Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study

Aims and objectives
To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses.

Background
Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present.

Design
A qualitative exploratory design was employed.

Methods
Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes.

Results
Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements.

Conclusions
The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory.

Relevance to clinical practice
Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.

The old and the new : student perceived efficacy of electronics laboratory equipment

Background
Undergraduate engineering students require exposure to an appropriate level of practical activities to complement the theory delivered in their course. This not only serves the purpose of catering to students’ different learning styles but in contributing to developing practical skills important to achieving an adequate level of job-readiness. The mode by which practical activities are implemented can vary widely across different units of study and different institutions. Electronics practicals within the School of Engineering at Deakin University have traditionally involved the construction and analysis of bread board circuits. Recently however, the practicals have changed to utilise modern computer-integrated Lab Volt FACET board equipment.

Patient deterioration education: Evaluation of face-to-face simulation and e-simulation approaches

Background: Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method: Final-year preregistration nursing students (n=97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST2ACTWeb™. Results: Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion: Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience.

Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study

Aim : To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory.

Background : Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory.

Methods : A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations.

Implications for nursing : The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring.

Conclusion : These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.

Improving laboratory learning through self and peer assessment of laboratory reports

The laboratory provides an opportunity for students to achieve many learning outcomes including to critically evaluate information, interpret and draw conclusions from scientific data, and communicate scientific results, information, or arguments. This paper describes a laboratory-writing task that involves self and peer evaluation. After discussion of the expectations of laboratory report writing during class, students self and peer evaluate reports. In a process similar to double-blind journal refereeing, students practise critically evaluating the quality of academic writing using a rubric. The summative assessment is based on how consistent their evaluations are with the evaluations of the same reports performed by their peers. The formative assessment is that students receive peer evaluations and feedback via a rubric on reports that they have written. The skill of critically evaluating their own reports is used to improve the laboratory reports in subsequent assessment tasks.

Development, evaluation and use of a student experience survey in undergraduate science laboratories: the advancing science by enhancing learning in the laboratory student laboratory learning experience survey

Student experience surveys have become increasingly popular to probe various aspects of processes and outcomes in higher education, such as measuring student perceptions of the learning environment and identifying aspects that could be improved. This paper reports on a particular survey for evaluating individual experiments that has been developed over some 15 years as part of a large national Australian study pertaining to the area of undergraduate laboratories—Advancing Science by Enhancing Learning in the Laboratory. This paper reports on the development of the survey instrument and the evaluation of the survey using student responses to experiments from different institutions in Australia, New Zealand and the USA. A total of 3153 student responses have been analysed using factor analysis. Three factors, motivation, assessment and resources, have been identified as contributing to improved student attitudes to laboratory activities. A central focus of the survey is to provide feedback to practitioners to iteratively improve experiments. Implications for practitioners and researchers are also discussed.

Novel design of a renewable energy remote laboratory

BACKGROUND OR CONTEXT: Current work in remote laboratories focuses on student interaction in a setting that can be at times disconnected from real world systems. Laboratories have been developed that show models of a working system, focusing on a single aspect, but very few laboratories allow the user to see the outputs of a working system that interacts with the real world as would be expected outside of a laboratory setting. It was aimed with this paper to show a design of a novel approach to building a remote laboratory that would be able to interact with a fully functional renewable energy system, and to show the students the outputs of such a system in real time. It allows for the user to be presented with information in a new context.
PURPOSE OR GOAL: With this research it is hoped to achieve a remote laboratory that will be able to present students with the data from a renewable energy system live, as it is generated as well as all the logged date generated. It is aimed with this novel approach to building a remote laboratory to assist the students in learning about renewable energy systems while allowing the student to access real data, instead of simulated data. Links to increased motivation due to realism in data given as well as change in student perception on learning in remote laboratories mean that a system such as this could change the way students approach learning about renewable energy generation systems. This will require further research however.
APPROACH: This remote laboratory required gathering data from an already established system. The live results were not recorded, and a log file was generated daily, however this was not fast enough to give to students as it was generated, so a system that could maintain communication between all systems, while also polling for data itself was required. In addition to this, the system had to communicate to a server that would give students access to the live data. The server was set up in such a way that students were not required to install any programs on their computer, multiple students could access the data at any given time, and a wide range of devices, including mobile devices, could all access the remote laboratory.
DISCUSSION: Key outcomes include the design of the remote laboratory, including screenshots of data acquisition from the renewable energy system from different devices. The design is split into two sections, one covering the server side architecture while another covers the data acquisition architecture. A very brief discussion on students’ initial interaction is also undertaken.
RECOMMENDATIONS/IMPLICATIONS/CONCLUSION: Research has shown that the degree of realism in remote education can have an effect on students’ behaviors/motivation in a remote laboratory. By allowing students to knowingly access a real system that is currently being used to generate power from renewable energy sources, the methods and motivations that students use when approaching renewable energy systems may change.