RCN Kompetensi

Kerangka kompetensi untuk

ortopedi dan trauma
praktisi
 Critical reviewers
Ucapan Terima Kasih
Rebecca Jester, Professor in Orthopaedic Nursing, Head of School (Nursing)
Penulis ingin mengucapkan terima kasih kepada RCN untuk pendanaan dan
Griffith University
mendukung praktisi ortopedi dan trauma kompetensi project.Alongside ini, terima
kasih khusus juga pergi ke kelompok pengembangan kompetensi, RCN Society of Julie Santy-Tomlinson, Senior Lecturer, University of Hull, England

Orthopedic dan Trauma Keperawatan (SOTN) dan delegasi di SOTN RCN Konferensi
internasional yang menghadiri lokakarya tentang rancangan kompetensi pada 22
Please contact Mary Drozd if there are any queries or feedback regarding this
September 2011 dan selanjutnya memberitahu mereka. Terima kasih kami juga
document. Email M.Drozd@wlv.ac.uk or telephone
meluas ke Alan Dobson, mantan RCN Advisor inAcute dan Perawatan Darurat, yang
01902 518927.
telah memfasilitasi dan mendukung pengembangan dokumen ini seluruh, serta
Profesor Rebecca Jester dan Julie Santy-Tomlinson untuk melakukan tinjauan kritis
dari dokumen.

kelompok pengembangan kompetensi

MaryDrozd, Senior Lecturer, University of Wolverhampton, Advanced Nurse

Practitioner, Dudley Group NHS Foundation Trust.

Sonya Clarke, Senior Teaching Fellow, Queens University, Belfast, Northern

Ireland

Elaine Collins, Head of Clinical Services, Nuffield Health, Bristol, England

AlanDobson, RCNAdviser inAcute and Emergency Care, England

Sandra Flynn, Consultant Orthopaedic Nurse, Countess of Chester

Hospital, England

SueMiles, National Casting Adviser, British Orthopaedic Association,

UK

JeanRogers, Practice Placement Educator, Stockport, England

BeverleyWellington, Clinical Nurse Specialist Orthopaedics, Victoria

Infirmary, Glasgow and Lecturer, University of West Scotland

MarionWilliams, Clinical Practitioner, Royal Gwent Hospital, Newport,Wales

ElizabethWright, Advanced Nurse Practitioner, Children’s Orthopaedic

and Trauma, Southampton, England

Published by the Royal College of Nursing, 20 Cavendish Square, LondonW1G 0RN

© 2012 Royal College of Nursing.All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means
electronic,mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or a licence permitting restricted copying issued by the Copyright
Licensing Agency, 90 TottenhamCourt Road, LondonW1T 4LP. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding
or cover other than that in which it is published, without the prior consent of the Publishers.

RCN legal disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in
each country and outside the UK.

The information in this publication has been compiled from professional sources, but its accuracy is not guaranteed.Whilst every effort has been made to ensure the RCN provides
accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used.Accordingly, to the extent permitted by law, the RCN shall
not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this information and
guidance.
 ROYALCOLLEGEOFNURSING

A competence framework for

orthopaedic and trauma practitioners

Contents
1 Introduction 2

The rationale for the framework 2

The benefits of the framework 2

The development of the competences 2

RCN competence statement for paediatric nurses 2

When the framework does not apply 3

2 The structure of the competence framework 4

The core competence domains 4

The competence levels 4

How to use the competence framework 5

3 The competences 6

Partner/guide 6

Comfort enhancer 9

Risk manager 12

Technician 16

4 References 29

5 Further reading and useful websites 32

1
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA
Introduction
The rationale for the framework
This document is intended to provide a framework for orthopaedic and
trauma practitioners in clinical practice. It is recognised that trauma and
orthopaedic practitioners require specific, specialist knowledge and skills
at different levels of practice (Clarke, 2003; Santy et al., 2005; RCN, 2005;
Lucas, 2006; Flynn andWhitehead, 2006; Drozd, Jester and Santy, 2007).
Kompetensi memberikan kejelasan untuk organisasi seperti apa yang dapat
mereka harapkan dari ortopedi dan trauma praktisi, dan juga dapat
digunakan sebagai tolok ukur untuk organisasi untuk digunakan dalam
perekrutan, seleksi, pengembangan, penilaian dan management.Alongside
kinerja individu ini, kompetensi dapat berkontribusi untuk pengembangan
profesional berkelanjutan individu dalam posting untuk mempertahankan dan
meningkatkan kompetensi. Dalam kerangka kompetensi ini harapan trauma
dan ortopedi praktisi (Level 2-8) yang jelas dan konsisten. Adalah penting
bahwa pendidikan, pelatihan dan pengembangan berada di tempat untuk
memastikan bahwa tingkat yang tepat dari praktisi, dengan pengetahuan
yang diperlukan, pemahaman dan keterampilan, merawat pasien ortopedi
dan trauma.
Manfaat dari kerangka kerja
Kerangka kompetensi ini memberikan dasar yang untuk mengembangkan
dan mengevaluasi aman dan efektif ortopedi dan trauma praktisi.
perawatan kesehatan kontemporer memerlukan efisiensi dan kompetensi.
Kerangka kerja ini bertujuan untuk memberikan landasan yang kuat untuk
mengoptimalkan praktik berbasis bukti dan memberikan aman, perawatan
yang kompeten.
Pengembangan
kompetensi
Trauma dan keperawatan ortopedi kompetensi pertama kali diterbitkan pada
tahun 2005 oleh Royal College of Nursing (RCN). kompetensi ini memberikan
kerangka kerja menyeluruh untuk mengaktifkan trauma dan ortopedi praktisi
untuk meningkatkan pengetahuan dan keterampilan untuk meningkatkan
keselamatan dan kualitas perawatan pasien.
2
Direvisi ortopedi dan trauma kompetensi (RCN 2012) telah dikembangkan
lebih lanjut oleh sekelompok pengembangan kompetensi yang mewakili
dewasa dan ortopedi dan trauma menyusui anak-anak. Kelompok itu
termasuk perwakilan fromNorthern Irlandia, Skotlandia, Inggris andWales
bekerja dalam kedua praktek dan pengaturan pendidikan.
Health care assistants and assistant/associate practitioners have been
included in this new framework as these practitioners are directly involved
in the care of orthopaedic and trauma patients. The skills and knowledge
required by orthopaedic and trauma practitioners in the paediatric setting
has also been evaluated (Judd andWright, 2008; Judd, 2010). Throughout
this framework please note that where the terms ‘child’ or ‘children’ are
used, these refer to ‘infant’, ‘child’ and ‘young person’. Children or young
people will be referred to as CYP.
RCN competence statement for
paediatric nurses
The orthopaedic competences outlined in this document can be applied
across the age range that extends from children to the older person, with
some specific amendments for paediatrics.All children must be cared for
by competent practitioners – for example, registered nurse (RN) Child or
registered sick children’s nurse (RSCN). Professionals caring for children
must have a sound knowledge of child anatomy and physiology, including
child development (both physical and psychosocial issues). Children’s
nurses will understand the different physical aspects of caring for children
with an orthopaedic/trauma condition, conservative management over
surgical intervention, using appropriately sized equipment and different
treatment plans appropriate to the child’s age and physical size. They
need to understand a child’s cognitive abilities and be able to
communicate in an appropriate manner. The health care professional also
needs to recognise the pivotal role of the child’s parents/guardians and be
able to fully involve them in the care of their child. This involves explaining
orthopaedic diagnosis and treatment plans and encouraging parents to
care for their child in the hospital
 ROYALCOLLEGEOFNURSING

environment, while also supporting/providing technical orthopaedic

clinical care. This extends to educating the family to be able to support
the child’s ongoing care at home.

Children’s nurses need to be aware of the effect a strange clinical

environment can have on a CYP and know how to familiarise the
environment. They need to understand and be able to employ distraction
therapy.

