The level of knowledge of all three NTS categories was ‘satisfactory’ (Table 2). For all three NTS categories, the majority of the participants had obtained a ‘satisfactory’ level knowledge score. The lowest knowledge score of 33% (0.59%, n=1) was obtained for ‘Communication and Teamwork’ and for ‘Situation Awareness’. The highest knowledge score of 100% was obtained for ‘Communication and Teamwork’ (37.87%, n=64), ‘Task Management’ (4.14%, n=7), and ‘Situation Awareness’ (31.95%, n=54).
The level of knowledge of all nine elements was ‘satisfactory’ (Table 2). For all 9 elements, the majority had obtained more than the mean knowledge score and a ‘satisfactory’ level knowledge score.
Level of NTS Practices: The level of practice was ‘Marginal’ with a mean practice score of 2.99(Table 3). Fifty-one percent (n=85) had less than the mean practice score. The lowest and the highest practice scores were 2.3(1.18%, n=2) and 3.7(0.59%, n=1) respectively. Out of the three NTS categories, ‘Situation Awareness’ had the highest mean practice score while ‘Task Management’ had the lowest mean practice score (Table 3).
Four out of nine NTS elements had a ‘Marginal’ level of practice (Table 3). ‘Planning and Preparing’ had the highest mean practice score, while ‘Coping with Pressure’ had the lowest Table 3). The majority had obtained more than the mean practice score in ‘Exchanging information’ (58.58%, n=99), ‘Planning and preparing’ (64.50%, n=109), and ‘Recognizing and understanding information’ (58.58%, n=99).
Communication and teamwork skills:
All OT NOs (N=169) were aware of the importance of ‘Communication and teamwork skills’. The majority changed their voice, tone, and manner of speaking according to the situation (86.9%, n=147), and asked for clarifications of instructions when needed (81%, n=137). Ninety-three percent (n=157) were aware of the necessity to inquire about unclear decisions of senior NOs and 42% (n=71) practiced it. When exchanging information, 87.6% (n=148) used both verbal and non-verbal communication methods depending on the situation. Ninety-five percent (n=161) correctly exchanged messages. When coordinating with team members, 71% (n=120) were able to manage interruptions to work by others. Seventy percent (n=119) were aware of the other members’ work and 40.9% (n=69) did not support others to complete the teamwork and did not consider that it is important to verbally acknowledge the requests made by the team members. Forty-seven percent (n=89) did not inform the team members when going on a break.
Task management skills:
The majority anticipate and prepare (95.3%, n=161), organize (98.2%, n=166), prioritize the work (98.2%, n=166), and utilize free time for preparatory work (65.7%, n=111). Ninety-six percent (n=163) were aware of the importance of ‘Providing and maintaining standards’. The majority did not adhere to guidelines when not being observed (87.6%, n=148), did not maintain professional behaviour (52%, n= 88), and got distracted by irrelevant conversations while working (52.1%, n=69). The majority admitted that they raised their voice (62.1%, n=105), got emotional outbursts, and lost their temper (59.8%, n=101) when under the pressure of work. Sixty-eight percent (n=115) tend to wait for instructions even when immediate action is needed Ninety-three percent (n=157) considered the ability to delegate as an NTS to reduce the pressure of work.
Situation Awareness skills:
All (N=169) were aware that OT NOs should be able to recognize and understand information. Eighty-eight percent (n=149) were able to understand and respond to information, 40% (n=67) ignored the information passed between other team members and focused on the ongoing task, and 80% (n=146) did not ask for information even when appropriate. Twenty-six percent (n=44) anticipated and prepared for the upcoming situations, and 24.3% (n=41) acted accordingly. Sixty-three percent (n=108) were unable to switch between tasks while 92% (n=155) could not respond effectively to sudden changes in the situation.
A knowledge gap was not evident as the level of knowledge was ‘Satisfactory’. A practice gap was identified as 50.3% of the participants had a ‘Marginal’ level of practice. A practice gap was identified in two out of the three NTS categories (i.e., ‘Communication and teamwork’ and ‘Task management’) and four out of the nine NTS elements (i.e., ‘Coordinating with others’, ‘Providing and maintaining standards’, ‘Coping with pressure’, and ‘Recognizing and understanding information’).
