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Bissonette S, Chartrand J, Bailey L, Lalonde M, Tyerman J. Interventions to improve nurse-family communication in the emergency department: A scoping review. J Clin Nurs 2024; 33:2525-2543. [PMID: 38476035 DOI: 10.1111/jocn.17068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
AIM To determine and describe what interventions exist to improve nurse-family communication during the waiting period of an emergency department visit. BACKGROUND Communication between nurses and families is an area needing improvement. Good communication can improve patient outcomes, satisfaction with care and decrease patient and family anxiety. DESIGN Scoping Review. METHODS A scoping review was conducted following the Joanna Briggs Institution methodology: (1) identify the research question, (2) define the inclusion criteria, (3) use a search strategy to identify relevant studies using a three-step approach, (4) select studies using a team approach, (5) data extraction, (6) data analysis, and (7) presentation of results. DATA SOURCES Medline, CINAHL, EMBASE, PsychInfo and grey literature were searched on 3 August 2022. RESULTS The search yielded 1771 articles from the databases, of which 20 were included. An additional seven articles were included from the grey literature. Paediatric and adult interventions were found targeting staff and family of which the general recommendations were summarised into communication models. CONCLUSION Future research should focus on evaluating the effectiveness of interventions using a standardised scale, understanding the specific needs of families, and exploring the communication models developed in this review. IMPLICATIONS FOR CLINICAL PRACTICE Communication models for triage nurses and all emergency department nurses were developed. These may guide nurses to improve their communication which will contribute to improving family satisfaction. REPORTING METHOD PRISMA-ScR. TRIAL AND PROTOCOL REGISTRATION Protocol has been registered with the Open Science Framework, registration number 10.17605/OSF.IO/ETSYB. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sarah Bissonette
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Liana Bailey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Lalonde
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, Ontario, Canada
| | - Jane Tyerman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Blake H, Adams EJ, Chaplin WJ, Morris L, Mahmood I, Taylor MG, Langmack G, Jones L, Miller P, Coffey F. Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7028. [PMID: 37998259 PMCID: PMC10671475 DOI: 10.3390/ijerph20227028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Emma J. Adams
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Wendy J. Chaplin
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lucy Morris
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Ikra Mahmood
- General Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Michael G. Taylor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Gillian Langmack
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lydia Jones
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Philip Miller
- Health Innovation East Midlands, Nottingham NG7 2TU, UK;
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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Butler K, Anderson N, Jull A. Evaluating the effects of triage education on triage accuracy within the emergency department: An integrative review. Int Emerg Nurs 2023; 70:101322. [PMID: 37597277 DOI: 10.1016/j.ienj.2023.101322] [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: 02/12/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Triage accuracy can affect patient outcomes. Education to ensure nurses provide the most accurate triage scores is paramount for patient safety.The objective was to investigate whether ongoing triage education increases triage accuracy, knowledge or behaviour. METHOD An integrative review was conducted by searching five databases to identify studies that included triage-based education. A systematic search strategy was completed followed by analysis with critical appraisal using the Critical Appraisal Skills Programme, a TIDieR Checklist and thematic analysis. FINDINGS Four thousand five hundred seventy-six studies were retrieved, with 34 studies selected for inclusion. Thirty-one studies were quantitative, and three were mixed methods. 18 out of 34 studies showed improvement in triage accuracy. Seven showed increased knowledge. Six studies showed no improvement in triage accuracy. Sixteen studies assessed triage behaviour and showed improvement post-intervention, with five showing no changes. Only three studies compared interventions. Fifty-three opportunities for changes to triage accuracy, knowledge or behaviour were found, 41 showed improvements. CONCLUSION Triage education interventions can improve accuracy, knowledge and behaviour, but whether improvements are sustained needs further research.
