Interprofessional Learning of Complicated Skills in Operating Room Environment

Abstract

Essentially it is noted that inter-professional training is a crucial approach of 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 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 on 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 literature and collect data from the trainers and nursing students in the OR setting to enable the fulfillment of these objectives. Importantly, it seeks the information in order to develop a course for the nurses in relation to the training of ICS and PRP methods.

Research Problem

The problems identified with regards to this research are essentially wide and a far-reaching in nature because this field has been bedeviled by profound shortcomings. First, Brennan, Olds, Dolansky, Estrada, & Patrician (2013) indicated that the operating room training sessions are costly 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 Operation Room (OR) training programs.

When training surgical procedure in the operating rooms, the balance between teaching and diagnosis becomes a difficult venture (Catchpole, Mishra, Handa, & Mcculloch 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 end results are not observed as planned. This may result to a scenario in which the learners lack some critical skills, which could have been acquired if the procedure was successful. In fact, such a critical failure of practice may contravene the theoretical knowledge acquired in class.

In regard to 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 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 the infectious organisms from affecting the patients. In addition, it was meant to minimize the pain experienced by a patient during surgery since it applies appropriate devices that reduce the latter. Furthermore, it has been noted that PRP can be used by the specialists to avoid the 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 have been identified as the rarest healthcare professionals to access. Whereas the 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 the 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 a competent and proficient training. Due to this dilemma, the trainers have been using random selections to instill skills on 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, Brennan et al. (2013) revealed that the research realm has not explored profoundly the pros and cons of training nurses in the operating room. In a different pursuit, Mann (2004) indicated that although there are research studies 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 investigates how the OR training helps them or impedes their progress in terms of skills acquisition.

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 as 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 anesthetic 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 the inter-professional training within the operating rooms, Brennan et al. (2013) 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) could be used to instigate collaboration between the professionals in order to ensure that patients are handled safely and proficiently.

However, they also explained that the inter-professional collaboration had been affected by the strategies used during training because they are less developed in nature. This implies that the teaching skills applied during training do not meet the needs of the trainees with regards to the technical knowledge required. In essence, the strategies in this case refer to the teaching skills employed by the trainers. In the same regard, Forse, Bramble and Mcquillan (2011) expressed the fact that there are new competencies which have been developed in order to ensure quality patient’s care and safety when practicing inter-professional collaboration.

This aspect implies that the trainers are coming up with new ways of imparting the skills required by the nursing trainees. These new methods are meant to use up-to-date technologies and knowledge to ensure they are consistent to the real challenges facing the nursing profession. In accordance to a study conducted by Gould, 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, Undre, Sevdalis, Koutantji, & Vincent, 2006). When the inter-professional education is conducted in the operating room, there is a tendency of professional 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. In this case, it means that professionals from various healthcare disciplines can collaborate by joining their technical skills harmoniously.

Accordingly, the professionals are not expected to showcase the superiority and the importance of their skills as compared to each other. Instead, they should employ their skills collaboratively to solve the problems facing the patient. In that regard, the patient is the primary and the sole focus of the professional. This ideology is very important because there are some instances where professionals approach issues from the perspective of their field of specialization and disregard the others. In this scenario, the inter-professional training becomes a knowledge-based battle field. The focus shifts from solving the patients’ problems to proving the importance of individual skills over others.

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, Luu, Murnaghan, & Gallinger, 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 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 engage in show-offs (Diwadkar & Jelovsek, 2010). Further, they raise the issue of how trainers can coordinate the learners in order to make a focused result that is patient-centered.

What We Do Not Know

Whereas the inter-professional learning and training in the operating room has been researched widely, there are various issues that have remained unknown. First, it is indicated by Brennan et al. (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 the operating room can be effective if the teaching strategies are still undeveloped. In this pursuit, the author meant that the method applied when training the nurses in an operating room have not taken care of the challenges facing the trainees in that case.

In addition, it implies that the methods used in training do not manage to achieve the set objectives. Understandably, the training of nurses in an authentic and inter-professional scenario must take care of challenges such as the conflict of specialization skills. 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 in order to achieve a common objective. In essence, the 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 the collaborative and integrated approach to handle patients. This raises the question as to which strategies of training are employed to achieve the required coordination.

