10 November 2017

Trauma Nursing

Ellaine Boo RN BSc CritCareDip(ED)MNursRes

Head, International Programs (East Asia)
National Trauma Research Institute, Alfred Health and Monash University
e.boo@alfred.org.au
Contents

What is trauma nursing?

Skills required
Trauma Nursing at the Alfred
Trauma Nursing Capacity Building
What is trauma nursing?
 10 November 2017 4

What is a trauma nursing?

Trauma nursing is a specialty area of nursing practice which

emcompasses all aspects of nursing care for the injured or those at
risk for injury. They provide a continuum of care beginning with:
o Prevention
o Reception and resuscitation
o Critical care (if required)
o Stabilisation
o Supportive Care
o Rehabilitation
o Integration into society
 10 November 2017 5

Why are trauma nurses so important?

Possess a specialised body of knowledge for caring for the injured

Fundamental component of trauma care and trauma systems development

Direct trauma care:
o Are at the bedside 24 hours a day
o Responsible for monitoring the trauma patient
o Assessing the patient for evolving injuries
o Actively perform procedures
o Assess and relieve pain
o Teach and comfort patients and families
 10 November 2017 6

Why are trauma nurses so important?

Trauma systems development they:
o A trauma program co-ordinator is pivotal in improving patient outcomes,
decrease costs, improve processes and enhance education
o Clinical Nurse Specialists, Nurse Practitioners, Nurse Educators and many
other nursing roles are also integral in to the successful functioning of
trauma centres
o Important for continuum of care

Optimal patient outcomes are dependent on the availability of qualified nurses

that are committed to the specialized needs of the injured patient and the
availability of resources dedicated to trauma care
What skills do we need as a trauma
nurse?
 10 November 2017 8

Skills needed as a trauma nurse

Critical and decisive thinking

Critical and decisive thinking is the ability to take a necessary action
in order to improve a situation. Trauma nurses must be able to
recognise and act quickly to provide life saving interventions. They
must remain calm under extreme pressure, manage multiple priorities
and tasks, and quickly provide and follow instructions in chaotic
situations.
 10 November 2017 9

Skills needed as a trauma nurse

Communication
Being able to communicate effectively to patients and families, the
trauma multi-disciplinary team efficiently is vital for the care of the
patient. This means being able to understand complex concepts and
medical terms so that you can understand and communicate what
needs to be done in order to effectively improve a patients health.

Clear and compassionate communication is essential in trauma

nursing, as distressed family members often ask nurses for updates
about their loved ones status.
 10 November 2017 10

Skills needed as a trauma nurse

Leadership
Quality and effective initial assessment and resuscitation of trauma
patients require a multidisciplinary trauma team led by medical and
nursing staff. A Trauma Nurse Leader can identified and resolved issues
in trauma room, improve team dynamics, the identification of patient
deterioration, improving patient outcomes and communication.
 10 November 2017 11

Skills needed as a trauma nurse

Teamwork mentality
Trauma care is a multidisciplinary team. While it is important that
individual members are highly skilled and technically competent
there are a number of key attributes that every team member should
display:
clear understanding of individual roles
awareness of shared goals
ability to display resilience under stress
ability to cooperate on a personal and professional level
flexibility to handle whatever comes their way
Nursing at The
Alfred
through the
Trauma Patient
Journey
 Alfred Health
3 hospitals;
o The Alfred Hospital (acute)
o Sandringham Hospital (sub-acute)
o Caulfield Hospital (rehabilitation)
Approximately 900 beds; 100,000 ED presentations; 110,000 inpatient events;
170,000 outpatient attendances
Approximately 5000 equivalent-full-time staff made up by around 8500 people
State-wide services for trauma, burns, heart & lung transplants, HIV / AIDS,
hyperbaric service, cystic fibrosis, haemophilia, Melbourne Sexual Health Centre
AUD 1.1 Billion per annum
Staffing at The Alfred
8432 Employees
672 (EFT) Doctors
2368 Nurses
554 Volunteers
Emergency and Trauma Centre