Health care professionals caring for children also need to understand

child development and behaviour to promote successful interaction with
the child, and to be able to detect delayed development and abnormal
behaviours. There has to be an acute awareness of child protection
issues and concerns, with a nurse needing to possess a detailed
knowledge of child protection policy and procedures.

When the framework does not

apply

The competences are for the purpose of practitioners working in

acute and primary orthopaedic trauma settings in the United
Kingdom. They have not been developed for the emergency
department or critical care practitioners, as these are covered by the
relevant RCN forums.

3
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

The structure of the competence framework

This framework has been developed using the levels of practice used in Table 1 Competence framework structure

the NHS Career Framework ( 2009). There are four core domains of
practice within orthopaedic and trauma practice: Domains of practice:

partner/guide comfort
partner/guide comfort
enhancer risk
enhancer risk
manager technician.
manager technician.

Level of practice – the level that the practitioner is working at based on

There are competences within each of the four domains and different the NHS Career Framework ( 2009).

levels of practice for each competence. Thus, it is possible to be working Competence statements – these are the role expectations at different
at a higher level for some competences and lower levels for others. For levels of practice, and describe what is required at each level.
example, in the technician domain, you may be at Level 5 in the casting
subsection and Level 7 within the mobility aids subsection. The
Performance criteria – describe what competent
competences within each domain build upon the previous levels of performance is at each of the different levels of practice.
practice. The majority of practitioners working in NHS organisations will be
working within the NHS Knowledge and Skills Framework (KSF)
Knowledge, understanding and skills – the specific orthopaedic and
(Department of Health 2004) and the competences have been linked to
trauma knowledge, understanding and skills that are required at each
this.
level of practice.

Contextual factors – relates to the evidence-based or best practice

that is available.

Please note that in the competence framework the term ‘carer’ refers Knowledge and Skills Framework (KSF) – here links are made
to familymembers or peoplewho provide significant care to the between the competences and the various dimensions and levels
patient. within the NHS KSF.

The core competence domains

The competence levels
Please refer to Table 1 for the core competence domains and the
The NHS Career Framework comprises nine different levels at which a
overall structure of the framework. These four core domains were
function may be performed, and reflects the level of responsibility,
used in the original orthopaedic and trauma nursing competences
autonomy and decision making expected in a role:
(RCN,
2005) following a national consultation project with trauma and
orthopaedic nurses. The competences define a minimum threshold for Level 1 the entry level for a support worker in the health

each level of practice; however the expectation is that practitioners will environment; these practitioners should soon move to

develop their practice beyond initial competence to optimise the quality of Level 2

patient care.
Level 2 health care support workers

Level 3 senior health care support workers

Level 4 assistant/associate practitioners

Level 5 a newly qualified, competent staff nurse

Level 6 an experienced, proficient nurse

4
 ROYALCOLLEGEOFNURSING

Level 7 a senior practitioner/expert nurse who tingkat yang diinginkan. Ada berbagai bentuk bukti yang dapat Anda
undertakes holistic history-taking and physical assessment of gunakan termasuk:
the patient with a musculoskeletal condition or injury;
Belajar sendiri
educated to masters degree or doctoral level in advanced
clinical practice usaha program dan / atau kualifikasi akademik belajar

Level 8 a consultant nurse who diagnoses and prescribes

mencari kesempatan belajar di tempat kerja
pengobatan untuk pasien dengan kondisi muskuloskeletal atau
- misalnya, pekerjaan membayangi praktek di bawah
cedera; bertindak sebagai sumber daya memberikan saran ahli
klinis lanjutan untuk perawat lain dan profesional perawatan pengawasan dengan studi kasus observasi langsung
kesehatan; mengintegrasikan praktik berbasis bukti dari sumber
yang berbeda untuk memastikan penyediaan perawatan yang
berkualitas tinggi; kontribusi untuk basis pengetahuan melalui
viva voce (penilaian / ujian lisan) diamati pemeriksaan

audit dan penelitian dan mengembangkan pedoman dan standar klinis terstruktur (OSCE) praktek write-up
untuk praktek

refleksi lisan dan / atau tertulis pada perawatan yang Anda

level 9 mempertahankan tanggung jawab utama untuk perawatan klinis,
berikan portofolio bukti reflektif praktek analisis insiden kritis.
pengambilan keputusan dan akuntabilitas penuh. Dokumen
ini meliputi Tingkat praktik 2-8 karena ada sedikit, jika ada, praktisi yang
bekerja di Level 9 dalam pengaturan klinis ortopedi dan trauma. Tingkat
kompetensi adalah tidak band dan tidak harus bingung dengan 'pita'
sebagai per Agenda untuk Perubahan ( DH, 2004). Tingkat latihan
Bukti ini harus disimpan dalam portofolio profesional dan pengetahuan,
bersifat kumulatif, dengan praktisi yang diperlukan untuk mencapai
keterampilan dan praktek harus diperbarui secara berkala.
semua tingkat pra-syarat; misalnya, akan dianggap kompeten di Level 6
bukti kompetensi Tingkat 2-5 diperlukan. Kerangka kerja harus
digunakan bersama Keperawatan dan Kebidanan Dewan Kode Etik ( 2008)
dan Prinsip Praktik Keperawatan ( RCN, 2010) untuk praktek Tingkat
5-8.

Cara menggunakan kerangka

kompetensi

Kompetensi menginformasikan pengembangan profesional. Adalah penting

bahwa penilaian yang jujur ​dari tingkat saat ini pengetahuan, pemahaman
dan keterampilan dilakukan dan kemampuan untuk menerapkan dalam
praktek. Bantuan dapat disediakan dari rekan-rekan, rekan-rekan dan
manajer saat melakukan penilaian ini. Pastikan bahwa Anda memahami apa
pernyataan kompetensi meminta dari Anda.

Tanggung jawab harus diambil untuk memproduksi bukti untuk mendukung

pencapaian masing-masing kompetensi di

5
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

kompetensi

Partner / panduan

This domain relates to the partnership between the patient and the health
care professional and the unique role in guiding the patient through their
journey in orthopaedic and trauma health care.

Supporting the patient and ensuring they are at the centre of their care
is essential. In addition, working in partnership with the patient's
family/informal carers is vital, as is liaison and collaboration with all
members of the multi-professional team (MPT) to ensure seamless
holistic care.

Partner/guide competences

Support and guidance.

Patient information and education. Health

promotion. Rehabilitation.

6
 ROYALCOLLEGEOFNURSING

Partner/guide
Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and skills factors
level

Health care Assists with patient care Provides basic information to the patient and Applies basic knowledge of the Communication.
support worker through effective carers about their musculoskeletal condition/injury. musculoskeletal system to Responsibilities for
Level 2 communication under the patient care. Possesses patient care. Core 1
direct supervision of a Supports and encourages the patient when mobilising, effective communication skills.
Level 1-2 HWB1
registered nurse. according to the rehabilitation plan, with a focus on Utilises excellent customer care
Level 1
maintaining musculoskeletal integrity and mobility. skills.

Senior health Assists with patient care All the above. All the above. Possesses All the above.
care support for an orthopaedic or Communicates basic information to the sufficient understanding of
worker Level 3 trauma patient under the orthopaedic/trauma patient at a level that is musculoskeletal conditions,
indirect supervision of a appropriate. surgery and injuries to safely
registered nurse. care for a patient under the
Accurately reports work activities to senior staff
direct supervision of a
verbally and via written documentation.
registered nurse.

Assistant Facilitates holistic All the above. Recognises the psychological All the above.
practitioner patient care through consequences of musculoskeletal conditions and

Level 4
effective communication, injuries and reports concerns to a registered nurse.
delivery and health Uses simple health promotion strategies to promote
promotion under the
musculoskeletal health within the immediate
indirect supervision of a
community.
registered nurse.

Competent Facilitates holistic All the above. Semua di atas. Kneale dan Ksatria Inti 1 Level 3
nurse Level 5 patient care through Gives detailed evidence-based verbal and written (1997) BOA (2011)
HWB1 Level 2
effective information and education to patients and carers RCN (2007)
communication,
Sebuah anatomi Tingkat HWB4 3
delivery and
Advises the patient about bone health in terms of dan fisiologi buku
delegation. Tingkat HWB6 3
healthy eating and healthy living. Develops and teks.
executes remobilisation and rehabilitation plans Tingkat HWB7 3

according to patient need within an MPT. Assesses

Tingkat HWB2 3
the psychological impact of orthopaedic and trauma
conditions and injuries on individuals and their
families and provides appropriate psychological
support.

Makes timely and appropriate referrals to other

professionals where the patient’s physical, social
and psychological needs indicate necessary.

Assesses, plans, implements and evaluates care for a

wide range of patients with a wide range of
musculoskeletal conditions and injuries.

Rencana dan mengelola debit dan / atau transfer

untuk pasien dengan kebutuhan debit tidak rumit.

Asia untuk bekerja dengan anggota MPT dalam melaksanakan

pelepasan rumit untuk seorang pasien.

7
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

Partner / panduan ( terus)

tingkat Kompetensi Kriteria kinerja Pengetahuan, faktor-faktor KSF

kerangka pemahaman dan kontekstual

Karir keterampilan

Berpengalaman / Koordinat dan panduan Semua di atas. Semua di atas. Naidoo dan Inti 1 Level 3 G1
mahir perawat pasien dan perawat
Mendidik staf kurang berpengalaman dalam anatomi Wills (2009) Level 3 HWB4
perjalanan perawatan
Level 6 dan fisiologi sistem muskuloskeletal, kondisi ortopedi Level 3 HWB1
ortopedi / trauma mereka.
dan trauma, operasi dan luka-luka dan implikasinya
Level 3
untuk perawatan.

Senior praktisi / Aktif mengembangkan Semua di atas. Semua di atas. Inti 1 Level 3
pakar perawat praktek lain di bidang
Mengembangkan dan update berdasarkan bukti
Tingkat G1 3
Tingkat 7 pendidikan dan
informasi dan pedoman pasien dan perawat tertulis.
dukungan pasien dan
Tingkat G1 3
perawat.
Menggunakan berbagai media untuk mengajar

pengiriman.

Menggunakan strategi promosi kesehatan yang kompleks

untuk meningkatkan kesehatan muskuloskeletal dalam
masyarakat luas. Mendidik dan update staf lain dalam
praktek berbasis bukti kontemporer dalam praktek ortopedi
dan trauma. Menyediakan dukungan fisik dan psikologis
ahli untuk pasien dengan kebutuhan yang kompleks
termasuk beberapa trauma dan stres pasca trauma.

Sarankan staf lain tentang pendaftaran masuk dan keluarnya

pasien dengan kebutuhan yang kompleks. Audit, mengembangkan

dan meningkatkan praktek dalam kaitannya dengan masuk dan

debit.

Konsultan Mengembangkan dan Semua di atas. All the above. Is Core 4 Level 4
perawat Level 8 mengarah rencana strategis research competent
untuk mempromosikan and generating new
kesehatan muskuloskeletal knowledge, developing
dari masyarakat luas. evidence-based
practice, policy and
protocol in relation to
supporting and guiding
patients with
musculoskeletal
conditions and/or
injuries.

8
 ROYALCOLLEGEOFNURSING

Comfort enhancer

Comfort is a concept which is central to the fundamental care of the

orthopaedic/trauma patient. Comfort is a complex human experience
which can be interpreted in different ways. It is closely related to the
experience of pain, especially for patients who have received an assault
to musculoskeletal tissue (Morse and Proctor, 1998; Tutton and Seers,
2004; Cohen, 2009).

The comfort of orthopaedic/trauma patients is paramount for high-quality

care and positive health outcomes. This essential aspect of care may be
more complex for the orthopaedic/trauma patient due to the nature of
their condition, injury or surgery.Musculoskeletal instability and
movement can result in significant pain and discomfort.

Competence in providing essential care within this context is therefore

central to high-quality care and again highlights the need for that care to be
provided in a specialist setting where practitioners possess the requisite
specialist competence (Santy et al., 2005; Drozd et al., 2007).

Comfort enhancer competences

Pain and comfort assessment. Pain and

comfort management. Moving and

handling.

9
 RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

Comfort enhancer

Career Competence Performance criteria Knowledge, understanding and Contextual KSF

framework skills factors
level

Health care Assists with essential Recognises and reports unacceptable levels of pain to a Demonstrates an awareness of the impact of The Equality Act HWB2

support worker care which takes into registered nurse. Provides care which meets the unresolved pain on the patient’s recovery and/or (2010) Level 1

Level 2 account the patient’s hygiene and comfort needs taking into account rehabilitation and quality of life. Describes simple HWB6
orthopaedic/ trauma their musculoskeletal condition and their cultural and non-pharmacological strategies for the Level 2
patient’s pain and spiritual needs. management of pain and the enhancement of HWB5
comfort levels under
comfort. Understands the importance of meeting the Level 2
the direct supervision
patient’s hygiene and comfort needs.
HWB7
of a registered nurse.
Level 1

Senior health Assists with essential All the above. All the above. Recognises pain and reports to a
care support care which takes into Ensures the patient’s pain management needs have qualified nurse. Recognises when a patient has
worker Level 3 account the received adequate pain relief prior to assisting with
been met. Uses simple, non-pharmacological strategies
orthopaedic/trau ma
to help the patients to manage pain – for example, their care. Understands the need for positioning and
patient’s pain and
distraction, heat and ice therapy. supporting the patient’s trunk, limbs and joints for
comfort levels under the
comfort and healing.
direct supervision of a
registered nurse.

Assistant Provides essential care All the above. All the above. Demonstrates an awareness of the British Pain

practitioner which takes into Accurately undertakes pain assessment. Ensures that impact of unresolved pain on the patient’s Society (2007a)

Level 4
account the patient’s recovery and/or rehabilitation and quality of life. British Pain
the patient’s trunk, limbs and joints are positioned and
pain and comfort levels, Displays a basic knowledge of the anatomy and Society (2007b)
supported comfortably taking into account the
under the indirect physiology of the musculoskeletal system to Royal College
musculoskeletal condition or injury. Effectively uses
supervision of a inform an understanding of how to position, of Nursing
pillows and other devices for the management of pain
registered nurse.
reposition and support patients in enhancing (2009)
and comfort.
comfort.

Competent Assesses, plans, All the above. Semua di atas. Mengadopsi pendekatan praktik RCN (2002) Tingkat

nurse Level 5 implements and Assesses andmonitors pain and anxiety levels for patients berbasis bukti untuk strategi nyeri dan manajemen NCEPOD (2010) HWB2 3
evaluates care in order kenyamanan. Menghargai sifat nyeri akut dan kronis
with chronic and acute pain showing an understanding of Asosiasi Pasien
to meet the patient’s Tingkat
the nature of pain inmusculoskeletal conditions or injuries. dalam kaitannya dengan kondisi muskuloskeletal (2012) DH (2011)
anxiety, distress, pain HWB6 3
All patients, including children, must have their pain levels dan cedera. Memiliki pengetahuan tentang obat
The Royal
and comfort needs.
established using an appropriate pain assessment tool. analgesik dan obat tambahan seperti obat Tingkat
College of
Administers prescribed analgesia according to assessed anti-inflamasi non-steroid. Memberikan alasan HWB5 3
Dokter-dokter
need. suara untuk strategi alternatif atau pelengkap untuk
anestesi (2004) Tingkat
menghilangkan rasa sakit dan kenyamanan bagi
NICE (2005) HWB7 3
pasien dengan kondisi muskuloskeletal dan / atau
SIGN (2009)
cedera.
Appropriate distraction techniques are used and a play
NICE (2011) RCN
specialist is employed for children. Uses a selection of
(2009)
simple, alternative or complementary strategies for pain
www.mhra.
management.
gov.uk/ publikasi

NMC (2008)
Regular and ongoing evaluation of pain management
Memahami metode yang berbeda dari nyeri dan
strategies. Makes timely and appropriate referrals to
dapat mengevaluasi kesesuaian mereka untuk
experts, such as the pain team, according to patient
pasien. Mendukung pasien dan pengasuh dalam
need.
mengelola kecemasan, kesusahan, sakit dan
kenyamanan.
Mengawasi andmanages penggunaan perangkat untuk
nyeri akut dan kronis; misalnya, pasien yang dikendalikan
analgesia (PCA) dan infus epidural.
Menunjukkan akuntabilitas individu untuk
manajemen nyeri dan kenyamanan pasien.