From a clearer perspective, it implies that the methods used to train the nurses inter-professionally in the operating room should help them to work with each other. This is based on the fact that patient’s problems cannot be handled by a single professional only. In most cases, collaboration is required in order to provide a multidimensional approach and diagnosis. If the nurses are not trained on how to work with professionals who have different fields of specialization the common goal of diagnosing the patient cannot be realized.

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 are able to 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 negative impact on the learning sessions. In addition to this, it is evident that the cost of conducting the training session is very high since the classes are set to resemble the actual operations. As such, there is a concern of whether the incurred cost can incapacitate the continuity of the training sessions to conclusion.

Research Context

  1. Inter-operative Cells Savage
  2. Platelets Rich Plasma

Theoretical Framework

Inter-professional Learning Theory

Reeves and Hean (2013) indicated that the inter-professional realm of training has been condemned of having deficiency of theories. In this regard, they stated that the curriculum was criticized due to 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 the point in time, 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 the 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, the inter-professional education was based on very few theories. With the increasing understanding that theories play a fundamentally vital role in 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 team-based approach of teaching the healthcare providers. First, the trainers may decide to apply the theory in the instructional domain in order 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 in order to achieve the patient-oriented goals (Craddock, O’halloran, Mcpherson, Hean, & Hammick 2013).

This theory is one of the most crucial cornerstones of this study because it 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.

This theory can be used to train nurses when it comes to the inter-professional teaching sessions. In essence, it is indicated above that the theory enables the transforming of theoretical instructions into practice. As such, the profession requires this aspect where students are allowed to apply what they have learned in the operating rooms. Indeed, the mere theoretical stipulation of skills cannot equip the nurses with the necessary knowledge to handle patients.

As a result, this theory can be applied to equip the trainees with the experimental knowhow. If the nursing trainees are not enabled to apply the skill practically, the theoretical knowledge will be rendered null and void. In other words, it will be useless to the trainees and the patients who rely on the deployment of skills. Indeed, the transformation of such knowledge into its physical equivalent will ensure a holistic and satisfactory training on the side of the nurses.

Inter-professional Learning Theory (IPL)

The inter-professional learning theory can be used effectively when conducting training among the nurses and health professionals. When discussing how this theory can be used during the nursing training, it is crucial to identify some critical issues. Despite the fact that the delivery techniques applied in inter-professional education (IPE) change with time, the program has been implemented in the entire nursing profession. However, it is established that conducting mere training for professionals from different realms will hardly instigate the attitude and knowledge of working in an inter-professional environment.

However, the theory should be used in a manner that enables the practitioners to interact in multi-professional teams. This aspect is considered as one of the key elements of instigating the inter-professional education among the practitioners. As such, it becomes one of the most critical elements when it comes to implementing a successful IPL program. In addition, it is established that the training professionals who facilitate the multi-professional team are essentially unprepared for their obligations. As such, they are faced by challenges that do not essentially affect the trainers who participate in uni-professional teams.

From the above paragraph, the challenges indicate that the use of this theory must be conducted in a diligent manner in order to use it for training. First, for a professional trainer to use the ideologies of inter-professional training, they must embrace an optimistic viewpoint towards the Inter-professional Learning theory and its ideological perspectives. The optimism of the facilitators plays a fundamental role when it comes to ensuring that the practitioners’ learning experience is enhanced.

In order to attain an optimistic attitude, the facilitators are encouraged to prepare in terms of the body of knowledge regarding Inter-professional Learning. In essence, vast and deep knowledge of a subject is a crucial determining factor of the trainers’ motivational level. Having developed the attitudes of the trainers, there are eight steps that should be followed when taking the practitioners through the learning processes.

Step 1: Agreement of the learning objectives

When the inter-professional learning forms the basis of the training, the trainers must start by setting the objectives. However, these objectives must be set in a manner that serves the skill-based needs for the practitioners. This is based on the fact that the practitioners are trained amidst other professionals whose specializations are different. As such, the learning objectives are displayed to all the practitioners whereby they give their preliminary thought about them.

