Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of the burn-injured individual. In 2019 at the 51st Annual Meeting of the American Burn Association, nurses from four U.S. burn centers reported on their center’s incorporation of the competencies within their educational nursing curriculums. This paper provides a forum for each of the lead authors from Rhode Island Hospital Burn Center, the University of Utah Health Burn Trauma Intensive Care Unit, Parkland Regional Burn Center, and the University of Chicago Medicine Burn Center to outline their current utilization of the new burn nurse competencies and plans for future use. Competence in nursing practice is a recognized expectation by the U.S. healthcare consumer. The ability to demonstrate competence is also important to authoritative entities such as The Joint Commission (TJC) and other verifying agencies or societies (e.g., the American Burn Association for burn center verification). Without established and recognized standards of nursing care and documented educational preparation for staff, burn centers cannot ensure consistent and competent care.
Introduction Prior to 2020, our small burn center had 1x/wk adult burn clinic and 1x/wk pediatric burn clinic. This schedule did not allow for optimal access to care for the geographic area our burn center serves. Also, our inpatient daily census was steadily increasing, and we identified many barriers to discharge for our acute burn survivors that would help to justify to hospital administration the need for increasing the frequency of our burn clinic to daily. These barriers to discharge included decreased availability of visiting nurse agencies for dressing changes, poor quality of rehabilitation services through visiting nurse agencies, and comfort and/or competence with family and/or caregivers being able to provide quality needed burn care. Methods Our burn leadership team developed a business plan for an everyday burn clinic to provide to hospital administration. This daily burn clinic would allow for both adult and pediatric burn survivors to be seen Monday-Friday, provide rehabilitative services a space within our burn clinic, and availability of daily dressing changes in burn clinic. The business plan was reviewed by hospital administration, meetings were held with hospital administration, rehabilitation department leadership and ancillary services leadership to help validate the need for the daily burn clinic. Results Hospital administration approved our daily burn clinic in July of 2020 allowing for improved outpatient dressing and wound management, easy access to quality burn rehabilitation, translating to decreased length of stay. Communication was sent to all area emergency rooms, urgent cares, pediatrician offices and primary care offices to inform them of the increased availability of the burn clinic. This communication included the American Burn Association transfer criteria, a referral form to facilitate access to our burn clinic, and a simple algorithm for assistance with triaging burn care. Prior to the everyday burn clinic in 2019, we were seeing 1,155 outpatient visits annually and in 2021 we saw 1,728 visits in our burn clinic. This is a 150% increase in outpatient burn clinic visits in two years. Conclusions Increasing accessibility to outpatient care for the burn survivor can benefit many aspects in their journey to recovery as well as support the surrounding community in quick access to quality burn care. Burn survivors benefit from shorter hospital stays with the availability of a daily burn clinic for ongoing dressing management while maintaining quality rehabilitation services to maximize their functional outcomes. Applicability of Research to Practice Data could be collected to evaluate the true impact the creation of the daily burn clinic had on burn survivors’ length of stay. Also, data can be collected regarding the number of burn survivors treated at other local emergency rooms and/or urgent care facilities prior to the creation of the daily burn clinic to evaluate the efficacy of the communication provided to the community.
Introduction Many factors are incorporated into designing medical simulation curriculum. If the action or procedure falls into a low volume / high acuity category there is typically a focus on simulating the action or procedure in the lab with those who are responsible for performing it. The main objective is to increase knowledge and skill as well as self-efficacy (confidence) in a controlled simulation environment in order to decrease provider anxiety and medical error. Medical simulation can be moved “into the field” or in-situ to replicate the actual environment. This simple action builds muscle memory as well as increases provider awareness of tools at their disposal in their own working environments. We examined the burn competency feedback and discovered a consistent request for a more hands-on approach. Some reviews stated that nurses felt that the competencies were not relevant to their duties and tasks. Taking all of this into consideration we decided that this year the competencies will follow a single patient through every step from arrival to discharge, incorporating hands on medical simulation and realistic moulage. The goal of this implementation of medical simulation into burn nurse competencies is to provide a more direct, hands-on, learning experience where nursing staff could follow a patient from arrival to discharge. Methods Our objective was to provide an effective and engaging competency curriculum while maintaining adherence to the ABA Burn Nursing Competency Domains. The main stations that were identified, ED, OR, ICU, Floor Level Care, and Discharge/Follow Up Care. We then created a pediatric track, and an adult track following the main station identification. Learners will follow the selected case, determined by the clinical background of the group, from EMS report to discharge planning. Each station will incorporate ABA Burn Nurse Competency Domain objectives. These objectives include, but are not limited to, dosing of analgesia, airway management, wound management, and providing ongoing resources for the simulated patient. Results The program will begin on Oct. 2nd 2019 with sessions through October and November of 2019. Data will be collected from a pre and post survey to ascertain if incorporating simulation into the burn nurse competency curriculum is an effective tool to increase knowledge, skill, and confidence of the burn team RN. Conclusions Upon conclusion of this years burn nurse competencies, we aim to establish a working model to incorporate relevant simulations to all future competencies in order to complete all ABA domain objectives within a three year cycle. Applicability of Research to Practice The program, if proven effective, will provide a framework for future burn competency curriculum and could be utilized in multiple aspects of nursing competencies throughout the entire system and beyond.
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