The social processes that emergency nurses use to achieve sustainability: A constructivist grounded theory.

AIM: To examine the experiences of emergency nurses and develop a substantive theory that describes the processes they use to support or prevent sustainability in their nursing practice. DESIGN: Constructivist grounded theory. METHODS: Between February 2018 and January 2019, observations and semi-structured interviews were conducted with 29 emergency nurses. Data underwent constant comparison, and coding was performed in three phases: open, focused, and theoretical, employing constructivist grounded theory. Additionally, some situational analysis mapping was undertaken and integrated as a method to explore the broader context affecting nursing practice. The study achieved theoretical saturation and rigour was ensured through evaluations of credibility, transferability, and confirmability. RESULTS: A substantive grounded theory was constructed to describe the basic social process of 'Achieving Personal and Professional Sustainability' with subprocesses that included 'Driving forces', 'Developing and using armouries', 'Balancing work-life', and 'Making emergency work effective'. This theory delineates two phases, 'exploration and establishment' and 'maintenance', and two key properties: 'Constructing and evolving professional identity' and 'Perceiving and reshaping the meaning of effective work and care'. The theory also highlights the dynamic interplay of individual, social, and institutional elements. CONCLUSION: 'Achieving Personal and Professional Sustainability' is important for emergency nurses to sustain themselves personally and professionally in their work. IMPACT STATEMENT: This research has substantial and global impacts. Emergency nursing can use this information as a guide to better understand strategies for both personal and professional sustainability. Policymakers may use the findings to foster a supportive work environment and enhance nurse well-being. Implementation of recommendations can lead to improved patient care outcomes. The methodological approach offers potential for future research, positively impacting emergency nursing practice and workforce sustainability worldwide. REPORTING METHOD: Reporting adheres to EQUATOR's COREQ guidelines for qualitative studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review.

AIMS AND OBJECTIVES: The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work. BACKGROUND: The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work. DESIGN AND METHODS: The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed. RESULTS: No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses. CONCLUSION: To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work. RELEVANCE TO CLINICAL PRACTICE: To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

Materials matter: Understanding the importance of sociomaterial assemblages for OSCE candidate performance.

INTRODUCTION: The OSCE is a sociomaterial assemblage-a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance. METHODS: We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team-based framework analysis of data. RESULTS: Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time-wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro-adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation. DISCUSSION: Our novel empirical study extends previous conceptual work by illustrating wide-ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation.

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.

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.

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.

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.

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.

Children's and adults' understanding of death: Cognitive, parental, and experiential influences.

This study explored the development of understanding of death in a sample of 4- to 11-year-old British children and adults (N=136). It also investigated four sets of possible influences on this development: parents' religion and spiritual beliefs, cognitive ability, socioeconomic status, and experience of illness and death. Participants were interviewed using the "death concept" interview that explores understanding of the subcomponents of inevitability, universality, irreversibility, cessation, and causality of death. Children understood key aspects of death from as early as 4 or 5years, and with age their explanations of inevitability, universality, and causality became increasingly biological. Understanding of irreversibility and the cessation of mental and physical processes also emerged during early childhood, but by 10years many children's explanations reflected not an improved biological understanding but rather the coexistence of apparently contradictory biological and supernatural ideas-religious, spiritual, or metaphysical. Evidence for these coexistent beliefs was more prevalent in older children than in younger children and was associated with their parents' religious and spiritual beliefs. Socioeconomic status was partly related to children's biological ideas, whereas cognitive ability and experience of illness and death played less important roles. There was no evidence for coexistent thinking among adults, only a clear distinction between biological explanations about death and supernatural explanations about the afterlife.

Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses.

