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Background: Nurse led clerking is currently practiced in a growing number of UK centres, but there is a paucity of evidence to underpin the safety of this innovation.Aim: To assess the safety of nurse led clerking in paediatric day case and minor surgery.Methods: Children aged 3 months to 15 years were randomly assigned to clerking by either a nurse or a senior house officer (SHO) (resident). All children were then independently reassessed by a specialist registrar anaesthetist to provide a "gold standard" against which practitioner performance could be judged.Results: In 60 children studied, nurses identified a significantly greater proportion of the detectable abnormalities present in the sample (p = 0.16). This difference is attributable to nurses' greater accuracy in history taking (p = 0.04); no conclusions regarding the comparability of nurses' and SHOs' skills in physical examination can be derived from the current study.Conclusion: Evidence attests to the likelihood of nursing having superior skills in history taking to SHOs. Exploration of nursing safety in undertaking physical examination, however, requires the conduct of a large scale equivalence study. Only then can conclusions be drawn as to whether nurse led physical assessment offers children a standard of care equivalent to that which they currently receive from SHOs. [ABSTRACT FROM AUTHOR]

In 2005 a study tour, funded by a Florence Nightingale Foundation Travel Scholarship, was undertaken by the author to gain insight into the teaching of 'History Taking and Physical Assessment' (HTPA) across different countries of the UK and beyond. The study tour was inspired by recent developments in health professional practice, which increasingly require nurses and other health care professionals to undertake the skills of history taking, inspection, palpation, percussion and auscultation. The study tour visit included 16 Universities across the UK, Eire, Canada and the United States. Insights were gained into similarities and differences in the content and structure of HTPA courses across the centres visited, with valuable observations in respect of mental health assessment and optimal session ordering. Insights into modes of delivery reinforced perceptions regarding the value of theory, demonstration and small group supervised practice, and highlighted interesting issues for debate in respect of course text options, videotaped demonstrations, electronic learning support programmes and use of mannequins. Consideration of assessment issues focused in particular on the value and design of Objective Structured Clinical Examination (OSCE) as a core mode of assessment. Wider insights gained in relation to HTPA included suggestions of the need for its cautious use in preregistration education. There is also debate regarding the teaching of HTPA within advanced practitioner preparation. Throughout the report, current and planned changes to local practice inspired by the study tour and underpinning literature are identified, alongside several recommendations for further research. [ABSTRACT FROM AUTHOR]

Aim: Changes in healthcare delivery make it increasingly likely that children accessing ambulatory care will receive their health assessment and management from nurses rather than junior doctors. As part of a larger study exploring the safety and efficacy of nurse-led pre-operative assessment (Rushforth et al 2006) this study aimed to discover children's views of nursing and medical roles.Method: Data were collected from 63 children using drawing and writing activity sheets during preadmission events.Findings: Findings suggest that there is a clear demarcation in children's minds between doctors and nurses. In addition to the gender differences, children saw 'caring' as a nursing role and 'curing' as a medical role. However, there has been some change since earlier studies with only three children noting that nurses 'helped doctors' or 'did what doctors tell them' and less than a quarter of the children drawing nurses with hats.Conclusion: As with all other patients, children should be fully informed of the status of the practitioner undertaking their care; understanding how they perceive the roles of doctors and nurses will support this information giving. [ABSTRACT FROM AUTHOR]

Aim: to explore whether nurses can undertake the pre operative assessment of children prior to day case surgery as safely as senior house officers.Design: a randomised controlled trial involving 595 children, using an equivalence methodology (a method which looks for similarity rather than a significant difference). Pre-operative assessment prior to day case surgery was randomised to either a nurse (experimental group) or a junior doctor (control group). Blinded expert verification of nurse/junior doctor performance was ascertained by an experienced anaesthetist (the 'gold standard').Results: there was equivalence between nurses and senior house officers in their ability to detect clinically significant abnormalities within the sample population. Subgroup analysis also demonstrated equivalence in respect of history taking abilities. The smaller number of clinically significant physical findings within the sample meant that equivalence in respect of physical examination remains uncertain. Although the study was limited to a single setting, the results demonstrate nurses' equivalence with junior doctors in a discrete paediatric context. [ABSTRACT FROM AUTHOR]

In spite of its benefits, day or minor surgery is not without complications; pain is a significant issue for some patients (Kotniemi et at 1997, Grenier et a.1998). Having witnessed considerable variation in the discharge advice given to parents about pain control we were prompted to discover what evidence there is to suggest that parents can effectively manage their child's postoperative pain at home following day or minor surgery. In this article we review the evidence and describe how review findings were used to inform practice. [ABSTRACT FROM AUTHOR]

Studies have shown that people who require single room isolation while in hospital often feel lonely, sad, worried, bored and in need of information. A literature review identified only 16 papers reporting on the child's experience of isolation. Findings indicate that children feel lonely, are scared of the personal protective equipment and feel bored. Patients' parents feel guilty, worried and under increased pressure to visit their children. It is also suggested that isolation may affect child development.

