The Development of Trauma Nursing in the UK
UK Trauma Developments
It is generally
widely acknowledged that the origins of trauma care stem from military
conflicts and battlefield experiences (1,2,3). Despite the peacetime
advances in trauma management e.g. the establishment of casualty
departments; the introduction of trained personnel in the prehospital
domain, key deficits in British trauma care still exists (4,5,6,7).
In addition to health care reforms political and social influence
have been brought to bear on the quest against accidental injury
change in UK trauma management came in 1988 following the reports
of Anderson et al (10) and The Royal College of Surgeons (4). Together
these papers highlighted that care of the multiply injured patient
was sub-optimal causing poor management and premature deaths. The
deficiencies in management were largely attributed to junior untrained
medical personnel treating seriously injured patients on an infrequent
basis. The remedial response to the 1988 review of UK trauma care
was to adopt the Advanced Trauma Life Support (ATLS) system of trauma
Evolution of UK
The plight of
UK trauma nursing was equally in disarray with many practitioners
having little or no instruction on how to care for their trauma
victims (11,12). In 1994 Lomas and Goodall highlighted that the
role of the trauma nurse is 'difficult to identify' and 'not explicit'(13).
Whilst this observation was made in direct reference to the trauma
resuscitation team, it transcends throughout the whole trauma continuum
wherein care is fragmented and poorly communicated thus perpetuating
suboptimal trauma management (14).
British A &
E nurses endeavoured to address some of the training deficits that
were identified. In November 1990 the Trauma Nurse Core Course (TNCC)
was imported from the States and the following February saw the
advent of Advanced Trauma Nursing Course (ATNC). This latter course
was of greater significance to British trauma nursing. For the first
time British nurses articulated their beliefs and values about the
care and management that trauma patients should receive. Central
to this philosophy was that trauma patient had a right to be care
for by specifically trained and educated nurses (14,15,16).
Much of the
early opportunities for training were limited and focused on the
immediate resuscitation and stabilisation post injury. In the first
three and a half years of ATNC 230 nurses had acquired provider
status the reality however was that this did not guarantee one trauma
trained nurse per A & E department; and moreover a further 1500
nurses still required training (12,14,15).
literature there are stark parallels between the evolution of UK
trauma nursing and American trauma nursing. Beachley et al, 1988
report that within 5-10 years of establishing US trauma centres
the need to train and educate practitioners became apparent (2).
It is interesting to note that it was also the American ER nurses
who took the lead in developing trauma education (18). In contrast
the dissemination of TNCC in the States was far more rapid. Within
the first three and a half years of TNCC 13,100 nurses had attended
the provider course with an overall success rate of 86%; and by
ten years this number had escalated to 75,000 (19,20). The accessibility
and funding of such courses needs further attention within the UK
if nurses are going to be adequately prepared to care for the complex
needs of the injured patient (14,15,21).
in the history of UK trauma care was the introduction of the ENB
A86 Trauma Care Course at City University in 1995. This course was
accredited at level three and embraced the 'road to rehabilitation
concept' of trauma care thereby recognising that trauma care does
not begin and end at the doors of the resuscitation room (22,23).
Indeed it has been suggested that a trauma nurse requires a specific
body of knowledge that encompasses the three phases of trauma care
i.e. resuscitation, stabilisation and rehabilitation (17,18).
specialist roles for trauma nurses are beginning to emerge. The
Trauma Nurse Co-ordinator (TNC) for example is sporadically appearing
in the UK. The interpretation and implementation of this role is
frequently different to the recommendations cited in the literature
by our US colleagues (2,24,25,26). For example, within the UK TNC's
have been assigned to orthopaedic directorates only, or spend much
of their time on data registry and audit. To date there has only
be one prospective study to evaluate this role in the UK reported
in the literature (28).
As this Millennium
draws to a close it is time to address the wider needs of the trauma
patient. Trauma care needs to be delineated as a separate entity.
Acknowledging trauma nursing in its' own right should allow its'
philosophical underpinnings and training needs to be considered,
proactively developed and enacted.
of a new speciality should encourage the emergence and development
of new roles, which should further expand the entire scope of practice
of the trauma nurse. At this juncture that it is time to relegate
the traditional image of British trauma nursing as depicted by Florence
Nightingale to the past and develop a new era of UK trauma nurses.
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