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Kennedy B, Curtis K, Kourouche S, Casey L, Hughes D, Chapman V, Fry M. Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments. Australas Emerg Care 2024:S2588-994X(24)00052-6. [PMID: 39217022 DOI: 10.1016/j.auec.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice. METHODS This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework. RESULTS The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention. CONCLUSION Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.
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Affiliation(s)
- Belinda Kennedy
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia.
| | - Kate Curtis
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia; Illawarra Shoalhaven Local Health District, New South Wales, Wollongong Hospital, Crown St, Wollongong, NSW, Australia
| | - Sarah Kourouche
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia
| | - Louise Casey
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Dorothy Hughes
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Vivienne Chapman
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Margaret Fry
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia; University of Technology Sydney, 15 Broadway, Ultimo, NSW, Australia; Northern Sydney Local Health District, Reserve Rd, St Leonards, NSW, Australia
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Rheinberger J, Curtis K, McCloughen A, Wiseman T. What are the training needs of emergency department resuscitation nurses? A scoping review. Australas Emerg Care 2024:S2588-994X(24)00038-1. [PMID: 38964973 DOI: 10.1016/j.auec.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The emergency resuscitation nurse is a challenging and specialised role at the forefront of critical care practice in the emergency department. Despite their extensive specialist knowledge and skill requirements, in Australia there is no state-wide or nationally agreed approach to how to best provide training that meets a set of fixed objectives and requisite skills for resuscitation nurses. Due to an ageing nursing population and increasing workforce attrition, an efficacious accelerated pathway to acquire specialist resuscitation nursing knowledge, is necessary. AIM The aim of this review is to identify, consolidate and summarise the available evidence on the training needs for the requisite clinical and non-technical skills of emergency resuscitation nurses ELIGIBILITY CRITERIA: Papers about nurses currently working in the emergency department; including Nurse Unit Managers (NUMs), Clinical Nurse Educators (CNEs), Clinical Nurse Consultants (CNCs), Clinical Nurse Specialists (CNSs), Registered Nurses (RNs) and Enrolled Nurses (ENs) were included. The review included primary and non-primary research, including papers addressing how emergency nurses are trained. There was no date limitation set to ensure all results could be reviewed. Papers that were not published in English, included nurses who were not working in the ED, or included doctors, allied health, and other staff where population cohorts could not be distinguished, were excluded. Abstract only, editorials, conference posters or oral presentations, were also excluded. SOURCES OF EVIDENCE Searches were conducted in MEDLINE, CINAHL and EMCARE. The authors conducted extensive hand-searching of the included study reference lists as well as the grey literature to ensure that all relevant literature was captured. METHODS A scoping literature review was conducted. RESULTS Data extraction was conducted on the final 33 articles (23 peer reviewed studies and 10 competency and practice standards documents). Specific training requirements to achieve competence in the requisite clinical and non-technical skills in resuscitation nursing do not exist. A decline in competency without regular reinforcement was reported. Multi-modal approaches, incorporating diverse teaching methods, show potential in enhancing knowledge retention and skill acquisition. CONCLUSION Resuscitation nursing lacks a standardised training approach in Australia, leading to a gap in ensuring consistent skill acquisition and knowledge among nurses. Research is required to identify what resuscitation nursing skills and training are necessary to ensure practice effectively meets the needs of patients.
