Exclusion criteria included non-English language resources and resources that described suctioning practices but did not provide a means to assess competence related to tracheal suctioning. Resources pertaining to informal caregivers or family members who perform tracheal suctioning, those dealing specifically with pediatric populations, those dealing exclusively with mouth care or subglottic suctioning devices, and those dealing with ventilator bundle assessments ie, where a group of related interventions are assessed together were also excluded because they were outside the direct scope of the primary research objective and questions.
The initial search strategy was developed in consultation with a librarian, with subsequent review and suggested modifications made to the final search strategy. A gray literature search was also conducted to locate additional relevant resources that had not been published or archived within the included scientific databases. As well, the reference lists of all included articles and resources were searched to identify additional relevant resources. The detailed search strategies used for the additional electronic databases are available upon request.
Study screening was performed using the online software Covidence Covidence, Melbourne, Australia. Two authors EM, LB independently reviewed all titles and abstracts. These authors met at the beginning, midpoint, and end of the title and abstract screening process to discuss any challenges or concerns.
Consensus was used to resolve any discrepancies, with a third reviewer DB available to resolve conflicts as needed.
Two authors EM, LB then independently reviewed all included full-text articles and other resources to arrive at a final decision for inclusion. A data-extraction form was developed by the authors specifying relevant variables to extract to address the research objective and questions for this scoping review. Two authors EM, LB independently extracted data from the first 5 included studies to pilot the data-extraction form and ensure clarity.
Data extraction was completed by the lead author using Excel. To address the first and second research questions, a descriptive analysis was conducted, followed by a summary of relevant study characteristics. A map of common elements across the assessment approaches was also produced. To address the third research question ie, what are the similarities and differences across these assessment approaches?
A directed content analysis is a qualitative approach used to interpret the meaning of text-based data, using an initial coding scheme developed prior to data analysis. Using our initial coding frame, the extracted data were then systematically coded to identify themes, highlighting the similarities and differences across the assessment approaches. Extracted data were then revisited to review and refine the identified themes. Findings from the content analysis have been presented by stating and describing the resulting themes.
A formal methodological quality assessment for the included studies was not undertaken because scoping reviews are intended to provide a broad view of the existing evidence, regardless of its methodological quality.
Comprehensive literature searches of electronic databases yielded 2, results, with an additional 11 articles or resources identified through gray literature and reference list searching. Following removal of duplicates and title and abstract screening, 70 records underwent full-text screening. Results of the comprehensive literature search are presented in Figure 1.
A descriptive summary of the included articles and resources is provided in Table 1. Country of origin varied, with multiple articles and resources from each of North America, South America, Asia, Europe, and Australia, and a single study from Africa.
A single study also used semi-structured interviews to question participants about the reasoning behind their observed practices, in addition to a questionnaire and observational tool. Directed content analysis revealed 3 major themes: 1 Consistency across overarching evaluation frameworks; 2 Inconsistency across components of the tools; and 3 Inconsistency in the evaluation or reporting of assessment tool measurement properties.
These similarities included the organizational structure, the nature of the included elements, and the processes used in their development. In terms of organizational structure, assessment tools were most often organized according to the order in which tasks are performed. Similarly, Day et al 30 , 32 grouped items according to prior to suctioning, suctioning, and post-suctioning.
Even when the included items were not explicitly grouped, a trend toward assessment according to the relative sequence of events before, during, and after the performance of suctioning persisted. Balbino et al 41 used no formal groupings but organized their assessment with washing hands before the procedure as the first item and recording the characteristics of the secretions in the medical record as the final item.
Across the assessment tools, patterns of commonly included assessment elements also emerged. Figure 2 provides a visual representation of these common elements, grouped chronologically. Because hand hygiene and the use of personal protective equipment PPE were often considered at multiple points during suctioning, their placement within the figure is intended to convey that they are not confined to a single point in the process.
Within this map, the included elements are well aligned with the 3 main components used to define clinical competence within this review ie, knowledge, skills, and judgment.
For example, identifying the need to suction and recognizing contraindications incorporates both knowledge and judgment, and handling the suction catheter is more closely aligned with an individual's skill level.
