Advanced Emergency Care - Essay Example

?Order: 559370, Advanced Emergency Care Completed: 13:40, 15.08.11 Bernhard Bierlich, PhD ADVANDED EMERGENCY CARE: CRITICAL ANALYSIS OF RESEARCH PAPER CONTENTS Introduction Evaluation of the research article, ‘Assessing advanced life support competence: Victorian Practices’ (Preston et al. 2009) Relevance to Practice resuscitation skills and techniques team dynamics Conclusion References Word count: 2,883 Introduction This essay analyses the research paper on resuscitation ‘Advanced Life support (ALS) competence: Victorian practices’ (Preston et al. 2009) in the light of the research guides regarding research practice and methodology by Bowling (2009) and Rees (2003). The article was chosen for its rigour and scientific form and the aim of this analysis is thus to assess the article by Preston et al. (2009) and how well they follow general research standards (posing and testing a hypothesis) and the use of (appropriate) methods. The analysis examines therefore the aim of Preston et al. (2009) and how well it is tested, whether it is properly contextualized in the relevant literature, whether the sample, research site or population are adequate and clearly defined and ethical questions have been considered and whether there is a thorough presentation of the results of the test (a RESULTS section). As part of the analysis the focus must also be on the conclusions and recommendations by Preston et al. and the relevance of the paper to advanced emergency care practice. The evaluation of Preston et al (2009) also notes in which sense the study under examination has tested the research question and whether limitations of the findings are acknowledged (Rees 2003). This essay analyses the work of Preston et al. (2009) and draws on external literary sources (Abella et al 2008; Bobrow et al. 2008; SOS KANTO Study Group 2007; Wilk et al. 2005; Van Alem et al. 2003) and the Resuscitation Council Guidelines (UK) 2010 when further clarification and referencing is be needed. After the analysis, it proceeds by framing the research paper in terms of its relevance to practice. The conclusions offered are a summary of the arguments in the essay. Evaluation of the research article, ‘Assessing advanced life support competence: Victorian Practices’ (Preston et al. 2009) 1. Aim in Preston et al. (2009) Preston et al. (2009) note that there are few studies that rigorously examining advanced life support (ALS) to direct educators about how to best assess ALS competence (knowledge and performance). The aim is therefore to point to a systematic approach to guide educators and has, as will be seen later, great relevance to practice. Preston et al.’s (2009) aim is accordingly to determine the most useful methods to assess competence among nurses and their resuscitation skills and knowledge (Preston et al. 2009, pp. 164-65). Their research is descriptive and uses content analysis (arranging the data into categories). It follows the standards of proper research presentation (Bowling, 2009; Rees, 2003). 2. Literature review Having outlined the problem by way of their hypothesis and aim, Preston et al. (2009) now turn to an analysis of relevant literary sources and concepts. So as to provide proper background to their own study (to contextualize it in the literature, Rees 2003) they cite the work of Chiarella et al. published in 2008. It identifies the competence to be tested, such as skills, knowledge, attitudes, values and abilities that appear to shape performance (ibid: 165). In the assessment of skills and ALS competence, psychomotor proficiency is recommended by other studies cited and refer to ‘arrhythmia [irregular heartbeat] recognition’, defribillation, intravenous therapy through insertion of intravenous cannula, administration of drugs and other means of coping with cardiac arrest by managing the airways and through ventilation and by assuring proper transport of the patient. While Preston et al. (2009) refer to Australian Resuscitation Council Guidelines (ibid: 165), one my here usefully refer to a similar set of Guidelines for the UK (Resuscitation Council Guidelines (UK) 2010, http://www.resus.org.uk/pages/medimain.htm). As Preston and her colleagues (2009) note there are only a recommendation for a written assessment and more or less conflicting statements and guidelines regarding ALS competence and the frequency of its assessment available. Otherwise, not much to guide nurse educators in terms of their assessment of nurses’ ALS competence (knowledge and skills) exists. This paucity in the educational literature of systematic guidelines for assessment and the supreme importance of the subject of resuscitation constitutes the reason for Preston and her research team (2009) tackling the subject and describing the state of the art (current Australian assessment practices and lacking information about the value of a particular ALS teaching method and how it relates to retention of knowledge and skills). This, then, is the background to the study by Preston et al. (2009) and this is highly relevant background information (Rees 2003). Considering this omission, Preston et al. (2009) base their study on a critical analysis of relevant literary sources and the concept of ALS assessment. This review of the literature is central to answering the research question. So as to provide proper background to their own study (to contextualize it further in the literature) they also refer to several sources (O’Brien et al. 2001; Chamberlain and Hazinski 2003; O’Steen et al. 1996; etc) to show that interactive tools (the use of manikins, simulations, scenarios, videos, games, posters, education notice boards) in teaching skills and competence have proved very useful and have been shown to improve healthy care practices and resuscitation outcomes (ibid: 165-66). The regular (annual) updating of a nurse’s knowledge and skills, Preston et al (2009) note, has also been noted to be vital as ALS knowledge and competence tends to deteriorate over time. Their study, based on descriptive telephone interviews of 20 intensive care educators in Victoria, southern Australia (the sample), is thus a critical evaluation and description of current assessment practices, methods used and the way they relate to best practice guidelines. In pointing out past omissions and introducing their own data, they are observing a truly scientific argument (Bowling 2009; Rees, 2003). 