Academic literature on the topic 'Emergency nursing Australia'

Emergency nurses have key roles in responding to healthcare disasters. Emergency nurses often complete postgraduate qualifications in their area of specialty to equip them with a breadth and depth of knowledge to respond to the challenges and complexities of emergency nursing care. However, little is known about the disaster preparedness of emergency nurses in Australia. More specifically, the educational preparedness and training for disaster nursing roles is not well understood. This purpose of this study is to describe the disaster content of Australian postgraduate tertiary emergency nursing courses as a means of better understanding emergency nurses' educational preparedness for disaster. An exploratory, descriptive approach was used to survey postgraduate tertiary emergency nursing course convenors. Data were collected from course convenors by structured telephone interview. Questions included: (1) nursing background; (2) demographics and disaster experience of course convenors; (3) course type, duration and mode of delivery; and (4) the type and amount of disaster content. Currently, 12 universities in Australia offer postgraduate courses specific to Emergency Nursing, ranging from Graduate Certificates to Masters Degree level. Of these universities, 10 participated in this research project. This presentation will report on the demographics of course convenors, including their disaster education and experience. However, the focus of the presentation will be on the review of the course content. Seven courses had some disaster content, while three had none. The disaster content in these courses varied in both content and duration. Three had learning objectives, and one had an assessment item related to disasters. Five had recent modifications relating to disaster content; this was in response to real-world events, such as terrorism and communicable diseases. This research highlights that the disaster content in Australian postgraduate emergency nursing courses varies. This finding supports the need for national consistency and supporting framework for disaster content in post-graduate courses. The 2009 Ben Morley Scholarship, a financial award sponsored by the College of Emergency Nursing Australasia, supported this research.

An Australian College of Operating Room Nurses (ACORN) submission (ACORN 2002–2008) recently stated that the specialities that suffered significantly from the transition of hospital-based nursing training to university training were the perioperative specialty, critical care and emergency. The main reason for this was that perioperative nursing was not included in the undergraduate nursing curriculum. Less than a handful of universities in Australia offer the subject as a compulsory unit. The University of Notre Dame Australia (UNDA) is one of these universities. This paper will provide an insight into the perioperative nursing care unit embedded within the Bachelor of Nursing (BN) undergraduate curriculum.

Medical team GOLF departed Melbourne on Australia Day bound for Banda Aceh. This was an AusAID initiative coordinated by Emergency Management Australia (EMA). The group of 24 was the seventh Australian government team sent to tsunami devastated areas. The team consisted of surgeons, anaesthetists, nursing staff, paramedics, environmental and public health experts and a laboratory team, comprising Dr Geoff Hogg (pathologist), Kay Withnall and myself. Our brief was to provide public health and medical support to communities affected by the tsunami, to coordinate with other agencies and to support local health authorities.

A survey of triage systems used in Health Department of Western Australia accident and emergency departments was undertaken to examine differences in practices between departments with and without designated triage nurses (TNs). One questionnaire surveyed 93 nurses in seven departments with TNs, a similar second questionnaire surveyed 89 nurses in 16 departments without TNs, and a third questionnaire was used in a structured telephone interview of receptionists in hospitals without TNs. Data were analysed using frequencies, percentages, means, standard deviations and ranges with common themes identified for open ended questions. The study was guided by Donabedian's systems evaluation model. The structures and processes of triage within each department were examined in relation to the outcome standards recommended by the Australian Council on Healthcare Standards. The study results revealed that triage nurses were employed in all departments where patient attendances exceeded 300 per week and nursing staff coverage in the department was higher than five per day. Three departments had introduced triage on weekends only, and these departments had the lowest nurse-patient ratio of one nurse per day to 74 patients per week. The highest nurse-patient ratio was in departments with TNs (1-35). Conclusions drawn from the findings suggest that when receptionists are the first person to see patients, they triage patients using an unsatisfactory two category priority system. The average waiting time to see nursing staff is too long in departments without TNs, 7.6 minutes, as compared to 3. 7 minutes in department with TNs. Nursing staff perceived that triage systems could be improved by having only experienced staff as the triageur. The surveillance of patients entering the department is unsatisfactory as 81% of departments without TNs and 43% of departments with TNs are unable to provide nurse surveillance. The surveillance of the waiting room is similarly unsatisfactory in many departments. All triage areas are inadequate, as facilities for private conversation, hand washing and physical assessment are not always available. The majority of departments without TNs do not have a satisfactory triage priority category system in place. The average time taken by nursing staff to triage patients is an acceptable 3.2 minutes in departments with TNs, and 5.3 minutes in departments without TNs. The practice of redirecting patients away from the department could compromise patient safety as patients are redirected away from most departments by any level of staff employed in the department, without any written documentation kept or any written criteria for the redirection of these non-urgent patients. The practice of ordering investigations and treating minor problems without referring to a doctor could also compromise patient safety, as most departments do not have written policies and guidelines to cover this practice. Most departments offer an inadequate triage training program of preceptoring only. Recommendations are focused on the reviewing of existing triage practices to comply with the standards identified.

