ORBIS - training nurses worldwide in ophthalmic care

AORN Journal, Oct, 1998 by Karen Watts, Helen Taylor, Kevin Taylor

To understand the unique training platform that ORBIS offers nurses, one has to first understand ORBIS and the two-way exchange of knowledge it offers. As a humanitarian, nonprofit, nonsectarian, international organization, ORBIS's mission is to combat unnecessary blindness worldwide through the training and education of nurses, physicians, and other health care professionals in developing countries. This training takes place both on-board the ORBIS flying eye hospital, in off-plane programs at local facilities, and at land-based training centers.

INTRODUCTION

The organization was conceived by David Paton, MD, in 1982. The first ORBIS flying eye hospital was a DC-8 jet donated by United Airlines. The DC-8 jet was retired in 1992 and replaced with a DC-10 jet. This was made possible through private donations and gifts-in-kind from many individuals and organizations around the world. Since its inception, ORBIS has traveled to more than 78 countries promoting its teaching mission.

The DC-10 has a fully functional OR, substerile room, postanesthesia care unit (PACU), laser room, and audiovisual center (Figure 1). The first-class section of the aircraft has been modified and now is a 48-seat classroom. If a larger space is needed, as often is necessary in countries like China, the audiovisual department can use an infrared transceiver system to expand the classroom capabilities to accommodate more than 300 people by linking to a terminal building. Biomedical engineering and flight operations ensure the smooth running of the program and are located in the belly of the aircraft.

[Figure 1 ILLUSTRATION OMITTED]

The ORBIS DC-10 is supported in the field by a crew of 23 professionals from 13 countries (ie, Australia, Bulgaria, Canada, England, France, Ireland, Myanmar, Philippines, Scotland, Sweden, Pakistan, Wales, United States). The crew includes ophthalmologists, nurses, a nurse educator, biomedical engineers, an anesthesiologist, a nurse anesthetist, audiovisual specialists, flight mechanics, and administrators. The cross-cultural nature of the crew spans religious, political, and cultural boundaries with ease, but more importantly, greatly enhances the method, content, and level of the teaching because of the many different experiences offered by each crew member.

The ORBIS nursing program is divided into two components. The first component consists of hands-on clinical experience combined with related workshops and mini-lectures. The second component is a lecture program for local nursing students, general nurses, anti nurses specialized in ophthalmology. This component of the nursing program is carried out by the nurse educator.

NURSE EDUCATOR'S ROLE

The key to a successful ORBIS mission rests with an accurate needs assessment. The needs assessment is conducted at least six months before the airplane's arrival. After it is determined that the country meets the requirements for an ORBIS program, a staff ophthalmologist, a nurse (usually the nurse educator), and an administrative coordinator visit the program site to begin structuring the program format with the hosts. The team members return one week before the airplane's arrival to finalize details.

Needs assessment. The nursing needs assessment involves making contact with local nurses, directors of nursing, and their ministerial counterparts. Local nursing schools and associations also are approached. At this time, the education level of the host country nurses is assessed and the available equipment and resources are determined. It is important that the ORBIS nurses understand the status of the host country nurses and the conditions under which they work before beginning the program so that the program can be adjusted accordingly.

In many countries, nurses have very little access to new information and techniques. Consequently, the ORBIS program is perceived as a wonderful opportunity for them to interact with nurses from other countries and to exchange experiences and information. The nurse educator's first contact with local nurses is crucial to promoting this information exchange. At this time, the teaching mission of ORBIS is introduced, and the opportunities for nurses are outlined. It is a delicate time as ORBIS staff members need to recognize the steps the local nurses have made and support their plans for the future while recommending changes. The diplomatic role that all ORBIS staff members must undertake is evident during this time.

After the needs assessment has been completed, the information is sent to the ORBIS International New York office and to the nurses on the plane. Five local nurses work with ORBIS nurses on the plane each week and receive training in OR skills, sterilization, and care of instruments and PACU nursing care of ophthalmic patients. These nurses are selected by the local nurses on the basis of the guidelines given by ORBIS team members.

Lectures. The nurse educator conducts lectures off the plane in a central venue for nurses who are not involved in the on-plane program (Figure 2). These lectures cover topics from infection control to specialized ophthalmic surgery and nursing care. The number and type of lectures depends on the needs of the local nurses and the times they have available.