They are mandated to evaluate the learning objectives based on the question of whether they reflect their expectations. This implies that the use of inter-professional theory in training should be set to achieve the individual objectives of the practitioners in their individual capacities while using multi-professionalism as a facilitator. In essence, opening the training session by exposing the learning objectives is not a unique venture.

However, it is a critically fundamental step when it comes to the inter-professional approach because practitioners can determine whether the contents are relevant to them. Indeed, a scenario where the content helps some specializations and disregards other would be discriminative and out of objectivity. Additionally, it is meant to reassure those participants who may be anxious about the prospects of contributing as facilitators during the sessions. This preliminary approach ensures that the pragmatists are enabled to participate easily bearing in mind that the practitioners can see the relevance of the sessions.

Step 2: Presentation of the Inherent Theory, Context, and Background

When engaging in inter-professional training of practitioners, the trainers must indicate and discuss the various concepts that underlie the sessions. Indeed, these theories must be based on the objectives that were identified by all the learners. In essence, these theories must be chosen to ensure they relate to the approach of IPL that is being facilitated. Although the facilitators are mandated to facilitate students learning in IPL, they should obtain a guide towards the Inter-professional Learning in order to understand how it works holistically. The overview provides the roadmap in terms of the logistical perspective and the idea of how students can develop their levels prospectively.

When it comes to the background, it is provided to the students in accordance to the engagement of various stakeholders and institutions related to the center. As such, it is meant to indicate how the concerned individuals and institutions have contributed to the contents that are taught. This background must be given from a multi-professional point of view in order to ensure that all practitioners relate to it. As such, the multidimensional approach helps to reassure the learners that the entire training is essentially relevant to their practices. In addition, the background must incorporate the previous research studies that have been conducted with regards to the skills taught.

This helps to make students feel that the lesson is part of a historical and futuristic pursuit of knowledge. Understandably, the professionals must be convinced that healthcare is a continuous process that requires collaborative approaches. Ultimately, the provision of this background enables the practitioners to identify and determine their position in the wide realm of research. In essence, therefore, the provision of background and context ensures that inter-professional learning has achieved various aspects as shown in this list.

  1. It ensures that all the practitioners share a common philosophy and aim in the IPL.
  2. They are aware of the contents of the training, objectives, and similar core experiences.
  3. It ensures that all the practitioners and facilitators understand their roles and positions during the program.
  4. It determines how the practitioners and facilitators collaborate to achieve their common objectives across the inter-professional teams.

Step 3: Subdivision to Small Working Groups

In order for the learners to have a vast understanding concerning the explored content, they are divided into sub-groups containing multi-professional participants. Each group undertakes different tasks that are assigned by the facilitators in order to ensure that all the potential tasks have been tackled. In light of engaging in the group discussions, the learners agree on five key areas that should be discusses in relation to the content. They work together in order to solve a practical patient’s cases whereby the nature of the case scenario and the possible diagnoses are discussed. Having held discussions in separate groups, the practitioners are requested to present the findings to the facilitators.

The presentation can be presented using any methodology as far as it helps to bring out the contents discussed by in the small groups. Although the groups are used to enable students to share ideas inter-professionally, the groups form the basis of peer evaluation after the discussion. The peer review process allows the practitioners to evaluate each other form a multi-professional point of view. As a result, they correct each other and provide valid suggestions that facilitate the improvement of each participant.

In addition, it contributes to the provision of experiential understanding of the entire practical process especially when it comes to the practice of theory. In essence, most of the practitioners do not have the experience to work with other professionals of different fields of specialization. As a result, the idea of working in groups helps practitioners to interact actively with the participants. They get an opportunity to identify the perceptions of others and those ones of other professionals. In addition, they can identify the benefits and challenges encountered by the multi-professional teams.

