Closing the gap between research and hands-on treatment
The best thing about being a nurse practitioner is the patient contact and “making their hospital stay better for them.” This is the philosophy of Orthopaedic Nurse Practitioner at Flinders Medical Centre (FMC) Cheryl Kimber, who spoke to Sue Cartledge about her National Institute of Clinical Studies Fellowship.
Kimber is the first nursing professional to receive a National Institute of Clinical Studies (NICS) Fellowship. The fellowship will enable her to undertake an evidence implementation project to improve the identification and management of osteoporosis in patients with low trauma wrist fractures.
“The aim is to help clinicians close the evidence to practice – we have the research as to what is best practice, now we need to develop the practical skills to put this into practice.”
Patients presenting at hospital A&E or fracture clinics with low trauma wrist fractures are generally women in the 45-55 age group, post-menopausal, who have had a minor fall. The injury is dealt with in A&E or at the orthopaedic clinic, and then they are sent home.
“Often they have osteoporosis, but we don’t teach them about risk factors, we don’t contact their GP, or make suggestions about medication.
“They are generally fit and healthy; this is hidden osteoporosis. It is undiagnosed and undertreated.
“We need to identify the people at risk, give them information on reducing their risk factors, bone density tests, suggest medication, and communicate with their GPs. We could prevent them from having another wrist fracture, or even a back or neck of femur fracture.”
Kimber has 20 years experience as an orthopaedic nurse, none of them as CNC orthopaedics at FMC, and the past three as an Extended Practice nurse, until she received her authorisation last July as the first orthopaedic nurse practitioner in Australia.
Orthopaedic nursing offers variety and many challenges, she says, covering injuries from trauma, sport, paediatric. Patients are people of all ages and all walks of life. The nurse practitioner’s role extends the nursing scope further. She can order X-rays, blood tests, perform traction, and woundcare for surgical and chronic wounds and fracture blisters, a subject on which she is an expert.
“The nurse practitioner’s role is very clinically based, very much looking at the patient. I also have time to do research and mentoring – nurses, medical students, registrars, as well as educating patients.”
She see patients in A&E, on the wards, in the orthopaedic clinic, assessing them, diagnosing, planning their care, as part of a team, with the registrar, RNs, physio and allied health workers, medical students, and where necessary, the geriatric team.
“The best part of it is the patient contact. Making their hospital stay or return to home better.”
An important part of the role of the nurse practitioner is education – educating the patient on how to prevent risks and what lifestyle changes would improve their bone health, and liaising with GPs and community health providers in aspects of health promotion and prevention.
“It’s making a difference to the patient, looking at the whole person and their health problems, family, social life, work – taking it all into consideration. If they understand their care, they are not so scared of hospital and work with you better.
“Nurses are good educators. It’s not just about the broken bones. It’s the wellness model, in which the patient takes charge of their own health.”