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Affiliation(s)
- Kayla Butler
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; Emergency Department, Whakatane Hospital, Te Whatu Ora Hauora a Toi, Bay of Plenty, New Zealand.
| | - Natalie Anderson
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; Auckland Emergency Department, Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Andrew Jull
- School of Nursing, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand; National Institute for Health Innovation, University of Auckland/Waipapa Taumata Rau, Auckland, New Zealand
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Gorick H, Rai AS. Training nurses to triage: a scoping review. Emerg Nurse 2023:e2163. [PMID: 37139556 DOI: 10.7748/en.2023.e2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 05/05/2023]
Abstract
Triage accuracy is important to ensure effective treatment and management of patients in the emergency department, however this requires nurses to receive high-quality triage training. This article reports the results of a scoping review that aimed to establish what research on triage training exists and what research is required to improve such training. Sixty-eight studies which used a range of training interventions and outcome measurements were reviewed. The authors conclude that the heterogeneity of these studies makes comparison challenging and that this, combined with low methodological quality, requires caution when applying the results in practice. The authors recommend establishing a gold standard for measuring triage training outcomes.
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Affiliation(s)
- Hugh Gorick
- School of Health Sciences, University of East Anglia, Norwich, England
| | - Aditi Sabrina Rai
- School of Health Sciences, University of East Anglia, Norwich, England
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Yang J, Wan X, Yu P, Li X. Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey. Int Emerg Nurs 2023; 67:101264. [PMID: 36773513 DOI: 10.1016/j.ienj.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making. METHOD A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form. RESULT Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability. CONCLUSION Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.
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Affiliation(s)
- Jiayi Yang
- The First Hospital of China Medical University, Shenyang 110000, China
| | - Xinli Wan
- Fourth Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Pengyu Yu
- The People's Hospital Of Liaoning Province, Shenyang 110000, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang 110000, China.
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Jang K, Jo E, Song KJ. Effect of problem-based learning on severity classification agreement by triage nurses. BMC Nurs 2021; 20:256. [PMID: 34930232 PMCID: PMC8691012 DOI: 10.1186/s12912-021-00781-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022] Open
Abstract
Background Differences in the classification results among triage nurses in the emergency room can be improved by training or applying an algorithm. This study aimed to confirm whether the agreement among triage nurses could be improved through learner-led problem-based learning. Methods This study had a single-group time series design to investigate the effect of problem-based learning led by triage nurses on the agreement of Korean Triage and Acuity Scale classification results for patients who visited the emergency department. We extracted 300 patients each in May and August 2018 before learning began and 300 patients each in May and August 2019 after learning. Results After problem-based learning was applied, the self-efficacy of triage nurses for emergency patient classification increased statistically significantly compared to before learning (7.88 ± 0.96, p < .001), and the weighted kappa coefficient was also found to be almost perfectly agreement (0.835, p < .001). Conclusions In this study, problem-based learning improved the inter-rater agreement of Korean Triage and Acuity Scale classification results and self-efficacy of triage nurses. Therefore, problem-based learning can contribute to patient safety in the emergency department by enhancing the expertise of triage nurses and increasing the accuracy of triage classification.
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Affiliation(s)
- Kyeongmin Jang
- Department of Nursing, Bucheon University, 56, Sosa-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Eunmi Jo
- Department of Nursing, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Emergency Medicine, Seoul, Korea
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Aslan R, Şahinöz S, Şahinöz T. Determination of START triage skill and knowledge levels of Prehospital Emergency Medical Staff: A cross sectional study. Int Emerg Nurs 2021; 56:101004. [PMID: 33957489 DOI: 10.1016/j.ienj.2021.101004] [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: 05/06/2020] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency medical staff working in pre-hospital (PH-staff) may encounter mass casualty incident (MCI) events. In these events these medical personnel should perform triage. The objective of this study is to determine the skill and knowledge levels of PH-staff about Simple Triage and Rapid Treatment (START) triage. METHODS With this cross-sectional, observational study we analyzed data from 127 PH-staff. Data was collected with the survey tool (response rate = 74.7%). Kruskal-Wallis H Test, Mann-Whitney U Test, and Spearman's Correlation analyzes were used in the data analysis by means of SPSS Software. RESULTS Of the participants, 63% were men, the median age was 24 years, 88 PH-staff (69.3%) intervened in MCI events, and 37 PH-staff (29.1%) applied START triage. The skill score was 60% and the knowledge score was 72.5%. There was a weak positive correlation between knowledge and skill scores (r = 0.337, p < 0.01). The knowledge level of the emergency medical technicians (EMTs) and paramedics was higher than those from the other professions. CONCLUSIONS The triage knowledge and skill levels of the PH-staff were not low contrary to the expectations. The triage knowledge and skill levels of professions that did not have pre-hospital training such as paramedics and EMTs were low.
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Affiliation(s)
- Ramazan Aslan
- Department of Emergency and Disaster Management, Faculty of Health Sciences, Gümüşhane University, Gümüşhane, Turkey.
| | - Saime Şahinöz
- Department of Public Health, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Turgut Şahinöz
- Department of Healthc Management, Faculty of Health Sciences, Ordu University, Ordu, Turkey
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Strategies to Enhance Knowledge and Practical Skills of Triage amongst Nurses Working in the Emergency Departments of Rural Hospitals in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094471. [PMID: 33922403 PMCID: PMC8122756 DOI: 10.3390/ijerph18094471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose: Lack of knowledge and practical skills on triage remains a global problem, especially within rural hospitals, and very little is known about enhancing the knowledge and skills of emergency nursing staff in rural hospitals of South Africa. The objective was to describe the perceived strategies for enhancing knowledge and practices of triage among nurses working in the emergency departments (EDs) of rural hospitals in South Africa. Research methods: A descriptive qualitative research design was applied to achieve the research objective. A non-probability sampling method was applied to select 17 professional nurses from rural hospitals. An unstructured face-to-face interview method was used to collect data. Data collected were analyzed using Tesch’s method of data analysis. Results: The study findings highlighted the academic needs of nurses working in the ED of rural hospitals. Two themes emerged from this study; (1) The consistent description of the importance of triage training for emergency unit staff, and (2) The description of measures to enhance triage practices amongst emergency unit staff. Findings indicated that triage knowledge and practice remains a challenge, but with formulated strategies like continuous training by workshops, refresher courses, and offering a training module on triage, evaluation of developed guidelines and benchmarks is often enhanced. Conclusions: The study describes the strategies to enhance the conversion of knowledge and practice of triage amongst nurses working in the ED of rural hospitals. The paper argues that the knowledge and practical skills of nurses working in ED are enhanced through the provision of continuous training as workshops, triage module, evaluating the developed guidelines to implement triage, and benchmarking with other hospitals.
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King R, Taylor B, Talpur A, Jackson C, Manley K, Ashby N, Tod A, Ryan T, Wood E, Senek M, Robertson S. Factors that optimise the impact of continuing professional development in nursing: A rapid evidence review. NURSE EDUCATION TODAY 2021; 98:104652. [PMID: 33190952 DOI: 10.1016/j.nedt.2020.104652] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Continuing professional development is essential for healthcare professionals to maintain and acquire the necessary knowledge and skills to provide person centred, safe and effective care. This is particularly important in the rapidly changing healthcare context of the Covid-19 pandemic. Despite recognition of its importance in the United Kingdom, minimum required hours for re-registration, and related investment, have been small compared to other countries. The aim of this review is to understand the factors that optimise continuing professional development impact for learning, development and improvement in the workplace. DESIGN A rapid evidence review was undertaken using Arksey and O'Malley's (2005) framework; identifying a research question, developing a search strategy, extracting, collating and summarising the findings. REVIEW METHODS In addressing the question 'What are the factors that enable or optimise CPD impact for learning, development and improvement in the workplace at the individual, team, organisation and system level?' the British Nursing Index, the Cochrane Library, CINAHL, HTA database, King's Fund Library, and Medline databases were searched for key terms. A total of 3790 papers were retrieved and 39 were included. RESULTS Key factors to optimising the impact of nursing and inter-professional continuing development are; self-motivation, relevance to practice, preference for workplace learning, strong enabling leadership and a positive workplace culture. The findings reveal the interdependence of these important factors in optimising the impact of continuing professional development on person-centred care and outcomes. CONCLUSION In the current, rapidly changing, healthcare context it is important for educators and managers to understand the factors that enhance the impact of continuing professional development. It is crucial that attention is given to addressing all of the optimising factors in this review to enhance impact. Future studies should seek to measure the value of continuing professional development for people experiencing care, nurses and the wider organisation.
