The International Collaboration of Orthopaedic Nursing: advancing nursing through technology A.J. Meehan1,2,3 RN-BC, MSN, ONC, FNGNA, A.B. Maher1,4 ONC & A. Hommel5,6,7 RN, CNS, PhD

RN, FNP-BC, MS,

1 Ambassador, 2 Founding Chair, 5 Chair, 6 Advisory Committee, International Collaboration of Orthopaedic Nursing, 3 Clinical Nurse Specialist, Geriatrics/Med-Surg, Nursing Administration, Akron General Medical Center, Akron, OH, USA, 4 Family Nurse Practitioner, Long Branch, NJ, USA, 7 Associate Professor, Department of Health Sciences, Lund University, Lund, Sweden

MEEHAN A.J., MAHER A.B. & HOMMEL A. (2015). The International Collaboration of Orthopaedic Nursing: advancing nursing through technology. International Nursing Review 62, 203–206 Aim: To report on the International Collaboration of Orthopaedic Nursing, a mostly virtual network of orthopaedic nursing organizations across four continents. Background: Formed by leaders of three national associations, the collaboration is based on recognition of patient problems and challenges shared by orthopaedic nurses globally. Methods/Initiatives: The Collaboration provides a range of services including education, mentoring, and organizational development. Low cost internet-based technologies, such as email and Skype, support global networking in real time. Discussion/Implications for Nursing and Health Policy: The Collaboration is a cost effective example of how nurses can collaborate internationally to promote the highest standards of orthopaedic nursing. Keywords: Collaboration, Global Network, Internet, Mentoring, Networking, Orthopaedic Nursing, Technology

Introduction As healthcare costs rise globally, smaller nursing specialties are often grouped under the larger umbrella of medical-surgical nursing. This can limit nurses’ access to specialty education and potentially diminish provision of quality, state of the science care to patients. The International Collaboration of Orthopaedic Nursing (ICON) is a mostly virtual organization of

Correspondence address: Anita J. Meehan, Nursing Administration, Akron General Medical Center, 1 Akron General Avenue, Akron, OH 44307, USA; Tel: +1 330-344-6953; Fax: +1 330-945-7931; E-mail: [email protected].

Funding: This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Conflict of interest: No conflict of interest has been declared by the authors.

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national and regional orthopaedic nursing groups representing countries across four continents. The Collaboration operates on a low-cost model that may be useful for other specialty groups to consider.

Background of the Collaboration In 2001, the leaders of three national associations of orthopaedic nursing agreed to form an alliance around the shared mission of promoting the universal application of the highest standards of orthopaedic nursing practice and care. Emerging technologies provided the platform allowing conversations to begin among the leaders of the Canadian Orthopaedic Nurses’ Association, the Royal College of Nursing Society of Orthopaedic and Trauma Nurses from the UK, and the National Association of Orthopaedic Nurses in the USA.

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Experience from the Field

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Email afforded a cost-effective means to initially reach across borders and engage in conversations with colleagues across the world. There was recognition of common challenges and practice issues. As Rosemary Bryant, ICN past President, noted in 2011, ‘As nurses we share a vision and we have a natural affinity for the issues that nurses from other countries are facing’ (Bryant 2011, p. 1). The Collaboration provides an opportunity for nurses caring for patients with musculoskeletal problems to network with each other and to learn from colleagues outside their usual circle of influence, establishing global connections and transcending organizational, professional and national boundaries. Access to funding is a challenge for many organizations; our model uses available (mostly free) technology to overcome this hurdle.

Organization of the Collaboration Starting from the initial three groups, the Collaboration now includes associations from Australia/New Zealand, Canada, Mainland China and Hong Kong, Denmark, Ireland, Malta, Portugal, Sweden and the UK. There are no individual memberships in the ICON; rather, membership is open to national and regional associations of orthopaedic nurses. Discussions are ongoing with a number of additional groups, and inquiries from established and fledgling orthopaedic nursing organizations are welcomed. There is a framework for operation (Terms of Reference) that all member associations agree to support. Each association appoints a representative to serve a 3-year term on the ICON Advisory Committee. These representatives, in turn, elect a Chair who serves one 3-year term. There are no annual dues or prescribed charges for membership. Each member association agrees to an annual pledge of the equivalent of 50 euros should there be any expenses. The funds are held by the member organizations and only distributed if there is a specific expense agreed upon for its disbursement. This money has been used, for example, to produce a poster that has been presented at several international professional meetings.

