Trauma Competencies Research Articles

Standard setting for orthopaedic trauma competencies in postgraduate specialty training- catching those falling behind the curve

BackgroundThe Curriculum for Trauma and Orthopaedics focuses on producing competent Day-One Consultants. However, the expected development trajectory is not clear. It is important, yet difficult to objectively identify trainees who are “falling behind”. This project proposes practical, consensus-based thresholds of Operative Trauma Competence at each Waypoint stage of training. Methods32 trainers and 73 trainees in one Deanery were identified. The trainers and trainees were asked their PBA level expectation of a trainee at ST4, ST6 and ST8 for nine trauma competencies. Lower quartile values were calculated providing thresholds. Results53 (72%) trainees and 22 (69%) trainers responded. At ST8, the lower quartile threshold was level 4 for all procedures. At ST6, three operation groups became apparent: Group 1 (hip hemiarthroplasty, Dynamic hip screw; k-wire distal radius fracture and Weber C Ankle open reduction, internal fixation (ORIF)) Group 2 (Tibial Nail; Olecranon Tension band wire, ORIF radial shaft; distal radius plate fixation)- Group 3 (supracondylar fracture fixation)Threshold levels for procedures were: Group 1- 4a; Group 2–3b and Group 3- 3a.At ST4, there was more variation and spread in responses, however, expectations could still be similarly grouped: Group 1- 3a; Group 2- 2b and Group 3- 2a. ConclusionIn an increasingly competency-based training environment we provide tangible thresholds for expectations of orthopaedic trainees’ progression and development. We identified two groups: basic trauma (Group 1 where level 4 competencies should be attained by ST6) and intermediate trauma (Groups 2 and 3 where level 4 competencies should be attained by ST8.)

The Trauma and Development Education Monitor (TANDEM): et nytt instrument for å måle traumekompetanse

There is a need to assess whether the resources invested in building trauma competence in services actually lead to higher levels of competence. For this purpose, we have developed an instrument called the Trauma and Development Education Monitor (TANDEM). The present article presents the process behind developing the instrument and an initial study of its psychometric properties. The tested version consisted of 59 items distributed across the domains of readiness, agency, reflexivity, knowledge, practice and culture at work. Based on responses from 415 professionals in relevant services, concept and criterion validity was examined through reliability analyses, factor analyses and regression analyses. Based on the analyses, the tested version was reduced to 54 items in the final version, distributed across the same six domains. As dimensions, the domains generally showed good scale reliability, and for the final version factor analyses confirmed a one-dimensional model for all domains. The instrument discriminated between respondents who reported more versus less previously received trauma competence building and showed specificity as a measure of trauma versus more general competence. The results indicate that TANDEM has the potential to become a useful tool in endeavours to implement trauma competence in services, as well as in research activities in this field.

Clinical competencies of emergency medical services paramedics in responding to emergency conditions using Objective Structured Clinical Examination (OSCE) in Guilan

Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.

Trauma training: Competencies, initiatives, and resources.

Traumatic stress is currently not a required component of the standard curricula in graduate-level education in clinical and counseling psychology. However, due to the high prevalence of trauma and its potentially deleterious physical and mental health effects in the general and clinical populations, it is imperative that psychology graduate students and practitioners understand the relevance of trauma in their clients' lives and its impact in clinical research. A comprehensive model of trauma-focused empirically informed competencies (knowledge, skills, and attitudes) was developed at a national consensus conference in 2013 and approved by the American Psychological Association in 2015 as part of that organization's education and training policy. These trauma competencies predated the American Psychological Association's Posttraumatic Stress Disorder Guidelines, and provided consensus about the scientific, theoretical, ethical, and professional foundational knowledge, skills, and attitudes for all trauma-informed professional practice, not solely treatment. The two endeavors are related and potentially synergistic, but separate. Intended to guide training programs' curriculum development and psychologists' self-monitoring, the trauma competencies serve as aspirational goals for psychologists. Training issues in these and other trauma competencies are discussed. Perhaps, most importantly, the scientific literature on trauma is constantly evolving, and thus embracing an ever-evolving curriculum and lifelong-learning approach is essential. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

3.29 Increasing Child Trauma Competence Among Mental Health Providers Through a Problem-Based Learning Approach

Curricula for training mental health professionals, including child and adolescent psychiatrists, on the complex impact of child trauma are limited. To address this issue, the National Child Traumatic Stress Network (NCTSN) developed the Core Curriculum on Childhood Trauma (CCCT), which incorporates 12 core concepts into child trauma case studies delivered to mental health professionals through a problem-based learning (PBL) approach. Primary CCCT learning objectives include using the core concepts to frame information, guiding critical reasoning, supporting case conceptualization, judging relative impact of factors, communicating effectively with stakeholders, and improving professional practice. The UCLA National Center for Child Traumatic Stress and the National Child Trauma Workforce Institute (NCTWI) at Hunter College are collaborating to develop a corps of CCCT facilitators and disseminate the CCCT across mental health disciplines nationwide, including child psychiatry. This analysis examines impact of this professional training.

