ORCID Profile
0000-0002-2100-994X
Current Organisation
University of Melbourne
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Preventive Medicine | Nursing | Clinical Sciences | Mental Health | Geriatrics And Gerontology | Clinical Nursing: Secondary (Acute Care) | Public Health and Health Services | Health And Community Services | Public Health And Health Services Not Elsewhere Classified | Clinical Sciences Not Elsewhere Classified |
ANZSRC Socio-Economic Objective (SEO)
The professions and professionalisation | Health and support services not elsewhere classified | Health related to ageing | Preventive medicine | Health education and promotion | Palliative care | Evaluation of health outcomes | Health status (e.g. indicators of “well-being”)
Related Links
Publications
Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review
Publisher: Elsevier BV
Date: 07-2021
Review of non-invasive ventilation in the emergency department: Clinical considerations and management priorities
Publisher: Wiley
Date: 10-11-2009
DOI: 10.1111/J.1365-2702.2008.02766.X
Abstract: We aimed to synthesise evidence from published literature on non-invasive ventilation to inform nurses involved in the clinical management of non-invasive ventilation in the emergency department. Non-invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Systematic review. A multi-database search was performed to identify works published in the English language between 1998-2008. Search terms included: non-invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Terminology used to describe aspects of non-invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non-invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non-invasive ventilation may be delivered with various interfaces and modes little evidence is available for the superiority of in idual interfaces or modes. Early use of non-invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Monitoring of non-invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask-fit and high air flows serious complications are few and occur infrequently. The use of non-invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department.
Why we do the things we do: applying clinical decision-making frameworks to triage practice.
Publisher: Elsevier BV
Date: 1999
DOI: 10.1016/S0965-2302(99)80103-9
Abstract: This paper discusses major themes presented in the published literature concerning clinical decision making and links these to the practice of emergency department nurse triage. Themes discussed include: approaches to decision research in nursing and medicine decision autonomy in nursing practice and clinical decision making under conditions of uncertainty. Some assumptions underpinning clinical decision-making frameworks are explored and the use of triage scales, algorithms and intuitive thought processes are discussed in terms of clinical practice. In addition, the strengths and limitations of each approach are outlined. It is argued that naturalistic research methods are necessary in order to describe the often uncertain and frequently chaotic environment in which triage decisions are made. This research must occur in order to evaluate and improve both the triage process and the outcomes of these decisions in practice.
Optimal management of mental health patients in Australian emergency departments: Barriers and solutions
Publisher: Wiley
Date: 17-08-2011
DOI: 10.1111/J.1742-6723.2011.01467.X
Abstract: The study aimed to describe: (i) the perceived barriers faced by emergency clinicians in the assessment and management of patients presenting with a mental health complaint to Australian hospital EDs and (ii) perceived strategies to optimize care of the mentally unwell in the ED. Semistructured interviews with open and closed question formats were used to explore the barriers perceived by ED doctors and nurses in assessing and managing patients with mental health presentations. Interviews were transcribed verbatim and thematically coded by two researchers using the Framework Approach. Thirty-six interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College of Emergency Nursing Australasia representing the various Australian jurisdictions. Thematic analyses revealed that a range of resource, environmental, staff and patient factors contribute to difficulties in managing mental health patients. Solutions suggested by interviewees included improved resources, ED redesign and improved links to resources outside the ED. An overwhelming majority of participants perceived the need for more educational opportunities in mental health. Although the provision of timely and quality care is expected for all patients attending EDs, there exist multiple barriers to provision of adequate care for ED patients presenting with mental illness. Many of these are systems-based and thus require systems-based solutions. ED clinician's perceive that improved educational opportunities in mental health, however, might alleviate some barriers they face. Consideration should be given to a comprehensive, quantitative mental health-related learning needs analysis of ED clinicians.
The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: A within-trial analysis of the border trial
Publisher: Wiley
Date: 06-10-2014
DOI: 10.1111/IWJ.12160
Identifying the core competencies of mental health telephone triage
Publisher: Wiley
Date: 02-08-2013
DOI: 10.1111/J.1365-2702.2012.04093.X
Abstract: The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. An observational design was employed to address the research aims. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call performing mental status examination risk assessment planning and action termination of call referral and reporting and documentation. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.
Mental health-related learning needs of clinicians working in Australian emergency departments: A national survey of self-reported confidence and knowledge
Publisher: Wiley
Date: 10-08-2011
DOI: 10.1111/J.1742-6723.2011.01472.X
Abstract: To identify the mental health-related learning needs of doctors and nurses working in Australian EDs. A purpose-designed survey was developed, and face validity was verified by 12 doctors and nurses. A cross-sectional survey of a national s le of nurses and senior doctors (registrars and consultants) working in EDs across Australia was then undertaken. The survey consisted of 130 items and required approximately 20 min for completion. The survey was delivered online through email invitation by the College of Emergency Nurses Australasia or the Australasian College for Emergency Medicine. A hardcopy format of the survey was also delivered at a national conference. Mental health presentations that involved a diagnosis of personality disorder, psychosis or behavioural disturbance, and the management of these conditions were patient factors that were considered problematic by up to 46.3% (118/255 95% CI 40.26-52.40) of doctors and 66.1% (72/109 95% CI 56.74-74.28) of nurses. Determining care plans, conducting mental status examinations, assessing risk of self-harm, pharmacology for treatment and for chemical restraint, management of patient aggression or violence, and alcohol or drug intoxication were also found to be areas of knowledge deficit. Doctors and nurses reported deficits in confidence and knowledge in tasks and patient presentations that they might frequently be expected to manage. These data can be used to inform future curricula at both undergraduate and postgraduate levels. Ultimately, this might pave the way for improved care and management of patients with mental health problems presenting to the ED.
Nurses' well‐being during the coronavirus (2019) pandemic: A longitudinal mixed‐methods study
Publisher: Wiley
Date: 21-06-2022
DOI: 10.1002/NOP2.1275
Abstract: To determine prevalence, predictors and change over time of nurses' and student nurses' mental health and well‐being, and explore nurses' perceptions, barriers and enablers of well‐being. Longitudinal mixed‐methods survey. Forty‐nine students and registered nurses participated from Victoria, Australia. Data were collected from December 2019 to July 2020. Validated psychometrics and free‐text response questions were employed. Analysis used latent growth curve modelling, Pearson product‐moment correlations and thematic analysis. A strong positive correlation was found between self‐determination and work well‐being, and a strong negative correlation between work well‐being and flight risk. Several moderate relationships were found a moderate positive correlation between work well‐being and nurse manager ability, leadership and support, and a moderate negative correlation between burnout and staffing and resource adequacy. Collegial nurse–physician relationships deteriorated. Three themes, physical health, psychological well‐being and social connection, were identified as important for nurses' well‐being.
An evaluation of the use of management care plans for people who frequently attend the emergency department
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.AUEC.2019.08.001
Abstract: To evaluate the use of management plans for people who frequently attend the emergency department (ED). Management plans are used to decrease ED utilisation by people who frequently attend. There is limited evidence regarding the use management plans for this population and the perspectives of staff who use them has previously not been considered. A descriptive observational design including before and after measures of attendance (November 2010 to September 2014) and survey of staff perceptions (July to November 2014). The setting was a major metropolitan hospital ED in Australia. The date for commencement of each plan was determined. Data were extracted regarding ED attendance 12 months before and after implementation. Staff perspectives were obtained via an online survey. Fifty-seven patients made 1482 ED attendances. Of these 830 occurred in the 12 months before the management plan was implemented and 652 during the 12 months after. The number of attendances per patient decreased from a median of 11 to 4. Staff considered management plans to be beneficial to care planning practices and in idual patient outcomes. Management plans were acceptable to staff, and implementation of management plans was associated with a decrease in ED attendance.
