Developing Expertise in Critical Care Nursing

by Scholes, Julie

• ISBN13: 9781405117159
• ISBN10: 140511715X
• eBook ISBN(s): 9781405172141
• Edition: 1st
• Format: Paperback
• Copyright: 2006-11-17
• Publisher: Wiley-Blackwell
• More Book Details

Summary

This book examines the development of professional expertise in critical care nursing based on the extensive research in clinical practice. It debates the issues surrounding the characteristics of expert practice and practice development and examines the acquisition of core skills, role transition, and career development in critical care. It will be of interest to practitioners who aspire to advanced level practice in critical care and to all who facilitate this process.

Author Biography

Professor Julie Scholes is Principal Lecturer in Research and Practice Development at the University of Brighton, with a national and international reputation in research and critical care.

Table of Contents

Foreword	xi
Preface	xiii
Acknowledgements	xvii
Author profiles	xix
Part 1: Theoretical pillars and political context of developing expertise in critical care	1	(52)
Expertise in critical care	3	(14)
Introduction	3	(2)
What is expertise? A review of the literature	5	(2)
Role modelling clinical decision making	7	(3)
The journey to expertise: the learning transitions model	10	(3)
Chapter overview	13	(2)
References	15	(2)
Critical to care: towards a model of caring excellence	17	(18)
Introduction	17	(1)
The dose of nursing	17	(5)
Scenario 2.1: Self before service	20	(1)
Scenario 2.2: The impact of a cast-away comment	20	(1)
Scenario 2.3: Contrasting absence and presence	21	(1)
Scenario 2.4: A model of excellence	22	(1)
Self in therapeutic service	22	(4)
Scenario 2.5: Cure and care	23	(1)
Scenario 2.6: Caring as common sense	24	(2)
Factors that impede caring excellence	26	(1)
Context	26	(1)
Factors that impede the transmission of expertise	27	(1)
Nurses who are uninterested in nursing	28	(2)
Managerialism and marketisation	30	(1)
References	31	(4)
The dynamic context of critical care provision	35	(18)
Caroline Williams
Introduction	35	(1)
The NHS and the modernisation agenda	35	(2)
Defining critical care	37	(1)
Modernising critical care services	38	(4)
Critical care networks	39	(1)
Developments in critical care outreach	39	(2)
Critical care follow-up	41	(1)
The Discovery Interview Process	41	(1)
Care bundles for critical care	42	(1)
Challenges for specialist services within critical care	42	(3)
Challenges for paediatric nursing in critical care	42	(1)
Reforms in emergency care services	43	(1)
Critical care or coronary care?	44	(1)
Supporting and retaining the critical care workforce	45	(2)
Education for developing practice	47	(1)
Conclusion	48	(1)
References	49	(4)
Part 2: Facilitating learning transitions towards expertise in critical care nursing	53	(102)
Role transition	55	(21)
Introduction	55	(1)
Theoretical perspective	55	(1)
Role transition and nursing	56	(1)
The process of role transition	57	(10)
Antecedent conditions	58	(1)
Scenario 4.1: Factors that trigger a role transition into an outreach service	59	(1)
Expectations	60	(3)
Role adjustment and role adaptation	63	(1)
Role strain	64	(1)
Moderators	65	(1)
Reactions	65	(1)
Consequences	66	(1)
Career transitions: the impact on professional and personal identity	67	(4)
Re-writing the self	68	(1)
Typologies of transition	69	(1)
The vicarious transitioner	70	(1)
Facilitating learning transitions in the induction period	71	(1)
References	72	(4)
Learning and transitions	76	(29)
Introduction	76	(1)
Pre-registration exposure to critical care nursing	76	(1)
Making a difference? Student placements in critical care	77	(2)
Outreach: learning critical care skills in the acute care environment	79	(2)
Learning the science to inform critical care skills	81	(2)
Facilitating the student through the preparation and encounter phase of their allocation to critical care	83	(2)
Socialisation and learning	85	(5)
Expectations of the experience	85	(1)
Initial behaviours on the A&E placement	86	(2)
`Fitting in'	88	(2)
Post-registration education in critical care	90	(8)
Socialisation in education: the case in post-registration programmes	91	(5)
Standardising educational competencies for critical care	96	(2)
Implications for future provision of critical care education	98	(2)
Factors to consider when facilitating learning transitions in colleagues	100	(1)
References	101	(4)
Effecting transitions: transforming knowledge and practice	105	(20)
Introduction	105	(1)
Facilitating transitions for registered nurses	105	(8)
Newcomers and novices to critical care	106	(1)
The practitioner returning to nursing	107	(1)
Factors to consider when facilitating a newcomer, novice and return-to-nursing practitioner	108	(1)
Scenario 6.1	109	(1)
Silent transitions: acting up	110	(1)
Facilitating horizontal transitions	111	(2)
Facilitating transitions into senior posts	113	(1)
Reflection	114	(6)
Strategies for facilitating interactive reflection	115	(5)
Conclusion	120	(1)
References	121	(4)
Assessment as learning	125	(30)
Introduction	125	(1)
Failing to fail	126	(16)
Procedural issues	126	(2)
Scenario 7.1a: Warning signs -- `attitude problem'	128	(2)
Scenario 7.1b: The consequences of inaction	130	(1)
Differing agendas	130	(1)
The students' perspective	131	(1)
Scenario 7.2: Red flag -- `high support'	132	(3)
The validity and reliability of the practice assessment documentation	135	(1)
Scenario 7.3: The OSCE assessment	135	(2)
Questioning	137	(1)
Scenario 7.4: Questioning to identify competence	138	(3)
The practice educators	141	(1)
Assessment of post-registered students	142	(1)
Transforming the practice of demotivated colleagues	143	(8)
Step 1: Recognition of one's limitations	143	(3)
Step 2: Confronting contradiction creating high intellectual interference	146	(2)
Step 3: Critical reflection and self-evaluation	148	(3)
Conclusion	151	(1)
References	151	(4)
Part 3: New ways of working: the contemporary context for developing expertise	155	(67)
Competence: the building blocks of professional practice	157	(22)
Introduction	157	(1)
Applying core skills and advancing clinical competence in critical care	158	(9)
Competence	159	(1)
Debate about competence-based approaches	160	(2)
The NHS Knowledge and Skills Framework	162	(1)
Skills for Health Framework	163	(1)
Faculty of Emergency Nursing Framework	164	(1)
Competence deflation and up-skilling	165	(2)
The role of the support worker in critical care	167	(7)
Factors inhibiting delegation to support workers	168	(2)
The transition from professor to HCA	170	(1)
Scenario 8.1: Reflecting on delegating fundamental care	171	(1)
Scenario 8.2: Reflecting on implicit criticism?	172	(1)
Scenario 8.3: Delegating observational tasks to the HCAs	172	(2)
Conclusion	174	(2)
References	176	(3)
New roles in critical care practice	179	(28)
John W. Albarran
Introduction	179	(1)
New roles: the early background	179	(1)
The context of new roles -- extension, expansion and development	180	(9)
The impact of health service reforms	180	(1)
The impact of government initiatives	181	(2)
Scenario 9.1	183	(1)
Scenario 9.2	184	(1)
Changes in the delivery of services	185	(2)
Professional expectations	187	(1)
Blurring and blending of roles	188	(1)
The nature and scope of nursing roles	189	(2)
Substitution of tasks	191	(3)
Intermediate and narrow-focus substitution	191	(2)
Scenario 9.3	193	(1)
Blended and bounded roles	194	(3)
Examples of autonomous practice	196	(1)
Consequences of new nursing roles	197	(1)
Loss of experiential wisdom	197	(1)
Educational preparation and advanced roles	198	(1)
Moving role transition forwards -- facilitators and barriers	199	(1)
Conclusion	200	(1)
Acknowledgement	201	(1)
References	201	(6)
Future gazing: the place for expert nursing?	207	(15)
Introduction	207	(1)
Leadership for the future	207	(1)
Advances in biotechnology	208	(1)
Moral and ethical health care and economics of provision	209	(1)
Hospitals as intensive care units	209	(1)
The emergence of new professions	210	(1)
Information technology and the place of nursing in future critical care provision	211	(2)
Future predictions on trends and drivers for critical care provision	213	(3)
The rise of fundamentalism and conservatism	213	(1)
Funding for science and technology moves into the private sector	213	(1)
Public involvement	214	(1)
The (re)emergence of revered intellectuals and professionals	215	(1)
The restoration of public trust in the new professions	215	(1)
Accountability for waste production and disposal	216	(1)
Global risks	216	(1)
Conclusion	217	(2)
References	219	(3)
Index	222