Elizabeth Anne Patterson

Clinical handover of patients arriving by ambulance to the emergency department – A literature review

AIM To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals. METHOD Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes. RESULTS From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED. CONCLUSION Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies.

Clinical handover of patients arriving by ambulance to a hospital emergency department: a qualitative study.

AIM The aims of this study were to (1) explore the clinical handover processes between ambulance and ED personnel of patients arriving by ambulance at one hospital and (2) identify factors that impact on the information transfer to ascertain strategies for improvement. METHODS A focused ethnographic approach was used that included participant observation, conversational interviews and examination of handover tools. Participants included ambulance paramedics, nurses and medical practitioners from an ambulance service and regional hospital located in South East Queensland, Australia. Grounded theory methods of constant comparative data analyses were used to generate categories of findings. FINDINGS Two types of clinical handover were identified: (1) for non-critical patients and (2) for critical patients. Quality of handover appears to be dependent on the personnels expectations, prior experience, workload and working relationships. Lack of active listening and access to written information were identified issues. CONCLUSION Clinical handover between two organisations with different cultures and backgrounds may be improved through shared training programmes involving the use of guidelines, tools such as a whiteboard and a structured communication model such as MIST. Future participatory research to evaluate new handover strategies is recommended.

Promoting leadership and management in Australian general practice nursing: what will it take?

AIM This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. BACKGROUND Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. CONCLUSIONS The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. IMPLICATIONS FOR NURSING MANAGEMENT There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

Nursing's contribution to general practice: general practitioners' and practice nurses' views.

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurses role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

The analysis and application of peer assessment in nurse education, like beauty, is in the eye of the beholder

Recent nursing literature has illustrated an increasing interest in the use of peer assessment in nurse education programs. An examination of this mode of assessment has revealed that the way in which peer assessment is both analysed and applied in the educational domain in general, and in the nursing education domain in particular, is dependent upon the philosophy or theoretical framework that explains and directs the context in which it takes place. This influence may originate from the guiding philosophy of a curriculum, the regulatory constraints of a professional body, the mission statement of an educational institution, or the prevailing values and beliefs of society at large. Underpinning each of these influences are the particular interests of the empirical, the interpretive and the critical paradigms. This paper will examine the concept of peer assessment from the perspectives of its purpose in the development of the professional nurse and the particular interest(s) it serves.

The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

BackgroundThere are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians’ detection of risk-taking and emotional distress, young people’s intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.MethodsPARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff’s self-perceived competency in young people’s care and clinicians’ detection and response to risk taking behaviours and emotional distress in 14–24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation.DiscussionThe PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months.Trial registrationISRCTN16059206

Experiences of graduate registered nurses in aged care: A case study

Abstract The number of Registered Nurses (RNs) working in aged care is declining, with few new RNs choosing aged care in their graduate year. This paper describes a study exploring 11 female graduate RNs’ experiences of working in an aged care setting in Victoria, Australia to assist in informing recruitment and retention strategies in aged care. Semi-structured interviews were undertaken and thematically analysed using open coding. This paper presents findings related to the themes of ‘free choice or allocated to aged care’ ‘reasons for graduate choices’, ‘nature of aged care: a match or mismatch for graduates’, ‘lack of professional support for graduate RNs in aged care’ and ‘role confusion’. Findings supported the recruitment of graduate RNs with an initial interest in aged care into the sector. A clearer definition of the new graduate RN’s role in aged care and a standardised graduate program may assist in increasing retention of such nurses in the future.

The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice - eScholarship

BackgroundThere are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians’ detection of risk-taking and emotional distress, young people’s intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.MethodsPARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff’s self-perceived competency in young people’s care and clinicians’ detection and response to risk taking behaviours and emotional distress in 14–24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation.DiscussionThe PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months.Trial registrationISRCTN16059206

Exploring the development of Australian general practice nursing: where we have come from and where to from here?

Significant development has occurred in the role and scope of Australian general practice nursing in the last decade. Although there has been a nursing presence in Australian general practice for many years (Linn 1977), current workforce shortages and the growing need for chronic and complex disease management and provision of preventive health care in the community have fuelled role development (Halcomb, Patterson & Davidson 2006). In an effort to explore and document the evolution of scholarship and professional development in Australian general practice nursing a content analysis of the proceedings of the four Australian practice nursing conferences was undertaken. This framework allows the mapping of the trajectory related to professional development issues, policy, research and scholarship. Content analysis revealed that the papers presented at each of the four conferences could be broadly divided into six major themes, namely: (1) role of the practice nurse, (2) education and training, (3) research, (4) legal, ethical and risk issues, (5) innovation in clinical practice, and (6) operational and management issues in general practice. Documenting the evolution of this emerging specialty is important in planning initiatives to maximise practice nurses– important contribution to primary health care.