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Our findings are consistent with outcomes of studies in non-healthcare domains, but are contrary to a study of ED physicians, suggesting differential responses to interruptions by physicians and nurses. Future studies on interruptions in healthcare should thus be discipline specific. Though the effect of interruptions on intervention length is only about 2 min, in an ED setting, this can increase patient risks and costs. To better focus efforts to reduce interruptions future research should focus on further separation of interruption type (eg, urgent vs routine or unnecessary).

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Young widowhood is a unique experience that has received little in-depth attention in research and clinical settings. The present study examined the lived experiences of young men and women who had lost a spouse. Eleven men and women between the ages of 18 and 49 were interviewed about their experiences postloss using phenomenological methods. After coding the interviews, three themes emerged: (1) relationship prior to death, (2) coping, and (3) concerns. Clinical implications included the need for more accessible resources for young widowed individuals, such as therapeutic services, finances, and childcare.

Background: As more hospitals transition to electronic health records (EHR) and rely on technology to inform practice, what is done with that information is increasingly important. Performance report cards for physicians and nurses are not new, yet there is little recent evidence on nurse-specific audit and feedback.Aim: The aim of the project was to conduct an evidence-based practice (EBP) review to answer the question, "Does implementing an individualized audit and feedback report tool for nurses improve compliance, adherence, and/or performance of nursing tasks?".Methods: Evidence was gathered from several databases. Reviewers read and appraised articles that answered the EBP question using the Johns Hopkins Nursing EBP Model. Data were then collated to synthesize and generate recommendations.Results: Of the initial 613 unique articles, eight (two research and six quality improvement) were included. Six articles demonstrated improvements while two did not. Articles analyzed nursing documentation (n = 3), tasks or skills (n = 2), and best practice compliance (n = 3). One manuscript utilized an EHR-generated report; all others were completed by hand. Overall, there was not consistent and compelling evidence to support individualized audit and feedback report tools in nursing. However, several themes emerged related to sustainability, timing of feedback, audit, and feedback in the context of quality improvement, and the methods of acquiring and distributing data.

Conclusions: NEWS can capture acutely ill patients to some degree. Using inpatient admission as a proxy for acutely ill, residents with NEWS of 5 and above were more likely to require inpatient admission. However, as a tool on its own, it is limited in its scope to avert ED attendance. There were conditions with a NEWS score of 0-1 which still required ED visits for treatment and services such as suturing and radiological investigations which were not available in the nursing homes. NEWS alone is also a poor tool in recognizing conditions such as mild acute bleeding (NEWS score 0), stroke (NEWS score 0) and myocardial infarction (NEWS score 3). Out of the 13 residents who were discharged from the ED, 4 residents could have potentially been managed in the community; they were diagnosed with LRTI, functional decline, dehydration and simple laceration. Matching these conditions with relevant care paths would allow appropriate utilization of community resources and may avert ED attendance. Teleconsultation facilitated the aversion of 3 cases but was not employed in 15 cases despite clear instructions. Further study is needed to explore the nurses' clinical decisionmaking process in overriding the NEWSteleconsultation guidelines and transferring residents to the ED immediately, as well as a wider research into expanding the assessment tools used. Access to medical advice is vital for aversion of ED attendance whether by teleconsultation or GP attendance. Despite the limitations, NEWS is still useful as an initial assessment tool in a nursing home setting where nurses rely on clinical assessment and medical support is low. Supplemented with teleconsultation, NEWS can recognize acutely ill patients and avert ED attendance.

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