Litigation related to casting in Orthopaedics-An analysis of claims against the National Health Service in England

The use of inter-professional education (IPE) healthcare law and ethics scenario based learning sessions amongst nursing, midwifery and law students: A qualitative investigation

BACKGROUND

The Nursing and Midwifery Council (NMC, 2018) require registrants to practice ethically and lawfully. Nevertheless, in 2019-2020, the NMC received 5704 referrals regarding registrants' fitness to practice, many of these referrals related to registrants' criminality, clinical competence, and misconduct. Additionally, litigation within healthcare remains a concern. NHS Resolution (2020) reported costs of payments relating to clinical negligence schemes of £2324.2 million in 2019/20. This paper discusses a qualitative investigation of healthcare law and ethics teaching and learning within undergraduate midwifery and nursing curricula and the use of scenario based (inter-professional education) IPE sessions amongst nursing, midwifery and law students.

METHODS

Two scenario based IPE sessions attended by nursing, midwifery and law students were delivered in addition to existing curricula. Scenarios were based on real life cases. Students collaborated to identify means of managing legal and ethical issues arising from the scenarios. Sessions were facilitated by lecturers from the schools of law, midwifery and nursing. Semi structured interviews were completed with IPE session participants and academics with an interest in healthcare law and ethics (students n = 3, academic staff n = 3). Thematic content analysis was applied to interview data. Findings Scenario based IPE sessions are valued by participants who claim they are effective in enabling the development of knowledge and understanding of healthcare law and ethics while providing insight into the application of theory in practice. Participants claimed that healthcare law and ethics was a fundamental part of caring professions and essential to nursing and midwifery curricula.

CONCLUSION

Substantial numbers of nurses and midwives are called to account by their professional body and in law for issues related to their practice, with significant financial and personal costs. Healthcare law and ethics remains fundamental to professional practice with IPE scenario based sessions offering a means to develop knowledge and enable students to consider ethical, legal and professional issues.

The use of inter-professional education (IPE) healthcare law and ethics scenario based learning sessions amongst nursing, midwifery and law students: An evaluation

BACKGROUND

Litigation and disciplinary action taken by the Nursing and Midwifery Council (NMC) against nurses' remains a concern with costs of claims against the NHS increasing by 72% over the five years up to 2015/16 with almost £1.5 billion spent in one year alone. Additionally, 5476 referrals regarding registrants' fitness to practice were made to the NMC in 2016-2017. The aims of this paper are to discuss how a pair of scenario based IPE sessions focussed on healthcare law and ethical topics were introduced as an addition to the existing nursing and midwifery curricula and to report the evaluation of these sessions.

METHODS

Two scenario based sessions attended by nursing, midwifery and law students were delivered as an addition to existing nursing, midwifery and law curricula. The scenarios were based on real life cases and students collaborated to identify means of managing legal and ethical issues arising from the scenarios. These sessions were facilitated by lecturers from the schools of law, midwifery and nursing.

FINDINGS

All attending students completed an evaluation questionnaire. Student evaluations indicated that the experience of working through the scenarios with their colleagues from other disciplines had enabled them to gain further knowledge and understanding around healthcare law and ethics. Student evaluations indicated a high level of engagement and interest in the subject and also drew attention to the supportive structure of the IPE sessions.

CONCLUSION

Nurses and midwives continue to be called to account by both their professional body and in law for issues related to their practice. A way to enable students to consider this and aid their preparation for clinical and professional practice is through the use of clinically and professionally relevant healthcare law and ethics scenarios in IPE sessions.

Identifying and managing non-complex fractures

Helen Chilvers, Senior Lecturer in Nursing, University of Lincoln, HChilvers@lincoln.ac.uk , emphasises the importance of understanding the bone-healing process and describes the care of patients with bony injuries.

Analysis of the factors causing tight cast syndrome after closed reduction and casting of pediatric distal radius fractures

Objective

The aim of this study was to evaluate the most important factors which can cause “tight cast syndrome’’ (TCS) in pediatric patients with distal radius fractures.

Methods

Patients, who were at or under 15 years old and treated conservatively with an diagnosis of distal radius fracture between August 2015 and August 2017 were included in to the study. Fifty four patients, who had been found to experience TCS were accepted as group 1 and sixty-two patients without TCS as group 2. Cast index, pre-/post reduction translation, pre-/post reduction angulation, localization and displacement of the fracture, need for re-manipulation, and presence of associated distal ulna fracture were evaluated for both groups. Statistical analysis was performed to evaluate cut off value for cast index values for both TCS and loss of reduction and logistic regression analysis of the other possible factors.

Results

Pre-/post-reduction translation (over 50% and 10%, respectively) (odds ratios:0.167 and 0.524, respectively), a cast index value below than 0.775 (odds ratio:3.080), displaced type fracture (odds ratio:8.028), presence of re-manipulation (odds ratio:0.131) and associated distal ulna fracture (odds ratio:2.029) were found to be statistically significantly important for the occurrence of TCS. The most important factors were decreased cast index value and presence of initially displaced type fracture. Loss of reduction (LOR) risk was found to be increased in patients with a cast index value of greater than 0.875.

Conclusion

One should be very careful when following a pediatric patient who have a displaced distal radius fracture which has initial/post reduction translation in AP plane, which is associated with distal ulna fracture, which required re-manipulation and most importantly which cast index is under than 0.775 in terms of occurrence of TCS. We recommend obtaining a cast index value between 0.775 and 0.875 to prevent both TCS and LOR.

Level of evidence

Level III, Therapeutic study.