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Background The DARE2-patient safety rubric was developed for the performance evaluation of final year nursing students. The rubric contains four domains of competency: systematic patient assessment, clinical response, clinical-psychomotor skills, and communication proficiency. The aim of this research was to investigate the inter-rater reliability of data from the DARE2. Method A nonexperimental quantitative exploratory design was employed. Archived recorded performances of students (n = 34) were independently evaluated by nurse lecturers who teach and examine in the simulation centre (n = 4). Results Intraclass correlation coefficients (ICC) were greater than 0.70 for three of the four domains of practice and 0.58 for the fourth (clinical-psychomotor skills). An ICC of 0.75 for the overall rubric score is indicative of excellent reliability. Percentage agreement for the overall rubric was 59%. Conclusion These results support the inter-rater reliability of data from the DARE - patient safety rubric and highlights the difference between consensus and consistency estimates of inter-rater reliability.

Background An integrative framework was used to guide the teaching, learning, and assessment approach taken in a final-year undergraduate nursing module. Method Students participated in three cycles of problem-based learning and associated simulations. An assessment rubric focused on patient assessment, clinical decision making, and technical and communication skills was used by students and assessors to score simulation performances. This study evaluated the trajectory of assessor and student self-assessed simulation performance scores over the course of the module. Results Descriptive statistics for assessors' scores show a mean improvement in all 4 competencies and for overall performance. Students' self-assessed scores do not show a mean improvement but are more closely aligned with assessor scores for later simulations.

Current curriculum models rely heavily on conventional teacher-centered approaches to student learning. Recent literature challenges educators to implement student-centered learning ap- proaches. Health care complexities that confront the future of nursing education, combined with the demands of technologically literate students, challenge educators to be responsive and proactive to ad- vance student-centered learning. Undertaking a scholarly approach to teaching and learning is in keep- ing with the concept of integrative learning. This article discusses the merger of two active-learning strategies, problem-based learning and simulation, on the basis of a review of recent literature, as well as the scholarly approach undertaken to develop an innovative teachingelearning strategy. Last, it rec- ommends potential pedagogical advantages of combining these strategies in nurse education. This dis- cussion article presents the rationale for merging two well-known teaching strategies for a baccalaureate nursing program at University College Cork, Ireland.

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.

Summary Pneumatic tourniquets are used world wide to provide a bloodless surgical field for a variety of extremity surgeries. However, their use is not without potential for complications such as superficial skin injury and deep tissue injury. This national study of orthopaedic nurses in Ireland aimed to determine orthopaedic nurse's actual practices in caring for patients following surgical procedures where pneumatic tourniquets were used. A quantitative descriptive exploratory study of 69 experienced orthopaedic nurses reported finding skin insults beneath tourniquet cuff sites as well as extremity pain, stiffness and swelling. This study concludes that orthopaedic nurses have a key role in the detection and reporting of potential pneumatic tourniquet complications and makes recommendations for practice.

Summary Serious injuries to the musculoskeletal system can result in increased morbidity, long-term functional impairment, pain and deformity [Handoll, H., Madhok, R., 2003. Conservative interventions for treating distal radial fractures in adults. Cochrane. Database of Systematic Reviews: CD000314]. The clinical presentation of compartment syndrome is often indefinite and confusing leading to delays with diagnosis despite the presence of signs and symptoms [Schoen, D., 2000. Adult Orthopaedic Nursing. Philadelphia, Lippincott]. Thus, it follows the orthopaedic nurse is in a key position to conduct a comprehensive neurovascular assessment and to reduce the risk of neurovascular compromise [Schoen, D., 2000. Adult Orthopaedic Nursing. Philadelphia, Lippincott; Lucas, B., Davis, P., 2005. Why restricting movement is important. In: Kneale, J., Davis, P., (Eds.) Orthopaedic and Trauma Nursing, second ed. Edinburgh, Churchill Livingston]. An issue of concern was raised by clinicians in relation to difficulties encountered in accurately recording the neurovascular status of patients in a large urban university hospital in Southern Ireland. Consequently, a collaborative working group formed to develop upper and lower limb assessment tools combining academic and clinical practice perspectives. The evidence-based tools developed have been approved for clinical use with orthopaedic and plastic surgical patients. By sharing the experiences of this endeavour the group fulfill an appeal made in the literature which encourages nurse researchers who undertake scholarly activities, to share experiences of the practicalities involved in doing so [Mc Lafferty, I. 2004. Focus group interviews as a data collecting strategy. Journal of Advanced Nursing 48 (2), 187–194]. In this paper the experiences of a group of several grades of nurses engaged in a practice development project are outlined as well as the opportunities which arose as a result of collaborative working.