Invasive ventilation in the emergency department. Part 2: Implications for patient safety
Publisher: Elsevier BV
Date: 03-2007
Mechanical ventilation in Australian emergency departments: Survey of workforce profile, nursing role responsibility, and education
Publisher: Elsevier BV
Date: 05-2009
Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting
Publisher: Wiley
Date: 22-08-2016
DOI: 10.1111/JOCN.13360
Abstract: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.
Perspectives of emergency department staff on the triage of mental health-related presentations: Implications for education, policy and practice
Publisher: Wiley
Date: 31-08-2012
DOI: 10.1111/J.1742-6723.2012.01592.X
Abstract: To explore ED staff perceptions of the factors that influence accuracy of triage for people with mental health problems. This qualitative learning needs analysis used a descriptive exploratory design. Participants were Australian emergency nurses and doctors. We used a criterion-based s ling approach. Recruitment was facilitated by the College of Emergency Nursing Australasia and the Australasian College for Emergency Medicine. A semi-structured interview schedule was developed. Telephone interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to identify factors perceived to affect triage outcomes and to explore strategies to optimise the accuracy of triage assessments. Thirty-six staff participated (16 nurses and 20 doctors). Four major factors were perceived to influence accuracy. These were: environmental factors (physical structure, time pressures, activity levels, and interruptions), policy and education (guidelines, training and resources), staff factors (knowledge, experience, attitudes) and patient factors (police presence, patient behaviour, clinical condition). Differences of opinion were expressed by emergency doctors about the validity of the time to treatment objectives included in the Australasian Triage Scale for mental health presentations, and the utility of the scale to differentiate urgency for psychiatric conditions. Clinical guidelines and training have been developed to support the use of the Australasian Triage Scale. Further evaluation of the application of this scale to assess mental health problems is indicated. Additional work is also required to reduce variance in urgency assignment based on staff knowledge and attitudes about the causes, assessment and early management of psychiatric disorders.
Medication use across transition points from the emergency department: Identifying factors associated with medication discrepancies
Publisher: SAGE Publications
Date: 20-10-2009
DOI: 10.1345/APH.1M206
Abstract: As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress. To identify the patient-, environment-, and medication-related factors involving unexplained medication discrepancies across transition points after ED presentation. Using a retrospective chart review design, a stratified, random s ling of data was undertaken over a 12-month period. Information was obtained from an electronic administrative database and medical records as patients moved from the ED to another transition point of care. Medication discrepancies were classified into 2 outcome groups: (1) no discrepancies and situations in which discrepancies were adequately explained and (2) discrepancies that had no adequate explanation. For the 12-month period, 210 randomly selected patients were included 73 (34.8%) had at least one unexplained medication discrepancy. Binary logistic regression modeling showed 4 factors that were statistically significant in determining the incidence of at least one unexplained medication discrepancy. Benefit card holders (in iduals who receive benefits from government insurance programs comparable to the US-based Medicare and Medicaid initiatives, which include the elderly, the disabled, low income earners, and unemployed persons) had 3.73 greater odds of experiencing an unexplained medication discrepancy (95% CI 1.72 to 8.07 p = 0.001). Patients prescribed 5 or more drugs at discharge from the ED had 12.22 greater odds of having at least one unexplained medication discrepancy (95% CI 5.52 to 27.08 p 0.001). Patients who were first seen by a physician within 1 hour of a change in working shift had 3.70 greater odds of having an unexplained medication discrepancy (95% CI 1.67 to 8.18 p = 0.001). For each additional minute of wait time for a physician, the odds of having an unexplained medication discrepancy increased by a factor of 1.01 (95% CI 1.00 to 1.01 p = 0.042). Patient-, environment-, and drug-related factors contribute to the risk of medication discrepancies across transition points from the ED.
Disaster preparedness and learning needs among community health nurse coordinators in South Sulawesi Indonesia
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.AUEC.2017.11.002
Abstract: The number of natural disasters occurring worldwide has increased, including Indonesia, a country that continues to experience natural disasters of varying level of severity. Despite this evidence, limited information is available about nurses' disaster preparedness in Indonesia particularly in community settings. This study aims to identify the current level of disaster preparedness and learning needs for managing natural disasters as perceived by community health nurse (CHN) coordinators who are working in community health settings in South Sulawesi, Indonesia. This study used a descriptive study design. A self-administered survey, the Disaster Preparedness Evaluation Tools (DPET In total 214 CHN coordinators completed the survey. There were around 6.5% respondents perceived their current disaster preparedness as weak 84.6% moderate and 8.9% rated their preparedness as strong. Around one-third of the participants considered frequent disaster drills as the best learning method to achieve effective disaster preparedness. Although overall disaster preparedness levels of the CHN coordinators in South Sulawesi province Indonesia were moderate, continuing disaster training that integrates CHN coordinators specific learning needs is still required to achieve effective disaster preparedness and management in community levels.
Understanding medication safety in healthcare settings: A critical review of conceptual models
Publisher: Wiley
Date: 10-07-2011
DOI: 10.1111/J.1440-1800.2011.00541.X
Abstract: Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.
Nurse wellbeing during the coronavirus (2019) pandemic: A qualitative descriptive study
Publisher: Elsevier BV
Date: 12-2021
Registered Nurses’ experiences of psychological well‐being and ill‐being in their first year of practice: A qualitative meta‐synthesis
Publisher: Wiley
Date: 12-12-2021
DOI: 10.1111/JAN.14667
Abstract: To synthesize Registered Nurses’ self‐reported perceptions and experiences of psychological well‐being and ill‐being during their first year of practice. Qualitative meta‐synthesis. Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Qualitative studies were considered for inclusion if published in English, from 2009–2019, reporting primary data analysis including psychological well‐being and ill‐being experiences of graduate nurses in first year of practice. Qualitative studies were systematically identified and critically appraised. A meta‐synthesis was applied using an open card sort technique to organize empirical data into a matrix of graduate nurses’ voices of psychological well‐being and ill‐being. Twenty‐two studies were included. Analysis revealed patterns of positive experiences and emotions. These included feeling valued and part of the team and learning from and feeling supported by other nurses. Negative experiences and emotions such as feeling overwhelmed, stressed, alone and inadequately prepared were also identified. Graduate nurses’ perceptions and experiences of their psychological well‐being and ill‐being revealed both positive and negative dimensions during this transition period. Specific ex les of strategies that may promote transition nurses’ well‐being and prevent ill‐being were identified such as social connection and support. Increasing the numbers of new nursing graduates world‐wide is required to strengthen health systems. Developing strategies to retain these graduates in the workforce is paramount. This review found some graduate nurses experience the transition period as a time of personal growth and fulfilment, for others this period was a stressor. These findings were illustrated in a model of ‘ways to well‐being’. The potential for knowledge translation of this model extends from graduate nurses as in iduals, to nurse entry to practice programs and graduate nurse programs, to organizational policy targeting future health workforce. CRD42020148812.
'Whither inter-professional collaboration in emergency care? - Calling for symbiotic mutualism'
Publisher: Elsevier BV
Date: 02-2011
Exploring the contribution of clinical placement to student learning: A sequential mixed methods study
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.NEDT.2022.105379
Abstract: Increasing demand and limited supply of clinical placements in nursing underscore the need to better understand the role of clinical placements in students' learning. Identifying pedagogically rich activities that support work place learning alongside factors that influence educational outcomes has the potential to optimise professional placement experiences. To explore student nurses perceptions of the value of nursing clinical placements to their learning. A descriptive research design was employed using a sequential mixed method approach. A cross-sectional student survey captured students' perceptions of work integrated learning based on the perceived contribution of a pre-determined list of activities undertaken on clinical placement. Four Australian universities took part. Participants included students undertaking entry to practice programs. Four hundred and sixty-nine students completed the survey. Thirty-eight students participated in 12 focus groups. Participants rated PRA including interacting and time with patients and performing assessments as the most useful activities. Less useful, were activities that took them away from the patient. To maximise workplace learning, consideration must be given to ensuring students are presented with goal directed activities that support learning and are focused on an expanding scope of practice with opportunities to discuss and engage with staff.
