- Endacott, Ruth, Cooper, Simon J., Scholes, Julie, Kinsman, Leigh, McConnell-Henry, Tracy
- Authors: Endacott, Ruth , Cooper, Simon J. , Scholes, Julie , Kinsman, Leigh , McConnell-Henry, Tracy
- Date: 2010
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 66, no. 12 (2010), p. 2722-2731
- Full Text: false
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- Description: Aim. This is a report of a study investigating processes used by final-year nursing students to recognize and act on clinical cues of deterioration in a simulated environment. Background. Initial decisions about patients who are deteriorating in medical and surgical wards are often made by newly qualified nurses and doctors, increasing the risk of clinical error. There has been an emphasis on the use of teams in simulation; however, signs of deterioration are missed by individual clinicians. Methods. During July 2008, final-year undergraduate nursing students in Australia attended a simulation laboratory for 1Æ5 hours and completed a knowledge questionnaire and two (mannequin-based) scenarios simulating deteriorating patients with hypovolaemic and septic shock. Scenarios were video-recorded and reflective interviews conducted. Additionally, scenarios were stopped around the midpoint to ascertain students’ level of Situation Awareness. Results. Fifty-one students participated in the study, providing a total of 102 videoed scenarios and 51 interviews. Thematic analysis of video data and reflective interviews identified considerable differences in processes used by students to identify cues. Four aspects of cue recognition were evident: initial response, differential recognition of cues, accumulation of signs and diversionary activity. Conclusion. Nursing skills training should emphasize the importance of trends in identifying and acting on deterioration and the need for systematic assessment in stressful situations. Nursing curricula should focus on enhancing the ability to piece information together, including linking pathophysiology with patient assessment, and identify trends, rather than seeing observations as parallel to each other.
- Cant, Robyn, Cooper, Simon J.
- Authors: Cant, Robyn , Cooper, Simon J.
- Date: 2014
- Type: Text , Journal article
- Relation: Resuscitation Vol. 85, no. (2014), p. 31-33
- Full Text: false
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- Description: Medical emergency team performance including non-technical skills, is receiving increased attention due to the influences on patient safety. The Team Emergency Assessment Measure View the MathML source was developed to enable standardized performance assessment and structured team debriefing. From several studies, the View the MathML source has demonstrated a substantial body of normative data confirming its validity and reliability. This includes high uni-dimensional validity, significant subscale relationships between Teamwork and Leadership and between Teamwork and Task Management (p < 0.001), a Cronbach alpha of 0.92 and adequate construct validity. The tool has potential for team training to improve team's non-technical performance. Further testing is required in ‘real’ clinical settings.
- Endacott, Ruth, Bogossian, Fiona, Cooper, Simon J., Forbes, Helen, Kain, Victoria, Young, Susan, Porter, Joanne, First2Act Team
- Authors: Endacott, Ruth , Bogossian, Fiona , Cooper, Simon J. , Forbes, Helen , Kain, Victoria , Young, Susan , Porter, Joanne , First2Act Team
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 24, no. 1-2 (2015), p. 90-100
- Full Text: false
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- Description: Aims and objectivesTo examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients.Background Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience.DesignMixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia.Methods Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken.ResultsObjective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support.Conclusions There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills.Relevance to clinical practiceThere is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies.
- Bucknall, Tracey, Forbes, Helen, Phillips, Nicole, Hewitt, Nicky, Cooper, Simon J., Bogossian, Fiona, FIRST2ACT Investigators
- Authors: Bucknall, Tracey , Forbes, Helen , Phillips, Nicole , Hewitt, Nicky , Cooper, Simon J. , Bogossian, Fiona , FIRST2ACT Investigators
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 72, no. 10 (2016), p. 2482-2494
- Full Text: false
- Reviewed:
- Description: Aim: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Background: Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. Design: A descriptive exploratory design. Methods: Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Results: Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Conclusions: Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students’ decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. © 2016 John Wiley & Sons Ltd
The impact of web-based and face-to-face simulation on patient deterioration and patient safety : Protocol for a multi-site multi-method design
- Cooper, Simon J., Kinsman, Leigh, Chung, Catherine, Cant, Robyn, Boyle, Jayne, Bull, Loretta, Cameron, Amanda, Connell, Cliff, Kim, Jeong-Ah, McInnes, Denise, McKay, Angela, Nankervis, Katrina, Penz, Erika, Rotter, Thomas
- Authors: Cooper, Simon J. , Kinsman, Leigh , Chung, Catherine , Cant, Robyn , Boyle, Jayne , Bull, Loretta , Cameron, Amanda , Connell, Cliff , Kim, Jeong-Ah , McInnes, Denise , McKay, Angela , Nankervis, Katrina , Penz, Erika , Rotter, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 16, no. 1 (2016), p. 1-8
- Full Text:
- Reviewed:
- Description: Background: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST2ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion: In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016). © 2016 The Author(s).