This study assessed the NTS of the OT NOs of NHSL in terms of knowledge and practices based on the SPLINTS taxonomy19 which is a commonly used NTS evaluation framework for OT NOs, with proven internal consistency, reliability, and usability12. The literature describes several instruments to assess NTS for healthcare professionals20. However, the literature has failed to identify any context-specific instrument for healthcare providers in Low and Middle Income Countries21. SPLINTS system is a behavioural rating system developed in Scotland to use for NTS assessment of OT NOs by senior staff members and peers, and self-assessment1. Using the ‘SPLINTS’ system enabled a relatively complete and systematic assessment. The skills were explored at the individual level as individuals are the “basic building blocks” of teams, and the team composition in healthcare settings is frequently changing due to shifts, rotations, and human resource constraints2,20.
Literature pointed out that assessing NTS is harder than assessing technical skills4. Assessing the NTS levels quantitatively had the advantage of minimizing personal judgments and providing more realistic estimates enabling the evaluation of the effects of intervention quantitatively.
Assessment of NTS should be standardized and tailored for professions and contexts11. In healthcare, NTS had been assessed mainly in seven different settings i.e., intensive/emergency care, adult inpatient, obstetrics, operating theatres, prehospital care, generic healthcare settings, undergraduate contexts20 and also in primary care settings22. The NTS had been explored in individuals or teams20. Initially, they were explored within professional groups and later they were explored within inter-professional groups3 commonly in acute care settings.
This study assessed the knowledge of OT NOs initially as it is the critical first step in exploring NTS levels4. It was done by a ‘True-False quiz’, which is one of the most common techniques to assess declarative knowledge. The practices were assessed using a performance rating method based on the SPLINTS system1. In literature, practices had been assessed commonly using performance ratings by self-assessments or observer-based assessments4, either in simulated or actual clinical settings20. Self-assessment promotes reflective practice, helps ongoing professional skill development, and has been used in many high-risk industries4, and is a less costly method that helps nurses to identify by themselves the areas they need to improve18. Self-assessment has the advantage over observer-based assessments as it does not have biases related to the observer, observation, and the situation of assessment. It is less time and resource-intensive as it does not need training or hiring observers with context-specific NTS knowledge4. The results of self-assessment ratings can be considered valid and reliable as they correlate with observer-based assessments2, without much difference between self-assessment and observation ratings, with slightly lower ratings for self-assessment in some NTS categories18.
The study population was OT NOs of NHSL. It was appropriate to use self-administered instruments as the participants were literate government employees. A higher response rate (73.8%) was achieved by explaining the research to the participants, recruiting only the consented participants, and maintaining anonymity and confidentiality. Sampling bias was minimized by considering all eligible participants in data collection. Non-respondents were minimized by obtaining informed consent and giving freedom to withdraw it.
The participants were relatively younger (mean age 33 years) with female predominance. This is in accordance with the national distribution of the age of NOs23 and global workforce feminization24. The majority having the minimum educational qualification to practice nursing in Sri Lanka (i.e., Diploma in General Nursing) may be a reason for their lesser previous exposure to formal NTS training. Since the majority were in the early years of their career and lower in the hierarchy with lesser experience, it is necessary to improve their NTS for future career performance.
The OT NOs’ level of knowledge was ‘satisfactory’ despite the presence of negatively affecting factors similar to the literature which described that most workers’ baseline of NTS is acceptable10.
Even with a satisfactory level of knowledge, their level of practice was ‘Marginal’ in contrast to a similar study in which all the NTS categories demonstrated acceptable practices18. This may be due to the literature finding that workers practice NTS at different competence levels even though their knowledge is acceptable10. In addition, all the mean practice scores observed in this study were lower than those of a similar study18, indicating the necessity for further NTS improvement.
The communication and Teamwork skill category is the most important in present complex healthcare systems with higher hand-offs11,15. Teamwork is the main NTS to ensure healthcare quality and safety7 and it influences performance29. Similar to most safety-critical industries, health services also operate through teamwork2. Patient handovers between teams are frequent between shifts, professions, and multidisciplinary teams30,31. This study identified an NTS gap in OT NOs’ ‘Communication and teamwork’ skills as their practices were ‘Marginal’. However, out of the three elements of this category, the practices of the ‘Exchanging information’ skill element were ‘Acceptable’ in contrast to similar literature that concluded an inadequacy of information exchange between nurses18.
