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First Line Emergency Care Extending Scope of
Practice for Registered Nurses Division
2 Carollyn Williams, RN, M Hlth Sc (Nur),
FRCNA. Trish Mant, RN, M Nur Sc, MRCNA.
Barwon Health 2007
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Barwon Health

• Geelong, Vic
• On Corio Bay
• Entrance
• to the Surfcoast
• Great Ocean Road

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Barwon South West Region

• Area of 29,637 sq km
• Residential population of 350,109
• Agriculture, industry, tourism
• 20 healthcare agencies

Geelong on Corio Bay
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Need for the course

• Initiative by regional hospital
• Emergency departments not staffed
• Nurses rostered by need
• More knowledge and skill required
• Extend scope of practice of RN Div 2

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Project model
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Consultation

• Site visits
• 12 regional 3 Melb
• Skill knowledge needs
• Behaviours, respiratory distress, fracture care,
  assisting IVs, basic assessment, documentation.
  paediatric geriatric
• Steering committee
• Health training authority, DHS, ANF, NBV, TAFE
• RN Div 2 work with RN Div 1 /or MO

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Scope

• Develop an accredited module with TAFE college
• From HLTEN617A Practise in contemporary rural
  health care
• Theory clinical content to meet needs of
  regional HCFs
• Care of elderly focus
• Assessment skills
• Clinical skills
• Assist with stabilisation of trauma
• Pilot the course
• Evaluate and report

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Agreements

• Business Model
• Curriculum
• Deliver
• Evaluate
• Service Level Agreements
• Key partnerships

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Implementation

• Curriculum developed by Gordon TAFE college
• Course developed by Barwon Health team of
  educators
• Pilot participants (12) from HCFs in Barwon South
  Western region
• Portland District Health (n4)
• South West Healthcare (Warrnambool) (n4)
• Moyne Healthcare (Terang/Mortlake) (n3)
• Barwon Health (n1)

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Course Aim

• To provide practical skills essential knowledge
  of emergency nursing procedures practice
• Underpinned by following skills
• communication
• team work
• problem-solving
• initiative enterprise
• planning organising
• self-management
• learning
• managing technology

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Course Objectives

• Work as part of the emergency health care team
• Assist the Registered Nurse Division 1 in the
  provision of emergency care and
• Contribute to the quality safety of emergency
  nursing care in collaboration with the Registered
  Nurse Division 1

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Course outline

• 60 theory hours over two week course
• Highly interactive and simulation based
• 18 clinical hours at Barwon Health /or regional
  hospital
• Formative assessments
• Summative assessments
• Clinical Skills Record
• Patient assessment

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Content
PROFESSIONAL PRACTICE ASSESSMENT
Scope of practice Initial assessment taking a history
Legal ethical practice Cardiac respiratory assessment
Reflective practice Abdominal pain assessment
Effective communication Pain assessment
Support processes in critical situations Musculoskeletal assessment
Managing difficult behaviours Mental health assessment
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Content
EMERGENCIES TRAUMA
Toxicology Slings, splints, crutches, plaster
Diabetic emergencies Spinal immobilisation
Obstetric emergencies Haemorrhage hypotension
Decontamination practices Altered conscious state
Thermal injuries Retrieval teams
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Content
PAEDIATRICS ELDERLY CARE
Kids SIDS Considerations in geriatric care
Risk factors for serious illness in children Planning for safe discharge for the elderly
OTHER
Infection prevention Adult paediatric basic life support
Wound management
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Formative assessments

• Classroom discussion
• Assignments
• Worksheets case studies
• Performance in simulated practicum situations
• Clinical Skills Record

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Personal journal

• Off the job learning
• Work based learning
• Record new information
• Outcomes of discussions
• Answers to questions
• Confirmation of learning in clinical placement

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Worksheets

• Neurological assessment
• Mental health assessment
• Cardiac assessment
• Musculoskeletal assessment

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(No Transcript)
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Case studies

• Diabetic emergency
• Patient presenting with bleeding and hypotension
• Patient presenting with abdominal pain
• Patient presenting with head injury

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Neurological case study

• A 38-year-old male brought via ambulance from a
  party at a nearby country property, arriving at
  2030hrs. He has been consuming alcohol most of
  the afternoon with his mates and witnesses say he
  was standing on a table when he slipped and fell,
  hitting his head on the ground. He is reported to
  have had a loss of consciousness for 10 minutes.
  As he walks into the department you note that he
  has an unsteady gait, is slurring his words and
  smells heavily of alcohol.

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Questions

• Causes of altered conscious state?
• Initial assessment priorities?
• Glascow Coma Scale findings
• Actions?
• Handover information to next carer
• Dilated pupil sign
• Indicates?

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Clinical skill acquisition

• Decontamination of hazardous substances
• Adult and paediatric basic life support
• Applying cardiac monitoring devices
• Diabetes management
• Administration of oxygen

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Clinical skill acquisition

• Fitting slings, splints and crutches
• Application/assisting of plaster and back slabs
• Spinal immobilisation
• Strategies to defuse difficult behaviours
• Assisting with paediatric procedures

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Summative assessment

• In clinical placement
• Observation of practice
• Patient assessment
• Questioning
• Clinical skill acquisition
• Supervisor reports

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Evaluation - understanding
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Evaluation - skills
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Evaluation job enhancement
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Evaluation course balance
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Evaluation - practicums
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Evaluation implement practice
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Qualitative feedback

• Fantastic course lots of learning, lots of
  laughing
• Mixing up the practical sessions with theory
  worked well and gives you a break from just
  sitting all day in class. The practical sessions
  I felt were very beneficial
• I felt the course had good content and the
  course was well organised

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Measuring change in practice

• Maintenance of best practice
• Safe, efficient and effective
• Incorporating new concepts, procedures and skills
• Collaborating with team
• Prioritising in emergency situations
• Excellent communication skills
• Consistent and appropriate documentation
• Identifying strengths and need for further
  development

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Sustainability

• Pilot hospitals key demonstrations sites for
  further rollout
• Employer commitment to enable nurses to complete
  program
• Pilot project review