This thesis evaluated the effectiveness and cost-saving potential of a health service delivery model in Queensland Australia, the Hospital in the Nursing Home program. The research adopted a before-after controlled study design, comparing the outcomes between an intervention hospital and a control hospital during the pre- and post-intervention periods. Findings from the research supported that the intervention was preferred over the current practice, which reduced the attendances to emergency departments (EDs) and inpatient hospitals from patients in residential aged care facilities, shortened their length of ED stay, and saved the overall costs.

This study investigates the preparedness of novice (student) paramedics for the mental health challenges of the paramedic profession and identifies the coping strategies used by veteran paramedics to successfully meet these challenges. The lived experience of veteran paramedics is utilised to provide this important assistance. Initially, two surveys were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate degree paramedicine courses across Australia and New Zealand, to identify the perceived need (for preparation) within the curriculum. In addition, the anticipations, confidence and fears of novice (student) paramedics, course coordinators and veteran paramedics were also collected as a means to facilitate the preparedness through self-evaluation, reflection and discussion. Twenty semi-structured interviews with veteran paramedics, each with a minimum 15 years paramedic experience from across Australia and New Zealand, were conducted to gain an understanding of their experiences, mental health coping strategies and advice for novice (student) paramedics. Results from the interviews were validated by three focus groups comprised of six veteran paramedics each, representative of the geographic spread. All 16 course coordinators and 302 novice (student) paramedics responded to the surveys. Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession within accredited undergraduate paramedic courses with 100% of course coordinators and 97% of students recognising this need. The semi-structured interviews with veteran paramedics provided valuable insights into the experiences and strategies used to aid the survival of the veterans throughout their careers. Within the interviews 70% of participants expressed a sincere love for theparamedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues. In addition, extensive advice was given to novice (student) paramedics based on the veterans lived experiences. This advice focused comprised of three themes; support, health and the profession. The findings of the study indicate that the preparation of novice (student) paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. By utilising the relatable data collected on the anticipation, confidence and fears of novices, course coordinators and veterans, the advice offered by the veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the lived experiences of the veteran paramedics. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion to the paramedic curriculum have been prepared to facilitate the knowledge and commence the development of conscious coping strategies by novice (student) paramedics during their learning phase.

This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.

Thesis (Ph. D.)--University of Sydney, 2005.
Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.

