ANZONACONFERENCE

PERTH2017

SusanHull

THISWASMEDURINGTHEFIRSTYEARINORTHO!!!

LACKINGCONFIDENCEØ ABILITYØ KNOWLEDGE

FEARFULIWOULDHARMAPATIENT

ISTHISWHATITISSTILLLIKETOSTARTINORTHOPAEDICS?????

LASTESTEVIDENCEINORTHOPAEDICS

• Relativelylight• Noarticlesfocusingonconfidenceforadvancedbeginnersinthespecialty

• Literature• Musculoskeletalassessment,knowledgeandeducationalrequirements(Flynn,Pugh&Jester2015)

• Gainingofconfidenceinmusculoskeletalassessmentsfornursepractitioners(Benham&Geier 2014)

• Developmentofeducationalprogramstoassistinincreasingknowledgeeg Paediatrics(Griffiths&Houghton2013)

CONFIDENCE

• ‘Afeelingoftrustinone'sabilities,qualities,andjudgment’(OxfordDictionary)

• ’Essentialcomponenttodecisionmakingandjudgement’(Drugoswitch2016)

• Maytakeuptooneyeartodevelopconfidencetoalevelofconsistency’(Oritz 2016)

• Confidentpractitionersmakegooddecisions (White(2013),Drugoswitch(2016)andOritz (2016)

TRANSITIONTOPRACTICE

AdvancedBeginners

DreyfusmodelofskillacquisitioninterpretedbyPatriciaBenner(1984)

•Minimalexperience• Anxioustodowellbypatients• Anxioustoimpresscolleagues• Gainconfidenceinprofessionalidentity• Ifnotsupportedcanfreeze/failtofunction

DoesanOrthopaedicWorkshopimprovetheConfidenceofNursesTransitioningtotheSpecailty of

Orthopaedics?

Intervention: OrthopaedicworkshopInclusion: RN/EN< than2yearsexperienceExclusion: RN/EN>than2yearsexperienceMethodology: Quantitativestudy,quasiexperimental

pre-test/post-test designMethod: Questionnaire– 26closedquestions,

LikertscalePopulation: Twelve- Sample10Where: AcuteRegionalFacility

32bedAdultOrthopaedicUnit

DEMOGRAPHICS

FREQUENCY NUMBER

AGE 21-25 426-30 2

31-35 236-40 1>45 1

GENDER Male 1Female 9

FREQUENCY NUMBER

LevelofEducation DipNursing 2

BNSc 8

ExperienceinOrtho 0-12months 713-24months

3

ExperienceinNursing 0-5years10

6-10/15-20/>20yrs 0

ORTHOPAEDICWORKSHOP

• LECTURECONTENT

• Musculoskeletalanatomyandphysiology

• Fractures– fragilityandtrauma

• Complications– CS,VTE,FES

• Spinalassessmentandmanagement

• Painmanagement

• Jointreplacements

• Communicationandcollaboration

PRACTICALCOMPONENT

• Skintractionapplicationandmaintenance

• Neurovascularassessment

• Careandapplicationoforthoticdevices

• Mobility

• Cryotherapy

QUESTIONNAIRE

• 26Closedquestions• Samequestionnaire– pre/post/12weeks• Tool– pilotpriortoimplementation

LIKERTSCALE• Noconfidence 1• Alittleconfidence 2• Averageconfidence 3• Confident 4• Veryconfident 5

QUESTIONNAIRETHEME

• Mobility• Assess,Plan,Manage• Education• Tractionapplication• Orthopaediccomplications• Communication• ApplicationOrthotics• ManagingSpinalInjuries

QUESTIONS• Q1,Q2• Q3,Q4,Q24• Q5Q18• Q6,Q7,Q8,Q9• Q10,Q19,Q20• Q11,Q12,Q13,Q14,Q25,Q26• Q15,Q16,Q17• Q21,Q22,Q23

WHATCOULDBE

ACHIEVED?

• Improvenursesconfidenceduringtheirtransition

• Improveconfidence– betterdecisionmakingskills–betterpatientcare

§Undertakefullscopeofskillsforthespecialty

§ReduceSeniornursesworkload

§ Encouragelifelonglearning

§ Provideevidenceformanagementtorecognisetheimportanceofsupporttospecialtyenvironments

OVERALLRESULTS

2.5

3.25 3.35

0

0.5

1

1.5

2

2.5

3

3.5

4

Pre Post 12week

QuestionnaireMean

TRACTIONRESULTSQ6ANDQ7

Q6PREPOST12WEEKS

Q7PRE.POST12WEEKS

Q6:HOWCONFIDENTAREYOUTOASSEMBLEATRACTIONFRAME?Q7:HOWCONFIDENCEAREYOUTOAPPLYSKINTRACTION

RESULTSQUESTIONS10,19,20COMPLICATIONSASSESSMENT

Q10PREPOST12WEEKS

Q20PREPOST12WEEKS

Q19PREPOST12WEEKS

Q10HOWCONFIDENTAREYOUINIDENTIFYINGCOMPLICATIONSASSOCIATEDWITHACAST?Q19HOWCONFIDENTAREYOUINASSESSINGPATIENTSWITHCOMPARTMENTS

SYNDROME?Q20HOWCONFIDENTAREYOUINASSESSINGPATIENTSFORVENOUSTHROMBOEMBOLISM?

WHERETONOW?

PATHWAYTOCONFIDENCE

§Management/organisational recognition

§Educationcanimproveconfidence

§Consistentandspecificeducationforadvancedbeginners

PATHWAYTOCONFIDENCE

• Induction– comprehensiveorientation

• Workshop1:1-3months• applicationorthotics,basicskills,assessment,fragilityfractures

• Workshop2:6months• Complications,skin/skeletaltraction

• Workshop3:12months• consolidationbasicskills

• Workshop4:18months• spinalinjuries,trauma

• Workshop5:24months• consolidationcomplexassessment/management

WHATCANWEDOTOSUPPORTTHENURSESOFOURSPECIALTYTOGAINCONFIDENCE

§Expandtowiderpopulation

§Mixedmethodsandaddqualitativeperspective

§Getthelivedexperienceadvancedbeginnerassiststrategies