Selected abstracts from the 23rd Royal College ofNursing Society of Orthopaedic and TraumaNursing International Conference and Exhibition,Newcastle upon Tyne, UK 24–26 September 2009

Hope: A core concept for trauma care? (Plenary)

Liz Tutton

John Radcliff Hospital, Oxford/RCN Institute, UK

Aim: To explore the practical utility of the con-cept of hope.

Abstract: This paper examines the concept ofhope from a theoretical and practical perspectivedrawing on data from a study of hope on a RegionalTrauma Unit. In general the concept of hope isappealing because it focuses on how people surviveand look forward to life, despite the many traumasand disruptive events that occur. The study drewon the principles of ethnography undertaking:21 h of observation; in depth qualitative interviewswith 10 patients and 10 multidisciplinary membersof staff; and two focus groups with staff to expandpreliminary findings from the study. Data collec-tion took place between March 2007 and October2007. Data were analysed by sentence and codedusing QSR N6 as a means of managing the data.The findings identified two themes that conveyedthe meanings of hope in trauma care; the natureof hope and realistic hopefulness. The nature ofhope identified the range of meanings inherent inhope for staff and people living with injury; theimportance of energy, self worth and moving for-ward. Staff used a process of realistic hopefulnessto support emotional and physical recovery frominjury alongside a practical goal directed approachto care. Both staff and people living with injuryfound living with uncertainty a struggle; in additionstaff were careful to avoid conveying false hope.Hope in this study represents the artistic blendingof a range of theories into a practical activity thathas relevance to daily ward life. Challenges for

practice and areas for further research areidentified.

Intended learning outcomes:

� To gain a theoretical understanding of the con-cept of hope.� To acquire an insight into hope as experiencedby staff and patients on a Trauma Unit.� To consider the practical utility of hope.

Recommended reading:Morse, J.M., Penrod, J., 1999. Clinical scholar-

ship. Linking concepts of enduring, uncertainty,suffering, and hope. Image: Journal of NursingScholarship 31 (2), 145–150.

Turner, D.S., Stokes, L., 2006. Hope promotingstrategies of registered nurses. Journal of Ad-vanced Nursing 56 (4), 363–372.

Wise, R., Cott, C., Gibson, B., 2008. Hope,expectations and recovery from illness: a narrativesynthesis of qualitative research. Journal of Ad-vanced Nursing 64 (6), 564–573.

doi:10.1016/j.joon.2009.07.008

Following Darzi – Our role as professionals indelivering high quality care (plenary)Elaine Collins

NHS Direct, West Midllands, UK

Aim: To provide an overview of the recommen-dations of the Darzi report ‘High Quality Care forall’ and its implications for orthopaedic nurses inpractice.

Abstract: In July 2007, Secretary of State forHealth Alan Johnson asked Lord Darzi to conduct

Journal of Orthopaedic Nursing (2009) 13, 132–154

a’once in a generation review’ of the health servicein England, consulting with patients and staff to setpriorities for the next 60 years, with a focus on ac-cess, quality and safety. Lord Darzi launched theNext Stage Review final report in June 08 entitled‘High Quality Care For All’ which sets a new foun-dation for a health service that empowers staffand gives patients choice. It ensures that healthcare will be personalised and fair, includes themost effective treatments within a safe system,and helps patients to stay healthy.

The report advocates a key message that ‘wecan only be sure to improve what we can actuallymeasure.’ The report sets out plans that all regis-tered healthcare providers will be required by lawto publish ‘Quality Accounts’ – just as they publishfinancial accounts.To make sure this is achieved,Lord Darzi has set out ambitious commitments formaking quality improvement the organising princi-ple of the NHS, starting with how things are doneas a basis for transforming quality.

Orthopaedic nurses, who are at the frontline ofpatient care, have first hand knowledge of whatquality means to patients and are in an ideal posi-tion to shape the way quality metrics are devel-oped to measure outcomes for patients within thespeciality.

This presentation will provide an overview of thethree quality domains set out in ‘High Quality Carefor All’, patient safety, effectiveness of care andthe patient experience. Delegates will be askedto consider how Orthopaedic Nurses should beinfluencing the development of quality metricswithin the speciality and how the professionalvoice of the RCN Society of Orthopaedic and Trau-ma Nursing can support them to influence and be-come actively involved in the development andmonitoring of their local quality agenda to guaran-tee the patients entire experience of Orthopaediccare.

Intended learning outcomes:

� To provide an overview of the recommendationsof ‘High Quality Care for all’.� To consider the implications for orthopaedicnurses in practice.� To discuss how the RCN Society of Orthopaedicand Trauma Nursing can support its members ininfluencing the development of quality stan-dards for orthopaedic patients.

Recommended reading:Professor the Lord Darzi of Denham, 2008. High

Quality Care for All: NHS Next Stage Review FinalReport. Department of Health, London.

Jennings, M., 2008. Delivering quality and value.Nursing Management 15 (6), 22–24.

Griffiths, P., 2008. Metrics for nursing. NursingManagement 15 (8), 10–11.

doi:10.1016/j.joon.2009.07.009

The use of the Liverpool Care Pathway to pro-mote good practice in end of life care on anacute orthopaedic trauma ward: A case report(plenary)Margaret Russell, Sam Byott

Manchester Royal Infirmary, UK

Aim: To describe the experiences of a multidis-ciplinary team’s use of the Liverpool Care Pathwayon an acute trauma orthopaedic ward, and demon-strate how the use of an evidence based frame-work can provide dignity and respect in end oflife care.

Abstract: Hip fractures are common in the el-derly and these patients have high mortality, withrates as high as 35% over one year being describedby Keene et al. (1993), SIGN (2002), and Kanis et al.(2003). Despite this, healthcare professionals with-in the acute orthopaedic ward have acknowledgeda lack of experience and skills in these areas.

The End of Life Care Strategy (Department ofHealth, 2008) promotes the provision of high qual-ity care for all adults approaching their dyingphase. The ‘Integrated Care Pathway for the DyingAdult’ commonly known as the LCP was imple-mented in this acute Trust between 2005 and2007. The LCP is an evidence based framework,and a model of excellence, for appropriate, highquality multidisciplinary care at the end life.

A case is described in which the LCP was used inan acute orthopaedic ward. A 93 year old lady withDementia was admitted following a fall and wasdiagnosed with a fractured neck of femur. Follow-ing internal fixation, the patient was slow to mobi-lise and drowsy on the ward. A CT scan confirmed anon-operable subdural haematoma. Following mul-tidisciplinary decisions and discussions with thefamily, end of life care was managed with dignityand respect using the LCP.

The multidisciplinary team were commended fortheir use of the LCP in terms of communication,teamwork, documentation and addressing thepsychosocial, spiritual and functional needs of thepatient, her family and caregivers. The case pre-sentation demonstrates how a change of culturewithin an acute orthopaedic setting, with the use

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