Networking in real time A range of free Internet-based programs, such as email, Skype, Dropbox, Google Chat, WhatsApp and LinkedIn, provide the means to engage colleagues in a range of collaborative endeavours. Access to the Internet via computer and cell phone in most countries allows representatives of the Collaboration to engage colleagues all over the globe for only the cost of Internet access. In addition, the Collaboration hosts a Facebook page as well as a website (www.orthopaedicnursing.org), providing a mecha-

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nism for member associations to share news about their local professional activities and educational offerings. The cost of this endeavour is minimal as the ICON maintains the website. To date, annual costs have not exceeded 150 euros; more affluent member organizations support the website on a voluntary, yearto-year basis.

ICON initiatives Early efforts focused upon relationship building, which began in the old-fashioned way, face-to-face, by bringing official association greetings and answering calls for abstracts to present at member associations’ educational conferences. Informal talks at these gatherings reinforced the commonality of patient care issues and led directly to one of the first group projects: a twopart article entitled, Acute nursing care of the older adult with fragility hip fracture: An international perspective (Maher et al. 2012, 2013). Subsequent initiatives are concentrated in one of three areas: professional, organizational and individual. At the professional level, nurses share evidence-supported, best practice strategies with orthopaedic nurse colleagues. This is achieved through publications available on our website without copyright restriction as well as through international conferences. The first ICON-sponsored conference was held in Dublin, Ireland, in 2010 with the support of Elsevier Publishing. Over 250 representatives from 22 countries attended. The second conference, in 2013, was held in conjunction with the Canadian Orthopaedic Nurses’ Association annual educational meeting in Vancouver. A third conference is in the planning stages and an Asian venue is anticipated, again in collaboration with a member association. The article on care of the patient with fragility hip fracture was written to present evidence on and best practice strategies for the prevention, detection and management of foreseeable risks and complications in the fragility fracture population, including pain, delirium, pressure ulcers, fluid balance, nutrition, constipation and urinary tract infection. These quality care indicators were chosen because they reflect the impact of independent nursing practice. Collaborative members are pleased that this work is cited in a new edition of a well-known professional reference text for geriatric nurses and nursing students (Kirkevold et al. 2014). While evidence-supported best practice information is important to deliver to appropriate audiences, the authors recognize that knowledge alone will not change practice. An Institute of Medicine (IOM) (2001) report, Crossing the Quality Chasm, identified that an average of 17 years is required for new knowledge generated by research to be incorporated into

ICON

practice. ICON’s most current project focuses upon actual policies and procedures at the practice level related to the nursesensitive quality indicators discussed in Maher et al. (2012, 2013). A pilot audit tool is being tested in a small number of hospitals across the member associations to determine if care processes for older adults with fragility hip fracture reflect those identified in the articles as evidence-supported best practice. The intent is to refine the audit tool and ultimately share the tool with member associations as a method for evaluating current nursing practice. Individual institutions could use the information obtained from the audit tool as the basis for staff education programmes as well as for development of nursing protocols and policies. At the organizational level, ICON leaders provide guidance on organizing within local regions and countries to raise the national profile of the specialty of orthopaedic nursing. The Australia/New Zealand Orthopaedic Nurses’ Association (ANZONA) and the Society of Maltese Orthopaedic Nurses formed with support and advice from ICON member leaders. In turn, these associations have provided educational offerings to orthopaedic nurses within their respective countries and beyond. At the individual level, ICON representatives mentor nurses to develop specific skills as requested. These include, for example, leadership development to serve at the national level of a professional organization, developing course materials for a continuing education programme, writing for professional publication and presenting at professional conferences. It is in this sphere primarily that ICON Ambassadors provide a range of services. ICON Ambassadors are orthopaedic nurse leaders invited by the Advisory Committee to serve as mentors. They are chosen for their experience and/or skills; for example, developing clinical practice guidelines, writing and editing, and leadership of a national nursing organization. This role is modelled on an initial grant to the Royal College of Nursing Society of Orthopaedic and Trauma Nursing (SOTN) in support of online leadership mentoring. One of the original grant recipients, Karen Hertz, worked with one of the authors (AJM) to develop leadership skills in support of serving on the Board of SOTN. Following her successful tenure in that position, Ms Hertz now serves on the Board of the Fragility Fracture Network, an international multidisciplinary organization. She also represents the SOTN on the ICON Advisory Committee. Mentors guide, advise and coach. The approach is informal and results oriented with the outcome and timeline tailored to the individual requesting assistance. The distance relationship relies again upon technology using primarily email, Skype and Dropbox.

