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There is mounting evidence that the pre-medical emergency team (pre-MET) of rapid response systems is underutilised in clinical practice due to suboptimal structures and processes and resource constraints. In this perspective article, we argue for examining the pre-MET through a 'Behaviour Change Wheel' lens to improve the pre-MET and maximise the associated patient safety benefits. Using pre-MET communication practices as an example, we illustrate the value of the COM-B model, where clinicians' 'capability', 'opportunity', and 'motivation' drive 'behaviour'. Optimising clinicians' behaviours and establishing failsafe rapid response systems is a complex undertaking; however, examining clinicians' behaviours through the COM-B model enables reframing barriers and facilitators to develop multifaceted and coordinated solutions that are behaviourally and theoretically based. The COM-B model is recommended to clinical governance leaders and health services researchers to explore the underlying causes of behaviour and successfully enact change in the design, implementation, and use of the pre-MET to improve patient safety. What is known about the topic? The pre-medical emergency team (pre-MET) was implemented to enhance hospital patient safety; however, there is evidence that it is underused by health professionals. What does this paper add? We argue that health professionals' behaviours within the pre-MET be understood differently by using the 'Behaviour Change Wheel', where behaviour is driven by capability, opportunity, and motivation. What are the implications for practitioners? To improve patient safety and assist in formulating theory-based solutions, hospital leaders and health services researchers are called upon to examine the pre-MET using behaviour change theory. [ABSTRACT FROM AUTHOR]

Objective: To explore clinicians' use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems. Method: A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted. Results: Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration. Conclusion: Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians' needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced. What is known about the topic? To promote earlier recognition of, and response to, deteriorating ward patients, Australian rapid response systems include a pre-medical emergency team (pre-MET) tier. Escalation pathways within the pre-MET tier are poorly understood. What does this paper add? Policy-defined escalation pathways were inconsistently utilised. Clinicians identified deficiencies in communication methods (e.g. alphanumeric pagers) for escalating pre-MET deterioration. Perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. What are the implications for practitioners? To optimise the management of pre-MET deterioration, ward-based communication infrastructure and interdisciplinary collaboration must be enhanced. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a prediction model to estimate the risk of Medical Emergency Team (MET) review, within 48 hours of an emergency admission, using information routinely available at the time of hospital admission.Design: Development and validation of a multivariable risk model using prospectively collected data. Transparent Reporting of a multivariable model for Individual Prognosis Or Diagnosis recommendations were followed to develop and report the prediction model.Setting: A 560-bed teaching hospital, with a 22-bed ICU and 24-hour Emergency Department in Melbourne, Australia.Patients: A total of 45,170 emergency admissions of 30,064 adult patients (≥18 yr), with an inpatient length of stay greater than 24 hours, admitted under acute medical or surgical hospital services between 2015 and 2017.Measurements and Main Results: The outcome was MET review within 48 hours of emergency admission. Thirty candidate variables were selected from a routinely collected hospital dataset based on their availability to clinicians at the time of admission. The final model included nine variables: age; comorbid alcohol-related behavioral diagnosis; history of heart failure, chronic obstructive pulmonary disease (COPD), or renal disease; admitted from residential care; Charlson Comorbidity Index score 1 or 2, or 3+; at least one planned and one emergency admission in the last year; and admission diagnosis and one interaction (past history of COPD × admission diagnosis). The discrimination of the model was comparable in the training (C-statistics 0.82; 95% CI, 0.81-0.83) and the validation set (0.81; 0.80-0.83). Calibration was reasonable for training and validation sets.Conclusions: Using only nine predictor variables available to clinicians at the time of admission, the MET-risk model can predict the risk of MET review during the first 48 hours of an emergency admission. Model utility in improving patient outcomes requires further investigation. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to describe the epidemiology of pre-medical emergency team (pre-MET) reviews, including patient characteristics, the frequency and nature of triggers and interventions and in-hospital outcomes. Methods. An exploratory retrospective cohort study was performed using a medical record audit. Fifty orthopaedic and general medicine patients at a hospital in Melbourne, Australia, with requests for pre-MET reviews in 2016 were included. Descriptive analyses were performed. Results. The median patient age was 80 years (interquartile range 19 years). Most patients were female (64%), general medical patients (82%), with limitation of medical treatment orders (52%) and modified pre-MET triggers (42%). Documented pre-MET reviews occurred for 68% of requests. Tachypnoea (24%) and staff worry (24%) were the most common pre-MET triggers. One-third of patients received two clinical interventions. One in five patients had repeat requests for a pre-MET review within 12 h. In-hospital mortality was 12%. Conclusions. Most requests for pre-MET reviews related to older female patients. Clinician adherence to pre-MET policy was variable. Multicentre studies are needed to inform improvements to pre-MET strategies. [ABSTRACT FROM AUTHOR]