Map of elements commonly included in the assessment of knowledge, skills and judgment related to suctioning. Kelleher and Andrews 39 reported collecting data using a structured observational tool that was adapted from a previously established tool created by McKillop. Inconsistencies were noted when the finer details of the assessment tools were considered. For example, while patient preparation often included both explaining the procedure to the patient and positioning the patient prior to suctioning, discrepancies existed regarding the specific position that was recommended.
The desired patient position for endotracheal suctioning ranged from Fowler's position 34 to semi-Fowler's position, 45 to supine position, 50 to supine position with the head slightly extended. Numerous assessment tools also contained unique assessment items not found in any other assessment tools, such as locking the suction catheter port, 36 the use of sterile gauze to clean secretions from the suction catheter, 41 and chest physiotherapy performed between subsequent suction passes.
The number of experts involved was generally provided, and on occasion the professional designations and qualifications of the included experts were also given. However, the specific processes used were often described in very limited detail. Evaluation or reporting on the reliability of the tools was also inconsistent. This scoping review revealed 36 articles and resources using or providing tools aimed at assessing competence or a component of competence related to the performance of tracheal suctioning for health care professionals working with adults.
While the tools originated from a wide variety of countries, the similar overarching frameworks likely reflect that many of the tools used common sources of evidence to inform their development and a number of the tools were adapted from one another. Despite these similarities, when individual components were examined in more detail, numerous inconsistencies emerged.
These inconsistencies may be rooted in ongoing gaps in the literature pertaining to the optimal performance of tracheal suctioning in both intubated and non-intubated adults.
For example, the lack of evidence addressing the appropriate suction pressure, optimal suction pass duration, and use of sterile versus clean technique.
In a study conducted across 27 health care facilities in the United States, Sole et al 59 found that policies related to suctioning vary widely and are not always aligned with current research.
This variation across organizational policies may help to further explain some of the discrepancies that are seen between the tools in terms of their specific components. We also noted inconsistent evaluation and reporting of measurement tool properties. For a testing instrument to be useful, it needs to measure variables of interest in a reliable and valid way.
However, even when more feasible aspects of validity were addressed, such as content validity, the lack of detail and transparency often detracted from establishing a strong argument in favor of the tool's use. This has been reported to be an important consideration, particularly in the context of observational tools where evaluation relies on the judgment of the rater.
To promote greater credibility, 61 it is recommended that future research aimed at assessing the competence of health care professionals related to the performance of tracheal suctioning provide greater detail regarding the processes used for the development of assessment tools and the processes used to establish the measurement properties of the tools for their intended use.
Competence assessment is a critical process for health care professionals, with particular importance being placed on competence assessment for both high-risk and low-volume health care activities. For example, nasotracheal suctioning may be performed across a wide variety of settings in addition to critical care environments, including emergency departments, in-patient acute care units, extended care environments, skilled nursing facilities, out-patient or ambulatory care settings, and during the provision of home care.
Tools identified in this review rarely aimed to address tracheal suctioning competence for health care professionals beyond nursing and nursing-related professions. Future research should consider the assessment of competence related to tracheal suctioning for health care professionals beyond nursing and nursing-related professions.
There is also a need to focus on assessment approaches that can be applied across different health care settings and that can be used to evaluate a broader variety of suctioning approaches. Researchers, clinicians, and educators will need to consider whether current tools can be used or adapted for use within their individual contexts, and whether the creation of new tools is required to meet their needs.
This scoping review used a transparent, systematic, and reproducible process, guided by a pre-established framework 17 , 18 and a protocol developed by the authors.
Although a comprehensive search was conducted, assessment tools which had not been published or shared through an accessible electronic source may have been missed. Additional articles and resources may also have been missed due to the exclusion of non—English-language documents.
However, given that numerous included studies were published prior to more recent clinical practice guidelines for suctioning, this could have contributed to some of the variability in our findings.
Similarly, heterogeneity of study origin may have contributed additional variability, given the potential for regional variation in terms of recommended or acceptable practices.
In addition, although the gray literature search and the directed content analysis were performed by a single author, the processes followed and the resulting findings were reviewed in detail by all team members.