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Affiliation(s)
- Josephine Rheinberger
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Kate Curtis
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia
| | - Andrea McCloughen
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW, Australia
| | - Taneal Wiseman
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW, Australia
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Pouresmail Z, Nabavi FH, Rassouli M. The development of practice standards for patient education in nurse-led clinics: a mixed-method study. BMC Nurs 2023; 22:277. [PMID: 37605142 PMCID: PMC10464384 DOI: 10.1186/s12912-023-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Educating patients and families about self-care is one of the important roles of nurses in Nurse-led clinics (NLCs). NLCs need standards for guiding the practice of nurses. A standard is an authoritative statement that sets out the legal and professional basis of nursing practice. This paper seeks to report the development of practice standards for patient and family education in NLCs. METHODS This project used a Sequential-Exploratory mixed methods design. Before the study, we conducted a literature review to identify gaps. Directed content analysis was used in phase 1. The second phase involved two focus groups. The third phase involves two rounds of modified Delphi. RESULTS Twenty-nine participants were interviewed, and 1816 preliminary codes were formed in phase 1. 95 standards were grouped into three main categories (structure, process, and outcome). In the first focus group, experts eliminate 32 standards. Experts eliminate 8 standards after the second stage of the focus group. After two rounds of Delphi, the final version of the standard consists of 46 standards (13 structure, 28 process and 5 outcome). CONCLUSIONS Nurses and institutions could benefit from practice standards for patient education in the NLCs, which consist of 46 statements in three domains, as a guide for clinical activities and a tool to gauge the quality of patient education in NLCs. The developed standards in this study can guide new and existing NLCs and help them evaluate ongoing activities. Providing patient education in NLCs based on standards can improve patients' outcomes and promote their health.
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Affiliation(s)
- Zohre Pouresmail
- Medical-Surgical Nursing Department, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Heshmati Nabavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Community Health and Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Rassouli
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Curtis K, Fry M, Kourouche S, Kennedy B, Considine J, Alkhouri H, Lam M, McPhail SM, Aggar C, Hughes J, Murphy M, Dinh M, Shaban R. Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial. BMJ Open 2023; 13:e067022. [PMID: 36653054 PMCID: PMC9853264 DOI: 10.1136/bmjopen-2022-067022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID. METHODS AND ANALYSIS Using an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites. ETHICS AND DISSEMINATION Ethics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman's Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, 'business as usual' ED training schedules and university curricula. TRIAL REGISTRATION NUMBER ACTRN12621001456842.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
- Emergency and Critical Care, Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, & Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Eastern Health Foundation, Box Hill, Victoria, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, NSW Agency for Clinical Innovation, North Ryde, New South Wales, Australia
| | - Mary Lam
- Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Steven M McPhail
- Australian Centre for Health Service Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christina Aggar
- Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - James Hughes
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - M Murphy
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Michael Dinh
- Department of Emergency, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ramon Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Department of Infection Control, Western Sydney Local Health District, Westmead, New South Wales, Australia
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Trisyani Y, Emaliyawati E, Prawesti A, Mirwanti R, Mediani HS. Emergency Nurses' Competency in the Emergency Department Context: A Qualitative Study. Open Access Emerg Med 2023; 15:165-175. [PMID: 37197564 PMCID: PMC10183472 DOI: 10.2147/oaem.s405923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
Background The availability of clear emergency nurses' competencies is critical for safe and effective emergency health care services. The study regarding emergency nurses' competencies remained virtually limited. Purpose This study aimed to explore the emergency nurses' competencies in the clinical emergency department (ED) context as needed by society. Methods This qualitative study involved focus group discussions in six groups of 54 participants from three EDs. The data were analysed using grounded theory approach including the constant comparative, interpretations, and coding procedures; initial coding, focused coding and categories. Results This study revealed 8 core competencies of emergency nurses: Shifting the nursing practice, Caring for acute critical patients, Communicating and coordinating, Covering disaster nursing roles, Reflecting on the ethical and legal standards, Researching competency, Teaching competencies and Leadership competencies. The interconnection of the 8 core competencies has resulted in 2 concepts of extending the ED nursing practice and demanding the advanced ED nursing role. Conclusion The finding reflected the community needs of nurses who work in ED settings and the need for competency development of emergency nurses.
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Affiliation(s)
- Yanny Trisyani
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Correspondence: Yanny Trisyani, Email ;
| | - Etika Emaliyawati
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ayu Prawesti
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Henny Suzana Mediani
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Caulfield R, Wiseman T, Gullick J, Ogilvie R. Factors preceding occupational distress in emergency nurses: An integrative review. J Clin Nurs 2022. [DOI: 10.1111/jocn.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/07/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Caulfield
- The Susan Wakil Health Building, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Discipline of Nursing, Faculty of Health University of Canberra Canberra Australian Capital Territory Australia
- Emergency Department Canberra Health Services Canberra Australian Capital Territory Australia
| | - Taneal Wiseman
- The Susan Wakil Health Building, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Janice Gullick
- The Susan Wakil Health Building, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Rebekah Ogilvie
- Synergy Research Centre Nursing and Midwifery Canberra Health Services Canberra Australian Capital Territory Australia
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Ndung'u A, Ndirangu E, Sarki A, Isiaho L. A Cross-sectional Study of Self-Perceived Educational Needs of Emergency Nurses in Two Tertiary Hospitals in Nairobi, Kenya. J Emerg Nurs 2022; 48:467-476. [PMID: 35787777 DOI: 10.1016/j.jen.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/27/2022] [Accepted: 04/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many low- and middle-income countries lack resources for well-functioning emergency care systems. Emergency nurses interact with injured and critically ill patients as the first contact in many health care settings. However, insufficient training limits nurses from providing ideal emergency care. The purpose of this research was to highlight educational needs specific to nurses working in 2 emergency departments in Nairobi, Kenya. METHODS A descriptive cross-sectional study involving emergency units of 2 of the largest referral and teaching hospitals (Aga Khan University Hospital, Nairobi, and Kenyatta National Hospital) in Nairobi, Kenya, was conducted. Data were collected by using an adapted structured, self-administered questionnaire. The data were analyzed using descriptive statistics. The skills and competencies of the participants were assessed. In addition, the educational gaps and needs of the participants around emergency care such as trauma, cardiovascular diseases, and respiratory and neurological illnesses were described. Results were presented in frequencies and percentages. RESULTS The questionnaire response rate was 63.6% (n = 84). Most of the respondents held associate degrees in nursing (72.6%), whereas 19% had a bachelor's degree in nursing. Most respondents (84.5%) perceived themselves as being highly competent in basic skills such as performing cardiopulmonary resuscitation and assessment of body systems. Less than half of the respondents (48.8%) perceived themselves as being highly competent in intermediate skills such as assisting with endotracheal intubation. In advanced competencies, such as analyzing electrocardiograms and administering thrombolytic medications, only 16.7% perceived themselves as highly competent. CONCLUSION The results of this study suggest there is a knowledge gap and educational needs among emergency nurses in Nairobi, Kenya. It identified injuries/trauma; cardiovascular, respiratory, and neurological disease; and other emergencies as topics of focus areas with a high need. To address these knowledge and skills needs, a future specialty training in emergency nursing is recommended and this could be achieved through continuing professional development and short courses or postgraduate-level training.
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Bull C, Latimer S, Crilly J, Spain D, Gillespie BM. 'I knew I'd be taken care of': Exploring patient experiences in the Emergency Department. J Adv Nurs 2022; 78:3330-3344. [PMID: 35719017 PMCID: PMC9545035 DOI: 10.1111/jan.15317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/14/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022]
Abstract
Aims To explore adult Emergency Department patient experiences to inform the development of a new Emergency Department patient‐reported experience measure. Design Descriptive, exploratory qualitative study using semi‐structured individual interviews with adult Emergency Department patients. Methodology Participants were recruited across two Emergency Departments in Southeast Queensland, Australia during September and October 2020. Purposive sampling based on maximum variation was used. Participants were recruited during their Emergency Department presentation and interviewed in 2‐weeks via telephone. Inductive thematic analysis followed the approach proposed by Braun and Clarke (2012). Results Thirty participants were interviewed, and four themes were inductively identified: Caring relationships between patients and Emergency Department care providers; Being in the Emergency Department environment; Variations in waiting for care; and Having a companion in the Emergency Department. Caring relationships between patients and Emergency Department care providers included being treated like a person and being cared for, being informed about and included in care, and feeling confident in care providers. Being in the Emergency Department environment included being around other patients, feeling comfortable and having privacy. Variations in waiting for care included expecting a longer wait, waiting throughout the Emergency Department journey and receiving timely care. Having a companion in the Emergency Department included not feeling alone, and observing care providers engage with companions. Conclusion Patient experiences in the Emergency Department are multifaceted, and themes are not mutually exclusive. These findings demonstrate consistency with the core experiential themes identified in the international literature. Impact Strategies to improve patient engagement in shared decision‐making, and communication between patients and care providers about wait times will be critical to optimizing Emergency Department patient experiences, and person‐centred practice. These findings holistically conceptualize patient experiences in the Emergency Department which is the first step to developing a new Emergency Department patient‐reported experience measure.
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Affiliation(s)
- Claudia Bull
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University - Logan campus, Logan, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - David Spain
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Zhao S, Duan X, Cheng L, Jiang J. Perspective and experience of newly graduated registered nurses with standardized training in the emergency department: A qualitative study in Shanghai, China. NURSE EDUCATION TODAY 2021; 105:104994. [PMID: 34174510 DOI: 10.1016/j.nedt.2021.104994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The standardized training system for newly graduated registered nurses (NGRNs) in China is different from that of other countries in the world, especially when frequent disasters occur, emergency department (ED) training is particularly important. However, the work experience of new Chinese nurses in standardized training in the emergency department still remained unclear. OBJECTIVES To explore the experience of newly recruited nurses in standardized training in the emergency department. DESIGN Qualitative research. SETTING A 3rd level hospital in Shanghai, China. PARTICIPANTS Fifteen NGRNs undergoing standardized training in the ED. METHODS Semi-structured face-to-face interviews were conducted between August and September 2020. Colaizzi seven-step framework was applied for data analysis. RESULTS Three main themes emerged: high occupational pressure, competency enhancement in ED and high satisfaction with standard training. CONCLUSIONS It is very important and necessary for NGRNs to have a training period in the emergency department. This not only helps NGRNs to improve their abilities in emergency care, but also reserve talents during emergency responses. At the same time, the training methods for NGRNs should be refined and improved, and effective support should be provided. This can help NGRNs relieve from work pressure, better and rapidly adapt to the clinical environment and enter the nursing role.
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Affiliation(s)
- Sijia Zhao
- Emergency Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xia Duan
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200126, China
| | - Lin Cheng
- Emergency Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jinxia Jiang
- Emergency Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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Wise S, Duffield C, Fry M, Roche M. Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team. J Nurs Manag 2021; 30:198-204. [PMID: 34436800 DOI: 10.1111/jonm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings. BACKGROUND Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom. METHOD Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically. RESULTS Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role. CONCLUSION Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience. IMPLICATIONS FOR NURSING MANAGEMENT The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Nursing and Health Services Management, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia
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Jones T, Curtis K, Shaban RZ. Practice expectations for Australian graduate emergency nursing programs: A Delphi study. NURSE EDUCATION TODAY 2021; 99:104811. [PMID: 33636653 DOI: 10.1016/j.nedt.2021.104811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/20/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Practice standards in nursing provide minimum expectations to enable the provision of high quality and safe care. There are currently no practice standards for post-registration graduate emergency nursing programs in Australia, leading to variation in graduate attributes and clinical expectations on completion of their program. OBJECTIVES The aim of this study was to establish consensus-based practice standards for graduate emergency nursing programs in Australia. DESIGN Delphi approach. PARTICIPANTS Australian nurses who identified as an emergency nurse and currently worked, or previously worked, in an emergency care environment. METHODS A modified two-round Delphi method was used. The survey was divided into four sections of data collection, including demographics, graduate emergency nursing course entry requirements, graduate expectations, and clinical care capabilities. Data were analysed using descriptive statistics including calculation of content validity index (CVI). RESULTS There were 204 respondents in Round One and 153 respondents in Round Two. Respondents agreed that nurses wanting to undertake graduate studies in emergency nursing require prior experience in the emergency care environment and should be working a minimum of 0.5 full time equivalent (FTE) whilst completing their studies. Thirty-nine statements presented under graduate attributes achieved a CVI of >0.8. All 70 clinical care capability statements presented in Round Two achieved a CVI of >0.8. CONCLUSION This study generated the evidence to establish minimum practice standards for Australian graduate emergency nursing programs. The standards centre around three key areas: graduate entry requirements, graduate attributes and clinical care capabilities. The standards provide a clear guide for employers, educators and clinicians, and inform capabilities for early career emergency nurses.
