Accident and emergency nursing
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This commentary paper highlights the every day reality for nurses facing episodes of violence and aggression while working in the health care system in Western Australia and identifies future research necessary to address the problem. Nurses, in a range of work environments, face the terrifying possibility of being victims of aggressive and violent incidents while caring for patients. The consequences of these events are far reaching and include an increased cost to the health care system, loss of experienced nurses from the workforce and the inability to attract nurses back to the bedside. ⋯ Sound research is important in raising awareness and providing direction for hospital policy and practice. Furthermore, future research in the area has to investigate the phenomenon as a whole taking into consideration all aspects of these events. The results of this research must then form the framework for future education programs, policies and best-practice guidelines for safety of nurses and ultimately patient care.
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Education to improve the triage of mental health patients in general hospital emergency departments.
General hospital emergency departments (EDs) are obvious places for individuals in distress or in a mental health crisis to seek assistance. However, triage nurses admit to a lack of expertise and confidence in psychiatric assessment which can result in less accurate assessments than for medical or trauma presentations. ⋯ Although average lengths of stay in the ED were also reduced after the education, this may or may not have been related to the educational sessions. The project was successful in increasing collaboration between the two departments and has resulted in enhanced, on-going mental health education for ED nurses.
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This paper is the first of two articles discussing the implementation and evaluation of an innovative Fast Track process. This current paper explains how one metropolitan hospital identified the need to establish Fast Track in their Emergency Department and the journey that was taken to implement the initiative. The other paper presents the findings of the evaluation of the Fast Track process over a twelve month time frame. ⋯ The model was based upon the available literature from studies on Fast Track and "See and Treat" conducted in the United Kingdom, North America and Australia, and was adapted to address the type of presentations arriving at the hospital's Emergency Department. The initial change management process lasted twelve months and as a result Fast Track has revolutionised the way many patients are treated in the Emergency Department. Furthermore, Fast Track has provided nurses with the opportunity to achieve advanced skills in the areas of suturing and plastering.
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Rising patient demand in emergency departments is an international problem. Patient dependency (the degree of nursing care required) has major implications for nursing. Nurse skill mix and staffing levels can be addressed more effectively when dependency can be measured. A valid and reliable method of determining patient dependency in the emergency department in the United Kingdom is required. ⋯ The Jones Dependency Tool can be recommended as a valid and reliable tool for the measurement of patient dependency in the emergency department.
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The majority of ambulance services in England provide pre-hospital thrombolysis, following publication of the National Service Framework for Coronary Heart Disease. A meta-analysis has confirmed the effectiveness of pre-hospital administration in terms of all-cause mortality reduction and time saved. Little is known however, about how paramedics perceive their role in thrombolytic administration. ⋯ Paramedics' perceptions of their role in pre-hospital thrombolysis were mixed, encompassing professional and political issues including lack of ownership of the emerging national strategy, desire for national certification and financial reward. For successful development and implementation of new strategies within the ambulance service early engagement of paramedics and other staff is essential.