Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/

Research into the use of ICT and e-learning for work-based learning in the skills sector

This research has been commissioned by Becta to provide an evidence-based overview of the current use and effectiveness of work-based e-learning and its integration with more traditional learning methods. The specific objectives of the research were to: investigate the known impact of ICT and e-learning on the skills sector; and describe the ways in which ICT and e-learning can support key workforce development issues such as addressing skills gaps and achieving sustainability in training and development

Improving the PhD through provision of skills training for postgraduate researchers

Postgraduate research degrees in some systems, such as the UK, can be almost exclusively research based, with little formal, compulsory taught component. Government reviews recommend 10 days per year training in generic or transferable skills to ensure the suitability of doctoral graduates for employment. Professional bodies stipulate a commitment to continuing professional development as a requirement for chartered or accredited status. This includes The Chartered Society of Forensic Science and the British Association for Forensic Anthropology, as well as institutions for related fields such as The Institution of Engineering and Technology. Increasing numbers of universities therefore offer skills training programmes. Research students were surveyed to investigate their attendance and views on non-mandatory training courses, and only 33% of students agreed that all training needs were covered by their degree. However, in contrast to the recommended training commitment, over a one-year period students attended a mean of 5.5±0.7 training days, with 12% attending no training. Responses indicate a significant demand for increased training in management, consistent with government reviews; however, this work also indicates that provision of technical training should be addressed.Short course availability, design, delivery, promotion and recognition are discussed in relation to improving student uptake to reduce to the discrepancy between attendance levels and recommendations or aspirations

Research into the use of ICT and e-learning for work-based learning in the skills sector

The report provided an overview of the research commissioned by Becta into the use of ICT for learning by SMEs and the public sector, in the context of work-based learning (WBL). The findings were illustrated with a number of case studies and vignettes of good practice. The report was targeted at stakeholders in work-based learning (WBL)

Cornwall College: report from the Inspectorate (FEFC inspection report; 42/95 and 26/98)

Comprises two Further Education Funding Council (FEFC) inspection reports for the periods 1994-95 and 1997-98

City of Liverpool Community College: report from the Inspectorate (FEFC inspection report; 64/97 and 58/00)

Comprises two Further Education Funding Council (FEFC) inspection reports for the periods 1996-97 and 1999-2000

1988-2008: Twenty years of BICA

The celebration of BICA’s twentieth anniversary in 2008 provides a timely opportunity to chart and review the Association’s achievements since its inception and, with an eye to the future, to identify continuing challenges - including those inherent in provisions in the Human Fertilisation and Embryology Bill that is currently under parliamentary review