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Affiliation(s)
- Rachel King
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK.
| | - Bethany Taylor
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Ashfaque Talpur
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Carolyn Jackson
- International Institute for Practice Transformation (ImpACT), School of Health Sciences, University of East Anglia, Queens Building 0.04/Edith Cavell Building, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Kim Manley
- International Institute for Practice Transformation (ImpACT), School of Health Sciences, University of East Anglia, Queens Building 0.04/Edith Cavell Building, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Nichola Ashby
- The Royal College of Nursing, 20 Cavendish Square, London WR10GN, UK
| | - Angela Tod
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Tony Ryan
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Emily Wood
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Michaela Senek
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Steve Robertson
- Division of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK; School of Health & Community Studies, City Campus, Leeds LS1 3HE, UK
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Reducing Preventable Surgical Cancellations: Improving the Preoperative Anesthesia Interview Process. J Perianesth Nurs 2019; 34:929-937. [PMID: 30894294 DOI: 10.1016/j.jopan.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Thorough and accurate preoperative anesthesia interviews may help improve perioperative efficiency by reducing unnecessary preoperative testing and preventable surgical cancellations, both of which create financial burdens. Standardized anesthesia preoperative interview guidelines and online educational modules for registered nurses (RNs) conducting preoperative interviews may improve this process. DESIGN Predesign and postdesign, retrospective chart review. METHODS Online educational modules and standardized preoperative anesthesia interview guidelines were developed for RNs conducting preoperative interviews. A retrospective chart review compared preoperative anesthesia interview record completion rates, compliance with laboratory testing, and the total number of preventable surgical cancellations. FINDINGS Documentation of preoperative anesthesia interview records increased, whereas unnecessary preoperative testing decreased, neither with statistical significance. Preventable cancellation rates decreased significantly from 34.3% to 20% (P < .5) contributing to a 3-month postimplementation cost savings of approximately $30,000. CONCLUSIONS A standardized preoperative anesthesia interview guideline and online anesthesia educational modules for RNs conducting preoperative anesthesia interviews improved preoperative record completion rates, reduced unnecessary laboratory testing, and averted surgical cancellations.
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Varndell W, Hodge A, Fry M. Triage in Australian emergency departments: Results of a New South Wales survey. Australas Emerg Care 2019; 22:81-86. [PMID: 31042523 DOI: 10.1016/j.auec.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
AIM To describe current models of triage, the preparation and education of triage nurses, and methods of auditing triage practice in New South Wales emergency departments. BACKGROUND Triage is a critical component of emergency department practice; affecting patient safety and access to emergency care. Within Australia, triage is an autonomous role predominantly conducted by trained emergency nurses. Patient safety and timely access to emergency care relies upon the experience, education and training of emergency triage nurses. To date, little is known about triage models of care, the preparation and education of triage nurses, and assessment of triage practice and decision accuracy. METHOD Descriptive, exploratory study design employing a self-reporting cross-sectional survey of clinical nurse consultants and educators in New South Wales. RESULTS The survey results reveal variability in models of triage, and the eligibility, preparation and education requirements of triage nurses; that appear geographically related. Auditing of triage practice was commonly undertaken retrospectively; feedback to triage nurses was infrequent. The survey found evidence of locally developed guidelines directing triage category allocation for specific conditions or symptoms. CONCLUSION The purpose of triage is to ensure that the level of emergency care provided is commensurate with clinical urgency. Variability in the preparation, education and evaluation of triage nurses may in and of itself, contribute to poor patient outcomes. Further, workforce size and geography may impede auditing and the provision of feedback, which are critical to improving triage practice and triage nurse performance. It is imperative that the Emergency Triage Education Kit be revised and maintained in tandem with future revisions of the Australasian Triage Scale.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Barker Street, Sydney, Australia; University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Alister Hodge