Assessment of Anatomical Knowledge and Core Trauma Competency Vascular Skills.

Surgical residents express confidence in performing specific vascular exposures before training, but such self-reported confidence did not correlate with co-located evaluator ratings. This study reports residents' self-confidence evaluated before and after Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based training, and 12-18 mo later. We hypothesize that residents will better judge their own skill after ASSET than before when compared with evaluator ratings. Forty PGY2-7 surgical residents performed four procedures: axillary artery (AA), brachial artery (BA), femoral artery exposure and control (FA), and lower extremity fasciotomy (FAS) at the three evaluations. Using 5-point Likert scales, surgeons self-assessed their confidence in anatomical understanding and procedure performance after each procedure and evaluators rated each surgeon accordingly. For all the three evaluations, residents consistently rated their anatomical understanding (p < 0.04) and surgical performance (p < 0.03) higher than evaluators for both FA and FAS. Residents rated their anatomical understanding and surgical performance higher (p < 0.005) than evaluators for BA after training and up to 18 mo later. Only for third AA evaluation were there no rating differences. Residents overrate their anatomical understanding and performance abilities for BA, FA, and FAS even after performing the procedures and being debriefed three times in 18 mo.

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Meta-analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self-regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.

Performance of Vascular Exposure and Fasciotomy Among Surgical Residents Before and After Training Compared With Experts

Surgical patient outcomes are related to surgeon skills. To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. This longitudinal study performed from May 1, 2013, through February 29, 2016, at Maryland State Anatomy Board cadaver laboratories included 40 surgical residents and 10 expert traumatologists. Performance was measured during extremity vascular exposures and lower extremity fasciotomy in fresh cadavers before and after taking the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. The primary outcome variable was individual procedure score (IPS), with secondary outcomes of IPSs on 5 components of technical and nontechnical skills, Global Rating Scale scores, errors, and time to complete the procedure. Two trained evaluators located in the same laboratory evaluated performance with a standardized script and mobile touch-screen data collection. Thirty-eight (95%) of 40 surgical residents (mean [SD] age, 31 [2.9] years) who were evaluated before and within 4 weeks of ASSET training completed follow-up evaluations 12 to 18 months later (mean [SD], 14 [2.7] months). The experts (mean [SD] age, 52 [10.0] years) were significantly older and had a longer (mean [SD], 46 [16.3] months) interval since taking the ASSET course (both P < .001). Overall resident cohort performance improved with increased anatomy knowledge, correct procedural steps, and decreased errors from 60% to 19% after the ASSET course regardless of clinical year of training (P < .001). For 21 of 40 residents (52%), correct vascular procedural steps plotted against anatomy knowledge (the 2 IPS components most improved with training) indicates the resident's performance was within 1 nearest-neighbor classifier of experts after ASSET training. Five residents had no improvement with training. The Trauma Readiness Index for experts (mean [SD], 74 [4]) was significantly different compared with the trained residents (mean [SD], 48 [7] before training vs 63 [7] after training [P = .004] and vs 64 [6] 14 months later [P = .002]). Critical errors that might lead to patient death were identified by pretraining IPS decile of less than 0.5. At follow-up, frequency of resident critical errors was no different from experts. The IPSs ranged from 31.6% to 76.9% among residents for core trauma competency procedures. Modeling revealed that interval experience, rather than time since training, affected skill retention up to 18 months later. Only 4 experts and 16 residents (40%) adequately decompressed and confirmed entry into all 4 lower extremity compartments. This study found that ASSET training improved resident procedural skills for up to 18 months. Performance was highly variable. Interval experience after training affected performance. Pretraining skill identified competency of residents vs experts. Extremity vascular and fasciotomy performance evaluations suggest the need for specific anatomical training interventions in residents with IPS deciles less than 0.5.