10
 ROYALCOLLEGEOFNURSING

Comfort enhancer ( terus)

tingkat Kompetensi Kriteria kinerja Pengetahuan, pemahaman faktor-faktor KSF
kerangka dan keterampilan kontekstual

Karir

Berpengalaman / Menilai, rencana, Semua di atas. Semua di atas. NMC (2006) HWB2 Level 4 HWB6

mahir perawat memberikan dan

Memecahkan masalah dan membuat keputusan Mengartikulasikan patofisiologi RCN (2006) Level 4 HWB5 Level 4
Level 6 mengevaluasi perawatan nyeri akut dan kronis.
mengenai pemeliharaan kenyamanan sehubungan HWB7 Level 4 Tanggung
untuk pasien dengan
dengan kondisi muskuloskeletal dan luka-luka. Melengkapi sebuah
jawab untuk G1 perawatan
kompleks kenyamanan dan
Menetapkan analgesia di bawah protokol setuju NMC-disetujui, perawat resep
manajemen nyeri pasien
sesuai dengan kebutuhan pasien. Mengajarkan staf modul.
kebutuhan.
lain tentang teknik penilaian nyeri dan manajemen
nyeri.

Senior Aktif berusaha untuk Semua di atas. Semua di atas. Semua di atas. Tingkat G1 3

praktisi / pakar meningkatkan praktek di

Bertanggung jawab untuk praktek audit untuk memastikan
perawat Tingkat perawatan yang berkualitas tinggi dalam kaitannya dengan
penilaian dan
7 kenyamanan dan manajemen nyeri.
pengelolaan nyeri dan
kenyamanan bagi
Mengembangkan bimbingan dan protokol untuk manajemen
pasien yang menderita
nyeri dan kenyamanan dalam hubungan dengan anggota
gangguan
lain dari MDT. Independen mengatur analgesia dan / atau
muskuloskeletal atau
cedera. tambahan berarti lainnya. Memberikan saran ahli untuk staf

lain memberikan perawatan kepada pasien dengan nyeri

yang bersifat belum terselesaikan atau kompleks.

Konsultan Diresepkan, Semua di atas. All the above. Develops Cox, Hill and Lack G2 Level 3

perawat Level 8 mengimplementasikan, evidence-based protocols and (2012) DH (2010)

Melakukan penilaian yang komprehensif dan
memantau dan guidance for the management of International
holistik pasien dengan masalah nyeri.
mengevaluasi rejimen pain in patients with
Mengidentifikasi faktor-faktor risiko dan Council for Nurses
manajemen nyeri - baik musculoskeletal conditions or
kontraindikasi untuk perawatan. Melakukan (2008) RCN (2010)
farmakologis dan
injuries. Develops educational
audit kinerja manajemen nyeri dan hasil pasien. Scottish
nonfarmakologi.
tools for staff working with this
Government (2010)
patient group. Acts as a resource
providing advanced, expert clinical
advice to other nurses/health care
Menyelidiki analisis akar penyebab dari
professionals. Active involvement
penyimpangan / hasil dari protokol.
and instigation of research leading
to new knowledge regarding pain
assessment and management.

11
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

Risk manager

Orthopaedic practitioners need to safely assess and manage the delivery

of orthopaedic and trauma care. One of the most central aspects of
orthopaedic and trauma practice is the fact that orthopaedic and trauma
surgery and injuries may carry with them a high risk of complications. The
range of complications varies from those which are common to all
situations where there is immobility and/or an assault to body tissues.
However, there are a number of complications which are specific to
trauma and orthopaedic patients such as compartment syndrome, fat
embolism, osteomyelitis, neurovascular impairment, venous
thromboembolism (VTE) and complex regional pain syndrome. It is the
nature of these complications which requires highly specialised care.

Risk manager competences

Risk assessment. Risk

management. Discharge

planning.

Orthopaedic and trauma practitioner knowledge.

12
 ROYALCOLLEGEOFNURSING

Management of clinical risks associated with trauma and orthopaedic

practice

Career Competence Performance criteria Knowledge, understanding and Contextual KSF

framework skills factors
level

Health care Assists in undertaking Assists in obtaining and recording basic assessment Discusses the purpose of obtaining HSE (2012) Attends Core 3

support worker basic risk assessments data including vital observations under the direct temperature, heart rate, blood relevant training Level 2

Level 2 for patients with a supervision of a registered nurse.* pressure, and respirations for patients. related to the HWB1
range of Accurately obtains basic vital signs of operation of Level 1
musculoskeletal Actively adheres to local policy for manual handling in patients under the direct supervision of equipment such as
HWB3
conditions or injuries tympanic
order to prevent injury to the patient, self and others. a registered nurse. Understands the
Level 2
under the direct thermometers and
Participates in a culture which focuses on the importance of recording and reporting
HWB5
supervision of a electronic blood
management of risk and the prevention of all abnormal basic vital signs to a
registered nurse. Level 2
registered nurse. Understands the pressure machines.
complications.
normal parameters for vital
observations.

Senior health Assists in undertaking All the above. All the above. All the above.
care support basic risk assessments Assists in obtaining, reporting and recording basic
worker Level 3 for patients with a
assessment data including vital signs under indirect
range of
supervision. Not neurovascular observations.
musculoskeletal
conditions or injuries
under the direct
supervision of a
registered nurse.

Assistant Undertakes basic risk All the above. Semua di atas. Memiliki pengetahuan DH (2010) SIGN

practitioner assessments for Accurately performs, reports and records basic yang mendukung dan keterampilan (2010) Wright
Level 4
patients with a range of dalam kaitannya dengan mendapatkan
assessment data including vital signs and neurovascular (2007) Hakim
musculoskeletal pasien tanda-tanda vital dan observasi
observations. Reports any suspected signs and
conditions and/or (2007)
neurovaskular. Menunjukkan
symptoms of complications to a registered nurse.
injuries under the kemampuan untuk segera mengenali
Undertakes actions required as a result of the risk
indirect supervision of a
diduga komplikasi dan laporan segera
assessment data and includes in the care delivery.
registered nurse.
untuk perawat terdaftar.

Actively adheres to local policy for manual handling in

order to prevent injury to the patient, self and others.
Participates in a culture which focuses on the
management of risk and the prevention of
complications.

* Harap dicatat bahwa ini tidak termasuk pengamatan neurovaskular.

13
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

Manajemen risiko klinis yang terkait dengan trauma dan praktek

ortopedi ( terus)
tingkat Kompetensi Kriteria kinerja Pengetahuan, faktor-faktor KSF
kerangka pemahaman dan kontekstual

Karir keterampilan

Kompeten Aktif menggunakan Semua di atas. Semua di atas. DH (2001) Inti 3

perawat Level 5 strategi pencegahan Level 2

Menilai risiko pasien komplikasi dan cedera seperti terjatuh, kekurangan gizi, bisul DH (2004)
berbasis bukti penilaian Level 3
tekanan dan VTE menggunakan alat valid dan reliabel.
risiko berikut untuk
HWB1
kondisi umum yang DH (2010)
Mengimplementasikan dan mengevaluasi strategi berbasis bukti untuk HWB3
mempengaruhi pasien
meminimalkan komplikasi tertentu termasuk: Level 3
dengan
• VTE NMC (2012)
HWB5
• sindrom kompartemen MHRA (2011)
Level 3
• emboli lemak Pemerintah
HWB7
• infeksi dada Skotlandia (2008)
kondisi Level 3
• ISK / retensi urin
muskuloskeletal Safeguarding
• ulkus tekanan
atau cedera. Children (2012)
• malnutrisi
• infeksi luka primer dan sekunder
• osteomyelitis
• kompromi neurovaskular
• gips luka / belat RCN (2011)
• kegagalan implan.