- Sutherland Hospital Emergency Department, Caringbah, Australia; The University of Sydney, School of Nursing, Sydney, Australia
| | - Margaret Fry
- University of Technology Sydney, Faculty of Health, Sydney, Australia
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Kim HJ, Kang HY. Effects of a Web-Based Korean Triage and Acuity Scale Learning Program on Triage Self-Efficacy and Triage Performance Ability for Nurses in Emergency Department. J Korean Acad Nurs 2019; 49:171-180. [DOI: 10.4040/jkan.2019.49.2.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Hyo-Jin Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Hee-Young Kang
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
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Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med 2018; 18:58. [PMID: 30572841 PMCID: PMC6302512 DOI: 10.1186/s12873-018-0215-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the emergency department, it is important to identify and prioritize who requires an urgent intervention in a short time. Triage helps recognize the urgency among patients. An accurate triage decision helps patients receive the emergency service in the most appropriate time. Various triage systems have been developed and verified to assist healthcare providers to make accurate triage decisions. The triage accuracy can represent the quality of emergency service, but there is a lack of review studies addressing this topic. METHODS A literature search was conducted in four electronic databases where 'emergency nursing' and 'triage accuracy' were used as keywords. Studies published from 2008 January to 2018 August were included as potential subjects. Nine studies were included in this review after the inclusion and exclusion criteria were applied. RESULTS Written case scenarios and retrospective review were commonly used to examine the triage accuracy. The triage accuracy from studies was in moderate level. The single-center studies which held better results than those from multi-center studies revealed the need of triage training and consistent training between emergency departments. CONCLUSIONS Regular refresher triage training, collaboration between emergency departments and continuous monitoring were necessary to strengthen the use of triage systems and improve nurse's triage performance.
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Affiliation(s)
- Hon Lon Tam
- Kiang Wu Nursing College of Macau, Est. Repouso No. 35, R/C, Macau, S.A.R. China
| | - Siu Fung Chung
- Flinders University, Sturt Road, Bedford Park, 5042 Adelaide, South Australia
| | - Chi Kin Lou
- City University of Macau, Avenida Padre Tomás Pereira Taipa, Macau, S.A.R. China
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Ebben RHA, Siqeca F, Madsen UR, Vloet LCM, van Achterberg T. Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open 2018; 8:e017572. [PMID: 30478101 PMCID: PMC6254419 DOI: 10.1136/bmjopen-2017-017572] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Guideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings. DESIGN Systematic review. DATA SOURCES PubMed (including MEDLINE), CINAHL, EMBASE and Cochrane. METHODS We selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care. Pairs of two independent reviewers performed the selection process, quality assessment and data extraction. RESULTS Eleven studies were included, nine of which were performed in the ED setting and two studies were performed in a combined prehospital and ED setting. For the ED setting, the studies indicated that educational strategies as sole intervention, and educational strategies in combination with audit and feedback, are probably effective in improving guideline adherence. Sole use of reminders in the ED setting also showed positive effects. The two studies in the combined prehospital and ED setting showed similar results for the sole use of educational interventions. CONCLUSIONS Our review does not allow firm conclusion on how to promote guideline and protocol adherence in prehospital emergency care, or the combination of prehospital and ED care. For ED settings, the sole use of reminders or educational interventions and the use of multifaceted strategies of education combined with audit and feedback are all likely to be effective in improving guideline adherence.
