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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., (Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Background: Early acute coronary syndrome (ACS) care occurs in the emergency department (ED). Death and disability from ACS are reduced with access to evidence-based ACS care. In this study, we aimed to explore if gender influenced access to ACS care., Methods: A retrospective descriptive study was conducted for 288 (50% women, n=144) randomly selected adults with ACS admitted via the ED to three tertiary public hospitals in Victoria, Australia from 1.1.2013 to 30.6.2015., Results: Compared with men, women were older (79 vs 75.5 years; p=0.009) less often allocated triage category 2 (58.3 vs 71.5%; p=0.026) and waited longer for their first electrocardiograph (18.5 vs 15min; p=0.001). Fewer women were admitted to coronary care units (52.4 vs 65.3%; p=0.023), but were more often admitted to general medicine units (39.6 vs 22.9%; p=0.003) than men. The median length of stay was 4days for both genders, but women were admitted for significantly more bed days than men (IQR 3-7 vs 2-5; p=0.005)., Conclusions: There were a number of gender differences in ED care for ACS and women were at greater risk of variation from evidence-based guidelines. Further research is needed to understand why gender differences exist in ED ACS care., (Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.)

Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care., (Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Research questions require specific data collection techniques to appropriately explore and understand the phenomena of interest. Observation as a term features commonly in the literature as a way to describe both the design of a study and methods deployed within procedures. Observation as a data collection method is a mode of inquiry to systematically collect information about different settings and groups. However, the objective of observation in data collection is to better understand the phenomena of interest situated in context. Specifically, observation data collection can improve understanding of practice, processes, knowledge, beliefs, and attitudes embedded in clinical work and social interactions. This pragmatic paper will assist emergency nurses and other clinicians to understand how observation can be used as a data collection method within clinical practice., (Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Background: Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care., Methods: A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia., Results: When controlled for length of stay, heart rate was the most frequently assessed vital sign per hour (median=0.9) whilst Glasgow Coma Score was the least frequently assessed vital sign per hour (median=0.5). Clinical deterioration (one or more vital signs fulfilling hospital medical emergency team activation criteria during emergency department care) occurred in 14.5% of patients. Of the 5466 vital sign measures, 19.6% were abnormal, 1.9% indicated clinical deterioration., Conclusions: Clinical deterioration occurred in one in seven patients, and one in five vital signs documented were outside of accepted normal ranges. Thus, emergency department physiological status has implications for patient safety and nursing practice, in particular clinical handover for patients requiring hospital admission., (Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Background: The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration., Aim: To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients., Methods: Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey., Results: Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience., Conclusions: Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Background: Emergency nurses have a key role in managing the large numbers of patients that attend Australian emergency departments (EDs) annually, and require adequate educational preparation to deliver safe and quality patient care. This paper provides a detailed profile of nursing resources in Australian EDs, including ED locations, annual patient attendances, nurse staffing including level of education, and educational resources., Methods: Data were collected via online surveys of emergency Nurse Unit Managers and Nurse Educators and the MyHospitals website. Data were analysed by hospital peer group and state or territory. Comparisons were made using the Kruskal-Wallis Test and Spearman Rank Order Correlation., Results: In 2011-2012, there were a median of 36,274 patient attendances to each of the 118 EDs sampled (IQR 28,279-46,288). Most of the nurses working in EDs were Registered Nurses (95.2%). Organisations provided educational resources including Clinical Nurse Educators (80.6%), learning packages (86%) and facilitation of postgraduate study (98%), but resources, both human and educational varied substantially between states and territories. One-third of emergency nurses held a relevant postgraduate qualification (30%)., Conclusion: There are important variations in the emergency nursing resources available between Australian states and territories. The high percentage of RNs in Australian EDs is a positive finding, however strategies to increase the percentage of nurses with relevant postgraduate qualifications are required., (Copyright © 2016 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The impact of limitation of medical treatment orders (LOMT) on patient outcomes following transfer from sub-acute care to the Emergency Department remains unclear., Methods: Retrospective medical record review of 431 adult in-patients who required ambulance transfer following clinical deterioration during a sub-acute care admission during 2010., Results: Common reasons for transfer were respiratory (18.9%) or neurological (19.0%) conditions; 35.7% (154/431) were transferred within one week of sub-acute care admission. LOMT orders were in place for 37.8% (n=163) patients who were