Emergency department waiting room nurses in practice: an observational study

Aim. To identify the activities and behaviours of waiting room nurses in emergency department settings. Background. Emergency care has expanded into waiting rooms in some emergency departments. Often viewed as an adjunct to triage, the aim of waiting room nurses is to commence care early, reassess patients and improve communication between patients, families and staff. There is however a paucity of literature relating to waiting room nurses, especially in relation to their current activities and behaviours. Design and methods. Part of a larger exploratory sequential mixed methods designed study. This phase used a non-participant observer role to observe waiting room nurses in their natural setting undertaking normal care and responsibilities. One observer, using a tool and reflective journal collected data on participant interactions, processes and practices on eight waiting room nurses over 13 episodes of observation (total 65h:50m) in two emergency departments. Data analysis used descriptive statistics and thematic analysis. Results. Participants were observed to anticipate and prioritise to deliver holistic, patient centred care in emergency department waiting rooms. Waiting room nurses had a varied and unpredictable workload, including facilitating the flow of patients from the waiting room. They contributed to patient safety in the waiting room, primarily by reassessing and detecting clinical deterioration. Conclusion. Further research into this role is required, including linking efficacy with experience of nurses, impact the role has on patient safety, and patient and family perceptions of the role

Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia.

ObjectiveInflammatory and metabolic pathways are implicated in preterm birth and preeclampsia. However, studies rarely compare second trimester inflammatory and metabolic markers between women who deliver preterm with and without preeclampsia.Study designA sample of 129 women (43 with preeclampsia) with preterm delivery was obtained from an existing population-based birth cohort. Banked second trimester serum samples were assayed for 267 inflammatory and metabolic markers. Backwards-stepwise logistic regression models were used to calculate odds ratios.ResultsHigher 5-α-pregnan-3β,20α-diol disulfate, and lower 1-linoleoylglycerophosphoethanolamine and octadecanedioate, predicted increased odds of preeclampsia.ConclusionsAmong women with preterm births, those who developed preeclampsia differed with respect metabolic markers. These findings point to potential etiologic underpinnings for preeclampsia as a precursor to preterm birth

An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. RESULTS: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. CONCLUSIONS: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups

Exploration of a nursing role in emergency department waiting rooms

University of Technology Sydney. Faculty of Health.The waiting room nurse role was introduced into emergency department waiting rooms in response to increased waiting times, poor patient outcomes and failure to meet key performance indicators. The aim of role was to decrease waiting times, reassess patients and improve communication. There is a paucity of literature relating to the role. The aim of the research was to explore nurses perception of the implementation of a nurse allocated to care for patients in emergency department waiting rooms. An exploratory sequential mixed-methods design was used. In Phase 1, data exploring factors contributing to the development of the role were collected from key informant (n=6) through semi-structured interviews. In Phase 2 waiting room nurses (n=8) from a major metropolitan and regional hospital in Victoria (Australia) were observed in clinical practice over 13 periods of observation. Phase 3 surveyed members of the College of Emergency Nursing Australasia, the peak professional body, on the implementation of the role across Australia and their perception of the role. There was a total of 197 survey responses. The key findings of the research were that nurses perceived the role contributed to care quality and patient safety in the waiting room. Waiting Room Nurses developed therapeutic relationships to deliver holistic patient-centred care and facilitated the flow of patients out the waiting room. Variations in preparation, experience and supporting policy were found. A number of challenges including role confusion, funding issues and high exposure to occupational stressors were noted. Integration of the results identified the characteristics and attributes of nurses performing the role, along with the organisational resources required. The activities of the WRN were found to be assessment, secondary triage interventions, communication and facilitating patient flow. Finally, expediting care, patient advocacy, therapeutic relationships, de-escalation, empowerment, improving care quality and safety and deliver of patient-centred care were identified as outcomes of the role. A standardised approach, with considerations for local priorities and work practices, to the preparation, education and supporting policies is required. In addition, policy relating to high exposure of WRNs to occupational stressors is necessary. Further research into the role is essential, including exploring patient outcomes and experiences of the role