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Affiliation(s)
- Remco H A Ebben
- Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Flaka Siqeca
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Erasmus Scholar from the University of Prishtina, Kosovo at the KU Leuven, Leuven, Belgium
| | | | - Lilian C M Vloet
- Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
- Department of Public Health and Primary Care, Uppsala University, Uppsala, Sweden
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Validity of the Pediatric Canadian Triage Acuity Scale in a tertiary children's hospital in Israel. Eur J Emerg Med 2018; 25:270-273. [PMID: 28362647 DOI: 10.1097/mej.0000000000000464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In 2015, the Israeli Ministry of Health issued national guidelines demanding the use of a five-level triage system in pediatric emergency departments (EDs). The present study aimed to evaluate the validity of the Pediatric Canadian Triage Acuity Scale (PedCTAS) in the ED of a tertiary children's hospital in Israel. METHODS A retrospective cohort study of all patients admitted between January 2011 and December 2015 was carried out. The proportion of hospitalization was the primary outcome measure. The secondary outcomes were proportion of admissions to the ICU, proportions of patients who left without being seen (LWBS), and length of stay (LOS) in the ED. RESULTS A total of 83 609 patients were included in our analysis. Triage levels 1-5 included 533 (0.6%), 4428 (5.3%), 46 461 (55.6%), 28 510 (34.1%), and 3677 (4.4%) patients, respectively. Hospitalization proportions were 70, 51, 28, 15, and 12% for triage levels 1, 2, 3, 4, and 5, respectively. Admission proportions to ICU were 24.2, 3.05, 0.24, 0.05, and 0.05% for PedCTAS levels 1, 2, 3, 4, and 5, respectively. The proportions of LWBS were 0.001, 0.002, and 0.005% for triage levels 3, 4, and 5, respectively. LOS was shorter as the triage level increased from 2 to 5. CONCLUSION Triage level was predictive of hospitalization, admission to the ICU, and proportions of LWBS and LOS in the ED. The findings suggest validity of the PedCTAS in this cohort. This is the first report of the performance of a triage tool in an Israeli ED.
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Triage education in rural remote settings: A scoping review. Int Emerg Nurs 2018; 43:119-125. [PMID: 30424946 DOI: 10.1016/j.ienj.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Triage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings. METHOD A scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases. RESULTS 6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included 'variability of triage accuracy and assessment'; 'education qualifications and experience'; and 'training and supervision'. CONCLUSION This review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.
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Vaona A, Banzi R, Kwag KH, Rigon G, Cereda D, Pecoraro V, Tramacere I, Moja L. E-learning for health professionals. Cochrane Database Syst Rev 2018; 1:CD011736. [PMID: 29355907 PMCID: PMC6491176 DOI: 10.1002/14651858.cd011736.pub2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive. OBJECTIVES To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies. SELECTION CRITERIA Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible. MAIN RESULTS We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies. AUTHORS' CONCLUSIONS When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Rita Banzi
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Koren H Kwag
- IRCCS Galeazzi Orthopaedic InstituteClinical Epidemiology UnitVia R. Galeazzi, 4MilanItaly20161
| | - Giulio Rigon
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | | | - Valentina Pecoraro
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Irene Tramacere
- Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Research and Clinical Development, Scientific DirectorateVia Giovanni Celoria, 11MilanItaly20133
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanSwitzerland20133
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Feldman O, Allon R, Leiba R, Shavit I. Emergency Department waiting times in a tertiary children's hospital in Israel: a retrospective cohort study. Isr J Health Policy Res 2017; 6:60. [PMID: 29126459 PMCID: PMC5681790 DOI: 10.1186/s13584-017-0184-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/03/2017] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to assess ethnic differences in Emergency Department (ED) waiting times between Jewish and Arab children in a tertiary childrens’ hospital in Israel. Methods This was a retrospective cohort study of all children who were admitted to the pediatric ED of the largest hospital in northern Israel, between January 2011 and December 2015. Univariate and multivariate analyses were used to assess the strength of association between ethnicity category and waiting time. The following were tested as possible confounders: triage category, age, gender, time of arrival category. The effect of nurse-patient ethnic concordance was assessed. Results Full data were available in 82,883 patients, 55,497 (67.0%) Jews and 27,386 (33.0%) Arabs. Jews and Arabs had a similar median waiting time of 38 min (interquartile range [IQR] 22–63 and IQR 21–61, respectively). Ethnicity was not associated with a change in waiting time (p = 0.36). Factors that most influenced shorter waiting time were triage category 1 (change in waiting time: −25.5%; 95% confidence interval [CI]: −29.3 to −21.7), or triage category 2 (change in waiting-time: −21.8%; 95% CI: -23.7 to −20.05). Factors that most influenced longer waiting time were patient arrival during the morning shift period (change in waiting time: 5.45%; 95% CI: 4.59 to 6.31), or during the evening shift period (change in waiting time: 4.46%; 95% CI: 3.62 to 5.29). Ethnic discordance between triage nurses and patients did not yield longer waiting times. Conclusion In this large pediatric cohort, ethnic differences in ED waiting time were not found.