AIMS AND OBJECTIVES: To determine, from the perspectives of enrolled nurses and registered nurses, the current scope of enrolled nurse practice and to identify the activities that most enrolled nurses frequently performed in their workplace. BACKGROUND: Enrolled nurse scope of practice in Australia has evolved and expanded over the past decade. However, the unclear role, function and competency differentiation between enrolled nurse and registered nurse leads to role confusion and ongoing professional debate. DESIGN: Exploratory Descriptive Study. METHODS: A cross-sectional online survey of enrolled nurses and registered nurses across Australia was conducted examining their levels of agreement on statements related to the scope of practice and the clinical and nonclinical activities that enrolled nurses were required to perform in their workplace. RESULTS: Valid responses were received from 892 enrolled nurses and 1,198 registered nurses. Enrolled nurses mostly agreed that they understood their scope of practice; did not undertake roles for which they were unprepared; sometimes undertook activities other than direct patient care; and believed that they operated equally to many registered nurses. The majority of enrolled nurses reported that they performed tasks mostly related to basic patient care in their workplace. There were a number of significant differences between perspectives of registered nurses and enrolled nurses. CONCLUSIONS: Clarifying the roles and scope of practice between the registered nurse and the enrolled nurse is important, and explicit differences in responsibility and accountability between their roles must be clearly articulated to harmonise perceptions about role and capability. Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned. RELEVANCE TO CLINICAL PRACTICE: Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned.

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.

Using pedagogical approaches to influence evidence-based practice integration - processes and recommendations: findings from a grounded theory study.

AIMS: The study aimed to explore the processes undertaken by nurse academics when integrating evidence-based practice (EBP) into their teaching and learning practices. This article focuses on pedagogical approaches employed by academics to influence evidence-based practice integration into undergraduate programs across Australian universities. BACKGROUND: Nursing academics are challenged to incorporate a variety of teaching and learning strategies to teach evidence-based practice and determine their effectiveness. However, literature suggests that there are limited studies available focusing on pedagogical approaches in evidence-based practice education. DESIGN: A constructivist grounded theory methodology, informed by Charmaz was used for this study. METHODS: Data were collected during 2014 from 23 nurse academics across Australian universities through semi-structured interviews. Additionally, nine were observed during teaching of undergraduate students. Twenty subject outlines were also analysed following Charmaz's approach of data analysis. FINDINGS: 'Influencing EBP integration' describes the pedagogical approaches employed by academics to incorporate EBP knowledge and skills into undergraduate curricula. With the use of various teaching and learning strategies, academics attempted to contextualize EBP by engaging students with activities aiming to link evidence to practice and with the EBP process. Although, some strategies appeared to be engaging, others were traditional and seemed to be disengaging for students due to the challenges experienced by participants that impeded the use of the most effective teaching methods. CONCLUSION: Study findings offer valuable insights into the teaching practices and identify some key challenges that require the adoption of appropriate strategies to ensure future nurses are well prepared in the paradigm of evidence-based practice.

Envisaging the use of evidence-based practice (EBP): how nurse academics facilitate EBP use in theory and practice across Australian undergraduate programmes.

AIMS AND OBJECTIVES: This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. BACKGROUND: Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. METHODS: Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. RESULTS: Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. CONCLUSION: Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive culture for nurses and students to apply evidence-based practice principles, and collaboration between academia and practice will make facilitation by academics practical and meaningful for students. RELEVANCE TO CLINICAL PRACTICE: Findings from this study point to a number of initiatives for clinical leadership to provide infrastructure and support for academics, practising nurses and undergraduate students to adopt evidence-based practice in practice settings, thereby influencing practice outcomes.

Lessons learned developing and piloting interprofessional handover simulations for paramedic, nursing, and physiotherapy students.

Interprofessional education is an important element in the preparation of healthcare students who can communicate effectively and work collaboratively. A grant from Health Workforce Australia funded a shared nursing, paramedicine, and physiotherapy simulation suite and a staff member dedicated to interprofessional simulation, with the aim of increasing high fidelity simulation within and across the three professions. This article describes the development process and pilot testing of four purpose-designed interprofessional handover scenarios for paramedic, nursing, and physiotherapy students. The scenarios tracked an elderly patient (manikin) with a fractured neck of femur from pre-hospital to postoperative assessment and handover. The National League of Nursing Simulation Design Scale was used to evaluate the scenarios. Students' feedback indicated they considered the simulations to be relevant to their practice, with a high level of fidelity. This study re-emphasises the importance of pilot testing simulations before use in large-scale studies.

Mental health recovery: A review of the peer-reviewed published literature.

