some critical difficulties when it comes to coordinating all the professionals to realize a collaborative and integrated approach to handling patients. This raises the question as to which strategies of training are employed to achieve the required coordination.

Lastly, it is indicated that the operating rooms are the most authentic areas of conducting inter-professional studies because they facilitate observational learning. In addition, the rationale of using operating rooms is reinforced by the fact that different professionals from various disciplines can share ideas and join forces to handle patients. However, the idea of over-valuing personal areas of specialization has not been researched to determine whether the aspect may have a negative impact on the learning sessions. In addition to this, it is evident that the cost of conducting the training session is very costly since the classes are set to resemble the actual operations. As such, there is the concern of whether the cost incurred cost can incapacitate the continuity of the training sessions to the conclusion.

Research Problem

The problems identified with regards to this research are essentially far-reaching in nature because this field has been bedeviled by profound shortcomings. First, Brennan (2009) indicated that the operating room training sessions are expensive to maintain because they are expected to provide an authentic environment of surgical care. Due to the expensive demand, the operating room sessions of training are mostly canceled such that the procedures do not take place as planned. In most cases, this scenario is occasioned by the unavailability or deficiency of the required blood which is needed to conduct the observational classes.

The medical learning institutions and the supporting hospitals are confronted by the challenge of providing enough and safe blood supply for the classes. Indeed, the training classes are conducted when the patients are being diagnosed. If the supply of blood is not enough or safe, it implies that the sessions cannot take place in such circumstances. This aspect becomes a critical challenge when it comes to conducting successful OR training programs.

When training surgical procedures in the operating rooms, the balance between teaching and diagnosis becomes a difficult venture (Catchpole et al., 2008). Essentially, there are cases of surgery that do not unfold according to the expectations of the trainers. Indeed, surgical procedures fail occasionally and lead to poor outcomes due to over-bleeding, cases of infection, and unfavorable homeostasis of blood.

In such cases, the learners lack the opportunity to follow the procedure successfully from diagnosis to healing. As a result, the operating room training becomes ineffective because the results are not observed as planned. This may result in a scenario in which the learners lack some critical skills which could have been acquired if the procedure was as successful. In fact, such a critical failure of practice may contravene the theoretical knowledge acquired in class.

Regarding inter-professional training, it is evident that different professionals, who are pertinent to a certain diagnosis, must be present to facilitate effective training. However, this requirement is met by the challenges of availability of those healthcare professionals. This challenge is caused by the fact that some of the highly specialized professionals are very rare. Indeed, they have a busy schedule to attend to patients across a wide area of coverage in terms of jurisdiction. Importantly, the deployment of Platelets Rich Plasma (PRP method) requires the collaboration of both nurses and perfusionists.

In overview, PRP is a developed method that was meant to speed the rate of healing and prevent infectious organisms from affecting the patients. In addition, it was meant to minimize the pain experienced by the patient during surgery since it applies appropriate devices that reduce the latter. Furthermore, it has been noted that PRP can be used by specialists to avoid some surgeries which are unnecessary in certain circumstances.

This undertaking is applicable in cases where the patients are handled both in the inpatient and outpatient environment. Despite the importance of this collaboration between the perfusionists and nurses, the latter has been identified as some of the rarest healthcare professionals to access. Whereas perfusionists are rare, the nurses are available in hospitals for 24 hours to serve the patients.

This scenario implies that the nurses can serve the patients in the absence of the perfusionist at least during emergencies to avoid mortality. However, it was noted that perfusionists operated on the patients without transferring the skills to the nurses working with them. The lack of inter-professional sharing among the specialists is indicative of the extent to which lack of skills transfer may affect the quality of services provided. Essentially, the unavailability of highly trained specialists may affect the proficiency of training the nurses in the operating rooms.

The authorization process has become a crucial subject of concern when it comes to the training of OR nurses in the operating rooms. Indeed, the authorization procedure has not been described fully and profoundly to show how the nurses should be instructed during the operations. As a result, the question of how the system should develop the authorization procedures for nurses has remained unanswered.

