Physical deterioration in an acute mental health unit : A quantitative retrospective analysis of medical emergencies
- Authors: Porter, Joanne , Cant, Robyn , Missen, Karen , Raymond, Anita , Churchill, Anne
- Date: 2018
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 27, no. 5 (2018), p. 1364-1370
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- Description: Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011–2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals’ quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the ‘Worried’ category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the ‘Worried’ category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am–12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.
An Australian mixed methods pilot study exploring students performing patient risk screening
- Authors: Gibson, Simone , Golder, Janet , Cant, Robyn , Davidson, Zoe
- Date: 2016
- Type: Text , Journal article
- Relation: Nursing and Health Sciences Vol. 18, no. 2 (2016), p. 203-209
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- Description: Clinical placement shortages and rising costs have created demand to provide low-resource, high value student learning opportunities. Malnutrition screening provides a vehicle for achieving this. A mixed methods explanatory sequential intervention study investigated time costs, and students' perceptions of preparedness after performing routine patient screening tasks, as well as students' overall views on their feelings of confidence and preparedness when commencing their first clinical placements. Pre-clinical student dietitians commencing initial placements participated (n=58), with 16 of these forming a subgroup who performed malnutrition screening tasks while the others attended usual placement orientation. The time saved when students undertook screening tasks usually assigned to nurses was substantial. Questionnaires revealed that student perceived confidence increased in the screening group when compared with controls. Focus group themes included "anxiety and confidence," "learning in the clinical learning environment," "communication skill development," and "the pre-placement screening experience." Students performing routine patient-screening tasks prior to initial clinical placement has potential cost savings for healthcare organizations and was perceived to be valuable for learning. © 2016 John Wiley & Sons Australia, Ltd.
Emergency and palliative care nurses' levels of anxiety about death and coping with death : A questionnaire survey
- Authors: Peters, Louise , Cant, Robyn , Payne, Sheila , O'Connor, Margaret , McDermott, Fiona , Hood, Kerry , Morphet, Julia , Shimoinaba, Kaori
- Date: 2013
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 16, no. 4 (2013), p. 152-159
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- Description: Background: Caring for dying patients and their families presents many challenges, and may be negatively affected by nurses' Fear of Death. This study investigates attitudes of emergency and palliative care nurses towards death and dying. Methods: A mixed methods design including questionnaire and interview, was utilised. This paper reports questionnaire results from the Death Attitude Profile-Revised Scale and coping skills. Results: Twenty-eight emergency nurses and 28 palliative care nurses from two health services participated. Nurses held low to moderate Fear of Death (44%), Death Avoidance (34%), Escape Acceptance (47%) and Approach Acceptance (59%). Emergency nurses reported higher death avoidance and, significantly lower coping skills than palliative care nurses. Both reported high acceptance of the reality of death (Neutral Acceptance 82%), and indicated they coped better with a patient who was dying than with, the patient's family. Conclusions: Nurses generally held positive attitudes towards death and dying. Participants could cope with caring for dying patients, but were significantly less comfortable coping with patients' family members. Nurses should be aware of the impact their attitude towards death may have on providing supportive nursing care for the dying. © 2013 College of Emergency Nursing Australasia Ltd.
Managing patient deterioration: assessing teamwork and individual performance
- Authors: Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Missen, Karen , Sparkes, Louise , McConnell-Henry, Tracy , Endacott, Ruth
- Date: 2013
- Type: Text , Journal article
- Relation: Emergency Medicine Journal Vol. 30, no. 5 (2013), p.
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- Description: Objective To assess the ability of rural Australian nurse teams to manage deteriorating patients. Methods This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure. Results Knowledge in relation to patient deterioration management varied (mean 63%, range 27–100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17–83%, SD 14.03) with significantly higher levels in younger participants (r=−0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001). Conclusion Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.
Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care
- Authors: Cant, Robyn , Foster, Michele
- Date: 2011
- Type: Text , Journal article
- Relation: Australian health review : a publication of the Australian Hospital Association Vol. 35, no. 4 (2011), p. 468-474
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- Description: To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives.