Emergency nursing education – engagement and leadership

Mrs Hollie Jaggard1

1Peninsula Health, Frankston, Australia

Background: All nurses and midwives are responsible and accountable for participating in continuing professional development (CPD) ensuring continual engagement and improvement on best practice, and patient care. All registered nurses must apply for registration renewal every year. Part of this process is a declaration that their practice is current, safe and competent.

As a method of protecting the public whilst providing leadership and support maintaining professional standards, minimum requirements for CPD are integrated into registration renewals for Registered Nurses. There is little research regarding the perspective and attitudes of Registered (emergency) Nurses towards mandatory CPD.

Study Aim: The research aimed to examine the attitudes of emergency nurses toward CPD, and to explore the factors that influence perception of CPD.

Design: using 5 focus groups, a qualitative study was undertaken. Participants (n=28) responded to open-ended questions, and discussion among participants was encouraged on each topic. Transcripts were analysed using thematic analysis. Institutional ethical approval was granted.

Findings: Four main themes were identified: Questioning of mandatory CPD – nurses ideas varied about what constituted CPD and why minimum hours were enforced; Extrinsic versus Intrinsic educational drive – the motivating factors that encourage nurses to engage in CPD; Barriers to CPD – obstacles described as a hindrance to engaging in regular CPD; and Accessible Learning – relevant educational opportunities that meet learners needs, encompassing appropriate skill levels, and learning styles.

Conclusion: Relevant and specific CPD is essential to increasing participation and engagement in ongoing professional development for the benefit of patients, staff and organizations.

Accountability and ownership for education needs to be established within the nursing profession; both to increase personal and professional drive for CPD and to assist in removing barriers and obstacles in prioritizing education. Leadership in nursing education is necessary to promote inherent requirements and standards.


Biography:

Hollie completed her Bachelor of Nursing in 2015 and was awarded the 2015 First State Super and ANMF Student Award. Following her graduate program, Hollie secured a position in the Peninsula Health Emergency Department, completing a Transition to Specialty Practice Program in 2017, while concurrently completing her Bachelor of Nursing (Honours). Hollie is currently completing her Master of Nursing degree.

Clickbait through social media; does it increase motivation and engagement in workplace learning?

Mrs Kylie Lovato1, Miss  Alison  Jeffers1

1SESLHD, Prince Of Wales ED, Randwick, Australia

Background: The use of social media offers several advantages over traditional face to face or printed educational tools; social media enables education to become more convenient, engages a larger number of people, enables connections to be made with learning groups and allows feedback and professional development1 , Current reported challenges exist with variable learner participation and privacy2.

A closed group facebook page and webpage were developed for the purpose of disseminating knowledge, providing feedback to users, increase engagement of learners and to motivate staff towards inquiry. The purpose of this study is to examine whether ‘clickbait’ though facebook, increases learner motivation and engagement.

Method: A survey was conducted in a single centre Emergency Department based upon a convenience sample of emergency nurses (n= 48%) identifying motivation of learning through social media. Data from facebook was obtained through posts, comments and reactions of leaners in order to ascertain learner engagement.

Results: Results will be presented to demonstrate motivation and learner engagement. Challenges will be discussed with the use of social media as a forum for education to include variable learner participation and confidence of staff to contribute in an online forum.

Conclusions: Opportunities exist for both passive and active learners with the delivery of education through social media. While learner participation may be variable, social media provides a convenient and easy way to engage and motivate a large number of staff.

  1. Chester CC, Flickinger TE, Chisolm MS, Social Media use in Medical Education: A systematic review. Academic Medicine, (2013) 88 (6) 893-901
  2. Peck, J.l, Social media in Nursing Education: responsible integration for meaningful use. Journal of Nursing Education; Thorofare (2014) 53 (3) 164-9

Biography:

Collectively we have 20 years+ experience as emergency nurses both in Australia and UK/Ireland. We currently work as Nurse Educators in busy Sydney metropolitan Emergency Department, our goal is to provide evidence based education to the emergency team to build staff capability and capacity. Education is delivered in a variety of different ways to enhance knowledge translation, increase learner engagement and maintain motivation of learning. We are passionate about teaching through new technologies and hope to research the effectiveness of this in the future  towards patient outcomes.

