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Emergency nurses are the first clinicians to see patients in the ED; their practice is fundamental to patient safety. To reduce clinical variation and increase the safety and quality of emergency nursing care, we developed a standardised consensus-based emergency nurse career pathway for use across Australian rural, regional, and metropolitan New South Wales (NSW) emergency departments. An analysis of career pathways from six health services, the College for Emergency Nursing Australasia, and NSW Ministry of Health was conducted. Using a consensus process, a 15-member expert panel developed the pathway and determined the education needs for pathway progression over six face-to-face meetings from May to August 2023. An eight-step pathway outlining nurse progression through models of care related to different ED clinical areas with a minimum 172 h protected face-to-face and 8 h online education is required to progress from novice to expert. Progression corresponds with increasing levels of complexity, decision making and clinical skills, aligned with Benner's novice to expert theory. A standardised career pathway with minimum 180 h would enable a consistent approach to emergency nursing training and enable nurses to work to their full scope of practice. This will facilitate transferability of emergency nursing skills across jurisdictions. [ABSTRACT FROM AUTHOR]

Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis is a major cause of morbidity and mortality in children. The aim of this study was to explore assessment and management of children aged between 6 and 48 months presenting to the emergency department (ED) with acute gastroenteritis. This retrospective cohort study included 340 children aged 6–48 months. Data were collected by medical record audit for children presenting between 1 January and 31 December 2019. General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies. ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. There was variability in the management of children with moderate dehydration and Australian Aboriginal children but it is unclear whether this is suboptimal or patient specific care. This study has highlighted areas for further research in this unique context. [ABSTRACT FROM AUTHOR]

To determine the impact implementation of Emergency Department Clinical Emergency Response System (EDCERS) on inpatient deterioration events and identify contributing causal factors. EDCERS was implemented in an Australian regional hospital, integrating a single parameter track and trigger criteria for escalation of care, and emergency, specialty and critical care clinician response to patient deterioration. In this controlled pre-post study, electronic medical records of patients who experienced a deterioration event (rapid response call, cardiac arrest or unplanned intensive care admission) on the ward within 72 h of admission from the emergency department (ED) were reviewed. Causal factors contributing to the deteriorating event were assessed using a validated human factors framework. Implementation of EDCERS reduced the number of inpatient deterioration events within 72 h of emergency admission with failure or delayed response to ED patient deterioration as a causal factor. There was no change in the overall rate of inpatient deterioration events. This study supports wider implementation of rapid response systems in the ED to improve management of deteriorating patients. Tailored implementation strategies should be used to achieve successful and sustainable uptake of ED rapid response systems and improve outcomes in deteriorating patients. [ABSTRACT FROM AUTHOR]

Shared decision-making supports women's choices in pregnancy. Women with high body mass index (≥35 kg/m2) experience a high rate of interventions in pregnancy, labour, and birth, providing an opportunity for clinicians to implement shared decision-making in practice. However, weight stigma may limit women's opportunities for shared decision-making. To understand how pregnant women with high body mass index perceive their involvement in antenatal decision-making, including whether weight stigma influences their experience. Women with high body mass index were recruited via purposive sampling from two sites in Melbourne, Australia. Semi-structured interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Ten pregnant women consented to participate. Three themes and six sub-themes were identified. These were: 1) Trusting the system, 2) Who takes the lead?, and 3) Defying disease. Shared decision-making is limited for women with high body mass index in antenatal care, and weight stigma is experienced by women. Clinical practice recommendations relating to excess weight have the potential to further limit women's involvement in decision-making if adequate support is not provided to ensure women's understanding and involvement in care. Women's involvement in care is a central component of shared decision-making and it is currently limited for women with high body mass index. Transparency regarding the rationale for recommendations is required, and further work must be done to address the influence and impact of weight stigma on the care of women with high body mass index. [ABSTRACT FROM AUTHOR]