Aims: This paper aims to identify the frequency and nature of evidence–practice gaps in the initial neuro‐protective nursing care of patients with moderate or severe traumatic brain injury provided by Thai trauma nurses. Background: Little is known about how Thai trauma nurses use evidence‐based practice when providing initial neuro‐protective nursing care to patients with moderate or severe traumatic brain injury. Design A mixed methods design was used to conduct this study. Methods: Data were collected from January to March 2017 using observations and audits of the clinical care of 22 patients by 35 nurses during the first 4 h of admission to trauma ward. The study site was a regional hospital in Southern Thailand. Results: The major evidence–practice gaps identified were related to oxygen and carbon dioxide monitoring and targets, mean arterial pressure and systolic blood pressure targets and management of increased intracranial pressure through patient positioning and pain and agitation management. Conclusion: There were evidence–practice gaps in initial neuro‐protective nursing care provided by Thai trauma nurses that need to be addressed to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury. SUMMARY STATEMENT: What is already known about this topic? Traumatic brain injury is a global problem that is a major public health issue in low‐resource settings like Thailand.Evidence‐based practice improves patient outcomes and quality of care while reducing health‐care costs, which is particularly important in low‐resource environments. What this paper adds? There were evidence–practice gaps in the initial neuro‐protective nursing care of patients with moderate or severe traumatic brain injury provided by Thai trauma nurses that increase the risk of secondary brain injury.This study has identified a number of evidence–practice gaps related to oxygen and carbon dioxide monitoring and targets, mean arterial pressure and systolic blood pressure targets and management of increased intracranial pressure. The implications of this paper for practice/policy: The study results provide a snapshot of the evidence–practice gaps of neuro‐protective nursing care for patients with moderate or severe traumatic brain injury that need to be improved in the Thai trauma context, which is a low‐resource setting.The evidence–practice gaps identified in this study will enable targeted interventions to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury. [ABSTRACT FROM AUTHOR]

Topic: Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance: Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper: To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered: Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Thai trauma nurses play a vital role in neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Nurses' knowledge of the evidence underpinning initial neuroprotective nursing care vital to safe and high‐quality patient care. However, the current state of knowledge of Thai trauma nurses is poorly understood. In this study, we investigated Thai nurses' knowledge of neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Data were collected by a survey, comprising a section on participant characteristics and series of multiple‐choice questions. All registered nurses (n = 22) and nursing assistants (n = 13) from the trauma ward of a regional Thai hospital were invited to participate: the response rate was 100%. Participants had limited knowledge of carbon dioxide monitoring; causes and implications of hypercapnia; mean arterial pressure and cerebral perfusion pressure targets; management of sedatives and analgesics; and management of hyperthermia. Improving their knowledge focusing on knowledge deficits through educational training and implementation of evidence‐based practice is essential to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine patient acceptability of wearable vital sign monitoring devices in the acute setting. Background: Wearable vital sign monitoring devices may improve patient safety, yet hospital patients' acceptability of these devices is largely unreported. Design: A systematic review. Methods: Cumulative Index to Nursing and Allied Health Literature Complete, MEDLINE Complete and EMBASE were searched, supplemented by reference list hand searching. Studies were included if they involved adult hospital patients (≥18 years), a wearable monitoring device capable of assessing ≥1 vital sign, and measured patient acceptability, satisfaction or experience of wearing the device. No date restrictions were enforced. Quality assessments of quantitative and qualitative studies were undertaken using the Downs and Black Checklist for Measuring Study Quality and the Critical Appraisal Skills Programme Qualitative Research Checklist, respectively. Meta‐analyses were not possible given data heterogeneity and low research quality. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and a Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist was completed. Results: Of the 427 studies screened, seven observational studies met the inclusion criteria. Six studies were of low quality and one was of high quality. In two studies, patient satisfaction was investigated. In the remaining studies, patient experience, patient opinions and experience, patient perceptions and experience, device acceptability, and patient comfort and concerns were investigated. In four studies, patients were mostly accepting of the wearable devices, reporting positive experiences and satisfaction relating to their use. In three studies, findings were mixed. Conclusion: There is limited high‐quality research examining patient acceptability of wearable vital sign monitoring devices as an a priori focus in the acute setting. Further understanding of patient perspectives of these devices is required to inform their continued use and development. Relevance to clinical practice: The provision of patient‐centred nursing care is contingent on understanding patients' preferences, including their acceptability of technology use. [ABSTRACT FROM AUTHOR]