Mengakui komplikasi aktual dan potensial dari ortopedi dan trauma kondisi, operasi
Asosiasi
luka dan. Menilai setiap anak untuk risiko keamanan potensial. Ini akan tergantung
pasien (2012)
pada usia, mobilitas dan kemampuan untuk berkomunikasi. Mengaji dan mengamati

setiap anak, dewasa yang lebih tua atau orang yang rentan untuk indikasi fisik dan /

atau perilaku kekerasan. Bertindak sesuai dengan kebijakan lokal jika penyebab

keprihatinan diidentifikasi. Segera mengakui dan laporan semua komplikasi staf

tomedical.

Menginformasikan dan mendidik pasien dan perawat tentang risiko kondisi

muskuloskeletal dan cedera. Menggunakan preventativemeasures berbasis bukti.

Menetapkan rencana perawatan berdasarkan pada penilaian risiko dan manajemen.

Mengatur dan memberikan perawatan kepada pasien yang memiliki komplikasi. Mengacu kepada

anggota lain dari theMPT seperti kelangsungan hidup jaringan.

Berpengalaman / Berlaku khusus Semua di atas. Semua di atas. Core 2

mahir perawat ortopedi dan Level 2
Menggunakan pengetahuan dan pengalaman untuk mendidik staf lain untuk
Level 6 perawatan trauma
memastikan pemahaman mereka tentang komplikasi ortopedi, trauma, operasi
pengetahuan dan Core 5
dan kondisi.
keterampilan dalam Level 2

pencegahan dan
pengelolaan
komplikasi.

14
 ROYALCOLLEGEOFNURSING

Management of clinical risks associated with trauma and orthopaedic

practice ( continued)
Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and factors
level skills

Senior Monitors, evaluates All the above. All the above. Core 5
practitioner and audits care given Reports identified risks and/or suboptimal outcomes to senior Authority to change Level 4
/expert nurse to patients at risk of management. practice. Competent
Level 7 suffering from
Leads on improving identified concerns through education of staff, changing with audit.
orthopaedic or trauma
clinical practice and amending resources as necessary.
complications.

Undertakes root cause analysis of discharge problems. Requests and

interprets clinical investigations to facilitate diagnosis of complications;
for example, ultrasound scan, bloods, skeletal x-rays.

Consultant Creates and develops a All the above. All the above. Core 5

nurse Level 8 culture of quality care by Undertakes root cause analysis of morbidity complications and untoward Authority to change Level 4
leading on specific incidents. practice. Competent
improvements that
Develops evidence-based guidance and protocols regarding the prevention with audit.
ensure that the complex
and management of orthopaedic and trauma complications.
needs of orthopaedic
and trauma patients
aremet. Leads on clinical risk assessment. Leads on corrective action to

improve clinical practice.

15
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

Technician

This domain relates to the technical aspects of orthopaedic and trauma

care and encompasses the highly technical nature of orthopaedic and
trauma practice; for example, the knowledge, understanding and skill
required for specialised devices and equipment which are used to either
treat orthopaedic conditions and injuries or to protect patients from
complications.

The trauma and orthopaedic practitioner therefore needs to be

competent in managing and using such treatment modalities.

These technical aspects of care carry their own risk of

complications and are therefore linked to the risk management
domain.

Banyak dari aspek teknis trauma dan perawatan ortopedi yang sangat khusus

dan beberapa praktisi mengembangkan keahlian ditingkatkan dalam

aspek-aspek tertentu; misalnya sementara banyak praktisi merawat pasien

dengan gips, pasien memerlukan keahlian praktisi yang sangat khusus untuk

aplikasi gips. Pada gilirannya, ini praktisi sangat terampil dan berpendidikan

membutuhkan fokus, pelatihan mendalam dan pendidikan. Menjaga

ketrampilan khusus up to date sangat penting untuk perawatan trauma

ortopedi yang aman dan efektif; misalnya, penggunaan traksi untuk orang

dewasa sekarang digunakan secara ekstensif dan karena itu kompetensi ini

mungkin memerlukan pembaruan rutin.

kompetensi teknisi
Daya tarik.

Pengecoran.

fixator eksternal dan pin perawatan situs skeletal.

Peralatan, sling, splints dan kawat gigi. alat bantu

mobilitas. kerah leher rahim.

16

Daya tarik
tingkat Kompetensi
kerangka
Karir
kesehatan Membantu dengan penerapan
dukungan traksi kulit dan / atau tiang
pekerja Level 2 gantungan / traksi Bryant dan
peduli untuk pasien diobati
dengan traksi di bawah
pengawasan langsung dari
seorang perawat terdaftar.
dukungan Membantu dengan penerapan
kesehatan traksi kulit dan / atau tiang
Senior pekerja gantungan / traksi Bryant serta
Level 3 menyediakan perawatan untuk
pasien dirawat dengan traksi,
di bawah pengawasan
langsung dari seorang perawat
terdaftar.
Assistant Applies skin traction
practitioner and/or
Level 4
Gallows/Bryant’s traction
and cares for a patient
being treated with traction,
under the direct
supervision of a registered
nurse.
ROYALCOLLEGEOFNURSING
Kriteria kinerja Pengetahuan, pemahaman faktor-faktor KSF
dan keterampilan kontekstual
Mengumpulkan peralatan yang tepat ketika diberi daftar Memahami kebutuhan traksi. HWB5
lengkap. Dapat nama peralatan. Dapat HWB7
mempersiapkan daerah klinis
Membantu dalam mempersiapkan daerah klinis di bawah Level 2
dengan instruksi yang tepat
pengawasan langsung dari seorang perawat terdaftar. Membantu
dengan perawatan pasien dirawat dengan traksi. dan pengawasan langsung.
Semua di atas. All the above. Demonstrates a
Assists in the application of skin/gallows traction only basic knowledge of traction
and technical skill when
with direct supervision from a registered nurse.
assisting with the application
of skin or Gallows traction.
Liaises with a registered nurse regarding the care of a
patient being treated with traction.
All the above. All the above. Understands
Selects the appropriate traction equipment. Prepares the principles of traction.
Demonstrates how to apply
the patient and the clinical area for application of
skin/gallows/Bryant’s
traction. Safely assists with applying skin or
traction under supervision.
Gallows/Bryant’s traction. Safeguards the patient
Understands and discusses
against injury from traction.
the safety issues for a
patient treated with traction.
Identifies the basic contraindications to treatment –
such as skin reactions – and informs senior
nurses.
17
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA
Traction ( continued)
Career Competence
framework
level
Competent Applies simple forms of
nurse Level 5 traction following the
prescription by others; for
example, skin traction
(Pugh’s or
gallows/Bryant’s) and
cares for a patient being
treated with traction.
Experienced Applies more complex
/proficient nurse forms of traction; for
Level 6 example, Thomas splint or
Dunlop traction.
Senior Monitors, evaluates and
practitioner supervises all aspects of
/expert nurse traction care.
Level 7
Konsultan Memimpin pada
perawat Level 8 pengembangan / praktek
terbaik berbasis bukti untuk
pasien yang menerima traksi.
Performance criteria Knowledge, Contextual KSF
understanding and skills factors
All the above. All the above. Knowledge and HWB7
Undertakes relevant risk assessments prior to applying traction; for understanding of the Level 3
example, moving and handling, health and safety and pressure musculoskeletal condition as
HWB3
area risk assessments. well as the management aims
Level 3
and purpose of traction.
Describes the signs and
Undertakes psychological and physical preparation of the HWB1
patient prior to and following application of traction. symptoms of potential Level 3
complications due to
application of traction. HWB5
Includes family members in the preparation of patients for
Level 3
treatment with traction. Gains informed consent from the patient
or carer prior to application or adjustment of traction. Prepares
relevant traction equipment. Administers appropriate and
adequate analgesia prior to application of traction. Measures
and fits traction equipment that is the correct size and weight
for the patient. Applies traction with regard for the anatomy of
the limb/area and risks of damage to underlying structures.
Checks the traction is working correctly and observes this regularly.
Teaches the patient to undertake appropriate exercises while
on traction in consultation with a physiotherapist.
Promptly recognises and reports potential and actual problems to
senior nursing staff. Teaches the patient, child, family about
recognising potential complications.
All the above. All the above. BAPRAS/ BOA HWB7
Rationalises the use of complex traction. Uses knowledge and (2009) Level 3
experience to educate other staff to enhance their
G1 Level 2
understanding of traction. Teaches the clinical skills of
applying traction and caring for patients on traction, to other
staff.
All the above. Semua di atas. Tingkat
Melakukan penilaian yang komprehensif dan holistik dari HWB7 3
kebutuhan klinis untuk traksi. Mengidentifikasi jenis traksi yang
G1 Level 2
akan digunakan dan mengatur beban di staf penghubung
withmedical. Monitor, mengelola dan mengevaluasi efek dari
traksi.
Semua di atas. Semua di atas. HWB7
Level 4
Audit dan mengembangkan lebih lanjut praktek yang berkaitan dengan
perawatan pasien dengan traksi.
Tingkat G1 3
18
 ROYALCOLLEGEOFNURSING