Withholding or terminating resuscitation in the prehospital context: A focus group study exploring paramedic preparation and support for resuscitation decision-making and patient death

Mrs Natalie Anderson1,2, Professor Merryn Gott1, Dr Julia Slark1

1School of Nursing, University Of Auckland , Auckland, New Zealand, 2Auckland Emergency Department, ADHB, Auckland, New Zealand

Background: Internationally, many emergency medical services authorise paramedics to withhold or terminate resuscitation in accordance with clinical guidelines.  Research suggests that the decision to terminate or withhold resuscitation is often a challenging one. Even in the context of extremely poor prognosis, ambulance personnel who lack confidence or feel uncomfortable with terminating or withholding resuscitation are likely to ‘default’ to commencing or continuing resuscitation until more senior back-up arrives.

Aim: To identify existing preparation and support mechanisms for New Zealand paramedics making decisions to withhold or terminate resuscitation and manage patient death.

Methods:  Focus groups were held with senior ambulance personnel currently working in clinical support or peer support roles across New Zealand.  A thematic analysis of transcribed data was then undertaken. A scoping review also provided an overview of international literature addressing this question.

Results: Paramedics need sufficient confidence in their ability to competently manage the resulting scene of a death, including post-mortem care, providing death notification to the bereaved, managing personal responses and supporting crew and bystanders. There is limited classroom or simulation-based training in this area. On-road clinical experience with supportive mentoring and opportunities for reflective practice are key.

Conclusion: Preparation and support for paramedic resuscitation decision-making is an under-researched area. Education interventions tend to focus on discrete skills such as death verification and death notification. There is, however, increasing inclusion of stress and coping strategies in paramedic training, and acknowledgement of the importance of both formal and informal mentoring and support.


Biography:

Natalie Anderson is a Professional Teaching Fellow and currently-practising emergency nurse, with clinical experience in prehospital, intensive care and emergency department settings.  Her dual-discipline academic background in nursing and health psychology has led to a research interest in the behaviour and experiences of health professionals when faced with challenging clinical, ethical or emotional situations. Natalie’s PhD explores  the experience of New Zealand paramedics, tasked with deciding when to start, continue, withhold or terminate resuscitation attempts.

Implementation of a triage self – review package: Enabling consistency in triage practice for nurses in the Emergency Department.

Stacey Williamson1, Elizabeth Ward, Tracey Ingvorsen, Vanessa Leonard-Roberts, Danielle Waddell, Adam Watts

1Northern Health, Epping, Australia

Background: Integral to the provision of emergency nursing practice is the ability to safely undertake triage for patients presenting to the emergency department (ED).Triage trained emergency nurses are required to make major decisions which impact on time to treatment for critically ill patients as well as department  performance thresholds 1.

Emergency nurses undertaking postgraduate training within Northern Health undergo extensive theoretical and practical triage training utilising the Emergency Triage Education Kit (ETEK). ETEK provides a nationally consistent approach to the educational preparation of emergency clinicians for the triage role, while promoting consistency in the application of the Australasian Triage Scale (ATS)1.

Aim:   To promote best clinical practice and consistency with the triage process in our ED.  From quality performance indicators there were knowledge deficits and inconsistency in triage practice evident, requiring the development of a structured approach to self-review of triage practice.

Method:  A triage self – review package was developed by the emergency nursing education team with the intent that all practicing triage staff members complete in 2013, and again in 2016-2017.

Each individual package included 12 of the nurses individual triages, randomly selected to include at least 2 from each ATS triage category, 1-5.   A mixture of adult, paediatric and mental health triages were selected.  Self-reflection by the staff member, as well as peer review by a member of the education team, was undertaken utilising the supplied ETEK audit tool.  Expected triage performance was discussed against ETEK criteria and any resultant deficits were identified as opportunities for improvement.

Conclusion: To ensure ongoing competence and consistency in triage practice, the triage self-review package enables a critique of performance and assists with the ongoing professional development of the triage nurse.

References

1.Gerdtz,M.,Considine,J.,Sands, N.,Stewart,C.,Crellin, D., Pollock,W. et al, Emergency Triage Education Kit. Australian Government Department of Health and Ageing, Canberra; 2007


Biography:

Stacey Williamson – Clinical nurse educator in the Emergency Department at The Northern Hospital, Victoria. Responsible for the education and support of nurses undertaking postgraduate emergency nursing studies in conjunction with Deakin and Melbourne University.

Elizabeth ward – Clinical support nurse in the Emergency Department at The Northern Hospital Victoria. Responsible for the education and support of nurses undertaking Postgraduate Emergency nursing studies on conjunction with Deakin and Melbourne University.

Hypocalcaemia induced tetany secondary to total thyroidectomy: An emergency nursing case study

Shannon Bakon1, Dr Judy Craft1, Associate Professor Martin Christensen1

1Queensland University Of Technology, Caboolture, Australia

Presentations to the emergency department with a diagnosis of hypocalcaemia induced tetany, secondary to total thyroidectomy are rare. A patient presented to the emergency department of a regional Australian hospital with hypocalcaemia induced tetany. A case study was employed to reflect on the care provided and identify knowledge practice deficits within this unusual patient presentation.  Calcium plays a central role within the nervous system and is vital for both cardiac and muscular contraction. The clinical manifestations of electrolyte disturbances such as hypocalcaemia can be life threatening and therefore appropriate assessment, monitoring and management is essential to ensure positive patient outcomes. Understanding the importance of calcium imbalance for the Emergency and Critical Care nurse is paramount in preventing complications associated with cardiac conduction and muscle tone especially the potential for airway compromise. Education is central to this, and may include clinical case reviews, the application of pathophysiological presentations of electrolyte imbalance and a review of electrolyte administration guidelines.  Understanding the role of calcium within the body will assist Emergency and Critical Care nurses to assess, monitor and intervene appropriately thereby preventing the life threatening manifestations of hypocalcaemia.


Biography:

Shannon Bakon has completed her Masters in Applied Science (Res) from the School of Nursing at Queensland University of Technology. She is a unit coordinator within the undergraduate curriculum and has published various papers in reputable peer reviewed journals while working on the ground at her local emergency department.

The application of high fidelity emergency nursing simulation to investigate perceptions towards simulation education and documentation practices after the transition to a digital health record system

Rikki Stanton1, Christie Harding1, Emily Cooper1, Mary Boyde1, Hannah Putland1, Jade Porter1, Clare Thomas1, Ben Learmont1, Elisabeth Fraser1, Lousie Nicholls1

1Princess Alexandra Hospital Emergency Department, Brisbane, Australia

Over the last eighteen months, our Queensland tertiary Emergency Department (ED) has been transitioning to a digital health record system. With this large organisational change, staff have been faced with many challenges including maintaining accurate documentation for deteriorating patients. Within nursing education, simulation has been recognised as an effective learning strategy providing an opportunity to develop verbal and written communication skills, psychomotor skills, and critical thinking skills. Simulation has enabled learning objectives to be met by using realistic scenarios in a safe learning environment. The nursing education team identified that high fidelity nursing simulations were underutilised within the ED, and staff were reluctant to participate as previous experience often related to simulation as an assessment tool. The perception of simulation as a useful education strategy was poor. The education team decided to commence a research project to evaluate an innovative simulation experience for nurses in ED focusing on patient assessment and documentation. A high-fidelity simulation was developed from current incident trends within the ED. This scenario was based on a gradually deteriorating Australian Triage Scale Category 2 toxicology overdose patient. The study, SImulation for EmeRgency Nurses (SIREN), aims to evaluate anxiety levels, self-efficacy in clinical practice and clinical documentation pre and post simulation together with overall satisfaction with the simulation experience. The 15 minute simulation  is followed by a short debrief utilising the advocacy/ inquiry model. This is followed by education of participants on the documentation procedure and individually optimising digital ‘shortcuts’ for mandatory notification. This single centre, prospective study commenced in November 2016, and aims to recruit 50 Registered Nurses. Preliminary results of the 36 participants who have been recruited have been extremely encouraging.


Biography:

Rikki graduated from Australian Catholic University with a Bachelor of Nursing in 2010. She has worked in the Princess Alexandra Hospital Emergency Department for 6 and a half years. During this time she has completed her Graduate Certificate in Emergency Nursing and Masters of Emergency Nursing. Rikki has a passion for education and has spent the majority of her career working in education including Clinical Facilitator, Clinical Nurse and Acting Nurse Educator.

Christie graduated from James Cook University in 2008 with a Bachelor of Nursing Science. She has worked in Plastics, Burns and ENT, then moved into Emergency nursing working in remote, metropolitan and international hospitals. Furthering her education in a Diploma of Midwifery and studied a Post Graduate Certificate in Emergency Nursing. She currently works as a Clinical Facilitator/ Clinical Nurse at the Princess Alexandra Hospital.

The Nursing Emergency eXternal Trauma Programme

Dr Sharyn Ireland1, Rachel Cross1,2, Kelly Decker1, Associate Professor Biswadev  Mitra1,3

1Emergency and Trauma Centre, Alfred Health., Melbourne, Australia, 2School of Nursing & Midwifery, La Trobe University., Melbourne, Australia., 3Department of Epidemiology & Preventive Medicine, Monash University., Melbourne, Australia

Background

Emergency nurses working in non-Major Trauma Service (non-MTS) facilities face the challenge of providing immediate care to seriously injured patients, despite infrequent presentations at their workplace. A one-day education programme endorsed by the Australian College of Nursing was developed to provide contemporary trauma education for nurses. The aim of this study was to report participants’ perceptions of their experience of this programme.