Accordingly, there is no defined way of authorizing the nurses when critical undertakings are required. This poses a major problem to inter-professional coordination and transfer of skills between the two levels of specialization. Importantly, the lack of this stipulation implies that the information required to make authorization is unknown. As such, it is very crucial to determine the informational requirements of the authorization process.

Additionally, the question of the perspective that should be applied during training has posed a dilemma to the inter-professional training. In this case, the training in the operating rooms may take place in groups or individual forms.

However, there are no determinations showing the correct approach that can lead to competent and proficient training. Due to this dilemma, the trainers have been using random selections to instill skills in the professionals without knowing and considering the impact of these methods. As such, it implies that the training of nurses in the operating rooms has been based on methods whose effectiveness is unknown. As a result, it is crucial to determine the approach that can fit the training in the operating rooms. This evaluation will play a fundamentally vital role when it comes to the inter-professional training of nurses.

Lastly, the research realm has not explored profoundly the pros and cons of training nurses in the operating room. Although it is evident that there are researches that have investigated the advantages and disadvantages of OR-based training inter-professionally, very few explorations have been conducted with regards to the nurses. Despite this scenario, it is clear that nurses are some of the most crucial service providers in the healthcare field. As such, it is important to attain a narrow focus that targets the nurses to investigate how the OR training helps them or impedes their progress in terms of skills acquisition.

Research Context

Inter-operative Cells Savage

Esper and Waters (2011) indicated that multiple methods have been conceptualized and developed to avoid the provision of allogeneic blood to patients. In essence, they revealed that the methods that were used primarily included the use erythropoietin technique, providing donation autologously, injection of blood which is based on hemoglobin, and the application of cell salvage methods. The research studies that focus on the development of hemoglobin-based techniques are in continuation.

These researchers are aimed to increase the level of safety and quality of the transfusion of blood to patients during surgery. Among the techniques that have been mentioned at the beginning of this paragraph, cell salvage provides a safe, efficient, and economical method of avoiding the cases of transferring allogeneic blood to patients. Whereas they have been termed as safe, effective, and cost-effective, the popular misinformation has portrayed them as inefficient, costly, and unfit for application in some specialized clinical cases. To discuss the entire procedure of cell savage, the image below shows a step-by-step portrayal of this process.

Inter-operative Cells Savage

The inter-operative cell savage method is used to prevent undesired outcomes during surgery (Aning et al., 2012). In particular, such unfavorable outcomes may arise due to bleeding beyond limits, the undesirable nature of blood in terms of its homeostatic component, infectious substances, and delayed process of healing. The method works in such a manner that allows the specialists to recover the bloodshed by the patient and the providing red blood cells that are autologous. In this regard, the specialists understand that the more the number of blood donors, the higher the risk of transferring allogeneic blood to the patients. As such, the cell savage method is preferable in cases of high risk of transferring this type of blood. Indeed, it is meant to offer maximum shield and protection against this scenario.

Before the application of the interoperative cell savage method, some indications are required to warrant its necessity. These indications have been developed in general terms to provide an overview of some of the guiding requirements. First, the ICS method should be applied when the patient has lost about 0.2 of his total amount of blood in terms of volume. Second, the patient should be in a position in which the cross-match-compatible blood cannot be determined by the specialists using their most effective means. The third general requirement seeks to provide the patient with an opportunity to decide concerning his or her will.

As such, the method should be applied in case the patient does not want to receive the transfusion of allogeneic blood to his or her body. However, he must allow the reception of the blood from intra-operative blood savage if any diagnosis will be conducted. This requirement is consistent with the social, religious, and political aspects of the patients which may affect their behaviour and preferences. In addition to these requirements, the technique should be applied in case more than one patient out of ten who are undertaking the process needs to undergo a transfusion of blood. Lastly, the specialists should consider applying the cell savage if the average blood transfusion for the entire procedure requires more than one unit of blood.

Essentially, these stipulated conditions of applying the ICS are obtained by comparing the cost incurred when providing allogeneic blood and using the ICS. Over the recent years, the cost of providing allogeneic blood to patients has increased substantially.

