The 2024 revision of the Norwegian standard for the safe practice of anaesthesia

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study

AIM(S)

To understand how nurse managers facilitate learning in clinical workplaces.

BACKGROUND

Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature.

METHOD(S)

A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation.

FINDINGS

Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices.

CONCLUSION(S)

This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines.

IMPLICATIONS FOR NURSING MANAGEMENT

Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Nurse-led oral and maxillofacial oncology clinics: a review

The "nurse-led" oral and maxillofacial (OMFS) head and neck (H&N) clinic has been introduced and developed over the last decade, and we are now close to a point that this endeavour can potentially be implemented nationwide. This paper is a systematic review of the proposed OMFS H&N nurse-led clinic model. Literature on the topic is limited: only eight eligible papers were identified and reviewed. These were appraised focusing on four domains: requirement/necessity, true cost, patient safety and outcomes, and education and training. Most of the advantages/proposed benefits of these clinics have previously been discussed. This current review has revealed that the available published evidence on the concept of OMFS H&N nurse-led clinics demonstrates that they might not be necessary. The alleged cost savings have not been described in detail and might not be as significant as expected, more intense collaboration is required to establish watertight quality assurance processes concerning patient safety, and the clinics might have an impact on the education and training of OMFS trainees. The nurse-led clinic concept is interesting and exciting, but more discussion and planning is needed prior to it being launched nationwide.

Safe Echocardiographic Practice in Hamad Medical Corporation during the Coronavirus Disease 2019 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has strained our healthcare system. Certain changes in practice were mandatory to protect our sonographers who carry a very high risk of being infected, and the patients whom we serve. This article aims to share this experience with you.

Nursing Students' Sleep Patterns and Perceptions of Safe Practice During Their Entrée to Shift Work

Background: The transition into shift work represents a critical and challenging time point in a nurse's career. The purpose of this study was to describe nursing students' sleep patterns and perceptions of safe practice during their first semester of clinical rotations. Method: Repeated measures pertaining to the sleep patterns of 19 full-time junior undergraduate nursing students were measured before, during, and after their first clinical rotations. Sleep was measured using wrist activity monitors and sleep diaries for seven consecutive days at each time period. Students' "self-efficacy" or belief in their ability to provide safe practice was measured for (a) patient care (preventing adverse events to patients) and (b) occupational health (preventing occupational injuries to themselves) using Bandura's self-efficacy scales. Associations between students' sleep, sleepiness, and their perceptions of safe practice were explored. Results: Nursing students' self-efficacy scores regarding patient care (preventing adverse events) improved across the three time periods (from 80% before clinical rotation, to 84% during clinical rotation, to 87% after clinical rotation). Although lower overall, students' self-efficacy scores regarding occupational health (preventing occupational injuries to themselves) also improved across the three time periods (from 71% before clinical rotation, to 76% during clinical rotation, to 77% after clinical rotation). Furthermore, increased sleepiness significantly predicted lower self-efficacy scores for both patient care and occupational health. Conclusion/Application to Practice: Sleepiness can impair nursing students' confidence in their ability to practice safely.

Approach to failed spinal anaesthesia for caesarean section

Failure of spinal anaesthesia for caesarean section may have deleterious consequences for the mother as well as the newborn baby. In this article, we discuss the mechanisms of failure of spinal anaesthesia as well as the approach to a failed block. We performed a literature search in Google Scholar, PubMed, and Cochrane databases for original and review articles concerning failed spinal anaesthesia and caesarean section. Strategies for a failed spinal anaesthetic include manoeuvers to salvage the block, repeating the block, epidural anaesthesia or a combined spinal-epidural (CSE) technique, or resorting to general anaesthesia. Factors influencing the choice of these alternative options are discussed. A "failed spinal algorithm" can guide the anaesthesiologist and help reduce morbidity and mortality.

