Rosemary Chapman

Evaluating nurses' knowledge and skills in the detection of child abuse in the Emergency Department

This commentary paper highlights the issue of child abuse and the important role that nursing staff working in the Emergency Department (ED) can play in halting the cycle of abuse. Child abuse is a worldwide problem that is occurring with increasing frequency. In fact, in Australia over the last 5 years the number of child protection referrals has more than doubled. As well as the immediate physical damage child abuse causes, it can also escalate to result in more serious injury and death. Furthermore, children who are abused in their early years of life are at increased risk of a range of adverse long-term developmental problems. Research has demonstrated that there is a significant lack of detection of suspected cases of child abuse in the ED. In fact the true incidence of children presenting to hospital EDs with abuse is difficult to determine, and many cases remain undetected. Nursing staff are perfectly positioned to detect the signs that a child may be at risk of abuse. However, in order to identify these signs it is essential that ED nurses have the knowledge and skills necessary to do so. Failure to consider the possibility of abuse will mean that the appropriate diagnosis is not made and the child is returned to an abusive environment. Therefore, this paper offers ED nurses recommendations for future directions in research and interventions to improve the detection of child abuse in Western Australia.

Deliberate Self-Poisoning Presenting to an Emergency Medicine Network in South-East Melbourne: A Descriptive Study

Background. Deliberate self-poisoning (DSP) comprises a small but significant proportion of presentations to the emergency department (ED). However, the prevalence and patient characteristics of self-poisoning attendances to EDs in Victoria have not been recently characterised. Aim. To identify and compare the characteristics of adult patients presenting to the three EDs of Monash Health following DSP. Methods. Retrospective clinical audit of adult DSP attendances between 1st July 2009 and 30th June 2012. Results. A total of 3558 cases over three years were identified fulfilling the search criteria. The mean age of patients was 36.3 years with the largest numbers aged between 18 and 30 (38%). About 30% of patients were born overseas. Forty-eight percent were discharged home, 15% were admitted to ED short stay units, and 5% required ICU admission. The median ED length of stay was 359 minutes (IQR 231–607). The most frequently reported substances in DSP were benzodiazepines (36.6%), paracetamol (22.2%), and antipsychotics (12.1%). Exposure to more than one substance for the episode of DSP was common (47%). Conclusion. This information may help identify the trends in poisoning substances used for DSP in Victoria, which in turn may provide clinicians with information to provide more focused and targeted interventions.

Australian Emergency Department health professionals' reasons to invite or not invite Family Witnessed Resuscitation: A qualitative perspective

BACKGROUND Debate continues regarding the effectiveness of Family Witnessed Resuscitation and little is known about the reasons why staff invite family presence. AIM Explore why health professionals invite or not invite Family Witnessed Resuscitation. DESIGN Descriptive qualitative study. METHOD Three open-ended questions enabled 114 clinicians to describe why they would or would not invite family presence. Data were analysed using qualitative data analysis. RESULTS Four themes representing factors that influenced staff decision to invite or not invite Family Witnessed Resuscitation were identified: motivating factors, personal choice, staff judgment, and organisational factors. Motivating factors described reasons to invite family presence, and staff and organisational factors were reasons to not invite family presence. CONCLUSION Family presence can be beneficial for staff and family and is likely to be motivated by family-specific factors where this choice is appropriate for all stakeholders. Participants described factors that can impact on the appropriateness of inviting family presence and these need to be considered before an invitation is extended. RELEVANCE TO PRACTICE To support all parties throughout the process it is imperative that a skilled support person be available to the family and that written policies and guidelines be available for staff.

Perceptions of Australian emergency staff towards patients presenting with deliberate self-poisoning: A qualitative perspective

INTRODUCTION/BACKGROUND Attitude of staff towards patients who present to the emergency department following deliberate self-poisoning may be integral to the outcome of these events. There is little in-depth understanding of emergency staff perceptions about this vulnerable group. AIM Explore staff perceptions about caring for patients who present to the emergency department following deliberate self-poisoning. DESIGN Qualitative descriptive study. METHODS Two open-ended questions enabled 186 clinicians to describe their perceptions about caring for people who present to the emergency department following deliberate self-poisoning. Data were analysed using qualitative data analysis procedures. RESULTS Three themes emerged from the data representing staff perceptions about caring for patients who deliberately self-poisoned and included depends on the patient, treat everyone the same, and skilled and confident to manage these patients. CONCLUSION Staff reported mixed reactions to patients presenting with deliberate self-poisoning. These included feelings of empathy or frustration, and many lacked the skills and confidence to effectively manage these patients. RELEVANCE TO PRACTICE Health networks are required to ensure that emergency staff have specialist support, knowledge, skills, and guidelines to provide effective care for this vulnerable population.

Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department

Abstract Aboriginal and Torres Strait Islander (ATSI) people experience challenges when accessing health care from the emergency department (ED). The aim of this project was to identify the perceived barriers and enablers to accessing health care at one Victorian Emergency Department for the local ATSI community. This qualitative explorative study collected data using focus groups or yarns to investigate the perceptions of the ATSI community presentations to the ED. Data were analysed following the standards of qualitative data analysis procedure. Three themes emerged organisational process, staff interactions and strategies for improvement. Information from this study will assist hospital and ED executives and practitioners to collaborate with the ATSI community in developing and implementing policy and practice changes that enable Aboriginal patients to be identified and receive culturally appropriate care.