How do we define quality at triage?
Publisher: Elsevier BV
Date: 11-2011
Challenges and opportunities of undertaking a video ethnographic study to understand medication communication
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/JOCN.12948
Abstract: To examine the challenges and opportunities of undertaking a video ethnographic study on medication communication among nurses, doctors, pharmacists and patients. Video ethnography has proved to be a dynamic and useful method to explore clinical communication activities. This approach involves filming actual behaviours and activities of clinicians to develop new knowledge and to stimulate reflections of clinicians on their behaviours and activities. However, there is limited information about the complex negotiations required to use video ethnography in actual clinical practice. Discursive paper. A video ethnographic approach was used to gain better understanding of medication communication processes in two general medical wards of a metropolitan hospital in Melbourne, Australia. This paper presents the arduous and delicate process of gaining access into hospital wards to video-record actual clinical practice and the methodological and ethical issues associated with video-recording. Obtaining access to clinical settings and clinician consent are the first hurdles of conducting a video ethnographic study. Clinicians may still feel intimidated or self-conscious in being video recorded about their medication communication practices, which they could perceive as judgements being passed about their clinical competence. By thoughtful and strategic planning, video ethnography can provide in-depth understandings of medication communication in acute care hospital settings. Ethical issues of informed consent, patient safety and respect for the confidentiality of patients and clinicians need to be carefully addressed to build up and maintain trusting relationships between researchers and participants in the clinical environment. By prudently considering the complex ethical and methodological concerns of using video ethnography, this approach can help to reveal the unpredictability and messiness of clinical practice. The visual data generated can stimulate clinicians' reflexivity about their norms of practice and bring about improved communication about managing medications.
Medication communication between nurses and patients during nursing handovers on medical wards: A critical ethnographic study
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.IJNURSTU.2012.02.008
Abstract: Communication is central to safe medication management. Handover is a routine communication forum where nurses provide details about how patients' medications are managed. Previous studies have investigated handover processes as general communication forums without specific focus on medication information exchange. The effects of social, environmental and organisational contexts on handover communication and medication safety have not been explored. To examine dominant and submissive forms of communication and power relations surrounding medication communication among nurses, and between nurses and patients during handover. A critical ethnographic approach was utilised to unpack the social and power struggles embedded in handover practices. The study was conducted in two medical wards of a metropolitan teaching hospital in Melbourne, Australia from January to November 2010. All registered nurses employed in the medical wards during the study time were eligible for participation. Patients were eligible if they were able to communicate with nurses about how their medications were managed. In total, 76 nurses and 27 patients were recruited for the study after giving written consent for participation. Participant observations, field interviews, video-recordings and video reflexive focus groups were conducted. Fairclough's critical discourse analytic framework guided data analysis. Nurse coordinators' group handovers in private spaces prioritised organisational and biomedical discourses, with little emphasis on evaluating the effectiveness of medication treatment. The ward spatial structure provided an added complexity to how staff allocation occurred. Handovers involving patients in the public spaces at the bedside facilitated a partnership model in medication communication. Nurses exercised discretion during bedside handovers by discussing sensitive information away from the bedside. Handovers across different wards during patient transfers caused communication breakdowns because information was not exchanged between bedside nurses. Nurse coordinators need to relinquish organisational control of the handover practice and appreciate the contribution of bedside nurses to patient information exchange. Bedside nurses need to be provided with opportunities to raise questions during the group handover. Designated meeting spaces need to be provided to reduce interruptions to the group handover process.
New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review
Publisher: Elsevier BV
Date: 09-2021
Behavioural assessment unit improves outcomes for patients with complex psychosocial needs
Publisher: Wiley
Date: 08-12-2018
Abstract: We aimed to assess the impact of a new model of care for patients presenting to the ED with acute behavioural disturbance. This pre- ost-intervention study involved creating a dedicated, highly resourced six bed unit, the behavioural assessment unit (BAU). Co-located with the ED at the Royal Melbourne Hospital, the unit was designed to fast-track the admission of patients affected by intoxication, mental illness or psychosocial crisis and provide front-loaded interventions. In 12 months from 1 April 2016, 2379 patients were admitted to the BAU. They were compared with a similar cohort of 3047 patients from the entire 2015 ED population. The BAU resulted in a decreased wait to be seen (40 min [interquartile range (IQR): 17-86] vs 68 min [IQR: 24-130], P < 0.001), a decreased wait for a mental health review (117 min [IQR: 49-224] vs 139 min [IQR: 57-262], P = 0.001) and a decreased ED length of stay (180 min [IQR: 101-237] vs 328 min [IQR: 227-534], P < 0.001). Patients admitted to the BAU were less likely to have a security code (349 (14.7%) vs 538 (17.7%), P = 0.003) and less likely to have mechanical restraint (156 episodes (6.6%) vs 275 (9.0%), P < 0.001) or therapeutic sedation (156 episodes (6.6%) vs 250 (8.2%), P < 0.001). A unit specifically designed to improve the care of patients requiring prolonged ED care due to mental illness and/or intoxication reduces the time spent in the ED and the use of some restrictive interventions. We recommend this model of care to EDs that care for this complex and challenging group of patients.
Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study
Publisher: Springer Science and Business Media LLC
Date: 15-01-2013
Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice
Publisher: Wiley
Date: 14-09-2020
DOI: 10.1111/INM.12779
Nursing skill mix and outcomes: A Singapore perspective: Original article
Publisher: Wiley
Date: 16-02-2007
DOI: 10.1111/J.1466-7657.2007.00518.X
Abstract: To summarize key evidence on nursing skill mix in acute care hospitals and their limitations and identify the gaps in current literature vis-à-vis Singapore's nursing workforce. Nursing skill mix has been theorized to be a factor influencing patient, nurse and organizational outcomes. While there is a growing body of literature explicating associations between nursing skill mix and positive outcomes, the evidence does not as yet provide firm directions in determining the best configuration. In addition, differences in nursing workforce characteristics also make it difficult to apply findings from one healthcare setting to another. In reviewing key evidence from the United States of America and Canada, this paper highlights three critical gaps in the nursing skill mix literature when examined in the context of Singapore's nursing workforce. Issues related to the interface between local and foreign nurses, the impact of speciality education, and the possible effects that work roles and distribution may have on quality of care need to be further examined. This knowledge should provide a robust evidence base with which to inform national policy on skill mix and maximize nursing resources in order to achieve optimal outcomes.
The comparability of emergency department waiting time performance data.
Publisher: AMPCo
Date: 12-2012
DOI: 10.5694/MJA12.11460
Influence of task properties and subjectivity on consistency of triage: A simulation study
Publisher: Wiley
Date: 04-2007
DOI: 10.1111/J.1365-2648.2007.04192.X
Abstract: This paper reports a study to determine nurses' levels of agreement using a standard 5-point triage scale and to explore the influence of task properties and subjectivity on decision-making consistency. Triage scales are used to define time-to-treatment in hospital emergency departments. Studies of the inter-rater reliability of these scales using paper-based simulation methods report varying levels of consistency. Understanding how various components of the decision task and in idual perceptions of the case influence agreement is critical to the development of strategies to improve consistency of triage. Simulations were constructed from naturalistic observation, cue types and frequencies were classified. Data collection was conducted in 2002, and the final response rate was 41 x 3%. Participants were asked to allocate an urgency code for 12 scenarios using the Australasian Triage Scale, and provide estimates of case complexity, levels of certainty and available information. Data were analysed descriptively, agreement between raters was calculated using kappa. The influence of task properties and participants' subjective estimates of case complexity, levels of certainty and available information on agreement were explored using a general linear model. Agreement among raters varied from moderate to poor (kappa=0 x 18-0 x 64). Participants' subjective estimates of levels of available information were found to influence consistency of triage by statistically significant amounts (F 5 x 68 <or=0 x 01). Strategies employed to optimize consistency of triage should focus on improving the quality of the simulations that are used. In particular, attention should be paid to the development of interactive simulations that will accommodate in idual differences in information-seeking behaviour.
