Operating department practitioners and adult nurses: interprofessional education bedfellows or a bridge too far?

Abstract

Background

Interprofessional education (IPE) is well embedded in undergraduate health curricula. However, scant literature exists on which health and care disciplines, such as adult nurses and operating department practitioners (ODPs), prefer to work within simulated learning events.

Methods

This study took place over a number of simulated interprofessional events, with a range of health and care disciplines students, using a variety of simulation tools. The total number of participants was: adult nurses 16 and ODPs 18.

Results

An ordinal logistic regression analysis was carried out on survey data collected. The OR of ODPs choosing adult nurses as the discipline they would prefer to work with at these events was 1.994 (95% CI 1.034 to 3.334) times that of adult nurses choosing ODPs as the discipline they would prefer to work with at these events, a statistically significant effect.

Conclusions

It is clear that a statistical difference in preferential choice exists, with ODPs choosing to work with adult nurses almost twice that of adult nurses choosing to work with ODPs. This supports the importance of IPE and the understanding of other professions, to improve team working across health and care organisations.

Introduction

Background to the operating department practitioner professional role

The aim of this study is to ascertain the role of the interprofessional interplay of a relatively new, and certainly unique, role of surgical or operative allied health professional within other health and care professions, specifically nursing. In simple terms, do operating department practitioners (ODPs) prefer to take part in simulation learning experiences with nurses or within their own discipline? In comparison, do nurses prefer to take part in these same simulations with ODPs or, again, within their own discipline of nursing? This study is the first findings of a wider study evaluating other health profession simulation education as an interprofessional learning tool.

Operating Department Practice is a UK-specific profession. These registered health professionals work with patients undergoing a surgical operation, with patients of all ages and at each part of an operation or during operative procedures. Although this role name is UK-centric, similar comparative professional roles might be considered somewhat analogous to surgical technologist or theatre nurse.

Although the esteemed and well-established history of nursing sets an example to other health disciplines, the profession of ODP is a relatively new one in comparison. ODPs gained formal recognition as a profession in the UK in 1971 and has been regulated by the Health and Care Professional Council (HCPC) since as recently as 2004.¹ However, this role seems to be UK-specific, despite some overlap with some parts of the role in both North America, Oceana and Australasia. This study therefore, by definition, will focus on this UK-specific role but will discuss wider implications for international interprofessional simulation education.

In November 2018, there were 13 731 ODPs registered in the UK with the HCPC, compared with >690 000 nurses and midwives registered with the Nursing and Midwifery Council giving a ratio of >50 nurses and midwives to each ODP.² This ratio is reflected in the role of the surgical technician in the USA (which has the highest number for comparison data) to registered nurses which has a ratio of 30 nurses to every surgical technician.^{3 4}

This would suggest that the role of the ODP, or any somewhat comparable profession in surgical or operative care, is still relatively unfamiliar among other healthcare professionals. This may be due to the sheer disparity of numbers, along with little commonality of skills and attributes. In addition, ODPs, and other operative practitioners, often work in relative isolation, they are overwhelmingly the only ODP within their multidisciplinary team and work extremely rarely with other ODPs. It could be argued, therefore, that ODPs have a relatively greater awareness and appreciation for the roles and responsibilities of other healthcare professionals.

Nursing placement in the ODP environment

Historically, ODPs and other surgical disciplines have worked behind the closed doors of the operating department and would be unheard of unless one had ventured into that department to work. As is typical of health schools, nursing students often undertake a placement in the operating department but this is usually quite short and under the supervision of a nurse supervisor or assessor⁵ and predominately focused on a single aspect of perioperative care, such as the surgical scrub practitioner role or as a recovery practitioner. The nursing student will often not realise that the surgical disciplines also undertake these roles alongside anaesthetic assistance and may assume that the disciplines such as surgical technicians are simply specialist nurses or merely ‘assistants’ also, rather than a highly skilled and specialist discipline in its own right.⁶

Interprofessional education

Interprofessional education (IPE) is a key part of training and education in all perioperative professions in the UK and is further developing,⁷ along with an increasing emphasis in all healthcare professions.⁸ ODPs regularly undertake clinical emergency simulation events, where they practice and rehearse the actions and communication skills required from them in clinical emergency scenarios. The nature of these events will often dictate the participants required, meaning that ODPs will invariably undertake training with junior doctors/anaesthetists for airway management and anaesthetic complications.

Other IPE events are not as readily available to ODPs, or other surgical or operative disciplines, which limits their opportunities to work among other professionals and share knowledge and skills and raise awareness of their role. Other IPE events offered to ODPs are predominately associated with surgical skills and undertaken with surgeons and their trainees. ODPs may feel a great sense of stress and responsibility during these simulations as they are expected to intervene, lead and manage and they are working with their senior, medical colleagues. These simulation events are often devised for particular teams, which means there is little transferability among fellow healthcare professionals. However, it could be argued that ODP students may be somewhat relieved to train with and undertake simulations with healthcare professionals of their own ‘grade’. Therefore, the aim of this study is to evaluate whether ODPs preferentially choose to work with their own profession in simulation learning or with nursing students (in the same simulations).

