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Changing practice

Setting up a training course to improve care for burn and plastic surgery patients

  • Comment

A training gap in a trust’s burn service was identified so a new university accredited course was set up for staff in the field of burn care and plastic surgery

 

Authors

Sharon Donnelly, BSc, RSCN, RGN, is sister, practice development, paediatric burns and plastic surgery; Jane Pragnell, BSc, RGN, is nurse practitioner; both at Royal Victoria Infirmary, Newcastle upon Tyne.

 

Abstract

Donnelly S, Pragnell J (2009) Setting up a training course to improve care for burn and plastic surgery patients. Nursing Times; 105: 43, early online publication.

The National Burn Care Review recommended that the care of all inpatient burn injuries should be provided by specialists trained in burn care.

This article outlines an initiative by The Newcastle Upon Tyne Hospitals Foundation Trust to deliver a university-accredited course for practitioners in its burn service.

Keywords Burn care, Burns, Plastics, Education

  • This article has been double-blind peer reviewed

 

Practice points

  • Setting up this course has ensured that burn care standards are now met. An experienced workforce delivering evidence-based practice also ensures patient safety.
  • It is one of the few courses around the country which provides models to meet the needs of paediatric and adult patients in this field.
  • This model could be - and is already being - used by other specialties facing similar training issues.

 

Introduction

In 1998, the British Burn Association launched a thorough review of UK burn care, as there was growing evidence that services were disorganised, inadequate and inequitable from patients’ perspective.

The National Burn Care Review (NBCR) (2001) recommended that the care of all inpatient burn injuries should be provided by specialists trained in burn care. It also recommended that in burn units and burn centres, 75% of the RGN and RSCN staff should be involved in or have completed a study course in burn-related care validated by a university. For more senior levels of staff this should be 100%.

The need for the course

At the time of the review, burn services at Newcastle Upon Tyne Hospitals Foundation Trust did not meet all the recommendations regarding training for nursing staff. The practice development team had already completed a training needs analysis across paediatric and adult care, which highlighted a theory-practice gap. This provided further confirmation of the need for a course to meet the specific training needs of staff, while also satisfying the educational standards set out by the NBCR (2001). Without full compliance with these standards, burn centre status would not be granted.

To address these needs course places for a burns and plastics course were purchased from a university in 2005. Unfortunately, the course came in at a high financial cost for the trust and student evaluations rated it as poor, failing to meet their expectations. Completion rates were approximately 50%, as only half the attending students submitted work.

Therefore the project’s aim was to develop a university-accredited course which would enable practitioners in burn care and plastic surgery to develop understanding and expertise in these specialist areas by exploring research-based practice. It would provide a cost-effective way of ensuring staff were appropriately trained as well as meeting defined NBCR standards.

Education in clinical nursing

Learning and development are central to delivering the government’s vision of patient-centred care (Department of Health, 2001). The first step in creating the burns and plastic surgery course was to consider the role of education in clinical nursing.

Benner (1984) described the five stages of development in clinical nursing as novice, advanced beginner, competent, proficient and expert. Although all nurses may begin as novices, not all will become expert. Knowledge, alongside clinical reasoning and virtue, can be considered a key component of expertise (Jensen, 1999). Therefore, the course would be designed to enhance clinical nurses’ professional skills and knowledge, helping to move them closer to being an expert.

Collins et al (2002) argued that the principles of good learning should be transformative, active and interactive, intrinsically motivating and lifelong, and should take place in the context of nurturing relationships and rich communications. It was essential that the course was designed to meet the needs of healthcare staff.

Portfolio development at postgraduate level should focus on the link between theory and practice and stress the importance of reflecting on practice (Joyce, 2005). Nurses can also use the portfolio to develop their clinical career pathways and encourage personal development planning (Joyce, 2005). Therefore portfolio development and critical analysis skills were chosen as tools to facilitate learning in the course.

The course

The burns and plastic surgery course forms part of the BSc Hons/Adv Dip/PGC Practice Development (practice development module) delivered by the burns and plastic practice development team at The Newcastle Upon Tyne Hospitals Foundation Trust. It was accredited by the University of Northumbria.

It consists of two theoretical units and its credit value is 40 points at level six. The units have been carefully designed to help students develop analytical skills to enable them to critically evaluate specialist therapeutic interventions which patients may require.

