Unit of competency details

Descriptor 

This competency unit describes the skills and knowledge required by Enrolled/Division 2 Nurses to perform nursing interventions to assist the person with an orthopaedic condition to regain optimal function and lifestyle

Application 

The knowledge and skills described in this competency unit are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements

Enrolled/Division 2 nursing work is to be carried out in consultation/collaboration with registered nurses and under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element.

ELEMENT 

PERFORMANCE CRITERIA 

1. Work as part of the multidisciplinary health care team  for the client with an orthopaedic condition

1.1 Contribute appropriately to support the role of the multidisciplinary health care team in the managing care of the client with an orthopaedic condition

1.2 Contribute to achieving effective team work and supportive group dynamics when working with health care colleagues

1.3 Establish appropriate relationships with other members of the health care team

1.4 Incorporate the philosophical framework for managing care for the client with an orthopaedic condition into own nursing practice

1.5 Recognise the contributions of emergency service personnel, referring agencies and other hospital department staff to the initial/emergency care needs of the client with an orthopaedic condition

1.6 Recognise specialist nursing and medical services as essential to the long term management and planning strategies for the client with an orthopaedic condition

2. Clarify the impact of client's orthopaedic condition  on the client and/or their family

2.1 Perform a holistic assessment of the client in consultation/collaboration with the registered nurse

2.2 Incorporate an understanding of anatomy and physiology into nursing practice

2.3 Work with a knowledge of the various manifestations of orthopaedic conditions and associated pathophysiology of each clinical manifestation

2.4 Discuss with the client the psychosocial impact of an orthopaedic condition  on their activities of daily living

2.5 Identify and discuss with the client and/or their family common problems and complications for the client with an orthopaedic condition

2.6 Communicate effectively with clients, family and health team members

2.7 Clarify the care needs of the client with an orthopaedic condition in terms of the phases of care required

3. Contribute to planning appropriate care for the client with an orthopaedic condition

3.1 Use contemporary assessment tools accurately

3.2 Establish a database of resource personnel to assist in decision making for the client with an orthopaedic condition

3.3 In consultation/collaboration with the registered nurse, use a problem solving framework to plan appropriate nursing management strategies

3.4 Develop an individualised plan of care for the client with an orthopaedic condition in consultation/collaboration with the client and the health care team

3.5 In consultation/collaboration with the registered nurse, incorporate into own practice health teaching and discharge planning for the client with an orthopaedic condition

3.6 In consultation/collaboration with the registered nurse, incorporate referral to community services into discharge planning strategies

4. Implement care plan  for the client with an orthopaedic condition

4.1 Ensure rehabilitation principles appropriately underpin nursing interventions for the client with an orthopaedic condition

4.2 Practise contemporary nursing interventions for the client with an orthopaedic condition

4.3 Act as a resource for staff and clients

4.4 Implement an individualised plan of care for the client with an orthopaedic condition

5. Assist to evaluate the outcomes of planned nursing actions for the client with an orthopaedic condition

5.1 Monitor client's response to planned nursing interventions  and progress toward planned goals and interventions, and document and report to the appropriate members of the health care team

5.2 Initiate appropriate first aid/emergency treatment in response to adverse reactions or orthopaedic condition complications

5.3 Report and document first aid/emergency treatment and the client's response to the treatment

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Admission and discharge process
• Age specific requirements eg older adult, young adult, paediatric client
• Anatomy and physiology
• Client rights and responsibilities
• Clinical manifestations of orthopaedic conditions
• Community and in-hospital services available for medical condition clients
• Critical thinking and problem solving
• Diagnostic tests and their meanings
• Emergency and first aid management of complications of orthopaedic condition/injury
• Emergency and first aid management of orthopaedic condition/injuries
• Health - illness continuum
• Legal and ethical issues related to practice
• Medical terminology
• Nursing management of the client with a fracture
• Nursing management of the medical orthopaedic client
• Nursing management of the surgical orthopaedic client
• Occupational health and safety legislation
• Organisation policy and procedure
• Participating as a member of the health care team
• Pathophysiology of clinical manifestations of orthopaedic conditions
• Phases of care for orthopaedic condition clients
• Philosophy underpinning orthopaedic nursing
• Reflective practice
• Specialised in-depth knowledge of anatomy and physiology and pathophysiology of clinical manifestations of orthopaedic conditions

Essential Skills 

It is critical that the candidate demonstrate the ability to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Apply clinical nursing skills to address:

• acute care and intensive care needs of orthopaedic condition client
• pain management needs
• pressure area care needs
• rehabilitative care needs of orthopaedic condition client

• Apply principles of:

