Intensive care unit nurses' perceptions of debriefing after critical incidents: A qualitative descriptive study.

BACKGROUND: Intensive care unit (ICU) nurses are exposed to critical incidents daily at their workplace, which may have long-term physical and psychological impacts. Despite the growing evidence supporting clinical debriefing in health care to prevent these impacts, a scarcity of literature exists to support its use in the adult intensive care setting. OBJECTIVES: The objective of this study was to explore nurses' perceptions of clinical debriefing after critical incidents in an adult ICU. METHODS: A qualitative descriptive design was utilised. Thematic analysis of data from individual semistructured interviews with six ICU nurses was undertaken. FINDINGS: In this study, two themes were identified. Firstly, participants valued hot debriefing after critical incidents for the key reasons of having an opportunity to reflect on and learn from a critical incident and reduce normalisation of stressful situations. Secondly, when logistical factors such as communication, timing, and location were not considered, the attendance at debriefings was negatively influenced. Participants identified that ICU nurses commonly prioritised patient tasks over attending a debrief; therefore, teamwork and flexibility with logistics was crucial. CONCLUSIONS: Hot debriefing, of a short duration and close to the time of the event, was valued and played an important role in staff wellbeing and self-care, contributing to preventing self-blame and normalisation of stressful situations. A clearer definition of the term along with greater recognition of types of events that could be considered critical incidents is required for staff support after critical incidents in the complex intensive care setting.

Impact of art and reflective practice on medical education in the emergency department.

OBJECTIVES: There is heightened intrigue surrounding the application of arts-based pedagogy in medical education. Art encompasses multiple forms of expression and is used to convey specific meaning and emotion, whereas provoking critical reflection. Our aim was to explore the effectiveness of art and reflective practice in medical education, in the context of the ED. METHODS: Longitudinal methodological study design. Prior to the first, and after the final clinical practicum, medical students watched a 3-min film: 'The Art of the ED'. Written reflections focused on changing perceptions towards the film during their medical education programme. Data were thematically analysed. RESULTS: Three themes were collected from 25 written reflections and included: 'professional growth' exploring personal and professional development across the medical programme; seeing 'patients are people'; and the purpose, structure and function of an ED exposed in 'the reality of ED'. Results highlight that arts-based pedagogy can facilitate meaningful and critical reflection in medical students, whereas also fostering professionalism. Reflecting on the film broadened their perspective into a realm of new possibilities, challenging them to identify implicit bias around ED, and promote professional identity formation. CONCLUSIONS: The combination of art and reflection in medical education enhances reflective learning and can lead to transformative change, including the development of core doctoring values of service, empathy and respect for patient. There are clear benefits to medical education incorporating more arts-based pedagogy that promotes reflective exploration and interpretation of the psychosocial context of health and illness, delivery of more holistic models of care and their role as doctors.

Belonging in high acuity settings: What is needed for newly graduated registered nurses to successfully transition? A qualitative systematic review.

BACKGROUND: A worldwide shortage of nurses providing clinical care, coupled with an increase in severity of illness of hospitalised patients has led to newly graduated Registered Nurses being placed into high acuity settings, such as the emergency department, intensive care unit and operating theatre. The feeling of belonging in these settings impacts on successful transition of newly graduated Registered Nurses, their learning, and may lead to high attrition rates. OBJECTIVE: To comprehensively synthesise qualitative research on newly graduated Registered Nurses' experiences of belonging, while working in high acuity clinical settings. DESIGN: Elements of the Joanna Briggs Institute (JBI) systematic review protocol were utilised. The Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to conduct the review. Data were analysed using thematic analysis. DATA SOURCES: Ovid Emcare, PsychInfo, CINHAL, Proquest and Scopus. METHODS: The PICo (population, interest and context) strategy was used as a guide to develop search terms. Published literature from January 2007 to April 2021 was searched. Screening, selection and data extraction were performed by two authors independently. All discrepancies were resolved through discussion with a third reviewer. RESULTS: A total of 506 studies were identified following the systematic search; after duplicates were removed, 440 were screened by title and abstract and 29 by full text. Six articles were included in this systematic review. Methodological quality was assessed utilising the JBI critical appraisal checklist, and discrepancies ratified through team consensus. The themes; emotional lability, structured program design, preceptors' influence and acceptance were identified. CONCLUSIONS: Newly graduated Registered Nurses in the high acuity setting feel emotionally insecure related mainly to their educational unpreparedness. They have need for a structured program, inclusive of both theory and supported practice. The role of the preceptorship team is vital in enabling a feeling of belonging, as is acceptance by nursing staff of the learning journey.

Australian emergency nurses' lumbar movement during a shift: An observational study.

BACKGROUND: Emergency nurses are at higher risk than the average worker of experiencing lumbar pain. This is the first study to undertake real time monitoring to quantify lumbar movements of nurses working in the emergency department (ED). METHODS: Emergency nurses at a single Australian ED were recruited for a prospective observational case study. Participants worked in four discrete clinical areas of the ED; In-charge, triage, resuscitation, and cubicles. Data collected included participant demographics, lumbar pain pre- and post-shift, and real-time recording of lumbar movements. RESULTS: Sixty-two nurses participated. There were statistically significant differences in time spent standing (p = 0.005), sitting (p ≤ 0.001) and in locomotion (moving) (p ≤ 0.001) when compared by clinical role. Triage nurses spent over half their shift sitting, had the most sustained (> 30 s) flexions (60+ degrees) and had a median of 4 periods of uninterrupted sitting (10-30 mins) per shift. CONCLUSIONS: Differences in movement demands were identified based on various clinical roles in the ED. Triage was associated with greater periods of uninterrupted sitting and with greater degrees of sustained flexion, both of which are predictors for back pain. This study provides foundation evidence that triage may not be the most appropriate location for staff returning from back injury.

Changing nursing practice in response to musculoskeletal l pain and injury in the emergency nursing profession: What are we missing?

BACKGROUND: Musculoskeletal disorders in emergency nurses result in physical, psychological and financial strain. Contributing factors include: environmental, organisational, patient-related, medical emergencies, nurse's knowledge and health status. Stress and moral distress impact on nurses changing manual handling practices. METHODS: Part of a cross-sectional survey of Australian emergency nurses, this study used content analysis to identify occurrence of change to practice and enablers to reporting injury. Secondary interpretive analysis using moral distress theory informed an alternative understanding of why nurses may not change their practice in response to injury. RESULTS: Most respondents made practice changes and reported pain/injury; 23% did not change, and 45.7% did not report. Respondents considered change impossible due to high demands and lack of resources; a position where nurses may have felt pressured to carry out unsafe manual handling practices. When conflicted between reporting a perceived insignificant injury, with feelings of guilt, nurses can feel devalued. Moral distress can occur when nurses and managers are conflicted between providing care and caring for self. CONCLUSIONS: A culture of trust, respect and open communication decreases stress/moral distress, enables safer manual handling and reporting of pain/injury. Moral distress is an invisible workplace challenge that needs to be met for staff wellbeing.

Exploration and model development for emergency department waiting room nurse role: Synthesis of a three-phase sequential mixed methods study.

BACKGROUND: To improve flow and care in waiting rooms, some emergency departments introduced a specific nursing role to care for this patient cohort with the aim of commencing interventions early, improving patient safety by reassessing and enhancing communication. The objective of the research was to explore to what extent does qualitative interviews and quantitative survey contribute to describing emergency department waiting room nurses, through integration and synthesis of findings from a multiphase mixed methods study. METHODS: Multiphase mixed methods exploratory sequential design with integration of findings. Data integration occurred during the phases and when assimilating all findings. FINDINGS: Experienced emergency nurses, preferably with graduate qualifications, who are autonomous practitioners with highly developed communication skills, clinical decision making and proficiency in assessment and monitoring are required to perform the role. The waiting room nurse provides patient-centered care and ensures safe, timely care is delivered to those in the waiting room. A standardised approach and high risk of exposure to occupational stressors need to be considered. CONCLUSIONS: This mixed methods sequential design explored the waiting room nurse role from the perspective of emergency nurses generating new knowledge into the role. This advanced practice nursing role contributes to patient safety and delivery of patient centred care in the emergency department waiting room.

Perceptions of final year nursing students transer of clinical judgement skills from simulation to clinical practice: A qualitative study.

AIM: To explore final year nursing student's ability to transfer clinical judgement skills to the clinical practice setting following immersive simulation. BACKGROUND: Clinical judgement is considered a fundamental skill for nurses to ensure safe, quality care is delivered. In undergraduate nursing education where students have limited clinical experience, simulation-based education is an important educational strategy for introducing and developing these skills. Simulation allows for students to be exposed to repeated experiences and emotional responses to varying clinical situations. Despite this, there is a paucity of literature relating to students' ability to transfer clinical judgement skills from the simulated environment into clinical practice. DESIGN: A naturalistic philosophical approach informed data collection in this qualitative phase of a larger study. METHODS: Data were collected from students and nurse educators using semi-structured interviews as well as from facilitated simulation debriefs. Data were thematically analysed. RESULTS: Four themes were identified which related to student knowledge, self-awareness and the clinical context: Safely collecting the data; Understanding the data to safely make decisions; Emotional intelligence; and Role variation. Students and educators held similar views on many of these elements. CONCLUSIONS: Questioning was identified as a key component of nursing students' clinical judgements. There were challenges in assessing students' ability to link theory to practice in the clinical setting, despite evidence of this occurring in the simulated setting. Simulation prepares students for practice by exposing them to new experiences and stressors and therefore an effective educational technique for developing clinical judgement skills in this cohort.

Caring for deteriorating paediatric patients in the emergency department: A mixed method study.

BACKGROUND: Paediatric presentations to emergency departments are common for a range of conditions with varying severity. Children can compensate well and early signs of deterioration may not be obvious. Nurses working in emergency departments (ED) should not only have the knowledge and skill to recognise the unwell child, but also be confident and competent to provide care. AIM: To explore the self-reported preparedness, confidence and competence of emergency nurses in caring for deteriorating paediatric patients, and to identify how their confidence and competence could be improved. METHODS: An exploratory sequential mixed methods study with two phases was used. In Phase One, qualitative data were collected via focus group and thematically analysed. The findings from Phase One informed Phase Two survey development, with quantitative data collected and analysed. RESULTS: Findings from both phases identified that emergency nurses' confidence and competence when caring for deteriorating paediatric patients did not correlate with their level of qualification. In contrast, increased years of experience in caring for this cohort did increase level of confidence. Availability of human resources further impacted nurses' confidence when caring for deteriorating paediatric patients and emergency nurses showed an interest and enthusiasm for further education in caring for the deteriorating paediatric patient. CONCLUSIONS: Regular exposure to paediatrics was key to nurses having confidence and competence to care for deteriorating patients, irrespective of educational qualifications. A focus on interprofessional insitu simulation could address human resource challenges to enhance skill development.

Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance.

BACKGROUND: Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them. PURPOSE: The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities. METHODOLOGY: Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth. FINDINGS: Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: "You cannot do both." Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: "We cannot refuse to treat." Incongruency between legislative requirements creates confusion for decision-making: "Which Act trumps what?" CONCLUSION: Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making. PRACTICAL IMPLICATIONS: This article exposes the underlying values, beliefs, and flawed assumptions underpinning practice related to WPV. Managers need to amend policies to reduce staff confusion, adopt a trauma-sensitive and resilience approach, and develop a clearly written framework to guide decision-making related to duty of care to consumers and staff safety. Incident reports and staff well-being/satisfaction surveys need to evaluate the effects of zero tolerance on staff and consumers. Regulators need to ensue legislative requirements are congruent with staff safety and well-being.

Practice priorities for acute care nursing: A Delphi study.

AIMS AND OBJECTIVES: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN: Delphi Method. METHOD: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

Managers' experiences of prevention and management of workplace violence against health care staff: A descriptive exploratory study.

AIM: To examine health care managers' and health and safety staff experiences of prevention and management of workplace violence against staff. BACKGROUND: Employers have a responsibility to protect employees from workplace violence. The varied care settings present challenges for those responsible for ensuring safety. METHOD: Descriptive exploratory study using semi-structured interviews with 99 participants responsible for workplace safety, from 29 health services across metropolitan and regional Victoria, Australia. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS: Five themes were identified: Workplace violence was accepted as "part of the job"; Participants relied on government resources and networking to guide them; Working alone and home visiting was a risk factor; Participants demanded a single, state-wide training programme; Sharing information is vital. CONCLUSIONS: Participants were acutely aware of the risks of violence towards staff, and of their responsibility in managing risks. Knowledge sharing and consistent, regular education can reduce the risks. Additional resources were required, particularly during home visits, or when working alone. IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to prioritize resources such as reliable rapid response systems to prevent and manage violence, particularly against staff working alone or home visiting. Information sharing between health services and other agencies is important to reducing risk.

The trouble with reporting and utilization of workplace violence data in health care.

AIM: The study aimed to evaluate the reporting, monitoring and use of workplace violence data in Victorian health services. BACKGROUND: Surveillance of workplace violence is important in understanding the circumstances in which workplace violence occurs and development of relevant and appropriate prevention and intervention strategies. METHOD: A descriptive exploratory approach was used. Fifteen staff from occupational health and safety, quality and safety, and nurse unit managers, from five major metropolitan health services were interviewed. Recorded interviews were transcribed verbatim and thematically analysed. RESULTS: Three themes were identified: (a) "under-reporting of workplace violence," (b) "inconsistent guidance" caused subjective and variable data coding and (c) "application of data" described how health services used the data available to them, to inform the development and implementation of systems designed to prevent workplace violence. CONCLUSIONS: Improved reporting systems may increase consistency in reporting, enable data sharing across organisations and assist in planning of prevention strategies. IMPLICATIONS FOR NURSING MANAGEMENT: Staff should be encouraged to complete incident reports for each episode of workplace violence. Incident reporting systems must be simplified to reduce the burden of reporting. Nurse managers should advocate for the sharing of health service workplace violence data, to enable improved prevention across all services.

Workplace violence perpetrated by clients of health care: A need for safety and trauma-informed care.

AIMS: To examine the relationship between workplace violence perpetrated by clients, their innate neurophysiological response to dis-ease and the resulting interactions with healthcare providers. BACKGROUND: Client-on-worker violence remains a problem globally. Workplace violence risk factors have been documented. A gap remains in understanding what has happened to clients that perpetrate violence, and the link between adverse childhood experiences (ACE), the neuroscience of threat and trauma-informed care. DESIGN: This explanatory study was part of a larger descriptive study. METHODS: Managers, directors, health/safety staff, nurses and educators (n = 99) from Australian rural and metropolitan health services participated in individual and group interviews. Following inductive thematic analysis, a secondary analysis, informed by understandings of ACE, polyvagal theory and trauma-informed care, was conducted. Analysis was guided by the question: What happens to clients that causes them to instigate violence against healthcare workers? Reporting of this research adheres to the COREQ guidelines. RESULTS: Clients can react aggressively when under perceived threat. Themes included are as follows: client stress and trauma, previous client trauma, impact of care provision on client and trauma-informed care. CONCLUSION: Healthcare services can be experienced as stressful environments. Coupled with high incidences of past trauma, clients' assessment of risk and safety can be compromised resulting in inappropriate reactivity when staff are trying to provide care. Care provision can be perceived as a threat to clients' physical and psychological safety, activating the fight protective response resulting in aggression. Understanding and applying neuroscience and implementing a cultural change of trauma-informed care have the potential to reduce workplace violence. Even with these understandings, it is imperative that healthcare staff are protected and feel safe at work. RELEVANCE TO CLINICAL PRACTICE: Understanding trauma and the neuroscience of threat and safety can assist staff to understand what happens to clients that causes them to instigate violence against healthcare providers and implement systems and strategies to respond to such threat.

A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions.

BACKGROUND: In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM: To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS: Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS: Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS: The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.

Healthcare providers' neurobiological response to workplace violence perpetrated by consumers: Informing directions for staff well-being.

AIMS: To examine the neurobiological response experienced by healthcare workers when exposed to workplace violence perpetrated by consumers, with a view to informing future training and self-care strategies for staff well-being. BACKGROUND: Considerable work has been undertaken internationally to identify the causes of workplace violence and to develop legislation and guidance for reducing the risk in healthcare. However, there is a gap in understanding workers' innate neurobiological response to workplace violence, and how to prepare staff to recognise the professional and self-care implications of such a response. DESIGN: This explanatory study was part of a larger descriptive study. METHODS: Individual and group interviews were conducted with managers, directors, health/safety staff, nurses and educators (n = 99) from rural and metropolitan health services in Australia. Inductive thematic analysis was conducted, followed by in depth analysis to answer the question: what neurobiological response could be occurring when healthcare workers experience workplace violence? The analytical framework was informed by polyvagal theory. RESULTS: With the increased risk of threat to physical and personal safety in the workplace, healthcare workers may experience activation of the fight, flight or freeze response, affecting their wellbeing and performance at work and at home. Participants recognised a need to care for themselves and understand their own reactions, so that they could better address the needs of consumers. CONCLUSIONS: Education for health care workers should include knowledge of the neurobiological responses to threat, and techniques to increase their capacity to identify, and manage their responses. An understanding of trauma-informed care for staff, will enable them to recognise the cumulative effects of workplace violence, and identify strategies to manage their well-being. RELEVANCE TO CLINICAL PRACTICE: Information about the body's neurobiological response to stressors that threaten physiological and psychological safety can assist healthcare providers to better understand how to respond to workplace violence and aggression.

Emergency department waiting room nurses in practice: An observational study.

AIMS AND OBJECTIVES: To identify the activities and behaviours of waiting room nurses in emergency department settings. BACKGROUND: Emergency care has expanded into waiting rooms in some emergency departments. Often viewed as an adjunct to triage, the aim of waiting room nurses is to commence care early, reassess patients and improve communication between patients, families and staff. There is however a paucity of literature relating to waiting room nurses, especially in relation to their current activities and behaviours. DESIGN AND METHODS: Part of a larger exploratory sequential mixed methods designed study. This phase used a nonparticipant observer role to observe waiting room nurses in their natural setting undertaking normal care and responsibilities. One observer, using a tool and reflective journal, collected data on participant interactions, processes and practices on eight waiting room nurses over 13 episodes of observation (total 65 hr:50 min) in two emergency departments. Data analysis used descriptive statistics and thematic analysis. RESULTS: Participants were observed to anticipate and prioritise to deliver holistic, patient-centred care in emergency department waiting rooms. Waiting room nurses had a varied and unpredictable workload, including facilitating the flow of patients from the waiting room. They contributed to patient safety in the waiting room, primarily by reassessing and detecting clinical deterioration. CONCLUSION: Further research into this role is required, including linking efficacy with experience of nurses, impact the role has on patient safety, and patient and family perceptions of the role. RELEVANCE TO CLINICAL PRACTICE: Therapeutic engagement allowed waiting room nurses to reassure and calm patients and families, and deliver holistic, patient-centred care. Waiting room nurses contributed to patient safety in the waiting room, by promptly commencing episodes of care in the waiting room and through close monitoring and assessment to detect patient deterioration.

Health professional perspectives of patient safety issues in intensive care units in Saudi Arabia.

AIM: To examine attitudes to patient safety in two intensive care units from the perspective of health care professionals in Saudi Arabia. BACKGROUND: Despite adverse errors leading to poor patient outcomes, there is a paucity of literature, including staff perceptions, on adverse errors in Saudi Arabian intensive care units. METHODS: A descriptive cross-sectional design was used. Health professionals (n = 144) completed the safety attitude questionnaire-intensive care unit. RESULTS: The scores from the six safety domains of the safety attitude questionnaire-intensive care unit showed all respondents had a negative attitude towards patient safety, with participants in one intensive care unit scoring lower in all domains. The mean scores across all domains ranged from 47.1 to 70.3 on a 100-point scale, with the lowest score reported in the "perceptions of management" domain. Respiratory therapists reported a significantly higher job satisfaction score than nurses, and physicians rated communication amongst themselves and nurses as high. CONCLUSION: There are significant challenges for safety culture in this study, with negative attitudes across all domains. IMPLICATION FOR NURSING MANAGEMENT: Managers may need to review and consider policies relating to safety culture including workforce planning, leadership and patient centred care. Further research into this global health priority is required to contribute to improving patient safety in intensive care units.