Aim: To describe what is currently known about nurses' assessment decisions when providing care to patients at home or in their usual place of residence. Methods: In August 2018, an integrative literature review using a systematic approach was conducted using specific search terms to search Informit, MEDLINE and Cumulative Index of Nursing and Allied Health Literature (CINAHL). The literature search was not limited by date, and included published papers or unpublished dissertations written between 1980 and 2018. Results: In total 25 full papers were assessed for inclusion in this review; seven met the inclusion criteria. Three themes were identified from this review: i) nurse education and experience; ii) assessment informing decision-making and iii) knowing the patient. Conclusion: Nurses' education, experience, abilities, prior learning, beliefs, attitudes and values are key factors in the delivery of home-based nursing care, and strongly influence how assessments, clinical judgements and decisions are made. Impact Statement: An understanding of home based nurses' decisions and response to clinical deterioration is needed to inform Hospital in the Home nursing-specific curricula. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Background: Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. Design: A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). Results: The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses’ assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Conclusion: Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. Relevance to clinical practice: The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. Background Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. Design Descriptive exploratory study using nonparticipatory observation. Methods Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. Results Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. Conclusions Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. Relevance to clinical practice This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' perceptions of using point‐of‐care ultrasound for assessment and guided cannulation in the haemodialysis setting. Background: Cannulation of arteriovenous fistulae is necessary to perform haemodialysis. Damage to the arteriovenous fistula is a frequent complication, resulting in poor patient outcomes and increased healthcare costs. Point‐of‐care ultrasound‐guided cannulation can reduce the risk of such damage and mitigate further vessel deterioration. Understanding nurses' perceptions of using this adjunct tool will inform its future implementation into haemodialysis practice. Design: Descriptive qualitative study. Methods: Registered nurses were recruited from one 16‐chair regional Australian haemodialysis clinic. Eligible nurses were drawn from a larger study investigating the feasibility of implementing point‐of‐care ultrasound in haemodialysis. Participants attended a semistructured one‐on‐one interview where they were asked about their experiences with, and perceptions of, point‐of‐care ultrasound use in haemodialysis cannulation. Audio‐recorded data were transcribed and inductively analysed. Findings: Seven of nine nurses who completed the larger study participated in a semistructured interview. All participants were female with a median age of 54 years (and had postgraduate renal qualifications. Themes identified were as follows: (1) barriers to use of ultrasound; (2) deficit and benefit recognition; (3) cognitive and psychomotor development; and (4) practice makes perfect. Information identified within these themes were that nurses perceived that their experience with point‐of‐care ultrasound was beneficial but recommended against its use for every cannulation. The more practice nurses had with point‐of‐care ultrasound, the more their confidence, dexterity and time management improved. Conclusions: Nurses perceived that using point‐of‐care ultrasound was a positive adjunct to their cannulation practice and provided beneficial outcomes for patients. Implications for the Profession and/or Patient Care: Haemodialysis clinics seeking to implement point‐of‐care ultrasound to help improve cannulation outcomes may draw on these findings when embarking on this practice change. Reporting Method: This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution: Patients were not directly involved in this part of the study; however, they were involved in the implementation study. Trial and Protocol Registration: The larger study was registered with Australian New Zealand Clinical Trials Registry: ACTRN12617001569392 (21/11/2017) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373963&isReview=true [ABSTRACT FROM AUTHOR]

The article discusses study to engage young adults with type 1 diabetes (T1D) who have self-reported low motivation and suboptimal blood glucose control in a specifically tailored Guided Self-Determination online program. It mentions perspectives of the young adults and their diabetes educators on the program. It adds website design issues relating to an inability to save material.

Aims and objectives To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Background Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. Design A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. Methods The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. Results A 96% response rate was achieved ( n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Conclusion Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Relevance to clinical practice Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 24 year old woman with diabetes. Topics discussed include consultation with a psychologist for high level of diabetes-related anxiety, use of sensor-augmented pump therapy for treating fear of hypoglycaemia during sleep, and managing her diabetes and anxiety with Guided Self-Determination (GSD) program.

Aims and objectives To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Background Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Design Discursive paper. Methods Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. Conclusion The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. Relevance to clinical practice All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy. [ABSTRACT FROM AUTHOR]

currey j., considine j. & khaw d. (2011) Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing. Journal of Advanced Nursing 67(9), 2275-2283. Abstract Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion. The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing. [ABSTRACT FROM AUTHOR]

Background. Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses’ perceptions of assuming responsibility for such patients. An understanding of nurses’ perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports. Aim. The aim of this study was to describe critical care nurses’ perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. Design. An exploratory descriptive study based on naturalistic decision-making. Methods. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called ‘Framework’ were used to analyse the interview transcripts. Results. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making. Conclusion. Nurses’ previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Relevance to clinical practice. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients. [ABSTRACT FROM AUTHOR]

Aim(s): To explore the published research related to nurses' documentation and use of vital signs in recognising and responding to deteriorating patients. Design: Scoping review of international, peer‐reviewed research studies. Data Sources: Cumulative Index to Nursing and Allied Health Literature Complete, Medline Complete, American Psychological Association PsycInfo and Excerpta Medica were searched on 25 July 2023. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews. Results: Of 3880 potentially eligible publications, 32 were included. There were 26 studies of nurses' vital sign documentation: 21 adults and five paediatric. The most and least frequently documented vital signs were blood pressure and respiratory rate respectively. Seven studies focused on vital signs and rapid response activation or afferent limb failure. Five studies of vital signs used to trigger the rapid response system showed heart rate was the most frequent and respiratory rate and conscious state were the least frequent. Heart rate was least likely and oxygen saturation was most likely to be associated with afferent limb failure (n = 4 studies). Conclusion: Despite high reliance on using vital signs to recognise clinical deterioration and activate a response to deteriorating patients in hospital settings, nurses' documentation of vital signs and use of vital signs to activate rapid response systems is poorly understood. There were 21studies of nurses' vital sign documentation in adult patients and five studies related to children. Implications for the profession and/or patient care: A deeper understanding of nurses' decisions to assess (or not assess) specific vital signs, analysis of the value or importance nurses place (or not) on specific vital sign parameters is warranted. The influence of patient characteristics (such as age) or the clinical practice setting, and the impact of nurses' workflows of vital sign assessment warrants further investigation. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: Many dedicated Coronary Care Units (CCUs) in Victoria, Australia, have been decommissioned and replaced with larger combined generic medical/cardiac precincts called hybrid units. Hybrid units are staffed with a low proportion of specialist critical care nurses. These changes may pose risks to nurse satisfaction and retention, and quality of patient care. The aims of this study were to explore specialist cardiac nurses' perceived work satisfaction across four CCUs, and differences in satisfaction between dedicated and hybrid CCUs. Methods: This concurrent mixed methods study comprised two Phases in four Victorian CCUs (2 dedicated, 2 hybrid). In Phase 1, 74 specialist cardiac nurses completed the Professional Practice Environment (PPE) Scale. In Phase 2, 17 specialist cardiac nurses were interviewed to further explore elements of the PPE subscales. Descriptive, inferential (Phase 1), and content analyses (Phase 2) were performed. Results: Survey participants' median age was 38 years (IQR 30, 45). The median PPE Scale score was 3.10 (IQR 2.90, 3.10) indicating high levels of satisfaction with their