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Affiliation(s)
- Tamsin Jones
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria, Australia.
| | - Kate Curtis
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Emergency services, Illawarra Shoalhaven Local Health District, NSW, Australia
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead. NSW, Australia
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Jansson J, Josse Eklund A, Larsson M, Nilsson J. Prehospital care nurses' self reported competence: A cross-sectional study. Int Emerg Nurs 2020; 52:100896. [PMID: 32763799 DOI: 10.1016/j.ienj.2020.100896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Swedish ambulance service has undergone major changes in recent decades due to advancements being made in medical and technical resources, professional competence, and patient care. Registered and specialist nurses share the same role, accountabilities, and responsibilities in the ambulance service, and their professional competence has not yet been evaluated. OBJECTIVES The aim of the study was to investigate and compare self-reported professional competence among nurses working in the ambulance service and to explore associations between potentially predictive background factors and self-reported professional competence. METHOD A cross-sectional study with a digital questionnaire was used for collecting data from 34 registered nurses and 71 specialist nurses. The Ambulance Nurse Competence Scale and the Research Utilization Questionnaire were used for data collection. RESULTS Significant differences were found among the nursing categories in terms of age, gender, education, and work experience. Prehospital emergency nurses reported the highest professional competence. Nurses with a master's degree did not report significantly higher professional competence than nurses with a bachelor's degree. CONCLUSIONS The findings indicated that there are differences in the professional competence of registered nurses and specialist nurses. Length of work experience in the ambulance service is an important factor associated with higher professional competence.
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Affiliation(s)
- Jörgen Jansson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, SE-651 88 Karlstad, Sweden.
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, SE-651 88 Karlstad, Sweden; Department of Health Promotion Sciences, Sophiahemmet University, SE-114 86 Stockholm, Sweden
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Boman E, Levy‐Malmberg R, Fagerström L. Differences and similarities in scope of practice between registered nurses and nurse specialists in emergency care: an interview study. Scand J Caring Sci 2019; 34:492-500. [DOI: 10.1111/scs.12753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | - Rika Levy‐Malmberg
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Health Care Novia University of Applied Sciences Vaasa Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Caring Science Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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Pangh B, Jouybari L, Vakili MA, Sanagoo A, Torik A. The Effect of Reflection on Nurse-Patient Communication Skills in Emergency Medical Centers. J Caring Sci 2019; 8:75-81. [PMID: 31249816 PMCID: PMC6589483 DOI: 10.15171/jcs.2019.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction: Reflection is formed through deep reflection on the event or a certain clinical position. The aim of this study was to determine the effect of reflection on nurse-patient communication skills of nurses working in emergency departments. Methods: This interventional study was conducted on intervention and control groups and with a pretest-posttest design. 142 nurses working in the emergency departments of hospitals affiliated to Golestan University of Medical Sciences were enrolled in the study in 2015, and randomly divided into two groups. During eight weeks of the study, the intervention group was asked to write their clinical experiences with regard to communication issues with their patients. Before the intervention, the communication skills of both groups were compared using a questionnaire. Data analysis was performed, using independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests. Results: Of the 142 nurses, 122 nurses had full participation. In the intervention group the mean scores of verbal communication skills, non-verbal communication skills, general communication skills and communication skills based on patient safety were statistically significant, but there was no significant difference in the control group. Conclusion: The results showed that eight weeks of reflection by nurses is an effective intervention in dimensions of communication skills. We therefore suggest that a reflective writing be encouraged as a vital tool for improving communication competency among emergency department nurses.
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Affiliation(s)
- Bahman Pangh
- Department of nursing, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Golesatn, Iran
| | - Leila Jouybari
- Department of Family and Community Medicine, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Mohamad Ali Vakili
- Department of Community Health Nursing, Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Akram Sanagoo
- Department of Family and Community Medicine, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Aysheh Torik
- Department of Women Affairs, Gomishan Government Office, Golestan, Iran
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Dağ GS, Bişkin S, Gözkaya M. Determination of nursing procedures and competencies in emergency departments: A cross-sectional study. Nurs Health Sci 2019; 21:307-315. [PMID: 30714670 DOI: 10.1111/nhs.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine the nursing procedures carried out by emergency department nurses. This descriptive study was carried out between April and September 2015 in the emergency departments of two state hospitals and one university hospital in Turkey. The study population comprised 139 emergency nurses working for at least 1 year in the emergency department of one of the three hospitals. Data were gathered by using the Emergency Nursing Procedures Questionnaire, which is composed of three sections to reveal nursing procedures performed in emergency departments. The procedures most frequently performed by the participants were administration of pain medication and assessment of patient responses (3.97 ± .18). Assessment of the patient's nutritional status (1.79 ± 1.16) was among the least frequently performed nursing procedures. Emergency nurses carried out nursing care procedures less frequently and took part most frequently in procedures related to medical diagnosis and treatment. According to results of this study, these procedures and competencies will highlight what knowledge and skills emergency nurses need. They will also guide in the creation of in-service training programs and illuminate competencies that need improvement.
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Affiliation(s)
- Gülten S Dağ
- Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Turkey
| | - Songül Bişkin
- Quality Improvement Unit, Akdeniz University Hospital, Dumlupınar Boulevard, Antalya, Turkey
| | - Meral Gözkaya
- Emergency Department, Akdeniz University Hospital, Antalya, Turkey
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Currey J, Massey D, Allen J, Jones D. What nurses involved in a Medical Emergency Teams consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient. A nurse-oriented curriculum development project. NURSE EDUCATION TODAY 2018; 67:77-82. [PMID: 29803014 DOI: 10.1016/j.nedt.2018.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 04/09/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Critical care nurses have been involved in Rapid Response Teams since their inception, particularly in medically led RRTs, known as Medical Emergency Teams. It is assumed that critical care skills are required to escalate care for the deteriorating ward patient. However, evidence to support critical care nurses' involvement in METs is anecdotal. Currently, little is known about the educational requirements for nurses involved in RRT or METs. OBJECTIVES We aimed to identify and describe what nurses involved in a MET consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient. METHODS An exploratory descriptive design was used and data was collected at a session of the Australian and New Zealand Intensive Care Society Rapid Response Team (ANZICS-RRT) Conference held at The Gold Coast, Australia in July 2015. All conference delegates were eligible to take part. Conference delegates totalled 293; 194 nurses, 89 doctors and 10 allied health professionals. Data collection took place in three phases, over a 90-minute period. First, demographic data were collected from all participants at the start of data collection. These data were collected using paper-based surveys. Second, extended response surveys; that is, paper-based surveys that asked open-ended questions to elicit free text responses, were used to collect participants' individual responses to the question: "What are the specific theoretical knowledge, skills and behavioural attributes required in a curricula to prepare nurses to be high functioning members of a MET?" Demographic, educational and work characteristics were descriptively analysed using SPSS (version 22). Participants perceptions of what knowledge, skills and attributes are required for nurses to recognise and respond to clinical deterioration were thematically analysed. RESULTS Participants were predominantly female (88.3%, n = 91) with 54.4% (n = 56) holding a Bachelor of Nursing. Participants had a median of 20 years (IQR 16) experience as RNs, and a median of 14 years (IQR 13) experience in critical care. Participants formed part of METs frequently, with nearly half the cohort seeing clinically deteriorating patients more than once per day (37.9%, n = 33) or daily (10%, n = 9). Thematic analysis of survey responses revealed four main themes desired in Rapid Response Team Curricula: Clinical Deterioration Theory, Clinical Deterioration Skills, Rapid Response System Governance, and Professionalism and Teamwork. CONCLUSIONS We suggest that a curriculum that educates nurses on the specific requirements of assessing, managing and evaluating all aspects of clinical deterioration is now required.