Trauma from an Individual Psychology Perspective

Trauma from an Individual Psychology Perspective Roy M. Kern and William L. Curlette This special issue on trauma was organized by Paul Peluso and Kenneth McCurdy. The articles consist of the neurobiology and personality dynamics of trauma, first responders to public disaster, a conceptual model to address institutional and internalized racism, the challenges of introducing a trauma curriculum to counselors, and helping betrayed couples address the trauma of extramarital affairs. The lead article, “Trauma, Neurobiology, and Personality Dynamics: A Primer” by Len Sperry, was selected as the first article in this issue because it addresses the trauma response in the context of lifestyle dynamics in conjunction with the neurological functioning of the brain. The author’s knowledge of both provides a splendid conceptual base related to the interplay of lifestyle and trauma and, in particular, posttraumatic stress (PTSD). Sperry’s ability to address the complexity of the interplay of personality and neurological functioning is impressive. The next article, “The Private Traumas of First Responders” by Garner, Baker, and Hagelgans, brings awareness to the fact that firefighters, police, and other first responders are not immune to trauma or PTSD. The authors weave a convincing case with empirical findings, and a critical social variable, that first responders are impacted by trauma as much as the general population. The authors conclude with an Adlerian-based clinical case study of a firefighter with a diagnosis of PTSD. Lemberger and Lemberger-Truelove, for the first time in the history of Adlerian psychology as far as we know, have developed a model to explain to clinicians the impact of racial trauma from an Individual Psychology perspective. In their article “Using the Transcultural Adlerian Conceptualization and Therapy (TACT) Model to Depict the Influence of Race-Based Trauma,” they describe the evolution of race-based trauma from a historical perspective and then describe their theoretical approach, called TACT. They describe [End Page 159] how Individual Psychology can be used to explain institutional and internalized racism and the accompanying trauma. We found the article informative and useful for clinicians who may not be aware of these subtle biases in society. The Van Asselt, Soli, and Berry article, “Crisis Fearlessness: A Call for Trauma Competencies in Counselor Education,” explores through an Adlerian lens the hesitancy of counselor educators to make adjustments regarding crisis-based curricula for counselors-in-training. To assess such hesitancies, 17 counselor educators participated in an experiential activity at an Association for Counselor Education and Supervision (ACES) conference. The authors conducted a survey to identify reasons for participant hesitancy. Among the responses were concerns that curricula participants were not taught as graduate students, changing standards and curricula expectations, and lack of perceived pleasure or joy for the content. The concluding article provides ways of exploring the connection between traumatic stress and extramarital affairs. “A Trauma-based Physiological Approach: Helping Betrayed Partners Heal from Marital Infidelity” by Duba Sauerheber and Disque begins with a robust literature review of approaches for addressing marital infidelity. The authors present an applied counseling model with a number of techniques for use with betrayed partners during their healing processes, and encourage clinicians to further their studies of the various trauma-related references noted. Finally, the authors make a case for clinicians to explore how the trauma of an extramarital affair changes clients’ self-concepts and worldviews and how lifestyle influences their healing processes, noting that client experiences and healing processes will be as unique and varied as their lifestyles. [End Page 160] Copyright © 2016 University of Texas Press

Crisis Fearlessness: A Call for Trauma Competencies in Counselor Education

The authors examine counselor educators’ potential for hesitancies when it comes to teaching and demonstrating crisis-based curricula to graduate students who are counselors-in-training (CITs). Results are presented utilizing Adlerian concepts including superiority, compensation, and Gemeinschaftsgefühl. Seventeen counselor educators participated in an experiential activity at a national Association for Counselor Education and Supervision (ACES) conference session, with an opportunity to debrief and discuss after the cross-the-line experience. Identified topics for hesitancy included: concerns about teaching curricula the counselor educators were not taught as graduate students, time elapsed since degree completion, changing standards and curricula expectations, lack of perceived pleasure or joy for the content, and other insights shared by participants. Limitations are addressed. A discussion for a non-judgmental culture among counselor educators is proposed along with implications for the field. A final exploration of Individual Psychology is integrated, examining a lifetime of striving and how that may affect counselor educators and supervisors.

The experiences of orthopaedic and trauma nurses who have cared for adults with a learning disability