3. Methodology Having provided a clear and relevant literature review and described their aim and sample which refers to 20 nurse educators working in intensive care units in public and private hospitals, they proceed to describe their methodology, telephone interviews (semi-structured) of nurse educators regarding their use of teaching methods and frequency of assessment, to assess ALS methods used in teaching resuscitation. The interview themselves were conducted by the primary researcher. They stresses that collecting data over the phone has benefits, being quick, efficient and rather inexpensive. This method has been used before and they reference Burnard (1994) and another source (Robson (2002). In connection with describing their methodology, they also note, importantly, that they obtained the necessary ethical approval (also Rees 2003). They take great care to describe their sample, 20 nurse educators, whom they purposively drew from intensive care units located in public and private hospitals in Victoria, southeastern Australia. The sample population, entirely adequate (consistent with their aim of describing methods that guide ALS assessments), refer to educators specialized in delivering ALS education and assessing the ALS competence of nurses. 20 educators from public and private hospitals were invited and all agreed to participate. Preston et al. (2009) ensure to describe the method chosen, semi-structured interviewing, in great dept as well as the ensuing (content) analysis of teaching methods used (interactive or not) and the frequency and timing (e.g., at particular points in the year) of competence assessment. Supporting the clarity of the interview (their data source), they also list some of the key questions of the interview and paraphrase other questions (e.g., regarding assessment strategies) asked (ibid: 166). The full benefit of the interview is further supported by a follow-up interview where answers to questions are clarified. The interview data (responses) collected are statistically quantified through the use of a content analysis. Ensuring full transparency but also reliability (the same method can be used over again. This is an important feature of proper research, Bowling 2009) a number of references (Neuendorf 2002; Bryman 2008)) are given for this analysis (ibid: 166). Their methods to collect their data seem very appropriate and consistent with their investigatory aim. Preston et al. (2009) therefore choose a qualitative methodology (semi-structured interviewing) to explore the question and a study design and sampling technique, whereby a section of resuscitation educators is sampled. Their research is qualitative and, according to Bowling (2009), their research question and hypothesis call for a qualitative approach and thus the choice of method and sampling is very suitable. Also in terms of the research process as such, the presentation in their “abstract” is entirely consistent and adheres to accepted scientific standards (Rees 2003). 4. Results and Discussion Following the previous paragraph on methodology, Preston et al. (2009) arrive at the presentation of data, its analysis and discussion (ibid: 167 ff). As an overall result, the data, they note, show a certain degree of variability with regard to the assessment tools/tests used (interactive and/or theoretical) and frequency of the assessment and test. Variability also relates to assessment timing (when and how often during a year) and the person performing the assessment and the ratio of educator-participant, 1:1, and 1: assessment group of several nurses, 1:2 or 2:2. The results show that educators in many cases use a combination of tools/tests in their assessments. Ratios and test modes are illustrated by figures 1 and 2. The support of the text by figures regarding ratio and assessment methods used also add to the readability and comprehension of the research paper. The message (the results) is clear (Rees 2003). The Data presentation begins thus with a presentation of the results regarding tools used in teaching ALS competence: interactive, scenario-based methods were used by all the interviewed educators (20) that involved the nurse in verbalising her/his knowledge and skills relating to rhythm analysis, attention to the airways, cardiopulmonary resuscitation, drug administration, defribrillation, transthoracic pacing and post-resuscitation care (ibid: 167). The assessment of knowledge and skills varies in terms of its timing, i.e. assessments were performed annually by the majority of educators (19 or 95%) but the exact timing as to when exactly during the year varied. There is again a figure to illustrate that variability (ibid: 167-68, fig. 3). A major complaint of the educators concerned the few educators available to assess the many nurses as well as an apparent ‘assessment-related anxiety’ on the part of some nurses (ibid: 168). Very appropriately in terms of the standards of scientific research papers, the result-section is followed by a discussion of the results ((ibid: 168-170); Rees 2003) focusing on the findings showing the dominant use by educators of scenario- or interactive teaching in the context of the Australian Resuscitation Council Guidelines and the great value of scenarios, ‘an ideal assessment method as they can replicate clinical events, provided the scenarios are specific to the nurse’s practice area’ (ibid: 168). At the same time, limitations (small sample size drawn from one locality only, the limited validity of telephone interviewing) are duly noted (ibid: 170). Relevance to Practice The article by Preston et al. has many points of relevance to resuscitation practices in general and to UK practices in particular. Assessing resuscitation skills and techniques may include, as in the Australian case examined by Preston et al. (2009), written, multiple choice theoretical tests that evaluate the individuals cumulative knowledge. That may, as Preston et al. (2009) indicate, be an important tool, but is not to stand alone as their findings also demonstrate. They note that all educators in their sample were found to perform assessments based on interactive, scenario teaching and the appropriate algorithms set by the Australia Resuscitation Council Guidelines (ibid: 