Trauma Nursing: Advanced Practice

Trauma Nursing 1

Trauma Nursing: Advanced Practice

Ted E. Dunn

Nursing 1070: Introduction to Nursing Science

Dr. Janet L. Grady

Trauma Nursing 2

Statement of Purpose

The role of trauma nurse practitioner (TNP) has been formed only in recent years. The purpose of this paper is to use nursing literature that includes research in this and other fields to describe that role and how it is evolving. Trauma represents a sudden event altering the course of the lives of those affected allowing little time for usual coping mechanisms to work their course. The nature of trauma makes it singularly important in demanding the best character traits and skills of nurses and those directly affected by the trauma incident. The changes in health care brought on by changes in technology, availability of physician residents in the hospital setting and rising health care costs have made it necessary for hospitals to make use of advance practice nurses (APNs).

The role of the TNP is one of a professional, with at least a Masters degree in nursing, who is a key player in health care delivery in the hospital and in critical care or trauma units. This professional through the newly defined role promotes team cohesion, communication and emphasis on the patient’s self-determination in making informed choices from a variety of more holistic health care options available. The leadership and comprehensive medical care provided by TNPs includes particular attention to continuity of care as the trauma patient returns to the community.

Significance

The rising prevalence of TNPs in the hospital critical care / trauma units has great significance for the nursing community and health care consumers because of the opportunities for improvement of self-determination in the trauma patient’s care and inclusion of all aspects of holistic health care that include complementary and alternative therapies as well as traditional

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surgical procedures. The health care team with TNPs is more likely to strive for excellence with enhanced teamwork and emphasis on improving skills through education.

Literature Review

The literature pertaining to the role of the TNP includes classical studies from the fields of nursing, psychology, sociology and medicine as well as more recent investigations. Anna Mae Cowgur (2006) examined vicarious traumatization in 123 emergency nurses. Findings suggest that there are certain qualities that protect those nurses who chose to work and have continued for years in such a critical care field that is rife with opportunities to treat trauma victims. In the discussion section of her dissertation presenting this study, that characterizes professional nurses in emergency departments (EDs), Cowgur (2006) proposes the personality trait of psychological hardiness as “a possible explanation for the lack of vicarious traumatization” (p 33). The findings of Cowgur (2006) support the conclusions of a classic study by Lambert, C. E. and Lambert, V. A. (1999) involving the “review and assessment of more than 50 journal publications on hardinessвЂ¦Ð²Ð‚Ñœ (p. 11). These journals are representative of the fields of psychology, medicine and nursing that present the topic of hardiness as it pertains to professionals.

Nursing brings to the practice of health care delivery the practice of holistic health. Holistic nursing has Gestalt theory as its roots. The concepts of planned change and group dynamics as developed by the renowned social psychologist, Kurt Lewin, are particularly significant is describing the evolving role of the TNP in hospital settings. Smith (2008) explains that in developing field theory which is the basis of planned change and group dynamics, Lewin extended Gestalt theory to describe behavior as being determined by the totality of an

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individual’s situation (Smith, 2008, para. 4). Group dynamics and two key concepts of group

process known as interdependence of fate and task interdependence were placed in this context

(Smith, 2008, paras. 8, 9).

The culture of a trauma unit is shaped by the implementation of holistic health which

includes the psychosocial and spiritual aspects of the trauma patient. As an important motivator

in the recovery of such patients the spiritual aspect of hope should not be underestimated.

Successful group dynamics depends on hope in the ultimate professionalism and positive results

of the health care team with the TNP often performing as the role model and leader in this

respect. In a qualitative study, Tutton, Seers, & Langstaff (2007) explored the factors that

facilitate or inhibit recovery on a trauma unit in sixteen periods of observation involving

qualitative interviews with 40 patients and 19 staff (p. 145). The results indicated the need for

stable but dynamic teamwork in acute care settings that enables patient-centered activities and

permits patients and staff to process their emotions surrounding trauma incidents in ways that are

constructive (Tutton, et al., 2007, p. 152).

In a classical non-experimental study, Stranahan (2001) examined “the relationships among

spiritual perception, attitudes about spiritual care and spiritual care practices in nurse

practitioners” (p. 90). Stranahan (2001) accomplished this through the use of a questionnaire

completed by 102 nurse practitioners (NPs) (p. 94). The findings of (Stranahan, 2001) indicate

that at the time of the study the “…practice