As such, the changes have altered the financial relationships between the two methods and how they are applied in terms of the cost thresholds. Concurrently, medical practitioners have obtained a deeper understanding concerning the costs correlated to the application of ICS. Accordingly, it has been suggested that the application of ICS should be chosen when the specialists expect to deal with small amounts of blood lost.

However, this condition is tricky when it comes to making the ultimate decision on whether to apply ICS or not. The difficulty is associated with the uncertainty involved when estimating the amount of blood loss that will be incurred by the patient. As such, it is recommended that the ICS system is set up in standby mode even when transfusing allogenic blood. This ensures that the ICS system can be used alternatively and timely if the latter method fails. Particularly, the standby mode is set up to include the collecting section, a line for suction, and the part that facilitates anticoagulation.

While making this decision, the specialists must ensure that it is made alongside a clarified explanation and communication among various personnel. The personnel includes the hospital administration employees, the surgeon assigned to the case specifically, as well as the anesthesiologist involved in the procedure. Importantly, the decision must be taken from a patient’s perspective because factors such as age, weight, and hemoglobin are crucial aspects that determine the risks involved.

In addition, they determine the possibility of requiring blood products from the transfused blood. While focusing on this research context, it is clear that the application of this process is dependent on various professionals. In this paragraph, it was stated that the decision to use the ICS must be accompanied by clear communication within the various levels of staff, including the administrative section and surgeon among others. Importantly, the nurses are fundamentally vital personnel in the process of applying the ICS. Accordingly, they should be informed about the application of this method bearing in mind that it is a high skill operation.

Additionally, the specialized staff must involve the nurses when using this system (Aning et al., 2012). Indeed, it cannot be disputed that the familiarization might play a great to ensure that the procedure becomes successful. If the nurses do not have any knowledge concerning the application of ICS, their service in the entire procedure might be less important and ineffective. As such, this research will focus on the training of nurses about ICS.

Platelets Rich Plasma

The second focus of this research is the application of the Platelets Plasma Method (PRP) especially when it comes to the treatment of surgery. In perspective, the research will be examining how the method can be applied in the operating rooms while the nurses are being trained about it.

In the recent past, there has been growing literature concerning the preparation and application of this method on patients. The literature research studies have also shown a lot of interest, not only on the method itself but also the effectiveness when it is applied to treat injuries. For instance, some of the famous sportsmen have been diagnosed using this method. They include people such as Tiger Woods who incurred knee injuries and tendon sprains.

Indeed, they have credited the use of PRP for quality treatment so that the method has been considered as one of the most effective and credible techniques which may be applied in such scenarios. Indeed, this being one of the areas of focus for this research, it is crucial to explain the method, describe how it world, indicate the requirements that should be considered when applying it, and evaluate its effectiveness on the patients.

Platelets are considered a crucial component since they facilitate the clotting of blood. In addition, they contain some types of proteins which facilitate the process of healing. The method involves the provision of blood with more platelets than the typical blood that occurs naturally in the human body. Mostly, the platelets are about five to ten times more than the usual blood. This implies that the rate of blood clotting is accelerated robustly and the healing process is also complemented by the increased level of growth factors. When preparing the PRP, blood is obtained from the patient’s body and the platelets are separated from the other components of the blood. In this process, centrifugation is involved in a manner that helps to increase the concentration of platelets in the blood and then introduced them into the patient’s body.

Researchers have indicated that it is not completely clear how the method of PRP works to treat injuries. Nonetheless, it is argued that the raised concentration of platelets is responsible for the clotting of the blood while the growth factors increased the rate of healing. To increase the rate of healing, the patients are treated in two different ways. First, the specialists can decide to introduce the PRP to the area that has been hurt.

For example, when an athlete or a tennis player is injured around the tendons, the tissues around that area are liable to swelling. To use the method successfully, the PRP is applied on the swelled muscles and tissues to facilitate direct effect. Essentially, the injection may increase the pain around that muscle for the first few weeks, but the condition improves with time to give beneficial results. The second application is used in surgery when the patients undergo operations. When the surgical operation is conducted, the PRP is injected to ensure that the healing process is speeded up.

