Fast-Track Training in Emergency Department During the COVID-19 Pandemic: Evaluation of a Hybrid Education Model.

INTRODUCTION: Emergency department (ED) fast track (FT) for the ambulatory, minor injury patient cohort requires rapid patient assessment, treatment, and turnover, yet specific nursing education is limited. The study aimed to test the feasibility and staff satisfaction of an education program to expand nursing skills and knowledge of managing FT patients during the COVID-19 pandemic. METHODS: This quasi-experimental study, including self-rating surveys and interviews, assessed the pre- and postimplementation of an education program for nurses working in FT in a metropolitan hospital ED in Australia. Hybrid (face-to-face and Teams) education sessions on 10 topics of staff-perceived limited knowledge were delivered over 8 months. RESULTS: Participants demonstrated higher knowledge scores after the implementation of short online education sessions to cover the core facets of minor injury management. Overall staff satisfaction with the program was high. Interview discussions involved three key themes, including "benefits to staff learning," "positive impact on patient care and flow," and "preferred mode of delivery." CONCLUSIIONS: Recorded education sessions on minor injury topics for nurses working in FT have proved effective, and this program has now become a core facet of ED education in our hospital.

e-Learning interventions for nurses to prevent venous thromboembolism in patients: A realist review.

AIM: To synthesise published literature exploring online venous thromboembolism (VTE) prevention education programmes to identify, test and refine a program theory supporting translation of knowledge into practice for registered nurses. BACKGROUND: Venous thromboembolism is a leading cause of preventable morbidity and mortality in hospitalised patients. Successful implementation of prevention strategies can be impeded by a lack of education and translation of knowledge to practice. Continuing professional development programs using e-learning platforms are increasingly common, however, there is little published literature exploring effective translation of such education to practice. DESIGN: Realist Review. METHODS: Searches were conducted in seven healthcare databases prior to July 2020 and updated in March 2022. Synthesis was informed by the unified theory of acceptance and use of technology (UTAUT) model and followed stages of a realist review outlined by Pawson et al. The results were reported according to the RAMESES publication standards. RESULTS: Eight context-mechanism-outcome combinations were identified to explain engagement, completion and adoption of VTE e-learning into practice. Mechanisms included valuing content as relevant to practice, having confidence in the ability to use the technology and empowerment to enact change based on learning. Contextual factors that may constrain the completion of learning include the support of managers and organisations through time, and the availability of resources. CONCLUSION: Translation of e-learning is critical to ensure clinical excellence. This realist review demonstrated the varying mechanisms contributing to engagement, completion and adoption of learning. These illustrate the complex nature of education for professional development. It demonstrates that the UTAUT model is suitable for guiding the design, implementation and adoption of e-learning programmes. RELEVANCE TO CLINICAL PRACTICE: This review used a common clinical practice (VTE) to provide a program theory that can guide clinical educators to understand mechanisms which can facilitate engagement with, completion and adoption of e-learning into practice by nurses. NO PATIENT OR PUBLIC CONTRIBUTION: The focus of this realist review was on e-learning for registered nurses. As such, no patient or public contribution was sought or given in the development, progress and writing of the submitted manuscript.

Inter-rater reliability of the occupational violence risk assessment tool for emergency departments.

BACKGROUND: The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses. METHODS: A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability. RESULTS: There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; ≥ 16 years, AC1 = 0.799, p < 0.001. CONCLUSION: The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses.

Emergency nursing nurse sensitive indicators: An integrative review.