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Affiliation(s)
- Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Raviv Allon
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronit Leiba
- Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. .,, POB 274, 3080500, Haifa, Israel.
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Ebben RHA, van Grunsven PM, Moors ML, Aldenhoven P, de Vaan J, van Hout R, van Achterberg T, Vloet LCM. A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study. Scand J Trauma Resusc Emerg Med 2015; 23:33. [PMID: 25887239 PMCID: PMC4422253 DOI: 10.1186/s13049-015-0113-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/09/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To standardize patient handover in the chain of emergency care a handover guideline was developed. The main guideline recommendation is to use the DeMIST model (Demographics, Mechanism of Injury/illness, Injury/Illness, Signs, Treatment given) to structure pre-hospital notification and handover. To benefit from the new guideline, guideline adherence is necessary. As adherence to guidelines in emergency care settings is variable, there is a need to systematically implement the new guideline. For implementation of the guideline we developed a e-learning program tailored to influencing factors. The aim of the study was to evaluate the effectiveness of this e-learning program to improve emergency care professionals' adherence to the handover guideline during pre-hospital notification and handover in the chain of emergency medical service (EMS), emergency medical dispatch (EMD), and emergency department (ED). METHODS A prospective pre-test post-test study was conducted. The intervention was a tailored e-learning program that was offered to ambulance crew and emergency medical dispatchers (n=88). Data on adherence included pre-hospital notifications and handovers and were collected through observations and audiotapes before and after the e-learning program. Data were analyzed using X(2)-tests and t-tests. RESULTS In total, 78/88 (88.6%) professionals followed the e-learning program. During pre- and post-test, 146 and 169 handovers were observed respectively. After the e-learning program, no significant difference in the number of handovers with the DeMIST model (77.9% vs. 73.1%, p=.319) and the number of handovers with the correct sequence of the DeMIST model (69.9% vs. 70.5%, p=.159) existed. During the handover, the number of questions by ED staff and interruptions significantly increased from 49.0% to 68.9% and from 15.2% to 52.7% respectively (both p=.000). Most handovers were performed after patient transfer, this did not change after the intervention (p=.167). The number of handovers where information was documented during handover slightly increased from 26.9% to 29.3% (p=.632). CONCLUSIONS The tailored e-learning program did not improve adherence to a handover guideline in the chain of emergency care. Results show a relatively high baseline adherence rate to usage and correct sequence of the DeMIST model. Improvements in the handover process can be made on the documentation of information during handover, the number of interruptions and questions, and the handover moment.
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Affiliation(s)
- Remco H A Ebben
- Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Pierre M van Grunsven
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Marie Louise Moors
- Emergency Department, Radboud university medical center, Nijmegen, the Netherlands.
| | - Peter Aldenhoven
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Jordan de Vaan
- Emergency Department, Radboud university medical center, Nijmegen, the Netherlands.
| | - Roger van Hout
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Theo van Achterberg
- Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium. .,Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands.