168). The finding of interactive teaching as a dominant method used in the Australian case and that teaching was consistently contextualized in terms of the prevailing Guidelines and algorithms is very relevant to UK practices. Australian teaching methods constitute namely a model against which UK practices may be usefully compared. As Preston et al. (2009) stress, it seems therefore particularly important to create scenarios that are applicable and valid according to a nurse’s specific practice area and the local conditions impacting the unit in which s/he is working (ibid: 168). In this connection, Preston et al (2009) also note the finding that Australian educators often created scenarios that were suitable to local contexts (ibid: 168; see also Perkin et al. 2007 on ‘the value of scenario teaching’ as well as Abella et al. 2005; Bobrow et al. 2008; Edelson et al. 2006; SOS-KANTO Study Group 2007; van Alem et al. 2003). This encourages the educator to be creative and shape scenarios that are suitable, in particular, in a situation (such as the one obtaining in Australia) where there is not a professional body providing scenarios for a specific practice area. This may also be the case in the UK, and while creativity is a valuable approach, lacking availability and standards regarding scenarios and specific practice areas may cause problems of validity and reliability (ibid: 168). The recommendation of including assessment scenario regarding ‘ventricular fibrillation’ as a standard requirement in all teaching is also highly relevant. As they note in their RESULTS-section, a focus on ‘ventricular fibrillation’ should be incorporated in all teaching as a basic requirement so as to rule out that a nurse practicing in a certain area is only assessed based on a scenario relevant to her specific practice but not ventricular fibrillation. Preston et al’s (2009) argument is clear and their recommendation is highly relevant to practice (ibid: 168 In general, the development of systematisation and applicable standards in teaching ALS is a very important contribution of Preston et al. (2009). Their recommendation of teaching ALS in teams (ibid: 168) is also noteworthy. One might have to consider the specific composition and team dynamics when teaching and assessing individuals that are taught in groups, especially, as Preston et al. (2009) themselves note, ‘because few resuscitation events are conducted by a single health professional’. The resulting problem is here identifying the competence of the individual vis-a vis the group, a very important and relevant consideration. This is where the written test may be useful. A combination of written tests assessing the individual’s knowledge and teaching practical scenarios may be called for. The Australian case shows 60% of educators using such a combination (ibid: 168). As to the timing of assessment, the Australian case throws light on what may also be a question of preference, in that some educators (4) prefer to assess newly educated nurses immediately upon graduation, while others may want to wait for the nurse to gain some experience and exposure to critical situations, emergency nursing and trauma before being assessed (Preston et al 2009, p. 168). There is thus a dilemma her: On the one hand, the ‘International Liaison Committee on Resuscitation (ILCOR)’ recommends that resuscitation testing take place immediately upon graduation. At the same time, there is also a solid case to be made for postponing assessment until the newly-educated nurses gains some experience and consolidates her knowledge. This may be equally important, Preston et al (2009) note (ibid: 168). In terms of a systematic practice, assessment should be performed regularly, and at least once a year. Preston et al. (2009) note, that the overwhelming part of the intensive care units included in their study, require nurses to be assessed annually (ibid: 168). However, recommendations regarding testing also vary between regularly and annually but have, somehow, been corrected by the ‘International Committee on Resuscitation (ILCOR)’ that require (since 2007) an annual assessment of resuscitation competence. Still, Preston et al. (2009) note, it may still be optimal in terms of knowledge retention with an initial assessment not later than 6 months after graduation (ibid: 168). They also cite various sources in support of this such as (Tippet 2004). Considering the complexity of certain emergency situations, Preston and her researchers (2009) also make the valuable point that given the intricacy of certain situations, the frequency of education and assessment may even have to be eased beyond the minimal annual requirement. These Australian discussions are very relevant to a discussion of practices in the UK, ensuring that a nurse’s knowledge and competence is regularly tested and updated. The benefit of two rather than one assessor vis-a-vis the test person/s is also to be noted as well as the suggested separation of the educator role and that of the assessor, i.e. educators and assessors not being the same person (Preston et al. 2009, p 169). Their recommendation is that criteria for passing or failing assessments need to be very specific. They cite Chamberlain and Hazinski (2003) and Perkins et al (2001). This may be a useful recommendation for improving practice. Given the overall lack of systematisation in teaching and timing noted above, Preston et al. (2009) make a final important recommendation saying that ?ALS practices that include revision of theoretical knowledge, review of current evidence regarding resuscitation, case study analysis and demonstration of psychomotor skills should be introduced at 3-4 monthly intervals’ (p. 169). In spite of the article’s great relevance, there is no consideration of legal and ethical issues involved in resuscitation. Conclusion This essay has concentrated on critically examining the research article by Preston et al. (2009) by examining it in terms of its scientific standard. The essay shows that their theory-methodology-data are clearly interconnected (Bowling, 2009; Rees, 2003) Moreover, the focus has also been on noting their findings and distilling its relevance for practice outside the country where the data for the research article, Australia, were collected. 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