Pengecoran

tingkat Kompetensi Kriteria kinerja Pengetahuan, pemahaman faktor-faktor KSF

kerangka dan keterampilan kontekstual

Karir

kesehatan Untuk membantu perawatan Peduli untuk pasien di plester cor di bawah pengawasan Memahami alasan mengapa Inti 1 Level 1 &
dukungan pasien dengan cor atau setelah langsung dari seorang perawat terdaftar seorang pasien bergerak di 2
pekerja Level 2 gips diterapkan, di bawah gips.
pengawasan langsung dari HWB7 Level 1 &

seorang perawat terdaftar. 2

HWB5 Level 1
&2

Tingkat HWB2 1

HWB5 Level 1 &

2

dukungan Untuk membantu perawatan Semua di atas. Semua di atas.

kesehatan pasien dengan cor atau setelah
Memilih peralatan yang tepat untuk aplikasi
Senior pekerja gips diterapkan, di bawah
gips.
Level 3 pengawasan langsung dari
Mempersiapkan pasien dan area klinis untuk aplikasi
seorang perawat terdaftar.
dari gips.

Membantu dengan penerapan gips sederhana di bawah

pengawasan langsung dari staf yang berkualitas tepat.

Asisten Untuk merawat pasien dengan Semua di atas. All the above. Describes the
praktisi Level cor atau memiliki cor
Mengidentifikasi kontraindikasi dasar untuk pengobatan care of a patient being treated
diterapkan, di bawah with a cast. Discusses
4 dengan gips; misalnya, ruam kulit, eksim yang parah, dan
pengawasan langsung dari strategies to minimise damage
memberitahu perawat senior.
seorang perawat terdaftar.
to the cast by the patient or the

Safeguards the patient against injury as a result of environment. Describes the

being treated with a cast. Advises the patient or child signs and symptoms of

and family on caring for a plaster cast and the potential or actual

potential complications to look for, using age and complications due to the

cognitive level appropriate explanations. application of a cast.

19
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

Casting ( continued)
Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and skills factors
level

Competent To care for a patient All the above. Understands the rationale for RCN SOTN Core 1 Level 2

nurse Level 5 in a cast based on casting as well as the (2000) Drozd,

Undertakes physical and psychological preparation of the patient
HWB7 Level 2 &
best practice and/or underpinning anatomy and Miles and
before, during and after cast application.
the evidence base. 3
pathophysiology of conditions Davies (2009)
leading to treatment in casts. Shields and
Prepares the patient for a cast as well as gathering the HWB1 Level 2
Cast adaptation and removal Clarke (2011)
appropriate equipment. Obtains informed consent is obtained &3
competences have been taught
from the patient.
and assessed by appropriately HWB5 Level 2 &
qualified staff. Provides patient 3
Pain assessment andmanagement are included in the education in relation to patient
HWB7 Level 2 &
assessment andmanagement plan for casting. Administers self-care and management
3
analgesia prior to the casting procedure Liaises with theMPT and following discharge.

appropriately qualified practitioners to ensure the safe application HWB1 Level 2

of casts. Discusses the complications of casting and the &3
preventative strategies including:
G1 Level 2

• elevation of the limb

• exercise of unaffected joints

• VTE prophylaxis

• correct casting procedure

• patient information regarding care of the cast. Safely and

competently performs the following:

• trimming the cast

• bi-valving the cast

• windowing the cast.

• removing the cast.

Recognises andmanages the risk of complications such as:

• neurovascular impairment

• plaster sores

• compartment syndrome. Documents neurovascular

observations. Patient education is provided verbally. Written

instructions regarding the care of the cast are explained and given

to the patient/family.

Experienced To care for a patient All the above. Semua di atas. Williams G1 Level 2
/proficient nurse in a cast based on
Menggunakan pengetahuan dan pengalaman untuk mendidik staf lain untuk
(2010)
Inti 1 Level 3
Level 6 best practice and/or
meningkatkan pemahaman mereka tentang merawat pasien dan anak-anak Jika menyanggupi pengecoran
the evidence base
dengan gips. Mengajar perawatan berbasis bukti dari pasien di gips untuk staf prosedur, penilaian sebagai
and supervises
lain. kompeten di casting oleh seorang
others in the delivery
praktisi dengan pengetahuan dan
of care to patients
keterampilan yang sesuai telah
with casts.
dicapai.

20
 ROYALCOLLEGEOFNURSING

Casting ( terus)
tingkat Kriteria Kinerja Kompetensi Pengetahuan, pemahaman faktor-faktor KSF
kerangka dan keterampilan kontekstual

Karir

Senior praktisi / Untuk menyebarluaskan Semua di atas. Semua di atas. Tingkat G1 3

pakar perawat berbasis bukti praktek /

praktek audit yang berkaitan dengan pengecoran.
Tingkat 7 praktek terbaik yang

berhubungan dengan

merawat pasien yang

diobati dengan gips.

Konsultan Menetapkan gips yang Semua di atas. All the above. Demonstrates HWB6 Level 3 &

perawat Level 8 tepat sesuai dengan

Performs a comprehensive clinical assessment to determine critical thinking and diagnostic 4
kebutuhan klinis dalam skills in the prescription of
the need and type of cast required. Identifies the
kemitraan dengan HWB2 Level 3 &
contraindications and risk factors associated with cast casts. Develops management
theMPT. 4
plans related to casting, based
application and removal. Assists in the application of specialist
on research and advanced G1 Level 3
casts and performs treatment manipulation, for example,
clinical knowledge and skills. &4
Ponseti casting.

21
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

External fixator and skeletal pin site care

Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and skills factors
level

Health care Assists with the care Assists with the preparation of the clinical area and the patient Recognises external pin sites. HWB5
support worker of a patient with for pin site insertion and/or cleaning, under direct supervision.
Core 1
Level 2 external fixator Collects appropriate equipment when given a comprehensive
devices and pin list. HWB7
sites under the
direct supervision of Level 2
a registered nurse.

Senior health Assists the patient All the above. All the above. Discusses the
care support and/or carer to care rationale for using external
Assists to prepare the clinical area and patient under indirect
worker Level 3 for the external fixation for certain patients’
supervision.
fixator devices and musculoskeletal
Supports the patient to care for the external fixator and/or pin
pin sites under the conditions/injuries. Describes
sites under the direct supervision of a registered nurse.
direct supervision of
the signs and symptoms of pin
a registered nurse.
site infection.

The external Assists the patient All the above. All the above. Discusses the
assistant and/or carer to care rationale for using external
Effectively communicates with the patient/family regarding the
practitioner for the external fixation for certain patients
care of external fixators and pin sites. Assists the patient and/or
Level 4 fixator device and musculoskeletal
carer with performing external pin site care.
pin sites under conditions/injuries. Describes
indirect supervision
the signs and symptoms of pin
of a registered Safeguards the patient and others against injury due to pin
site infection. Cleans the pin
nurse. insertion.
sites according to local policy
Identifies complications associated with external fixators and
and best practice under the
pin sites.
direct supervision of a
registered nurse.

22
 ROYALCOLLEGEOFNURSING

External fixator and skeletal pin site care ( continued)

Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and factors
level skills

Competent Assesses, plans, All the above. Semua di atas. NMC (2008) Tingkat HWB7 3

nurse Level 5 implements and Prescribes care for the external fixators and pin sites. Educates the patient Pengetahuan tentang Timms et al
Tingkat HWB3 3
evaluates the patofisiologi dari (2011)
about the external fixator and pin site care.
evidencebased care muskuloskeletal kondisi Tingkat HWB1 3
for a patient with an / cedera.
external fixator and Identifies the basic contraindications to treatment, for example, infection Tingkat HWB5 3
Mengartikulasikan
pin sites. and allergic reactions and reports to the medical team.
pedoman terbaru untuk
Tingkat HWB7 3
fixators eksternal dan
Recognises and reports the signs and symptoms of external fixators and pin Inti 1 Level 2
perawatan situs pin.
site infections, reactions and complications to themedical team.
&3

G1
Recognises and reports any complications to themedical team including, tissue
necrosis and skin blistering. Delivers and evaluates external fixator and pin site
care based on best practice.

Assesses andmanages external fixator and pin site related pain

adequately.

Administers analgesia prior to insertion or removal of external fixator pins or

wires.

Mendukung pasien dan pengasuh dengan datang untuk berdamai dengan citra tubuh dan

masalah psikologis lainnya.

Mengidentifikasi dan laporan komplikasi teamany themedical frame fixator eksternal

dan situs pin. Menjelaskan kondisi themusculoskeletal atau cedera dan program

pengobatan yang direncanakan untuk pasien dan keluarga. Memanfaatkan alat

peraga yang sesuai.

Berpengalaman / Memberikan dan Semua di atas. Semua di atas. Inti 1 tingkat 3

mahir perawat mengawasi perawatan
Menggunakan pengetahuan khusus dan pengalaman untuk mendidik staf lain untuk
Tingkat G1 3
Level 6 berbasis bukti untuk
meningkatkan pemahaman mereka tentang merawat pasien dengan fixator atau pin situs
pasien dengan fixators
eksternal.
eksternal dan / atau
Mengajar fixator eksternal dan perawatan situs pin kepada pasien dan praktisi lainnya.
situs pin skeletal.

Senior praktisi / Menyebarkan Semua di atas. Semua di atas.

pakar perawat evidencebased /
Mempersiapkan pasien / anak secara psikologis dan fisik untuk fixator eksternal dan
Tingkat 7 praktek terbaik yang
situs pin penyisipan dan penghapusan.
berhubungan dengan

merawat patientswith

perangkat fixator

eksternal dan / atau

situs pin skeletal.

Konsultan Menetapkan perawatan Semua di atas. All the above. Core 1

perawat Level 8 berbasis bukti untuk

Aman mengubah perangkat fixator eksternal sebagai akibat dari penilaian pasien
Level 4
pasien dengan fixators
yang komprehensif termasuk perubahan strut dan eksternal penyesuaian bingkai
eksternal dan / atau
fixator. Mengajarkan pasien / anak dan keluarga bagaimana merawat perangkat HWB6 Level 3
situs pin skeletal.
fixator dan pin situs eksternal. &4

HWB7 Level 3
Prescribes themanagement of external fixator/pin site care. Audits practice
&4
related to external fixator and pin site care. Develops evidence-based
G1 Level 4
patient information related to external fixators and pin site care.

23
RCNCOMPETENCES–ORTHOPAEDICANDTRAUMA

Appliances, slings, splints and braces

Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and skills factors
level

Health care Assists in the Safely assists in the application of commonly used Discusses the use and HWB6
support worker application of appliances; for example; collar ’n’ cuff, broad armand high application of commonly used
HWB7 Level 2
Level 2 commonly used arm slings, a Bradford sling and a poly sling under direct appliances in the
appliances under the supervision. orthopaedic/trauma setting.
direct supervision of
a registered nurse.

Senior health Uses common All the above. All the above. Articulates the
care support appliances under the principles of treating patients
worker Level 3 direct supervision of with the different appliances.
a registered nurse. Describes the signs and
symptoms of potential
complications resulting from
treatment with orthopaedic
appliances.

Assistant Uses common All the above. All the above.

practitioner appliances under the
Safely and correctly applies slings, splints and braces.
indirect supervision
Level 4
of a registered nurse.

Competent Assesses the All the above. All the above. Discusses the HWB7
nurse Level 5 patient holistically underlying musculoskeletal
Understands the rationale for the choice of sling, splint or
Level 3
and correctly uses condition or injury. Articulates
brace.
various appliances, knowledge of the
Identifies the purposes of the different HWB3 Level 3
slings, splints and
appliances. pathophysiology of the
braces which have HWB1 Level 3
musculoskeletal system.
been prescribed. Provide patient education in relation to self-care of
Accurately demonstrates HWB5 Level 3
appliance, sling, splint/brace. Monitors and documents the
functional and resting positions.
patient’s neurovascular status.
G1 Level 3

Recognises and reports problems immediately to senior staff.

Takes prompt action tominimise or resolve

complications.

Refers to the orthotics teamas necessary.

Experienced Supervises the All the above. All the above.

/proficient nurse practice of other
Uses knowledge and experience to educate other staff to
Level 6 staff in relation to
enhance their understanding of orthopaedic appliances,
the application of
slings, splints and braces.
orthopaedic
appliances, slings,
Teaches clinical skills to others.
splints and braces.

24
 ROYALCOLLEGEOFNURSING

Appliances, slings, splints and braces ( continued)

Career Competence Performance criteria Knowledge, Contextual KSF
framework understanding and skills factors
level

Senior Prescribes all types All the above. Semua di atas.

practitioner of orthopaedic
Menilai kebutuhan klinis untuk alat ortopedi.
/expert nurse appliances, slings,

Level 7 splints and braces

Berlaku peralatan dipilih dan mengkaji hasil
and supervises staff
pengobatan.
caring for patients
requiring appliances. Mengidentifikasi komplikasi perawatan alat.
Rationalises pilihan sling, belat atau penjepit.
Menetapkan TATAkelola alat dan mengacu jika perlu
toMPT.

Konsultan Menyebarkan basis Semua di atas. Semua di atas.

perawat Level 8 bukti / praktek terbaik

praktik audit terkait dengan ortopedi peralatan, sling,
yang berkaitan
splints dan kawat gigi. Menyelidiki insiden yang
dengan perawatan
merugikan terkait dengan peralatan ortopedi.
pasien yang diobati
dengan ortopedi
peralatan, sling, Menghasilkan pengetahuan baru yang menginformasikan

splints dan kawat pengembangan kebijakan dalam kaitannya dengan ortopedi peralatan,

gigi. sling, splints dan kawat gigi.

25
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

alat bantu mobilitas

tingkat Kompetensi Kriteria kinerja Pengetahuan, pemahaman faktor-faktor KSF

kerangka dan keterampilan kontekstual

Karir

kesehatan Assist dengan Demonstrates safe and competent practice when mobilising Understands the function of HWB1
dukungan memobilisasi pasien patients under indirect supervision with the following: mobility aids. Recognises the
Core 1 Level 2
pekerja Level 2 ortopedi / trauma di safe use of mobility aids.
bawah pengawasan
• crutches Core 3 Level 1
langsung dari seorang
• walking sticks
perawat terdaftar. HWB5
• frames
Level 2
• wheelchairs.

