Sleep and Long-term EEG monitoring —
Training activity: 3

Details

Prepare patients and perform a long-term diagnostic test for patients in the:

• Ward setting
• Home setting

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Patient centred care and support
• Patient identity and safety
• Patient history
• Patient referral
• Environment for testing
• Range of diagnostic tests
• Electrode placement systems
• Effective communication skills
• Electrode impedance
• Uses of polygraphy
• Local, national, international guidelines and standards
• Range of control settings and continuous review
• Optimisation of data capture
• Recording parameters
• Patient positioning and compliance
• Artefact management
• Multidisciplinary team working

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to successfully preparing patients and performing the LTM diagnostic test itself in both the ward setting and the home setting. This includes applying electrode/transducers accurately, maintaining patient safety and dignity, and obtaining a successful recording.
• Consider how the learning outcomes apply, specifically in relation to planning, preparing, and performing LTM recordings in home-based settings and on the ward, and practicing according to relevant guidelines and protocols.
• Discuss with your training officer what constitutes a successful performance of LTM in these different environments. What are the key differences and challenges for success in the ward versus the home setting?

What is your prior experience of this activity?

• Think about what you already know about preparing patients for medical tests and performing technical procedures like applying electrodes for LTM. Have you performed LTM before? In a ward setting? In a home setting?
• Consider possible challenges you might face during the activity, such as managing patient mobility, dealing with environmental artefacts (e.g., from machinery or home environment), ensuring equipment function remotely in the home, or electrode application for long-term wear.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example:
  • If encountering unexpected patient responses or significant artefacts affecting data quality
  • When technical issues with the equipment arise, especially when alone in a home setting
  • If the patient’s clinical stability or comorbidities require modifications to the standard recording protocol
• Acknowledge how you feel about performing LTM in potentially less controlled environments like a patient’s home compared to a clinical setting.

What do you anticipate you will learn from the experience?

• Consider the specific practical skills you want to develop, such as robust electrode application techniques for LTM, adapting procedures for different environments (ward/home), and troubleshooting common issues.
• Identify the specific insights you hope to gain into the logistical and technical challenges and adaptations required when performing LTM studies in diverse settings.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of performing patient procedures, especially technical ones, or working in less traditional clinical environments.
• Identify important information you need to consider before starting the preparation and performance, such as reviewing patient history, potential mobility issues or comorbidities, environmental factors in the ward/home, and ensuring all necessary equipment and consumables are available and functional. Reviewing relevant protocols for LTM setup and troubleshooting is also crucial.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the patient or performing the diagnostic test setup in the ward or home setting?
• Are you encountering situations such as:
  • Unexpected technical issues arise in the setting (e.g., noise/interference in the home environment, sudden equipment malfunction, or difficulty managing artefacts)?
  • Patient stability changes (e.g., increased agitation, sudden haemodynamic shift) requiring rapid modification or temporary halting of the setup?
  • Difficulty applying electrodes or transducers robustly due to unexpected skin condition, patient mobility issues, or inaccessibility due to monitoring equipment?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to technical troubleshooting or patient handling?
• Consider the steps you are taking in the moment, such as:
  • Immediately troubleshooting equipment or adjusting electrode placement to mitigate noise while prioritising patient comfort and safety.
  • Quickly seeking assistance from ward staff or your supervisor to manage patient positioning or technical issues in the unfamiliar setting.
• How are you feeling in that moment? For instance, are you finding it difficult to manage patient safety while troubleshooting technical issues simultaneously? Is it affecting your confidence in obtaining a high-quality recording in that specific environment?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the technical issue without compromising patient safety or data quality? Or are you needing support because equipment failure or patient instability requires senior clinical intervention?
• What are you learning as a result of the unexpected development? For example, are you mastering a specialised technique for managing artefacts in challenging environments? Or gaining insight into adapting the procedure to maintain quality despite patient instability?

On action

What happened?

• Begin by summarising the key steps involved in preparing the patient and performing the long-term diagnostic test for the specific case, noting whether it was in a ward or home setting.
• Consider specific events, actions, or interactions which felt important, including your own feelings during the experience.
• How did the patient respond to the preparation and performance of the test?
• What technical aspects of performing the test stood out (e.g., electrode application accuracy, measuring the head)?
• Were there any specific patient interactions, environmental factors (ward vs home), or technical challenges during the activity? Did anything unexpected occur? Include any moments where you adapted your approach in the moment (reflect-in-action).

How has this experience contributed to your developing practice?

• What learning can you take from this experience regarding preparing patients and performing long-term diagnostic tests in either a ward or home setting? What strengths did you demonstrate? What skills and/or knowledge gaps were evident, particularly in relation to following relevant guidelines/protocols?
• Compare this experience against previous engagement with similar activities. Were any previous identified actions for development achieved? Has your practice improved?
• Identify any challenges you experienced during the activity and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges? What did you learn as a result of any unexpected developments?
• Identify anything significant about the activity. Did you need to seek advice or clarification? Did you need to escalate to ensure you were working within your scope of practice? Were you able to adhere to relevant guidelines and protocols?

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt regarding preparing patients and performing long-term diagnostic tests in different settings, including from any feedback you have received.
• What will you do differently next time you perform this test in a similar setting?
• Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as specific practical skills or adhering to guidelines/protocols?

Beyond action

Have you revisited the experiences?

• Have you looked back at your reflections on preparing patients and performing long-term monitoring tests in both ward and home settings?
• What previous actions for development did you identify concerning patient preparation or performing the long-term test itself (e.g., electrode application, patient comfort, setting-specific challenges) for these different environments?
• Have you consistently worked on implementing these identified improvements in subsequent procedures? Are you confident in demonstrating the skills you’ve developed based on revisiting past experiences and new learning?
• Has engaging in professional storytelling with peers about performing challenging long-term monitoring tests in different settings provided new perspectives on your past experiences?

How have these experiences impacted upon current practice?

• How does reflecting on your past experiences performing long-term monitoring tests contribute to your preparation for DOPS, such as applying electrodes/transducers for a long-term EEG study or accurately annotating clinical events during monitoring?
• How has your overall ability to prepare patients and perform long-term monitoring tests evolved, considering the distinct demands and challenges of the ward versus the home setting?
• Does revisiting past experiences help you better understand your limits and recognise when you need to escalate or seek help during patient preparation or the procedure itself to ensure patient safety and working within your scope of practice?

Relevant learning outcomes

#	Outcome
# 1	Outcome Plan, prepare and perform long term EEG recordings in home-based settings and on the ward.
# 2	Outcome Practice according to relevant guidelines and protocols.