Description:
Aim of study: This study aimed to investigate the attitudes of personnel working in emergency departments on the constitution of a resuscitation team in particular the perceptions of the family liaison role. Methods: A paper base survey on family presence during resuscitation was distributed to emergency personnel working in 18 public departments in the state of Victoria, Australia. Results: A combination of nurses (n = 282) and doctors (n = 65) working in rural and metropolitan emergency departments, identified seven unique resuscitation team roles. Resuscitation teams were identified as comprising of three doctors, three nurses and one other which could be either. Respondents identified seven unique roles as consisting of a team leader, airway doctor, airway nurse, procedure doctor and procedure nurse, drugs nurse and a scribe. The respondents identified the following components as key to discussions with family members; emergency personnel, reassurance, diagnosis, regular updates, intervention, and prognosis (ER-DRIP). Conclusion: The acronym ER-DRIP can be used as a reminder to emergency staff when speaking with family members during resuscitation events ensuring they receive all the necessary information and support.
Description:
Aim of study: This study aimed to investigate the attitudes of personnel working in emergency departments on the constitution of a resuscitation team in particular the perceptions of the family liaison role. Methods: A paper base survey on family presence during resuscitation was distributed to emergency personnel working in 18 public departments in the state of Victoria, Australia. Results: A combination of nurses (n = 282) and doctors (n = 65) working in rural and metropolitan emergency departments, identified seven unique resuscitation team roles. Resuscitation teams were identified as comprising of three doctors, three nurses and one other which could be either. Respondents identified seven unique roles as consisting of a team leader, airway doctor, airway nurse, procedure doctor and procedure nurse, drugs nurse and a scribe. The respondents identified the following components as key to discussions with family members; emergency personnel, reassurance, diagnosis, regular updates, intervention, and prognosis (ER-DRIP). Conclusion: The acronym ER-DRIP can be used as a reminder to emergency staff when speaking with family members during resuscitation events ensuring they receive all the necessary information and support.
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.
Description:
Aims: To evaluate the impact of Acute Deterioration Detection System (ADDS) charts introduced to a regional healthcare service. Background: To assist health professionals in identifying essential elements for recognizing patient clinical deterioration, a national initiative introduced track and trigger observation charts, to hospitals in Australia. This study investigated whether the introduction of ADDS charts had an impact on the number of Medical Emergency Team (MET) and Code Blue activations at one regional healthcare service, according to their incident recording database. Method: A retrospective study of all Code Blue and MET activations was undertaken at a regional hospital, pre and post the introduction of ADDS charts in a two year period, June 2012 to June 2014. Results: There was a significant increase in MET activations from 5.91 to 11.27 per 1000 admissions (p < 0.01) after the implementation of ADDS charts. There was also an unexplained non-significant increase from 0.50 to 0.88 per 1000 admissions in the activations of Code Blue during this period (p = 0.05). It was also found that ADDS charts did not overly influence the activation criteria for calling a MET/Code Blue, except for an increase in reports of high heart rate and a decrease in the use of the criteria ‘worried’. Conclusion: The introduction of ADDS charts has provided health professionals with a clear track and trigger set of criteria, improving the detection of early signs of deterioration in patients. This study demonstrated an increase in activations as a result of the introduction of ADDS charts in one regional healthcare service.
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.
Description:
Aim To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. Background Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. Methods (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time’ events. Results Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork’ construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p < 0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were ‘fair’, with positive feasibility ratings following ‘real time’ testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. Conclusion In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.
Description:
Objective: To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. Design: Interrupted time series analysis. Setting: A rural Australian hospital. Participants: All registered nurses (Division 1) employed on an acute medical/surgical ward. Intervention: The FIRST2ACT simulation program. Outcome measures: Appropriate frequency of a range of observations and administration of oxygen therapy. Results: Thirty-four nurses participated (83% of eligible nurses) in the FIRST2ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. Conclusion: FIRST2ACT was associated with measurable improvements in nursing practice.
Description:
The aim of this study is to evaluate the effect of a mental health clinical placement on student nurses attitudes towards mental illness and mental health nursing. Health holds different definitions for different people. The term health can mean wellness or a state of being. Mental health in our society still is wrought with stigma. It is the use of negative labels to identify someone living with a mental illness. Stigma can be a barrier and may discourage families and individuals from seeking help. In the health care system, these barriers need to be broken, from the first contact with the health profession, these being the nurses. Nurse’s attitudes can develop for many different reasons, these being, and lack of knowledge, stigma, and prior experience with mental illness. As a health care profession, we need to start at the beginning, with assessing and encouraging more understanding and tolerance of mental illness with our student nurses. This study used a longitudinal descriptive pre-post survey design to determine the degree to which a clinical placement with a psychiatric/mental health agency changed student nurses’ attitudes towards mental illness and mental health/psychiatric nursing. Bachelor of nursing students are required to complete a mental health unit of study within the Bachelor of Nursing Degree. This unit of study required student nurses to complete a 4 week clinical placement in a mental health facility. Students were invited to complete a survey before the clinical placement and at the completion of the clinical placement. Of the (n=184) nurses invited to participate in this study, 65 completed the pre and post clinical placement surveys, giving a response rate of 35%.The results show that there is a statistical significance of .001 in the mean attitude scores towards mental illness for pre and post placement. The attitudes towards psychiatric nursing show a statistical significance of .01.Results from this study support recent literature towards a positive change in student nurses attitudes towards mental illness and mental health nursing on the completion of a clinical placement in a mental health facility.
Description:
Background Health professionals work in teams in a variety of health care settings especially in medical emergency teams at times of crisis. However, Registered Nurses (RNs) rarely have the chance to partake in educational programs designed for teams of nurses to practice working together in life-threatening situations. Further RN’s employed in rural setting have less opportunities for professional development than their city based counterparts. Simulated scenarios with a patient actor in a rural hospital have been utilised in this study to provide nurses with the opportunity to work as a team in the early recognition and management of patients with acute medical conditions. Aim This discussion paper focuses on one aspect of a larger research project with the aim of describing the development of team based scenarios for a rural hospital setting, focusing on the detection and management of a deteriorating patient. Methods Three team based scenarios, the related assessments and feedback techniques are all described. Conclusion Team based simulation provides a unique opportunity to assist registered nurses in rural settings in re-skilling or maintaining their emergency management skills.
Description:
Background: Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods: Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results: One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion: A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making.
Description:
Background: Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods: Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results: One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion: A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making.
Description:
Aim: To measure final-year nursing students’ preparation for high-acuity placement with emphasis on clinical skill performance confidence. Background: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. Method: A modified pretest/posttest survey design was used to measure the confidence of thirdyear undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (α = 0.90) and reliability was established by the pilot study in 2009. Comparisons were made between confidence levels at the beginning and end of semester. Results: Student confidence to perform individual clinical skills increased over the semester; however their feelings of preparedness for high-acuity clinical placement decreased over the same time period. Reported confidence levels improved with further exposure to clinical placement. Conclusion: There may be many external factors that influence students’ perceptions of confidence and preparedness for practice. Further research is recommended to identify causes of poor self-confidence in final-year nursing students.
Description:
Aim: To measure final-year nursing students’ preparation for high-acuity placement with emphasis on clinical skill performance confidence. Background: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. Method: A modified pretest/posttest survey design was used to measure the confidence of third-year undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (
Description:
Aim: To measure final-year nursing students’ preparation for high-acuity placement with emphasis on clinical skill performance confidence. Background: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. Method: A modified pretest/posttest survey design was used to measure the confidence of thirdyear undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (α = 0.90) and reliability was established by the pilot study in 2009. Comparisons were made between confidence levels at the beginning and end of semester. Results: Student confidence to perform individual clinical skills increased over the semester; however their feelings of preparedness for high-acuity clinical placement decreased over the same time period. Reported confidence levels improved with further exposure to clinical placement. Conclusion: There may be many external factors that influence students’ perceptions of confidence and preparedness for practice. Further research is recommended to identify causes of poor self-confidence in final-year nursing students.
Description:
Aim: To measure final-year nursing students’ preparation for high-acuity placement with emphasis on clinical skill performance confidence. Background: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. Method: A modified pretest/posttest survey design was used to measure the confidence of third-year undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (
Description:
This paper follows previous publications on generic qualitative approaches, qualitative designs and action research in emergency care by this group of authors. Contemporary views on mixed methods approaches are considered, with a particular focus on the design choice and the amalgamation of qualitative and quantitative data emphasising the timing of data collection for each approach, their relative ‘weight’ and how they will be mixed. Mixed methods studies in emergency care are reviewed before the variety of methodological approaches and best practice considerations are presented. The use of mixed methods in clinical studies is increasing, aiming to answer questions such as ‘how many’ and ‘why’ in the same study, and as such are an important and useful approach to many key questions in emergency care.
Description:
This paper describes a project to promote a research culture amongst nurses in Malaysia. The project, funded by the Australian Government’s Australia Malaysia Institute, and implemented by a group of Australian nurse academics, provided a rare professional development opportunity to nurses in urban and remote areas of Malaysia
Description:
Aim: To explore the experiences of nurses and doctors on the implementation of family presence during resuscitation (FPDR) in Victorian emergency departments. Methods: An interpretative qualitative study design was utilized which incorporated the open ended responses on a state wide Victorian survey of emergency department nurses and doctors. A thematic analysis of the responses was conducted involving data reduction, identification of key words, phrases and themes. Results: A total of 18 emergency departments consented to participate with a mean participant age of 41 years, made up of 91 (81) nurses and 21(19) doctors. The participants came from both metropolitan (64 (57), hospitals 300 – >500 beds) and regional (48 (43), hospitals <80 – 300 beds) health services. There were four emerging themes from the analysis; Depends on the day, impact family have on staff, organisational considerations and incorporating family centred care. Conclusion: There remain a number of variables which have been identified as continuing to create barriers to implementation of family presence during resuscitation that need to be investigated further in order to ensure emergency personnel have consistency of FPDR practice.
Description:
Objectives This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Design Mixed-method multi-centre study. Setting High fidelity simulated acute clinical environment in three Australian universities. Participants A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. Method In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Results Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Conclusions Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.