Like any other operation, the PRP method requires some conditions that necessitate its application. Recent research studies are being carried out to determine the effectiveness of the PRP method when it comes to treating injuries. Since the results are not essentially conclusive, the effectiveness of PRP can be termed as a varying variable. In essence, various aspects affect the efficiency of the PRP method as shown in this list.

  1. The part of the body that has been injured and hence being treated
  2. The general health of the patient in question
  3. The nature of the injury in terms of whether it is acute or chronic at the time of diagnosis.

With regards to this above condition, the application of PRP in the treatment of chronic tendons problems is highly recommended. One of the most popular injuries of this kind is the tennis injury that occurs when the ball hits the elbow. As such, although it is inappropriate to indicate that the application of PRP to chronic tendons is more effective than traditional techniques, it is evident that it is essentially effective in these cases.

Nonetheless, the much applause received by the PRP method has originated from the treatment of minor injuries incurred by the sportsmen. Although the entire progress has been realized there is very little scientific literature and empirical evidence showing that the PRP method speeds up the healing process in these cases. The other application of this method is the treatment of knee arthritis. Since this is a disease that has been critical to healthcare, few preliminary research studies have been commenced to show the applicability of PRP on the cases of knee arthritis. In addition, the method has been used experimentally to treat bone fractures.

Besides the minor injuries, surgeries have been the main area of focus for the use of PRP. Indeed, this research can mainly focus on this area since it is more relevant to the training of nurses in the operating rooms. In the recent past, PRP has been used preliminarily to hasten the process of healing after surgical operations. The very first time this method was used by the specialists targeted the diagnosis of shoulder injuries whereby the torn rotary ligaments were treated.

However, the outcomes have shown a little positive effect on this diagnosis and have not been used widely for that reason. In addition, the surgery involving the repairing of torn knees has also applied this method of PRP. However, there have not been critical developments to show the usefulness of the method to the surgical operations on the knee.

Regarding the context of this research, it is understood that the future of the PRP application has a great future in the operational surgery that involves the nurses and necessitates their training to instill the necessary skills. However, there is a lack of credible evidence to show that, indeed, the diagnosis will provide a lasting solution for surgical operations and other injuries. As such, although it has been established that the PRP is effective when it comes to the treatment of chronic tendons, it is clear that the researchers must find credible evidence to support this realization scientifically.

In essence, such research should seek to expound the body of research on the applicability of PRP on other areas and conditions of diagnosis. Although its effectiveness is under scrutiny, it poses minimal risk to the patient when applied in treatment. Indeed, there are increased pains incurred after the injection of PRP, but the risk of incurring other related problems such as infection and damage of tissues is very negligible.

Importantly, the nurses should be trained on ways to familiarize themselves with this method of diagnosis bearing in mind that it is new in the field of healthcare. The familiarization will ensure that the person has the required skills right from the discovery stages. The entire acquisition of these skills is an inter-professional aspect that requires the healthcare system to facilitate effective OR training to allow observational learning.

Theoretical Framework

Interactive team cognition Theory

Cooke et al. (2013) indicated that the body of knowledge has experienced a paradigm shift from the physical approaches to the cognitive orientations. The authors suggested that the complexity of a task provided cannot be tackled by a single individual effectively because one person cannot have all the required disciplinary knowledge.

Essentially, Cooke et al. (2013) indicated that team cognition is dependent on the model used by the individuals when processing knowledge and information. The team cognition theory has various aspects that define it, including the theories and methods that share assumptions. In essence, the authors acknowledged that the theory works on the basis that shared cognition components extend to the frameworks of data processing to consider the individual understandings.

The individual inputs are combined with collective information and knowledge that informs the behaviour of the team. The overall behaviour that has been adopted through collective cognition is then used to determine the results of the group. As such, shared knowledge becomes a crucial variable when it comes to cognitive knowledge (Prichard, Stratford & Bizo, 2006). This importance is based on the fact that the knowledge of each team member is an input that is processed later to give team-based results (Bennardo, 2013). To a certain extent, team cognition is viewed as the existence of shared knowledge among the team members (Schumacher, Englander & Carraccio, 2013).