Internationally violence persists as a complex problem for nurses. While it is widely accepted that nursing staff in any health care setting can be the target of violence, in high acuity areas such as Emergency Departments (ED) nurses have an increased risk of violence. There is limited Australian research into violence experienced by nurses in the Australian Health sector, in particular the rural and regional Australian ED. Greater understanding of the phenomena of violence towards ED nurses, as it is manifest in the ‘real world’ rural and regional Australian setting is needed to enable development of context specific solutions for this problem. This thesis presents a contextual, specialty nurses’ assessment of violence risk, strategies for violence prediction and management, and the sequelae for the nurse. The aims of this study were to: Explore and describe the contextual assessment skills and preventative strategies rural and regional ED nurses use to understand and predict violent events, where the agent of violence is the patient, their family or friends, and understand the nature and scope of the sequelae of work place violent events from the nurse’s perspective. A mixed method instrumental case study was used to generate both qualitative and boundary for inquiry, and a structured process within which the chosen methods were able to define ‘the case’ and answer the research question. This study was undertaken in 2005, at a regional Australian ED. Twenty (20) Registered Nurses were recruited into the study and consented to being observed. Textual qualitative data were generated from two hundred and ninety (290) hours of participant observation, sixteen (16) semi-structured interviews, thirteen (13) unstructured field interviews, and researcher journaling. In addition, sixteen (16) violent events were observed and recorded via a structured observation tool. Textual data were analysed thematically assisted by the qualitative data management and retrieval software NVivo2, and numeric data were analysed using frequency counts. The participants used their nursing knowledge(s), experience and context to assess their risk of violence. Embedded in the practice of these ED nurses was their ability to convey caring and respectfully approach all people presenting to ED. The participants’ caring respectful demeanour underpinned their understanding of violence prevention strategies. Using this violence prevention approach, they attributed contextual meaning(s) to the violent event and agent of violence. The meaning(s) they attributed in turn shaped their response(s) to both the violent event and the agent of violence. A high level of observable collegial awareness supported and fostered their resilience towards the potentially negative affects of violence in the workplace. The five themes revealed by this study were; Conveying caring: Averting violence: Being alert: Recognising, assessing and responding to violence: Attributing meaning: Subjective understandings that shape responses to Violence : Collegial awareness: Forming trusting relationships to help manage violence: Fostering resilience: resisting the negative sequelae of violence. Violence was interpreted by these ED nurses in a more systematic and complex way than the current definitions make possible. Violence assessment, prevention and management skills were embodied in the participant ED nurses’ routine practice and their conceptualisation of caring. The meanings given to violence were contextually constructed and these ascribed meaning(s) and judgments informed the actions that the nurses took in response to both the violent event and the agent of violence.
Doctor of Philosophy (PhD)

The MHEC-RAP project involves the innovative application of video conferencing to mental health assessment in rural NSW. The preliminary evaluation findings of the project are presented. Mental health emergencies in rural and remote settings cause particular problems and are not amenable to conventional health service solutions. Patients and local health care staff may be isolated from specialist mental health staff and from acute inpatient services. Decisions to transport patients for specialist assessments or treatment may be required at night or at weekends and may involve families, police, ambulance services and local health staff. Such decisions need to be made promptly but carefully and the ability to obtain a specialist assessment may assist in making a decision about how best to care for the patient bearing in mind the need to provide a responsive, high quality and safe service to patients and local clinicians. In this chapter we examine a novel approach which uses audio-visual technology to conduct remote emergency mental health patient assessment interviews and provide consultations to local clinicians in rural communities in western NSW. The Mental Health Emergency Care – Rural Access Project or ‘MHEC-RAP’ was developed in 2007 following a series of consultations held in rural towns and implemented in 2008 within the Greater Western Area Health Service (GWAHS), New South Wales, Australia. GWAHS is a primary example of a rural and remote health service. It serves 287,481 people (8.3% of whom are Indigenous Australians) in an area that is 445,197sq km or 55% of the state of New South Wales (Australian Bureau of Statistics, 2001; Greater Western Area Health Service, 2007, 2009). The communities within GWAHS are mostly small, the towns are widely dispersed and local services are “limited by distance, expense, transport, and the difficulty of recruiting health professionals to these areas” (Dunbar, 2007 page 587). The chapter focuses on the design of the service, its implementation and its performance in the first year. We conclude with a discussion about the service, its broader relevance, transferability and its sustainability.

Work integrated learning in the space of nursing informatics is a new concept in Australian nursing curriculum. This study examined nursing students’ experiences in the pilot nursing informatics clinical placement centered on electronic medical records, their use in patient care and clinical decision making. Students completed reflective diaries of their learning during the four-week placement. Data was explored by thematic analysis. Emergent themes included: importance of adequate training in using EMR; impact of EMR on nursing workflow and patient care; shaping future career choices; forming rewarding relationships; and potential for improvements. These themes will be used to enhance teaching and learning opportunities as this pilot placement evolves into permeant part of the nursing curriculum.