BACKGROUND: Nurse sensitive indicators (NSIs) capture the outcomes of each nursing function impacted by nursing care. NSIs are critical in clarifying foci for emergency nurses when providing care in the emergency department (ED). OBJECTIVE: To establish NSIs key to emergency nursing from existing published literature. METHODS: Ten databases were searched as well as grey literature and Google Scholar in the development of data for this integrative review. Articles underwent a title and abstract review to establish inclusion/exclusion suitability followed by a full text critical appraisal. Data were extracted, synthesized, and analyzed using a structured process. RESULTS: Twenty-eight emergency nursing NSIs were identified from three included studies, with little consensus across the literature. The NSIs established in the literature reflected a broad range of non-specific technical skills. Overall, the quality of the included articles was low due to factors including study design and high risk of bias. CONCLUSIONS: The constrained range of NSIs and the limited literature exploring the outcomes of emergency nursing care perhaps reflects a wide ranging and seemingly evolving scope of emergency nurses. Further research is needed to delineate emergency nursing NSI, perhaps underpinned by a clear definition of an emergency nurse in terms of capability statements, core skills and defining attributes.

Monthly Identification of High Frequency Emergency Presenters to Improve Care Delivery and Evaluation: A Unique Methodological Approach.

Background: Frequent presenters to emergency departments (EDs) pose many challenges around care delivery and health service management. The aim of this study was to investigate the presentation patterns of people with 5 or more ED visits in any calendar month (5+ frequent presenter [FP5+]) to develop a useful methodological framework on which the real impact of interventions may be assessed. Methods: This study is a retrospective analysis of de-identified frequent ED presentation data using segmented regression analysis of an interrupted time series (ITS). Results: A total of 82 FP5+ to this single ED were identified in a year. Of these presenters, 77% had 10 or more presentations in a year. The total FP5+ presentations in the 12 months preceding and after each participant's ≥5 presentations in 1 month (the trigger month for inclusion in the study) accounted for 1,064 and 1,606 visits, respectively. ITS analysis of frequent ED presentations did not show a significant level change or trend change during the data collection period. Monthly review of people who frequently present to a single ED showed that presentations typically occurred in bouts that may span calendar years. Presentation bouts then typically slow, potentially distorting evaluation of the effects of interventions. Conclusion: Rolling monthly examination of presentation data may facilitate timely case review and care delivery, as well as provide a holistic picture of the impacts of interventions targeting patient care needs. This unique analysis demands a reconsideration of the typical before-and-after analysis of interventions for this vulnerable and high-cost group of patients.

Development and validation of a script concordance test to assess biosciences clinical reasoning skills: A cross-sectional study of 1st year undergraduate nursing students.

BACKGROUND: Developing evaluative measures that assess clinical reasoning remains a major challenge for nursing education. A thorough understanding of biosciences underpins much of nursing practice and is essential to allow nurses to reason effectively. A gap in clinical reasoning can lead to unintended harm. The Script Concordance test holds promise as a measure of clinical reasoning in the context of uncertainty, situations common in nursing practice. The aim of this study is to develop and validate a test for first year undergraduate nursing students that will evaluate how bioscience knowledge is used to clinically reason. METHODS: An international team, teaching biosciences to undergraduate nurses constructed a test integrating common clinical cases with a series of related test items: diagnostic, investigative and treatment. An expert panel (n = 10) took the test and commented on authenticity/ambiguities/omissions etc. This step is crucial for validity and for scoring of the student test. The test was administered to 47 first year undergraduate nursing students from the author sites. Students rated educational aspects of the tool both quantitatively and qualitatively. Statistical and content analyses inform the findings. FINDINGS: Results indicate that the test is reliable and valid, differentiating between experts and students. Students demonstrated an ability to identify relevant data, link this to their bioscience content and predict outcomes (mean score = 50.78 ± 8.89). However, they lacked confidence in their answers when the scenarios appeared incomplete to them. CONCLUSION: Nursing practice is dependent on a thorough understanding of biosciences and the ability to clinically reason. Script concordance tests can be used to promote both competencies. This method of evaluation goes further than probing factual knowledge. It also explores capacities of data interpretation, critical analysis, and clinical reasoning. Evaluating bioscience knowledge and real-world situations encountered in practice is a unique strength of this test.

Utilising a nurse navigator model of care to improve prisoner health care and reduce prisoner presentations to a tertiary emergency department.

