Learning and Assessing in Practice

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In 1977 the DHSS stated that the clinical nursing role might be extended by delegation from a doctor and in response to an emergency. Nurses had to gain certificates of competence in order to perform tasks referred to as extended roles, leaving minimal scope for nurses to take control of decisions necessary for patient care delivery (Phillips 2001, 1-22).


It stated simply that; 'Practice must be sensitive, relevant and responsive to the needs of individual patients and clients and have the capacity to adjust, where and when appropriate to changing circumstances....the range of responsibilities which fall to individual nurses should be related to their personal experience, education and skill' (UKCC, 1992). However, coming as did between the publication of the New Deal for Doctors (NHSME, 1991) and The Calman Report, which respectively initiated reduction of junior doctors hours and shortening of specialist training, scope understandably created considerable tension within the nursing profession (Downie 2000, 1-7). Many were concerned about the 'medicalisation' of nursing and the loss of its intrinsic value. It was feared that in medical terms, the interpretation of 'good' may be to the advantage of medical care and the interests of the physician, but at odds with the interests of the patient and nursing.
The scope of practice appears to give nurses more freedom in practice. Cahill (1996, 791-799) described how scope enabled nurses in one trust to move the boundaries of care in almost unlimited ways, for example, the setting up of nurse led clinics. ...
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