Pub Date : 2024-09-25DOI: 10.1016/j.auec.2024.09.001
Samantha Ryan , Elizabeth Forster , Bronwyn Griffin
Aim
To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes.
Background
There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked.
Method
Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool.
Results
After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement.
Conclusions
Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. Relevance to practice: There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.
{"title":"A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever","authors":"Samantha Ryan , Elizabeth Forster , Bronwyn Griffin","doi":"10.1016/j.auec.2024.09.001","DOIUrl":"10.1016/j.auec.2024.09.001","url":null,"abstract":"<div><h3>Aim</h3><div>To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes.</div></div><div><h3>Background</h3><div>There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked.</div></div><div><h3>Method</h3><div>Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool.</div></div><div><h3>Results</h3><div>After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement.</div></div><div><h3>Conclusions</h3><div>Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. Relevance to practice: There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 282-289"},"PeriodicalIF":2.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.auec.2024.09.002
Dania Abu Awwad , Noor Akl , Franziska Jerjen , Ernest Ekpo
Background
In emergency presentations, it is not uncommon for patients to present with imaging requests of multiple body regions to detect concurrent injury. While current literature explores diagnostic efficacy of adjacent imaging for forearm fractures, there is limited research on its effectiveness across all extremities. This paper explores the diagnostic yield of X-ray adjacent imaging of the upper and lower limb in paediatric patients.
Methods
A retrospective audit was performed using information available on radiology request forms from paediatric patients (age <18 years) that had multiple X-rays of adjacent body regions over six months at two hospitals. The main or first X-ray was referred to as initial imaging, while all subsequent X-rays of adjacent regions was considered secondary imaging. Clinical history and radiologists’ findings were collected, categorised, and analysed using Chi square.
Results
There were 661 X-rays performed across 277 patients. Initial imaging was significantly more likely to detect injuries or abnormalities (35 %) than X-rays of adjacent regions (1.6 %), with 94 % of all abnormalities detected on initial imaging overall (χ2(3) = 241.247, p < 0.001). X-ray request forms with no clinical symptoms were significantly more likely to have no findings detected (χ2(3) = 53.493, p < 0.001).
Conclusion
X-ray imaging of a body region adjacent to an injury has low diagnostic yield, suggesting the need for interventions to reduce unnecessary adjacent X-ray imaging. Clinical history information was often limited and concurrent injuries were low.
背景在急诊病例中，患者要求对身体多个区域进行成像以检测并发损伤的情况并不少见。虽然目前的文献探讨了前臂骨折邻近成像的诊断效果，但对其在所有四肢的有效性研究有限。方法利用两家医院的儿科患者（年龄小于 18 岁）的放射科申请表上的信息进行了回顾性审核，这些患者在 6 个月内接受了多个身体邻近区域的 X 光检查。主要或首次 X 光检查被称为初次成像，而随后所有相邻区域的 X 光检查则被视为二次成像。结果277名患者共接受了661次X光检查。初次成像发现损伤或异常的几率（35%）明显高于邻近区域的 X 光（1.6%），初次成像发现的异常占所有异常的 94%（χ2(3) = 241.247，P < 0.001）。无临床症状的 X 光申请表未发现异常的几率明显更高（χ2(3) = 53.493，p < 0.001）。临床病史信息通常有限，并发损伤较少。
{"title":"X-ray imaging of multiple adjacent regions in paediatric patients: Potential utility for diagnosis and patient management","authors":"Dania Abu Awwad , Noor Akl , Franziska Jerjen , Ernest Ekpo","doi":"10.1016/j.auec.2024.09.002","DOIUrl":"10.1016/j.auec.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>In emergency presentations, it is not uncommon for patients to present with imaging requests of multiple body regions to detect concurrent injury. While current literature explores diagnostic efficacy of adjacent imaging for forearm fractures, there is limited research on its effectiveness across all extremities. This paper explores the diagnostic yield of X-ray adjacent imaging of the upper and lower limb in paediatric patients.</div></div><div><h3>Methods</h3><div>A retrospective audit was performed using information available on radiology request forms from paediatric patients (age <18 years) that had multiple X-rays of adjacent body regions over six months at two hospitals. The main or first X-ray was referred to as initial imaging, while all subsequent X-rays of adjacent regions was considered secondary imaging. Clinical history and radiologists’ findings were collected, categorised, and analysed using Chi square.</div></div><div><h3>Results</h3><div>There were 661 X-rays performed across 277 patients. Initial imaging was significantly more likely to detect injuries or abnormalities (35 %) than X-rays of adjacent regions (1.6 %), with 94 % of all abnormalities detected on initial imaging overall (χ2(3) = 241.247, p < 0.001). X-ray request forms with no clinical symptoms were significantly more likely to have no findings detected (χ2(3) = 53.493, p < 0.001).</div></div><div><h3>Conclusion</h3><div>X-ray imaging of a body region adjacent to an injury has low diagnostic yield, suggesting the need for interventions to reduce unnecessary adjacent X-ray imaging. Clinical history information was often limited and concurrent injuries were low.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 31-36"},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31DOI: 10.1016/j.auec.2024.08.002
Belinda Kennedy , Kate Curtis , Sarah Kourouche , Louise Casey , Dorothy Hughes , Vivienne Chapman , Margaret Fry
Background
Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice.
Methods
This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework.
Results
The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention.
Conclusion
Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.
{"title":"Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments","authors":"Belinda Kennedy , Kate Curtis , Sarah Kourouche , Louise Casey , Dorothy Hughes , Vivienne Chapman , Margaret Fry","doi":"10.1016/j.auec.2024.08.002","DOIUrl":"10.1016/j.auec.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice.</div></div><div><h3>Methods</h3><div>This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework.</div></div><div><h3>Results</h3><div>The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention.</div></div><div><h3>Conclusion</h3><div>Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 290-298"},"PeriodicalIF":2.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.1016/j.auec.2024.07.001
Claire L. Samanna , Paul Buntine , Daniel L. Belavy , Ron V. Sultana , Clint T. Miller , Vasilios (Bill) Nimorakiotakis , Patrick J. Owen
Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.
人们建议在医疗机构中通过临床实践指南来管理腰背痛，但大量证据表明，在急诊科环境中遵守指南的情况并不理想。公立医院和私立医院在遵守指南方面是否存在差异尚不清楚。对澳大利亚两家急诊科进行的一项回顾性审计将86名私立医院患者和86名公立医院患者按年龄（±5岁）、性别（男/女）和枸杞痛持续时间（首次/有枸杞痛病史）进行了配对。根据澳大利亚枸杞痛治疗临床指南对患者病历进行了审查。对指南进行了单独考量，并通过指南遵守情况集体评分（GAS）进行考量。与公立医院患者相比，私立医院患者的管理 GAS 较低（d [95 %CI]：-0.67 [-0.98, -0.36]，P.
{"title":"Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison","authors":"Claire L. Samanna , Paul Buntine , Daniel L. Belavy , Ron V. Sultana , Clint T. Miller , Vasilios (Bill) Nimorakiotakis , Patrick J. Owen","doi":"10.1016/j.auec.2024.07.001","DOIUrl":"10.1016/j.auec.2024.07.001","url":null,"abstract":"<div><div>Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 276-281"},"PeriodicalIF":2.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1016/j.auec.2024.06.003
Sonja Maria , Marc Colbeck , Matt Wilkinson-Stokes , Adam Moon , Michelle Thomson , Joel Ballard , Lachlan Parker , Fraser Watson , James Oswald
Background
This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services.
Methods
Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field.
Results
Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation.
Conclusion
The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.
{"title":"Paramedic clinical practice guideline development in Australia and New Zealand: A qualitative descriptive analysis","authors":"Sonja Maria , Marc Colbeck , Matt Wilkinson-Stokes , Adam Moon , Michelle Thomson , Joel Ballard , Lachlan Parker , Fraser Watson , James Oswald","doi":"10.1016/j.auec.2024.06.003","DOIUrl":"10.1016/j.auec.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services.</div></div><div><h3>Methods</h3><div>Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field.</div></div><div><h3>Results</h3><div>Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation.</div></div><div><h3>Conclusion</h3><div>The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 259-267"},"PeriodicalIF":2.1,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-04DOI: 10.1016/j.auec.2024.06.004
Javier Jacob , Elena Fuentes , Juan González del Castillo , Inmaculada Bajo-Fernández , Aitor Alquezar-Arbé , Eric Jorge García-Lamberechts , Sira Aguiló , Cesáreo Fernández-Alonso , Guillermo Burillo-Putze , Pascual Piñera , Pere Llorens , Sònia Jimenez , Adriana Gil-Rodrigo , Jorge Sánchez Tembleque-Sánchez , Maria Pilar López-Diez , Marta Iglesias-Vela , Rafael Antonio Pérez-Costa , Marién López-Pardo , Rebeca González-González , Marina Carrión-Fernández , Òscar Miró
Objective
Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED).
Methods
We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model.
Results
A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 – 1.950), ECG 1.793 (95 %CI 1.664 – 1.932) and X-ray 1.707 (95 %CI 1.583 – 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests.
Conclusions
Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED.
{"title":"Use of diagnostic tests in elderly patients consulting the emergency department. Analysis of the emergency department and elder needs cohort (EDEN-8)","authors":"Javier Jacob , Elena Fuentes , Juan González del Castillo , Inmaculada Bajo-Fernández , Aitor Alquezar-Arbé , Eric Jorge García-Lamberechts , Sira Aguiló , Cesáreo Fernández-Alonso , Guillermo Burillo-Putze , Pascual Piñera , Pere Llorens , Sònia Jimenez , Adriana Gil-Rodrigo , Jorge Sánchez Tembleque-Sánchez , Maria Pilar López-Diez , Marta Iglesias-Vela , Rafael Antonio Pérez-Costa , Marién López-Pardo , Rebeca González-González , Marina Carrión-Fernández , Òscar Miró","doi":"10.1016/j.auec.2024.06.004","DOIUrl":"10.1016/j.auec.2024.06.004","url":null,"abstract":"<div><h3>Objective</h3><div>Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED).</div></div><div><h3>Methods</h3><div>We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model.</div></div><div><h3>Results</h3><div>A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 – 1.950), ECG 1.793 (95 %CI 1.664 – 1.932) and X-ray 1.707 (95 %CI 1.583 – 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests.</div></div><div><h3>Conclusions</h3><div>Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 268-275"},"PeriodicalIF":2.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1016/j.auec.2024.06.001
Josephine Rheinberger , Kate Curtis , Andrea McCloughen , Taneal Wiseman
Background
The emergency resuscitation nurse is a challenging and specialised role at the forefront of critical care practice in the emergency department. Despite their extensive specialist knowledge and skill requirements, in Australia there is no state-wide or nationally agreed approach to how to best provide training that meets a set of fixed objectives and requisite skills for resuscitation nurses. Due to an ageing nursing population and increasing workforce attrition, an efficacious accelerated pathway to acquire specialist resuscitation nursing knowledge, is necessary.
Aim
The aim of this review is to identify, consolidate and summarise the available evidence on the training needs for the requisite clinical and non-technical skills of emergency resuscitation nurses
Eligibility criteria
Papers about nurses currently working in the emergency department; including Nurse Unit Managers (NUMs), Clinical Nurse Educators (CNEs), Clinical Nurse Consultants (CNCs), Clinical Nurse Specialists (CNSs), Registered Nurses (RNs) and Enrolled Nurses (ENs) were included. The review included primary and non-primary research, including papers addressing how emergency nurses are trained. There was no date limitation set to ensure all results could be reviewed. Papers that were not published in English, included nurses who were not working in the ED, or included doctors, allied health, and other staff where population cohorts could not be distinguished, were excluded. Abstract only, editorials, conference posters or oral presentations, were also excluded.
Sources of evidence
Searches were conducted in MEDLINE, CINAHL and EMCARE. The authors conducted extensive hand-searching of the included study reference lists as well as the grey literature to ensure that all relevant literature was captured.
Methods
A scoping literature review was conducted.
Results
Data extraction was conducted on the final 33 articles (23 peer reviewed studies and 10 competency and practice standards documents). Specific training requirements to achieve competence in the requisite clinical and non-technical skills in resuscitation nursing do not exist. A decline in competency without regular reinforcement was reported. Multi-modal approaches, incorporating diverse teaching methods, show potential in enhancing knowledge retention and skill acquisition.
Conclusion
Resuscitation nursing lacks a standardised training approach in Australia, leading to a gap in ensuring consistent skill acquisition and knowledge among nurses. Research is required to identify what resuscitation nursing skills and training are necessary to ensure practice effectively meets the needs of patients.
