Emergency department waiting room nurse role: A key informant perspective

How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis

BACKGROUND

The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar.

METHODS

A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature.

RESULTS

The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues.

CONCLUSION

The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.

Implementation of advanced triage in the Emergency Department of high complexity public hospital: Research protocol

AIM

To evaluate the efficacy of advanced nurse triage based on the quality of care outcomes of patients attending the Emergency Department of a high-complexity hospital. To analyse the concept of advanced triage and the essential elements of the construct.

DESIGN

Mixed longitudinal study, divided into 4 steps; which will include an initial qualitative step, two observational studies and finally, a quasi-experimental study.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05230108.

METHODS

Step 1 will consist of a concept analysis. Step 2 will include a mapping of advanced practice protocol terminologies. Step 3 will analyse the opinion of health professionals on advanced triage. In step 4: in the retrospective phase (n = 1095), sociodemographic and clinical variables and quality indicators such as waiting time will be analysed. After that, in the prospective phase (n = 547), advanced triage will be implemented and the two cohorts will be compared. The whole study will be carried out from January 2022 to January 2024.

DISCUSSION

Patients classified as low complexity at triage are more vulnerable to emergency department overcrowding. The implementation of advanced triage would make it possible to respond to patient needs by offering equitable and quality healthcare, facilitating accessibility, safety and humanization of the emergency department.

Structured evaluation of a virtual emergency department triage model of care: A study protocol

OBJECTIVE

A new virtual ED service was introduced into a hospital network in the northern suburbs of Melbourne in response to changing needs during the COVID-19 pandemic. The 'virtual ED' utilises a telehealth model as a means of assessment for appropriately selected patients to facilitate either complete care or navigation into streamlined pathways for ongoing care, in some cases bypassing the ED entirely where appropriate. The proposed study aims to evaluate the implementation of the model and identify future improvement opportunities, assess the impact on traditional health service delivery processes and patient experience, and determine the acceptability of the 'virtual ED' model of care.

METHODS

The present study will consist of a pre-post- implementation evaluation using the RE-AIM framework. Routine health service data will be collected for 6 months post-implementation of the virtual ED model and compared to 24 months prior to implementation. Prospective data will be collected using routinely collected and survey data. Interviews and focus groups will be conducted to understand consumer and clinician perspectives on barriers and enablers to implementation and adoption of the virtual ED.

RESULTS

Descriptive statistics will be used to describe the study population and key outcomes, including changes in ED presentations and length of stay. Thematic analysis will be conducted on transcribed interviews and focus group data. This will be triangulated with data collected from patient feedback surveys.

CONCLUSION

This project will support the delivery of care to ED patients by evaluating the 'virtual ED' model of care.

Exploration and model development for emergency department waiting room nurse role: Synthesis of a three-phase sequential mixed methods study

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.

Emergency Department Operations I: Emergency Medical Services and Patient Arrival

The emergency department (ED) is by its nature inherently an environment with the potential for chaos because of the high volume and varied types of patients cared for in an ED setting. This article discusses potential system opportunities from the prehospital environment through arrival in the ED before provider evaluation. The Emergency Medical Treatment and Active Labor Act is reviewed in detail. Management and the reduction of risk to waiting room patients and patients who leave without being seen is explored. Description of the risks and mitigation strategies are discussed to decrease risk to patients, providers, and hospitals.

A practitioner researcher’s opportunities and challenges in accessing interpretive case participants in a public healthcare setting

Purpose

The purpose of this paper is to document the opportunities and challenges of a practitioner researcher in accessing interpretive case participants in the public healthcare sector in Ireland.

Design/methodology/approach

The paper documents the research design and implementation phases of a longitudinal interpretive research project with specific focus on, research ethics, preparing for data collection, identifying and recruiting the research participants and analysis of the findings based on the specific nuances of the public health context and design considerations. Considerations as an insider researcher in a large public organisation are also presented.

Findings

Conducting interpretive research in a healthcare setting presents both opportunities and some challenges; key amongst these is agreed access to research participants. In addition, with research taking place in a healthcare environment, the potential for disclosure of information regarding something harmful to patients or of a criminal nature exists. This risk can be addressed through the ethical approval process documented in this paper. Insider researcher considerations are also explored focussing on the specific nuances affiliate to carrying out a longitudinal interpretive study in a public healthcare setting.

Research limitations/implications

Insights for those wishing to conduct longitudinal interpretive case research in the public healthcare setting are included. The implications for enhanced engagement with interpretive research in this context are addressed.

Originality/value

Through documenting the opportunities and challenges of a practitioner researcher in accessing research participants in the public healthcare sector, this paper discusses insider researcher considerations and seeks to address concerns in the literature regarding insufficient detail relating to interpretive research design and implementation in healthcare contexts.

A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions

BACKGROUND

In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role.

AIM

To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions.

METHODS

Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively.

RESULTS

Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported.

CONCLUSIONS

The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.

Registered nurses' own experience of using a nurse-initiated pain protocol based on their working experience

AIMS AND OBJECTIVES

To explore registered nurses' (RNs) own experience of using the nurse-initiated pain protocol (NIPP) in the emergency department (ED) based on their working experience.

BACKGROUND

Pain is known to be one of the most common symptoms among adult patients seeking care at the ED. Several strategies aiming to improve pain management have been developed. Despite some improvements in pain management using NIPP, a large number of patients continue to have inadequate pain treatment when cared for in EDs.

DESIGN AND METHOD

A cross-sectional study design based on a questionnaire was used. The variable working experience was based on a theory that experience will make a change in RNs' knowledge. Descriptive statistics and Pearson's chi-square tests were used for analysing quantative data. Qualitative data were analysed by summative content analysis.

RESULTS

Seventy RNs answered the questionnaire (response rate 42%) and 61% considered the NIPP adequate to relieve patients' acute pain at the ED. No significant difference was found on how the RNs used the NIPP. However, qualitative data showed that more experienced RNs adapt the NIPP according to the patients' needs in a higher extent.

CONCLUSION

A majority of the RNs consider the NIPP to be adequate to relieve patients' acute pain in the ED. An increase in working experience showed an impact on how the NIPP was used, with an increase in pain management that is personalised depending on individual patients' needs. The RNs used several alternatives to both dosage and type of medication when the ED becomes crowded.

RELEVANCE TO CLINICAL PRACTICE

Registered nurses' working experience should be considered when planning nursing schedules to be better able to meet patients' needs. Guidelines should be developed and evaluated by both healthcare professionals and patients.