High Dependency and Critical Care Education Report - Page 2
Developing local critical care nurse education in NHS Shetland
Island NHS Boards, having failed to release staff in sufficient numbers to engage with mainland education programmes, had been starting to develop their own in-house educational models and approaches to high dependency and critical care education.
Complex planned surgical work drove the development of a ‘home grown’ competency-based high dependency nursing course in NHS Shetland, as did the learning gained from previously sending nurses (who were working as anaesthetic assistants) on a course in Glasgow. The experience involved a lot of travel, travel problems, and long periods away from home and family commitments. In addition, the product was not necessarily what was needed in a RGH and not the best use of funding.
The critical care education programme was competency based. It included an initial induction and orientation to develop a knowledge and skills base locally, as well as a placement in a high-volume centre.
Staff within the placement centre supported supervision and assessment.
Critical care nursing education in NHS Shetland
- Delivered by the anaesthetists, anaesthetic nurses and High Dependency nurses in Shetland
- Included initial induction and orientation, developing a knowledge and skills base, with assessment acting as gatekeeper to placement in a high-volume centre
- Initial local learning and clinical placements helped ensure that ‘off-island’ learning was focused on developing knowledge and skills that were relevant to the environment they would be working in
- Building a relationship with a specific placement centre helped ensure that staff were aware of the specific needs of NHS Shetland nurses and facilitated future support
The need for accessible education for all remote and rural NHS Boards
RRHEAL has a responsibility to explore options for supporting need that avoids duplication and supports more sustainable delivery. Given the unique challenges faced in remote and rural areas in maintaining skills and keeping up to date, accessing suitable education and recruiting expert educators, RRHEAL began to facilitate representative RGH discussion. Whilst access to an at distance route to speciality education is a desirable ‘end point’, the more immediate need was for agreement of a common set of competencies for nursing staff that support high dependency and critical care needs in RGHs.
Identifying the needs
An initial meeting with interested parties was held by video-conference in March 2016. Those present at this meeting described a wide variety of educational activities and resources which they had found useful in their own settings, including the work in NHS Shetland.
Following additional exploratory work, a RRHEAL High Dependency and Critical Care Advisory Board was established to support involvement from remote, rural and island Boards to help inform the adaptation of existing education programmes, monitor the development of the programme of work and oversee the delivery of the agreed products and outcomes between the partners.
Summary of barriers to effective education/critical care delivery in remote and rural critical care
- Lack of suitable affordable training i.e. expert but relevant to remote and rural practitioners
- Different levels of training needed e.g. for ‘diagnosers’ and for ‘those working under leadership’ also primary and secondary care responders
- Marked differences in the way things are done in different rural centres; education and other components may not be directly transferrable but will need to be adapted
- Aversion to and fear of simulation as an educational tool
- Difficulty in finding appropriate speakers with capacity to take on training
- Difficulty for remote and rural staff leaving domestic responsibilities for periods of experience in mainland critical care and difficulty with funding and management buy in for this
Adaptation of existing education programmes
In view of the recognised need for adapted high dependency and critical care education in the remote and rural hospital setting, the Advisory Board agreed that an adapted programme of work would focus on the development of education to support staff who on occasion may be required to recognise, assess and initiate care for the acutely unwell patient presenting within an RGH setting. It was agreed that programme of work should:-
- focus on hospital-based patient presentation and care needs and not pre-hospital
- acknowledge that some staff may have mixed generic remote health care responsibilities split between hospital and community settings
- the course content should be specific to hospital-based care and should:-
- focus on the sick and deteriorating adult
- include a proportion of the educational content relating to the needs of the sick child
- equip learners with knowledge and skills relating to the recognition of the deteriorating patient, early assessment and the need for escalation/ seeking expert help, as well as supporting diagnosis and treatment.
Mark Smith, Practice Development Nurse in NHS Highland says:
“The background to this programme is the challenges around skill maintenance. In remote and rural locations, there are often situations that the workforce doesn’t come across very often, but still must deliver a high standard of care.
Currently the uptake of critical care education is low due to funding and the challenges of releasing staff for courses that require a lot of travel and time away from home etc. The benefit of the new programme will combination of local and specialist external placements, mentoring and supervision.”
Educational delivery should:-
- be a level 9 programme of education, which could equip staff at an earlier stage of career development or those newer to acute care to function well for service in RGH critical care. Level 11 options would be advantageous to the maintenance of a flexible workforce Level 11 is not being offered
- include the established patient in high dependency/critical care but with a greater emphasis on the recognition of critical illness and early intervention whilst planning for any necessary retrieval/ repatriation
- ensure that learners complete education with the correct knowledge, placement experience and assessed skills to function competently in such environments
- make effective use of digital technologies, ensuring access to more high-quality learning opportunities, qualifications and educational pathways for the remote, rural and Island workforce
- exploit the use of discussion forums, virtual scenarios, simulation, drills, skills engagement and virtual OSCE’s.
