INSTITUTIONAL FACTORS THAT INFLUENCE THE ASSESSMENT ... · Expert Practice University of Adelaide...
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INSTITUTIONAL FACTORS THAT INFLUENCE THE ASSESSMENT PRACTICES OF EXPERT ORTHOPAEDIC NURSES Paul McLiesh Lecturer University of Adelaide
Transcript of INSTITUTIONAL FACTORS THAT INFLUENCE THE ASSESSMENT ... · Expert Practice University of Adelaide...
INSTITUTIONAL FACTORS THAT INFLUENCE THE ASSESSMENT PRACTICES OF EXPERT ORTHOPAEDIC NURSES
Paul McLieshLecturerUniversity of Adelaide
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What is the single thing that you find most frustrating in
your practice?
? Patients
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? Documentation
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Documentation
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Essential to practice
• Ensures safety, consistency & continuity
• Legislative requirements
• Allows effective care delivery, conveys vital information
Documentation
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BUT ….
When (and) does documentation requirements stop being useful and
start becoming harmful?
Assessment
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Reflection
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Take a minute now and think about how you assess a patient.
• The processes
• The skills & knowledge (how did you develop these)
• The required documentation
Assessment
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For those experienced nurses:
• Do you develop an understanding of the patients needs quickly (before using assessment tools)?
• Do you find yourself predicting the patient needs/ diagnosis?• Do you find yourself jumping ahead while conducting formal
assessments – start planning care interventions?• Do you start to implement care and educate the patient while
assessing?
Expert Practice
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Expert nurses reflect on practice:
• Able to identify Global Triggers
• Identify key elements in the assessment process, quickly
• Don’t need large amounts of data to make decisions
• May not be able to fully articulate this practice
• May not fully appreciate this method of practice
• Not just about length of practice but about reflective practice
? Hindering Expert Practice
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Do the current assessment requirements suit the practice of expert nurses?
Are assessment requirements that are the same for novice/experts nurses effective
and best practice?
Assessment requirements
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Most contemporary institutions require nurses to conduct assessments and document using structured nursing
assessment tools.
Think about the tools in your practice
https://www.slideshare.net/juuliacarolina/mc-gill-pain-questionnaire-short-form
Structured Assessment tools
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Are important…. ? Allows novice nurses to conduct a rigorous &
comprehensive assessment
Guides documentation- removes variables and errors.
Assessment vs Screening vs Risk Assessment
Duplication
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Literature supports too much duplication of data –
ineffective and potential errors
• ? Frustration, overwhelmed
• focussed on documentation- not patient risk or
needs
https://www.ringlead.com/data-duplication-sales-over-projection/
Focus of practice- Assessment
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Is this the case? –• Assessment has moved towards screening and
risk assessment
• Implementation of tools not planned (facility
level)
• Suitability for variations in practice levels not
considered
Consequences
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Ineffective practice
Focus on documenting assessment, not implementing care
Frustration and work arounds …..
Research
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Identify how expert nurses assess
Do documentation requirement impacts nurses practice?
Identify if and how these requirements impact on the natural practice of expert nurses
Consider changes to requirements to improve practice and care delivery
References Adams, S, Carryer, J & Wilkinson, J 2015, 'INSTITUTIONAL ETHNOGRAPHY: AN EMERGING APPROACH FOR HEALTH AND NURSING RESEARCH', Nursing Praxis in New Zealand, vol. 31, no. 1, pp. 18-26.
Beckwith, S, Dickinson, A & Kendall, S 2010, 'Exploring understanding of the term nursing assessment: A mixed method review of the literature', Worldviews on Evidence-Based Nursing, vol. 7, no. 2, pp. 98-110.
Benner, P 1982, 'From Novice To Expert', AJN The American Journal of Nursing, vol. 82, no. 3, pp. 402-407.
Benner, PE 2001, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Prentice Hall.
Crow, RA, Chase, J & Lamond, D 1995, 'The cognitive component of nursing assessment: an analysis', Journal of Advanced Nursing, vol. 22, no. 2, pp. 206-212.
Cunningham, L, Kennedy, J, Nwolisa, F, Callard, L & Wike, C 2012, Patients Not Paperwork – Bureaucracy affecting nurses in the NHS, NHS- Insititue for Innovation and Improvement
Pearson, A, Vaughan, B, Vaughan, B & FitzGerald, M 2005, Nursing Models for Practice, Butterworth-Heinemann.
Peña, A 2010, 'The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective', Medical Education Online, vol. 15, p. 10.3402/meo.v3415i3400.4846.
Redley, B, Raggatt, M & Heenan, J 2016, Risk screening and assessment for avoiding preventable harm to older people in hospitals Centre for Quality and Patient Safety Research: Deakin University and Monash Health.
Tanner, CA 2006, 'Thinking like a nurse: A research-based model of clinical judgment in nursing', Journal of Nursing Education, vol. 45, no. 6, pp. 204-211.
Townsend, E, Langille, L & Ripley, D 2003, 'Professional tensions in client-centered practice: using institutional ethnography to generate understanding and transformation', American Journal of Occupational Therapy, vol. 57, no. 1, pp. 17-28.
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Thank you
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PaulMcLieshLecturerAdelaideNursingSchoolUniversityofAdelaide