older (p<0.001), with more comorbidities (p<0.005), specifically cardiac, renal and pulmonary disease than patients without LOMT. Patients with LOMT orders had more physiological abnormalities before transfer; tachypnoea (43.7% vs 28.6%), hypoxaemia (63.5% vs 48.4%) and severe hypoxaemia (27.6% vs 14.5%). There were no differences in rates of admission, cardiac arrest, Medical Emergency Team activation or ICU admission. For admitted patients, those with LOMT orders had significantly (p≤0.005) higher mortality: in-hospital (21.9% vs 11.3%); 30 days (23.9% vs 12.3%) and 60 days (28.2% vs 13.4%)., Conclusions: Patients with LOMT had higher levels of comorbidity and were more acutely ill during their sub-acute care admission. Once transferred those with a LOMT had similar rates of cardiac arrest, MET activation and unplanned ICU admission, but higher mortality., (Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration., Methods: Retrospective case-controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls)., Results: Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84 beats/min; p=0.008); after 3h in the ED (91 vs. 80 beats/min; p=0.0007); and at ED discharge (91 vs. 81 beats/min; p=0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2 breaths/min; p=0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02-1.12] for each 1 breath/min increase in RR; and 1.02 [95% CI 1.002-1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86-11.65]; p=0.0003) compared with controls., Conclusions: Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED., (Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited., Aims: To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care., Methods: A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random sampling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages., Results: The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7%; 68.8%; 55.3%; 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h; p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044)., Conclusions: A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes., (Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: To date, emergency nursing Transition to Specialty Practice Program (TSPP) evaluations have been single-site observational studies. The aim of this paper was to examine the professional development, recruitment and retention outcomes of Australian emergency nursing TSPPs., Methods: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Unit Managers and Nurse Educators. Survey data from EDs with TSPPs and EDs without TSPPs were compared. Qualitative data were analysed using content analysis., Results: Data were collected from 118 EDs, and 13 interviews. TSPPs were offered in 72.1% of EDs. EDs with TSPPs had higher proportions of nurses with postgraduate qualifications (Mdn 28.3% vs. 22.1%, p=0.45) and Clinical Specialists (Mdn 16.4% vs. 6.3%, p=0.04). The median proportion of currently rostered nurses with TSPP completion was 34.2% in EDs with TSPPs introduced in 2000-2005 indicating ED high levels of retention., Conclusion: Emergency nursing TSPPs have had a positive effect on nursing professional development, recruitment and retention. To ensure consistency in outcomes and optimise reliability of emergency nursing skills and knowledge, a national emergency nursing TSPP framework is needed., (Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings., Methods: In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'., Results: There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation., Conclusion: There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers., (Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Despite many studies of family presence during resuscitation, no validated tool exploring the attitudes and beliefs of healthcare staff towards family presence has been published. The aim of this paper is to describe the development of a tool to accurately measure the attitudes and beliefs of emergency department staff towards family presence in the deteriorating adult patient, present the results of validity and reliability testing, and present the final validated tool. Twenty-nine items were developed, informed by themes from the literature and unvalidated published tools related to family presence during resuscitation. The tool was piloted on a sample of 68 emergency nursing and medical staff. Content validity and face validity were established using feedback from participants. Reliability was established by unidimensionality, exploratory factor analysis and internal consistency. Sixteen items were deleted from the original tool due to low item-to-total correlations and low communalities. Exploratory factor analysis of the remaining items revealed four factors with acceptable correlation coefficients and appropriate explanation of variance. Cronbach's alpha for each factor was >0.7 indicating a high degree of internal consistency. The four factors were labelled and arranged in a logical order to form the final tool, the Emergency Department Family Presence Survey., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Background: Formal processes for recognising and responding to deteriorating emergency department (ED) patients are variable despite features of the ED context that may increase the risk of unrecognised or unreported clinical deterioration. The aim of this study was to determine the frequency and nature of unreported clinical deterioration in emergency care., Methods: A prospective, exploratory descriptive design was used. Data were collected during nine point prevalence surveys (PPS) from 1 May to 30 June 2009 at an urban district hospital in Melbourne Australia. Patients present in ED cubicles during the PPS (n=186) were included in the study., Results: Unreported clinical deterioration occurred in 12.9% of patients (n=24/186). Unreported clinical deterioration was more common when: (i) patients aged ≥65 years comprised >50% of patients within the ED; (ii) occupancy of the resuscitation, monitored or general adult cubicles was >50%; and (iii) the proportion of patients requiring treatment within 30 min (Australasian Triage Category 1, 2 or 3) was ≤50% of the total ED population., Conclusions: Unreported clinical deterioration is an important quality indicator of emergency care. The effect of the collective ED patient group on the frequency and nature of adverse events for individual ED patients is poorly understood and warrants further investigation., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI., Aim: The aim of this paper is to describe the development of an evidence-based care bundle for initial emergency nursing management of patients with severe TBI for use in a Thai ED context., Results: An evidence-based care bundle focused on seven major elements: (1) establish a secure airway along with c-spine protection, (2) maintain adequacy of oxygenation and ventilation, (3) maintain circulation and fluid balance, (4) assessment of GCS, and pupil size and reactivity, (5) maintain cerebral venous outflow, (6) management of pain, agitation, and irritability, and (7) administer for urgent CT scan., Conclusions: A care bundle is one method of promoting consistent, evidence-based emergency nursing care of patients with severe TBI, decreasing unnecessary variations in nursing care and reducing the risk of secondary brain injury from suboptimal care. Implementation of this evidence-based care bundle developed specifically for the Thai emergency nursing context has the potential to improve the care of the patients with severe TBI., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Medication safety is of increasing importance and understanding the nature and frequency of medication errors in the Emergency Department (ED) will assist in tailoring interventions which will make patient care safer. The challenge with the literature to date is the wide variability in the frequency of errors reported and the reliance on incident reporting practices of busy ED staff., Methods: A prospective, exploratory descriptive design using point prevalence surveys was used to establish the frequency of observed medication errors in the ED. In addition, data related to contextual factors such as ED patients, staffing and workload were also collected during the point prevalence surveys to enable the analysis of relationships between the frequency and nature of specific error types and patient and ED characteristics at the time of data collection., Results: A total of 172 patients were included in the study: 125 of whom patients had a medication chart. The prevalence of medication errors in the ED studied was 41.2% for failure to apply patient ID bands, 12.2% for failure to document allergy status and 38.4% for errors of omission. The proportion of older patients in the ED did not affect the frequency of medication errors. There was a relationship between high numbers of ATS 1, 2 and 3 patients (indicating high levels of clinical urgency) and increased rates of failure to document allergy status. Medication errors were affected by ED occupancy, when cubicles in the ED were over 50% occupied, medication errors occurred more frequently. ED staffing affects the frequency of medication errors, there was an increase in failure to apply ID bands and errors of omission when there were unfilled nursing deficits and lower levels of senior medical staff were associated with increased errors of omission., Conclusions: Medication errors related to patient identification, allergy status and medication omissions occur more frequently in the ED when the ED is busy, has sicker patients and when the staffing is not at the minimum required staffing levels., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Team-based learning (TBL) is a highly structured educational strategy that improves student engagement, promotes deeper learning and builds professional skills but has had limited use in nursing education., Aims: To examine participant experiences of TBL using one-off teams in a hospital setting., Method: A prospective exploratory design was used in an urban district hospital in Melbourne, Australia. The sample was 49 registered nurses. The intervention was a TBL-based education program focused on assessment and management of adult patients with isolated distal limb injuries. Data were collected using two instruments that evaluated participant experiences of the narrated slide presentation and participant experiences of learning of using TBL. Quantitative data were analysed using descriptive statistics and thematic analysis was used to analyse the qualitative data., Results: The results revealed two key themes: "quality of learning" and "positive team experience". The presentation was accessed twice or more by 51% of participants. Participants perceived a high quality of learning: 95.5% stated that their learning expectations were met or exceeded. Three quarters of participants (77.5%) commented about the contribution of their team members., Conclusion: Participants in this study thought TBL provided them a positive learning experience, as individuals and as teams. Education methodologies that focus on professional attributes and behaviours in addition to clinical skill are well suited to emergency nursing whereby nurses have to be theoretically prepared for practice and work well in teams., Relevance to Clinical Practice: TBL has a natural synergy with the requirements of advanced nursing practice and offers a positive learning experience that enhances clinical outcomes., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The use of rapid response systems such as Medical Emergency Team (MET) improves recognition and response to clinical deterioration in in-patient settings. However, few published studies have investigated use of rapid response systems in Australian emergency departments (ED)., Aim: To examine the frequency, nature and outcomes of clinical deterioration in ED patients and compare the utility of hospital MET calling criteria with ED specific Clinical Instability Criteria (CIC) for recognition of deteriorating patients. The