workplaces. Specialist cardiac nurses in one hybrid unit were significantly less satisfied compared with each of the other three units (p < 0.05). There were no significant differences in overall satisfaction or in any subscale of the PPE Scale between dedicated and hybrid units. Qualitative data revealed nurses in hybrid units felt they had less control over practice, lacked autonomy, had poor relationships with physicians, and experienced inadequate nurse leadership. Conclusions: Specialist cardiac nurses' workplace satisfaction overall is high, with no significant differences between dedicated and hybrid CCUs. However, the structure of specialist cardiac units and NUM leadership skill level can impact nurses' satisfaction with their workplace and collegial relationships. Strong nursing leadership that is respectful of nursing expertise and places patient safety foremost positively impacts nurses' satisfaction. Further studies should assess the impact of the types of CCUs and NUM leadership on workforce factors such as nurse retention rates and patient outcomes such as adverse events. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has been used in various vascular access contexts; however, to date, it has not been widely adopted in haemodialysis clinics. People with end-stage kidney disease receiving haemodialysis require an arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous access device (CVAD) in order to access their blood for therapy/treatment. Cannulation issues, such as haematoma and extravasation, related to AVFs and AVGs are common. This pilot and feasibility study will assess the feasibility of a randomised controlled trial aimed at evaluating whether POCUS-guided cannulation results in more successful and accurate AVF needle placement than the standard practice of blind cannulation. Methods: A controlled, random order crossover design will be used to evaluate two clinical conditions: (1) POCUS-guided cannulation and (2) standard practice of blind cannulation, when used by haemodialysis nurses. The feasibility of conducting this type of trial for these two clinical conditions will be assessed through recruitment, retention, and attrition rates; perceptions of acceptability; implementation measures; and assessment of methods of data collection. Clinical outcomes to be assessed are overall cannulation success on first attempt, accuracy of needle tip placement, number of extravasations, procedural time, and patient and nurse perceptions. The setting is a 16-chair dialysis unit in regional Australia. Participants will include adult haemodialysis patients with an AVF in situ for greater than 2 months and haemodialysis-trained registered nurses working full- or part-time. Clinical outcomes will be analysed using generalised linear mixed models. Feasibility data will be reported using descriptive statistics. Qualitative audio data will be digitally recorded, transcribed verbatim, and analysed using thematic analysis. Discussion: Point-of-care ultrasound for cannulation has the potential to promote high-quality, safe nursing care and decrease cannulation damage for patients on haemodialysis. Due to the lack of evidence for patient benefit and its innovative and niche use in haemodialysis centres, POCUS is currently only specified in one international guideline. This study will inform sample size calculations for a future multi-site trial. Trial registration: Australian New Zealand Clinical Trials Registry, (21/11/2017) ACTRN12617001569392 [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) for access assessment and guided cannulation has become more common in hemodialysis units. The aims of this scoping review were to determine: circumstances in which renal nurses and technicians use POCUS; the barriers and facilitators; and evidence of the effects of POCUS in guiding assessment and cannulation. A search was conducted of CINAHL, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ProQuest, Trove and Google Scholar as grey literature sources. Of 1904 publications, 21 studies met inclusion criteria (11 full text and 10 abstracts). These included primary research publications (n = 5), clinical observational cohort studies (n = 5), case studies (n = 3), published guidelines (n = 2), and published position papers (n = 6). POCUS was used for: assessing arteriovenous fistula (AVF) maturation; identifying landmarks and abnormalities; assessing alternate cannulation sites; performing new AVF cannulation; performing difficult cannulation; increasing cannulation accuracy; performing cannulation through stents; and patient self-cannulation training. There were scant data on the barriers to, and facilitators of the use of POCUS, and a distinct lack of empirical evidence to support its use. These knowledge gaps highlight the need for further clinical studies, particularly randomized clinical trials, to test the effectiveness of POCUS in hemodialysis for assessment and guided cannulation. [ABSTRACT FROM AUTHOR]

Background: Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. Objectives: To explore critical care nurses' knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. Methods: A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care. Results: Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed 'as required' or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Conclusion: Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care. [ABSTRACT FROM AUTHOR]

