Understanding nurses perspectives of acuity in the process of emergency mental health triage: A qualitative study

Background Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for. Impact statement This paper provides evidence to support calls for specific consideration of the physical environment, specific nursing cultural factors and differing understandings of acuity in order to improve the management of people with a mental illness in the ED. Doing this may positively influence the ED triage assessment and referral, and subsequent response by mental health clinicians, improving outcome for those presenting with a mental illness

Recognition for registered nurses supporting students on clinical placement: A grounded theory study

Objective: This study examined registered nurses’ perspectives of being supportive of nursing students and providing them with learning opportunities when on clinical placements. Background: In Australia, as part of their three-year Bachelors degree, undergraduate nursing students undertake a minimum of 800 hours of clinical placement. During these clinical placement hours, nursing students are supervised by registered nurses who are required to be supportive of the students and provide them with learning opportunities. Study design and methods: This study used a grounded theory approach. In this qualitative study there were fifteen registered nurse participants. Thirteen participants were female participants and two were male. Participants were individually interviewed. Transcripts from these in–depth interviews were analysed using constant comparative analysis. Results: The major category, an added extra, emerged from this study. An added extra is about registered nurses’ perception that having a student is an added extra to their daily duties. The major category an added extra is informed by three emergent themes. The first theme was time, the second theme was workload and the third theme was wanting recognition.Discussion: Registered nurses perceived that their workloads tend not to be taken into consideration when they have nursing students. The literature suggests that nursing students often miss out on learning opportunities when they are on clinical placement because registered nurses do not have additional time to effectively support students’ clinical learning. Conclusion: Participants in this study believed being supportive of nursing students and providing them with learning opportunities was an added extra to their daily nursing duties. Findings revealed registered nurses want to be recognised for the extra time and effort they dedicate to students’ learning. Implications for research, policy, and practice: When allocated nursing students, registered nurses should have their workloads adjusted because being supportive of nursing students and providing them with learning opportunities is time consuming. Further research is recommended to determine if patient workloads are being decreased when registered nurses are allocated nursing students. © 2020 Australian Nursing and Midwifery Federation

Developing a nurse practitioner to work in residential aged care: A qualitative evaluative study

Background: The effectiveness of advanced practice nurses, such as nurse practitioners (NP), has been demonstrated across several measures of health status and family satisfaction, for older adults in residential aged care settings. There is limited evidence, however, about how best to develop NP from the existing workforce in this setting. Aim: To describe the structures and processes that both enabled and were barriers to the development of the nurse practitioner role. Methods: Qualitative descriptive methods, involving semistructured interviews and focus groups, were employed to explore participant perspectives of the structures and processes involved in developing a nurse practitioner candidate (NPC) (student). Study participants included older adult residents, visiting General Practitioners (GPs), the NPC and facility staff, including nurses and personal care assistants. Content analysis of data categorised as structural and processes enablers and barriers was undertaken. Findings: Nine residents and 25 staff participated in individual interviews or focus groups. Physical structures required for appropriate functioning of the NP role included integrated practice management software, however, social structures such acceptance by existing staff and visiting GPs were initially a barrier but improved over time. Efficient collaboration, enhanced assessment and surveillance of older adults, and improved communication were identified as the key processes enabling the development of the nurse practitioner role from candidate to endorsed nurse practitioner. Discussion and conclusion: The development of a NPC onsite in a residential aged care setting improved communication with GPs and local hospital emergency staff and supported facility staff through capacity building and providing access to primary care onsite. These improvements could stimulate policymakers to access the potential of their existing registered nursing staff, interested in becoming NP to improve primary care for older populations while undertaking their education and beyond

Understanding registered nurse decision-making, communication and care delivery between emergency departments and residential aged care facilities: A research protocol

Objectives: Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision-making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. Methods: The proposed mixed-method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. Results: The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs