Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters.

BACKGROUND: Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other low- and middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. The aim of the study was to establish the feasibility of formal training of TBS and subsequent integration into the healthcare system. METHODS: Two focus group discussions were conducted involving five TBS and eight orthopaedic surgeons in Enugu Nigeria. Audio-recordings made during the focus groups were transcribed verbatim and analysed using a thematic analysis method. RESULTS: Four themes were identified: Training of TBS, their experiences and challenges; perception of traditional bonesetting by orthopaedic surgeons; need for formal training TBS and willingness to offer and accept formal training to improve TBS practice. Participants (TBS group) acquired their skills through informal training by apprenticeship from relatives and family members. They recognized the need to formalize their training and were willing to accept training support from orthopaedists. The orthopaedists recognized that the TBS play a vital role in filling the gap created by shortage of orthopaedic surgeons and are willing to provide training support to them. CONCLUSION: This study demonstrates the feasibility of providing formal training to TBS by orthopaedic surgeons to improve the quality of services and outcomes of TBS treatment. This is critical for integration of TBS into the primary healthcare system as orthopaedic technicians. Undoubtedly, this will transform the trauma system in Nigeria and other LMICs where TBS are widely patronized.

A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals.

AIM: The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. BACKGROUND: Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. DESIGN: A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. DATA SOURCES: Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. REVIEW METHODS: Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. RESULTS: Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. CONCLUSION: Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives.

Defining deviation: The peer professional opinion defence and its relationship to scope expansion and emerging non-medical health professions.

The law imposes a duty to exercise reasonable care and skill in the provision of professional advice and treatment on all health practitioners, which in Australia is assessed via a modified Bolam principle. In an era of medical dominance, this standard was clearly related to the standards of the medical profession. However, the evolving nature of the Australian health workforce has fuelled speculation as to how non-medical professions are assessed to be practising in accordance with established standards. This article explores the peer-professional defence in relation to new, emerging and established non-medical professions practising in areas that were not historically part of their remit, and finds that individual health professions--even those which do not possess traits historically defined by professionalism--have ultimate discretion in determining the standards by which they are assessed, though such standards may be rejected by courts if they are deemed irrational.

We need nationally agreed patient group directives.

For years, paramedics have been able to administer a list of more than 30 drugs to ensure that patients receive appropriate and timely treatment. But for emergency care nurses (ECNs), patient group directives vary according to the organisation in which they practise.

Transforming continuing education across the health professions.

Transforming continuing education (CE) in the health professions requires a focus on competence and performance improvement by all health care professionals to ensure the public's trust. Measures of competence include individual, team, and systems-based performance meeting the growing expectations for quality care by consumers and the government. CE professionals have a critical role in meeting these new expectations for health care professionals as they pursue their continued professional development. This competence-based framework demands new knowledge, skills, and abilities for the CE health professional, including standardization and formalization of this field as an emerging profession.

Why Is Treatment Urgency Often Overestimated? An Experimental Study on the Phenomenon of Over-triage.

In the 19th century, triage emerged as an administrative concept to overcome the unjust and medically unreasonable consequences of an unsystematic adhoc selection of casualties. Until today, however, triage concepts are often applied incorrectly. High over-triage rates are a well-known phenomenon, which increase mortality rates. In order to examine their frequent occurrences, the article discusses different reasons and presents results of an experimental study. Two triage exercises were conducted: a paper-based triage exercise and a real-world simulation. Both exercises used the same case-vignettes consisting of 5 pairs. Each pair described a patient with the same injury pattern and vital parameters but with differing behaviour (calm/highly excited). Different behavior has a minor but no significant effect on over-triage rates. Over-triage is significantly higher in the real-world simulation than in the paper exercise. This is explained by the characteristics of face-to-face situations themselves: they are more complex and ambiguous, and hold more normative power. Accordingly, over-triage is understood as a means to resolve unclear situations ("better to over- than to under-triage") and to comply with normative demands "within" the strict margins of an administrative concept.

Socialisation of seconded healthcare assistants.

AIM: To compare the clinical practice experiences of seconded healthcare assistants (HCAs) with four major socialisation concepts. METHOD: The sample was comprised of eight seconded HCAs, all from the same pre-registration mental health nursing cohort. A semi-structured focus group strategy was used, with the group convening on a yearly basis. FINDINGS: The practice learning experiences of seconded HCAs are different to other nursing students and could be viewed as a unique socialisation process. CONCLUSION: Course planning teams should consider socialisation factors and supportive mentor strategies when designing the first year of pre-registration nursing programmes.

Working towards a new standard of care.

The Care Certificate is aimed at all healthcare assistants and support workers to ensure they deliver 15 standards of effective care. It is not a legal requirement, so there are concerns that in a sector such as social care, it may be more costly to implement than existing training programmes.

Independent non-medical prescribing for paramedics.

Independent non-medical prescribing has made significant advances in nursing and is now being considered and developed by other professions. The role of the paramedic is evolving and there is great emphasis on managing people at home and reducing rates of conveyance to hospital. This article discusses the role of the paramedic and suggests the benefits that independent non-medical prescribing could have for both the paramedic profession and for the patients paramedics treat during their clinical practice.