Importantly, shared knowledge is partially considered as an overlapping body of understandings. In other perspectives, it is seen as the existence of complementary concepts that do not intersect in any material way (Roberts et al., 2009). In other words, the individuals are the primary units of concern so that the group becomes the secondary factor of analysis in the flow of knowledge (Suter et al., 2013). Further, there is a mental model that is seen as the reserved portrayal of the environment that enables the team members to understand the environment and predict how it behaves in the future. This construct is shared among the team members to promote a framework of interest that is common and relevant to all the individuals to make a cohesive team (Wonjoon, Holly & Chiaburu, 2014).

Team cognition theory is found as a new condition that describes how the knowledge pertinent to the entire team is organized, portrayed, and shared among the members. This system of organization and distribution of knowledge is seen as the aspect that allows the team to predict the future and act in line with its possible events. The critical aspect that backs the shared cognition is the fact that individual team members who may have different, but complementary models can predict the requirement of others. As such, they can easily work in coordination with each other to achieve a given objective.

For example, interprofessional education (IPE) is a team-based system of learning and training. If the team members can predict the needs of their colleagues, it implies that the various professionals can play a complementary role when instilling multidisciplinary skills. In addition, it implies that the professionals can tolerate each other to accommodate different bodies of knowledge rather than relying on the individual understanding only and over-valuing the personal area of specialization. In this theory, it is indicated that the performance of the team as a whole is developed by action-based interactions between the various team members.

Accordingly, the member who is set with conceptual structures that are similar to the reference point performs better. Since it is evident that the cognition theory purports the idea of using shared knowledge to enable a team approach, it applies to this research. In perspective, the research seeks to evaluate how the nurses can learn from other professionals in the OR. Understandably, this creates a scenario where a team approach is required. As a result, the idea of cognition theory applies in all prospects.

Inter-professional learning theory

Reevees and Hean (2013) indicated that the inter-professional realm of training has been condemned for having a deficiency of theories. In this regard, they stated that the curriculum was criticized for avoiding the application of theories. As such, the critical evaluation of the work indicated that the curriculum was based on descriptive ideologies that did not use scientific evidence to support its rationale.

At this point, the authors indicated that there was resistance against the use of theoretical frameworks. Most of the scholars regarded themselves as action-oriented personnel who sought to adopt a practical approach rather than a theoretical one (Cooper & Spencer, 2006). These practitioners expressed themselves as people who sought to focus on the welfare of patients rather than their academic endeavors.

It was also misconceived that the personnel did not have enough time to evaluate the academic ideologies and understand the theoretical framework (Mann, 2004). As a result, inter-professional education was based on very few theories. With the increasing understanding that theories played a fundamentally vital role in the diagnosis and development of new knowledge, the inter-professional theory was developed in this field.

Clark (2006) indicated that the theory is based on two different applications in the team-based approach of teaching the healthcare providers. First, the trainers may decide to apply the theory in the instructional domain to understand learning and stipulate the activities that should be undertaken to facilitate the achievement of the desired learning outcomes. As such, the theory identifies and explains the main concepts that should be considered when developing the program of the IPE. It indicates the aims of learning in a specific manner and also indicates how the students are involved during learning.

Lastly, the theory stipulates the methods of measuring and assessing the performance of students. As a result, the students are guided holistically to understand how they interact with others and share knowledge to achieve the patient-oriented goals (Craddock et al., 2013). This theory is one of the most crucial cornerstones of this study because the research seeks to research and determine various aspects associated with inter-professional training among the nurses in OR. Since it is vital in the setting of the learning objectives and their achievements, the theory will be of great importance to the successful study of this research.

The 4C/ID model: From theory to practice

Vandewaetere (2014) indicated that medical students should be equipped with multidimensional skills that allow them to take part in various roles at the workplace. As such, the students are mandated to engage in a multiplicity of skills acquisition to accomplish this task. Importantly, the students must explore the skills of decision making, communication, and management of resources within the organization.

