Mary Drozd1 and Sinead Hahessy2
1 University of Wolverhampton, Walsall, West Midlands, UK
2 National University of Ireland, Galway, Ireland
The aim of this chapter is to discuss ongoing or continuing professional development (CPD) for orthopaedic and trauma nurses. Nursing is a constantly changing profession and continuing professional development is a compulsory part of being a professional. Keeping up to date with best practice and research and acquiring new skills helps to facilitate an effective contribution to patient care. Patients have a right to expect, at the very least, a practitioner who is competent in their sphere of practice. One existing competency framework (Royal College of Nursing 2012) will be discussed along with specialist orthopaedic and trauma nurse education, mentorship in orthopaedic and trauma nursing practice and the role of reflection in continuing professional development.
Continuing professional development (CPD) can be defined as ‘the systematic maintenance, improvement and broadening of knowledge and skills, and the development of personal qualities necessary for the execution of professional, managerial and technical duties throughout one’s working life’ (Tomlinson 1993, p. 231) and is at the heart of professional development (Hawkins and Smith 2008). Activities to promote professional development can take the form of both informal and formal activity and can help the practitioner to move beyond prescribed parameters of practice and develop expertise.
Professional regulation is the hallmark of professions and ensures that standards are met and that practice is maintained and developed (Munro 2008). In many countries regulatory bodies require practitioners to meet specific standards for both practice and education. The purpose is to link professional development and the maintenance of competence to protect the public through safe practice. Nurses have a specific professional responsibility to engage with CPD (O’Shea 2008) and employers recognise that their most valuable resource is their staff, but it is often learning and development opportunities that are sacrificed in financially constrained environments. Barriers to professional development often include financial issues, employment demands, work schedules, anxiety, the learning climate, support for learning, lack of job satisfaction (Cooley 2008), individual motivation and lack of financial support from employers (Lawton and Wimpenney 2003).
The employer has an important role in facilitating and encouraging CPD and in investing in staff to ensure that professional learning occurs in the workplace alongside development of the organisation (Gopee 2002). They expect individuals to contribute to their own learning and that of others because of the perceived benefit to the individual and team’s professional growth, future employability and ability to perform their current role effectively. Modernisation agendas for health services include the development of a culture of learning that enables staff to progress and develop. CPD is often an obligatory element of this that values evidence of personal development and this is achieved in various ways.
Literature detailing the relevance of CPD emerged in the 1980s and is mainly UK orientated (e.g. Charles 1982, Brown 1988, Hunt 1991). It focused on philosophical debates, underpinning frameworks, the relevance of continuing education and the challenges associated with implementation. Barriball et al. (1992) noted a lack of empirical data analysing nurses’ perceptions of their continuing education needs. Further debates focused on what constituted an effective continuing professional education (CPE) system (Nolan et al., 1995) or the tensions between the ‘luxury or necessity’ of the endeavour (Perry 1995). Nonetheless, CPE has developed at an accelerated pace. The pioneers of educational change embraced the pursuit of ‘new’ knowledge through various curricular and pedagogical approaches. Concepts central to the professionalisation debate such as pursuing the accumulation of a distinct body of knowledge through research activity and reflective practice have emerged. CPE in orthopaedic and trauma nursing strives to promote the specialist nature of knowledge and the majority of postgraduate/post-qualifying programmes are designed to address this. The ‘artistic’ forms of nursing knowledge such as intuition and experience are increasingly being accepted as valid forms of knowledge.
The current focus of CPD has now moved to evaluating the impact of post-registration programmes from the perspectives of the student and the impact learning has on clinical practice and patient outcomes, although there is a paucity of research in relation to the latter. A review of the CPD literature (Hegarty et al., 2008) concludes that patient outcomes are neglected in 61 studies and they advise that future research endeavours should aim to include patient outcomes. Gijbels et al.’s (2010) systematic review focused on the student perspective and concluded that nurses welcomed the effects that CPD has on professional and career trajectories. There is little research that has addressed the impact of orthopaedic and trauma CPD from either the student perspective or measurement of patient outcomes as a consequence of CPD (See box 3.1 for a general example).
Literature from a wide range of disciplines refers to the use of mentoring to assist career development. This is practiced differently in particular locations, settings and healthcare professions. Mentors are crucial in facilitating the development of other practitioners as they assist the next generation in developing skills and knowledge. They must have a sound evidence-based knowledge and skill base along with an understanding of how individuals learn and grow professionally in order to be able to nurture practitioner development (Gray 2011). At the point of socialisation to the orthopaedic and trauma environment the mentor can help to instill values associated with life-long learning and professional development in the specialty by relating a ‘sense of partnership’ (Ali and Panther 2008) in which the student or practitioner feels assimilated into the clinical setting.
Mentors provide a spectrum of learning and supportive behaviours such as challenging and being a critical friend, being a role model, helping to build networks and develop resourcefulness, simply being there to listen, helping people work out what they want to achieve and planning how they will bring change about (Clutterbuck 2004). Price (2004) suggests that a mentor will be in a position to shape other nurses’ understanding of practice and practice wisdom for years to come. The specialist knowledge and skills such as postoperative orthopaedic care, the prevention and recognition of complications or the application of traction are best learned in the practice setting. Great responsibility for this is placed on mentors even though resources are finite and mentors must juggle the delivery of care with their teaching and supportive roles (Price 2004). No other role in nursing has such power to shape other nurses’ practice and knowledge and nothing can be more important than passing on clinical skills and knowledge to others while caring for patients and their families (Price 2004). A system of mentorship is essential in enabling the less experienced practitioner to be supported in specialist knowledge and skill development and such a mentor should aim to provide leadership in developing learning (Gopee 2011).
Competence has become a defining feature of practice-based professions (Bradshaw 2000). Axley (2008, p. 217) argued that “there is no officially agreed upon theoretical or operational definition of competency among nurses, educators, employers, regulating bodies, government and patients” and that the attributes of ‘competency’ are multi-faceted and context-dependent, which can lead to confusion. Aspects of competence most frequently cited are:
- knowledge (information, teaching, training)
- actions (ability, skill)
- professional standards (criteria, requirements, qualification)
- internal regulation (accountability, attitude, autonomy)
- dynamic state (ongoing change, consistent improvement).