The educational preparation of nursing staff undertaking pre-assessment of surgical patients--a discussion of the issues

The dissemination and uptake of competency frameworks

Clinical competencies are increasingly being used to structure career and clinical progression in post-registration nursing. Competency framework documents have been proposed as a way of supporting competence development. One major national initiative in this respect is the NHS Education for Scotland (NES) competency frameworks which have seen development of over 26 such frameworks dealing with a wide range of nursing specialties.

Utilising an initial scoping study followed by a stakeholder evaluation the dissemination and uptake of a selected number of competency frameworks was investigated. Participants in the scoping study ( n = 18) and in the main stakeholder survey ( n = 24) from a sample of Health Boards and Higher Education Institutions were recruited. Data were collected by telephone and face-to-face interviews.

Within the NHS and HEI's the specified framework documents have a variable penetration. Documents are used to support CPD at the individual and organisational levels. They also inform, albeit in a very limited way, curricular developments in HEIs. The success of framework documents is linked to their timeliness in relation to local and national developments such as service redesign and to whether or not documents were `championed' by committed practitioners or professional groups.

Competency framework documents are recognised and utilised by clinicians, NHS managers and Education providers. Information providers and users need to co-ordinate their initiatives in order that staff development links with service redesign.

Nursing students' experiences with the use of authentic assessment rubric and case approach in the clinical laboratories

BACKGROUND

One current challenge for nurse educators is to examine effective nursing assessment tools which integrate nursing knowledge into practice. Authentic assessment allows nursing students to apply knowledge to real-life experiences. Contextualized cases have engaged students for preparation of diverse clinical situations and develop critical thinking skills.

AIM

This study aimed to explore nursing students' experiences and learning outcomes with the use of an authentic assessment rubric and a case approach.

METHODS

An exploratory qualitative approach using focus-group discussions and an open-ended survey was adopted. Sixteen nursing students participated in three focus-group discussions and 39 nursing students completed an open-ended survey.

RESULTS

Nursing students noted that an authentic assessment rubric with a case approach provided clarity for their learning goals; built confidence; developed knowledge, skill competencies and critical thinking skills; increased awareness of caring attributes and communication skills; and enriched and extended learning through self-, peer- and teacher-assessments.

CONCLUSIONS

These findings provide rich insights for nurse educators and curriculum developers in the use of an authentic assessment rubric and a case approach in nursing education.

Incidents in anaesthesia: past occurrence and future avoidance

This article is a revised version of an analysis of reported incidents related to anaesthesia, originally published in the journal Anaesthesia (Catchpole et al 2008a) and undertaken on behalf of the National Patient Safety Agency. The purpose was to examine the range, types, frequencies and causes of reported patient safety incidents associated with anaesthesia. First we examined anaesthetic incidents as a sub-set of the total number of reported incidents; then we examined pre-surgery assessment, epidural anaesthesia, and anaesthetic awareness incidents, as they were identified as being frequent and of potential concern. To our knowledge it was the first paper to analyse and present results of the NPSA's database in a clinical academic journal. Here, we take the opportunity to re-present and review the findings in light of subsequent progress in understanding and improving patient safety and quality of care.

A synthesis of the literature on "competence" as it applies to perioperative nursing

Perioperative competence is an eclectic concept that has been difficult to define and even more difficult to measure. Competence has been described in relation to standards of practice with little emphasis placed on its interpersonal aspects. This article presents a synthesis of the literature focused on perioperative nurse competence. Although specialized knowledge in the form of technical proficiency is important, it is no longer the only indicator of perioperative competence. The findings in this synthesis attest to the increased awareness and emphasis given to human factors--recognition that teamwork, communication, coordination, and leadership also affect human performance. Based on these findings, the next important step would be to develop and test these categories of competence empirically.

Safety in anaesthesia: a study of 12,606 reported incidents from the UK National Reporting and Learning System

The incident reporting database at the National Patient Safety Agency was interrogated on the nature, frequency and severity of incidents related to anaesthesia. Of 12,606 reports over a 2-year period, 2842 (22.5%) resulted in little harm or a moderate degree of harm, and 269 (2.1%) resulted in severe harm or death, with procedure or treatment problems generating the highest risk. One thousand and thirty-five incidents (8%) related to pre-operative assessment, with harm occurring in 275 (26.6%), and 552 (4.4%) related to epidural anaesthesia, with harm reported in 198 (35.9%). Fifty-eight occurrences of anaesthetic awareness were also examined. This preliminary analysis is not authoritative enough to warrant widespread changes of practice, but justifies future collaborative approaches to reduce the potential for harm and improve the submission, collection and analysis of incident reports. Practitioners, departments and professional bodies should consider how the information can be used to promote patient safety and their own defensibility.

Cardiac disease in the non-cardiac surgical population: effect on survival

Mortality from cardiac disease is decreasing, yet the prevalence of ischemic heart disease, diabetes and hypertension is increasing. This, combined with an aging population, affects the characteristics of the surgical population. Survival in this subgroup of the non-cardiac surgical population has not been studied in a UK setting. This study aimed to determine the mortality rate at 1, 6 and 24 months for patients with underlying cardiac risk factors undergoing elective non-cardiac surgery, and to identify independent risk factors associated with 1-year mortality (death within 365 days of original operation date). Following ethical approval, 1622 patients were included in the study. Demographic, pre-, peri- and postoperative variables were collected from medical and nursing notes. Follow-up was completed using the National Office of Statistics tracking system. Copies of death certificates were obtained on all patients who had died within 12 months of surgery. Risk factors for 1-year mortality were identified using multiple regression modelling. Survival at 12 months was 89%. The majority of cardiac-related deaths occurred within the first 6 months of surgery. Independent risk factors associated with 1-year mortality were advanced age, preoperative angina, odds ratio=1.59 (1.02-2.47), surgery type, perioperative blood transfusion and a prolonged hospital stay. A significant portion of the non-cardiac surgical population who have underlying cardiac disease risk factors are at risk of a cardiac-related death within 1 year of surgery. Patients with angina had nearly a 60% greater risk of death compared with asymptomatic patients. In the hospital setting, nurses with the appropriate pre-assessment and critical care competencies are pivotal to the successful management of this group of patients. In the long term, careful follow-up by the primary care team can help modify cardiac risk factors and potentially reduce cardiac-related mortality.