Step 4: Role-Play of IPL Teams

Understandably, the participants from different professions cannot work with each other easily. Essentially, they find it hard to get along and work on something that is objective and resourceful. In that regard, the group dynamics might become difficult to accomplish in this condition. As such, it is crucial for practitioners to engage in role-play so that the facilitators can guide them on how to collaborate effectively. In this case, each of the participants is given a role to accomplish individually whereby the play is stopped at some points to make corrections. At these points, the facilitators provide an opportunity for the practitioners to share their thoughts and inquire about issues of interest.

Step 5: Discussion and Reflection of the Participants’ Roles

The role-play is meant to provide an opportunity for the participants to apply the learned skills practically and multi-professionally. However, collaboration should be reinforced by a critical and deep evaluation of the various roles and players. In this case, it is crucial to identify and reflect on each participant in order to help the participants to understand the importance of their colleagues in the process of solving the patient’s case. Indeed, this evaluation becomes a critical undertaking with regards to how the participants perceive others and the attitude towards inter-professional operations.

Step 6: Facilitating On-going Support and Opportunities

Inter-professional learning is a complex and involving process that requires enough time to execute and realize the required results. In this regard, the training and learning cannot be achieved over a short period of time that would necessitate minimal guidance. As a result, it is important to engage in continuous support from the facilitators in order to ensure the students enjoy continuous support. In light of accomplishing this support, the facilitators convene support-oriented networks that facilitate futuristic development of the learners. In essence, there are various forms of support that can be provided in the process of implementing inter-professional learning.

The first form of support is based on continuous and well-planned teams of practitioners (Gould et al., 2007). The participants involved in each team are allowed to learn from each other and conduct various undertakings together. The team support is expected to foster a number of aspects, including motivation and encouragement. In most cases, practitioners loose synergy when they work individually. As a result, the training might not be effective if the practitioners are left to work individually. Due to this factor of lost motivation, the team participants motivate and encourage each other to forge forward and implement the aspects taught by the facilitators in the operating rooms.

As such, students are required to meet regularly throughout the year to ensure they have continuous and persistent support from each other. The second form of support originates from the facilitators who are mandated to provide guidance and encouragement. The facilitators are not only expected to coordinate the practitioners in light of their practice, but they are also expected to ensure that practitioners engage themselves consistently. In addition to this, the centre provides a critical point of support for the practitioners. In this case, it supports both the practitioners and the facilitators because it provides an opportunity for the trainers to call directly and seek help.

Step 7: Evaluation and Review

This is considered as one of the most crucial steps in the process of implementing inter-professional learning. In this evaluation, the participants are required to provide a feedback to their facilitators regarding the challenges, benefits, and the skills learned during the sessions. This evaluation is conducted routinely in order to ensure the assessment gradually. The gradual approach makes sure that each part of the program is as effective as expected. In addition, it seeks to determine whether each of the stipulated objectives is achieved in the process of training or not. The centre is responsible of evaluating the holistic evaluations to determine whether the training is responsive and dynamic in nature.

Role of This Research in Improving the Theory

Although the theory has been stipulated and applied widely in training, this research focuses on a unique area regarding the nursing profession. In particular, it touches on the training that takes place in the operating room occasioned by the facilitators. In this case, the research explores some ways in which the inter-professional theory can be used to facilitate training in operating rooms. Understandably, the training that takes place in the operating rooms is practical in nature. As such, the research must determine how the various stages of training can be contextualized in the practical environment. In essence, it will come up with relevant ways of developing the objectives, making the sub-groups, and evaluations among other steps that have been discussed.

The 4C/ID Model: From Theory to Practice

Vandewaetere et al. (2014) indicated that medical students should be equipped with multidimensional skills that allow them to perform various roles at work place. As such, the students are mandated to engage in multiplicity of skills acquisition in order 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 presents the challenge of coordinating all the disciplines in order 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 cases, the theory is based on the inclusion of various steps that help to build modules of learning from an integrated perspective.

The model also stipulates the necessity of using the cycles of change in order to innovate educational curriculum that enable students to study issues based on the real challenges in the environment. As such, it incorporates the fragmentation, learning in 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 4C/ID model in the development of curriculum and achievement of the objectives that are set for the classes.