Senior health Assists with patient All the above. All the above. Able to identify
care support mobility for an Communicates basic mobility education and information potential safety hazards
worker Level 3 orthopaedic/ trauma associated with mobility aids.
to the patient at a level that is appropriate, under
patient under the Checks the aids are fit for
indirect supervision. Accurately reports the patient’s
indirect supervision of purpose and reports faulty aids
mobility activities to senior staff.
a registered nurse.
immediately to senior staff.

Assistant Liaises with the MPT All the above. All the above. Measures and
practitioner regarding supplies mobility aids

Level 4
appropriate mobility following appropriate
aids for patients. education and training.

Competent Accurately assesses All the above. All the above. NICE (2011) Core 1 Level 2

nurse Level 5 the patient’s needs

Assesses the patient’s ability to progress from mobilising SIGN (2009)
Core 3 Level 2
and selects
with supervision of staff tomobilising independently in liaison
appropriate mobility
with the physiotherapist. HWB5 Level 3
aids in conjunction
with the HWB6 Level 3
Educates the patient and carers about the safe use of
physiotherapist.
themobility aid. G1 Level 2

Experienced Teaches and All the above. All the above. Knowledge All the G 1 Level 3
/proficient nurse supervises other staff Uses knowledge and experience to educate other staff and understanding of above.

Level 6 who assist patients altered gait patterns.

to enhance their understanding of caring for patients
with mobility aids.
usingmobility aids. Teaches clinical skills relating
tomobility to others.

Senior Prescribes mobility All the above. All the above. As level 6
practitioner aids for patients.
/expert nurse
Level 7

Consultant Disseminates All the above. All the above. HWB2 Level 4

nurse Level 8 evidence-based best

HWB5 Level 4
practice related to
Audits practice related tomobility aids. HWB6 Level 4 G1
supporting patients
with mobility needs. Level 4 Core 1
Investigates adverse incidents related tomobility aids.
Level 4 IK2 Level 3

26
 ROYALCOLLEGEOFNURSING

Cervical collars
Career Competence Performance criteria Knowledge, understanding and Contextual KSF
framework skills factors
level

Health care Assists in caring for a Discusses the reason a patient has been Understands the function of a cervical Core 1 Level 1 & 2

support worker patient treated in a cervical
Level 2 collar under the direct
supervision of a registered
nurse.
prescribed a cervical collar. collar. Articulates that a cervical collar is HWB7 Level 1 & 2
never removed without direct medical
HWB5 Level 1 & 2
advice and is performed only under the
HWB2 Level 1
direct supervision of a more senior
HWB5 Level 1 & 2
practitioner.

Senior health Menunjukkan praktek yang Semua di atas. Mengidentifikasi komplikasi Semua di atas. Mengamati kulit pasien untuk

care support aman ketika merawat seorang potensial dan aktual memakai kerah leher tanda-tanda kerusakan tekanan di bawah

worker Level 3 pasien dirawat di kerah leher rahim dan segera melaporkan ke perawat pengawasan langsung.
rahim di bawah pengawasan terdaftar.
langsung dari seorang perawat

terdaftar.

Asisten Menunjukkan praktek yang Semua di atas. Semua di atas. Membahas anatomi dasar

praktisi Level aman ketika merawat pasien tulang belakang leher dan sumsum tulang
dirawat di kerah leher rahim di
4 belakang.
bawah pengawasan langsung
dari seorang perawat
Mengakui dan laporan perubahan kulit
terdaftar.
pasien ke perawat terdaftar. Baik
kebersihan kulit pasien dilakukan.

Kompeten Mengaji, rencana, Semua di atas. Semua di atas. Memahami cedera pasien dan NMC (2008) Inti 1 Level 2 inti 3

perawat Level 5 melaksanakan dan

Aman peduli untuk pasien dengan kerah leher
mengevaluasi perawatan untuk
rahim.
pasien memakai kerah leher
Refers to an orthotist or doctor for the initial
rahim.
assessment, measurement and fitting of the
cervical collar. Discusses the evidence-based
management of a patient wearing a cervical
collar.
Discusses spinal precautions and spinal
protection for the patient. Pressure area
care is performed to reduce the incidence of
pressure ulceration as a result of wearing a
cervical collar.
potensi komplikasi yang berhubungan dengan British Trauma Level 2 HWB2
cervical collar serta cedera. Memahami bahwa Society (2002)
Level 2 & 3 HWB3
jika seorang pasien memakai kerah keras
BOA (2008)
Level 2 & 3 HWB5
sementara yang ini harus diganti dengan
Level 2 & 3 HWB6
alternatif sesuai resep dokter dalam waktu 48
jam masuk. Menanti izin tulang belakang oleh Level 2 & 3 HWB7
dokter. Nama yang berbeda kerah leher rahim Level 2 & 3
dan rationalises penggunaannya. Melakukan
log bergulir untuk pasien di tempat tidur
istirahat, dengan minimal lima praktisi,
setidaknya setiap dua jam. Seorang praktisi
senior memimpin log bergulir manuver
sementara mendukung kepala dan leher
pasien untuk menjaga keselarasan tulang
belakang.

27
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

kerah leher rahim ( terus)

tingkat Kompetensi Kriteria kinerja Pengetahuan, pemahaman dan faktor-faktor KSF
kerangka keterampilan kontekstual

Karir

Berpengalaman / Assesses, plans, All the above. Teaches other staff about All the above. Core 1

mahir perawat implements and evaluates the assessment andmanagement of Level 3

Level 6 the care for a patient patients wearing cervical collars. Core 3
wearing a cervical collar
Level 3
and supervises other staff.
HWB2

Level 3

HWB3

Level 3

HWB5

Level 3

HWB6

Level 3

HWB7

Level 3

G1 Level

Senior Measures and sizes the All the above. All the above. Assessed as competent to As level 6
practitioner patient for a cervical measure and fit cervical collars by an
/expert nurse collar. appropriately qualified practitioner.
Level 7

Consultant Prescribes cervical All the above. All the above. Audits practice related to Core 1

nurse Level 8 collars. cervical collars. Level 4

Assesses andmanages the care of patients with
potential spinal injuries. Performs and Core 3

documents a full physical neurological Level 4

Investigates any adverse incidents related
assessment of the patient. Measures, sizes and to the care of patients in cervical collars. HWB2

fits cervical collars. Level 4

HWB3

Level 4

HWB5

Level 4

HWB6

Level 4

HWB7

Level 4

G1 Level

28
 ROYALCOLLEGEOFNURSING

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31
RCNCOMPETENCES - ORTHOPAEDICANDTRAUMA

Bacaan lebih lanjut dan situs

web yang berguna

Bacaan lebih lanjut

Jester R, Santy J dan Rogers J (2011) Oxford buku pegangan ortopedi dan trauma

keperawatan, Oxford: Oxford University Press. Kneale J dan Davis P (2005) Ortopedi

dan traumaNursing (2nd edition), London: Churchill Livingstone.

situs yang berguna

arthritis ResearchUK
www.arthritisresearch.org

Internasional HipDysplasia Insitute

www.hipdysplasia.org

andDeaths Hasil Nasional Penyelidikan Rahasia intoPatient

www.ncepod.org.uk

National Institute forHealth andClinical Excellence

www.nice.org.uk

FractureDatabase Hip Nasional

www.nhfd.co.uk

Registry Joint National

www.njrcentre.org.uk

ortopedi Skor
www.orthopaedicscores.com

PerthesAssociation
www.perthes.org.uk

Skotlandia Intercollegiate Guidelines Jaringan www.sign.ac.uk

LANGKAH, asosiasi nasional untuk anak-anak dengan

kelainan ekstremitas bawah
www.steps-charity.org.uk

32
 ROYALCOLLEGEOFNURSING

33
RCN mewakili perawat dan keperawatan,
mempromosikan keunggulan dalam praktek dan bentuk
kebijakan kesehatan

edisi revisi September 2012

REVIEWDATE September 2015

RCN online
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RCN Langsung
www.rcn.org.uk/direct 0345
772 6100

Diterbitkan oleh Royal College of Nursing 20

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Kode publikasi 004 316 ISBN

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