Methods

Peer reviewed lesson plans were developed to guide educational activities.  Of 32 participants, 24 consented to and completed pre and post-programme surveys.  Thematic analysis and descriptive statistics were used to report study findings.

Results

Most participants were nurses with greater than two years’ experience in Emergency Nursing (92%).  Trauma patient transfers each year from a non-MTS to a Major Trauma Service occurred infrequently; eight nurses (33.3%) reported greater than 10 trauma transfers per year.  Participant expectations of the programme included personal growth, knowledge acquisition, increased confidence and a focus on technical skills.  Participants reported the day to be worthwhile and valuable; improved confidence, increased knowledge, and the opportunity to discuss current evidence based practice were highly regarded.  Recommendations for future programmes included extending to two days and include burns and more complex pathophysiology.

Conclusions

With centralisation of trauma care to major trauma services, frequent and continuing education of nurses is essential.  Nurses from non-Major Trauma Service facilities in Victoria found this programme worthwhile as they gained knowledge and skills and increased confidence to care for trauma patients.


Biography:

Dr Ireland has an extensive background in Emergency Nursing with her career expanding 25 years. Completing her postgraduate qualification in Intensive Care Nursing with a Major in Emergency Nursing, she has a keen interest in all aspects of Emergency Nursing. In 2011, Sharyn was awarded a Doctor of Nursing for her thesis titled “Optimising the Assessment and Management of Adult Major Trauma Patients who are Hypothermic”. Publications from this work have influenced the clinical assessment and management of hypothermia in trauma patients, having won a number of prizes for her published work. Sharyn continues to support nurses worldwide in their endeavour to complete their own research in this area of practice. Sharyn’s passion for education in particular the use of Simulation to enhance learning experiences for health professionals has led to many interesting adventures. Sharyn was the fellow on the Victorian Multidisciplinary Trauma Resource Management Project where simulation was used to support rural and regional nursing, medical and paramedical staff to develop their knowledge and skills both technical and non-technical in their own working environments. She is currently a senior adjunct lecturer at La Trobe University and a Clinical Nurse Educator at the Emergency and Trauma Centre, Alfred Health.

Knowledge and awareness of HIV/AIDS infection among patients with sexually transmitted infections (STIs) at KATH Polyclinic

Emmanuel Kwasi Acheampong1, Dr  Paa Kobina Forson1, Abena Agyekum Poku1, Gabriel Ofori Adjei1, Amina Alhassan1, Dr Anthony Enimil1, Dr George Oduro1

1Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Ghana has an overall HIV prevalence of 1.3%. Like other developing countries,, it is still considered a high-risk country for several reasons: the presence of covert multi-partner sexual activity, low level of knowledge and low condom use, unsafe professional blood donation, high incidence of self-reported sexually transmitted infections (STIs) among vulnerable groups, infected expatriates who infect their sexual partners when they return to Ghana, and high levels of HIV/AIDS in the bordering countries all contribute to the spread.

This study was conducted to describe the knowledge and awareness of HIV/AIDS among patients with sexually transmitted infections at KATH.

Methods: A cross-sectional study was carried out at the Family Medicine directorate of KATH for three month. We interviewed participants using a structured questionnaire. Patients were consented before being interviewed. After the interview, patients were then educated on HIV/AIDS and its relatedness to other STIs using an educational material that was developed by investigators. Analysis was done using SPSS 16.0.

Results: A total of 112 participants were recruited but 4 participants refused to consent, therefore, 108 interviewed over the study period. The average age at which participants became sexually active was 19 years. Two-thirds of the participants had had up to 4 lifetime sexual partners. 16 % had had between 5 and 25 lifetime partners. Males had more lifetime partners compared to females.

Participants were generally aware of HIV/AIDS and admitted that HIV/AIDS more than pregnancy and other STIs was going to significantly change their lives, change their career goals and affect their social lives.

Conclusion: Most participants had knowledge about STIs and HIV/AIDS but exhibited risky sexual behaviour and practices. Frequent education for this high risk group will be useful in changing behaviour and reducing the transmission of STIs and HIV/AIDs.


Biography:

I am an Emergency Nurse of 8 years standing, a leader in Emergency Nursing in Africa,  a ‘Trainer of Trainers’, Clinical Emergency Nurse Examiner and a Researcher. I currently double as the National Coordinator for Advanced Trauma Life Support, Ghana.

