An exploration of emergency nurses’ perceptions, attitudes and experience of teamwork in the emergency department
- Authors: Grover, Elise , Porter, Joanne , Morphet, Julia
- Date: 2017
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 20, no. 2 (2017), p. 92-97
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- Description: Background Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. Method A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three major themes emerged from the data. The first theme ‘when teamwork works’ supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme ‘team support’ revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme ‘no time for teamwork’ centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. Discussion Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED. © 2017 College of Emergency Nursing Australasia
At the crossroads of violence and aggression in the emergency department : Perspectives of Australian emergency nurses
- Authors: Morphet, Julia , Griffiths, Debra , Plummer, Virginia , Innes, Kelli , Fairhall, Robyn , Beattie, Jill
- Date: 2014
- Type: Text , Journal article , Review
- Relation: Australian Health Review Vol. 38, no. 2 (2014), p. 194-201
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- Description: Objective Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. Methods The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. Results Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED Conclusion There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence. © AHHA 2014.
Effectiveness of paracetamol versus ibuprofen administration in febrile children : A systematic literature review
- Authors: Narayan, Kaajal , Cooper, Simon J. , Morphet, Julia , Innes, Kelli
- Date: 2017
- Type: Text , Journal article
- Relation: Journal of Paediatrics and Child Health Vol. 53, no. 8 (2017), p. 800-807
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- Description: Aim: The use of antipyretics to manage the febrile child is becoming increasingly popular. Paracetamol and ibuprofen are the most commonly used interventions to manage fever in children; however, there have been no comparative analyses. The aim of the study is to evaluate the evidence comparing paracetamol to ibuprofen in the treatment of fever in children. Methods: A systematic review of randomised controlled trials investigating the administration of oral paracetamol and ibuprofen to reduce fever in children. Children aged 1 month to 12 years with a temperature between 37.5 and 41°C were included. A total of 3023 papers were identified. After removal of duplications, application of inclusion criteria and screening, eight papers were subjected to critical appraisal and included in this study. Results: Six of the studies identified that ibuprofen was slightly, but not significantly, better at reducing fever in children than paracetamol. Dosage variances and route of temperature measurement ranged between studies, limiting the comparability of studies. While ibuprofen was reported to be marginally more effective at reducing fever and fever associated discomfort in children, there is insufficient data to conclude that ibuprofen is superior to paracetamol. Conclusion: There is little evidence supporting the superior efficacy of paracetamol or ibuprofen in the treatment of fever in children with indications that both drugs are equally effective. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
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.
Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events : a qualitative descriptive study
- Authors: Madhuvu, Auxillia , Endacott, Ruth , Plummer, Virginia , Morphet, Julia
- Date: 2022
- Type: Text , Journal article
- Relation: Intensive and Critical Care Nursing Vol. 68, no. (2022), p.
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- Description: Objective: To explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. Design: A qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. Setting: The study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. Methods: Individual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. Findings: Four major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. Conclusions: These themes helped to explain previously reported deficits in nurses’ knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units. © 2021 Elsevier Ltd
Intensive care nurses’ knowledge of evidence-based guidelines for prevention of ventilator-associated events : an evaluation study
- Authors: Madhuvu, Auxillia , Morphet, Julia , Plummer, Virginia , Endacott, Ruth
- Date: 2020
- Type: Text , Conference paper
- Relation: World Congress of Intensive Care, 14-18 October 2019, Melbourne, Australia Vol. 33, p. S3-S3
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Interprofessional simulation of birth in a non-maternity setting for pre-professional students
- Authors: McLelland, Gayle , Perera, Chantal , Morphet, Julia , McKenna, Lisa , Hall, Helen , Williams, Brett , Cant, Robyn , Stow, Jill
- Date: 2017
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 58, no. (2017), p. 25-31