outcomes of interest were the prevalence of deterioration in ED patients, the utility of MET versus ED CIC, and the outcomes (MET activation, in-hospital mortality at 30 days) of patients who experienced deterioration during ED care., Method: An exploratory descriptive design was used. Vital sign data were prospectively collected from 200 patients receiving ED care in the general treatment areas of regional, publicly funded health service in Victoria, Australia, during May 2012. Outcome data were collected by follow up medical record audit., Results: Of the 200 ED patients recruited, 2% fulfilled the study site MET criteria and 7.5% fulfilled ED CIC. The median age of patients fulfilling MET criteria was 85 years compared with a median age of 74 years for patients fulfilling the ED CIC criteria. Of the 136 ED patients admitted to in-patient wards, 5.9% required MET activation during admission and 3.7% of these MET activations occurred within 24h of emergency admission. Five percent of patients died in-hospital within 30 days of ED attendance., Conclusions: ED specific criteria for activation of a rapid response system identifies more ED patients at risk of clinical deterioration. The results of this study highlight a need for EDs to implement and evaluate systems to increase recognition of deteriorating patients designed specifically for the emergency care context., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: In Thailand, the rate of TBI-related hospitalisation is increasing, however, little is known about the evidence-based management of severe TBI in the developing world. The aim of this study was to explore Thai emergency nurses' management of patients with severe TBI., Methods: An exploratory descriptive mixed method design was used to conduct this two stage study: survey methods were used to examine emergency nurses' knowledge regarding management of patients with severe TBI (Stage 1) and observational methods were used to examine emergency nurses' clinical management of patients with severe TBI (Stage 2). The study setting was the emergency department (ED) at a regional hospital in Southern Thailand., Results: 34 nurses participated in Stage 1 (response rate 91.9%) and the number of correct responses ranged from 33.3% to 95.2%. In Stage 2, a total of 160 points of measurement were observed in 20 patients with severe TBI over 40 h. In this study there were five major areas identified for the improvement of care of patients with severe TBI: (i) end-tidal carbon dioxide (ETCO2) monitoring and targets; (ii) use of analgesia and sedation; (iii) patient positioning; (iv) frequency of nursing assessment; and (v) dose of Mannitol diuretic., Conclusions: There is variation in Thai nurses' knowledge and care practices for patients with severe TBI. To increase consistency of evidence-based TBI care in the Thai context, a knowledge translation intervention that is ecologically valid, appropriate to the Thai healthcare context and acceptable to the multidisciplinary care team is needed., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.)

Background: Much of the literature about emergency nurses willingness to work during disasters has been from a non-Australian perspective. Despite the many recent disasters, little is known of Australian nurse's willingness to participate in disaster response. This paper presents findings from a study that explored nurses willingness to attend work during a disaster and the factors that influenced this decision., Methods: Data were collected consecutively using a combination of focus group and interview methods. Participants in this study, registered nurses from emergency departments, were recruited through convenience sampling from four hospitals in Australia. Participant narrative was electronically recorded, transcribed and thematically analysed., Results: The participants for both the focus groups and interviews compromised a mix of ages, genders and years of experience as emergency nurses from across four jurisdictions within Australia. Three major themes that influenced willingness emerged with a number of subthemes. Theme one reflected the uncertainty of the situation such as the type of disaster. The second theme surrounded the preparedness of the workplace, emergency nurse and colleagues, and the third theme considered personal and professional choice based on home and work circumstances and responsibilities., Conclusions: The decision to attend work or not during a disaster, includes a number of complex personal, work-related and professional factors that can change, depending on the type of disaster, preparedness of the work environment and the emergency nurses' personal responsibilities at that time., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The type of disaster, individual demographic factors, family factors and workplace factors, have been identified in the international, multidisciplinary literature as factors that influence a person's willingness to attend and assist in their workplace during a disaster. However, it is unknown if these factors are applicable to Australasian emergency nurses., Aim: The research aims to determine the extent to which Australasian emergency nurses are willing to attend their workplace in a disaster., Method: This research was exploratory and descriptive study design, using online and paper based surveys as a means of data collection. Australasian emergency nurses from two Australasian emergency nursing colleges and four Australian hospitals were recruited to participate. Data analysis was conducted using both descriptive and inferential statistics., Results: In total, 451 Australasian emergency nurses participated in this research. Participants were more willing to attend their workplace during a conventional disaster (p ≤ 0.001), if they worked full-time (p = 0.01), had received formal education pertaining to disasters (p ≤ 0.001), had a family disaster plan (p = 0.008), did not have children (p = 0.001) and worked in an environment in which they perceived their colleagues, managers