BACKGROUND: Prisoners are a vulnerable population requiring complex care interventions in challenging environments, particularly around provision of emergency care. The aim of this study was to explore the effectiveness of a Nurse Navigator (NN) -led prisoner intervention from the perspective of the emergency department. METHODS: This study undertook a retrospective analysis of the prisoner presentations to a public emergency department. It used time-series analysis of publicly available deidentified data, collected during standard care evaluation, to explore the impact of this unique care model over 24 months (12-pre and 12-post). Synthesis of documents pertaining to this NN model of care provide a summary of key initiatives and interventions. RESULTS: With the introduction of NN, the rate of change of yearly prisoner presentations dropped from + 32.8% to - 2.7%. Interrupted time-series analysis on emergency department presentations per 1000 prisoners in custody confirmed a postintervention level drop of 15.1% (rate ratio 0.849; 95% CI 0.755-0.954) followed by a period of downward trending of presentations resulting in an absolute drop of 31.5% in twelve months (rate ratio 0.685; 95% CI 0.556-0.843). CONCLUSIONS: The bundle of capacity-building initiatives instigated by the NN appear to have contributed to a reduction of prisoner presentations.

Validity and reliability of the novel three-item occupational violence patient risk assessment tool.

AIM: To develop and psychometrically test an occupational violence (OV) risk assessment tool in the emergency department (ED). DESIGN: Three studies were conducted in phases: content validity, predictive validity and inter-rater reliability from June 2019 to March 2021. METHODS: For content validity, ED end users (mainly nurses) were recruited to rate items that would appropriately assess for OV risk. Subsequently, a risk assessment tool was developed and tested for its predictive validity and inter-rater reliability. For predictive validity, triage notes of ED presentations in a month with the highest OV were assessed for presence of OV risk. Each presentation was then matched with events recorded in the OV incident register. Sensitivity and specificity values were calculated. For inter-rater reliability, two assessors-trained and untrained-independently assessed the triage notes for presence of OV risk. Cohen's kappa was calculated. RESULTS: Two rounds of content validity with a total of N = 81 end users led to the development of a three-domain tool that assesses for OV risk using aggression history, behavioural concerns (i.e., angry, clenched fist, demanding, threatening language or resisting care) and clinical presentation concerns (i.e., alcohol/drug intoxication and erratic cognition). Recommended risk ratings are low (score = 0 risk domain present), moderate (score = 1 risk domain present) and high (score = 2-3 risk domains present), with an area under the curve of 0.77 (95% confidence interval 0.7-0.81, p < .01). Moderate risk rating had a 61% sensitivity and 91% specificity, whereas high risk rating had 37% sensitivity and 97% specificity. Inter-rater reliability ranged from 0.67 to 0.75 (p < .01), suggesting moderate agreement. CONCLUSIONS: The novel three-domain OV risk assessment tool was shown to be appropriate and relevant for application in EDs. The tool, developed through a rigorous content validity process, demonstrates acceptable predictive validity and inter-rater reliability. IMPACT: The developed tool is currently piloted in a single hospital ED, with a view to extend to inpatient settings and other hospitals.

Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review.

AIMS: Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. DESIGN: Systematic mixed studies review. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. REVIEW METHODS: Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. RESULTS: Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. CONCLUSION: The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. IMPACT: This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.

Compression Socks Reduce Running-Induced Intestinal Damage.

ABSTRACT: Zadow, EK, Edwards, KH, Kitic, CM, Fell, JW, Adams, MJ, Singh, I, Kundur, A, Johnstone, ANB, Crilly, J, Bulmer, AC, Halson, SL, and, and Wu, SSX. Compression socks reduce running-induced intestinal damage. J Strength Cond Res 36(9): 2461-2464, 2022-Exercise is associated with a reduction in splanchnic blood flow that leads to the disruption of intestinal epithelium integrity, contributing to exercise-induced gastrointestinal syndrome. Strategies that promote intestinal blood flow during exercise may reduce intestinal damage, which may be advantageous for subsequent recovery and performance. This study aimed to explore if exercise-associated intestinal damage was influenced by wearing compression garments, which may improve central blood flow. Subjects were randomly allocated to wear compression socks ( n = 23) or no compression socks (control, n = 23) during a marathon race. Blood samples were collected 24 hours before and immediately after marathon and analyzed for intestinal fatty acid-binding protein (I-FABP) concentration as a marker of intestinal damage. The magnitude of increase in postmarathon plasma I-FABP concentration was significantly greater in control group (107%; 95% confidence interval [CI], 72-428%) when compared with runners wearing compression socks (38%; 95% CI, 20-120%; p = 0.046; d = 0.59). Wearing compression socks during a marathon run reduced exercise-associated intestinal damage. Compression socks may prove an effective strategy to minimize the intestinal damage component of exercise-induced gastrointestinal syndrome.