{"title":"What are the training needs of emergency department resuscitation nurses? A scoping review","authors":"Josephine Rheinberger , Kate Curtis , Andrea McCloughen , Taneal Wiseman","doi":"10.1016/j.auec.2024.06.001","DOIUrl":"10.1016/j.auec.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><div>The emergency resuscitation nurse is a challenging and specialised role at the forefront of critical care<span> practice in the emergency department. Despite their extensive specialist knowledge and skill requirements, in Australia there is no state-wide or nationally agreed approach to how to best provide training that meets a set of fixed objectives and requisite skills for resuscitation nurses. Due to an ageing nursing population and increasing workforce attrition, an efficacious accelerated pathway to acquire specialist resuscitation nursing knowledge, is necessary.</span></div></div><div><h3>Aim</h3><div>The aim of this review is to identify, consolidate and summarise the available evidence on the training needs for the requisite clinical and non-technical skills of emergency resuscitation nurses</div></div><div><h3>Eligibility criteria</h3><div><span>Papers about nurses currently working in the emergency department; including Nurse Unit Managers (NUMs), Clinical Nurse Educators (CNEs), Clinical </span>Nurse Consultants<span><span> (CNCs), Clinical Nurse Specialists (CNSs), </span>Registered Nurses (RNs) and Enrolled Nurses (ENs) were included. The review included primary and non-primary research, including papers addressing how emergency nurses are trained. There was no date limitation set to ensure all results could be reviewed. Papers that were not published in English, included nurses who were not working in the ED, or included doctors, allied health, and other staff where population cohorts could not be distinguished, were excluded. Abstract only, editorials, conference posters or oral presentations, were also excluded.</span></div></div><div><h3>Sources of evidence</h3><div>Searches were conducted in MEDLINE, CINAHL and EMCARE. The authors conducted extensive hand-searching of the included study reference lists as well as the grey literature to ensure that all relevant literature was captured.</div></div><div><h3>Methods</h3><div>A scoping literature review was conducted.</div></div><div><h3>Results</h3><div>Data extraction was conducted on the final 33 articles (23 peer reviewed studies and 10 competency and practice standards documents). Specific training requirements to achieve competence in the requisite clinical and non-technical skills in resuscitation nursing do not exist. A decline in competency without regular reinforcement was reported. Multi-modal approaches, incorporating diverse teaching methods, show potential in enhancing knowledge retention and skill acquisition.</div></div><div><h3>Conclusion</h3><div>Resuscitation nursing lacks a standardised training approach in Australia, leading to a gap in ensuring consistent skill acquisition and knowledge among nurses. Research is required to identify what resuscitation nursing skills and training are necessary to ensure practice effectively meets the needs of patients.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 244-253"},"PeriodicalIF":2.1,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.auec.2024.06.002
Happy Indah Kusumawati , Suis Galischawati , Sri Warsini , Bayu Fandhi Achmad , Nurul Aida Fatma , Nazhifah Salsabila Tiyani , Dewi Nirmalasari , Eko Budi Santoso
Background
The nursing field is the fourth most stressful occupation in the health sector. Emergency department nurses often face crises and unpredictable situations that can negatively affect their quality of life and the quality of care. This study aimed to investigate the determinants of work stress among ED nurses in Sleman, Yogyakarta, Indonesia.
Methods
A descriptive cross-sectional study was conducted. Participants (n = 122) were emergency nurses recruited through convenience sampling from four EDs in Sleman District, Yogyakarta, Indonesia. Data were gathered using an online self-administered survey consisting of the workload, self-efficacy, and work stress questionnaires. Hierarchical linear regression analysis with the entry method was used to examine the main determinants of work stress.
Results
The average work stress (38.29 ± 8), workload (30.83 ± 9.21), and self-efficacy (32.47 ± 3.61) scores were at a moderate level. Hierarchical linear regression showed that workplace, being a head nurse, and workload were the main determinants that contributed to 25.4 % of work stress among ED nurses.
Conclusions
The study results confirm that having a high workload, working in a private hospital, and being a head nurse are the main determinants of work stress among ED nurses in Sleman, Indonesia.