• Hospitalized patients in isolation experience adverse mental health and physical outcomes. • Music therapy and psychological interventions have been investigated but the quality the evidence is poor. • Improved communication and increased contact between staff and patients and their families is needed, including regular monitoring of patient's mental wellbeing as part of standard care. • Comprehensive multi-faceted interventions might be an appropriate and effective way to manage patients in isolation which needs to be investigated in high quality studies. Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes. To summarize the effects of interventions to improve safety and outcomes for patients in isolation Systematic review (PROSPERO protocol registration - CRD42020222779). Acute hospital Intervention studies including patients in preventative or protective isolation in a single room. MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality. We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. Samples sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed. There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients. [ABSTRACT FROM AUTHOR]

Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3–78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6–86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4–40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability. Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE. [ABSTRACT FROM AUTHOR]

Undetected clinical deterioration is a major cause of high mortality events in Emergency Department (ED) patients. Yet, there is no known model to guide the recognition and response to clinical deterioration in the ED, integrating internal and external resources. An integrative review was firstly conducted to identify the critical components of recognising and responding to clinical deterioration in the ED. Components identified from the review were analysed by clinical experts and informed the development of an ED Clinical Emergency Response System (EDCERS). Twenty four eligible studies were included in the review. Eight core components were identified: 1) vital sign monitoring; 2) track and trigger system; 3) communication plan; 4) response time; 5) emergency nurse response; 6) emergency physician response; 7) critical care team response; and 8) specialty team response. These components informed the development of the EDCERS protocol, integrating responses from staff internal and external to the ED. EDCERS was based on the best available evidence and considered the cultural context of care. Future research is needed to determine the useability and impact of EDCERS on patient and health outcomes. [ABSTRACT FROM AUTHOR]

• Nurses' ratings of context suggest a positive setting for evidence implementation. • Nurse and hospital characteristics impact ratings of work context. • Outcomes did not differ in EDs with high or low work context. • Contextual aspects beyond those of The Alberta Context Tool need to be assessed. Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. To identify how context affects the provision of stroke care in 26 Australian EDs. Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs. [ABSTRACT FROM AUTHOR]

Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge' perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients. A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis. Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management. Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED. [ABSTRACT FROM AUTHOR]

Emergency nurses work consecutive, rotating shift patterns. However, how their occupational physical activity levels are associated between these shifts is unknown. This study aimed to examine the associations between emergency nurses' time spent in different activity levels across one shift and the following day's shift. Fifty emergency nurses (45 female, five male) wore an ActiGraph accelerometer and completed work and sleep diaries across four weeks in 2018. A sub-sample (n = 42) also wore an activPAL inclinometer. Time spent sedentary, physically active, and in postural positions was determined. Multi-level analyses examined associations between one shift and the following day's shift. Additional time spent sedentary and in light-intensity physical activity during the first shift was associated with more time spent being physically active in the following day's shift for all rotations except back-to-back night shifts. However, additional time spent engaged in moderate- to vigorous-intensity physical activity during the first shift was associated with less time spent physically active in the following day's shift for afternoon-morning and morning-afternoon rotations. These findings demonstrate that shift sequences may impact emergency nurses' physical activity across shifts. Future research should identify the strategies emergency nurses use to maintain activity levels between shifts. [ABSTRACT FROM AUTHOR]

• What is already known about this topic? The standard of the initial patient assessment is critical to the quality and safety of healthcare, particularly as emergency patients often have extended wait times for medical review. Currently, there is no widely used structured approach to patient assessment for emergency nurses and consequently there exists great variability in the quality and documentation of patient assessments. • What does this paper add to the currently published literature? HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration for use by US emergency nurses. • What is the most important implication for clinical emergency nursing practice? HIRAIDTM could provide an evidence-based solution to improve the consistency and quality of emergency nursing in an increasingly inexperienced workforce. Successful uptake requires training and organizational support. Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAIDTM , an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAIDTM resulted in significant improvements to nurse-led communication and reduced adverse patient events. First, to explore United States (US) emergency nurses' perceptions of the evidence-informed emergency nursing framework, HIRAIDTM; second, to determine factors that would influence the feasibility and adaptability of HIRAIDTM into nursing clinical practice in EDs within the US. A cross-sectional cohort study using a survey method with a convenience sample was conducted. A 4-hour workshop introduced the HIRAIDTM framework and supporting evidence at the Emergency Nurses Association's (ENA) conference, Emergency Nursing 2022. Surveys were tested for face validity and collected information on nurse-nurse communication, self-efficacy, the practice environment and feedback on the HIRAIDTM framework. The workshop was attended by 48 emergency nurses from 17 US States and four countries. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment. HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organizational support. HIRAIDTM training should incorporate face-to-face interactive workshops. [ABSTRACT FROM AUTHOR]