Non-invasive mechanical ventilation in Australian emergency departments: A prospective observational cohort study
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.IJNURSTU.2008.10.009
Abstract: Data describing use of non-invasive ventilation (NIV) in the emergency department (ED) setting consist primarily of physician surveys. Our objective was to conduct a prospective study to document the characteristics of patients receiving NIV, interfaces, mode, and parameters used as well as NIV duration and decision-making responsibility. We conducted a 2-month prospective observational study of adult patients who received NIV in 24 EDs. Patient characteristics, delivery methods, and decision-making responsibility were documented for each ED presentation. Data were recorded on 245 patients 185 patients received non-invasive positive pressure ventilation (NIPPV) and 60 received continuous positive airway pressure (CPAP). Acute cardiogenic pulmonary oedema (ACPO) (80/245, 33%) and exacerbation of chronic obstructive pulmonary disease (COPD) (75/245, 31%) were the two most frequent indications for NIV. Compared to patients with respiratory failure from other aetiologies, those with ACPO were more likely to receive CPAP (28/80 [35%] versus 32/165 [19%] P=0.008). Initial NIV settings were selected by ED nurses for 118/245 (48%) patients, by ED physicians for 118/245 (48%) patients, and by ICU staff for 3/245 (1.5%) patients (not reported for 6 [2.5%] patients). The role of ED nurses in the selection of initial NIV settings was not influenced by ED location, patient type or triage category. Acute exacerbations of CPO and COPD were the most common indications for NIV. Clinicians demonstrated a preference for NIPPV for all patient aetiologies except ACPO. Responsibility for NIV management was shared by ED nurses and physicians.
Methodological approaches to measuring the incidence of unplanned emergency department presentations by cancer patients receiving systemic anti-cancer therapy: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 21-03-2022
DOI: 10.1186/S12874-022-01555-3
Abstract: The need to mitigate the volume of unplanned emergency department (ED) presentations is a priority for health systems globally. Current evidence on the incidence and risk factors associated with unplanned ED presentations is unclear because of substantial heterogeneity in methods reporting on this issue. The aim of this review was to examine the methodological approaches to measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy in order to determine the strength of evidence and to inform future research. An electronic search of Medline, Embase, CINAHL, and Cochrane was undertaken. Papers published in English language between 2000 and 2019, and papers that included patients receiving systemic anti-cancer therapy as the denominator during the study period were included. Studies were eligible if they were analytical observational studies. Data relating to the methods used to measure the incidence of ED presentations by patients receiving systemic anti-cancer therapy were extracted and assessed for methodological rigor. Findings are reported in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. Twenty-one articles met the inclusion criteria: 20 cohort studies, and one cross-sectional study. Overall risk of bias was moderate. There was substantial methodological and clinical heterogeneity in the papers included. Methodological rigor varied based on the description of methods such as the period of observation, loss to follow-up, reason for ED presentation and statistical methods to control for time varying events and potential confounders. There is considerable ersity in the population and methods used in studies that measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy. Recommendations to support the development of robust evidence include enrolling participants at diagnosis or initiation of treatment, providing adequate description of regular care to support patients who experience toxicities, reporting reasons for and characteristics of participants who are lost to follow-up throughout the study period, clearly defining the outcome including the observation and follow-up period, and reporting crude numbers of ED presentations and the number of at-risk days to account for variation in the length of treatment protocols.
Alcohol and Other Drug (AOD) Education for Hospital Staff: An Integrative Literature Review
Publisher: Informa UK Limited
Date: 14-12-2017
DOI: 10.1080/01612840.2016.1248876
Abstract: Alcohol and Other Drug (AOD) education amongst hospital staff is often inadequate. This leads to suboptimal care of patients and is a missed opportunity for early identification and treatment. This integrative review evaluates the core features of current education for hospital-based doctors and nurses in AOD, including country of origin, content, duration, and pedagogy. The majority of included studies were conducted in the USA (72%), target alcohol rather than AOD in general (72%), adopted a purely medical model of treatment (94%), and utilised a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model (94%). The overall quality of the studies was weak-moderate, which led to small effect sizes in most studies and limits the generalizability of any conclusions. More high quality research trials are needed to establish the core features of effective AOD education for hospital staff. Future research should include a focus on the psychosocial context of addiction, other drug use and the impact of negative attitudes on care delivery.
Establishing quality standards for graduate entry master of nursing curricula in Australia and New Zealand: A Delphi study
Publisher: Elsevier BV
Date: 08-2021
Homelessness, health status and emergency department use: An integrated review of the literature
Publisher: Elsevier BV
Date: 11-2007
Socio-demographic and disease related characteristics associated with unplanned emergency department visits by cancer patients: a retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 06-09-2019
Medication communication through documentation in medical wards: Knowledge and power relations
Publisher: Wiley
Date: 04-07-2014
DOI: 10.1111/NIN.12043
Abstract: Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals.
Use of the Safewards Model in healthcare services: A mixed-method scoping review protocol
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-039109
Abstract: Safewards is an organisational approach to delivering inpatient mental health services. The aim of Safewards is to minimise the number of situations in which conflict arises between healthcare workers and patients that lead to the use of coercive interventions (restriction and/or containment). The Safewards Model has been developed, implemented and evaluated for its impact on all forms of containment. Safewards has been adopted as the recommended approach to preventing patient agitation and clinical aggression in some jurisdictions. Notwithstanding these recommendations, the outcomes of Safewards for staff and patients have not been comprehensively described. The aim of the scoping review is to describe (1) Safewards interventions (2) how Safewards interventions have been implemented in healthcare settings (3) outcome measures used to evaluate the effectiveness of Safewards (4) barriers and enablers to the uptake and sustainability of Safewards. This review will provide a foundation for further research and/or systematic review of the effectiveness of Safewards. Peer-reviewed manuscripts of quantitative, qualitative and mixed-method research in English with be included for the period 01 January 2013– December 31st 2020. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Joanna Briggs Institute, Medline, Global Health, PsycINFO and Scopus will be searched. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and explanation and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol will be followed. Publications will be excluded if they do not include the required participants, concept or context. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion. Ethical approval for this review is not required as the information to be collected is publicly available. There are no participants or safety considerations in this review of published literature. Key findings for future research and clinical practice will be disseminated though peer-reviewed publication, stakeholder reporting and conference presentations.