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Affiliation(s)
- Judy Currey
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, c/- Deakin University, Geelong, Victoria 3125, Australia.
| | - Debbie Massey
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
| | - Josh Allen
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, c/- Deakin University, Geelong, Victoria 3125, Australia.
| | - Daryl Jones
- Austin Health, A/Prof School of Public Health and Preventive Medicine, Monash University, Honorary A/Prof Department of Surgery, University of Melbourne, Austin Hospital, 145 Studley Rd, Heidelberg, VIC 3084, Melbourne, Australia.
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Emergency nursing students' and nurse educators' perception of care delivery: A comparison study of self-assessment ratings. Int Emerg Nurs 2018; 41:31-37. [PMID: 29884436 DOI: 10.1016/j.ienj.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/06/2018] [Accepted: 05/31/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postgraduate emergency nursing studies strengthen the emergency nursing workforce and contribute to specialist patient care. Formative and summative assessments in postgraduate study are important for student learning as they enable self-reflection and feedback. AIM To compare formative and summative appraisal assessments between postgraduate emergency nursing students and nurse educators. METHOD Retrospective review of assessments completed by postgraduate student and educator in the final multi-system complex subject of the postgraduate emergency nursing course during 2015. Data were extracted from university records. Data for the two appraisal periods were compared using chisquare test of independence. RESULTS Data from 52 emergency nursing students and 16 educators were extracted. Significant differences were detected between most student and educator ratings for both assessment appraisals. The lowest self-ratings of independence for students and educators at the summative assessment were for the provision and coordination of patient care and critical analysis of research evidence. Educators did agree that students were performing independently on domains relating to legal, professional and ethical frameworks. CONCLUSION Postgraduate emergency nursing study is important for the emergency nursing workforce. Examining student learning and educator assessment in this context enables a broader understanding of student learning and transition to emergency nursing speciality practice.
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Abdolrahimi M, Ghiyasvandian S, Zakerimoghadam M, Ebadi A. Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electron Physician 2017; 9:4968-4977. [PMID: 28979730 PMCID: PMC5614280 DOI: 10.19082/4968] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/16/2017] [Indexed: 12/30/2022] Open
Abstract
Background and aim Therapeutic communication, the fundamental component of nursing, is a complex concept. Furthermore, the poor encounters between nursing student and patient demonstrate the necessity of instruction regarding therapeutic communication. The aim of this study was to define and clarify this important concept for including this subject in the nursing curriculum with more emphasis. Methods A literature search was conducted using keywords such as “nursing student”, “patient” and “therapeutic communication” and Persian-equivalent words in Persian databases (including Magiran and Medlib) and English databases (including PubMed, ScienceDirect, Scopus and ProQuest) without time limitation. After extracting concept definitions and determining characteristic features, therapeutic communication in nursing students was defined. Then, sample cases, antecedents, consequences and empirical referents of concept were determined. Results After assessing 30 articles, therapeutic communication defining attributes were as follows: “an important means in building interpersonal relationships”, “a process of information transmission”, “an important clinical competency”, “a structure with two different sections” and “a significant tool in patient centered care”. Furthermore, theoretical and clinical education and receiving educators’ feedback regarding therapeutic communication were considered as antecedents of the concept. Improving physical and psychological health status of patient as well as professional development of nursing students were identified as consequences of the concept. Conclusion Nursing instructors can use these results in order to teach and evaluate therapeutic communication in nursing students and train qualified nurses. Also, nursing students may apply the results to improve the quality of their interactions with patients, perform their various duties and meet patients’ diverse needs.