Timely, evidence-based emergency care for sepsis saves lives. The primary aim of this systematic review was to examine the effect of implementation of guidelines for the ED management of sepsis on time to antibiotic administration. Secondary aims were to examine changes in evidence-based sepsis care and patient outcomes. In August 2018, we performed a systematic literature review of English language publications from 1st January 2002 and 31st July 2018 indexed in a number of academic databases using search terms related to sepsis, emergency care, guidelines and evidence-based practice. Twenty-four studies were included for analysis: all used longitudinal repeated-measures cohort study designs. The studies were of low-to-moderate methodological quality. Of the 24 studies included, 22 (92%) reported decreases in antibiotic administration times and two (8%) reported an increase in antibiotic administration time. All eight studies measuring compliance to completing all components of the sepsis guidelines, as well as all 12 studies measuring lactate sampling reported improvements in antibiotic administration times. Reductions in inpatient mortality ranging from 0.8% to 30.4% were reported in 12 studies and two studies reported increases. Implementation of local sepsis management guidelines in EDs improves the timeliness of processes of care and may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Intensive care nurses care for critically ill patients in a complex, fast paced environment. Management of noradrenaline (norepinephrine) is core business for intensive care nurses and nurse decision-making on noradrenaline is poorly understood. The study objective was to investigate decision-making processes nurses use when caring for intensive care unit patients receiving noradrenaline. A qualitative exploratory design used the Cognitive Continuum Theory as a framework for naturalistic observations and interviews in t wo medical/surgical intensive care units in Melbourne, Australia. Observational and interview data from field notes and audiovisual recordings were transcribed and coded to develop themes using reflexive thematic analysis. Fourteen nurse and patient dyads were recruited to observational sessions from December 2019 to June 2021. Three major themes developed were Learning through doing; Individualised patient care; and Clinical expertise, with six supporting sub-themes. Nurses learned to manage noradrenaline experientially and developed titration and weaning strategies to support decision-making. Blood pressure targets and monitor alarms were used consistently to aid decision-making processes. Nurses were observed practicing across the cognitive continuum depending on knowledge structure, complexity of interventions, response time, and patient acuity. Experiential learning of complex and high-risk interventions in the absence of guidelines or algorithms meant nurses developed their own titration and weaning strategies based on constant evaluation and re-evaluation of patient cues. Patient heterogeneity, cue ambiguity and a dynamic practice environment contributed to decision-making complexity that would benefit from development of evidence-based practice resources. Nurses learn to manage noradrenaline through experiential learning, using blood pressure targets and monitor alarms to support decision-making when titrating and weaning noradrenaline. Nurses develop noradrenaline titration and weaning strategies to support decision-making in the absence of guidelines or algorithms. Supporting nurse decision-making and streamlining practice would reduce practice variation and cognitive workload. [ABSTRACT FROM AUTHOR]

Recognising and responding to clinical deterioration is a safety priority. The aim of this study was to determine the frequency, nature, and response of emergency department Nursing Shift Leaders to episodes of escalation of care for patient clinical deterioration. A prospective exploratory descriptive design was used. Participants were recruited from the senior nurses at the study site that fulfilled the role of being in charge of the ED. Study data were collected between 29 October and 17 December 2015 across various shifts using an observation tool developed specifically for this study. This study had three major findings. First, escalation of care for clinically deteriorating patients to the Nursing Shift Leader occurs frequently. There were 37 observed escalations of care, equating to 1.02 episodes per hour. Second, Nursing Shift Leaders rely on clinical emergency nursing skills to recognise, prioritise and respond to escalation of care for clinically deteriorating patients. Finally, the Nursing Shift Leaders' role in responding to escalation of care for clinical deterioration is multifaceted. The Nursing Shift Leaders' role in responding to escalation of care for clinical deterioration is complex and includes navigation of a multifaceted team environment and logistical challenges unique to the time pressured, unpredictable ED milieu. [ABSTRACT FROM AUTHOR]