Coronavirus disease 2019 Critical Care Essentials course for nurses: Development and implementation of an education program for healthcare professionals
Publisher: Australian Nursing and Midwifery Federation
Date: 28-02-2022
Can simple mobile phone applications provide reliable counts of respiratory rates in sick infants and children? An initial evaluation of three new applications
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.IJNURSTU.2015.01.016
Abstract: Respiratory rate is an important sign that is commonly either not recorded or recorded incorrectly. Mobile phone ownership is increasing even in resource-poor settings. Phone applications may improve the accuracy and ease of counting of respiratory rates. The study assessed the reliability and initial users' impressions of four mobile phone respiratory timer approaches, compared to a 60-second count by the same participants. Three mobile applications (applying four different counting approaches plus a standard 60-second count) were created using the Java Mobile Edition and tested on Nokia C1-01 phones. Apart from the 60-second timer application, the others included a counter based on the time for ten breaths, and three based on the time interval between breaths ('Once-per-Breath', in which the user presses for each breath and the application calculates the rate after 10 or 20 breaths, or after 60s). Nursing and physiotherapy students used the applications to count respiratory rates in a set of brief video recordings of children with different respiratory illnesses. Limits of agreement (compared to the same participant's standard 60-second count), intra-class correlation coefficients and standard errors of measurement were calculated to compare the reliability of the four approaches, and a usability questionnaire was completed by the participants. There was considerable variation in the counts, with large components of the variation related to the participants and the videos, as well as the methods. None of the methods was entirely reliable, with no limits of agreement better than -10 to +9 breaths/min. Some of the methods were superior to the others, with ICCs from 0.24 to 0.92. By ICC the Once-per-Breath 60-second count and the Once-per-Breath 20-breath count were the most consistent, better even than the 60-second count by the participants. The 10-breath approaches performed least well. Users' initial impressions were positive, with little difference between the applications found. This study provides evidence that applications running on simple phones can be used to count respiratory rates in children. The Once-per-Breath methods are the most reliable, outperforming the 60-second count. For children with raised respiratory rates the 20-breath version of the Once-per-Breath method is faster, so it is a more suitable option where health workers are under time pressure.
Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education Kit
Publisher: Wiley
Date: 06-05-2008
DOI: 10.1111/J.1742-6723.2008.01089.X
Abstract: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. A postal survey of 237 paper-based triage scenarios was utilized. A quota s le of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was kappa >or= 0.6. Data were collected during 2 April to 14 May 2007. Agreement for the set was kappa = 0.412 (95% CI 0.410-0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6-45.3) showed concordance >or=70% to the modal triage category (kappa = 0.632, 95% CI 0.629-0.636) and 155/237 (65.4%, 95% CI 59.3-71.5) showed concordance >or=60% to the modal triage category (kappa = 0.507, 95% CI 0.504-0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (kappa = 0.243, 95% CI 0.237-0.249 kappa = 0.319, 95% CI 0.310-0.328). All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task-related factors influence consistency of triage.
The influence of patient acuity on satisfaction with emergency care: Perspectives of family, friends and carers
Publisher: Wiley
Date: 11-02-2008
DOI: 10.1111/J.1365-2702.2007.02052.X
Abstract: To investigate the factors that influence satisfaction with emergency care among in iduals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency. Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective however, in iduals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes. A prospective cross-sectional survey with a consecutive s le (n = 128 response rate 83.7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care. Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients' triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons. Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care. Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes.
Factors influencing consistency of triage using the Australasian Triage Scale: Implications for guideline development
Publisher: Wiley
Date: 29-07-2009
DOI: 10.1111/J.1742-6723.2009.01197.X
Abstract: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale. A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota s le of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance. A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4% P<or= 0.001 65.0% P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P<or= 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05). We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.
A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial
Publisher: Wiley
Date: 27-05-2015
DOI: 10.1111/IWJ.12101
Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial
Publisher: Mark Allen Group
Date: 02-08-2015
DOI: 10.12968/JOWC.2015.24.8.340
Abstract: Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients’ stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152 p .001) who developed a total of 19 heel PUs. We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.
Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AENJ.2011.12.004
Abstract: To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 in iduals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13). The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.
The clinical and cost effectiveness of remote expert wound nurse consultation for healing of pressure injuries among residential aged care patients: A protocol for a prospective pilot parallel cluster
Publisher: Wiley
Date: 02-08-2023
DOI: 10.1111/IWJ.14121
Abstract: Pressure injuries affect 1 to 46% of residents in aged care (long term) facilities and cause a substantial economic burden on health care systems. Remote expert wound nurse consultation has the potential to improve pressure injury outcomes however, the clinical and cost effectiveness of this intervention for healing of pressure injuries in residential aged care require further investigation. We describe the remote expert wound nurse consultation intervention and the method of a prospective, pilot, cluster randomised controlled trial. The primary outcome is number of wounds healed. Secondary outcomes are wound healing rate, time to healing, wound infection, satisfaction, quality of life, cost of treatment and care, hospitalisations, and deaths. Intervention group participants receive the intervention over a 12‐week period and all participants are monitored for 24 weeks. A wound imaging and measurement system is used to analyse pressure injury images. A feasibility and fidelity evaluation will be concurrently conducted. The results of the trial will inform the merit of and justification for a future definitive trial to evaluate the clinical and cost effectiveness of remote expert wound nurse consultation for the healing of pressure injuries in residential aged care.
Medication communication during ward rounds on medical wards: Power relations and spatial practices
Publisher: SAGE Publications
Date: 06-06-2013
Abstract: Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with in idual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.
Telephone survey of service-user experiences of a telephone-based mental health triage service.
Publisher: Wiley
Date: 29-01-2013
DOI: 10.1111/INM.12003
Abstract: The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service-user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service-users' (consumers and informal carers) experiences of a telephone-based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone-based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision-making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self-referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer-focused care.
Prevalence of illicit substance use among patients presenting to the emergency department with acute behavioural disturbance: Rapid point-of-care saliva screening
Publisher: Wiley
Date: 11-01-2020
Abstract: To determine the prevalence of illicit substance use among patients presenting to one ED with acute behavioural disturbance using point-of-care saliva testing. A prospective observational study was conducted. Acute behavioural disturbance was defined as any episode requiring a security response for unarmed threat (Code Grey). The setting was a single ED and tertiary referral centre located in metropolitan Australia. Participants were adults presenting to the ED requiring a Code Grey. Saliva was analysed for meth/ hetamine, cannabis, cocaine and opiates using a rapid point-of-care test. Self-reported drug use was recorded at the time of saliva testing. Data collection occurred between August 2016 and March 2017. There were 229 valid saliva s les. Participants were, on average, 35 years (range 18-72) and male (168/229 73%). Forty percent (95% confidence interval 34-47) of s les tested positive, with 20% positive for two or more substances. Meth/ hetamines was detected in 92% of positive s les, 17% of s les tested positive for opiates, 8% for cannabis and 7% for cocaine. Among participants, 19% self-reported current substance use and 20% reported using illicit substances within the past 24 h. The prevalence of illicit substance use among this cohort was 40%. Self-reporting was unreliable. Point-of-care saliva testing is feasible. Early identification of harmful drug use may assist clinical decision making in selected or undifferentiated cases and provide an opportunity to implement harm minimisation strategies and make referrals.
Republished paper: Emergency department triage revisited
Publisher: Oxford University Press (OUP)
Date: 08-2010
DOI: 10.1136/PGMJ.2009.077081REP
Abstract: Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the ersity of factors determining the urgency of any in idual patient. It is timely to accept this ersity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.
Complex health service needs for people who are homeless
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10967
Abstract: Background. Homeless people face many challenges in accessing and utilising health services to obtain psychosocial supports offered in hospital and community settings. The complex nature of health issues is compounded by lack of accessibility to services and lack of appropriate and safe housing. Objective. To examine the perceptions and experiences of homeless people in relation to their health service needs as well as those of service providers involved with their care. Design. A purposive s ling approach was undertaken with a thematic framework analysis of semi-structured interviews. Participants. Interviews were undertaken with 20 homeless people who accessed the emergency department in an acute hospital in Melbourne, Australia and 27 service providers involved in hospital and community care. Results. Six key themes were identified from interviews: complexity of care needs, respect for homeless people and co-workers, engagement as a key strategy in continued care, lack of after-hour services, lack of appropriate accommodation and complexity of services. Conclusions. Findings revealed the complex and erse nature of health concerns in homeless people. The demand on hospital services continues to increase and unless government policies take into consideration the psychosocial demands of the communities most vulnerable people efforts to ert hospital demand will continue to fail. What is known about the topic? Homeless people have complex healthcare needs and are high users of emergency departments (EDs). The increasing demand on hospital services has led to a focus by the Australian State, Territory and Federal Governments on strategies to ert homeless people from presenting to the ED. What does this paper add? This paper gives an insight into the experiences of homeless people and health service provides who are directly involved in their care. This insight gives important focus on the health needs and service responses that currently exist and the ongoing challenges that face homeless people and the health professionals responding to those needs. What are the implications for practitioners? To adequately respond to the needs of homeless people safe and supportive accommodation is a crucial component of services required to try and break the cycle of representation to the emergency department. In idual engagement strategies with coordinated care between hospital and community are required to address the complex care needs and psychosocial issues.
