No abstract

Simulation is a valuable research tool used to evaluate the clinical performance of devices, people and systems. The simulated setting may address concerns unique to complex clinical environments such as the Emergency Department, which make the conduct of research challenging. There is limited evidence available to inform the development of simulated clinical scenarios for the purpose of evaluating practice in research studies, with the majority of literature focused on designing simulated clinical scenarios for education and training. Distinct differences exist in scenario design when implemented in education compared with use in clinical research studies. Simulated scenarios used to assess practice in clinical research must not comprise of any purposeful or planned teaching and be developed with a high degree of validity and reliability. A new scenario design template was devised to develop two standardised simulated clinical scenarios for the evaluation of a new assessment framework for emergency nurses. The scenario development and validation processes undertaken are described and provide an evidence-informed guide to scenario development for future clinical research studies.

Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.

HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators ( TDF domains ) were: understanding evidence-informed patient care and understanding risk factors ( Knowledge ); patient assessment skills and blunt chest injury management skills ( Physical skills ); identification with professional role ( Professional role and identity ); belief of consequences of care bundle (Belief about consequences ); provision of training and protocol design ( Environmental context and resources ); and social supports ( Social influences ). Barriers were: not understanding the term ‘care bundle’ ( Knowledge ); lacking regional analgesia skills ( Physical skills ); not remembering to follow protocol ( Memory, attention, and decision processes ); negative emotions relating to new protocols ( Emotions ); equipment and protocol access ( Environmental context and resources ). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implement...

Introduction: Emergency nurses must be highly skilled at performing accurate and comprehensive patient assessments. In 2008, the inaugural emergency nursing assessment framework (ENAF) was devised at Sydney Nursing School, to provide emergency nurses with a systematic approach to initial patient assessment. In 2014 the assessment framework was re-developed to reflect the most recent evidence. Aim: To describe the process and evidence used to re-develop ENAF, to provide ED nurses with an evidence-informed approach to the comprehensive assessment of patients presenting to ED after triage, so that it may be implemented and tested in the clinical (simulated) setting. Methods: A thorough literature review was conducted to inform the re-development of ENAF. Literature review findings were reviewed and ENAF was re-developed by a panel of expert emergency nursing clinicians using the Delphi Technique. Results: Modifications to ENAF were undertaken and a new, more comprehensive assessment framework was developed titled 'HIRAID'. HIRAID is informed by current evidence, comprising of seven assessment components: History; Identify Red flags; Assessment; Interventions; Diagnostics; reassessment and communication.

No abstract

Injury is a leading cause of mortality, hospitalised morbidity and disability in Australia and New Zealand. Of the many public health challenges facing clinicians on a daily basis, traumatic injury is one of the most significant. A large spectrum of injury severity may result, ranging from minor injuries which require little medical intervention through to severe multisystem trauma, requiring definitive management by an experienced multidisciplinary team. An improved understanding of the incidence and prevalence of trauma can empower clinicians of all levels of experience to contribute to improving the trauma system they work in at a local level. This paper provides an overview of the history and epidemiology of traumatic injury in Australia and New Zealand. The reading of this article and completion of revision questions is equivalent to 2h of self-directed learning.