Training and assessment of non‐technical skills in the operating theatre: where next?

Jenkins, B. J.

doi:10.1111/anae.13182

Cited by 6 publications

(10 citation statements)

References 51 publications

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“…The term non-technical skill is used by several technical professions, 13,14 of which perioperative nursing is one. Non-technical skills may be defined as ‘the cognitive (decision-making, situation-awareness) and interpersonal (communication, teamwork, leadership) skills that underpin technical proficiency’ (p. 19).…”

Section: Introductionmentioning

confidence: 99%

Non-technical skills in operating room nursing: Ethical aspects

Hanssen

Jacobsen²,

Skråmm

2020

Nurs Ethics

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Background: Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. Aim: To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. Research design: Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Participants and research context: Eleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian university hospital. Ethical considerations: Approval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer. Findings: Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. Discussion: Defending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner. Conclusion: Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team.

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Section: Introductionmentioning

confidence: 99%

Non-technical skills in operating room nursing: Ethical aspects

Hanssen

Jacobsen²,

Skråmm

2020

Nurs Ethics

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“…Unlike rare critical events, non-technical skills can be reinforced in the operating room after training. 33 Whilst the causality of non-technical skills retention observed in this study cannot be fully determined because of the study design, the pedagogic principles of VAST align with features that promote episodic memory. Simulation fidelity is increasingly viewed as a continuum, with a limited additional benefit of high-cost simulation for certain learners and learning objectives.…”

Section: Discussionmentioning

confidence: 82%

Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting

Mossenson

Tuyishime

Rawson

et al. 2020

British Journal of Anaesthesia

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Background: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings.Methods: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. Results: The ANTS total scores improved from pre-(11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. Conclusions: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.

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“…As we were only able to study routine clinical practice, it is unclear whether crisis situations will have a more clinically significant effect on non‐technical skills. Logistically, these are difficult to capture in clinical practice due their rarity and are perhaps more appropriately studied in simulation scenarios …”

Section: Discussionmentioning

confidence: 99%

“…The recognition of the importance of non‐technical skills led to the development of the anaesthetist's non‐technical skills taxonomy (ANTS) . Since its development, several studies have been published which utilise the ANTS score, however, these studies are often performed in simulation scenarios and therefore have limited validity when compared to routine clinical practice . Stress is known to affect non‐technical skills, although no study has evaluated the direct effect of stress on non‐technical skills in routine anaesthetic clinical practice.…”

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confidence: 99%

Anaesthetists stress is induced by patient ASA grade and may impair non‐technical skills during intubation

Doleman

Blackwell

Karangizi

et al. 2016

Acta Anaesthesiol Scand

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Background The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non‐technical skills. Methods Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non‐technical skill ratings and the association between stress measurements. Results ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision‐making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non‐Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003). Conclusion This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non‐technical skills.

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Training and assessment of non‐technical skills in the operating theatre: where next?

Cited by 6 publications

References 51 publications

Non-technical skills in operating room nursing: Ethical aspects

Non-technical skills in operating room nursing: Ethical aspects

Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting

Anaesthetists stress is induced by patient ASA grade and may impair non‐technical skills during intubation

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