Abstract
The aim of this research project was to explore nurses' perceptions of the self-directed x-ray assessment and referral education package in preparing them for leading assessment and referral for x-rays for patients presenting with elbow and/or below knee injuries. previously, there has been no evidence available to suggest that nurse-initiated x-ray education tools are being used in the primary care setting. Following an audit by the researcher in her workplace, it was shown that a nurse-initiated education tool may be beneficial, hence the reason for this study. The study was executed in a large rural primary care setting. Nurses were invited to complete an education package, which was developed from best practice evidence, and would need to pass a test before being able to request x-rays for patients presenting with below elbow and/or below knee injuries. The participants met a single criteria of two or more years nursing experience.
A qualitative descriptive design was utilised to undertake this research. Data was collected using an open-ended questionnaire, from seven primary health care nurses who had completed the self-directed learning package. Data was analysed using Thomas's General Inductive Approach.
Overall, the nurses' perceptions of the education package were positive, with nurses unanimously acknowledging the education package as user friendly; they were confident to apply the knowledge gained after completing the package, with agreement that the education package was beneficial for patients, nurses, and doctors in this primary care setting. The education package provided advanced knowledge to nurses to safely request x-rays for patients presenting with below elbow and/or below knee injuries, while remaining within the registered nurse scope of practice. Support from the researcher's team members was encouraging as they could see future benefits of having a nurse-initiated x-ray package. Further research such as an audit would provide 'specifics' of implementing a nurse-initiated x-ray criterion such as time saved for patients waiting to see a doctor, accuracy of nurse-initiated x-ray requests and number of identified fractures. Additionally, recommendations suggest the need for minor changes to the education package, such as exploring evidence and process for when a patient only meets part of the x-ray criteria. Future work could also explore the relevance of the education package for Māori nurses and whether the nurse-initiated x-ray service increases equity of access for Māori patients.