Invasive ventilation in the emergency department. Part 1: What nurses need to know
Publisher: Elsevier BV
Date: 03-2007
Evaluation of a multifaceted intervention on documentation of vital signs at triage: A before-and-after study
Publisher: Wiley
Date: 08-11-2013
Abstract: Triage systems provide a centralised safety mechanism where all patients are assessed for clinical urgency at point of entry to the ED. The present study aims to evaluate the effect of a multifaceted intervention on triage documentation rates and guideline adherence. A before-and-after design was used. The intervention involved restructuring the computerised interface, regular audit and feedback and education sessions. The setting was one adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. Participants were triage nurses. Data were collected at five time points for a consecutive s le of one month of presentations. Over a 15 month period, we s led 35.8% (24,862/69,395) episodes of triage performed by 122 nurses. Documentation rates for all vital signs progressively increased from baseline. There were significant increases in the proportion of episodes of triage where any vital sign was documented (32.2% vs 82.6%), and where pair and triplet combinations of vital signs were recorded in the triage field (heart rate and respiratory rate: 17.9% vs 64.6% heart rate, respiratory rate and temperature: 7.0% vs 30.4%). No significant change in guideline adherence was observed after the intervention. Progressive sustained improvements in vital sign documentation were observed over the study period however, no such increases were noted in guideline adherence. To facilitate evaluation of guideline adherence, we recommend specific vital sign parameters be included in the Australasian Triage Scale Guideline for all levels of urgency.
Anxiety as a factor influencing satisfaction with emergency department care: Perspectives of accompanying persons
Publisher: Wiley
Date: 10-11-2009
DOI: 10.1111/J.1365-2702.2009.02873.X
Abstract: To measure levels of anxiety among people accompanying consumers to the emergency department and to explore how anxiety influences satisfaction with care. When people seek treatment in an emergency department they are often accompanied by a next-of-kin, family member or friend. While the accompanying person plays a vital role in providing psycho-social support to consumers, little is known about how they perceive the quality of care. Learning more about how accompanying persons perceive care may inform the development of strategies to enhance communication processes between staff, consumers and accompanying persons. DESIGN A prospective cross-sectional survey design. Data were collected from a consecutive s le of accompanying persons at one Australian metropolitan teaching hospital. Of all eligible in iduals approached, 128/153 (83.7%) returned completed questionnaires. The questionnaire comprised a series of open- and close-ended questions about perceptions of medical need, urgency and satisfaction with the overall visit. Anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A). There was a significant association between the accompanying person's levels of anxiety and satisfaction at point of discharge. In the satisfied group, mean VAS-A scores were 17.4 (SD 17.5) compared to 42.9 (SD 26.6) in the not satisfied group (p = 0.011). Moreover, those participants who were not satisfied with the visit did not show a significant reduction in VAS-A scores from triage to point of discharge. The lower the level of anxiety reported by accompanying persons when leaving the emergency department, the more satisfied they are likely to be with their emergency department visit. Ultimately, well informed and confident accompanying persons are beneficial for ensuring quality patient support. Asking accompanying persons about their anxiety level before discharge gives them the opportunity to pose clarifying questions and is, therefore, an effective way of improving their satisfaction with the emergency department visit.
Organizational strategies to optimize women’s safety during labor and birth: A scoping review
Publisher: Wiley
Date: 05-07-2021
DOI: 10.1111/BIRT.12570
Abstract: Safety is a priority for organizations that provide maternity care, however, preventable harm and errors in maternity care remain. Maternity care is considered a high risk and high litigation area of health care. To mitigate risk and litigation, organizations have implemented strategies to optimize women's safety. Our objectives were to identify the strategies implemented by organizations to optimize women's safety during labor and birth, and to consider how the concept of safety is operationalized to measure and evaluate outcomes of these strategies. This scoping review was conducted using the Joanna Briggs Institute Scoping Review Methodology. Published peer‐reviewed literature indexed in CINAHL, Medline, and Embase, databases from 2010 to 2020, were reviewed for inclusion. Fifty studies were included. Data were extracted and thematically analyzed. Three categories of organizational strategies were identified to optimize women's safety during labor and birth: clinical governance, models of care, and staff education. Clinical governance programs (n = 30 studies), specifically implementing checklists and audits, models of care, such as midwifery led‐care (n = 11 studies), and staff training programs (n = 9 studies), were predominately for the management of obstetric emergencies. Outcome measures included morbidity and mortality for woman and newborns. Three studies discussed women's perceptions of safety during labor and birth as an outcome measure. Organizations utilize a range of strategies to optimize women's safety during labor and birth. The main outcome measure used to evaluate strategies was focused on clinical outcomes for the mother and newborn.
Complexities of medicines safety: Communicating about managing medicines at transition points of care across emergency departments and medical wards
Publisher: Wiley
Date: 11-09-2015
DOI: 10.1111/JOCN.12685
Abstract: To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals. Medicines errors are common at transition points of care. Little qualitative work has targeted communicating about medicines management across patients' journeys from admission through to discharge. A qualitative descriptive study was undertaken. In-depth, semi-structured interviews were conducted with patients and family members, and focus groups and interviews were undertaken with doctors, nurses and pharmacists (n = 103). These in iduals were situated in emergency departments and general medical wards. Data were analysed using thematic analysis. Four themes were identified: contextual environment of care, competing responsibilities of care, awareness of responsibility for safety, and interprofessional communication. Contextual environment of care was affected by time pressure and efficiency, and an overriding priority to move patients out of emergency departments. In competing responsibilities of care, a reactive focus was displayed in emergency departments while a proactive stance was demonstrated in medical wards. There was an awareness of responsibility for safety, whereby key stakeholders appreciated the chain of events involved, interpersonal communication affected patients and carers, and consequences existed for patient education related to lack of information. Interdisciplinary communication was associated with communication modalities used in encounters, compartmentalised thinking, and medicines changes relayed to external providers. Medicines management at transition points involved a complex interplay of dynamic features. This interplay infiltrated across erse environments, affecting patient care within and outside hospitals. Health professionals require greater appreciation of each other's roles at transition points of care. Prioritisation of high-risk patients is needed, such as those with cognitive impairment and multiple co-morbidities. Establishing workable protocols of communication etiquette and a structured approach to medicines activities may assist in pre-empting problems before they occur.
Feasibility and need for violence risk screening at triage: An exploration of clinical processes and public perceptions in one Australian emergency department
Publisher: BMJ
Date: 08-07-2015
DOI: 10.1136/EMERMED-2013-202979
Abstract: Research on patient aggression in hospital emergency departments supports the development of a systematic process for identifying in iduals at risk of becoming violent. The feasibility and community acceptance of this approach is unknown. In this study, we determine the feasibility and explore the need for a violence risk screening process in one Australian emergency department. We used a descriptive exploratory design that involved semistructured interviews and observations of practice. The setting was an adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. A convenience s le of nine triage nurses were observed assessing patients to explore how risk screening was undertaken in practice. Semistructured interviews were conducted with emergency department (ED) service users (N=19) to explore community perspectives on the process of violence risk screening. Observations of practice revealed that nurses used observed and reported information to screen for potential risk of violence rather than employing a direct questioning approach. Interviews with community members in the emergency department waiting room highlighted a public expectation that nurses screen and accurately identify patients at risk of violence on arrival to the ED. Consistent with local prevalence data, public expectations of emergency care supported the need to adopt a uniform approach to identifying people at risk of becoming violent on arrival to hospital. Observations of triage nurses interactions with patients revealed that the existing violence risk screening approach was not being consistently used by triage nurses. An integrated approach to determining violence risk during triage assessment is recommended.