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- Description: Background Simulation-based learning is an approach recommended for teaching undergraduate health professionals. There is a scarcity of research around interprofessional simulation training for pre-professional students in obstetric emergencies that occur prior to arrival at the maternity ward. Objectives The primary aims of the study were to examine whether an interprofessional team-based simulated birth scenario would improve undergraduate paramedic, nursing, and midwifery students' self-efficacy scores and clinical knowledge when managing birth in an unplanned location. The secondary aim was to assess students' satisfaction with the newly developed interprofessional simulation. Design Quasi-experimental descriptive study with repeated measures. Setting Simulated hospital emergency department. Participants Final year undergraduate paramedic, nursing, and midwifery students. Methods Interprofessional teams of five students managed a simulated unplanned vaginal birth, followed by debriefing. Students completed a satisfaction with simulation survey. Serial surveys of clinical knowledge and self-efficacy were conducted at three time points. Results Twenty-four students participated in one of five simulation scenarios. Overall, students' self-efficacy and confidence in ability to achieve a successful birth outcome was significantly improved at one month (p < 0.001) with a magnitude of increase (effect) of 40% (r = 0.71) and remained so after a further three months. Clinical knowledge was significantly increased in only one of three student groups: nursing (p = 0.04; r = 0.311). Students' satisfaction with the simulation experience was high (M = 4.65 / 5). Conclusions Results from this study indicate that an interprofessional simulation of a birth in an unplanned setting can improve undergraduate paramedic, nursing and midwifery students' confidence working in an interprofessional team. There was a significant improvement in clinical knowledge of the nursing students (who had least content about managing birth in their program). All students were highly satisfied with the interprofessional simulation experience simulation. © 2017 Elsevier Ltd
Practice priorities for acute care nursing : a Delphi study
- 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
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- 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
Preparation for high-acuity clinical placement: confidence levels of final-year nursing students
- Authors: Porter, Joanne , Morphet, Julia , Missen, Karen , Raymond, Anita
- Date: 2013
- Type: Text , Journal article
- Relation: Advances in Medical Education and Practice, no. 4 (2013), p. 83-89
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- 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 (
Setting priorities for health education research : a mixed methods study
- Authors: Palermo, Claire , King, Olivia , Brock, Tina , Brown, Ted , Crampton, Paul , Hall, Helen , Macaulay, Janet , Morphet, Julia , Mundy, Matthew , Oliaro, Louise , Paynter, Sophie , Williams, Brett , Wright, Caroline , Rees, Charlotte
- Date: 2019
- Type: Text , Journal article
- Relation: Medical Teacher Vol. 41, no. 9 (2019), p. 1029-1038
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- Description: Introduction: Identifying priority research topics that meet the needs of multiple stakeholders should maximize research investment. Aim: To identify priorities for health education research. Methods: A three-stage sequential mixed methods study was conducted. Priorities for health education research were identified through a qualitative survey with 104 students, patients, academics, and clinicians across five health sciences and 12 professions (stage 1). These findings were analyzed using framework analysis and transposed into a quantitative survey whereby 780 stakeholders rated and ranked the identified priorities. Descriptive statistics identified priorities, exploratory factor analysis grouped priorities and differences between stakeholders were determined using Mann–Whitney U tests (stage 2). Six individual or group interviews with 16 participants (stage 3) further explicated the results from previous stages. Results: Of 30 priorities identified, the top were: how best to ensure students develop the required skills for work; how to promote resiliency and well-being in students; and ensuring the curriculum prepares students for work. For the majority of priorities, no significant differences were found between different stakeholder groups. Conclusions: These findings will be used to inform health educational research strategy both locally and nationally. Further research should explore if setting priorities can be translated effectively into education research policy and practice. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
The effect of transition to specialty practice programs on Australian emergency nurses’ professional development, recruitment and retention
- Authors: Morphet, Julia , Kent, Bridie , Plummer, Virginia , Considine, Julie
- Date: 2015
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 18, no. 4 (2015/11/01/ 2015), p. 204-211
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- Description: Summary Background To date, emergency nursing Transition to Specialty Practice Program (TSPP) evaluations have been single-site observational studies. The aim of this paper was to examine the professional development, recruitment and retention outcomes of Australian emergency nursing TSPPs. Methods An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Unit Managers and Nurse Educators. Survey data from EDs with TSPPs and EDs without TSPPs were compared. Qualitative data were analysed using content analysis. Results Data were collected from 118 EDs, and 13 interviews. TSPPs were offered in 72.1% of EDs. EDs with TSPPs had higher proportions of nurses with postgraduate qualifications (Mdn 28.3% vs. 22.1%, p=0.45) and Clinical Specialists (Mdn 16.4% vs. 6.3%, p=0.04). The median proportion of currently rostered nurses with TSPP completion was 34.2% in EDs with TSPPs introduced in 2000–2005 indicating ED high levels of retention. Conclusion Emergency nursing TSPPs have had a positive effect on nursing professional development, recruitment and retention. To ensure consistency in outcomes and optimise reliability of emergency nursing skills and knowledge, a national emergency nursing TSPP framework is needed.