Virginia Plummer

Family presence during resuscitation: a descriptive study of nurses' attitudes from two Saudi hospitals

BACKGROUND The presence of family in the patient care area during resuscitation events is a matter of current debate among health care professionals in many communities. Family presence is highly recommended by many health organizations worldwide for several reasons including patient and family rights. There are no policies or guidelines in Saudi Arabia to guide health professionals in their practice regarding the option of family being present during resuscitations. The purpose of this study was to identify the attitudes of nurses towards family presence during resuscitation in the Muslim community of Saudi Arabia. DESIGN This is a descriptive survey using data from a convenience sample of 132 nurses using a self-administered questionnaire. The study took place in two major trauma centres in the eastern region of Saudi Arabia. RESULTS The analysis of the data revealed that nurses (n = 132) had negative attitudes towards family presence during resuscitation. A high percentage (77·2%) agreed that witnessing resuscitation is a traumatic experience for the family members. Almost all participants (92·3%) disagreed with the statement that the practice of allowing family members to be present during the resuscitation of a loved one would benefit the patient and 78% disagreed with the statement that it would benefit families. The majority of the participants (65%) revealed that the presence of family would negatively affect the performance of the resuscitation team. However, almost half of the sample (43·8%) would prefer a written policy allowing the option of family presence during resuscitation in Saudi Arabia. CONCLUSION The findings of the study strongly suggest the need for the development of written policies offering families the option to remain with patients during resuscitation in Saudi Arabia. The study further recommends the development of education programs for staff and public for the safe implementation of the practice.

At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses

OBJECTIVE Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. METHODS The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. RESULTS Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED CONCLUSION :There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence.

Care of patients in emergency department waiting rooms--an integrative review.

AIM To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. BACKGROUND Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. DESIGN Integrative review. DATA SOURCES Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. REVIEW METHODS Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. RESULTS Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. CONCLUSION Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives.

Providing culturally congruent care for Saudi patients and their families

Abstract This article aims to increase an awareness of caring for Saudi families by non-Saudi nurses to improve their understanding of culturally competent care from a Saudi perspective. Healthcare providers have a duty of a care to deliver holistic and culturally specific health care to their patients. As a consequence of ‘duty of care’ obligations, healthcare providers must facilitate culturally congruent care for patients of diverse cultural backgrounds. For the Saudi family considerable cultural clashes may arise when Saudi patients are hospitalized and receive care from healthcare professionals who do not understand Islamic principles and Saudi cultural beliefs and values. The healthcare workforce in Saudi Arabia is a unique multicultural workforce that is mix of Saudi and significant other nationalities. Saudi nurses for example represent only 36.3% of the workforce in the different health sectors. Whilst the different ethnic and cultural background expatriate nurses represent 63.7% (Ministry of Health, 2010). This article also could increase the awareness of healthcare professionals caring for Arab and Muslims patients in another context in the world.

Using creativity to encourage reflection in undergraduate education

Preparing undergraduate nurses to meet the challenges of clinical reality and develop their reflective skills requires innovative and creative pedagogical approaches. It has been suggested that the use of creative arts media enables one to surface well‐springs of knowledge and critique it artistically, cognitively and meta‐cognitively. Recent research highlights the sense of graduate nurses being unprepared at the completion of their undergraduate studies to face the responsibilities and challenges of being a registered nurse. Confronted as an educator with the challenge to address this sense of un‐preparedness, Jenny sought to introduce an element of creative reflectivity into a final year clinical practice unit of the Bachelor of Nursing. This was done in anticipation that it might encourage students to draw upon their multiple intelligences, embrace their artistic intelligence and realise their knowledge and learning. This paper presents through a reflective dialogue, the approach taken by the authors sharing their experiences of the introduction of reflective creativity into the course. Examples of creative works produced by students are celebrated, as are the responses to those works. Students expressed their learning, in many differing media and in doing so gained a sense of realisation that during their course of study they had actually acquired a knowledge base to engage as novice practitioners. As educators it raised a significant issue of being caught up in the creativity of the student and the need to see beyond the creation into the meaning and reflection of what it offered.

EMS systems in lower-middle income countries: A literature review

Introduction Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped. Problem There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries. METHODS A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care. RESULTS There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing the prehospital care system. CONCLUSION The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organized EMS system with most ambulances used purely for transport and not as an emergency care vehicle. Financial issues are the most common problems faced by LMICs with support from developed countries a necessity. Suryanto , Plummer V , Boyle M . EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64-70.

Hospitalisation impacts on oral hygiene: an audit of oral hygiene in a metropolitan health service

BACKGROUND Poor oral health has been associated with systemic diseases, morbidity and mortality. Many patients in hospital environments are physically compromised and rely upon awareness and assistance from health professionals for the maintenance or improvement of their oral health. This study aimed to identify whether common individual and environment factors associated with hospitalisation impacted on oral hygiene. METHODS Data were collected during point prevalence audits of patients in the acute and rehabilitation environments on three separate occasions. Data included demographic information, plaque score, presence of dental hygiene products, independence level and whether nurse assistance was documented in the health record. RESULTS Data were collected for 199 patients. A higher plaque score was associated with not having a toothbrush (p = 0.002), being male (p = 0.007), being acutely unwell (p = 0.025) and requiring nursing assistance for oral hygiene (p = 0.002). There was fair agreement between the documentation of requiring assistance for oral care and the patient independently able to perform oral hygiene (ICC = 0.22). CONCLUSION Oral hygiene was impacted by factors arising from hospitalisation, for those without a toothbrush and male patients of acute wards. Establishment of practices that increase awareness and promote good oral health should be prioritised.

Profiling nursing resources in Australian emergency departments

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.

The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.

Review objective The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on: length of stay satisfaction pain level cost of care functional abilities knowledge anxiety quality of life in orthopedic settings. Background Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre‐admission, peri‐operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self‐care using the experience and guidance of the multidisciplinary team.1 With an effective and well‐structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care.2‐6 According to Huang et al.3 a simplified pre‐operative education program reduced the length of stay and cost of care. Similarly, Jones et al.4 found that length of stay of a patient who received pre‐operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre‐operative education to five days in patients who received pre‐operative education. These results suggest that pre‐operative education programs are an effective method in reducing the length of stay of orthopedic patients. Johansson et al.7 also described pre‐operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self‐efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education.7 While Johansson et al.7 included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013. Kruzik8 also reported benefits of decreased length of stay, reduced pain medication requested post‐operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.9 Types of education involved in this systematic review are patient education, pre‐operative education, and discharge education. Only one study discussed discharge education and the outcome from this review.10 The outcomes that have been discussed in this systematic review include length of stay,3,4,11‐15 satisfaction,5,16‐19 pain level,5,6,11,16,17,18,19,20,21, 21 cost of care,2,23 functional abilities,5,6,11,14,23,24 knowledge,16,19,25,26 anxiety,18,20,21,27,28 and quality of life.5,6,23 Major outcomes discussed in these studies are length of stay,3,4,11‐15 pain,5,6,11,16,17,18,19,20,21, 21 functional abilities,5,6,11,14,23,24 and anxiety.18,20,21,27,28 Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.3,4,11‐15 Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement.3,4,5,12,13,15,19,20,23,29,30 A study on spinal surgery patients and the effects of pre‐operative education,17 which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain. This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.

The effect of Transition to Specialty Practice Programs on Australian emergency nurses’ professional development, recruitment and retention

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.