Innovations in delivery of sepsis education in Belmont Emergency Department

Marcia Ingles1, Gary Crowfoot

1Hunter New England Local Health District, Belmont, Australia, 2University of Newcastle, Newcastle, Australia

In 2012, a multimodal education strategy  was developed to reduce time to first dose antibiotics for patients presenting to the Emergency Department with sepsis.  These education strategies were refined and implemented, directly resulting in a reduction in time between presentation to antibiotic administration from 254 minutes (median) in August 2012 to 41 minutes in March 2016 [1]. Strategies included, but were not limited to, the designation of a Clinical Nurse Specialist as SEPSIS Lead; consistent audits; and targeted education programs for triage nurses.

Since this time, innovations and improvements to the multimodal strategy have been ongoing with a specific focus on interdisciplinary involvement and collaboration, resulting in the inclusion of nurse-led sepsis education in orientation of Junior Medical Officers (JMOS).  This orientation specifically focuses on developing awareness of the Sepsis Pathway and recognition of sepsis signs and symptoms. Other Strategies included the introduction of the Sepsis Education Board to provide up-to-date research, education and feedback of audit results, and acknowledging individual effort in consistently recognising and responding to sepsis in the ED.

Inclusion of these additional strategies has been well received by JMOs and ED staff.  These changes have contributed to continual improvement in the management of sepsis in Belmont ED.  The most recent audit has identified a median time of 37 minutes from presentation to antibiotic administration.

The continued reduction in time from presentation to antibiotic administration demonstrates the successful nature of the ongoing multimodal and interdisciplinary education strategies developed within Belmont ED to improve the identification and treatment of sepsis. Potentially, these strategies might be useful to other EDs attempting to reduce the time between presentation and antibiotic administration for people with sepsis.

References:

[1] Ingles M and Crowfoot G. Reduction in time to first dose antibiotics in one Australian

Emergency Department. Critical Care 2016, 20(Suppl 3):P1


Biography:

Marcia Ingles has been a Clinical Nurse Specialist in Emergency at Belmont Hospital for 5 years.  As Sepsis Lead, she has worked passionately to raise the sepsis awareness of Clinical staff by developing interesting and innovative ways of delivering sepsis education.  In 2016, Marcia’s project work was recognised internationally, when she received both the Ko Awatea Award for Sustained Quality Improvement, and the Global Sepsis Alliance Award for Individual Achievement in raising sepsis awareness.  Marcia subsequently presented posters of the project at both the APAC forum in Sydney, and the International Sepsis Forum in Paris.

Marcia is also a Clinical Facilitator for the University of Newcastle, and is currently undertaking the Foundational Clinical Leadership Program through Hunter New England Local Health District.

How clean is your stethoscope?

Sharon Klim1, Brittany Scott-Rimington2, Professor Anne-Maree Kelly1

1Western Health, Footscray, Australia, 2University of Melbourne, Parkville, Australia

Background: It has long been known that healthcare facilities themselves contribute to disease. While a lot of research has been conducted on the in-hospital transmission of infectious organisms between humans, few studies have explored stethoscopes as a fomite for healthcare-associated infection.  Indeed a 2014 study showed that, following a physical examination, stethoscope diaphragms have a greater bacterial load than physician’s hands.

Objectives:  This project aimed to determine the rate of contamination of stethoscope diaphragms used in ED through microbiological culture and to measure the effectiveness of a multimodal educational campaign on improving staff stethoscope cleaning behaviours in ED.

Methods:  This was a two-part project that was conducted in the ED of Sunshine and Footscray Hospitals. For the first part of the study, thirty randomly chosen stethoscopes in use by clinicians in ED were swabbed and sent for bacterial culture. For the second part of the study, using observation we measured compliance with stethoscope cleaning before and after an educational intervention comprising presentations at staff meetings and a poster campaign.

Results: Seventy percent of cultures grew bacteria (21/30, 95% CI 52-83%), most of which were mixed skin flora.  There were 118 observations in each data period.  Stethoscope cleaning rates improved from 0% (95% CI 0-3%) to 25% (95% CI 18-33%).

Conclusion: Few stethoscopes were free of bacteria, although highly pathogenic bacteria were uncommon. Implementation of a multimodal educational package resulted in a modest change in staff behaviour.  Further research is needed to explore barriers to stethoscope cleaning and sustain and improve stethoscope cleaning rates.


Biography:

Sharon is a research nurse and coordinator for the Joseph Epstein Centre for Emergency Medicine Research at Western Health.

She is also a Clinical Nurse Specialist with the Emergency Department at Footscray Hospital in Melbourne.  Her area of interest is clinical handover and leadership.

12