BackgroundThere is no published empirical research about the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. However, adults with a learning disability sustain more injuries, falls and accidents than the general population. Because of their increased health needs, there has been a corresponding increase in their numbers attending general/acute hospitals. The 6 Cs is a contemporary framework and has been used to gauge how orthopaedic and trauma nurses rate the Care, Communication, Competence, Commitment, Courage and Compassion for patients with a learning disability in orthopaedic and trauma hospital settings compared to patients without a learning disability. AimThe aim of the study was to explore the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. DesignThe study is based on a descriptive survey design and used a questionnaire to elicit data from participants. MethodsA convenience sample of Registered Nurses completed a questionnaire. The study was explained to delegates attending a concurrent session on the topic of acute hospital care for people with a learning disability at a conference and the questionnaire was left on a table for participants to take if they wished. Questionnaires were returned anonymously. FindingsOf the participants who had completed the questionnaire 100% (n = 13) had cared for a patient with a learning disability. Using the 6 Cs as a framework suggested that care, communication and competence of nurses were worse for people with a learning disability than for people without a learning disability. Three main themes emerged regarding areas of good practices: (1) promoting a positive partnership with patients and carers; (2) modifying care and interventions; (3) supporting the healthcare team. ConclusionThere was evidence of good practices within orthopaedic and trauma settings such as the active involvement of family or a paid carer who is known to thepatient and the modification of care and interventions along with specialist advice and support from the Acute Liaison Learning Disability Nurse. There were areas of concern such as the lack of use of Hospital Passports and the inconsistent implementation of reasonable and achievable adjustments. It is unknown if the care for patients with a learning disability is adequate. However, the themes that have emerged accord with the key domains in ‘A competency framework for orthopaedic and trauma practitioners’ (Royal College of Nursing 2012a, 2012b) and therefore could be considered for inclusion in future orthopaedic and trauma competencies to enable sharing of best practices.

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS.Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

A rewarding teaching experience: taking ATCN to the USNS MERCY (T-AH 19).

Navy nurses are challenged to maintain trauma competency between deployment settings. The Advanced Trauma Care for Nurses (ATCN) course provides trauma nurse training to Navy nurses. Presenting ATCN in a nontraditional environment aboard a Naval vessel during a training exercise provided a rewarding teaching and learning experience.

Abdominal injuries in a major Scandinavian trauma center - performance assessment over an 8year period.

IntroductionDamage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period.MethodsData from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared.ResultsThere was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period.ConclusionEven in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM.

A consensus statement on trauma mental health: The New Haven Competency Conference process and major findings.

Although the scientific literature on traumatic stress is large and growing, most psychologists have only a cursory knowledge of this science and have no formal training in, nor apply evidence-based psychosocial treatments for, trauma-related disorders. Thus, there exists a clear need for the development and dissemination of a comprehensive model of trauma-focused, empirically informed competencies (knowledge, skills, and attitudes). Therefore, the New Haven Competencies consensus conference was assembled. Sixty experts participated in a nominal group process delineating 5 broad foundational and functional competencies in the areas of trauma-focused and trauma-informed scientific knowledge, psychosocial assessment, psychosocial interventions, professionalism, and relational and systems. In addition, 8 cross-cutting competencies were voted into the final product. These trauma competencies can provide the basis for the future training of a trauma-informed mental health workforce.

Development of a trauma care assessment instrument for emergency nurses in West Africa

<h2>Abstract</h2><h3>Background</h3> Strengthening the provision of emergency health services, including the nursing workforce, is progress towards decreasing the burden of injury in sub-Saharan Africa. The WHO Essential Trauma Care Guidelines provide minimum knowledge and skills to ensure quality in-hospital trauma care. Our aim was to develop an emergency nursing trauma care knowledge, attitudes, and skills minimum competency assessment instrument with WHO guidelines for African emergency care settings. <h3>Methods</h3> Constructs anchoring the assessment were defined by an expert panel of six emergency nurses from Ghana, Malawi, South Africa, and Tanzania, with a modified Delphi approach. The panel did each phase of the knowledge, attitudes, and skills instrument creation and validation by: (1) identifying objectives and attributes; (2) narrowing the domain of content previously predefined by WHO; (3) developing survey questions; (4) reviewing questions in the instrument; and (5) pilot testing the survey with 23 emergency nurses in Ghana. <h3>Findings</h3> A four-part instrument was created. Important objectives and attributes of the instrument included easy measurement and discrimination of trauma care knowledge, attitudes, and skills among emergency nurses in sub-Saharan Africa. Domains assessed were primary, secondary, focused, and ongoing trauma assessment and management, including team-oriented practices, nursing analysis, planning, and implementation. The knowledge, attitudes, and skills instrument included ten demographic and 46 attitude questions self-administered on paper, 49 open-ended oral interview questions, and 26 administered in an observed patient simulation format. Pilot results show the instrument was easy to apply, appropriate for low-resource testing, and was able to discriminate knowledge, attitudes, and skills among nurses of various competencies. <h3>Interpretation</h3> In Ghana, the longitudinal assessment instrument should be implemented for cohorts of newly trained emergency nurses. In other sub-Saharan African countries, actively trained emergency nurses the instrument should be locally validated and piloted, then deployed to measure basic trauma competencies between nurses. Ultimately, the instrument should serve as a standard across sub-Saharan Africa for measurement of competency among nurses, thereby allowing multination comparisons or longitudinal assessments. <h3>Funding</h3> Fogarty International Center.