| | - Lilian C M Vloet
- Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands. .,Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
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Peng L, Hammad K. Current status of emergency department triage in mainland China: A narrative review of the literature. Nurs Health Sci 2014; 17:148-58. [PMID: 25196171 DOI: 10.1111/nhs.12159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 06/04/2014] [Accepted: 06/08/2014] [Indexed: 01/24/2023]
Abstract
In this review, the current status of emergency department triage in mainland China is explored, with the purpose of generating a deeper understanding of the topic. Literature was identified through electronic databases, and was included for review if published between 2002 and 2012, included significant discussion of daily emergency department triage in mainland China, was peer reviewed, and published in English or Chinese. Thematic analysis was used to identify themes which emerged from the reviewed literature. This resulted in 21 articles included for review. Four themes emerged from the review: triage process, triage training, qualification of triage nurses, and quality of triage. The review demonstrates that there is currently not a unified approach to emergency department triage in mainland China. Additionally, there are limitations in triage training for nurses and confusion around the role of triage nurses. This review highlights that emergency department triage in mainland China is still in its infancy and that more research is needed to further develop the role of triage.
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Affiliation(s)
- Lingli Peng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan province, China
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McCrow J, Sullivan KA, Beattie ER. Delirium knowledge and recognition: a randomized controlled trial of a web-based educational intervention for acute care nurses. NURSE EDUCATION TODAY 2014; 34:912-7. [PMID: 24393287 DOI: 10.1016/j.nedt.2013.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/06/2013] [Accepted: 12/18/2013] [Indexed: 05/04/2023]
Abstract
Delirium is a significant problem for older hospitalized people and is associated with poor outcomes. It is poorly recognized and evidence suggests that a major reason is lack of education. Nurses, who are educated about delirium, can play a significant role in improving delirium recognition. This study evaluated the impact of a delirium specific educational website. A cluster randomized controlled trial, with a pretest/post-test time series design, was conducted to measure delirium knowledge (DK) and delirium recognition (DR) over three time-points. Statistically significant differences were found between the intervention and non-intervention group. The intervention groups' DK scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for DR when comparing T2 and T1 results (t=2.56 p=0.011) between both groups but not for changes in DR scores between T3 and T1 (t=1.80 p=0.074). Participants rated the website highly on the visual, functional and content elements. This study supports the concept that web-based delirium learning is an effective and satisfying method of information delivery for registered nurses. Future research is required to investigate clinical outcomes as a result of this web-based education.
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Affiliation(s)
- Judy McCrow
- School of Nursing and Midwifery, Queensland University of Technology, Queensland 4059, Australia.
| | - Karen A Sullivan
- School of Psychology and Counseling, Queensland University of Technology, Queensland 4059, Australia.
| | - Elizabeth R Beattie
- School of Nursing and Midwifery, Queensland University of Technology, Queensland 4059, Australia.
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Laibhen-Parkes N, Codone S. Web-based evidence based practice educational intervention to improve EBP competence among BSN-prepared pediatric bedside nurses: a mixed methods pilot study. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2056-9157-1-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reay G, Rankin JA. The application of theory to triage decision-making. Int Emerg Nurs 2012; 21:97-102. [PMID: 23615516 DOI: 10.1016/j.ienj.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/22/2012] [Accepted: 03/28/2012] [Indexed: 11/15/2022]
Abstract
Theory in nursing is frequently thought of as being a mainly academic exercise with little relevance to the everyday practice of nursing. In nursing there is disagreement about what theory is and what it is not. Scientific theory is an abstract systematic explanation of how concepts are related to each other. Many nursing theories do not fit this description and should therefore, in the opinion of the authors, be thought of as models. Nursing knowledge has been described as the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or other disciplines. Decision-making (DM) and triage nursing have been investigated by several nurse researchers, however, most have not clearly articulated a theoretical or conceptual framework. The recognition primed decision (RPD) model is based on research about DM under uncertain conditions such as time pressure, limited time available, high stakes, and changing cues. The context of emergency triage nursing DM is congruent with the RPD model. The authors propose that the RPD model can serve as a foundation for research that seeks to understand DM by triage nurses with the aim of yielding new knowledge that is useful for their practice.
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Affiliation(s)
- Gudrun Reay
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
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