Introduction of a nurse led implantable loop recorder service

Introduction An Implantable Loop Recorder (ILR) continuously records the patient's electrical cardiac activity and is used to diagnose cardiac causes of unexplained syncope that have not been diagnosed with other tools. Method Previously loop recorders were implanted in a dedicated pacing theatre by a consultant cardiologist. The patient was kept nil by mouth and the wound from the device was around 4 cm and was closed with sutures. The typical time in theatre was around 30 min. With the next generation of loop recorders, this device has become injectable and it is now becoming commonplace in various centers around the world, for nurses or allied health professionals to insert the ILR. In our center we have recently set up an ILR service run by senior cardiac nurses without the need for medical staff to be present. A process was started, and a pathway/protocol developed, to set out the conditions under which a registered nurse can be credentialed to safely manage the care of patients for an ILR insertion, from admission to discharge. A training program has been set up for nurses to be trained in obtaining informed consent, the use of a local anaesthetic and the technical/surgical skills for device implantation. The first 10 implants are done under direct supervision of the consultant, followed by a further 10 indirectly supervised before being signed off to perform this procedure independently. They are required to keep a log of their insertions for the first year and submit an audit of their practice after the first year of insertion practice. They will perform an annual audit for quality and complication monitoring and to assure continuing competency. Most of these patients will be day-stay patients, cared for in the Cardiac cath lab holding area. Patients no longer require fasting and the incision, no longer than 1cm is closed with Steristrips and a waterproof dressing. The average procedure time is 10min. After wards the patients and their family are educated on wound care, use of the device and then discharged home. The waiting time for this procedure has significantly reduced with cases now generally done within 2 weeks. Previously the waiting time for a consultant to implant a loop recorder was around 2 months. Conclusion Our experience so far is consistent with various publications worldwide and has demonstrated that non-medical, non Cath-lab ILR implantations are both safe and effective practice. Funding Acknowledgement Type of funding source: None

Continuing competency in ethical decision making: An interpretive description of occupational therapists’ perspectives

Background. Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited. Purpose. The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists. Method. Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency. Findings. Two main themes regarding gaps were identified: “I didn’t have the knowledge” and “I don’t have anybody.” Education, tool development, and ethics mentorship were identified directions for development. Implications. Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making.

Occupational Therapists With Oncology Exposure: Perceived Needs on Adults and Older Adults With Cancer-Related Cognitive Impairments

Cancer-related cognitive impairments (CRCI) can limit participation in meaningful activities before, during, and after cancer treatment. This study explored occupational therapists’ perceived knowledge gaps and needs regarding CRCI in adults and older adults. An online survey was sent to a convenience sample of 60 practitioners at facilities throughout the continuum of care and 176 directors and faculty in accredited occupational therapy programs. Using a snowball sampling approach, recipients were asked to forward the survey to other occupational therapists. One hundred seven occupational therapists participated. The majority (92%) responded that it would be beneficial to attend a face-to-face continuing education program; preferences for the content and design of a continuing competency seminar are described. These findings support the development and delivery of continuing competence programs tailored toward occupational therapists’ CRCI knowledge needs.

STUDENT PAPER: Continuing Competency in Nursing Practice

Within bureaucratic organizations, registered nurses experience environments and situations which are complex in nature. The theory of bureaucratic caring (Ray, 1989) identifies caring as a dynamic concept which is influenced by both bureaucratic and humanistic factors; the ethical and education factors of caring may influence registered nurses’ competency. Continuing competency programs must prepare RNs to deal with the growing challenge of clients with multiple comorbidities seeking care in complex health systems. Recommendations will be suggested to augment current educational programs to ensure continuing competency for RNs.