- Authors: Cooper, Simon J. , Kinsman, Leigh , Chung, Catherine , Cant, Robyn , Boyle, Jayne , Bull, Loretta , Cameron, Amanda , Connell, Cliff , Kim, Jeong-Ah , McInnes, Denise , McKay, Angela , Nankervis, Katrina , Penz, Erika , Rotter, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 16, no. 1 (2016), p. 1-8
- Full Text:
- Reviewed:
- Description: Background: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST2ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion: In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016). © 2016 The Author(s).
- Al-Moteri, Modi, Symmons, Mark, Cooper, Simon J., Plummer, Virginia
- Authors: Al-Moteri, Modi , Symmons, Mark , Cooper, Simon J. , Plummer, Virginia
- Date: 2018
- Type: Text , Journal article
- Relation: Applied Ergonomics Vol. 73, no. (2018), p. 174-182
- Full Text: false
- Reviewed:
- Description: Eye-tracking methodology was used to investigate lapses in the appropriate treatment of ward patients due to not noticing critical cues of deterioration. Forty nursing participants with different levels of experience participated in an interactive screen-based simulation of hypovolemic shock. The results show that 65% of the participants exhibited at least one episode of non-fixation on clinically relevant, fully visible cues that were in plain sight. Thirty-five percent of participants dwelt for sufficient time (>200 ms) on important cues for perception to take place, but no action followed, indicating they had pattern-matching failure. When participants fail to notice what, they should notice in patient status until it is too late, this can have serious consequences. Much work needs to be done, since these human perceptual limitations can affect patient safety in general wards.
- Chung, Catherine, Cooper, Simon J., Cant, Robyn, Connell, Cliff, McKay, Angela, Kinsman, Leigh, Gazula, Swapnali, Boyle, Jayne, Cameron, Amanda, Cash, Penelope, Evans, Lisa, Kim, Jeong-Ah, Masud, Rana, McInnes, Denise, Norman, Lisa, Penz, Erika, Rotter, Thomas, Tanti, Erin, Breakspear, Tom
- Authors: Chung, Catherine , Cooper, Simon J. , Cant, Robyn , Connell, Cliff , McKay, Angela , Kinsman, Leigh , Gazula, Swapnali , Boyle, Jayne , Cameron, Amanda , Cash, Penelope , Evans, Lisa , Kim, Jeong-Ah , Masud, Rana , McInnes, Denise , Norman, Lisa , Penz, Erika , Rotter, Thomas , Tanti, Erin , Breakspear, Tom
- Date: 2018
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 64, no. (2018), p. 93-98
- Full Text: false
- Reviewed:
- Description: Background: There are international concerns relating to the management of patient deterioration. The “failure to rescue” literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses’ recognition and management of patient deterioration. Objectives: To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. Design & Setting: A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. Participants: Nursing staff working in four public and private hospital medical wards in the State of Victoria. Methods: In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. Results: Both WB and F2F participants’ knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups’ performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. Conclusion: WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education strategy is recommended to enhance competence and patient safety. © 2018 Elsevier Ltd
The safe administration of medication : Nursing behaviours beyond the five-rights
- Martyn, Julie-Anne, Paliadelis, Penny, Perry, Chad
- Authors: Martyn, Julie-Anne , Paliadelis, Penny , Perry, Chad
- Date: 2019
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 37, no. (2019), p. 109-114
- Full Text: false
- Reviewed:
- Description: This paper discusses the findings from the observation phase of a more extensive, appreciative inquiry qualitative study exploring registered nurses' experiences of administering medications. The observations aimed to explore the participants' application of the five-rights of medication administration in practice. Twenty registered nurses working in inpatient medical/surgical units at a regional Australian hospital were observed administering medications from the commencement to the completion of their shift. A data collection tool based on the five-rights of medication administration was used. The findings indicated that medication administration was not as routine as the rights framework suggests. Indeed, what was observed rarely reflected all the criteria of the rights framework. Notably, in practice, some of the rights were unable to be observed because the critical thinking that underpins the rights are implicit. However, the participants were observed to implement strategies beyond those described by the rights framework that ensured safe and timely medication administration. In brief, medication administration in contemporary healthcare settings is more complicated than the linear process suggested by the rights framework. So more attention is warranted, to the safe practice strategies of nurses who, to deal with complex clinical contexts. Their person-centred strategies respond to patient circumstances and maintain safety.
A cross-sectional survey of nursing students' patient safety knowledge
- Levett-Jones, Tracy, Andersen, Patrea, Bogossian, Fiona, Cooper, Simon J., Guinea, Stephen, Hopmans, Ruben, McKenna, Lisa, Pich, Jacqui, Reid-Searl, Kerry, Seaton, Philippa
- Authors: Levett-Jones, Tracy , Andersen, Patrea , Bogossian, Fiona , Cooper, Simon J. , Guinea, Stephen , Hopmans, Ruben , McKenna, Lisa , Pich, Jacqui , Reid-Searl, Kerry , Seaton, Philippa
- Date: 2020
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 88, no. (2020), p.
- Full Text: false
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- Description: Background: Knowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge. Objective: The overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts. Design: A cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz. Setting and participants: Nursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study. Results: In total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety. Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark. Conclusions: Given the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety. © 2020 Elsevier Ltd
Practice priorities for acute care nursing : a Delphi study
- Connell, Clifford, Plummer, Virginia, Crawford, Kimberley, Endacott, Ruth, Foley, Pieternella, Griffiths, Debra, Innes, Kelli, Schwerdtle, Patricia, Walker, Lorraine, Morphet, Julia
- Authors: Connell, Clifford , Plummer, Virginia , Crawford, Kimberley , Endacott, Ruth , Foley, Pieternella , Griffiths, Debra , Innes, Kelli , Schwerdtle, Patricia , Walker, Lorraine , Morphet, Julia
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 13-14 (2020), p. 2615-2625
- Full Text: false
- Reviewed:
- Description: Aims and objectives: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design: Delphi Method. Method: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results: High patient acuity or complexity, as well as inadequate bed space on wards, are “very high” risks that occur “often” and “very often,” respectively. The pressure to admit patients, delayed medical review and patient boarding are all “high” risks that occur “often.” Though only occurring “sometimes,” inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a “very high” risk to patient care. Conclusion: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care. © 2020 John Wiley & Sons Ltd
Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit
- Manias, Elizabeth, Street, Maryann, Lowe, Grainne, Low, Jac, Gray, Kathleen, Botti, Mari
- Authors: Manias, Elizabeth , Street, Maryann , Lowe, Grainne , Low, Jac , Gray, Kathleen , Botti, Mari
- Date: 2021
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 21, no. 1 (2021), p.
- Full Text:
- Reviewed:
- Description: Background: Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. Methods: A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. Results: There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Conclusions: Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm. © 2021, The Author(s).
- Authors: Manias, Elizabeth , Street, Maryann , Lowe, Grainne , Low, Jac , Gray, Kathleen , Botti, Mari
- Date: 2021
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 21, no. 1 (2021), p.
- Full Text:
- Reviewed:
- Description: Background: Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. Methods: A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. Results: There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Conclusions: Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm. © 2021, The Author(s).
Exploration and model development for emergency department waiting room nurse role : synthesis of a three-phase sequential mixed methods study
- Innes, Kelli, Jackson, Debra, Plummer, Virginia, Elliott, Doug
- Authors: Innes, Kelli , Jackson, Debra , Plummer, Virginia , Elliott, Doug
- Date: 2021
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 59, no. (2021), p.
- Full Text: false
- Reviewed:
- Description: Background: To improve flow and care in waiting rooms, some emergency departments introduced a specific nursing role to care for this patient cohort with the aim of commencing interventions early, improving patient safety by reassessing and enhancing communication. The objective of the research was to explore to what extent does qualitative interviews and quantitative survey contribute to describing emergency department waiting room nurses, through integration and synthesis of findings from a multiphase mixed methods study. Methods: Multiphase mixed methods exploratory sequential design with integration of findings. Data integration occurred during the phases and when assimilating all findings. Findings: Experienced emergency nurses, preferably with graduate qualifications, who are autonomous practitioners with highly developed communication skills, clinical decision making and proficiency in assessment and monitoring are required to perform the role. The waiting room nurse provides patient-centered care and ensures safe, timely care is delivered to those in the waiting room. A standardised approach and high risk of exposure to occupational stressors need to be considered. Conclusions: This mixed methods sequential design explored the waiting room nurse role from the perspective of emergency nurses generating new knowledge into the role. This advanced practice nursing role contributes to patient safety and delivery of patient centred care in the emergency department waiting room. © 2021 Elsevier Ltd
- Authors: Innes, Kelli , Jackson, Debra , Plummer, Virginia , Elliott, Doug
- Date: 2021
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 59, no. (2021), p.
