Minor Injuries E-Book , livre ebook

Table of Contents

Cover image
Front matter
Dedication
Copyright
Foreword
Preface
Acknowledgements
1. Clinical examination and the written record
2. The injured child
3. Basics of musculoskeletal injury and examination
4. The neck and upper limbs
5. The back and lower limbs
6. Minor wounds and burns
7. Minor head injuries
8. The face
References
Bibliography
Index
Front matter
Minor Injuries

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Minor Injuries

A Clinical Guide
SECOND EDITION
Dennis Purcell MA RGN , Minor Injuries Nurse Educator, New Victoria Hospital, Greater Glasgow and Clyde, Glasgow, UK
Foreword by
Mark Cooper PgC LTHE PhD RN FHEA , Lecturer-Practitioner in Advanced Practice, Glasgow Royal Infirmary, Greater Glasgow and Clyde, Glasgow, UK
Dedication
This book is offered with love to Lynda, Jude and Rebecca
Copyright

© 2010 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions .
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
First edition 2003
Second edition 2010
ISBN 978-0-443-10311-7
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.


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Foreword
Mark Cooper

Minor Injuries has arguably become a field in its own right; with its own practitioners, clinical departments, university courses and, of course, textbooks. Whilst it is a multidisciplinary field, nurses are taking a lead. Across the world nurse practitioners are managing minor injury patients in a growing number of countries including Canada, United States, Australia, New Zealand, Ireland and the Netherlands. In the UK, nurse practitioners are now virtually ubiquitous and can be found in almost every Emergency Department, Minor Injury Unit and Walk-in Centre. In addition, numerous Minor Injury Units and Walk-in Centres are led by nurses. Many of these departments are solely staffed by nurse practitioners, but in others the clinical team can include physiotherapy practitioners, paramedic practitioners and medical staff.
It's often easy to forget that it's only around 25 years ago that the first nurse practitioners began practising in Emergency Departments in the UK. Since the pioneering days in the mid-1980s, the role of the nurse practitioner has moved forward considerably. When the first edition of Minor Injuries was published, the evidence demonstrating that nurse practitioners could manage minor injuries as well as junior medical staff was only just beginning to amass. However, the role was also quite disparate. Practitioners were educated in various ways and at different levels and often managed assorted types of minor injuries. Practitioners were also paid at different levels. Interestingly, the level of education, pay and clinical responsibility did not always seem to align. Wide variations existed within the UK, but differences also existed between countries. In the UK, nurse practitioners were able to legally prescribe (the Nurse Prescribers Extended Formulary was only introduced in 2002), but the range of medications they could prescribe and the number of conditions they could prescribe for were quite limited. In addition, at a UK level, there was no consensus around the definition, the appropriate level of educational preparation, remuneration or even agreement about whether the role should be regulated.
Over the last few years the role has continued to evolve and taxonomies have developed to better articulate the nurse practitioner's role and level of practice. Evolutionary theory can help us understand how the role has developed and give insights into its future development (incidentally its 150 years since the publication of Darwin's On the Origin of Species second edition). Just as different species were not ‘independently created’, but have evolved from previous descendents so, too, have nurse practitioners. Just as species evolve because of factors in their environment so, too, do nurse practitioner roles, and just as variations in species can be deliberately propagated so, too, can professional roles. This evolution, I think, explains much of the variation in nurse practitioner characteristics that is evident today, and may give us some ideas about how the role can be developed.
The role of the nurse practitioner has evolved as services have changed, as policy changes have impacted on the role and as education has developed. Often the role has developed to meet specific local needs and is impacted on by national developments. Since the first edition of Minor Injuries an enormous amount has changed. Nurse prescribers can now prescribe almost any medication from the British National Formulary (BNF) including some controlled drugs; the number of nurses who have expanded into nurse practitioner roles has greatly increased; and education has developed not only in terms of the number of courses, but also in terms of the type and level of education available. Informal on-the-job training is no longer acceptable. In fact, in Scotland, there is a Government expectation ‘that individuals working at an advanced practice level should be able to show evidence of Masters level learning’ ( SGHD 2010 ) – an expectation that already exists in many other countries including Ireland, New Zealand, Canada, various states in Australia, and most states in the US.
Whilst there is still considerable variation between different nurse practitioner roles there is greater understanding and consensus around the role. In 2001, the International Council of Nurses published an international definition of Advanced Practice. In 2003, NHS Education for Scotland described the nurse practitioner role in the field of minor injuries and, for the first time, made the suggestion that there should be two distinct levels of nurse practitioner practice. In 2006, the NHS Career Framework was published and articulated roles in the NHS from ‘initial entry level jobs’ to ‘more senior staff’. Within this framework there are effectively four levels of practice for registered nurses: practitioner, senior practitioner, advanced practitioner and consultant practitioner. More recently, the work of the Modernising Nursing Careers coalition and the Advanced Practice Toolkit have identified areas of consensus and have provided further clarity around the advanced practitioner role, including the notion that the particular characteristics of advanced practice map most closely to masters level on the qualifications frameworks.
Just as the first edition came at a turning point, this second edition marks another change in the evolution of the role of the nurse practitioner. We have proved that nurse practitioners can manage minor injuries, we now need to demonstrate the impact nurse practitioner have on patient care and to examine ways of improving that care. This means that nurse practitioners should be more involved in research in minor injuries and that we should be confident about examining new ways of working. Nurse practitioners have been practising at different levels over the last quarter of a century; we should embrace this fact and define what nurse practitioners should do at the senior practitioner level (as nurse practitioners), the advanced practitioner level (as advanced nurse practitioners) and also at the consultant level. Creating a clear pathway will aid succession planning and will help ensure the sust