Developing Expertise in Critical Care Nursing

Julie Scholes

• Publisher: Wiley-Blackwell
• Year: 2009
• Print ISBN: 9781405117159
• eBook ISBN: 9781405172141
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Developing Expertise in Critical Care Nursing examines the development of professional expertise in critical care nursing, based on extensive research in clinical practice. It offers a repertoire of learning and assessment methods that enable practitioners to grow their own expertise and foster developments in others.

Developing Expertise in Critical Care Nursing will be of interest to practitioners who aspire to advanced level practice in critical care and to all who facilitate this process. It debates the characteristics of expert practice and practice development and examines the acquisition of core skills, and career development in critical care using a role transition model.

Table of contents

• Foreword
• Preface
• Acknowledgements
• Author profiles
• Part 1 Theoretical pillars and political context of developing expertise in critical care
• 1 Expertise in critical care
• Introduction
• What is expertise? A review of the literature
• Role modelling clinical decision making
• The journey to expertise: the learning transitions model
• Chapter overview
• References
• 2 Critical to care: towards a model of caring excellence
• Introduction
• The dose of nursing
• Scenario 2.1: Self before service
• Scenario 2.2: The impact of a cast-away comment
• Scenario 2.3: Contrasting absence and presence
• Scenario 2.4: A model of excellence
• Self in therapeutic service
• Scenario 2.5: Cure and care
• Scenario 2.6: Caring as common sense
• Factors that impede caring excellence
• Context
• Factors that impede the transmission of expertise
• Nurses who are uninterested in nursing
• Managerialism and marketisation
• References
• 3 The dynamic context of critical care provision Caroline Williams
• Introduction
• The NHS and the modernisation agenda
• Defining critical care
• Modernising critical care services
• Critical care networks
• Developments in critical care outreach
• Critical care follow-up
• The Discovery Interview Process
• Care bundles for critical care
• Challenges for specialist services within critical
• Challenges for paediatric nursing in critical care
• Reforms in emergency care services
• Critical care or coronary care?
• Supporting and retaining the critical care workforce
• Education for developing practice
• Conclusion
• References
• Part 2 Facilitating learning transitions towards expertise in critical care nursing
• 4 Role transition
• Introduction
• Theoretical perspective
• Role transition and nursing
• The process of role transition
• Antecedent conditions
• Scenario 4.1: Factors that trigger a role transition into an outreach service
• Expectations
• Role adjustment and role adaptation
• Role strain
• Moderators
• Reactions
• Consequences
• Career transitions: the impact on professional and personal identity
• Re-writing the self
• Typologies of transition
• The vicarious transitioner
• Facilitating learning transitions in the induction period
• References
• 5 Learning and transitions
• Introduction
• Pre-registration exposure to critical care nursing
• Making a difference? Student placements in critical care
• Outreach: learning critical care skills in the acute care environment
• Learning the science to inform critical care skills
• Facilitating the student through the preparation and encounter phase of their allocation to critical care
• Socialisation and learning
• Expectations of the experience
• Initial behaviours on the A&E placement
• ‘Fitting in’
• Post-registration education in critical care
• Socialisation in education: the case in post-registration programmes
• Standardising educational competencies for critical care
• Implications for future provision of critical care education
• Factors to consider when facilitating learning transitions in colleagues
• References
• 6 Effecting transitions: transforming knowledge and practice
• Introduction
• Facilitating transitions for registered nurses
• Newcomers and novices to critical care
• The practitioner returning to nursing
• Factors to consider when facilitating a newcomer, novice and return-to-nursing practitioner
• Scenario 6.1
• Silent transitions: acting up
• Facilitating horizontal transitions
• Facilitating transitions into senior posts
• Reflection
• Strategies for facilitating interactive reflection
• Conclusion
• References
• 7 Assessment as learning
• Introduction
• Failing to fail
• Procedural issues
• Scenario 7.1a: Warning signs – ‘attitude problem’
• Scenario 7.1b: The consequences of inaction
• Differing agendas
• The students’ perspective
• Scenario 7.2: Red Flag – ‘high support’
• The validity and reliability of the practice assessment documentation
• Scenario 7.3: The OSCE assessment
• Questioning
• Scenario 7.4: Questioning to identify competence
• The practice educators
• Assessment of post-registered students
• Transforming the practice of demotivated colleagues
• Step 1: Recognition of one’s limitations
• Step 2: Confronting contradiction creating high intellectual interference
• Step 3: Critical reflection and self-evaluation
• Conclusion
• References
• Part 3 New ways of working: the contemporary context for developing expertise
• 8 Competence: the building blocks of professional practice
• Introduction
• Applying core skills and advancing clinical competence in critical care
• Competence
• Debate about competence-based approaches
• The NHS Knowledge and Skills Framework
• Skills for Health Framework
• Faculty of Emergency Nursing Framework
• Competence deflation and up-skilling
• The role of the support worker in critical care
• Factors inhibiting delegation to support workers
• The transition from professor to HCA
• Scenario 8.1: Reflecting on delegating fundamental care
• Scenario 8.2: Reflecting on implicit criticism?
• Scenario 8.3: Delegating observational tasks to the HCAs
• Conclusion
• References
• 9 New roles in critical care practice John W. Albarran
• Introduction
• New roles: the early background
• The context of new roles – extension, expansion and development
• The impact of health service reforms
• The impact of government initiatives
• Scenario 9.1
• Scenario 9.2
• Changes in the delivery of services
• Professional expectations
• Blurring and blending of roles
• The nature and scope of nursing roles
• Substitution of tasks
• Intermediate and narrow-focus substitution
• Scenario 9.3
• Blended and bounded roles
• Examples of autonomous practice
• Consequences of new nursing roles
• Loss of experiential wisdom
• Educational preparation and advanced roles
• Moving role transition forwards – facilitators and barriers
• Conclusion
• Acknowledgement
• References
• 10 Future gazing: the place for expert nursing?
• Introduction
• Leadership for the future
• Advances in biotechnology
• Moral and ethical health care and economics of provision
• Hospitals as intensive care units
• The emergence of new professions
• Information technology and the place of nursing in future critical care provision
• Future predictions on trends and drivers for critical care provision
• The rise of fundamentalism and conservatism
• Funding for science and technology moves into the private sector
• Public involvement
• The (re)emergence of revered intellectuals and professionals
• The restoration of public trust in the new professions
• Accountability for waste production and disposal
• Global risks
• Conclusion
• References
• Index