Nurses\u27 perceptions of their preparation for triage

Background: Triage is the process of assessment and prioritisation of care for all patients presenting to the emergency department (ED). To improve consistency in triage education the Triage Education Resource Book was introduced in 2002, which contained the Australasian Association of Emergency Nurses (AAEN) \u27AAEN recommendations for triage education\u27. The aim of the research was to determine if triage education met the standards identified in the \u27AAEN recommendations for triage education\u27. Method: A retrospective exploratory design was used to examine triage nurses\u27 perceptions of their preparation for triage practice. Participants were divided into two groups based on their commencement date at triage. Comparisons were made between groups to determine if the \u27AAEN recommendations for triage education\u27 influenced participant triage preparation. Data was collected by self-report questionnaires. Descriptive statistics, correlations and inferential statistics were calculated using SPSS. Results: Triage education provision increased following the introduction of the \u27AAEN recommendations for triage education\u27, however of concern, is the finding that participation in annual triage auditing has declined since the introduction of the recommendations. Conclusion: The \u27AAEN recommendations for triage education\u27 have contributed to improvements in triage nurse preparation

Care of patients in emergency department waiting rooms - an integrative review

Aim: To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. Background: Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. Design: Integrative review. Data sources: Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. Review methods: Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. Results: Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. Conclusion: Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives. © 2015 John Wiley & Sons Ltd

Effectiveness of paracetamol versus ibuprofen administration in febrile children : A systematic literature review

Aim: The use of antipyretics to manage the febrile child is becoming increasingly popular. Paracetamol and ibuprofen are the most commonly used interventions to manage fever in children; however, there have been no comparative analyses. The aim of the study is to evaluate the evidence comparing paracetamol to ibuprofen in the treatment of fever in children. Methods: A systematic review of randomised controlled trials investigating the administration of oral paracetamol and ibuprofen to reduce fever in children. Children aged 1 month to 12 years with a temperature between 37.5 and 41°C were included. A total of 3023 papers were identified. After removal of duplications, application of inclusion criteria and screening, eight papers were subjected to critical appraisal and included in this study. Results: Six of the studies identified that ibuprofen was slightly, but not significantly, better at reducing fever in children than paracetamol. Dosage variances and route of temperature measurement ranged between studies, limiting the comparability of studies. While ibuprofen was reported to be marginally more effective at reducing fever and fever associated discomfort in children, there is insufficient data to conclude that ibuprofen is superior to paracetamol. Conclusion: There is little evidence supporting the superior efficacy of paracetamol or ibuprofen in the treatment of fever in children with indications that both drugs are equally effective. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians

Caring for the mental illness patient in emergency departments - an exploration of the issues from a healthcare provider perspective

AIMS AND OBJECTIVES: To identify issues, from the emergency department clinicians' viewpoint, with the management of patients presenting to the emergency department with a mental illness. BACKGROUND: Despite the introduction of several statewide and national initiatives, barriers remain affecting the care and management of consumers presenting with an mental illness to the emergency department. Improving the responsiveness of mental health services, including the provision of more efficient emergency responses for people in crisis, is a key goal. To achieve responsive mental health services in emergency departments, services are required to work together to ensure appropriate referrals between mainstream services and to those services developed to meet the unique needs of specific population groups. DESIGN: A mixed method approach using surveys and focus groups. METHODS: Data were collected from patients with mental illness and their next of kin/carers, as well as staff working within the emergency department and the mental health services of the healthcare network. RESULTS: The study found that there were inconsistencies and deficits in the educational preparation of emergency department staff to manage consumers presenting with mental illness. Further, the inadequate physical environment of the emergency department contributed to difficulties in assessing and managing this group of patients. CONCLUSIONS: Staff members working within mental health services and the emergency department summarised the key improvement areas as the need for electronic case notes, improvements to the emergency department environment, mental health training, implementation of a referral service and increasing the number of staff. RELEVANCE TO CLINICAL PRACTICE: Although initiatives have been implemented, there needs to be a greater focus on educating the staff in emergency departments in relation to the policies and strategies which aim to improve the care and management of patients presenting with a mental health problem

At the crossroads of violence and aggression in the emergency department : Perspectives of Australian emergency nurses

Objective Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. Methods The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. Results Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED Conclusion There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence. © AHHA 2014