Essentially, this theory can be applied when training nurses with regards to the inter-professional teaching. When using this theory, there are three critical components that should be considered. These components include the managerial skills, decision making, and communication. Since the theory is based on those three aspects, the trainers will ensure they incorporate these skills when imparting the technical skills. For example, nurses should be involved when it comes to making some decision concerning the diagnosis of the patients.

This will enable them to learn the art of using the prevalent factors to choose an appropriate option. In addition, the idea of teaching the nurses how to manage resources is a critical undertaking. In this case, it is evident that the theory advocates for the knowledge of managing the available tools in a diagnostic environment. As a result, the nurses can choose some of the inputs that should be used and the ones that should be reserved. As such, the nurses will learn to approach diagnosis from a sustainable point of view.

Training

Unlike the Dreyfus model of skill acquisition, the 4C/ID model applies secondary information to make scientific conclusions. The model applies four imperative tactics in the developing resolutions to problems and integration of information. It incorporates handling learning assignments, literal information, procedural directions, as well as part-task practice. In essence, nursing care management has been based mostly on theory since its practical sense and implications have not been well-established.

As a result, the training programs for healthcare lack the depth on intellectual knowledge needed for proficient training. In the next ten years, this profession may undergo critical evolution in regard to practice so as trainers can have sufficient experience regarding the various aspects of care management. Drawings from such experience, healthcare management have deep intellect to develop and improve their training programs. As a result, healthcare will experiences better, deeper, and more informative training programs in the next ten years of existence. Additionally, the researchers, theorists, and healthcare managers have conducted various studies pertaining to care management.

It is facilitated by continuous engagement of R&D department in their quest to improve the quality of services, win more customers, and increase market share. As a result of such research, a lot of skills can be available for use by trainers in the light of imparting them.

The development of care management is practical under the ID anticipations and therefore has great expected achievements. The techniques allow the customers to apply practice and literature to understand the processes in nursing. Possibly, the care management has improved under all the discussed areas where the services are affordable, accessible, high quality and reliable. These achievements are attributed to aspects of economic development, competition, and new discoveries among other factors. The information management systems make the dispersion of information easier and more accessible by all people without limitation.

More so, people are getting busy due to employments and may demand the care services with time leading to better accessibility and many care centers. It cannot be disputed that the development of care services are intertwined to many aspects integrated in the prevailing state of the world. It is less doubtful that the anticipations are true when they appear.

Quality of Services

The 4C/ID model is an all inclusive supposition that provides diverse attributes of experiencing the theory alongside practice. The quality of the services offered is, therefore, coherent to literature. Essentially, nursing practices are highly reliable during the application of such diverse studies. They lead confirmatory procedures approved by researchers and affirmed by the health institutions. Quality is a factor determined by the strategies dictated by practice and literature. For instance, the literature indicates whether an approach has been approved. Quality is reliant of routine, procedures, timelines and deadline, literal support and conviction from instructors.

There are various factors that lead to better quality of services. First, quality is determined by the delivery of information and its accessibility to the public. It is about how the management establishes its responsiveness and answers questions from the target customers. Secondly, the time and speed of delivering services without delaying the customers play a significant proportion in the management and maintenance of quality. If these attributes are not considered properly, the repercussions may be the loss of patients in the competitive market structure.

The incompetent service providers are replaced by the competent ones. In this light, the healthcare becomes a practice for institutions offering quality services in order to avoid losing the patients seeking health attention. This factor implies that the quality of services rises significantly not only due to economic development, but also because of the competition experienced in the market. Furthermore, the quality will be a strategy of advertising services to friends of the people who have received the care.

The research performed by Pride and Ferrell (2008) indicated that quality services act as a channels of advertisement to other people within a society. Pride and Ferrell (2008) argued that quality of services leads to customer satisfaction that triggers the customers in recommending the services to other people within the society. Consequently, the advocacy for quality services continues to be a stronghold of improvement in the future.

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 researches 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 realized when an individual undergoes five stages.

