Assessment of nurse performance plays an important role in guaranteeing high quality clinic care to achieve desired patient outcomes. Many tools measuring nurse performance in clinical settings have different dimensions of nurse skills. The objective of this research is to develop and test a new performance assessment tool incorporating applicable task and contextual performance items to measure clinical nurse's performance. Thirty-eight performance items were derived from previously cited literature and some tools that were in use. A questionnaire containing all items under eight categories was designed to reveal the appropriateness levels of the items. It was distributed to 233 clinical nurses from different hospitals in one city, who were asked to score them on a seven-point scale. The results indicate that although clinical skill and professional skill are the most important categories, the most scored item is "Working systematically" (mean = 6.07, s.d. = 0.89) in contextual category.

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Sixty children undergoing inguinal or urogenital surgery were allocated randomly to three groups to receive a caudal injection of either 0.125% bupivacaine 0.75 mL kg-1 with 0.5% midazolam 50 micrograms kg-1 (n = 20) or with 1% morphine chlorhydrate 0.05 mg kg-1 (n = 20), or bupivacaine alone (n = 20) after surgery under general anaesthesia. There were no significant changes in heart rate, blood pressure, respiratory rate or oxygen haemoglobin saturation values in all groups, and there were no significant differences in the incidence of vomiting and pruritus between the groups (P > 0.05). Sedation scores were higher in the bupivacaine-midazolam and the bupivacaine-morphine groups than in the bupivacaine group at 8-12 h post-operatively (P < 0.01). The durations of analgesia were 21.15 +/- 1.2 h in the bupivacaine-midazolam group, 14.50 +/- 1.6 h in the bupivacaine-morphine group and 8.15 +/- 1.3 h in the bupivacaine group. Differences between the bupivacaine-midazolam group and the bupivacaine group (P < 0.001), the bupivacaine-midazolam group and the bupivacaine-morphine group (P < 0.01), and the bupivacaine-morphine group and the bupivacaine group (P < 0.01) were significant. It is suggested that caudal administration of a bupivacaine-midazolam mixture produces a longer duration of post-operative analgesia than a bupivacaine-morphine mixture and bupivacaine alone with sedation for 8-12 h post-operatively.

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The results indicated that two new nursing jobs titled nurse B and nurse advanced B should be added to the list of national nursing jobs in the NHS JE system.

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