Training curriculum and simulator training for the whole surgical team: what do nurse assistants think?

In Finland, many laparoscopic operations (eg, laparoscopic cholecystectomy) are performed by a team consisting of a surgeon and an assisting nurse. The skills of the assistant nurse include providing technical assistance to the surgeon, using surgical instruments to assist the surgeon and facilitate the surgical intervention, and aiding in exposure of operative site to promote a safe and effective surgical procedure. The result and safety of a surgical operation depend on the contribution of every participant of the operating team. Generally, the central role of the surgeon is well recognized and thus highlighted in many ways, training included. The roles of the other participants of the team are rarely mentioned or considered in detail. Because laparoscopic surgery is complex in nature and demanding for both the surgeon and the assistant, in addition, the educational needs of operating room (OR) nurses should be better recognized and taken into consideration. Continuous education together with new innovative training practices, for example, laparoscopy simulator training, is crucial in maintaining and enhancing OR nurses’ professional competency. In the Central Hospital of Central Finland, we have developed a structured laparoscopic skills curriculum including simulator training for residents. In the future, we wish to use this existing curriculum, insofar as it is professionally meaningful, to also serve the educational needs of OR nurses. We believe that a fluently coworking and thus professionally competent nurse assistant would enhance patient safety. Because multiprofessional education policy of this kind, with a structured curriculum, is a novel approach, the underlying opinions and expectations of the participants need to be known at the outset, as well as experienced barriers to training. We found no previous studies focusing on improving nurses’ laparoscopic skills using a computerbased laparoscopy simulator. In addition, basic research on nurses’ perceptions toward laparoscopy simulator training is lacking. This is an interesting gap of knowledge because several studies conclude that the laparoscopic simulators have many remarkable advantages varying from improving residents’ single skills to enhancing the whole patient safety and because more hospitals in Finland invest in surgical skills training facilities, making simulator training of the whole operating team feasible. First, we surveyed what expectations the OR nurses of the Central Hospital of Central Finland (N = 35) have toward laparoscopy simulator training a priori and if self-estimated level of laparoscopic skills is associated with these expectations. Second, we developed a simple laparoscopic training program (LAP Mentor and LAP Mentor Express; Simbionix) for OR nurses and gave them the possibility to start training. Table 1 describes nurses’ expectations and opinions according to the predefined statements. Results of the open-ended questions stated that the expectations toward simulator training were mainly associated with improved hands-on skills (instrument and camera handling), eye-hand coordination, and visual and perceptual skills (anatomy and instrument handling without direct visualization). Nurses thought that improving these specific skills would lead to more active assisting and further to professional competency together with enhanced self-confidence. Statistical analyses revealed no connection between selfestimated level of laparoscopic skills and expectations or opinions toward simulator training. Nurses’ simulator training program was designed to improve orientation, eye-hand coordination, and manual skills through manipulation of virtual 3-dimensional models using virtual laparoscopic instruments. These are essential basic skills when working as a first assistant, and the same tasks are included in the residents’ training program. The 6 tasks