An exploration of an expanded nursing role in paediatric pre-operative assessment

Rushforth, Helen Elizabeth (2000) An exploration of an expanded nursing role in paediatric pre-operative assessment. University of Southampton, School of Nursing and Midwifery, Doctoral Thesis , 298pp.


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This thesis explores the appropriateness of suitably trained children's nurses undertaking
the pre-operative assessment of children prior to day case and minor surgery. The central
focus of the study is a 60 subject hypothesis refining randomised controlled trial (RCT),
comparing the pre-operative assessment of children carried out by suitably trained nurses
with the assessment carried out by senior house officers (SHO's). Findings demonstrate
significantly greater accuracy by nurses in the detection of abnormalities in children's
history, when compared with the SHO's. No significant difference is demonstrated
between the performance of nurses and SHO's in detecting abnormalities within the
physical examination, or in the correct identification of children who have no detectable
abnormalities. However, these findings of 'no significant difference' must be
substantiated within a larger equivalence trial before assurances can be given that
paediatric pre-operative assessment might safely be transferred from SHO's to nurses.
Supplementary data explores the perspectives of parents and practitioners with regard to
children's nurses undertaking a pre-operative assessment role. The views of parents,
gathered via questionnaires, are supportive of the initiative. The views of nurses and
SHO's involved in the RCT are similarly supportive, although the conduct of in-depth
interviews with the nurses also reveals insights into their perceived vulnerability when
carrying out such expanded roles. The views of anaesthetists are less positive, and
convey a reluctance to accept nurses carrying out the pre-operative assessment of
children. Finally, a national survey explores the views of nurses and SHO's involved in
paediatric pre-operative assessment, revealing that nurses attribute significantly greater
importance and enjoyment to the pre-operative assessment role when compared with
SHO's. This factor may in part explain the greater accuracy demonstrated by nurses in
the RCT, but such speculation must be substantiated by further enquiry.
This study contributes to the nursing literature in offering what is thought to be the first
systematic UK exploration of the role of the paediatric nurse within pre-operative
assessment. It is also the first study, as far as the author is aware, to demonstrate
significantly greater accuracy in history taking by nurses when compared with doctors, in
a paediatric specific UK study. It therefore makes a meaningful contribution to both the
paediatric and expanded role evidence bases. It also offers systematically informed
hypothesis generation to underpin the ongoing exploration of an expanded nursing role
within paediatric pre-operative assessment.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
R Medicine > RD Surgery
R Medicine > RJ Pediatrics
Divisions : University Structure - Pre August 2011 > Superseded (SONM)
ePrint ID: 50633
Accepted Date and Publication Date:
October 2000Made publicly available
Date Deposited: 06 Apr 2008
Last Modified: 27 Mar 2014 18:33

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