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Collaboration with other specialties To achieve the goal of providing optimal nursing care to orthopaedic patients globally, alliances have also been forged beyond the boundaries of orthopaedic nursing to collaborate with colleagues in other specialties. ICON Advisory Committee representatives participate in formulating education programming for both the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and the international Fragility Fracture Network (FFN). In October 2014, Swedish and Danish ICON member associations co-sponsored a conference with the FFN. The ICON is also partnering with the USA-based Nurses Improving Care for Healthsystem Elders (NICHE) to produce educational materials for their membership with specific focus on care for older adults with orthopaedic diagnoses. Two documents in the ‘Need to Know’ series authored by ICON representatives include Hip Fracture and Repair, and Care after Hip Fracture. The documents are used by nurses to educate both patients and their families and can be accessed at http:// nicheprogram.org/need_to_know. Also, in collaboration with the National Gerontological Nursing Association (USA), ICON members from four countries are currently developing a webinar on prevention and treatment of fragility fractures. The webinar will be available in both live and recorded formats, and participants can obtain continuing education credit. The ICON actively seeks opportunities to partner with groups with similar patient care interests with a focus on providing optimal care for individuals with musculoskeletal problems.

Discussion As orthopaedic nurses, we are members of a global community and we have a world of colleagues who share our interests. Modern technology permits us to come together, share information and communicate on issues of common concern across vast geographic distances in real time. The website allows us to extend our reach as does Facebook, which has attracted over 400 people from across the globe to join our site. Webinars allow us to take best practice orthopaedic nursing information to an audience of other nursing specialty organizations who care for individuals with musculoskeletal problems such as home care nurses, theatre (operating room) nurses, Gerontological nurses and emergency department nurses.

Implications for nursing and health policy This international Collaboration of orthopaedic nurses is a cost-effective example of how nurses from across the globe can use technology to create a broader perspective on issues of

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common concern. The Collaboration encourages crosspollination of ideas and cultures that foster professional relationships across borders. Joining together on issues of common concern amplifies the voices of orthopaedic nurses and raises awareness of the specialty. Such international partnerships have the potential to enhance our practice, inform colleagues and benefit our patients. The Collaboration brings together nurses who are passionate about the profession and the specialty, encouraging creativity and development of initiatives aimed at supporting best nursing practice at the bedside. These initiatives have the potential to inform change within individual care settings as well as provide guidance for policy advocacy by orthopaedic nursing organizations. The Collaboration provides a forum for sharing information to improve and potentially standardize orthopaedic nursing care based upon evidence and best practice recommendations in both advanced and developing healthcare systems.

Acknowledgements The authors acknowledge the dedication of Elaine Collins and Valerie MacDonald, previous ICON Chairs, to strengthening

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orthopaedic nursing practice worldwide and thank Claudia Cuddy for her editorial expertise.

References Bryant, R. (2011) The universality of nursing. International Nursing Review, 59 (1), 1–2. Institute of Medicine (IOM) (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Washington, DC. Kirkevold, M., Brodtkorb, K. & Hylen Ranoff, A. (2014) Geriatric Nursing, Good Caring to the Older Patient, 2nd edn. Gyldendal, Oslo, Norway. Maher, A.B., et al. (2012) Acute nursing care of the older adult with fragility hip fracture: an international perspective (Part 1). International Journal of Orthopaedic and Trauma Nursing, 16, 177–194. Maher, A.B., et al. (2013) Acute nursing care of the older adult with fragility hip fracture: an international perspective (Part 2). International Journal of Orthopaedic and Trauma Nursing, 17, 4–18.

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The International Collaboration of Orthopaedic Nursing: advancing nursing through technology.

To report on the International Collaboration of Orthopaedic Nursing, a mostly virtual network of orthopaedic nursing organizations across four contine...
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