Pattern of Adverse Drug Reactions in Children Attending the Department of Pediatrics in a Tertiary Care Center: A Prospective Observational Study

AIM

To study the pattern of various adverse drug reactions (ADRs) occurring in children attending the Department of Pediatrics, SMGS Hospital, Jammu over 1 year.

SUBJECTS AND METHODS

This was a prospective study, with study population of patients attending Department of Pediatrics over a period of 1 year. A structured format was used to enroll the participants. A pilot study was conducted to test the suitability of the format and feasibility of the study. The study was carried out to review various pattern of ADRs by using the Naranjo probability scale, and severity was assessed by using the Hartwig severity scale. ADRs were classified according to the classification used by the Adverse Drug Reaction Monitoring Center, Central Drugs Standard Control Organization, New Delhi, India.

RESULTS

In the present study, 104 patients were found to have developed acute drug reactions. Among these, 83.6% were type B, 14.42% type A, and 1.92% were type U. Furthermore, 25.96% ADRs were due to anticonvulsants, followed by antibiotics (22.11%), antipyretics (11.53%), vaccination (8.65%), steroids (6.73%), decongestants (5.67%), snake antivenom and antiemetics (3.84%), and fluids, insulin, and antacids (1.92%). The patients’ dermatological system was involved in 67.30%, followed by the central nervous system (CNS) in 11.53% patients. Renal system was involved in 6.73% patients. Cardiac, musculoskeletal, metabolic, and other systems were involved in 4.80%, 3.84%, 2.88%, and 0.96%, respectively. According to the Hartwig severity scale of ADRs, 64.4% patients had moderate ADRs, 29.8% patients had severe ADRs, and 5.76% had mild ADRs. In the present study, 64.4% patients expressed moderate severity, whereas 29.8% expressed high severity and 5.76% expressed mild ADRs.

CONCLUSION

ADRs were seen in 71% of the patients between 1 and 5 years of age, 26% in the age group of 5–10 years, and 3% were more than 10 years old. Anticonvulsants (25.96%) and antibiotics (22.11%) were responsible for majority of ADRs. Rash (55.76%) was the most common presentation of ADR. Owing to the high number of ADRs, the present study points to the need for rigid adverse drug monitoring among pediatric patients to ensure the safety of drug therapy.

Assessment of knowledge, attitude, and practice related to epilepsy: a community-based study

Religious and sociocultural beliefs influence the nature of treatment and care received by people with epilepsy. Many communities in Africa and other developing nations believe that epilepsy results from evil spirits, and thus, treatment should be through the use of herbaceous plants from traditional doctors and religious leadership. Community-based cross-sectional study designs were used to assess the knowledge, attitude, and practice related to epilepsy and its associated factors by using a pretested, semi-structured questionnaire among 660 respondents living in Sululta Woreda, Oromia, Ethiopia. According to the results of this study, 59.8% of the respondents possessed knowledge about epilepsy, 35.6% had a favorable attitude, and 33.5% of them adopted safe practices related to epilepsy. The following factors had significant association to knowledge, attitude, and practice related to epilepsy: being rural dwellers, living alone, those with more years of formal education, heard information about epilepsy, distance of health facility from the community, had witnessed an epileptic seizure, age range from 46 years to 55 years, had heard about epilepsy, prior knowledge of epilepsy, occupational history of being self-employed or a laborer, history of epilepsy, and history of epilepsy in family member. The findings indicated that the Sululta community is familiar with epilepsy, has an unfavorable attitude toward epilepsy, and unsafe practices related to epilepsy, but has a relatively promising knowledge of epilepsy.

Medicines management

All newly registered graduate nurses are required to have the appropriate knowledge and understanding to perform the skills required for patient care, specifically the competencies identified in the Nursing and Midwifery Council's essential skills clusters. This article focuses on the fifth essential skills cluster – medicines management. Nursing students should work to attain the knowledge and skills required for effective medicines management throughout their pre-registration education. The roles and responsibilities of the newly registered graduate nurse in the area of medicines management are discussed in this the final article of the essential skills cluster series.