Method

Participants

Participants were purposively sampled from currently enrolled cohorts of all undergraduate health courses at a large multidisciplinary undergraduate nursing, midwifery and allied health school, who took part in IPE simulation days. The total number of participants was adult nurses 16 and ODPs 18 (total number of participants, n=34).

Simulation events

The simulation events consisted of a range of healthcare undergraduate students working as an interprofessional team on four different simulations: (i) standardised patient, (ii) high-fidelity mannequin, (iii) video case study and (iv) virtual reality resource. After all four simulations were completed, all participants were asked to complete an online questionnaire immediately after, asking them to rate which profession(s) they would prefer to work with in future events. This survey tool was the question: Which profession(s) would you prefer to work with in future simulation events? A simple ranking of the nine disciplines in a standard nursing and allied health school, plus an additional ‘other’ answer possibility. Participants could choose none, one or several answers (including their own discipline) and rank them preferentially. Therefore, of the total number of students who took part (n=34), 34 completed the question, with no online responses discarded.

Data analysis

Many of the common sample and effect size statistics, like eta-squared and Cohen’s d, cannot be calculated in a logistic regression model, but the ORs, as an unstandardised effect size statistic is appropriate here. The ORs therefore, used in this study, is used an effect size rather than a sample size calculation seen in non-OR statistics. Therefore, logistic regression allows the formulation of predictive models on a probabilistic basis. Similar to other regression analyses, it predicts the value of a dependent variable from one or more explanatory variable(s). The logistic regression used in this study can also be utilised to rank the relative importance of the response variables.⁹ The significance threshold was set at 0.05.

An ordinal logistic regression analysis was carried out on survey data collected. The independent variables were ODPs and adult nurses and the dependent variables were the participant answers on a 5-point Likert-type scale asking which other (not their) discipline they would prefer to work with. The list of choices included all of the nine health disciplines within the school, plus a free text box to outline any other choice.

Results

Discipline preference

The results show OR of ODPs choosing adult nurses as the discipline they would prefer to work with at these events was 1.994 (95% CI 1.034 to 3.334) times that of adult nurses choosing ODPs as the discipline they would prefer to work with at these events, a statistically significant effect, Wald χ² (1)=5.122, p=0.021 (M=1.09, SD=1.02). Demographic data were not collected.

These results strongly suggest that ODPs, in the case of this study, acting as proxies for other allied health surgical professionals, overwhelmingly would choose to do interprofessional simulation learning with nurses, far more than nurses would choose to do a simulation with ODPs.

Discussion

This study, first of a multiphase analysis of interprofessional simulation in undergraduate health curricula, evaluated the working preferences of surgical allied health professional students and adult nursing students. The use of four simulation tool events, undertaken as part of a multi-disciplinary team, allowed participants to preferentially choose, immediately after the simulations, which health discipline students they would like to undertake this type of learning with.

In this study, ODP students chose adult nurse students to undertake simulation learning with, nearly twice as much as nurses chose to carry out simulations with ODPs. Why this may be the case may be multifactorial, as outlined below.

Professional identity development

The conceptual identity of professional identity has been explored extensively, with the idea of healthcare staff needing to identify who they are, and are not, as a vital process towards psychosocial development.¹⁰ However, this idea that the person is central to the development of the identity rather than the identity development relying on working in one’s own professional group has become increasingly accepted.¹¹ This would therefore suggest that the isolation of groups, during the learning journey, merely retards the professional identity development and it is the use of interprofessional working—and interprofessional working with all relevant disciplines—that truly aids the development of both the nurse and ODP identity.

Stereotypical roles

This then would lead to the argument that to provide a strong identity within the occupation that students belong to (either ODP or adult nurse), then the theory of social identity must play a role. This social identity theory has overwhelmingly been shown to foster group favouritism, at the expense of feeling other groups are somehow less or rather their own group is better.¹² This keeping within social identities of one’s own group, as either an ODP or adult nurse, merely reinforces boundaries and power structures and it is these power structures that bridge from ODP to nurse and nurse to ODP that merely gets extended and expanded without extensive interprofessional learning.¹³

A new problem?

Perhaps the most frustrating aspect of this research is the imbalance in knowledge between nursing staff and ODPs has been highlighted before. In 2006, the differing roles were discussed and suggestions for closer working in interprofessional learning events suggested.¹⁴ That over a decade has passed with no evidence, as shown in this research, that the roles are in any way on an equal level of interprofessional learning need (or rather, perceived need) is disappointing. This perhaps is seen in the dearth of joint OPD and nursing research, rectified somewhat by this paper, which is part of a larger IPE project across 10 health and care disciplines.

Limitations

This study has several limitations, the major one being the small study sample. It merely provides a snapshot of a larger study but it remains than, just a snapshot. In addition, the survey tool has no evidence to validate its use for this type of research. Finally, the response bias from the participants. Although participants completed the online questionnaire anonymously, there remains a limitation of a one-time data collection response.

Conclusions

The results of this research would indicate a lack of awareness for surgical and operative allied health roles, such as ODP. This would suggest that the use of IPE events become embedded with undergraduate and continuing education in order to develop the culture of learning with and from one another, gaining awareness, trust and respect and discovering the commonalities of skill sets that exist within various healthcare professions and ultimately seeking to improve patient care.