Finally, the sixth step in conducting a scoping review, as outlined by both Arksey and O'Malley 17 and Levac et al, 18 ie, consulting with experts was not undertaken within the current review. We acknowledge the inherent value in this step, and expert consultation regarding the assessment of competence related to tracheal suctioning is being incorporated into a future study. A variety of tools to assess competence or a component of competence related to tracheal suctioning for health care professionals working with adults were identified within this scoping review.
Although these tools shared consistent overarching frameworks in terms of their organizational structure, the nature of the included elements, and the processes used in their development, inconsistencies were evident when individual assessment items were examined in greater detail.
The vast majority of the tools were designed to be used with nurses or nursing-related professions, and their appropriateness for use wither other health care professionals is unclear. Further gaps in the literature included a lack of tools to assess tracheal suctioning performed outside of intensive care or other high acuity hospital-based units, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding tool development and the evaluation of measurement properties.
Future research is recommended to address these limitations. We thank Erica Lenton for her assistance in developing and refining the search strategy that was used for this scoping review. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
We do not capture any email address. Skip to main content. Review Article Narrative Review. Erin K Miller. Abstract Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Introduction Airway suctioning is a health care intervention that falls within the scope of practice of a number of regulated health care professionals, including physical therapists, respiratory therapists, registered nurses, nurse practitioners, and physicians.
To meet this objective, our review addressed the following questions: What is the nature and extent of assessment being used to evaluate the competence of health care professionals related to the performance of tracheal suctioning ie, country of origin, setting, context of assessment, type of suctioning, included health care professionals, type of assessment?
What elements are being included in these assessment approaches? What are the similarities and differences across these assessment approaches? Methods Protocol A protocol for this scoping review was developed based on the 6-stage framework proposed by Arksey and O'Malley, 17 with the incorporation of modifications suggested by Levac et al. Search Strategy. Data Extraction A data-extraction form was developed by the authors specifying relevant variables to extract to address the research objective and questions for this scoping review.
Nurs Stand , 23 18 , 01 Jan Cited by: 12 articles PMID: Contact us. Europe PMC requires Javascript to function effectively. Recent Activity. Search life-sciences literature Over 39 million articles, preprints and more Search Advanced search. Abstract Available from publisher site using DOI. A subscription may be required. Coates VE ,. M Chambers Search articles by 'M Chambers'. Chambers M. Share this article Share with email Share with twitter Share with linkedin Share with facebook.
Abstract Assessment of student nurses' clinical skills is an important issue in nurse education. However suitable instruments are difficult to locate, and also to design. In the course of this article the need for scientifically designed and tested assessment instruments is discussed. The thoroughness with which 11 clinical assessment documents were developed was evaluated using specific criteria.
It was found that in the majority of cases use of a systematic research process to guide development was not evident. However it must be noted that the assessment documents were only evaluated via their presentation in journal articles.
Full details of the entire project had perhaps not been published. The implications of the results, some of the difficulties inherent in instrument design and the limitations of this small review are considered.
Full text links Read article at publisher's site DOI : References Articles referenced by this article 29 Title not supplied Abdellah Research on research: meta-analysis of nursing and health research Abraham Clinical evaluation of the affective domain. Clinical assessment: a state-of-the-art review. Issues in competency-based testing. Title not supplied Benner Omissions in nursing research: another look. Title not supplied Brink Developing a system of student nurse profiling through action research.
Show 10 more references 10 of Nurse Competence Scale--psychometric testing in a Norwegian context. Early identification of several students who did not meet performance improvement criteria at Midterm help all parties develop a plan for clinical progression. Outcome based competencies: Our clinical unit nurse educators also provided input such as customer service criteria. While the acronyms vary, the concept consistently contained themes such as immediate trouble shooting, acknowledgment, prevention, and service.
The relationship with clinical site nurse educators will be integral for the future. When active or latent safety infractions occur on the unit, a post conference debriefing included a root cause analysis level III clinical evaluation tool, Quality Improvement competency.
The group exercise facilitates team work and collaboration. A score of 4 requires a clinical exemplar as recommended by Drs. Use of exemplars create connections between their knowledge integrated from the classroom into the clinical practice and the humanistic science of caring.
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