Aim: To examine nursing handover of vital signs during patient care transition from the emergency department (ED) to inpatient wards. Background: Communication failures are a leading cause of patient harm making communication through clinical handover an international healthcare priority. The transition of care from ED to ward settings is informed by nursing handover. Vital sign abnormalities in the ED are associated with clinical deterioration following hospital admission. Understanding the role and perceived value of vital sign content in clinical handover is important for patient safety. Methods: An integrative design was used. A search of electronic databases was undertaken using MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and SCOPUS. Identified records were screened to elicit further studies for inclusion. A comprehensive peer‐review screening process was performed. Studies were included that described the surrounding issues of handover, vital signs, ED, transition of care and ward. Results: Five studies were included in the final review, one specific to nursing and four specific to emergency medicine. Vital signs were perceived to be an important inclusion in clinical handover, and the communication of vital signs in handover was perceived to be indicators for patient safety and risk factors for future clinical deterioration. The ED environment had an influence on effective communication within handover. Conclusions: Vital signs were an important inclusion for clinical handover. Deficiencies in vital sign content were perceived to be risk factors for patient adverse events following hospital admission. The quality of vital sign information in clinical handover may be important for accurate decision‐making. Relevance to clinical practice: Vital signs are an important component of clinical handover and are perceived to be indicators for patient safety and risk of future adverse events. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore nurses' documentation of physiological observations in acute care; emergency department, medical and surgical units. Background. In Australia, physiological observations include respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness. There is a clear relationship between abnormal physiological observations and adverse events. Nurses have highest level of responsibility for accurate measurement, interpretation and documentation of physiological observations. Design. A descriptive exploratory design was used and the study data were collected using a prospective point prevalence approach between 25 July 2012-22 August 2012. Methods. The study was conducted in the emergency department, two 30-bed medical units and one 30-bed surgical unit of a 578 bed public health service in Melbourne, Australia. All adult patients aged >18 years present during data collection periods were eligible for inclusion. Patients in the emergency department resuscitation area were excluded. Patient characteristics and physiological observations for the preceding 24 hours in ward patients or eight hours in emergency department patients were collected. Results. One hundred and seventy-eight patients were included; 38 emergency department patients, 84 medical patients and 56 surgical patients. The median age was 72-5 years and 43-8% were males. The most frequently documented physiological observations were respiratory rate, oxygen saturation, heart rate and systolic blood pressure. The least frequently recorded physiological observations were temperature and conscious state. One or more abnormal physiological parameters was documented in 79-8% (n = 142) patients; evidence of reporting abnormalities was documented in 19-7% of patients (n = 28/142). When controlled for length of stay, physiological observations were more frequently documented in the emergency department. Conclusions. There was variability in the number of parameters documented and frequency of physiological observations documented by nurses. Relevance to clinical practice. Physiological abnormalities that do not necessarily fulfil rapid response team activation criteria are common in acute care patients and provide nurses with an opportunity for early recognition of deteriorating patients. [ABSTRACT FROM AUTHOR]

Background The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing. Methods A consensus conference with workgroup sessions, consisting of 77 nurse participants with clinical experience in cardiothoracic transplantation, was arranged. This was followed by subsequent discussion with the ISHLT Nursing, Health Science and Allied Health Council. Evidence and expert opinions regarding key issues were reviewed. A modified nominal group technique was used to reach consensus. Results Consensus reached included: (1) a minimum of 2 years nursing experience is required for transplant coordinators, nurse managers or advanced practice nurses; (2) a baccalaureate in nursing is the minimum education level required for a transplant coordinator; (3) transplant coordinator–specific certification is recommended; (4) nurse practitioners, clinical nurse specialists and nurse managers should hold at least a master’s degree; and (5) strategies to retain transplant nurses include engaging donor call teams, mentoring programs, having flexible hours and offering career advancement support. Future research should focus on the relationships between staffing levels, nurse education and patient outcomes. Conclusions Delineation of roles and guidelines for education, certification, licensure and staffing levels of transplant nurses are needed to support all nurses working at the fullest extent of their education and licensure. This consensus document provides such recommendations and draws attention to areas for future research. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the use and student outcomes of Team‐Based Learning in nursing education. Background: Team‐Based Learning is a highly structured, evidence‐based, student‐centred learning strategy that enhances student engagement and facilitates deep learning in a variety of disciplines including nursing. However, the breadth of Team‐Based Learning application in nursing education and relevant outcomes are not currently well understood. Design: A scoping review of international, peer‐reviewed research studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews. Methods: The following databases were searched on 7 May 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO and Education Resources Information Center. Search terms related to nursing, education and Team‐Based Learning. Original research studies, published in English, and reporting on student outcomes from Team‐Based Learning in nursing education programmes were included. Results: Of the 1081 potentially relevant citations, 41 studies from undergraduate (n = 29), postgraduate (n = 4) and hospital (n = 8) settings were included. The most commonly reported student outcomes were knowledge or academic performance (n = 21); student experience, satisfaction or perceptions of Team‐Based Learning (n = 20); student engagement with behaviours or attitudes towards Team‐Based Learning (n = 12); and effect of Team‐Based Learning on teamwork, team performance or collective efficacy (n = 6). Only three studies reported clinical outcomes. Conclusions: Over the last decade, there has been a growing body of knowledge related to the use of Team‐Based Learning in nursing education. The major gaps identified in this scoping review were the lack of randomised controlled trials and the dearth of studies of Team‐Based Learning in postgraduate and hospital contexts. Relevance to clinical practice: This scoping review provides a comprehensive understanding of the use and student outcomes of Team‐Based Learning in nursing education and highlights the breadth of application of Team‐Based Learning and variability in the outcomes reported. [ABSTRACT FROM AUTHOR]

