Creation of Operating Room Nurse Competency Assessment Tool (ORN-CAT): An

Exploratory Sequential Mixed Methods

CHAPTER I

Introduction

The Philippines is gearing towards the Universal Health Care (UHC), with the “provision
to every Filipino of the highest possible quality of health care that is accessible, efficient,
equitably distributed, adequately funded, fairly financed, and appropriately used by an informed
and empowered public”. It is therefore imperative to have a strong and effective health system
that can address the problems between service delivery and health. Nurses play a vital role to
help shape the care that will be provided today and tomorrow. Through policy work, nurses can
and should influence the highest practice standards and processes to achieve the best quality of
care.

More than 200 million surgeries are performed worldwide each year and recent reports
reveal that adverse event rates for surgical conditions remain unacceptably high, despite multiple
nationwide and global patient safety initiatives over the past decade. Surgical procedures and
outcomes have been a largely neglected global healthcare issue particularly in low and middle-
income countries. Globally, surgical disease has been estimated as among the top 15 causes of
disability. It has been estimated that there is approximately one operation performed for every 25
people—double the annual world volume of childbirth. According to the WHO report on
estimated 11 % of the global burden of disease can be treated by surgery and that complications
perioperatively has to be assessed and addressed.

Currently, guidelines for patient safety in surgery are general and not specific for each
surgical subspecialties and training programs. The operating room environment demands a high
level of standardization and safety processes decrease errors and human mistakes. Researchers
have determined that the success in patient safety depends on several factors that include
identification, revision of systems, education, and training of operating room staff, surgeons, and
nurses to address known patient safety issues. Healthcare providers and policy body makers must
conduct further research to understand and practice the culture of patient safety in current
operating room settings in order to avoid and limit surgical errors committed by the operating
room staff. One area of concern is to further research in the aspects of clinical competency of the
operating room staff, specifically the perioperative nurses. In a rapidly advancing surgical and
nursing profession, nurses are expected to use their competency skills in giving a safe and quality
care. Competency encompasses knowledge, skills and attitude that nurses should possess in order
to provide a safe and quality care. According to the 2012 National Nursing Core Competency
Standards, there are 5 competencies being used to evaluate a nurse, these are (1) Practices with
Legal Principles and Code of Ethics in making professional judgment, (2) Promotes safe quality
care, (3) Complete and accurate recording and reporting system, (4) Collaboration relationship
with other colleagues, and (5) Professional and personal growth development (Labour
Organization, 2014).

Throughout many countries, professional bodies rely on yearly self-assessment of

competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical
practice. The Operating Room Nurses Association of the Philippines (ORNAP) has been
established and committed to “develop/cultivate the highest professional standard in
perioperative nursing through education and research activities.” The “Life Purpose” of the
ORNAP is to promote the highest professional standard of Perioperative Nursing. But there are
limited researches focusing on the level of competency specifically among operating room
nurses currently employed in the Philippines. One of the main challenges among of educating
operating room nurses' education is the lack of clinical competence that reduces the quality of
patients’ care. Measuring the clinical competency of perioperative nurses is effective in
developing, planning, and evaluating the surgical outcome and ultimately the quality of patient
care.

According to Bonito et al, in the article published in the Journal of Philippine Nursing
regarding nursing workforce and issues in the Philippines, aside from the “shortage” of nurses
there is a need to address contributing factors like implementation of nursing standards in
education, lack of positions and local employment opportunities, and barriers to returning nurses
in being hired back into hospitals and institutions.” Furthermore, the researchers emphasized that
nurses who work in the operating room should be problem solvers and be confident making
critical decisions. Although under the supervision of a surgeon, operating room nurses they still
need to be able to function independently. Surgeons depend on their team, especially the nurse's
competence; to perform their job without a lot of direction. Aside from the ability to
communicate information quickly, concisely and accurately, clinical knowledge and competency
are an essential aspect of the operating room nurse. Small mistakes in the operating room can
have a big impact on a patient’s condition. Therefore, clinical competency of the operating room
nurse is critical to the outcome and ultimately in the delivery of the “highest possible quality of
health care” to the Filipino people.

Operating rooms are complex environments that require OR professionals to maintain

their knowledge and abilities in order to stay clinically competent and ensure patient safety.
Despite the fact that the competency of the operating room (OR) nurse has a significant impact
on the effectiveness and quality of the surgical team's treatment, there is little knowledge
concerning OR nurse abilities in surgical teams.

Fukada M. (2018) (2018) examined research on nursing competency definitions and

qualities in Japan, as well as competency structure, elements, and evaluation. In addition, the
study looked into training approaches for teaching nursing competency. According to the study,
the idea of nursing competency has not yet been fully developed. As a result, issues with
determining and defining nursing competency, evaluating the levels of competency required of
nursing professionals, and establishing methods for training still persist. As a result, further study
is required to establish an in-depth understanding of nursing competency.
A number of research studies on competency assessment have been found in the
literature, but there is not a single instrument that is capable of monitoring nurses' overall
competency. In the study conducted by Tanzo, F., the author developed a competency
assessment tool fitted to Philippine nursing practices a benchmark for student nurses to prepare
them for expected competencies in the actual nursing practice. The study by Tanzo F. provides
evidence that competency assessment is dependent on a specific health institution's environment,
culture, and practices in accordance with the framework of a standard given by an authorized
organization.

It is the aim of this study to develop an assessment tool to measure core competencies for
operating room nurses. The findings of the study may give healthcare facilities insight into
potential tools for evaluating the performance of operating room nurses. The assessment tool
could be used by hospitals to evaluate operating room nurses' performance to further strengthen
the delivery of optimum nursing service in the operating room. Self-assessment tools for
monitoring, measuring, and assessing the development process, while adhering to national and
international standards in the operating room, should be developed.