Using the Core Curriculum on Childhood Trauma to Strengthen Clinical Knowledge in Evidence-Based Practitioners

The high prevalence of trauma exposure in mental health service-seeking populations, combined with advances in evidence-based practice, competency-based training, common-elements research, and adult learning make this an opportune time to train the mental health workforce in trauma competencies. The Core Curriculum on Childhood Trauma (CCCT) utilizes a five-tiered conceptual framework (comprising Empirical Evidence, Core Trauma Concepts, Intervention Objectives, Practice Elements, and Skills), coupled with problem-based learning, to build foundational trauma knowledge and clinical reasoning skills. We present findings from three studies: Study 1 found that social work graduate students’ participation in a CCCT course (N = 1,031) was linked to significant pre–post increases in self-reported confidence in applying core trauma concepts to their clinical work. Study 2 found significant pre–post increases in self-reported conceptual readiness (N = 576) and field readiness (N = 303) among social work graduate students participating in a “Gold Standard Plus” educational model that integrated classroom instruction in core trauma concepts, training in evidence-based trauma treatment (EBTT), and implementation of that EBTT in a supervised field placement. Students ranked the core concepts course as an equivalent or greater contributor to field readiness compared to standard EBTT training. Study 3 used qualitative methods to “distill” common elements (35 intervention objectives, 59 practice elements) from 26 manualized trauma interventions. The CCCT is a promising tool for educating “next-generation” evidence-based practitioners who possess competencies needed to implement modularized, individually tailored trauma interventions by strengthening clinical knowledge, clinical reasoning, and familiarity with common elements.

Cumulative Trauma and Relational Competence

What about the patients who grew up in good families, whose reliable reports are free of explicit abuse? And yet they have difficulty in negotiating the worlds of career, friendship, and intimacy. Cumulative trauma is a concept that describes a child's experience of chronic lack of attunement to her developmental needs. And the concept of deficits in relational competence is one way to understand the consequences of cumulative trauma.

Self-Assessment of Trauma Competencies among Army Family Nurse Practitioners

The objective of this descriptive study was to determine whether Army family nurse practitioners perceive themselves as competent in providing trauma care. Using an adaptation of trauma competency outcomes from various trauma courses, all Army family nurse practitioners were asked to evaluate self-perceived level of trauma competence and self-perceived importance of trauma skills. Results (n = 96) indicate a general agreement that all skills identified in the questionnaire were important in the management of a trauma patient. The respondents considered themselves trained/somewhat competent or higher in 50% of the skills identified. Mann-Whitney U analysis was used to compare various groups within the sample. Significant differences on self-perceived competency were noted with intensive care/emergency room, Advanced Trauma Life Support, and deployment experience. Trauma Nursing Core Course experience was not significant to self-perceived trauma competency. Findings support the need for additional trauma training, such as Advanced Trauma Life Support and hands-on trauma experience.

Monitoring performance: Longterm impact of trauma verification and review1

This study documents how the verification process at a Level I pediatric trauma center affected patient care through changes in care indicators (CIs) from predesignation through four postverification time frames. An important component of any verification program is its effectiveness, not only at the time of verification but during the time between "examinations." To date, few data exist describing the interval periods and the progression and maturation of a trauma program after initial verification. Forty-seven distinct CIs were monitored monthly through data generated from the trauma registry. Six distinct time periods were identified. PRE (January, June, October 1997), trauma care without monitoring; VER (November 1999 to September 2000), preparation for verification; and four postverification periods: P1 (January to June 2001), P2 (July to December 2001), P3 (January to June 2002), and P4 (July to September 2002). Between 1997 and 2002, trauma admissions increased from 200 per year to 313 per year. Mortality rate and Injury Severity Score distributions remained unaltered. Statistically significant (p < 0.05) quantitative and qualitative changes were observed in numbers (percent) of patients reaching clinical criteria. These included prehospital, emergency department, and hospital-based trauma competencies. Trauma patient evaluation (including radiology) and disposition out of the emergency department (<120 minutes) improved in each study section and remained high during the postverification time period. There was a strong pair-wise correlation (p < 0.005, Cronbach alpha 0.8) between CNS charting and acquisition of head CAT scans. Pediatric ICU duration of stay increased in both the (summer) P2 and P4 time periods. Prehospital and emergency department fluid monitoring remained unsatisfactory. Statistically significant changes in patient care indicators were noted to improve during the trauma center designation process, and other key deficiencies were identified and addressed. Maintaining these improvements requires constant monitoring or performance may revert below accepted levels.