Effectiveness of paracetamol versus ibuprofen administration in febrile children: A systematic literature review.

AIM: The use of antipyretics to manage the febrile child is becoming increasingly popular. Paracetamol and ibuprofen are the most commonly used interventions to manage fever in children; however, there have been no comparative analyses. The aim of the study is to evaluate the evidence comparing paracetamol to ibuprofen in the treatment of fever in children. METHODS: A systematic review of randomised controlled trials investigating the administration of oral paracetamol and ibuprofen to reduce fever in children. Children aged 1 month to 12 years with a temperature between 37.5 and 41°C were included. A total of 3023 papers were identified. After removal of duplications, application of inclusion criteria and screening, eight papers were subjected to critical appraisal and included in this study. RESULTS: Six of the studies identified that ibuprofen was slightly, but not significantly, better at reducing fever in children than paracetamol. Dosage variances and route of temperature measurement ranged between studies, limiting the comparability of studies. While ibuprofen was reported to be marginally more effective at reducing fever and fever associated discomfort in children, there is insufficient data to conclude that ibuprofen is superior to paracetamol. CONCLUSION: There is little evidence supporting the superior efficacy of paracetamol or ibuprofen in the treatment of fever in children with indications that both drugs are equally effective.

Emergency department waiting room nurse role: A key informant perspective.

BACKGROUND: Emergency departments have become overcrowded with increased waiting times. Strategies to decrease waiting times include time-based key performance indicators and introduction of a waiting room nurse role. The aim of the waiting room nurse role is to expedite care by assessing and managing patients in the waiting room. There is limited literature examining this role. METHODS: This paper presents results of semi-structured interviews with five key informants to explore why and how the waiting room nurse role was implemented in Australian emergency departments. Data were thematically analysed. RESULTS: Five key informants from five emergency departments across two Australian jurisdictions (Victoria and New South Wales) reported that the role was introduced to reduce waiting times and improve quality and safety of care in the ED waiting room. Critical to introducing the role was defining and supporting the scope of practice, experience and preparation of the nurses. Role implementation required champions to overcome identified challenges, including funding. There has been limited evaluation of the role. CONCLUSIONS: The waiting room nurse role was introduced to decrease waiting times and contributed to risk mitigation. Common to all roles was standing orders, while preparation and experience varied. Further research into the role is required.

Using transprofessional care in the emergency department to reduce patient admissions: A retrospective audit of medical histories.

The demand for emergency department (ED) services has increased significantly, due to our increasingly ageing population and limited access to primary care. This article reports outcomes from a transprofessional model of care in an ED in Victoria, Australia. Nurses, physiotherapists, social workers, and occupational therapists undertook additional education to increase the range of services they could provide and thereby expedite patient flow through the ED. One hundred patients who received this service were matched against 50 patients who did not. The most common reasons for patient admission were limb injury/limb pain (n = 47, 23.5%) and falls (n = 46, 23.0%). Transprofessional interventions included applying supportive bandages, slings, zimmer splints and controlled ankle motion (CAM) boots, and referral to new services such as case management and mental health teams. The rate of hospital admissions was significantly lower in the transprofessional group (n = 27, 18.0%) than in the reference group (n = 19, 38%, p = 0.005). This group also had a slightly lower re-presentation rate (n = 4, 2.7%) than patients in the reference group (n = 2, 4.0%). There are many benefits that support this model of care that in turn reduces ED overcrowding and work stress. A transprofessional model may offer a creative solution to meeting the varied needs of patients presenting for emergency care.