The Alfred

Timely Quality Care

 10 November 2017 15

Emergency and Trauma Centre

260 full time, part time and casual nurses

Nurse Unit Manager: 1
Associate Nurse Unit Manger: 6
Clinical Nurse Specialist: 39
Critical Care Trained Nurse: 110
Educators: 6
 10 November 2017 16

Nurses in Trauma Team

Trauma Centre
o 4 beds
o AM Shift (0700 1530hrs): 3 Nurses
o PM Shift (1300 2130hrs): 3 Nurses
o Night Shift (2100 0700hrs): 3 Nurses

Trauma Nurse Team

o Critical Care Nurse Leader: 1

o Critical Care Trained Nurse: 2
 10 November 2017 17

What is Trauma Nurse ED?

Emergency Nurses who are assigned to the Trauma Centre
Nurses are required to complete Postgraduate Certificate in
Emergency Care before working in the Trauma Centre
Care for people with critical, often life-threatening injuries.
These injuries include auto accidents, blunt trauma, penetrating
trauma, work accidents, electrocutions, burns, and many more.
They work in tandem within a multidisciplinary trauma team to
receive and resuscitate the patients.
Have an excellent knowledge of policies and procedures of the
trauma systems, ensuring smooth running of the trauma care.
 10 November 2017 18

Nurses in the trauma team - ED

Play a critical role in the

management of the trauma
patient.
It is important for nurses to
be knowledgeable about
trauma assessment, the
mechanisms of injury and
the high risk and frequent
complications that threaten
the trauma patient.
 10 November 2017 19

Nurses in Trauma Team Activation

They are 3 nurses on the

team.
They are allocated to their
specific roles at the
beginning of each trauma
o Trauma Nurse Leader
o Airway Nurse
o Procedure Nurse
 10 November 2017 20

Trauma Nurse Leader

Communicates and co-

ordinates trauma team activities
alongside the medical team
leader
Ensures that the trauma bay is
set up and all equipment is
ready according to the pre-
hospital information.
Ensures that all team members
are following universal
precautions and that roles are
clearly delegated
Ensures adequate number of
Trauma Bay

team members present with the

right skill mix
 10 November 2017 21

Trauma Nurse Leader

Collates all information and records it on
trauma charting
Keeps an accurate record of time of arrival,
interventions and events
Records drug dosages, time of administration
and amounts
Ensures that the primary and secondary
surveys have been completed and outcomes
documented
Communicates with other departments based
on patient needs and as directed by the
Medical Team Leader, for example, blood
bank (blood products), operating suite (urgent
transfer to theatre)
Communicates with family members
regarding patient progress in consultation with
Medical Team Leader
Arranges disposition of the patient, admission
and transfer
 10 November 2017 22

Airway Nurse

Introduces self to the Airway Doctor

Ensures a safety check of all necessary
airway equipment has been completed prior
to arrival of patient
Ensures that a functioning bag valve mask
circuit attached to oxygen flow meter is ready
for use
Ensures drugs are available for rapid
sequence intubation if required
Ensures that oxygen is being delivered via a
face mask with high flow oxygen
Ensures spinal immobilisation is maintained
as required
Prepares equipment for portable monitoring
for transfer to CT or operating suite
 10 November 2017 23

Procedure Nurse

Introduces self to Procedure Doctor

Works alongside Procedure Doctor
Removes patient clothing
Attaches all monitoring
Applies blanket to prevent hypothermia
Clearly communicates vital signs to Nurse
Team Leader for documentation
Assists Procedure Doctor with procedures
Gives (warmed) fluids
Assists with haemorrhage control and
splinting
Assesses level of patients pain and
administers prescribed pain relief as required
Assesses, cleans and apply dressing to
wounds
 10 November 2017 24