Challenges in the recognition and management of paediatric sepsis - The journey.

Paediatric sepsis remains a leading cause of childhood death. Morbidity is high, with up to one third of children affected developing ongoing, sometimes lifelong sequelae. To address the major burden of sepsis on child health, there is need for a unified approach to care, as outlined in the Australian National Action Plan for sepsis. While the Surviving Sepsis Campaign 2020 guidelines provided evidence-based recommendations for sepsis management in hospital, additional emphasis on families, pre-hospital recognition and post-sepsis care incorporating the multidisciplinary team is paramount to achieve quality patient outcomes. The role of families, paramedics and nurses in recognising and managing paediatric sepsis remains an under-represented area in current literature. The aim of this paper is to critically discuss key challenges surrounding the journey of paediatric sepsis, drawing on contemporary literature to highlight key areas pertinent to recognition and management of sepsis in children. Application of a holistic, patient-centred focus will provide an overview of paediatric sepsis, aiming to inform future development for enhanced healthcare delivery and identify critical areas for further research.

What can we do about occupational violence in emergency departments? A survey of emergency staff.

AIMS: To explore and collate solutions for occupational violence from emergency department (ED) staff. BACKGROUND: Despite publications highlighting the progressively worsening issue of occupational violence in EDs and its detrimental impacts, few strategies aimed to reduce or manage it have been discussed in the literature. METHODS: This was a cross-sectional study involving ED staff. Participants completed an electronic survey that prompted interventions for occupational violence. Free-text data were analysed and logically categorized using validated techniques. RESULTS: Participants (N = 81) suggested 24 interventions: 12 were classified as prevention strategies, 10 as response strategies and two as recovery strategies. Prevention and response strategies for occupational violence targeted key participants: patients, staff and ED environment. Recovery strategies centred around staff management of the personal impacts of incidences of occupational violence and on systems in place to support them after occupational violence incidents. CONCLUSION: Solutions to occupational violence should be multifaceted encompassing prevention, response and recovery for patients, staff and the ED environment. IMPLICATIONS FOR NURSING MANAGEMENT: No single, universal intervention can be endorsed to reduce or mitigate the impacts of occupational violence in EDs. However, a combination of the interventions (strategies) discussed in this paper can be recommended.

Optimising emergency department and acute care for people experiencing mental health problems: a nominal group study.

Objective The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic? There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add? For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What are the implications for practitioners? Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel.

Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the Implementation of a Pediatric Sepsis Pathway Within the Emergency Department.