However, learning multiple skills present the challenge of coordinating all the disciplines to develop a holistic approach to the training. The 4c/ID model is meant to provide a methodology of developing the tasks that are meant to equip students with the required tools and skills of acquiring broad knowledge. The development includes the stipulation of how the learning environment should be set to allow the learning and acquisition of many skills by the students taking inter-professional education (Merrinboer, Clark & Croock, 2002). In most case, the theory is based on the inclusion of various steps that helps to build modules of learning from an integrated perspective.

The model also stipulates the necessity of using the cycles of change to innovate an educational curriculum that enables students to study issues based on the real challenges in the environment. As such, it incorporates fragmentation, learning on a classroom basis, and blending of disciplines to achieve the stipulated objectives of the learner. This theory will play a crucial role when it comes to the stipulation of this paper. Importantly, training nurses inter-professionally in the operating room is a complex venture (Pace, 2004). As a result, it implies that there is the need to use the 4C/ID model in the development of curriculum and achievement of the objectives that are set for the classes.

Dreyfus Model of Skill Acquisition Theory

Benner (2004) indicated that Dreyfus developed a model to help with the gaining of skills based on examining chess players and other specialists who engage in activities such as piloting as well as driving the tanks. Essentially, this theory is one of the concepts that have evoked profound research concerning the acquisition of knowledge and skills as well as manifestation on nursing methods. It is a developmental theory that was meant to improve on the originally conceived experiential learning theory as well as situated performance.

A total of three pieces of research regarding the instilling of skills in the nursing profession have been based on the model of Dreyfus. In essence, Dreyfus (2004) suggested that the acquisition of skills is realized when an individual undergoes five stages. The first stage of this model is stipulated as the novice step. In this stage, Dreyfus suggested that the trainer should simplify the task into aspects that starters can understand without the required skills.

The instructor is then mandated to give rules that should be followed by the learner when accomplishing the task. For example, a nurse may be tasked to recognize context-free aspects such as temperature by merely looking at the thermometer and reading the measurements as shown in the calibrations. However, although the rules are given by the instructor, a successful student does not need to follow them blindly because the real world does not behave ideally. As such, the students should learn the facts along with the contextual understandings of the subject studied. In the second stage, the learners are referred to as advanced beginners.

As the novice obtains more skills by emulating the instructor, he gains some additional skills above the rules provided. The student is capable of evaluating situations and making decisions based on different circumstances that characterize the condition at hand. The advanced beginners start using maxims that combine both the situational and non-situational features to decide on what to do. Dreyfus (2004) indicated that the third step is the stage of competence. In this stage, the number of pertinent aspects and processes identified by the students increase overwhelmingly. Since the rules do not apply exactly, the learner may not know how the skill is mastered to this level.

As such, students require more experience to identify the skills and choose a perspective of approaching the issues. In the same stage, students limit themselves to several relevant features rather than using the vast features that were applied previously. As such, decision-making becomes easier since the student has chosen a perspective as well as the feature that will be used to accomplish tasks per the dimension taken. The fourth stage is commonly referred to as the step of proficiency as indicated by Dreyfus (2004). At this stage, the learners become emotionally involved in the tasks.

They go beyond the rules and gain more experience that helps them to make decisions intuitively. The emotional engagement allows the learner to shift from a mere analytical approach to handling issues to a holistic method of incorporating emotional intelligence. In this case, the emotional involvement is mostly manifested when the student seeks to take charge of their success in the acquisition of skills. This is reinforced by awarding successes and correcting unsuccessful ventures. The final stage is the step of expertise where the skills are highly polished. At this stage, the most defining aspect is that the learner does not only understand what to do but also how and when to apply the skills.

Research Questions

There are four pertinent research questions that this research study seeks to answer as part of fulfilling its objectives.

What are the advantages and disadvantages of teaching practical skills in a team-based environment for nurses studying in the operating rooms?

This research question seeks to investigate the various benefits and shortcomings of training nurses in the OR using teams. In this case, the research question will be answered by the administration of questionnaires and literature reviews from previous studies. The questionnaires will be administered to the strainers as well as the students who have undergone this training in the OR.

What information do the instructors require to make authorization to nurses when allocating specific tasks to nurses?

