Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

Highlights

• ISTNR utilizes expert nursing knowledge in managing trauma patient care.

• ISTNR provide individualised bed-side education for nursing staff in the care of trauma patients.

• ISTNR improved inter-departmental collaboration around trauma patient care.

• Changes to trauma patient care was directly due to ISTNR.

Abstract

Background

Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.

Objectives

The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.

Methods

The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.

Results

There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.

Conclusions

Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.

Introduction

Trauma patients admitted to the Intensive Care Unit (ICU) frequently present with complex and clinically challenging care needs including significant life-changing scenarios. The complexity of trauma patients’ injuries requires multiple speciality medical teams to provide specific care (Rose, 2011). Effective communication and inter speciality collaboration is essential to enhance the quality of patient care as the focus needs to be on the patient as a whole and not one aspect of their injury (Costa et al., 2014, O’Leary et al., 2011).

Providing optimum nursing care to complex ICU trauma patients is equally challenging as nurses have varying levels of skill and knowledge. Patient care is contingent upon the nurses’ ability to make effective evidence based clinical decisions (Gardner et al., 2010) and nurses may benefit from support to implement best practice to effectively care for complex trauma patients.

Nursing Rounds provide a process by which patients are discussed on an individual basis to identify challenges and issues. Exchanges of information among team members occur (Catangui and Slark, 2012, Dodek and Raboud, 2003) and educational opportunities within a specific patient context provide meaningful, contemporaneous patient-centred care (Catangui and Slark, 2012, Gardner et al., 2010, Vincent, 2005).

Nursing Rounds have been previously described to consist of nursing specialists from the ward in which the patient resides. Attendees potentially include the nurse in charge, other experienced nurses and direct patient care nurses (Catangui and Slark, 2012, Costa et al., 2014). They have been lauded as effective in instigating changes to ICU patient care (Aitken et al., 2010). Intensive Care nurses and patient care may benefit from drawing on expert nursing knowledge from other areas such as emergency departments, orthopedic units, spinal and trauma services. We have coined these as Inter Specialty Trauma Nursing Rounds (ISTNR), defined as a nursing round with expert specialty nurses from across the hospital together with ICU nurses who collectively discuss the best care options for the trauma patient at the bed-side.

The aim of this study was to improve trauma patient care. ICU direct care nurses’ perceptions of ISTNR was assessed in terms of patient benefits and quantified the subsequent patient care changes.