• bandaging
• health assessment
• plaster of paris management
• rehabilitation
• traction

• Apply professional standards of practice:

• ANMC code of conduct
• ANMC code of ethics
• ANMC national Enrolled/Division 2 nurse competency standards
• state/territory Nurse Regulatory Nurses Act
• state/territory Nursing and Midwifery Regulatory Authority standards of practice
• scope of nursing practice decision making framework

• Apply principles of documentation to document planned nursing interventions
• Ensure maintenance of skin integrity
• Facilitate activities of daily living
• Maintain effective symptom management
• Maintain evidence based practice in line with current literature and work of professional bodies associated with medical condition
• Manage administration of medications as per jurisdictional and legal requirements
• Recognise and address appropriately religious and cultural needs of client and significant others
• Recognise and address needs of client and significant others in relation to grief and loss
• Undertake health teaching to address specific needs of client and significant others
• Undertake nursing management of the client with an amputation
• Use language, literacy and numeracy competence required to communicate effectively with client, group, colleagues and to record or report client outcomes
• Use prosthetic aids and devices appropriately
• Use communication skills for:

• counselling
• interviewing

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Observation of performance in a work context is essential for assessment of this unit
• Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion and be assessed by a registered nurse

Context of and specific resources for assessment :

• This unit is most appropriately assessed in the clinical workplace or in a simulated clinical work environment and under the normal range of clinical environment conditions prior to assessment in the workplace
• Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible

Method of assessment 

• Observation in the work place
• Written assignments/projects
• Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice.
• Questioning - verbal and writing
• Role play/simulation

Access and equity considerations :

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Multidisciplinary health care team members may include :

• Client and their significant others
• Medical staff
• Nursing staff
• Social workers
• Physiotherapists
• Occupational therapists
• Speech pathologists
• Dietitian
• Prosthetists
• Podiatrists
• Drug and alcohol services
• Emergency services including - ambulance, Royal Flying Doctor Service, Care Flight
• Community services
• Transitional rehabilitation services

Health care settings may include :

• Hospital - private or public
• Day clinic
• Long stay centres
• Short stay centres
• Medical clinic
• Aged care
• Respite centres
• Community
• Paediatric environments

Orthopaedic conditions include  (but are not limited to ):

• Musculoskeletal conditions e.g. gout, systemic lupus erythematosus, osteomyelitis, bursitis, epicondylitis, hallux valgus, avascular necrosis, compartment syndrome, thromboembolism, disseminated intravascular coagulation, delayed union, fat embolism, contractures
• Congenital musculoskeletal conditions e.g. torticolis, spina bifida
• Traumatic musculoskeletal conditions including - dislocations, sprains, fractures, traumatic amputations
• Degenerative musculoskeletal conditions e.g. arthritis, back pain, muscle spasm, disc prolapse, osteoarthritis, osteitis deformans, osteomalacia
• Surgical interventions for musculoskeletal conditions e.g. internal and external fixtures for fractures, applications of surgical braces, removal of bunions, elective surgical procedures (joint replacement surgery), laminectomy, surgical amputation
• Bone tumours e.g. metastatic bone carcinoma, multiple myeloma, bone tuberculosis, osteosarcoma, chondrosarcoma

Assessment of impact of orthopaedic condition include :

• Performance of activities of daily living
• Loss or limitation to physical function
• Assessment of musculoskeletal function
• Accompanying trauma and injuries
• Impact on sexuality, relationships, self image, body image
• Grief and loss
• Loss of vocation
• Coping mechanisms
• Personal and community support mechanisms
• Level of communication
• Maintenance/improvement of quality of life
• Maintenance/improvement of lifestyle
• Impact of secondary disease processes

Plans of care may include :

• Nursing care plans
• Clinical pathways
• Treatment plans
• Medical notes
• Rehabilitation
• Community referrals
• Health teaching
• Discharge plans
• Rehabilitation plans

Specific nursing interventions / clinical skills include :

• Management of elimination (urinary and bowel) needs including - insertion of indwelling catheters, irrigation of indwelling catheters
• Wound care
• Skin care including - assessment and management of skin care
• Health teaching in relation to client care needs
• Pain management
• Manual handling
• Co ordination of clinical care
• Application of specific prosthetic devices
• Assessment of oxygen saturation levels
• Peak flow
• Electrocardiography
• Management of intravenous therapy
• Management of blood product infusions
• Rehabilitative care practices
• Emergency resuscitation skills

Evaluation of planned care includes :

• Level of independence in performance of activities of daily living
• Access and use of community support services
• Participation in rehabilitation programs
• Self management of symptoms of musculoskeletal injury including muscle spasm, pressure care, elimination management