Trauma Nurse role at The Alfred

CLINICAL
Clinical nurse leadership in reception and resuscitation of the trauma
patient
Critical care of severly ill trauma patients in Intensive Care Unit
Ongoing care of trauma patients in the ward

RESEARCH
Developing, managing and implementing the trauma registry
Involvement in trauma research Trauma Resuscitation and
Reception (TRR) Software
Trauma quality improvement and audits
Development of trauma management

EDUCATION
Short course development and implementation
Post graduate training
 10 November 2017 25

Continuum from novice to expert

Specialty Post-
training graduate
Graduate Foundation Courses Trauma
Courses Nurse
nurse Grad Nurse Doctorate
in-house Practitioner
Bachelors Diploma Leader (in- of Nursing
accredited (Masters)
Degree Critical house)
courses Care
EMERG88 Nursing

Starting point
 10 November 2017 26

Accredited Foundation Courses

Introduction to Emergency Nursing (Accredited Course -
Alfred)

o Emergency Nursing Fundamentals and Trauma Nursing (Alfred)

12 week part-time

o Intermediate Emergency Nursing (Alfred)

oTrauma Nursing Program (Alfred)
o Relevant to Victoria State Trauma System (VSTS)

Other Foundation Course

o CENA Trauma Nursing Program (2 day course )
o Consists of two clinical modules, emergency nursing & trauma management
o Core trauma content focuses on management and system errors that were identified
in ROTES report 1999.
 10 November 2017 27

Graduate Diploma of Emergency Nursing

Designed for registered nurses currently working in the emergency
environment
Enables trauma nurses to anticipate and prioritise patient care,
provide accurate assessment, intervention and effective ongoing
management
Develops proficiency in emergency patient assessment and
management
Course assists nurses to become clinical leaders
Clinical experience is integrated and used to inform practice of others.
Pathway to a Masters degree
Alfred/Monash are in the process of developing a trauma specific
graduate diploma for nurses
 10 November 2017 28

Advanced Nursing Practice

Nurse Practitioner
o Advance Practice Emergency Nursing Short Course

Masters of Nursing (Emergency Care)

Masters of Nursing (Education)
Masters of Nursing (Research)
Doctorate
 10 November 2017 29

Related Short Courses

The Alfred Emergency & Trauma Centre/NTRI offer the following
courses:
Trauma Team Training Program
Basic Life Support Annual Competency for all clinical staff
o Online learning modules and assessment
Advanced Life Support Annual competency for all clinicians in
trauma
o Online and practical learning modules and assessment
Trauma Resuscitation Workshop
Introduction to Research Methods
Introduction to Biostatistics
Capacity Building
 10 November 2017 31

What is Capacity Building

the development and strengthening

of human and institutional
resources (WHO)

"the ability to perform functions, solve

problems, and achieve objectives at
three levels: individual, institutional
and societal. (United Nations
Development Program)
 10 November 2017 32

Building Trauma Nursing Capacity

AIMS & OBJECTIVES:

Fostering of individuals, institutions, and networks to expand,
enhance, and sustain the trauma and emergency nursing
workforce by:
Improving the quantity, quality, and relevance
Building local and regional partnerships
Identifying, evaluating, and disseminating innovative education
programs
Developing National Standards and a recognised professional body
Developing strategies for retention of staff and appropriate funding
 10 November 2017 33

Proposed pathway to trauma nurse capacity building

Commitment
(Policy)

Identification
Maintain &
of training
Retain
goals
Workforce
(Review)

Key
Partner
Development Development
of a Trauma or
Nursing identification
Faculty of courses

Training &
Mentoring Education
and Support (Train the
trainer)
 10 November 2017 34

OUTCOMES:
A comprehensive and sustainable
national strategy for trauma nursing
More lives saved and reducing the
burden of injury
Thank You!

Questions?
E.boo@alfred.org.au
www.ntri.org.au