This research question is aimed to identify how the process of authorization is developed to offer the right instructional aspect to the nurses. While answering the questions literature concerning the authorization process will be evaluated to provide relevant information according to previous studies. In addition, interviews will be conducted to determine the aspects of authorization that should be included in the venture.

What is the appropriate method of training practical skills for the nursing students in an authentic environment such as the OR in terms of the group of individual approaches?

The question addresses the issue of determining the best methods of teaching students in authentic environments. In this case, the authentic environment will be the operating room since it is pertinent to the nursing profession. In an attempt to answer it, the research will review the relevant literature, conduct interviews, and carry out ethnographic studies to make all-rounded determinations.

How can the specialists use the information concerning the benefits and limitations as well as the details of the authorization process to create a comprehensive training course for a team-based workplace with regards to the ICS and PRP skills acquisition?

Methods and Settings


This research study will consider collecting primary data from twenty-five General Operating Rooms, eight operating rooms that deal with oncology and liver complications, and one gynaecological OR. In addition, it will be conducted with regards to the categorization of both the inpatient and outpatient settings to develop profoundly expansive results. The entire focus will ensure that all the clinical aspects have been considered during the collection of data and the review of the literature.


Method per Study 1

In this methodology, there will be a comprehensive review of past research that has been conducted in this area. The review will be in line with both professional education and workplace-based learning. In addition, it will be mixed research where the various research questions will be analysed quantitatively and qualitatively according to the information required.

Method per Study 2

In this case, there will be a profound review of literature which will help to determine the various issues that have been raised in the problem statement and the third research question. Additionally, an interview will be administered to make the relevant determinations obtained from the students and trainers.

Method per Study 3

In this study, various aspects will be included as shown in this list.

  1. Creation of a learning module for IPE in OR for nurses.
  2. Observing participants modules of learning
  3. Assessing the team cognition skills acquisition
  4. Conduction ethnographic studies in terms of confessional and micro-ethnography perspectives.

Method per Study 4

  1. The studies above will be analysed and integrated to determine how the benefits and limitations of a working team-based approach can be used to create training courses for ICS and PHP.
  2. The participants will include surgeons, perfusionists, physicians, and anaesthesiologists working on ICS with qualified nurses.
  3. In addition to the methods, there will be close observations of the nurses in operating rooms and their instructors to determine the level of skills obtained and how they are transferred.


Aning, J., Dunn, J., Daugherty, M., Mason, R., Pocock, R., Ridler, B. (2012). Towards bloodless Cystectomy: A 10-year experience of intra-operative cell salvage during radical cystectomy. BJU International, 110(11), 608-613.

Bennardo, G. (2013). Cognitive Anthropology’s Contributions to Cognitive Science: A Cultural Human Mind, a Methodological Trajectory, and Ethnography. Topics in Cognitive Science, 6(138-140), 138-140.

Benner, P. (2004). Using The Dreyfus Model Of Skill Acquisition To Describe And Interpret Skill Acquisition And Clinical Judgment In Nursing Practice And Education. Bulletin of Science, Technology, and Society, 24(3), 188-199.

Brennan, C., Olds, D., Dolansky, M., Estrada, C., & Patrician, P. (2013). Learning by doing: observing an interprofessional process as an interprofessional team. Journal of Interprofessional Care, 28(3), 249-251.

Boud, D., & Middleton, H. (2003). Learning from Others at Work: Communities Of Practice And Informal Learning. Journal of Workplace Learning, 15(5), 194-202.

Catchpole, K., Mishra, A., Handa, A., & Mcculloch, P. (2008). Teamwork and Error in the Operating Room. annals of surgery, 247(4), 699-706.

Clark, P. (2006). What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training. Journal of Interprofessional Care, 20(6), 577-589.

Craddock, D., O’halloran, C., Mcpherson, K., Hean, S., & Hammick, M. (2013). A top-down approach impedes the use of theory? Interprofessional educational leaders’ approaches to curriculum development and the use of learning theory. Journal of Interprofessional Care, 27(1), 65-72.

Cooke, N., Gorman, J., Myers, C., & Duran, J. (2013). Interactive Team Cognition. Cognitive Science, 37(2), 255-285.