and organisation to be prepared., Conclusions: The factors that influenced Australasian emergency nurses to attend their workplace in a disaster were similar to that described in the international multidisciplinary literature. Of particular note, improving disaster knowledge and skills, having a family disaster plan and improving the perceptions of the nurses' workplace preparedness can enhance the nurses' willingness to assist in a disaster., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Emergency nurses play a pivotal role in disaster relief during the response to, and recovery of both in-hospital and out-of-hospital disasters. Postgraduate education is important in preparing and enhancing emergency nurses' preparation for disaster nursing practice. The disaster nursing content of Australian tertiary postgraduate emergency nursing courses has not been compared across courses and the level of agreement about suitable content is not known., Aim: To explore and describe the disaster content in Australian tertiary postgraduate emergency nursing courses., Method: A retrospective, exploratory and descriptive study of the disaster content of Australian tertiary postgraduate emergency nursing courses conducted in 2009. Course convenors from 12 universities were invited to participate in a single structured telephone survey. Data was analysed using descriptive statistics., Results: Ten of the twelve course convenors from Australian tertiary postgraduate emergency nursing courses participated in this study. The content related to disasters was varied, both in terms of the topics covered and duration of disaster content. Seven of these courses included some content relating to disaster health, including types of disasters, hospital response, nurses' roles in disasters and triage. The management of the dead and dying, and practical application of disaster response skills featured in only one course. Three courses had learning objectives specific to disasters., Conclusion: The majority of courses had some disaster content but there were considerable differences in the content chosen for inclusion across courses. The incorporation of core competencies such as those from the International Council of Nurses and the World Health Organisation, may enhance content consistency in curriculum. Additionally, this content could be embedded within a proposed national education framework for disaster health., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Triage nurse initiated X-rays (NIXRs) are safe and effective, however, little is known about the ability of other RNs, particularly those without postgraduate qualifications in emergency nursing, to order NIXRs. The aim of this study was to evaluate an innovative NIXR education programme for emergency nurses., Method: The education programme was multi-faceted, delivered using Team-Based Learning (TBL) and augmented by a decision support checklist. Using a prospective exploratory design, 276 NIXR requests from June to December 2011 were audited. Three groups were compared: (i) RNs with and without postgraduate qualifications irrespective of how they were educated in NIXR, (ii) RNs with and without postgraduate qualifications who undertook the NIXR education programme, and (iii) RNs who did and did not undertake the NIXR programme irrespective of postgraduate qualifications., Results: There were 130 NIXRs by 28 RNs with postgraduate qualifications and 146 NIXRs by 12 RNs without postgraduate qualifications. Analysis of all RNs showed RNs without postgraduate qualifications had higher incidence of appropriate NIXRs (83.6% vs 66.2%, p=0.003) however when controlled for the NIXR education programme, statistical significance was lost (83.6% vs 67.5%, p=0.017). RNs who undertook the NIXR education programme had superior documentation of patient assessment findings and higher incidence of appropriate X-ray requests than RNs who did not undertake the NIXR education programme (80.4% vs 65.2%, p=0.042)., Conclusions: With appropriate educational preparation, RNs without postgraduate qualifications in emergency nursing can safely engage in NIXR. Structured education using TBL and a decision support checklist produces superior assessment and X-ray requests when compared to ad hoc education and role modelling., (Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: There are many Emergency Department (ED) demand management systems that include advanced practice emergency nursing roles. The aim of this study is to examine and compare three advanced emergency nursing practice roles: ED Fast Track, Clinical Initiatives Nurse (CIN) and Rapid Intervention and Treatment Zone (RITZ)., Method: A descriptive exploratory approach was used to conduct this study at an urban district hospital in Melbourne, Australia. The study participants were patients managed in each of the three systems with advanced practice emergency nursing roles: Fast Track, CIN and RITZ., Results: There were a total of 551 patients: 195 Fast Track patients, 163 CIN managed patients and 193 RITZ patients. CIN managed patients were older (p<0.001), with higher levels of clinical urgency (p<0.001), and higher hospital admission rates (p<0.001). CIN managed patients had shorter waiting time for nursing care (p=0.001) and lower incidence of medical assessment within the time associated with their triage category (p<0.0001). ED LOS for discharged patients was significantly longer for CIN managed patients (p<0.001). CIN managed patients had a significantly higher incidence of electrocardiography (p<0.001), blood glucose measurement (p<0.001), intravenous cannulation (p<0.001), pathology testing (p<0.001), and analgesia administration (p<0.001) when compared to Fast Track and RITZ patients., Conclusions: Advanced practice roles in emergency nursing can have different applications in the ED context. Clarity about role intent and scope of practice is important and should inform educational preparation and teams within which these roles operate., (Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)