The Medical Emergency Team (MET) has enhanced the recognition and response to clinical deterioration in acute healthcare. However, patients reviewed by the MET are at increased risk of in-hospital death. Identifying patients at risk of deterioration may improve patient outcomes. To identify patient demographic, medical characteristics and healthcare systems and processes at the time of admission (baseline), associated with Medical Emergency Team (MET) review within 48 h (MET-48 h) of admission. Single-site, year-long, retrospective cohort comprising patients admitted for at least 24 h, using routinely collected hospital data. A three-stage modelling approach was used to identify baseline factors associated with MET-48 h The study included 15,695 patients with mean age 62.1 years (SD 19.6), male (53.5%), born in Australia or New Zealand (60.9%) and 51.6% held a low-income concession card. A total of 4.3% of patients received a MET review within 48 h of admission. Variables independently associated with MET-48 h in a fully adjusted logistic model included age of 80 years or more (OR = 1.37); ≥3 previous emergency admissions (OR = 1.59); Charlson Comorbidity Index 1 or 2 (OR = 1.47), or ≥ 3 (OR = 1.99); history of alcohol-related behaviour concerns (OR = 2.04), chronic heart failure (OR = 1.48); chronic obstructive pulmonary disease (OR = 1.35); admission for colorectal (OR = 2.66) or upper gastro-intestinal (OR = 1.94) surgery, respiratory or tracheostomy (OR = 2.24); immunology and infections (OR = 1.90); emergency admission (OR = 1.36); admission at night (OR = 1.74), or summer (OR = 1.41) This is the first study to demonstrate the potential to predict clinical deterioration using data that is readily accessible at the time of admission to hospital. • At admission, patient diagnosis, comorbidities are associated with later MET review. • Charlson Score 1–2 or ≥ 3; 3+ prior emergency admissions; are important risk factors. • MET risk double in admissions for colorectal, respiratory, upper GI or infection. • Health system factors including time or season of admission associated with MET. • Associations similar for MET within 48 or 72 h of admission. [ABSTRACT FROM AUTHOR]

Aims To examine the relationship between physiological status at the emergency department-ward interface and emergency calls (medical emergency team or cardiac arrest team activation) during the first 72 hours of hospital admission. Background Ward adverse events are related to abnormal physiology in emergency department however the relationship between physiology at the emergency department-ward interface and ward adverse events is unknown. Design Descriptive and exploratory design. Methods The study involved 1980 patients at three hospitals in Melbourne Australia: i) 660 randomly selected adults admitted via the emergency department to medical or surgical wards during 2012 and who had an emergency call; and ii) 1320 adults without emergency calls matched for gender, triage category, usual residence, admitting unit and age. Results/findings The median age was 78 years and 48·8% were males. The median time to the first emergency call was 18·8 hours and ≥1 abnormal parameters were documented in 34·9% of patients during the last hour of ED care and 47·1% of patients during first hour of ward care. Emergency calls were significantly more common in patients with heart rate and conscious state abnormalities during the last hour of emergency care and abnormal oxygen saturation, heart rate or respiratory rate during the first hour of ward care. Medical emergency team afferent limb failure occurred in 55·3% patients with medical emergency team activation criteria during first hour of ward care. Conclusion The use of physiological status at the emergency department-ward interface to guide care planning and reasons for and outcomes of medical emergency team afferent limb failure are important areas for future research. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients. [Copyright &y& Elsevier]