Task Management:
Task management skills favour good overall practice25. They correlate with higher performance and are influenced by experience26. Task prioritization depends on work-specific knowledge26, and is vital for task management in healthcare in which the urgency of tasks changes over time25. The ‘Task Management’ category obtained the lowest mean knowledge (82.64%) and practice (2.92) scores. This may affect their overall performance, as ‘Task management’ skills are vital for good overall practice1,25. However, for the ‘Planning and preparation’ element, the majority demonstrated the expected levels of knowledge (73.37%, n = 124) and practices (89.35%, n = 151) indicating their work-specific knowledge to perform tasks. It was observed that workers use proactive task management with moderate workloads and reactive task management with higher workloads26.
Situation awareness is important for surgical safety13. It is compromised by a lack of experience26, failure in perception, latent factors such as distractions, workload, stress33,36, fatigue2, and deficits in other NTS and technical skills27. The participants obtained the highest mean knowledge (93.96%) and practice (3.11) scores for the ‘Situation Awareness’ category. ‘Marginal’ practices in the other two NTS categories may lead to a reduction of practices of ‘Situation Awareness’ skills.
NTS Gap:
Similar to many high-risk settings, this study observed an NTS gap among the OT NOs of NHSL, with the majority having a ‘marginal’ level of expected NTS practices amidst a ‘satisfactory’ level of knowledge. In the NTS categories, the practice gap was evident in ‘Task management’ (n=91, 53.85%) and ‘Communication and teamwork’ (n=80, 47.34%). Out of the nine NTS elements a practice gap was observed in four elements, mainly in ‘Coping with pressure’ (n = 152, 89.94%) and ‘Coordinating with others’ (n=78, 86.98%). The NTS gap observed was more prominent than in a similar literature in which the mean practice scores of NTS were higher18.
Limitations of this study were the unavailability of a context-specific tool to explore the NTS of OT NOs compelled to design this study based on the ‘SPLINTS’ system. Assessing the practices through self-assessment assuming that the participants rated themselves honestly was a limitation caused by time and resource constraints to assess practices through observation. The effects of this might have compromised the quality of data on NTS practices. Self-assessment itself may have promoted reflective practice and self-realization of the need for NTS improvement18. Several eligible NOs refrained from consenting and out of the seventeen OTs with eligible NOs, only the NOs in fifteen OTs consented to participate in the study. The In-charge nursing sisters and NOs in the other two OTs did not give consent giving the reason for as higher workload. Both those reasons hindered including all the eligible participants in the study despite the efforts to maximize participation. This may have introduced information bias.
This research observed that the majority of the OT NOs of the NHSL had a ‘Marginal’ level of practices of expected NTS despite a ‘Satisfactory’ level of knowledge before the implementation of interventions. This indicated an NTS gap in practices among them. This study contributed to filling the research gap on the NTS of healthcare workers in Sri Lanka. It has generated new knowledge on an existing NTS gap in OT NOs. This would provide new knowledge for future NTS studies in OTs in other hospitals in the country as well as in other high-risk healthcare settings which in turn would contribute to enhancing performance, quality, and safety of the services. It would be beneficial to explore the NTS of NOs working in all settings. The presence of a practice gap despite having a satisfactory level of knowledge is a future research area to explore and is an important finding to consider for human resource development decisions by policymakers. As NTS are less specific, the new knowledge generated by this research may be generalized to other public and private sector hospitals, and other sector settings in Sri Lanka with similar risk levels2.
The research was self-funded.
CONFLICTS OF INTEREST:
There are no conflicts of interest regarding this research.
ABBREVIATIONS:
|
IQR |
Inter Quartile Range |
|
NHSL |
National Hospital of Sri Lanka |
|
N |
Total number of participants recruited for data collection |
|
n |
Total number of participants responded |
|
NO |
Nursing Officers |
|
NTS |
Non-Technical Skills |
|
OT |
Operating Theatre |
|
SD |
Standard Deviation |
|
SPLINTS |
Scrub Practitioners’ List of Intraoperative Non-Technical Skills |
|
% |
Percentage |
ACKNOWLEDGEMENT:
To Dr WMUS Wijemanne, Director Planning, Ministry of Health, Sri Lanka.
REFERENCES:
1. R. Flin, L. Mitchell, K. Coutts, G. Youngson, and J. Mitchell. Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS). World. 2010, [Online]. Available: https://www.yumpu.com/en/document/read/41969861/scrub-practitioners-list-of-intraoperative-non-technical-skills.