OBJECTIVES: To evaluate the implementation of a pediatric sepsis pathway in the emergency department as part of a statewide quality improvement initiative in Queensland, Australia. DESIGN: Multicenter observational prospective cohort study. SETTING: Twelve emergency departments in Queensland, Australia. PATIENTS: Children less than 18 years evaluated for sepsis in the emergency department. Patients with signs of shock, nonshocked patients with signs of organ dysfunction, and patients without organ dysfunction were assessed. INTERVENTIONS: Introduction of a pediatric sepsis pathway. MEASUREMENTS AND MAIN RESULTS: Process measures included compliance with and timeliness of the sepsis bundle, and bundle components. Process and outcome measures of children admitted to the ICU with sepsis were compared with a baseline cohort. Five-hundred twenty-three children were treated for sepsis including 291 with suspected sepsis without organ dysfunction, 86 with sepsis-associated organ dysfunction, and 146 with septic shock. Twenty-four (5%) were admitted to ICU, and three (1%) died. The median time from sepsis recognition to bundle commencement for children with septic shock was 56 minutes (interquartile range, 36-99 min) and 47 minutes (interquartile range, 34-76 min) for children with sepsis-associated organ dysfunction without shock; 30% (n = 44) and 40% (n = 34), respectively, received the bundle within the target timeframe. In comparison with the baseline ICU cohort, bundle compliance improved from 27% (n = 45) to 58% (n = 14) within 60 minutes of recognition and from 47% (n = 78/167) to 75% (n = 18) within 180 minutes of recognition (p < 0.05). CONCLUSIONS: Our findings on the introduction of protocolized care in a large and diverse state demonstrate ongoing variability in sepsis bundle compliance. Although bundle compliance improved compared with a baseline cohort, continued efforts are required to ensure guideline targets and sustainability are achieved.

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study.

BACKGROUND: Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis Campaign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs. METHODS: This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses' perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables. RESULTS: In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% (IQR = 46.7-66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score. CONCLUSION: Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.

Illustrating a novel methodology and paradigm applied to Emergency Department research.

AIM: To provide a practical example of how a novel methodology and paradigm was applied to a mixed methods study exploring the healthcare experiences of Australian adults who frequently use emergency department services. DESIGN: Discussion Paper. DATA SOURCES: We explored published literature discussing philosophical and methodological issues related to mixed methods research. Literature searches were performed between July 2019 and February 2021. IMPLICATIONS FOR NURSING: Phenomenology is a powerful methodology to explore the lived experience of research participants, but it is not without limitations. Mixed methods phenomenology allows nurse researchers to bring further clarity to their research phenomena, however, including phenomenology in mixed methods studies may be seen to be philosophically incompatible. The philosophical metaparadigm of dialectical pluralism provides nurse researchers with a new coherent methodological and philosophical framework for combining participants' descriptions of lived experience with a variety of data collection methods. It is effective when working with transdisciplinary research teams, and stakeholders representing diverse values and disciplines. CONCLUSION: Complex healthcare environments require sophisticated, flexible research approaches. This paper presents mixed methods phenomenological research combined with the metaparadigm of dialectical pluralism providing a methodological framework that can support multifaceted nursing research. IMPACT: The combination of mixed methods phenomenology and dialectical pluralism represents a novel solution for nurse researchers to articulate a research methodology and philosophical paradigm reflecting the complexity embedded in everyday nursing practice. This methodology offers a unique approach to exploration of challenging clinical and patient scenarios with multifaceted elements, and overcomes theories of philosophical incompatibilities between divergent methods.

Isolated systolic hypertension in young males: a scoping review.

Isolated systolic hypertension typically occurs in young males; however, its clinical significance is unknown. Given the prevalence of the hypertension and its contribution to global morbidity and mortality, a synthesis of the most recent available evidence around isolated systolic hypertension is warranted. This review aims firstly to review the haemodynamic and physical characteristics indicative of cardiovascular risk in young males (aged 18 to 30 years) with isolated systolic hypertension, and secondly to synthesize the associated clinical management recommendations reported in the literature. Six databases were systematically searched for all relevant peer-reviewed literature examining isolated systolic hypertension in young males. Search results were screened and examined for validity, those that did not meet the inclusion criteria were removed. A total of 20 articles were appropriate for inclusion. Key factors indicative of cardiovascular risk in isolated systolic hypertension were characterized by several distinctive haemodynamic parameters and physical characteristics. After the literature was synthesized based around these key factors, two distinct cohorts (healthy and unhealthy) were highlighted. The healthy cohort of younger males with isolated systolic hypertension was associated with a decreased cardiovascular risk and therefore no medical interventions were recommended. The second (unhealthy) cohort was, however, associated with an increased cardiovascular risk and may therefore, benefit from antihypertensive therapy.

