Related Experiment Videos
A pilot randomised controlled trial of medical versus nurse clerking for minor surgery
H Rushforth1, A Bliss, D Burge
1University of Southampton School of Nursing and Midwifery, Level B, South Block, Southampton General Hospital, Southampton SO16 6YD, UK. her@soton.ac.uk
Insights
Nurse-led clerking in paediatric surgery demonstrated superior history-taking accuracy compared to senior house officers (SHOs). Further research is needed to assess the safety of nurse-led physical examinations in this patient group.
Area of Science:
- Paediatric Surgery
- Nursing Practice
- Patient Safety
Background:
- Nurse-led clerking is expanding in UK healthcare settings.
- Limited evidence exists regarding the safety of this innovative practice.
Purpose of the Study:
- To evaluate the safety of nurse-led clerking for paediatric day case and minor surgery patients.
Main Methods:
- Children aged 3 months to 15 years were randomized to nurse-led or senior house officer (SHO) clerking.
- An independent specialist registrar anaesthetist reassessed all children to establish a gold standard for performance comparison.
Main Results:
- Nurses identified a significantly higher proportion of abnormalities than SHOs (p=0.16).
- This improvement was primarily due to nurses' enhanced accuracy in history taking (p=0.04).
- The study could not determine the comparability of physical examination skills between nurses and SHOs.
Conclusions:
- Evidence suggests nurses possess superior history-taking skills compared to SHOs.
- Large-scale studies are required to assess the safety and equivalence of nurse-led physical examinations in paediatric care.
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.