For many years, nurses have sought to define advanced practice (AP). There is now a developing consensus that it should be broadly defined in ways which include and embrace not only clinical practice, but also other domains such as education, management and leadership. This broad definition is congruent with Benner's notion of the novice to expert trajectory and lends support to the view that the risks around AP are minimal, since advanced practitioners by definition have expertise. The broad model of AP, however, ignores one distinct subset of advanced practice nurses who we term nurse practitioners (NPs). NPs are distinct because of their hybrid, quasi-medical practice, which crucially involves autonomous medical diagnosis and treatment. The risks in this area of practice are substantial, and consequently require nothing less than a nationally-regulated set of benchmarks. These must address the training, assessment and registration of NPs for the primary purpose of public protection.

Since 1992, expanded practice has been an important issue in the career progression of the qualified nurse. Its contemporary relevance in the early years of the 21st century is underpinned by recent and ongoing national initiatives to blur the boundaries between healthcare providers, and to regulate practice at a higher level. This article reports the findings of a survey and in-depth, semi-structured interviews conducted with nurses from across the UK, which explores their views and experiences in terms of decisions regarding whether or not to undertake expanded practice roles. Insights are gained in a variety of domains of expanded practice including preparation for the role, competency verification, perceptions of accountability and liability, effects on patient care, role refusal and utilization of evidence to underpin expanded practice. These reported views and experiences have important implications for current practice and future research.

The topic of nursing role expansion has caused much heated debate in the nursing press in recent years. The contemporary relevance of the debate is heightened by the current recruitment and retention crisis in nursing, and continued pressures to reduce junior doctors' hours and workload. This article re-examines the 'expanded role debate' by putting current concerns in an historical framework. The perceived benefits of role expansion are discussed, and balanced against continued concerns expressed by practitioners regarding possible detrimental effects on care delivery. The potential erosion of 'caring' as the heart of nursing practice is acknowledged, and challenges are made to the belief that nursing has the 'monopoly on caring'. The issue of 'nursing time', perhaps the major barrier to continued role expansion, is also explored. The future division of labour within healthcare delivery is seen as pivotal to this aspect of the debate, and a pragmatic vision for the future is offered. Finally, the issue of the paucity of the evidence base underpinning role expansion is considered and a plea is made for future developments to be soundly underpinned by research.

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

The physical assessment skills of inspection, palpation, percussion and auscultation currently have only minimal recognition in UK nursing practice. Authors attest to perceived benefits in terms of continuity of care, holistic care delivery, rapidity of emergency intervention and reduction in junior doctors' hours and workload. However, the use of such skills by nurses has been subject to little in the way of formal outcome-based evaluation, and there is a clear need for such research to be carried out within the UK. Important guidelines exist within the literature to underpin educational programmes in physical assessment; these are reviewed and their implications for UK practice are considered. It is concluded that while generation of a UK evidence base is required, there is a persuasive argument to underpin continued development of physical assessment skills within UK nursing practice.

This paper explores the implications of the contextual forces currently underpinning nurse education. It challenges the notion of a model of education which is principally founded on the concept of 'fitness for purpose'. Open acknowledgement is made that the driving forces impacting on the purchasers and providers of nurse education are different, and may be in conflict. The central tenet of this debate is based upon a growing awareness that the notion of practitioners being fit for purpose is increasingly being dictated and articulated by local purchasers. Their views may reflect financial expedience and short-term goals, arguably to the detriment of a longer term vision. Tensions also exist between purchasers' locally driven agendas and the reality that practitioners receive a nationally and internationally recognized qualification. The importance of manpower planning is also central to the debate. Solutions are offered which consider guidelines offered by a range of recent policy documents. Their contribution to the debate is assessed. Recommendations are made which recognize the need to equip practitioners with skills that have currency at point of registration, but argue that dominance must be given to the longer term goals of the educational enterprise.