- Full Text: false
- Reviewed:
- Description: Background: To improve flow and care in waiting rooms, some emergency departments introduced a specific nursing role to care for this patient cohort with the aim of commencing interventions early, improving patient safety by reassessing and enhancing communication. The objective of the research was to explore to what extent does qualitative interviews and quantitative survey contribute to describing emergency department waiting room nurses, through integration and synthesis of findings from a multiphase mixed methods study. Methods: Multiphase mixed methods exploratory sequential design with integration of findings. Data integration occurred during the phases and when assimilating all findings. Findings: Experienced emergency nurses, preferably with graduate qualifications, who are autonomous practitioners with highly developed communication skills, clinical decision making and proficiency in assessment and monitoring are required to perform the role. The waiting room nurse provides patient-centered care and ensures safe, timely care is delivered to those in the waiting room. A standardised approach and high risk of exposure to occupational stressors need to be considered. Conclusions: This mixed methods sequential design explored the waiting room nurse role from the perspective of emergency nurses generating new knowledge into the role. This advanced practice nursing role contributes to patient safety and delivery of patient centred care in the emergency department waiting room. © 2021 Elsevier Ltd
Patients’ experiences of acute deterioration and Medical Emergency Team (MET) encounter : a grounded theory study
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter : a grounded theory study
- Chung, Catherine, McKenna, Lisa, Cooper, Simon
- Authors: Chung, Catherine , McKenna, Lisa , Cooper, Simon
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 78, no. 12 (2022), p. 4062-4070
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- Description: Aim: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. Background: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. Design: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. Methods: Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. Findings: Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional–patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. Conclusion: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. Impact: The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration. © 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
- Authors: Chung, Catherine , McKenna, Lisa , Cooper, Simon
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 78, no. 12 (2022), p. 4062-4070
- Full Text:
- Reviewed:
- Description: Aim: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. Background: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. Design: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. Methods: Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. Findings: Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional–patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. Conclusion: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. Impact: The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration. © 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
Patient safety elements taught to preregistration nurses using simulation designs : an integrative review
- Ryan, Colleen, Kurup, Chanchal, Cant, Robyn, Reid-Searl, Kerry, Johnson, Trish, Barlow, Melanie, Heaton, Leeanne
- Authors: Ryan, Colleen , Kurup, Chanchal , Cant, Robyn , Reid-Searl, Kerry , Johnson, Trish , Barlow, Melanie , Heaton, Leeanne
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Clinical Simulation in Nursing Vol. 84, no. (2023), p.
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- Description: This integrative literature review aimed to examine preregistration nursing simulation-based education aligned to patient safety. Understanding quality standards and simulation best practices used to guide the simulation activities also featured. Eight data bases were searched using a standardized search strategy. A total of 33 studies met the inclusion criteria. Six patient safety standards featured in over 38 simulation scenarios, particularly the management of deteriorating patients. Students’ patient safety knowledge and simulated performances consistently returned significant gains following the interventions. Manikin-based, face to face delivery was the most commonly described simulation modality, followed by virtual simulation and virtual reality programmes. The evidence supports simulation as a beneficial technique for teaching patient safety in nursing education. In future, well planned controlled experimental studies are needed to deliver more evidence. Simulation design best practices aligned to international guidelines could be reported in more depth. © 2023
- Authors: Ryan, Colleen , Kurup, Chanchal , Cant, Robyn , Reid-Searl, Kerry , Johnson, Trish , Barlow, Melanie , Heaton, Leeanne
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Clinical Simulation in Nursing Vol. 84, no. (2023), p.
- Full Text:
- Reviewed:
- Description: This integrative literature review aimed to examine preregistration nursing simulation-based education aligned to patient safety. Understanding quality standards and simulation best practices used to guide the simulation activities also featured. Eight data bases were searched using a standardized search strategy. A total of 33 studies met the inclusion criteria. Six patient safety standards featured in over 38 simulation scenarios, particularly the management of deteriorating patients. Students’ patient safety knowledge and simulated performances consistently returned significant gains following the interventions. Manikin-based, face to face delivery was the most commonly described simulation modality, followed by virtual simulation and virtual reality programmes. The evidence supports simulation as a beneficial technique for teaching patient safety in nursing education. In future, well planned controlled experimental studies are needed to deliver more evidence. Simulation design best practices aligned to international guidelines could be reported in more depth. © 2023
Review article : use of the team emergency assessment measure in the rating of emergency teams' non-technical skills : a mapping review
- Cooper, Simon, Connell, Clifford, Cant, Robyn
- Authors: Cooper, Simon , Connell, Clifford , Cant, Robyn
- Date: 2023
- Type: Text , Journal article , Review
- Relation: EMA - Emergency Medicine Australasia Vol. 35, no. 3 (2023), p. 375-383
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- Description: The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams. © 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.
- Authors: Cooper, Simon , Connell, Clifford , Cant, Robyn
- Date: 2023
- Type: Text , Journal article , Review
- Relation: EMA - Emergency Medicine Australasia Vol. 35, no. 3 (2023), p. 375-383
- Full Text:
- Reviewed:
- Description: The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams. © 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.
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