Educational Needs of Emergency Nurses Reka Dulandas M.N. (Critical Care & Trauma), Hons.BA (Health Sc),CCRN Prof Petra Brysiewicz (supervisor) UKZN (School of Nursing)
Purpose of the study To describe the educational needs of emergency nurses
Significance of the study 1. Paucity of research in SA on: Educational needs Skills/competencies deemed satisfactory for emergency nurses 2. Findings may contribute to: The development of a core curriculum for emergency nurses CPD skills & competencies
Introduction Nurses working in trauma and emergency centres are usually the first person to interact with the critically ill or injured patient. These nurses require advanced skills and extensive clinical knowledge to be able to manage such patients appropriately.
Introduction Definitions: Emergency nursing specialty in which nurses care for patients during the emergency or critical period of their illness or injury, focusing on severity levels and timeous treatment (ENSSA, 2010)
Introduction Definitions: Emergency Centre accident and emergency (A&E) casualty trauma emergency department emergency unit emergency room
Introduction Definitions: Emergency Nurse A nurse working in a trauma or emergency centre providing care to acutely ill or injured patients by means of a NCP. ENSSA (2010) adds that she/he should have basic, intermediate and advanced skills.
Introduction Emergency nursing: What do we know? Fastest growing specialties in the developed world In SA & Sub-Saharan Africa it s in its infancy ENSSA promotes advancement in emergency nursing through leadership, collaboration, education, practice development & research
South African Nursing Council SANC has developed competencies for: Occupational health Ophthalmic nursing Orthopaedic nursing Paediatric nursing Nephrology EMERGENCY NURSING COMES UNDER THE BANNER OF CRITICAL CARE NURSING
Benner s Theory: Novice to expert Increasing roles and responsibilities for emergency nurses Emergency nurses to be trained at proficient and expert levels (Wolf et al, 2012)
Methods Design: quantitative survey Settings: 2 private, 2 public hospitals Sample: convenience sampling, target population 163 Instrument: self administered questionnaire Data collection: over 4 weeks, 6am 8am Data analysis: SPSS version 23 Validity and reliability: Univ of Michigan Ethics approval: UKZN, hospital ethics committees
Results: demographics Response rate: 128 (78.5%) Public Private n (%) Registered nurses Enrolled nurses 45 30 75 (59%) 34 19 53(41%) Total (n) 79 (62%) 49 (38%) 128(100%)
Results: demographics YEARS OF EXPERIENCE Registered nurses Enrolled nurses Total (n) 0 months < 1 year > 1 year < 2 years > 2 years < 5 years > than 5 years n (%) 11 3 18 42 74(59%) 16 7 17 11 51(41%) 27 10 35 53 125(100%)
Competency levels
Test of competency levels Category p value Years of experience 0.027 Nurse designaron 0.001 Hospital sector 0.052
Results: Competency levels QuesRonnaire item Basic Intermediate Advanced L e a s t competent % Competent % H i g h l y competent % Able to assess breathing: rate, effort, cyanosis 2 28 70 Able to administer oxygen: cannula, mask, bag-valve-mask 1 25 74 Able to assess circularon: pulses, skin colour, capillary refill, blood 0 27 73 pressure, signs of bleeding Able to perform cardiopulmonary resuscitaron 11 37 52 Able to prepare and assist with endotracheal intubaron 14 38 48 Able to control haemorrhage: apply tourniquet, fracture splint, pelvic 19 34 47 wrap Able to manage shock: obtain intravenous/ intraosseous access and 10 46 44 administer fluids Able to prepare and administer drugs in cardiac arrest 20 38 42 Able to prepare and administer thrombolyrcs 38 33 29 Able to perform cardioversion/defibrillaron 42 38 20 Able to obtain and interpret echocardiograms: detect arrhythmias 45 39 16 e.g. atrial fibrillaron
Results: EducaConal needs - trauma EducaRonal needs % Abdominal trauma e.g. intra-abdominal bleed 79 Paediatric emergencies 79 Orthopaedic e.g. fractures, compartment 68 syndrome Spinal cord injuries 75 Burns and traumarc injuries 69 Head injuries e.g. intracranial bleeding 75
Results: EducaConal needs cardiac EducaRonal needs % Stroke 69 Acute Coronary Syndrome 81 Acute Myocardial InfarcRons 74 Arrhythmias 76 Cardiac MedicaRons 76 DefibrillaRon / Cardioversion 69
Results: EducaConal needs short courses EducaRonal needs % ABG Analysis 78 Triage 79 ACLS 83 PALS 80 VenRlators 80
Preferred learning methods Learning method % DemonstraRon 76 Lecture 57 SimulaRon 30 Online learning 6 Distance learning 5
Barriers & facilitators to educaronal development Lack of funding Lack of support from management Limited access to educational institutions. Staffing issues Lack of time
RecommendaCons Similar studies in other provinces on competency levels and educational needs of emergency nurses. The findings can be used to help develop a core curriculum for emergency nurses.
Conclusion There are significant deficits in knowledge, skills and competency levels concerning emergency care. Educational gaps can be rectified through CPD, that incorporates competency based education on specific emergency nursing skills.
References 1. Wolf, L, Brysiewicz, P., et al. 2012. Developing a framework for emergency nursing practice in Africa. African Journal of Emergency Medicine, 2:174-181. 2. Benner, P. 1984. From novice to expert: excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley. 3. EMSSA. 2012. The South African Triage Scale. Accessed on 21 April 2014 from http://emssa.org.za/sats/
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