The focus is to build on their current knowledge and clinical experience. This is achieved through critical analysis of contemporary care practices for a child or adult following burn trauma and/or for a child or adult who may need plastic or reconstructive surgery from: immediate resuscitation; during the critical and acute phases of care; wound healing; and the peri-operative phase of rehabilitation and beyond. Patients’ physical, psychological and psychosocial needs are explored and discussed. The roles of the family and members of the multidisciplinary team are also explored to promote an integrated approach to burn care.

Applicants are qualified healthcare professionals working in an area where they manage patients with a burn injury or plastic reconstructive surgery. This may include working in a burn centre, trauma unit, intensive care unit, plastic surgery unit, A&E or primary care.

The course aims to advance existing knowledge and expertise, and develop specialist clinical decision making in the assessment, treatment and management of children or adults following burn trauma and/or requiring plastic or reconstructive surgery. It also enables students to develop higher levels of judgement and decision making in line with specialist practice criteria.

The modules cover:

  • Anatomy and physiology of the skin and underlying tissues;
  • Principles of plastic and reconstructive surgery;
  • Ethical issues in burn care;
  • Congenital deformities;
  • Traumatic wounds;
  • Classification and management of specific types of burns;
  • Contemporary wound management practices;
  • Primary burns surgery;
  • Altered body image;
  • Management of scarring and contractures.

The course is delivered in two modules (burns module and plastics module) over 10 weeks. Summative assessment for the modules is through submission of a portfolio of evidence.

The process

There are few such courses around the country and this one provides models to meet the needs of paediatric and adult patients in the field of burn care and plastics. A multidisciplinary approach to course delivery allows a wide range of expert knowledge to be shared. This helps to address the theory-practice gap identified in the training needs analysis.

These are the key steps in setting up the course, which other trusts might find helpful:

  • Create a proposal outlining the project’s aims, timeframe, costs and benefits for the trust;
  • Present the proposal to the directorate manager to ensure full support;
  • Seek approval from the trust education forum with funding from the university education contract;
  • Create a course synopsis, module handbook, objectives and approach the university for accreditation;
  • Receive approval and assign a university course leader;
  • Once the course content has been confirmed, assign subjects to speakers with expertise in the area;
  • Advertise the course both internally and externally;
  • Start the course;
  • Obtain evaluation from students;
  • Analyse this and modify course accordingly.

In this case, it took just 12 months from creating the proposal until the course started.

Evaluation

The course runs annually and is now in its third year. It is always fully subscribed and we now have a waiting list. The course content has encouraged inter-professional participation.

To date, 30 staff have completed the course, with a pass rate of 85%. Within the trust, 100% of senior and 50% of junior staff in paediatrics now meet the standard NBCR requirement, while in adult care 60% of senior and 50% of junior staff meet this.

Evaluations are fundamental to the course’s success and evaluation reports are distributed to senior key staff. Comments from student evaluation forms include:

  • Would like the course to have gone on longer”;
  • Nice to involve patient perspective, enlightening”;
  • Covering all aspects from different users’ perspective must be challenging but has worked really well.”

In addition, all those students who responded felt the course had been beneficial in their practice.

The course continues to evolve. Initially it was validated as meeting the requirements for 20 level six points, which is the standard number of points for a 10-day module at higher education institutions. However, the academic leads were particularly impressed with the quality of portfolios that students produced and so increased the number of points awarded to 40.

We have now incorporated patient experience, with a patient from the “burn buddies group” talking about their journey of care.

While delivering a new, university accredited course has been a huge undertaking, feedback has been extremely positive. There has also been much interest in this course from other directorates keen to deliver similar programmes, which is a further measure of our success.

Conclusion

The National Burn Care Review recognised that once the recommended changes were efficiently implemented burn care in the UK could once again be of world-class quality. This is what the burn services at Newcastle Upon Tyne Hospitals Foundation Trust strive towards and is closer to achieving following the successful implementation of this course.

Background

  • In the UK approximately 250,000 people suffer burns each year (Hettiaratchy and Dziewulski, 2004).
  • It is estimated that about 30% of children and 40% of adults requiring hospital admission are admitted to non-specialist burn units (National Burn Care Review, 2001).


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