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Van de Glind G, Crilly J, Galenkamp N, Schut B, Werner L, Chan E, Hilton E, Schoonhoven L, Scheepers FE, Muir R, Baden D, van Veen M, Ham WHW. Defining the concept of mental dysregulation in patients requiring ambulance and/or emergency department care: protocol for a Delphi consensus study. BMJ Open 2024; 14:e077666. [PMID: 38262647 PMCID: PMC10824022 DOI: 10.1136/bmjopen-2023-077666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. METHODS AND ANALYSIS A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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Affiliation(s)
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Niek Galenkamp
- University of Applied Sciences, Utrecht, The Netherlands
| | - Bart Schut
- Person With Lived Experience, Utrecht, The Netherlands
| | - Lente Werner
- Person With Lived Experience, Utrecht, The Netherlands
| | - Eric Chan
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Emily Hilton
- Person With Lived Experience, Calgary, Alberta, Canada
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- UMC Utrecht, Utrecht, The Netherlands
| | | | - Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Baden
- Emergency Department, Diakonessenhuis Utrecht Zeist Doorn Locatie Utrecht Spoedeisende hulp, Utrecht, The Netherlands
| | - Mark van Veen
- University of Applied Sciences, Utrecht, The Netherlands
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Varndell W, Fry M, Elliott D. Applying real-time Delphi methods: development of a pain management survey in emergency nursing. BMC Nurs 2021; 20:149. [PMID: 34407815 PMCID: PMC8371887 DOI: 10.1186/s12912-021-00661-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023] Open
Abstract
The modified Delphi technique is widely used to develop consensus on group opinion within health services research. However, digital platforms are offering researchers the capacity to undertake a real-time Delphi, which provides novel opportunities to enhance the process. The aim of this case study is to discuss and reflect on the use of a real-time Delphi method for researchers in emergency nursing and cognate areas of practice. A real-time Delphi method was used to develop a national survey examining knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. While designing and completing this real-time Delphi study, a number of areas, emerged that demanded careful consideration and provide guidance to future researchers.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, NSW, 2031, Randwick, Australia. .,Faculty of Health, University of Technology Sydney, NSW, 2007, Ultimo, Australia. .,College of Emergency Nursing Australasia, PO Box 7345, Victoria, 3193, Beaumaris, Australia.
| | - Margaret Fry
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, 15 Broadway, NSW, 2007, Ultimo, Australia.,Director Research and Practice Development Nursing and Midwifery Directorate NSLHD, Royal North Shore Hospital, Level 7 Kolling Building, NSW, 2065, St Leonards, Australia
| | - Doug Elliott
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, 15 Broadway, NSW, 2007, Ultimo, Australia
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Minchella S, De Leo A, Orazi D, Mitello L, Terrenato I, Latina R. Violence against women: An observational study in an Italian emergency department. Appl Nurs Res 2021; 58:151411. [PMID: 33745559 DOI: 10.1016/j.apnr.2021.151411] [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: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
Violence against women is a pervasive phenomenon affecting one in three women aged ≥15 in the world that are more likely to visit an emergency department (ED) for the serious physical and psychological consequences of the abuse. The aim of this observational single-centre study is to describe the socio-demographic and clinical variables associated with violence against women. We enrolled 425 female patients who attended an Italian ED for trauma on 2019 and the patients' information was collected and analyzed with descriptive statistics. The average age of the patients was 41.5 (standard deviation = 14.2) years. 74.6% of the women were Italians, and 86.6% were of metropolitan origin. The reasons for the ED visit included aggression (67.5%), accidental trauma (29.0%) and unknown reasons (3.5%). Multivariate analysis confirmed that three factors were independently associated with violence: nationality (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.09-0.77), head/face/neck injuries (OR = 7.32; 95% CI, 3.76-14.27) and multiple injuries (OR = 8.52; 95% CI, 1.03-70.47). Age over 25 was a protective factor. The study confirmed that being a foreigner and having head/face/neck injuries or multiple injuries are associated with violence against women.
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Affiliation(s)
- Sonia Minchella
- Department of Health Professions, School of Nursing and Midwifery AO S. Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
| | - Aurora De Leo
- School of Nursing and Midwifery AO S. Camillo-Forlanini Hospital, Sapienza University, Rome, Italy.
| | - Daniela Orazi
- Health Direction, AO S. Camillo-Forlanini Hospital, Rome, Italy
| | - Lucia Mitello
- Department of Health Professions, School of Nursing and Midwifery AO S. Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
| | - Irene Terrenato
- Biostatistical Unit, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Latina
- Department of Health Professions, School of Nursing and Midwifery AO S. Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
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Varndell W, Fry M, Lutze M, Elliott D. Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review. Int Emerg Nurs 2020; 56:100867. [PMID: 32238322 DOI: 10.1016/j.ienj.2020.100867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
AIM To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice. BACKGROUND Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined. DESIGN Systematic literature review. DATABASES AND DATA TREATMENT A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review. RESULTS Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied. CONCLUSION Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick 2031, NSW, Australia; Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Director Research and Practice Development Nursing and Midwifery Directorate NSLHD, Level 7 Kolling Building, Royal North Shore Hospital, St Leonards 2065, NSW, Australia.
| | - Matthew Lutze
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Nursing Practice and Informatics, NSW Ministry of Health, St Leonards 2065, NSW, Australia; School of Nursing, University of Sydney, Camperdown 2050, NSW, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
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Lovi R, Hutchinson M, Hurley J. Inclusion of intimate partner violence-related content within undergraduate health care professional curriculum: mixed methods study of academics' attitudes and beliefs. Contemp Nurse 2018; 54:592-602. [PMID: 30303044 DOI: 10.1080/10376178.2018.1530946] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Undergraduate preparation is important in ensuring health care professionals are prepared to identify and respond to intimate partner violence (IPV). Previous studies confirm this education is highly variable and IPV-related content remains marginalised in undergraduate nursing, midwifery and paramedicine curricula. AIM To investigate frontline academics' attitudes and beliefs in relation to the inclusion of IPV-related content in the aforementioned degrees. DESIGN A large multi-phase mixed methods Australian case study of Australian undergraduate nursing, midwifery and paramedicine degrees. In this paper, components of the survey and interviews from this study will be reported on. METHODS Quantitative comparative analysis of a 51-item on-line survey and qualitative thematic analysis of guided conversational interviews. RESULTS Across Australian universities IPV remains poorly embedded in nursing, midwifery and paramedicine programmes. Academics report a range of barriers to such inclusion, including an already overcrowded curriculum, a lack of confident and competent academics to teach this content area and a lack of support for this content inclusion. One factor statistically significant in its association with non-inclusion of IPV-related content was academic attitudes of professional role resistance. Gender was also identified as a significant factor associated with non-inclusion and resistant professional attitudes. Qualitative interviews revealed that only six of the 18 participants identified IPV-related care as within their scope of practice, with professional role resistance a common theme identified. CONCLUSION Though professional organisation and policy makers now advocate for the inclusion of IPV-related content in the undergraduate preparation of nurses and midwives, work remains to address gendered and resistant attitudes amongst academics.
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Affiliation(s)
- Renee Lovi
- a School of Health and Human Sciences , Southern Cross University , Gold Coast Campus, Southern Cross Drive, Bilinga , QLD , Australia
| | - Marie Hutchinson
- b School of Health and Human Sciences , Southern Cross University , Hogbin Drive, Coffs Harbour , NSW 2450 , Australia
| | - John Hurley
- b School of Health and Human Sciences , Southern Cross University , Hogbin Drive, Coffs Harbour , NSW 2450 , Australia
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Gómez-Fernández MA, Goberna-Tricas J, Payà-Sánchez M. Intimate partner violence as a subject of study during the training of nurses and midwives in Catalonia (Spain): A qualitative study. Nurse Educ Pract 2017; 27:13-21. [DOI: 10.1016/j.nepr.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
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