2. R. Flin, P. O’Connor, and M. Crichton, Safety at the Sharp end a Guide to non-technical Skills. Farnham, UK: Ashgate, 2008.
3. L. Donaldson, W. Ricciardi, S. Sheridan, and R. Tartaglia. Textbook of Patient Safety and Clinical Risk Management. 2021.
4. M. J. W. Thomas. Training and assessing non-technical skills a practical guide. 2018; 62(10).
5. M. Kroning. Fostering soft skills is a must for nurse leaders’, Am. Nurse Today. 2015; 10(2): 1-5, [Online]. Available: https:// www.researchgate.net/profile/Maureen-Kroning/publication/272088851_Fostering_Soft_Skills_a_Must_for_Nursing_Leaders/links/54da54e40cf2ba88a68cfdd9/Fostering-Soft-Skills-a-Must-for-Nursing-Leaders.pdf.
6. B. Janakiraman. Transferable Skills as Facilitator for Placement amongst B School Students. Asian J. Manag. 2018; 9(1): 162-167.
7. L. H. Lippman, R. Ryberg, R. Carney, and K. A. Moore, ‘Workforce connections: key "Soft Skill” that foster youth workforce success: Toward a consensus across fields, Child Trends Publication.ctions: key "Soft Skill” that foster youth workforce success: Toward a consensus across fields’, 2015.
8. Prachi Singh, S. Gupta, and K. Sahu. An Overview of Talent Management: Driver for Organizational Success. Asian J. Manag.. 2014; 5(2): 240–245.
9. K. Ramya, ‘Nurses perception of patient safety culture in operating rooms’, Int. J. Nur. Edu. Res., 2017; 5(1): 59–64.
10. Institute of Medicine, To Err Is Human: Building a Safer Health System (2000), vol. 283, no. 7582. Washington, D.C, 2000.
11. G. P. Amrutha. A Study on Effects of Virtual Communication Technology on the Interpersonal Skills of Employees in E- Commerce Sector. Asian J. Manag. 2019; 10(4): 301–304.
12. P. Kumari and G. Tanty. The Quest of Bridging the Gap Between Skill Training and Education Together for Sustainable Employability. Asian J. Manag. 2020; 11(2): 161–166.
13. D. J. Lindegger et al. Strategies for improving quality and safety in global health: Lessons from nontechnical skills for surgery implementation in Rwanda. Glob. Heal. Sci. Pract. 2021; 9(3): 481–486, doi: 10.9745/GHSP-D-21-00042.
14. WHO, Global patient safety action plan 2021–2030: Towards eliminating avoidable harm. e Health Care. 2021.
15. G. Casali, W. Cullen, and G. Lock. The rise of human factors: Optimising performance of individuals and teams to improve patients’ outcomes. J. Thorac. Dis. 2019; 11(7): S998–S1008, doi: 10.21037/jtd.2019.03.50.
16. O. Loup, S. D. Boggs, M. M. Luedi, and C. R. Giordano. Nontechnical skills in a technical world. Int. Anesthesiol. Clin. 2019; 57(1): 81–94, doi: https://boris.unibe.ch/121570/1/ Nontechnical%20skills%20in%20a%20technical%20world_IAC_for%20BORIS_2018.pdf.
17. X. Yuan. Non-Technical Skills of Scrub Nurses: A Literature Review. J. Clin. Med. Images Rev. 2022; 6(3): 1–16, doi: https://www.clinandmedimages.com/wp-content/uploads/2022/03/JCMI-v6-1512.pdf.
18. R. Kalantari, Z. Zamanian, M. Hasanshahi, S. A. Faghihi, J. Jamali, and H. Niakan. The Effect of Educational Intervention on the Improvement of Nontechnical Skills in Circulating Nurses. Biomed Res. Int. 2021; 2021, doi: 10.1155/2021/5856730.
19. I. Sirevĺg, I. Tjoflĺt, and B. S. Hansen. Expanding the non-technical skills vocabulary of operating room nurses: A qualitative study. Res. Sq. 2023; 1–20, doi: https://doi.org/10.21203/rs.3.rs-2965173/v1 License.
20. M. Kommalage. Hidden and informal curricula in medical schools: impact on the medical profession in Sri Lanka. Ceylon Med. J. 2011; 56(1): 29–30, doi: 10.4038/cmj.v56i1.1893.
