The aims of this study were to systematically assess the barriers and facilitators to evidence-based nursing handover in a clinical environment, and to identify potential adopters and attributes of evidence-based nursing handover for translation into practice. The study was conducted in the medical wards of a major tertiary referral hospital in Brisbane, Australia. Participants comprised registered and enrolled nurses permanently employed in the participating wards for at least three months prior to the commencement of study. Using a qualitative focus group design, a context specific assessment of the barriers and enablers to knowledge translation was performed through five semi-structured focus groups. Focus groups discussions were recorded by a registered court reporter using a stenotype machine for voice to text transcription, transcribed verbatim and de-identified for analysis. Focus group data were analysed using thematic analysis. Three themes emerged from the focus group discussions: 1) Content (information transferred); 2) Process (steps used to transfer accountability and responsibility for care); and 3) Environment (factors impacting on safe handover). Participants identified barriers to effective nursing handover including variability of handover content and process, uncertainty around sharing sensitive information, inconsistency around clarifying gaps through questioning during the handover, superficial patient involvement, time constraints and environmental challenges. Key facilitators discussed during the focus groups were the use of integrated electronic medical records, support and clear expectations from the nursing leadership and targeted handover education. During the focus group discussions, participants identified several barriers and facilitators to effective handover. These findings will guide the development of research translation strategies to support the implementation of best practice, standardised clinical handover.

Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.

A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.

BackgroundHealth reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities.MethodsThis study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care.ResultsThe median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models.ConclusionsThere was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2395-9) contains supplementary material, which is available to authorized users.

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