Challenges of objective structured clinical examination in undergraduate nursing curriculum: Experiences of faculties and students.

BACKGROUND: Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula. OBJECTIVE: The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education. DESIGN: This study used a qualitative approach that included thematic analysis of the transcribed interviews. SETTING: Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran. PARTICIPANTS: Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE. METHODS: A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified. RESULTS: Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature. CONCLUSION: The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.

Final-year nursing students' foundational knowledge and self-assessed confidence in interpreting cardiac arrhythmias: A cross-sectional study.

BACKGROUND: Graduating nurses should possess knowledge and understanding of cardiac arrhythmia interpretation, so they can assess abnormal and life-threatening arrhythmias. However, literature around nursing students' foundational knowledge in cardiac arrhythmia interpretation remains scarce. OBJECTIVES: To examine final-year nursing students' foundational knowledge and self-assessed confidence in interpreting cardiac arrhythmias. DESIGN: Cross-sectional study design. SETTINGS: Two Australian universities (one regional and the other large metropolitan). PARTICIPANTS: Nursing students in the final year of a program of study leading to initial registration as a registered nurse. METHODS: An online survey was adopted to examine final-year nursing students' foundational knowledge and their self-assessed confidence when interpreting cardiac rhythms. RESULTS: A total of 114 participants completed surveys, representing a response rate of 22%. More than 70% of the participants were able to interpret asystole, sinus rhythm, and sinus bradycardia. Over 50% correctly identified ventricular tachycardia, atrial flutter, sinus tachycardia, atrial fibrillation, and ventricular fibrillation. Under 15% of the participants were able to interpret junctional rhythm, paced rhythm, and unifocal/multifocal premature ventricular contractions. Self-assessed confidence levels were generally lower than the accuracy rates of arrhythmia interpretation. Although many participants acknowledged that learning arrhythmia interpretation was difficult and challenging, most of them had positive perceptions and wanted to learn more. CONCLUSION: Nursing curricula need to be supported and strategies need to be implemented to standardise educational electrocardiogram interpretation programs, which are critical to improving final-year nursing students' foundational knowledge and confidence in interpreting cardiac arrhythmias and enhancing patient safety.

Final year nursing student's exposure to education and knowledge about sepsis: A multi-university study.

BACKGROUND: Sepsis is a leading cause of death and disability in adults and children. Evidence suggests that early recognition and management can significantly improve patient outcomes, therefore education of healthcare workers around sepsis is critical. Little is known about the preparation of final year nursing students regarding recognition and response to sepsis. OBJECTIVES: To explore Australian final year nursing student's exposure to and knowledge of sepsis, and their awareness of the importance of early recognition, escalation and management of patients with sepsis. METHODS: An online 17-question survey was developed, validated and then used to evaluate final year nursing students' awareness and knowledge about sepsis. DESIGN: Multi-site, cross-sectional, study. SETTINGS: Data were prospectively collected from final year nursing students from five university (graduate entry and undergraduate) programmes from four Universities in Queensland, Australia. RESULTS: Response rate of 22% (237/1075 eligible students responded). Final year nursing students possessed limited knowledge about sepsis (mean scores = 3.8/9; SD = 1.6), and very limited knowledge of paediatric sepsis (median 1[interquartile range 0-1]). Many participants (54%; 128/237) had heard of sepsis prior to commencing their nursing studies, however only 22% (53/237) reported formal dedicated educational units on sepsis. Sepsis education was delivered primarily through didactic lectures (32%; 77/237) and often as part of courses encompassing acute care (38%; 91/237). Only 6% (14/237) of participants recalled exposure to education dedicated to paediatric sepsis. CONCLUSIONS: The knowledge of final year nursing students in relation to recognising, escalating and managing sepsis was limited. There is an urgent need to design education which adequately and safely prepares nurses for the challenges they face when caring for patients with sepsis, particularly paediatric sepsis. Accrediting bodies should consider mandating inclusion of sepsis education as part of all nursing programmes.