Cooper, H., & Spencer, E. (2006). Involving service users in interprofessional education narrowing the gap between theory and practice. Journal of Interprofessional Care, 20(6), 603-617.

Diwadkar, G., & Jelovsek, J. (2010). Measuring Surgical Trainee Perceptions to Assess the Operating Room Educational Environment. Journal of Surgical Education, 67(4), 210-216.

Dreyfus, S. (2004). The Five-Stage Model of Adult Skill Acquisition. Bulletin of Science, Technology and Society, 24(3), 177-181.

Esper, S., & Waters, J. (2011). Intra-operative cell salvage: a fresh look at the indications and contraindications. PubMed, 9(2), 139-147.

Forse, R., Bramble, J., & Mcquillan, R. (2011). Team training can improve operating room performance. Surgery, 150(4), 771-778.

Gould, D., Drey, N., & Berridge, E. (2007). Nurses experiences of Continuing Professional Development. Nurse Education Today, 27(6), 602-609.

Healey, A., Undre, S., Sevdalis, N., Koutantji, M., & Vincent, C. (2006). The Complexity Of Measuring Interprofessional Teamwork In The Operating Theatre. Journal of Interprofessional Care, 20(5), 485-495.

Hutchings, M., Scammell, J., & Quinney, A. (2013). Praxis and reflexivity for interprofessional education: towards an inclusive theoretical framework for learning. Journal of Interprofessional Care, 27(5), 358-366.

Jones, R., & Morris, W. (2006). Facilitating learning in the operating theatre and intensive care unit. Anaesth Intensive Care, 34(6), 758-764.

Kanashiro, J., Mcaleer, S., & Roff, S. (2006). Assessing the educational environment in the operating room a measure of resident perception at one Canadian institution. Surgery, 139(2), 150-158.

Leung, A., Luu, S., Murnaghan, L., & Gallinger, S. (2012). First, Do No Harm: Balancing Competing Priorities in Surgical Practice. Academic Medicine, 87(10), 1368-1374.

Lyon, P. (2004). A model of teaching and learning in the operating theatre. Medical Education, 38(12), 1278-1287.

Mann, K. (2004). The role of educational theory in continuing medical education: Has it helped us?. Journal of Continuing Education in the Health Professions, 24(S1), 22-30.

Merrinboer, J. J., Clark, R. E., & Croock, M. B. (2002). Blueprints for complex learning: The 4C/ID-model. Educational Technology Research and Development, 50(2), 39-61.

Pace, D. (2004). The Amateur in the Operating Room: History and the Scholarship of Teaching and Learning. The American Historical Review, 109(4), 1171-1192.

Prichard, J. S., Stratford, R. J., & Bizo, L. A. (2006). Team-skills training enhances collaborative learning. Learning and Instruction, 16(3), 256-265.

Roberts, N. K., Williams, R. G., Kim, M. J., & Dunnington, G. L. (2009). The Briefing, Intraoperative Teaching, Debriefing Model for Teaching in the Operating Room. Journal of the American College of Surgeons, 208(2), 299-303.

Reeves, S., & Hean, S. (2013). Why we need theory to help us better understand the nature of interprofessional education, practice and care. Journal of Interprofessional Care, 27(1), 1-3.

Schumacher, D., Englander, R., & Carraccio, C. (2013). Developing the Master Learner: Applying Learning Theory to the Learner, the Teacher, and the Learning Environment. academic medicine, 88, 1635-1645.

Suter, E., Goldman, J., Martimianakis, T., Chatalalsingh, C., Dematteo, D. J., & Reeves, S. (2013). The use of systems and organizational theories in the interprofessional field: Findings from a scoping review. Journal of Interprofessional Care, 27(1), 57-64.

Wonjoon, H., Holly, C., & Chiaburu, S. (2014). Do trainer style and learner orientation predict training outcomes?. Journal of Workplace Learning, 26(5), 331-334.

Vandewaetere, M., Manhaeve, D., Aertgeerts, B., Clarebouti, G., ANN ROEX, J. M., & Roex, A. (2014). 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93. Early Online, 5, 1-17.