Extending nursing practice.

For long-time cardiac nurse Murray Hart, working in the pre-assessment clinic at Christchurch Hospital's cardiac day unit (CDU) has offered a number of professional rewards. He has worked in cardiology at the hospital for the East seven years and completed the post-graduate hearth assessment paper through Christchurch Polytechnic Institute of Technology (CPIT) in 2002. "As a hospital-trained nurse the graduated from Christchurch Hospital in 1984], I'd had no training in health assessment. The CPIT course taught me a whore set of new skills and knowledge which gave a new dimension to my practice. And working in CDU, even before the establishment of the pre-assessment clinic, gave me a great deal of opportunity to practise what I'd learnt."

He decided to get involved in the pre-assessment clinic as a way of maintaining those skills. The health assessment course has enabled him to assess patients' physical condition in greater depth. "I can do a more comprehensive assessment before contacting medical staff, eg if a person is short of breath, I can now assess air entry and additional breath sounds."

He now has a greater sense of professional satisfaction. "I practise in a more holistic way because often I have met a client's family and dealt with their questions. And when a person has the procedure, I can follow them through and deal with the issues picked up at pre-assessment."

Each patient pre-assessment takes about an hour, during which Hart carries out a very comprehensive "systems review", focusing particularly on the cardiovascular and respiratory systems, explains the procedure step-by-step, and answers any questions the patient has. "This time is very valuable in establishing a rapport with the patient and for building trust." If Hart has any problems in the clinic, he discusses those with the consultant cardiologist, who sees the patient after the health assessment to discuss medico-legal issues and to gain consent.

Hart sees his role in the pre-assessment clinic as extended nursing practice, rather than delegated medical responsibilities. "Nursing initiatives such as the pre-assessment clinic are a way of demonstrating and validating our extended practice in a particular speciality."