The first stage of this model is stipulated as 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 the 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 on the basis of different circumstances that characterize the condition at hand. The advanced beginners start using maxims that combines both the situational and non-situational features to make a decision 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 processed 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 in order to identify the skills and choose a perspective of approaching the issues. In the same stage, students limit themselves to a number of 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 in accordance to 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 decision intuitively. The emotional engagement allows the learner to shift from a mere analytical approach of 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 the 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. In case the trainers would wish to use this theory to teach the practicing nursing in the operating room, the critical aspects that should be considered is the progressive training. The nurses should be prompted to conceptualize the skills in a gradual manner. The beginners should be equipped with additional skills when they are through with the previous ones. This enables the trainees to create a strong foundation and the progress upwards with great prowess.

Accessibility and Reliability

The training and instillation of knowledge is a paramount factor in the development of ideas and their circulation across the human population. Nurses have a fundamental role to secure the operations that are devised to strengthen the state of health in various imperative considerations (Dreyfus, 2004). In this regard, practitioners do not only apply the normative teaching strategies which are applied by scholars heavily.

Instead, they allow improvising of reliable practice-based learning. Essentially, the tactical approach of learning through the application of formal tactics does not only facilitate the stepwise styles, but also provides a three dimensional faces of the real training. In this respect, the Dreyfus model of skill acquisition is one component of intrinsic 5 staged strategies of effective training. It incorporates how a person becomes competent, proficient, expert, master and vicious of the nursing practices. The mastery of the theoretic approaches is the route from which learning is initiated. The development of systems and the development of practices from theories are part of an outstanding approach.

Training through formal requirement allows a person to implement theoretical approaches in the delivery of nursing practices. For instance, it answers how the information has been handled prior to delivery from the practitioners. These issues commence from where the demand of services have a considerable influence on practitioners practices initiated to serve the target families. In a reciprocal manner, the need creates demand and causes the formation of businesses relative to the level of demand.

This implies that the many service providers are formed in areas where there is high demand while less quality is initiated relative to low demand. Therefore, it is apparent that the accessibility and quality of the services is dictated by professionalism of the trainees. Assuming that people are informed about the advantages of domestic care services, the demand becomes high, and therefore the center for the services are many and highly accessible to people in the future.

In other instances, care may involve diseases which might require adequate and special care. In such cases, the requirements are obligatory because an individual might not live without the care services. The selection of the institutions or businesses to undertake the care chores for the diseased person might rely on trust and reliability passed through satisfied clients. Therefore, the accessibility might only be vital in cases of emergency but not when there is ample time to select the best care providers. These care providers will provide prevention tactics for the diseases and establish training to the individuals with this need.

Research and Development

Scholarly masters and proficient practitioners are the inventors of ideas for research and development in the nursing fields. Essentially, researchers are still investigating this area of healthcare management where they aim at discovering new strategies and information to make their services credible (Brodnik, 1998). Therefore, it is expected that care management is developed through research where discoveries are made and used to make the services substantial. Moreover, some discoveries require evaluation and review to establish new knowledge in this area. New drugs will be invented for the treatment of disease or other products in offering services to the people. Finally, the prevailing problems in the processes used in care management will be solved through research.

Research is a core in the development of science as a whole which assists in breaking down problems and finding data to prove the viability of incidences. Healthcare provider cannot be exempted in this imperative trend. Researchers established through these nursing theories can identify ideas that require scientific assessment and apply research techniques to find the answer to these problems. In fact, the study initiates further research with or without discovering new knowledge in the care management through recommending further investigations.

Accountability and Reliability

Theoretical approaches may dictate how nursing chores should be performed, but instilling professional approaches to the usual practices demands inventive and practical ways. For instance, accountability is a technique that may be instilling through practice. A practitioner is accountable for its actions whether they are right or inappropriate. This attribute makes most BSN nurses to monitor and review their action to prevent misdeeds which can compromise their reputation.

The loyalty of customers towards a service relies on the maintenance of continued trust and reliability. For instance, the response time when a client requests for a services will be a code for reliability. Reliable care providers respond within a short time while the unreliable ones delay or fail to deliver the services. In ten years time, it is anticipated that large institutions with many loyal customers may arise to provide quality services to their clients.

