A comparison of the management of venous leg ulceration by specialist and generalist community nurses: A judgement analysis

Abstract

BackgroundVenous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy. ObjectivesTo compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment. DesignJudgement analysis. SettingUK community and primary care nursing services. Participants18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. MethodsData were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance. ResultsSpecialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements. ConclusionIt is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists.