Remediation in clinical practice for student nurses - A scoping review.

BACKGROUND: Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice. OBJECTIVES: A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice. METHODS: The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed. RESULTS: Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice. CONCLUSIONS: This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice.

Characteristics and outcomes of emergency department presentations brought in by police with and without an emergency examination authority: A state-wide cohort study.

BACKGROUND: The aim of this study was to describe and compare the demographic characteristics, clinical characteristics and patient and health service outcomes of emergency department (ED) presentations brought in by police with and without an emergency examination authority. METHODS: A retrospective cohort study of adult (≥ 18 years old) presentations brought in by police to EDs in Queensland, Australia from 01 January 2018 to 31 December 2020. Routinely collected ED data were used to describe and compare the demographic characteristics, clinical characteristics, and outcomes of people brought in by police with and without an emergency examination authority. RESULTS: A total of 42 502 adult ED presentations were brought in by police over the three-year period, of which 22 981 (44.7%) had an emergency examination authority. Compared with presentations brought in by police without an emergency examination authority, those brought in by police with an emergency examination authority had a higher proportion of presentations for mental health problems, were from major cities, and were allocated more urgent Australasian Triage Scale categories. Presentations brought in by police with an emergency examination authority were less likely to be seen within their Australasian Triage Scale timeframe and experienced a longer length of stay than those brought in by police without an emergency examination authority whether admitted (217 mins vs. 186 mins, p < 0.001) or discharged (212 mins vs. 97 mins, p < 0.001). CONCLUSIONS: The characteristics and outcomes of people brought in by police with emergency examination authorities differed to those brought in by police without emergency examination authorities. Further research is required to enhance understanding of this relatively unexplored group of people and foster interagency collaborations.

Clinicians' experiences of caring for people brought in by police to the emergency department: A qualitative interpretive study.

AIM: To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED). DESIGN: A qualitative interpretive study using in-depth individual interviews. METHODS: Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis. RESULTS: Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay. CONCLUSION: The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes. IMPLICATIONS FOR THE PROFESSION: Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation. IMPACT: This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes. REPORTING METHOD: This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study focused on ED staff experiences.

Corrigendum to: Factors associated with emergency department service outcomes for people with a mental health problem brought in by police: a retrospective cohort study.

Objective This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission.

Profile and Outcomes of Emergency Department Mental Health Patient Presentations Based on Arrival Mode: A State-Wide Retrospective Cohort Study.

INTRODUCTION: People arriving to the emergency department with mental health problems experience varying and sometimes inferior outcomes compared with people without mental health problems, yet little is known about whether or how their arrival mode is associated with these outcomes. This study describes and compares demographics, clinical characteristics, and patient and health service outcomes of adult mental health emergency department patient presentations, based on arrival mode: brought in by ambulance, privately arranged transport, and brought in by police. METHODS: Using a retrospective observational study design with state-wide administrative data from Queensland, Australia, mental health presentations from January 1, 2012, to December 31, 2017, were analyzed using descriptive and inferential analyses. RESULTS: Of the 446,815 presentations, 51.8% were brought in by ambulance, 37.2% arrived via privately arranged transport, and 11.0% were brought in by police. Compared with other arrival modes, presentations brought in by ambulance were more likely to be older and female and have more urgent triage categories and a longer length of stay. Presentations arriving by privately arranged transport were more likely than other arrival modes to present during the day, be assigned a less urgent triage category, be seen within their recommended triage time, have a shorter length of stay in the emergency department, have higher rates of discharge, and have waited longer to be seen by a clinician. Presentations brought in by police were more likely than other arrival modes to be younger and male and experience a shorter time to be seen by a clinician. DISCUSSION: Discrepancies between arrival modes indicates a need for further investigation to support inter- and intra-agency mental health care interventions.

People brought to the emergency department under involuntary assessment orders: A scoping review.

BACKGROUND: Some people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs. METHOD: A scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O'Malley framework. RESULTS: In total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of staylonger than four hours. CONCLUSION: This review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population.

Factors associated with emergency department service outcomes for people with a mental health problem brought in by police: a retrospective cohort study.

Objective This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission.

Characteristics and outcomes of patient presentations to the emergency department via police: A scoping review.

BACKGROUND: As emergency department (ED) presentations continue to rise, understanding the complexities of vulnerable populations such as people brought in by police (BIBP) is crucial. This review aimed to map and describe the research about people BIBP to the ED. DESIGN AND METHOD: A scoping review, guided by the Joanna Briggs Institute process, was undertaken. The databases CINAHL, Embase and PubMed were searched between November 2017 and July 2022. The Patterns, Advances, Gaps, Evidence for practice, Research recommendations (PAGER) framework was used to guide the analysis. RESULTS: A total of 21 studies were included in the review, originating mainly from westernised countries. Examination of patterns across studies revealed four themes: routinely collected data is used to describe people BIBP to the ED; a focus on mental health care; the relationship between care delivery and outcomes; and the role of police in providing emergency care. CONCLUSION: There is some understanding of the demographic characteristics, clinical characteristics, and outcomes of people BIBP to the ED. Knowledge gaps surrounding sociodemographic factors, prehospital and ED care delivery for people BIBP require further investigation to optimise outcomes for this vulnerable cohort of presenters.

Predictors of Emergency Department service outcome for people brought in by police: A retrospective cohort study.

BACKGROUND: People brought in by police (BIBP) to the emergency department (ED) can present with complicated health conditions that may impact care delivery. We sought to identify factors predictive of an ED length of stay (LOS) ≥4 hours and hospital admission for presentations BIBP. METHODS: This retrospective cohort study comprised a sample of all adults (aged ≥ 18 years old) BIBP to public hospital EDs across Queensland, Australia between 1 January 2018 and 31 December 2020. Univariate and multivariate logistic regression were used to identify predictors of an ED LOS ≥4 hours and hospital admission for presentations BIBP. RESULTS: Of the 42,502 presentations BIBP, independent predictors of an ED LOS ≥4 hours included higher priority triage categories, hospital transfer/admission, evening/night shift arrival, an Emergency Examination Authority (EEA), (i.e. an involuntary presentation), and a non-descript mental health diagnosis. Independent predictors of hospital admission included higher priority triage categories, increasing age, day/evening shift arrival, a 'mental or behavioural issues' diagnosis, and an ED LOS ≥4 hours. CONCLUSIONS: Noted predictors of a LOS ≥4 hours and hospital admission indicate further need to support intra and inter-agency interventions to optimise patient outcomes.

Indigenous-led First Peoples health interprofessional and simulation-based learning innovations: mixed methods study of nursing academics' experience of working in partnership.

Background: Collaborative, Indigenous-led pedagogical and research approaches in nursing education are fundamental to ensuring culturally safe curriculum innovations that address institutional racism. These approaches privilege, or make central, Indigenous worldviews in the ways healthcare practices are valued and assessed. With the aim of informing excellence in cultural safety teaching and learning, and research approaches, this study draws on the experiences and key learnings of non-Indigenous nursing academics in the collaborative implementation of First Peoples Health interprofessional and simulation-based learning (IPSBL) innovations in an Australian Bachelor of Nursing (BN) program.Methods: An Indigenous-led sequential mixed method design was used to investigate non-Indigenous nursing academics' experiences in the design, development and delivery of two IPSBL innovations. A validated survey (the Awareness of Cultural Safety Scale, (ACSS)) was administered to nursing academics before and after the innovations were delivered. Phenomenological interviews were also conducted following the implementation of the innovations.Results: Of the 27 staff involved in the delivery of the innovations, six nursing academics completed both pre-and post-surveys (22%). Nine (33%) participated in phenomenological interviews. There was a non-significant trend towards improved scores on the ACSS following the delivery of the innovations. Nursing academics' perceptions of the innovations' relevance to their practice were enhanced. An increased awareness of culturally safe academic practices was reported among those actively involved in innovations.Impact statement: Indigenous-led approaches in teaching and research promote excellence within mandatory cultural safety education for nurses and midwives.Conclusions: This study confirms the importance of educating the educators about cultural safety in teaching and learning, and research approaches. It also provides important insights into how non-Indigenous nursing academics can work within Indigenous-led pedagogical and research approaches to design culturally safe curriculum innovations.

Profile and outcomes of emergency department presentations based on mode of arrival: A state-wide retrospective cohort study.

OBJECTIVE: Understanding how people arrive to the ED assists in planning health services' response to fluctuating ED demand. The present study aimed to describe and compare demographics, clinical characteristics and health service outcomes of adult ED patient presentations based on mode of arrival: brought in by police (BIBP)/brought in by ambulance (BIBA)/privately arranged transport (PAT). METHODS: A retrospective cohort study of ED patient presentations made between 1 January 2018 and 31 December 2020 from all public hospital EDs across Queensland, Australia. Descriptive and inferential analyses were performed to ascertain presentation characteristics and predictors of health service outcomes. RESULTS: From 4 707 959 ED presentations, 0.9% were BIBP, 34.8% were BIBA and 64.0% were PAT. Presentations BIBP were younger and comprised a higher proportion of mental health problems and Emergency Examination Authority orders compared to presentations BIBA or PAT. Compared to presentations BIBP or PAT, presentations BIBA were more likely to be assigned more urgent triage scores, be admitted to hospital, and have a longer ED length of stay (LOS). Compared to other modes of arrival, presentations arriving by PAT were more likely to be discharged and have a shorter ED LOS. CONCLUSION: Presentations BIBA and BIBP encountered a longer ED LOS and higher admission rates than PAT, suggesting more complex care needs than those from PAT. Clinical care pathways for specific modes of arrival that support pre-hospital providers and patients and are considerate of the throughput and output stages of ED care may be needed.