{"title":"Determinants of work stress among emergency department nurses in Sleman, Yogyakarta, Indonesia","authors":"Happy Indah Kusumawati , Suis Galischawati , Sri Warsini , Bayu Fandhi Achmad , Nurul Aida Fatma , Nazhifah Salsabila Tiyani , Dewi Nirmalasari , Eko Budi Santoso","doi":"10.1016/j.auec.2024.06.002","DOIUrl":"10.1016/j.auec.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>The nursing field is the fourth most stressful occupation in the health sector. Emergency department nurses often face crises and unpredictable situations that can negatively affect their quality of life and the quality of care. This study aimed to investigate the determinants of work stress among ED nurses in Sleman, Yogyakarta, Indonesia.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional study was conducted. Participants (n = 122) were emergency nurses recruited through convenience sampling from four EDs in Sleman District, Yogyakarta, Indonesia. Data were gathered using an online self-administered survey consisting of the workload, self-efficacy, and work stress questionnaires. Hierarchical linear regression analysis with the entry method was used to examine the main determinants of work stress.</div></div><div><h3>Results</h3><div>The average work stress (38.29 ± 8), workload (30.83 ± 9.21), and self-efficacy (32.47 ± 3.61) scores were at a moderate level. Hierarchical linear regression showed that workplace, being a head nurse, and workload were the main determinants that contributed to 25.4 % of work stress among ED nurses.</div></div><div><h3>Conclusions</h3><div>The study results confirm that having a high workload, working in a private hospital, and being a head nurse are the main determinants of work stress among ED nurses in Sleman, Indonesia.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 254-258"},"PeriodicalIF":2.1,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-23DOI: 10.1016/j.auec.2024.05.001
Anne Kuoppala , Eetu Skaffari , Timo Iirola , Hilla Nordquist
Background
The amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive?
Methods
This was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis.
Results
The response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience.
Conclusions
Predominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.
{"title":"The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland – A qualitative survey study","authors":"Anne Kuoppala , Eetu Skaffari , Timo Iirola , Hilla Nordquist","doi":"10.1016/j.auec.2024.05.001","DOIUrl":"10.1016/j.auec.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive?</div></div><div><h3>Methods</h3><div>This was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis.</div></div><div><h3>Results</h3><div>The response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience.</div></div><div><h3>Conclusions</h3><div>Predominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 237-243"},"PeriodicalIF":2.1,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22DOI: 10.1016/j.auec.2024.04.003
Chloe Betts, Alannah Stoneley, Tara Picker
Background
Paramedics play a pivotal role in delivering emergency medical care, contributing to excellence in the prehospital environment and ensuring a seamless continuum of healthcare. Achieving this objective is subject to various factors. This review aims to explore, the relationship between paramedic personality profiles and key factors including stress, burnout and employment retention or attrition.
Methods
The JBI approach was used to perform a scoping review. Key words including paramedic* , ambulance* , personalit* , retention OR attrition and burnout OR stress were inserted into the search engines OVID, CINAHL Plus, Scopus, Web of Science Core Collection, Psychology ProQuest, and Nursing ProQuest. Titles and abstracts of 226 results were screened and inclusion and exclusion criteria applied. Full texts of the remaining 18 results were screened to inform the results.
Results
Three themes emerged relevant to the objective including the correlation of neuroticism with stress and burnout, personality types and mental illness with the ability to cope during stressful situations and finally resilience and burnout with the intention to quit.
Conclusion
Further research should be completed into specific personality characteristics, including neuroticism, perfectionism, and excitability to facilitate the development of strategies aimed at improving the health and wellbeing of paramedics and EMT workers internationally.
{"title":"Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review","authors":"Chloe Betts, Alannah Stoneley, Tara Picker","doi":"10.1016/j.auec.2024.04.003","DOIUrl":"10.1016/j.auec.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Paramedics play a pivotal role in delivering emergency medical care, contributing to excellence in the prehospital environment and ensuring a seamless continuum of healthcare. Achieving this objective is subject to various factors. This review aims to explore, the relationship between paramedic personality profiles and key factors including stress, burnout and employment retention or attrition.</div></div><div><h3>Methods</h3><div>The JBI approach was used to perform a scoping review. Key words including paramedic* , ambulance* , personalit* , retention OR attrition and burnout OR stress were inserted into the search engines OVID, CINAHL Plus, Scopus, Web of Science Core Collection, Psychology ProQuest, and Nursing ProQuest. Titles and abstracts of 226 results were screened and inclusion and exclusion criteria applied. Full texts of the remaining 18 results were screened to inform the results.</div></div><div><h3>Results</h3><div>Three themes emerged relevant to the objective including the correlation of neuroticism with stress and burnout, personality types and mental illness with the ability to cope during stressful situations and finally resilience and burnout with the intention to quit.</div></div><div><h3>Conclusion</h3><div>Further research should be completed into specific personality characteristics, including neuroticism, perfectionism, and excitability to facilitate the development of strategies aimed at improving the health and wellbeing of paramedics and EMT workers internationally.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 227-236"},"PeriodicalIF":2.1,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141079624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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