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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?
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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
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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
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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?
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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.
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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 one’s status.
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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.
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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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 patient’s pain and
administers prescribed pain relief as required
• Assesses, cleans and apply dressing to
wounds
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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
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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
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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.
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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 Master’s degree
• Alfred/Monash are in the process of developing a trauma specific
graduate diploma for nurses
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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
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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
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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)
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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
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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)
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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