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Affiliation(s)
- Mahbobeh Abdolrahimi
- Ph.D. Candidate of Nursing, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Associate Professor, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Zakerimoghadam
- Assistant Professor, Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Associate Professor, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Clinical Skills Performed By Iranian Emergency Nurses: Perceived Competency Levels and Attitudes Toward Expanding Professional Roles. J Emerg Nurs 2017; 44:156-163. [PMID: 28755762 DOI: 10.1016/j.jen.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 04/23/2017] [Accepted: 06/17/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed. METHODS In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings. RESULTS Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P < .001). Participants had positive attitudes toward expanding their professional roles (2.13 ± 0.92), with 81.5% agreeing it would improve their job satisfaction. DISCUSSION Higher perceived competency levels were significantly associated with more frequent performance of clinical skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures.
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Abstract
Purpose - The purpose of this paper is to evaluate the performance on standardizing appointment slot length in a primary care clinic to understand the impact of providers' preferences and practice differences. Design/methodology/approach - The treatment time data were collected for each provider. There were six patient types: emergency/urgent care (ER/UC), follow-up patient (FU), new patient, office visit (OV), physical exam, and well-child care. Simulation model was developed to capture patient flow and measure patient wait time, provider idle time, cost, overtime, finish time, and the number of patients scheduled. Four scheduling scenarios were compared: scheduled all patients at 20 minutes; scheduled ER/UC, FU, OV at 20 minutes and others at 40 minutes; scheduled patient types on individual provider preference; and scheduled patient types on combined provider preference. Findings - Standardized scheduling among providers increase cost by 57 per cent, patient wait time by 83 per cent, provider idle time by five minutes per patient, overtime by 22 minutes, finish time by 30 minutes, and decrease patient access to care by approximately 11 per cent. An individualized scheduling approach could save as much as 14 per cent on cost and schedule 1.5 more patients. The combined preference method could save about 8 per cent while the number of patients scheduled remained the same. Research limitations/implications - The challenge is to actually disseminate the findings to medical providers and adjust scheduling systems accordingly. Originality/value - This paper concluded standardization of providers' clinic preference and practice negatively impact clinic service quality and access to care.
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Affiliation(s)
- Yu-Li Huang
- Mayo Clinic Minnesota, Rochester, Minnesota, US
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Biz C, Buffon L, Marin R, Petrova N. Orthopaedic nursing challenges in poly-traumatised patient management: A critical analysis of an Orthopaedic and Trauma Unit. Int J Orthop Trauma Nurs 2016; 23:60-71. [PMID: 27561247 DOI: 10.1016/j.ijotn.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/15/2016] [Accepted: 04/15/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND BACKGROUND Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences. STUDY AIMS This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature. This has led to the development of a pre-established algorithm for evaluation, preventive care and management of the poly-trauma patient and a flow-chart for improved patient care. RESEARCH METHODS A five-step observational and exploratory approach was employed in this study which critically analysed the nursing management of 60 multiple trauma patients admitted to our Orthopaedic Unit from April 2013 to October 2014. RESULTS The findings highlight the need for adherence to plans of care, which can be approached by a shared management of poly-trauma patients that involves the medical team, the patient and his family/caregiver. DISCUSSION The protocols and guidelines in use in our Orthopaedic and Trauma Unit are in line with European standards, although there is still margin for improvement. The study has led to the development of an algorithm that allows health professionals to have reference values for the care of polytrauma patients. CONCLUSIONS AND RECOMMENDATIONS This study demonstrates the use of theoretical and practical tools for the evaluation and management of poly-traumatised patients during their hospital stay. We recommend the use of both proposed tools: the general algorithm and the flow-chart for the management of the poly-trauma patient, as they allow identification of barriers and facilitators related to the implementation of international guidelines, currently well-defined for Emergency Departments but not yet for Orthopaedic Units.
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Affiliation(s)
- Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padova, Italy; Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy.
| | - Lisa Buffon
- Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy; Edith Cavell Campus, Bretton Gate, Peterborough, Cambridgeshire PE3 9GZ, United Kingdom
| | - Roberto Marin
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padova, Italy
| | - Natalia Petrova
- Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy
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