From asthma to pneumonia: how good are your respiratory nursing skills?

1 June 2010

Be it asthma or pneumonia, every nurse at some point cares for someone with a respiratory condition. Helping nurses evaluate their respiratory nursing skills or guide their development as a specialist is the aim of a soon-to-be-finalised knowledge and skills framework. Fiona Cassie finds out more.

Patients with asthma walk in daily to general practices. Aged-care nurses face residents with pnenumonia. Patients with severe lung disease and COPD turn up everywhere from operating theatres to district nurse rounds.

“All registered nurses have contact with somebody at some time with respiratory conditions,” points out respiratory nurse practitioner Marina Lambert.

But what makes someone competent or expert in the field of respiratory nursing has been unclear. And the plethora of titles used in the past for someone specialising in the field made things no more straightforward.

Inconsistencies in the care delivered to respiratory patients was also starting to cause concern for Lambert and her specialist colleagues. “Different nurses were doing different things and there were no guidelines around that.”

A local survey had also left them “quite shocked” at the level of respiratory nursing knowledge – with some nurses lacking basic knowledge on asthma inhalers.

These concerns were raised at the 2005 Thoracic Society of Australia and New Zealand (TSANZ) conference with the TSANZ nurse special interest group – particularly the gap between best practice and current practice in respiratory nursing care.

The group agreed a framework could be the answer by providing a “measurable means of evaluating practice” and also being a useful professional development tool.

In 2006 TSANZ funded the group to join forces with the Respiratory Nurses Section of the New Zealand Nurses Organisation and the two groups formed a framework development committee of respiratory nurses working across primary and secondary care and including all three NPs in the field.

The committee drew on the national diabetes framework and other respiratory frameworks from the UK, Australia and the USA, to develop the 80-page draft framework document.

The document – that sets out guidelines for achieving competent, proficient or expert levels in adult respiratory nursing – is now seeking sign-off from the NZNO board and may be the first such document to seek national endorsement under the joint professional organisations’ consortium process.

The aim of the framework is to promote best practice and provide guidelines not only for nurses wanting to specialise but also for nurses or employers to use as a check-list for basic competency in respiratory nursing skills.

Lambert says the framework does not cover specialty areas like children, ED or intensive care but it was also not exclusive and additional areas like sleep apnoea could be added in the future.

The framework was put to a practical test during its development thanks to a MidCentral DHB professional development contract for a group of community respiratory nurses.

Lambert says working on the contract while refining the framework helped them simplify the framework and brought home to her how pivotal mentoring was in developing skills and knowledge.

The resulting framework was less prescriptive and, after a review by nurse educators, the writers also simplified the language to make requirements clearer.

The foreword to the draft framework document notes that the “magnitude” of the gap between recommended best practice and actual practice in respiratory nursing is unknown but current patient data indicated care can be “significantly improved”.

It is now hoped that the framework gets the tick of approval and subsequent national endorsement so it can help “close the gap” and improve patient care. ✚