The concept of mental health recovery promotes collaborative partnership among consumers, carers and service providers. However views on mental health recovery are less explored among carers and service providers. The aim of this review was to analyse contemporary literature exploring views of mental health consumers, carers and service providers in relation to their understanding of the meaning of mental health recovery and factors influencing mental health recovery. The literature review questions were: How is mental health recovery and factors influencing mental health recovery viewed by consumers, carers and service providers? What are the differences and similarities in those perceptions? How can the outcomes and recommendations inform the Australian mental health practices? A review of the literature used selected electronic databases and specific search terms and supplemented with manual searching. Twenty-six studies were selected for review which included qualitative, mixed method, and quantitative approaches and a Delphi study. The findings indicated that the concept of mental health recovery is more explored among consumers and is seldom explored among carers and service providers. The studies suggested that recovery from mental illness is a multidimensional process and the concept cannot be defined in rigid terms. In order to achieve the best possible care, the stakeholders require flexible attitudes and openness to embrace the philosophy.

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.

Aged care residents in the emergency department: the experiences of relatives.

AIMS AND OBJECTIVES: The aim of this study was to investigate the experiences of relatives who had a family member in an aged care facility subsequently transferred to an emergency department. BACKGROUND: The provision of timely and relevant patient information is vital for assessment and management of older patients presenting to the emergency department from aged care facilities. Older people are commonly accompanied by relatives who are an important resource for emergency department staff, providing medical information and assisting with treatment decisions. Investigating the experiences of relatives may provide key information to enable improvements in the delivery of emergency department care. DESIGN: This study used a descriptive qualitative design. METHODS: Semi-structured interviews were undertaken with 24 relatives of residents who were transferred from an aged care facility to an emergency department in Victoria, Australia in the previous three years. Inductive content analysis was used to analyse the transcripts. RESULTS: Relatives reflected on four main themes following their emergency department visit: The need for clear communication; The role of relatives in emergency department care; How older people are perceived in the health care system and an Ability to provide specialised care. CONCLUSIONS: Many people link their emergency department experience to the quality of communication with emergency department staff, and participants in this study felt satisfied with their visit when they were included in discussions about treatment, and their role was recognised by staff members. In contrast, participants were dissatisfied with the care provided to their family member when staff members failed to communicate with them, or recognise their role in the care of the family member. RELEVANCE TO CLINICAL PRACTICE: The findings of this study emphasise the importance of effective communication between emergency department staff and family members, in relation to treatment and end-of-life care.

Spatial demonstratives and perceptual space: describing and remembering object location.

Spatial demonstratives - terms including this and that - are among the most common words across all languages. Yet, there are considerable differences between languages in how demonstratives carve up space and the object characteristics they can refer to, challenging the idea that the mapping between spatial demonstratives and the vision and action systems is universal. In seven experiments we show direct parallels between spatial demonstrative usage in English and (non-linguistic) memory for object location, indicating close connections between the language of space and non-linguistic spatial representation. Spatial demonstrative choice in English and immediate memory for object location are affected by a range of parameters - distance, ownership, visibility and familiarity - that are lexicalized in the demonstrative systems of some other languages. The results support a common set of constraints on language used to talk about space and on (non-linguistic) spatial representation itself. Differences in demonstrative systems across languages may emerge from basic distinctions in the representation and memory for object location. In turn, these distinctions offer a building block from which non-spatial uses of demonstratives can develop.

At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses.

OBJECTIVE: Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. METHODS: The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. RESULTS: Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED CONCLUSION :There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence.

Initiatives to reduce overcrowding and access block in Australian emergency departments: a literature review.

Australian emergency departments are experiencing an increasing demand for their services. Patient throughput continues to expand resulting in overcrowding and access block where patients cannot gain entry to appropriate hospital beds. This is despite both state and federal governments implementing numerous schemes to address the complex causes of stress on emergency departments. This paper explores the current literature and highlights the key strategies adopted by different emergency departments to reduce delays and streamline patient flow, including: waiting room nurses; streaming; rapid assessment teams; short stay units and care coordination programmes. Many of these initiatives have proven successful at reducing the number of people re-presenting to the emergency department, addressing time delays and improving the management of existing resources and patient flow. More recent changes include increasing the scope of practice and workload for triage nurses. With the recent introduction of the National Emergency Access Target, which requires that most patients presenting to Australian emergency departments are reviewed and transferred or discharged from the department within 4h, traditional roles of nurses in the emergency department are changing and expanding to meet the needs of modern healthcare systems.