Structures, processes and outcomes of health care for people detained in short-term police custody settings: A scoping review.

BACKGROUND: People detained in short-term custodial settings can require health care that may necessitate transfer to an Emergency Department (ED). What and how health care is delivered to detainees in short-term custodial settings may influence their health outcomes. OBJECTIVE: The aim of this scoping review was to synthesise and critically appraise the evidence on health care delivered to detainees in short-term custody settings. DESIGN: A scoping review was undertaken. Five online databases (CINAHL, PubMed, Medline, Embase and Criminal Justice Database) were searched from January 2010 to May 2020. Data extracted pertained to the structures, processes and outcomes of health care delivery. The Mixed Methods Assessment Tool was used to quality appraise the studies. Deductive analysis was used to sort the findings into structures, processes and outcomes of health care delivery and then thematic analysis was undertaken to synthesise these findings. RESULTS: In total, 37 studies with varied designs were included in this review; 3 randomised control trials, 4 quantitative comparative studies, 21 quantitative descriptive studies, 8 qualitative studies and 1 mixed methods study. Studies were mainly from westernised countries. The quality of evidence varied across studies. Health care delivery structures had a strong focus on the identification of mental illness, with processes predominantly comprising health assessment screening on arrival to the short-term custodial setting. Outcomes (at the detainee and organisation level) included increased identification of substance misuse issues and improvement of health conditions, alongside inadequate assessment/identification of physical and mental health issues for detainees. CONCLUSION: Gaps in evidence identified limited international perspectives as most studies originated from the US, a focus on detainee conditions/symptoms and limited long-term research within the area of health care in short-term custodial settings. Literature regarding health care delivery in short-term custodial settings focused predominantly on mental illness identification. Understanding the nature of health care delivery in short-term custodial settings further through research into specific roles such as the custody nurse is required to develop targeted interventions that address the needs of the detainee on a comprehensive level.

Vulnerability: A concept synthesis and its application to the Emergency Department.

AIM: The aim of this concept synthesis was to add clarity to the concept of vulnerability with application to the Emergency Department (ED) by critiquing, analysing and amalgamating published concept analyses. BACKGROUND: The concept of vulnerability has been used widely, however it has various meanings. A clearer understanding of vulnerability and application to the ED may help healthcare professionals provide high quality care responsive to the needs of vulnerable individuals. METHOD: Nine concept analyses of vulnerability were retrieved using Medline, CINAHL, and PsycINFO databases. After extracting data on each analysis, Walker and Avant's concept synthesis method was used to structure this synthesis, with a thematic synthesis approach used in the analysis. FINDINGS: Four themes associated with vulnerability emerged from the synthesis. The first theme, vulnerability as a journey, reflected elements within an individual's life that perpetuate and exacerbate vulnerability. The second theme, vulnerability as susceptibility and risk, highlighted intrinsic and extrinsic elements that contribute to a state of risk. The third theme, positive and negative repercussions, emphasised lessons that can be learned from experience, with the fourth theme of a shared understanding indicating the importance of understanding the concept of vulnerability for patient care. CONCLUSION: Findings from this synthesis highlight the multiple elements associated with a vulnerable state, evident in the context of the ED. With multiple ED-specific elements contributing to vulnerability, clarity of the term is important to inform ED-specific interventions designed to meet the needs of vulnerable populations.

Exploring the expectations of preceptors in graduate nurse transition; a qualitative interpretative study.

Preceptors provide fundamental support for the graduate registered nurse, acting as both teacher and role model with an aim to transition the graduate to becoming an independent practitioner. The purpose of this study was to investigate the expectations of the preceptor role from the preceptor's perspective. An interpretative phenomenological approach was used to explore the experience of being a preceptor with seven nurses working in acute clinical areas. Three themes emerged from the thematic analysis; balancing the preceptor role, exploring past experiences reveals current expectations and developing relationships. Participants had distinctive views on their role during the graduates' transition period, which were influenced by personal experience. Preceptors discussed their role including; education and support and the influence of the connection with the graduate nurse. The participants reflected on their own experiences and how this challenged their role expectations. Graduate characteristics were also highlighted to influence the balance of support. Overall the role of the preceptor was a complex role of balancing support and guidance while aiming to achieve professional development. The development of communication workshops and relationship building programs may be useful in addressing the multiple influencing elements of this relationship.