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
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