Research is vital to responding to contemporary challenges of providing safe, high quality emergency nursing care, yet the research priorities for emergency nursing practice in Australia are unknown. This study aimed to establish research priorities for emergency nursing in Australia. A two-stage descriptive, exploratory study was conducted. First, research themes were identified through a survey of 232 emergency nurses the Delphi Technique (2 rounds) was used to rank and prioritise the research themes. There were five research themes with a CVI ≥ 0.90: (i) recognising and responding to deteriorating ED patients; (ii) effect of access block on clinical care of admitted ICU patients; (iii) effects of ED overcrowding on clinical care; (iv) scope of practice of specialist emergency nurses; and (v) effect of access block on clinical care of admitted ward patients. These are reflected in four broad research priority areas: professional issues, patient safety, emergency care of vulnerable populations, and healthcare system issues. Future research should focus on these priority areas in partnership with other emergency disciplines to enable safe, high quality emergency care, and, to inform the practice of emergency nursing in Australia. [ABSTRACT FROM AUTHOR]

Background Effective hospital-wide antimicrobial stewardship (AMS) programs need multidisciplinary engagement; however, clinicians' attitudes have not been investigated in Thailand where AMS is in early development. The aim of this study was to explore Thai clinicians' (doctors, nurses, and pharmacists) perceptions and attitudes toward AMS. Methods A paper-based survey was distributed in a 1,000-bed university hospital in Bangkok, Thailand, between November 9, 2015, and December 21, 2015. A total of 1,087 clinicians participated: 392 doctors, 613 nurses, and 82 pharmacists. Results Most participants agreed that improving antimicrobial prescribing would decrease antimicrobial resistance (AMR) and should be a priority of hospital policy. Doctors were less likely to agree with policies that limit antimicrobial prescribing ( P  < .001) than nurses or pharmacists, and were less likely to be interested in participating in AMS education than other clinicians ( P  < .001). Pharmacists indicated higher agreement with the statement, recommending that a specialist team provide individualized antimicrobial prescribing advice ( P  < .01) and that feedback improves antimicrobial selection ( P  < .001). Nurses were less likely to agree that community antibiotic use ( P  < .001) or patient pressure for antibiotics contribute to AMR ( P  < .001). Conclusions AMS programs are vital to improving antimicrobial use by clinicians. Understanding clinicians' attitudes and perceptions related to AMS is important to ensure that AMS programs developed address areas relevant to local clinical needs. [ABSTRACT FROM AUTHOR]

Introduction Older persons aged over 65 years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. Methods A 12-month retrospective medical record audit of persons over 65 years presenting to four EDs. Results Data from 44,774 (26.6%) patients aged 65 years and over were analysed. Patients with acute conditions presented more frequently (n = 30,373; 67.8%), received more urgent triage categories (n = 13,471; 30.1%) and had higher admission rates (n = 18,332; 61%). Chronic conditions presented less frequently (n = 14,396; 32.1%) and had higher discharge rates (n = 9302; 65%). Patients over 80 years were allocated more urgent triage categories and commonly presented with falls (n = 3814; 8.5%). Patients between 65 and 79 years had a higher discharge rate (n = 10,397; 46.1%). Conclusion Older persons with acute illnesses were more likely to be admitted than those with chronic conditions and who were more likely to be discharged home. There is scope for further investigation of new models of care to better manage older persons with chronic conditions and ED discharge practices. [ABSTRACT FROM AUTHOR]

Background Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses’ knowledge and self-assessment of care for older patients is poorly understood. Aim To assess emergency nurses’ knowledge and self-rating of practice when caring for older patients. Methods A cross-sectional self-report survey of emergency nurses (n = 101) in Melbourne, Australia. Results Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as ‘very good’ or ‘good’ in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a ‘poor’ ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). Conclusions There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration. [ABSTRACT FROM AUTHOR]

The purpose of research is to discover new knowledge. All good research starts with a clear, answerable question that addresses an important and significant problem or phenomenon of interest. In this paper, emergency nurses and other clinicians will be provided with a practical guide to successfully developing a quality research question as the basis of quality research. In this paper, how to plan and prepare question development using the PICO Framework, develop a literature search strategy, and perform a search, extracting and analysing information will be detailed. [ABSTRACT FROM AUTHOR]