Health care organisations such as the World Health Organisation (WHO) and An Bord Altranais (ABA, The Irish Nursing Registration Board) demand higher standards of new graduate nurses than heretofore. This is in conjunction with the implementation of degree programmes for undergraduate nurse education. These organisations stipulate that graduates must be well-educated, accountable, and can demonstrate the skills of a safe, caring and competent decision-making practitioner. The Bachelor of Science (BSc) four-year degree programme for undergraduate nurse education was introduced in Ireland in 2002, and is provided in universities and colleges of higher education throughout The Republic of Ireland. During the implementation process, each university and college of higher education developed a range of assessment strategies to clinically assess students. Preceptor nurses were subsequently assigned the responsibility of clinically assessing students, a remit previously undertaken by Clinical Ward/Unit Nurse Managers. Preceptors are qualified nurses, working in clinical units who are specially prepared to support BSc students during clinical placements. The purpose of this study was to explore to what extent preceptor nurses use the devised assessment strategies to clinically assess BSc students in one university in The Republic of Ireland. Data were collected by using a questionnaire distributed to all known preceptors in General, Psychiatric and Intellectual Disability nursing, during year four of the first cycle of the BSc programme. Findings from this descriptive study revealed that many preceptors were inexperienced, did not fully comprehend the assessment process and were not applying all of the recommended assessment strategies when assessing students in clinical practice. In light of these findings suggestions are made in the context of further research, management and education.

Summary Pneumatic tourniquets are used in over 1 million surgical cases annually in North America [McEwen, J., 2005. Retrieved 2.10.2006 "Complications and preventative measures". ]. There is a paucity of nursing literature about the complications and preventative measures in relation to pneumatic tourniquet use. Pneumatic tourniquets may be used in surgical and nonsurgical settings to establish a bloodless field for extremity surgery and anaesthetic procedures. Nevertheless, their use may induce injuries that are commonly transient and even unnoticeable but some are permanent. Injuries vary depending on the inflated pressure, the duration of inflation and the physical status of the patient. Current evidence based research has predominantly come from medical research. This article outlines the historical background, relevant physiological changes induced by tourniquet during surgery and issues of nursing management relevant to orthopaedic nursing to prevent and reduce tourniquet injury.

A self-report questionnaire is described which records the main symptoms experienced during withdrawal from benzodiazepines in pharmacologically dependent patients. The questionnaire consists of 20 items; evidence is given that these are reasonably independent and are sensitive in detecting withdrawal symptoms from a study of 68 patients undergoing slow withdrawal from benzodiazepines.

210 psychiatric outpatients with generalised anxiety disorder (71), or panic disorder (74), or dysthymic disorder (65) diagnosed by an interview schedule for DSM-III were allocated by constrained randomisation to one of five treatments: diazepam (28), dothiepin (28), placebo (28), cognitive and behaviour therapy (84), and a self-help treatment programme (42). All treatments were given for 6 weeks and then withdrawn by 10 weeks. Ratings of psychopathology were made by psychiatric assessors blind to both treatment and diagnosis before treatment and at 2, 4, 6, and 10 weeks after randomisation. 18 patients had insufficient data for analysis because of early drop-out. There were no important differences in treatment response between the diagnostic groups, but diazepam was less effective than dothiepin, cognitive and behaviour therapy, or self-help, these three treatments being of similar efficacy. Significantly more patients in the placebo group took additional psychotropic drugs in the 10 week period, and those allocated to dothiepin and cognitive and behaviour therapy took the least.