21. M. Uramatsu, Y. Fujisawa, S. Mizuno, T. Souma, A. Komatsubara, and T. Miki. Do failures in non-technical skills contribute to fatal medical accidents in Japan? A review of the 2010-2013 national accident reports. BMJ Open. 2017; 7(2): 1–7, doi: 10.1136/bmjopen-2016-013678.
22. A. S. Yousef, M. M. Shazly, and H. A. Omar. Soft Skills Training Strategy and Its Effect on Nurse Interns’ Civil Behavior. Evidence-Based Nurs. Res. 2020; 2(3): 8, doi: http://eepublisher.com/index.php/ebnr/article/view/132/86.
23. A. Ribakova and L. Deklava. Assessment of non-technical skills of operating room nurses. SHS Web Conf. 2018; 51: 2011 doi: 10.1051/shsconf/20185102011.
24. R. Flin. Non-technical skills for anaesthetists, surgeons and scrub practitioners (ANTS, NOTSS and SPLINTS). Heal. Found. 2013; 1–9,.
25. H. Higham, P. R. Greig, J. Rutherford, L. Vincent, D. Young, and C. Vincent. Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: A systematic review. BMJ Qual. Saf. 2019; 28(8): 672–686 doi: https://ora.ox.ac.uk/objects/ uuid:b9e628c5-9501-4ad4-9304-dcfd75d773b2/download_file?file_format=pdf&safe_filename=Higham_et_al_2019_Observer-based_tools_for_non-technical_skills_assessment.pdf&type_of_work=Journal+article.
26. J. Scott, D. Revera Morales, A. Mcritchie, R. Riviello, D. Smink, and S. Yule. Non-technical skills and health care provision in low- and middle-income countries: A systematic review. Med. Educ. 2016; 50(4): 441–455, doi: 10.1111/medu.12939.
27. A. Ashour, D. L. Phipps, and D. M. Ashcroft .The role of non-technical skills in community pharmacy practice: An exploratory review of the literature. Int. J. Pharm. Pract. 2021; 29(3): 203–209, doi: 10.1093/ijpp/riaa014.
28. Ministry of Health, Health Staff Inposition by 31 December 2015. Health Information Unit Management Development and Planning Unit Ministry of Health Sri Lanka, 2015.
29. WHO, Global strategy on human resources for health: Workforce 2030. 2016.
30. R. K.R and P. T. Raveendran. Teamwork in Patient Care Delivery: Assessing the Perceptions of Government Medical Officers. Asian J. Manag. 2015; 6(4): 321–324.
31. K. Patidar and S. N. Patidar. Exploration of Quality of Hand over Among Nurses. Asian J. Nur. Edu. Res. 2014; 4(1): 117–118.
32. R. Tandon and P. Kaushik. Quality of Life and Interpersonal Communication among Nursing Professionals. Int. J. Nur. Edu. Res. 2015; 3(3): 325–329.
33. S. Middleton, A. Charnock, S. Forster, and J. Blakey. Factors affecting individual task prioritisation in a workplace setting. Futur. Healthc. J., 2019; 6(1): 14–114, doi: 10.7861/futurehosp.6-1-s114.
34. R. Y. I. Koh, T. Park, and C. D. Wickens. An investigation of differing levels of experience and indices of task management in relation to scrub nurses’ performance in the operating theatre: Analysis of video-taped caesarean section surgeries. Int. J. Nurs. Stud. 2014; 51(9): 1230–1240, doi: 10.1016/ j.ijnurstu.2014.01.005.
35. V. G. Mallika and T. Das. Impact of Stress on working performance of Nurses and Organizational effectiveness in Hospitals. Asian J. Manag. 2020; 11(3): 225–232.
36. V. Indra. Stress Management among Nurses: A Review. Int. J. Nur. Edu. Res. 2018; 6(4): 431–434.
37. L. Stubbings, W. Chaboyer, and A. McMurray. Nurses’ use of situation awareness in decision-making: An integrative review. J. Adv. Nurs. 2012; 68(7): 1443–1453, doi: 10.1111/j.1365-2648.2012.05989.x.
|
Received on 01.07.2024 Revised on 30.09.2024 Accepted on 23.11.2024 Published on 12.12.2024 Available online on December 30, 2024 Asian J. Nursing Education and Research. 2024;14(4):251-258. DOI: 10.52711/2349-2996.2024.00050 ©A and V Publications All right reserved
|
|
|
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License. |
|
