Nurse-led sedation for paediatric magnetic resonance imaging

Abstract

M R J Sury and colleagues' paper on nurse-led sedation (May 15, p 1667)1Sury MRJ Hatch DJ Deeley T Dicks-Mireaux C Chong WK Development of a nurse-led sedation service for paediatric magnetic resonance imaging.Lancet. 1999; 353: 1667-1671Summary Full Text Full Text PDF PubMed Scopus (106) Google Scholar should raise concerns for the nursing profession. First, we have moved from hospital-based training to a university-based degree qualification to bring nursing in line with other health professions. The authors describe a selection and training process that seems intended to limit the practice of nurses to a cut-price anaesthetist role, based purely on cost. The role of these nurses should be that of an advanced practitioner and should relate to higher-level formal qualifications plus specific technical training, not just the latter.Second, although Sury and co-workers may have been able to achieve a safe system, the same results might not be achieved in other centres. We should be cautioned by experiences at the National Women's Hospital in Auckland, New Zealand, which began percussion physiotherapy for neonates in the late 1980s with disastrous consequences.2Harding JE Miles FK Becroft DM Allen BC Knight DB Chest physiotherapy may be associated with brain damage in extremely premature infants.J Pediatr. 1998; 132: 440-444Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar Centres that consider taking up such new ideas should read the injury report of this incident.3Inquiry Under S47 of the Health and Disability Act 1993 into the provision of chest physiotherapy treatment provided to pre-term babies at National Women's Hospital between April 1993 and December 1994. Ministry of Health, New Zealand1999Google ScholarTo view this report from the child's perspective is illuminating. For example, were the children (or their parents) aware that they were participating in a trial of a new process of care; and was permission obtained from the children used for training while anaesthetised in theatre? Furthermore what research, if any, had the investigators done into the emotional and psychological effects of sedation where a child may be aware but not in control? The assumption that lack of verbal recall procedures performed under sedation means that no harm was done seems a large leap of faith. M R J Sury and colleagues' paper on nurse-led sedation (May 15, p 1667)1Sury MRJ Hatch DJ Deeley T Dicks-Mireaux C Chong WK Development of a nurse-led sedation service for paediatric magnetic resonance imaging.Lancet. 1999; 353: 1667-1671Summary Full Text Full Text PDF PubMed Scopus (106) Google Scholar should raise concerns for the nursing profession. First, we have moved from hospital-based training to a university-based degree qualification to bring nursing in line with other health professions. The authors describe a selection and training process that seems intended to limit the practice of nurses to a cut-price anaesthetist role, based purely on cost. The role of these nurses should be that of an advanced practitioner and should relate to higher-level formal qualifications plus specific technical training, not just the latter. Second, although Sury and co-workers may have been able to achieve a safe system, the same results might not be achieved in other centres. We should be cautioned by experiences at the National Women's Hospital in Auckland, New Zealand, which began percussion physiotherapy for neonates in the late 1980s with disastrous consequences.2Harding JE Miles FK Becroft DM Allen BC Knight DB Chest physiotherapy may be associated with brain damage in extremely premature infants.J Pediatr. 1998; 132: 440-444Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar Centres that consider taking up such new ideas should read the injury report of this incident.3Inquiry Under S47 of the Health and Disability Act 1993 into the provision of chest physiotherapy treatment provided to pre-term babies at National Women's Hospital between April 1993 and December 1994. Ministry of Health, New Zealand1999Google Scholar To view this report from the child's perspective is illuminating. For example, were the children (or their parents) aware that they were participating in a trial of a new process of care; and was permission obtained from the children used for training while anaesthetised in theatre? Furthermore what research, if any, had the investigators done into the emotional and psychological effects of sedation where a child may be aware but not in control? The assumption that lack of verbal recall procedures performed under sedation means that no harm was done seems a large leap of faith.