Customers can trust the institutions due to the provision of quality services and high level of accountability. Otherwise, the institutions defying this trend may be neglected and subjected to failure due to lack of loyalty and trust. This establishment of trust-directed activities promotes satisfaction of the customers and discourages the aspects that mistreat the clients.

Integration of Practitioner’s Roles

Practice allows a person to integrate the procedures of nursing. This development of intellectual capacity is achieved through experiences. Primarily, it cannot be disputed that domestic care has been integrated with other social aspects and development. For instance, most people are seeking to employ nurses who have academic qualifications and healthcare experiences to assist children during health complications.

This aspect shows that parents are seeking other services rather than domestic care only. Consequently, it will be integrated with other aspects such as education and nutrition. In regard to integration of care management and education, business will arise to offer services that cater for both aspects in order to increase their relevance to customers in accordance to the observed trend. In addition, nutrition has also become a critical issue in domestic circles where people are struggling to attain good eating habits. As a result, there is a likelihood that care management will be integrated with nutritional services in order to focus on poor eating habits. This will be inspired by the quest of service providers to increase their market share.

Value of Services

Satisfaction is a core factor that cannot be ignored while delivering services as a practitioner. The delivery of quality services is imperative to the basic handling of patients. In the modern world, nursing care has become very expansive due to the existing popular culture, economic demands and healthcare requirements. For example, unlike in the past ten years where people avoided the health requirements at personal level, they presently seek for healthcare services broadly. Additionally, they are considered capable of holding official, administrational, and organizational roles among others gradually.

This aspect implies that most of them are involved in the performance of such crucial roles implying that they need health care services. Based on this present situation, it is anticipated that the general demand for domestic care services will essentially increase in the next ten years. Lastly, it is evident that people are experiencing harsh economic demands which require them to use extra hours in their work to meet their basic requirements.

Consequently, the time available for accomplishing the practitioner’s chores has become substantially limited when calling for such people to seek help from available service providers. This generally implies that the demand for domestic healthcare may increase gradually with time until the available service providers are incapable of meeting their demand without similar expansions.

Trends of Legality in Nursing

Health issues must be apparent and approachable through an all inclusive technique. Primarily, failure to become accountable for deaths and super-infections experiences during infection and other health issues may compromise service delivery. Subsequently, the legality of these factors is paramount. In the modern world, legal issues have become prevalent owing to the raising concern that institutions and initiatives must comply with the stipulated rules.

In this regard, the care management is no exception to this trend because it is a sensitive area of human sociology. For example, the question of whether care management meets health demands has become pertinent to the future trends. In this regard, there is a possibility that the government requires the care providers to obtain a license from certified health officers. The certification is not only a mark of legality, but also an indication that the care providers meet certain standard in regard to their professionalism. Additionally, there is likelihood that the government and other public authorities focus on the age of people working in healthcare.

In this regard, care management is prone to employment of under-aged personnel in their firms. Essentially, the young girls who are below the age of 18 years are prone to this menace which impacts their education and leads to child labor. This aspect has evoked profound interest among the interested parties such as the human rights associations, government and parents. This focus results to enactment of stringent rules stipulating how companies employ their staff in healthcare facilities. It is an integration of knowledge while working as a practitioner, which is achieved through profound Dreyfus model of skill acquisition.

Interactive Team Cognition Theory

Cooke, Gorman, Myers, & Duran (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 to collective information and knowledge that informs the behavior of the team.

The overall behavior that has been adopted through collective cognition is then used to determine the results of the group. As such, the shared knowledge becomes a crucial variable when it comes to cognitive knowledge (Prichard, Stratford & Bizo, 2006). This importance is based in the fact that the knowledge of each team member is an input that is processed later to give team-based result (Bennardo, 2013). To a certain extent, the 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 overlapping body of understandings. In other perspectives, it is seen as the existence of complimentary concepts that do not intersect in any material way (Roberts, Williams, Kim, & Dunnington 2009).

In other words, the individuals are the primary units of concern so that the group becomes the secondary factor of analysis in flow of knowledge (Suter et al., 2013). Further, there is a mental model that is basically seen as the reserved portrayal of the environment that enables the team members to understand the environment and predict how it behaves in 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 the manner in which 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, inter-professional education (IPE) is a team based system of learning and training. If the team members can predict the needs of their colleague, 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 so as to accommodate different bodies on 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 is similar to 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 is applicable to this research. In perspective, the research seeks to evaluate how the nurses can learn from other professional in the OR. Understandably, this creates a scenario where a team approach is required. As a result, the idea of cognition theory is applied in all prospects.

This theory can be used effectively to impart skills and facilitate teaching of the nursing trainees. Importantly, this theory is based on the ideology of facilitating resourceful interpersonal interaction between the trainees and the trainers. In addition, the trainees obtain helpful skills that enable them to interact with each other and share ideas. In that regard, the professionals can easily share their skills and orientate each other about ideas that are not within their field of specialization. In essence, prolonged and controlled interaction of the team members can improve the collaboration of the different professional to help them to diagnose some the patients’ problems in an efficient manner.

Using Team Cognition in Training

Under the team cognition theory, it is assumed that the cognitive undertakings conducted by team members have implications on the overall performance of the group involved. As a result, some of the failures that occur during the team operation in healthcare can be attributed to the ineffectiveness of the team cognition (Aning et al., 2012). In this regard, there are three critical aspects of team cognition that theory helps the students to understand, conceptualize and use during their work. These aspects include the awareness of a situation, coordination among members, communication at different levels, and decision making capabilities of the team as a single entity.

When training students on the basis of team cognition theory, the teams are considered as single entities. For example, the aggregate cognitive team in a healthcare situation would include a nurse, anesthesiologist, and surgeon among other relevant personnel. When training these practitioners, the three aspects must be incorporated in order to apply the theory of cognition effectively.

First, the team should be equipped with efficient communication skills that enable the team members to inform each other about the patient’s development and progress. Indeed, communication becomes the starting point because it enables the practitioners to embody the other two aspects in a better manner. Evidently, the efficient communication is instrumental when it comes to ensuring accurate situational awareness.

Situational awareness is the aspect where practitioners are mandated to understand the real events and causative agents involved in a case. If the causative agents or the prevalent factors are not identified properly, the team might make critical mistakes. In fact, the understanding of the situation enables the team to make the right decisions. In this case, decision making is also identified as a critical component of team cognition (Dhakal, 2006).

This implies that situational awareness opens the way for accurate and good decision making process. Lastly, team cognition is used to train practitioners on how to coordinate with each other in order to harmonize the various cognitive capabilities into a single entity. In accordance to the four aspects, including the coordination, situational awareness, decision, and communication, it is evident that team cognition theory is used to improve the logistics of the groups in light of performing its roles.

Research Questions

There are research questions that are relevant to the problem statement raised in the previous sections. In essence, this research study is based on these research questions in order to ensure that the research objectives are outlined. Understandably, the objectives can only be achieved if these research questions are answered.

What are the pros and cons of imparting practical-based skills to a team of nurses for who are trained 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 review 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 in order to make authorization to nurses when allocating specific tasks to nurses?

This research question is aimed to indentify the manner in which 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 limitation as well as the details of 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

Setting

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 gynecological OR. In addition, it will be conducted with regards to the categorization of both the inpatient and outpatient setting in order 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 literature.

Methods

Method per Study 1

In this methodology, there will be a comprehensive review of the past researches that have been conducted in this area. The review will be in line with both professional education and workplace-based learning. In addition, it will be a mixed research where the various research questions will be analyzed in a quantitative and qualitative manner according to the information required. Since the research problem concerns the inter-professional training and the questions addresses the impact of this aspect, the mixed research methodology will ensure that profound data is collected.

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, 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 analyzed and integrated to determine how the benefits and limitations of working team-based approach can be used to create training courses for ICS and PHP.
  2. The participants will include the surgeons, perfusionists, physicians and anesthesiologists working on ICS with the 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.

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