Mental health-related risk factors for violence: Using the evidence to guide mental health triage decision making
Publisher: Wiley
Date: 15-11-2012
DOI: 10.1111/J.1365-2850.2011.01839.X
Abstract: Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patient-initiated violence. We conducted a systematic review based on the National Health and Medical Research Council of Australia's methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient's general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.
The outcome of a rapid training program on nurses' attitudes regarding the prevention of aggression in emergency departments: A multi-site evaluation
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.IJNURSTU.2013.01.007
Abstract: Patient aggression is a common source of occupational violence in emergency departments. Staff attitudes regarding the causes for aggression influence the way they manage it. The Management of Clinical Aggression - Rapid Emergency Department Intervention is a 45 min educational program that aims to promote the use of de-escalation techniques and effective communication skills to prevent patient aggression. We sought to evaluate the impact of the program on staff attitudes regarding the prevention and early management of patient aggression. A mixed methods approach was used including a pre-test post-test survey of training participants and in idual interviews with key stakeholders. The setting was public sector hospital emergency departments located in metropolitan and regional Victoria, Australia. A convenience s le of eighteen emergency departments was recruited via the Victorian Department of Health. Survey participants were nurses and midwives who were employed at the study sites. Interview participants were a purposive s le of nurse unit managers and trainers. The Management of Aggression and Violence Attitude Scale was administered to training participants immediately before and 6-8 weeks after training. Semi-structured telephone interviews with trainers and managers occurred 8-10 weeks after the intervention. Four hundred and seventy one participants completed the pre-test and post-test. Statistically significant shifts were observed in 5/23 items (Wilcoxon Signed Ranks Test: p ≤ 0.01). Despite training, participants were undecided if it was possible to prevent patient aggression, and continued to be unsure about the use of physical restraint. Twenty-eight (82.3%) of managers' and trainers' eligible to be interviewed provided their perceptions of the impact of the program. Overall, these perceptions were consistent with the significant shifts observed in the survey items. There was limited evidence to demonstrate that the program significantly modified staff attitudes towards the prevention of patient aggression using the Management of Aggression and Violence Attitude Scale. Additional survey items that specifically measure staff attitudes about the use of restraint in emergency settings are needed to better understand decision making about restraining practices. Further work is indicated to quantify the impact of training in practice.
Investigating the predictive validity of an emergency department mental health triage tool
Publisher: Wiley
Date: 11-11-2014
DOI: 10.1111/NHS.12095
Restrictive interventions in Victorian emergency departments: A study of current clinical practice
Publisher: Wiley
Date: 26-11-2020
Abstract: To determine current clinical practices for managing behavioural emergencies within Victorian public hospital EDs. A multi-centre retrospective study involving all patients who attended ED in 2016 at the Alfred, Ballarat, Dandenong, Geelong and Royal Melbourne Hospitals. The primary outcome was the rate of patient presentations with at least one restrictive intervention. Secondary outcomes included the rate of security calls for unarmed threats (Code Grey), legal status under the Mental Health Act at both the time of ED arrival and the restrictive intervention, and intervention details. For each site, data on 100 patients who had a restrictive intervention were randomly extracted for indication and methods of restraint. In 2016, 327 454 patients presented to the five EDs the Code Grey rate was 1.49% (95% CI 1.45-1.54). Within the Code Grey population, 942 had at least one restrictive intervention (24.3%, 95% CI 23.0-25.7). Details were extracted on 494 patients. The majority (62.8%, 95% CI 58.4-67.1) were restrained under a Duty of Care. Physical restraint was used for 165 (33.4%, 95% CI 29.3-37.8) patients, 296 were mechanically restrained (59.9%, 95% CI 55.4-64.3), median mechanical restraint time 180 min (IQR 75-360), and 388 chemically restrained (78.5%, 95% CI 74.6-82.0). Restrictive interventions in the ED largely occurred under a Duty of Care. Care of patients managed under legislation that covers assessment and treatment of mental illness has a strong clinical governance framework and focus on minimising restrictive interventions. However, this is not applied to the majority of patients who experience restraint in Victorian EDs.
Triage nurses' clinical decision making. An observational study of urgency assessment
Publisher: Wiley
Date: 27-08-2001
A randomised controlled trial of the clinical effectiveness of multi‐layer silicone foam dressings for the prevention of pressure injuries in high‐risk aged care residents: The Border III Trial
Publisher: Wiley
Date: 10-04-2018
DOI: 10.1111/IWJ.12891
Communicating about the management of medications as patients move across transition points of care: an observation and interview study
Publisher: Wiley
Date: 14-01-2016
DOI: 10.1111/JEP.12507
Abstract: As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.
Screening major trauma patients for prevalence of illicit drugs
Publisher: Wiley
Date: 15-07-2022
DOI: 10.1111/DAR.13355
Abstract: Australasian emergency departments (ED) routinely test patient alcohol levels following major trauma, but assessment for illicit drugs is uncommon. A prospective cross‐sectional study of major motor‐vehicle‐related trauma patients attending both adult major trauma centres in Victoria, Australia. All eligible patients had point‐of‐care saliva testing to determine the prevalence of common illicit drugs. Over 12 months, 1411 patients were screened, 36 refused (2.6%) and 63 were excluded. Of the final 1312 cases included, 173 (13.2% 95% confidence interval 11.5, 15.1) tested positive to at least one illicit substance, with 133 (76.9% 69.7, 82.8) positive for meth/ hetamines. One in five had more than one illicit substance detected. Patients testing positive were most frequently in motor vehicles (91.9% vs. 85.6%) and least frequently cyclists (2.3% vs. 4.2%) or pedestrians (5.2% vs. 10.3%), compared to those testing negative. They were younger (mean age 35.4 vs. 43.1 years), more likely to arrive overnight (27.2% vs. 12.1%) or after single vehicle crashes (54.3% vs. 42.3%). Although the initial disposition from ED did not differ, those testing positive were more likely to re‐present within 28 days (13.9% vs. 5.4%). A high prevalence of potentially illicit substances among patients presenting with suspected major trauma supports the need for urgent preventive strategies. The low rate of patient refusal and large numbers screened by ED staff suggests that point‐of care testing for illicit substances in major trauma is acceptable and feasible. This study and ongoing surveillance may be used to inform driver education strategies.
An observational study of the maintenance of the 30° side‐lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpos
Publisher: Wiley
Date: 12-07-2019
DOI: 10.1111/IWJ.13142
Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital‐acquir
Publisher: Wiley
Date: 09-06-2023
DOI: 10.1111/IWJ.14230
Abstract: Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non‐blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID‐19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop‐out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.
The effects of physical environments in medical wards on medication communication processes affecting patient safety
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.HEALTHPLACE.2013.12.017
Abstract: Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.
Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: Implications for service delivery
Publisher: Springer Science and Business Media LLC
Date: 10-11-2007
Effect of Safewards on reducing conflict and containment and the experiences of staff and consumers: A mixed-methods systematic review
Publisher: Wiley
Date: 12-11-2022
DOI: 10.1111/INM.12950
Abstract: Safewards is an internationally adopted framework that provides interventions to reduce conflict and containment in healthcare settings. This systematic review evaluated the effect of Safewards on conflict and containment events in inpatient units and the perceptions of staff and consumers. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Following the Joanna Briggs Institute methodology, two reviewers independently screened, appraised, and extracted data. Qualitative data were synthesized using inductive-thematic analysis. Quantitative and qualitative data were integrated with a convergent-segregated approach and presented in tabular and narrative format. A search of 13 databases and grey literature yielded 14 studies of variable methodological quality. Four studies reported reduced rates of conflict and one study reported reductions that were not statistically significant. Six studies reported reductions in rates of containment, three studies found no statistical significance and one study reported statistically significant reductions at follow-up. Staff and consumers in four studies reported an improved experience of safety. Three themes were developed as follows: (i) therapeutic hold, cohesion, support and the environment, (ii) conflict, containment and the experience of safety, and (iii) the complexities of adapting and embedding change. This review found most staff and consumers reported Safewards improved therapeutic relationships, cohesion, and ward atmosphere. Staff and consumers reported improved ward atmosphere, leading to consumer-centred, recovery-oriented care. Safewards improved the experience of safety from the perspective of staff and consumers when combined with ongoing training, leadership and time for consolidation. While results are promising they should be used cautiously until more robust evidence is established.
5-20: A model of minimum nurse-to-patient ratios in Victoria, Australia
Publisher: Hindawi Limited
Date: 2007
DOI: 10.1111/J.1365-2934.2006.00657.X
Abstract: This study presents a critique of a new model of minimum nurse-to-patient ratio and considers its utility alongside established Patient Dependency Systems. Since 2001 legislation mandating minimum nurse-to-patient ratios has been enacted throughout large public hospitals in the state of Victoria, Australia. The Victorian model mandates minimum staffing of five nurses to 20 patients in acute medical and surgical wards. In conjunction with this approach, Patient Dependency Systems are employed to anticipate short-term resource needs. Although this legislation has been successful in attracting nurses back into the public sector workforce, no published empirical evidence exists to support specific ratios. In addition, neither ratio nor Patient Dependency Systems approaches account for the critical influence of skill mix on hospital, employee, or patient outcomes. There is an urgent need for further research that specifically examines relationships between models of staffing, skill mix and quality outcomes.
Emergency department triage revisited
Publisher: BMJ
Date: 02-2010
Abstract: Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the ersity of factors determining the urgency of any in idual patient. It is timely to accept this ersity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.
Amphetamine-type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes
Publisher: Wiley
Date: 06-03-2020
DOI: 10.1111/INM.12710
A survey of psychiatrists' and registered nurses' levels of mental health literacy in a Chinese general hospital
Publisher: Wiley
Date: 23-05-2011
DOI: 10.1111/J.1466-7657.2011.00883.X
Abstract: Mental health literacy (MHL) is the term used to describe people's knowledge and beliefs about mental disorders which aid in the recognition, management or the prevention of illness. Health professionals' levels of MHL will shape the therapeutic relationship in which they work in partnership with patients. Studies have been conducted in Australia and Singapore to determine levels of MHL among members of the general public and health professionals. To date, no such studies have been published in Chinese populations. The study aims to compare levels of MHL between registered nurses and psychiatrists in a Chinese general hospital. The paper reports participants' diagnosis and beliefs about interventions used to manage depression and schizophrenia. A descriptive cross-sectional survey was undertaken among a group of psychiatrists and registered nurses in the psychiatric department of one large teaching hospital in China (n=70). Participants completed the survey by rating written vignettes related to depression and schizophrenia. The psychiatrists were highly accurate in correctly diagnosing both depression and schizophrenia the registered nurses were less so for diagnosing depression. In terms of treatment options, the two groups reached a broad agreement on beliefs about the use of mental health interventions, but differed significantly in the use of some specific mental health interventions. This study provides preliminary information about levels of MHL among Chinese mental health professionals and describes their attitudes towards the helpfulness of interventions used to restore mental health and well-being. Future large-scale studies are required to identify factors that influence beliefs about the use of mental health interventions. The findings have implications for further education of registered nurses in the specialization of mental health nursing in China.
Homelessness: Patterns of emergency department use and risk factors for re-presentation
Publisher: BMJ
Date: 03-08-2011
Abstract: To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an in idual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.
Use of invasive mechanical ventilation in Australian emergency departments: Original Research
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1742-6723.2009.01167.X
Abstract: There are few published reports describing the use of invasive mechanical ventilation in EDs. We explored the characteristics of patients receiving mechanical ventilation, the ventilator modes and parameters used as well as the duration of ventilation and the nature of ventilator decision-making in Australian ED. We conducted a 2 month prospective survey of adult patients who received invasive mechanical ventilation in 24 Australian ED. Data forms were completed by ED staff during the patient's ED presentation. We documented ventilator settings post intubation, after a 1 h stabilization period, and immediately before ED discharge or extubation. The person responsible for selection of ventilator settings was noted at each time point. Data were recorded on 307 patients. Altered mental status (179/307 [58%, 95% CI 53-64]) was the most common indication for mechanical ventilation. Volume-controlled modes were most frequently used at all measured time points with a median tidal volume of 8 mL/kg. Responsibility for initial selection of ventilator settings was shared between ED physicians (157/307 [51%, 95% CI 46-57]), ED nurses (111/307 [36%, 95% CI 31-42]) and ICU or paramedic staff (9/307 [3%, 95% CI 1-5]) (not recorded 30/307 [10%, 95% CI 6-13]). Ongoing responsibility for titration of ventilation was more commonly that of the ED nurse. The application of mechanical ventilation was similar to descriptions reported in the critical care literature both in Australia and internationally. Decision-making responsibilities were shared by ED medical and nursing staff.
Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department
Publisher: Wiley
Date: 19-06-2017
DOI: 10.1111/ACEM.13218
Abstract: Behavioral emergencies are commonly seen in emergency departments (EDs). Acutely agitated patients can be difficult to manage and sedation may be required to decrease dangerous behavior and to ensure the safety of both the patient and the staff. While the experience of staff caring for this population has been reported, patients' experiences with their overall management remains unknown. We aimed to describe the perceptions and experiences of patients regarding the use of sedation during acute behavioral emergencies. Face-to-face semistructured interviews were conducted with adults aged 18 years or older, who had received parenteral sedative medication for the management of a behavioral emergency and were deemed capable to participate. The participants were asked about their experiences of receiving care in the ED during the episode and their perceptions of sedation. All interviews were transcribed verbatim and analyzed thematically. Data saturation was reached after 13 interviews. Two broad themes emerged: trusting relationships and needs or wants following sedation. A trusting relationship is built through 1) confidence in care, 2) sedation as an appropriate treatment, 3) insight into own behavior, and 4) humane treatment. Four subthemes of needs or wants were identified: 1) empathy, 2) debrief, 3) addressing concerns, and 4) follow-up. A trusting relationship was identified as crucial to minimize the negative impact of coercive measures used to manage behavioral emergencies. Participants expressed similar needs to patients presenting with medical problems. This study illustrates their needs for compassionate communication, adequate information about the treatment provided, and follow-up care.
Mental Health Nurses' Dispositional Decision-Making for People Presenting to the Emergency Department With Deliberate Self-Harm: An Exploratory Study
Publisher: Hindawi Limited
Date: 20-10-2015
DOI: 10.1111/PPC.12086
Abstract: There is no clear treatment pathway for people presenting to Australian emergency departments with deliberate self-harm. To explore variations in mental health nurses' disposition decisions for patients following risk assessment for deliberate self-harm. A survey was distributed to mental health nurses. This survey comprised demographic items and questions in response to nine vignettes describing episodes of deliberate self-harm. Dispositional decision and reasoning were also sought for each vignette. Poor levels of agreement for disposition were found. There was a lack of consensus regarding dispositional outcomes. This suggests a high level of subjectivity in decision-making which needs to be taken into account within clinical governance.
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