Interventions for people presenting to emergency departments with a mental health problem: a systematic scoping review

Dr. AmyNB Johnston1,2,3, Ms Melinda  Spencer4, Prof Marianne Wallis4,5, Prof Stuart Kinner6,7, Dr Marc Broadbent5, Dr Jesse Young6,7,8,9, Prof Ed Heffernan10, Prof Gerry Fitzgerald11, Dr Emma Bosley12, Prof Gerben Keijzers2,13,14, Prof Paul Scuffham4, Dr Ping Zhang4, Prof Melinda Martin-Khan15, Prof Julia Crilly2,4

1Princess Alexandra Hospital, Department Of Emergency Medicine And Sonmsw University Of Queensland, Brisbane Woolloongabba, AUSTRALIA, 2Gold Coast Health, Department of Emergency Medicine, Southport, AUSTRALIA, 3University of Queensland, Brisbane Woolloongabba, AUSTRALIA, 4Griffith University, Menzies Health Institute Queensland, Gold Coast, AUSTRALIA, 5University of the Sunshine Coast, Sunshine Coast Health Institute, Sippy Downs, AUSTRALIA, 6Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, AUSTRALIA, 7University of Melbourne, Centre for Health Equity, Melbourne School of Population and Global Health, Melbourne, Parkville, AUSTRALIA, 8University of Western Australia, Centre for Health Services Research, School of Population and Global Health, Perth, AUSTRALIA, 9Curtin University, National Drug Research Institute, Perth, AUSTRALIA, 10Queensland Centre for Mental Health Research, Queensland Forensic Mental Health Services, Brisbane, Wacol, Australia, 11Queensland University of Technology, School of Public Health and Social Work, Brisbane, Kelvin Grove, Australia, 12Emergency Services Complex, Queensland Ambulance Service, Brisbane, Kedron, Australia, 13Griffith University, School of Medicine, Gold Coast, Australia, 14Bond University, School of Medicine, Gold Coast, Australia, 15University of Queensland, Centre for Health Services Research, Brisbane, Woolloongabba, Australia

Nearly half (45%) of Australians aged 16-85 will experience a common mental disorder in their lifetime[1], and a proportion of these will present to emergency departments (EDs) with mental health problems (MHP). To enhance and promote the delivery of safe and efficient healthcare, it is important to understand what interventions can be effectively delivered in the ED for adults presenting with MHP, to improve health and social outcomes for this vulnerable group.

This scoping review aimed to identify and evaluate current research on interventions delivered or initiated in the ED for people presenting with a MHP.

A systematic search of eight databases using search terms relating to ED, mental health, psyc*, and interventions, with additional reference chaining, was undertaken. For included studies, the level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps.

A total of 277 papers met the inclusion criteria. The interventions identified were grouped thematically into seven domains by consolidating the wide range of primary intervention types examined. These seven domains included pharmacological (n=43), psychological/behavioural (n=25), triage/assessment/screening (n=28), educational/informational (n=12), case management (n=28), referral/follow-up (n=36), and mixed interventions (n=105). There was large heterogeneity in the quality of evidence within each domain. Interventions were focused on either staff, patient, or institutional level processes. Few studies focused on multiple level processes (n=64) and/or included the patient’s family (n=1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence regarding ED interventions to support people with MHP. The unique care requirements for these patients contributes to the variety of interventions used. The lack of inclusion of carers, and a lack of coherent, integrated, multifaceted, person-centred interventions, are important barriers to providing effective care for this vulnerable population who present to the ED.

[1].Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0


Biography:

Dr Amy Johnston currently holds a conjoint position between Metro South Hospital & Health Service, Department of Emergency Medicine (based at Princess Alexandra hospital) and the School of Nursing, Midwifery and Social Work, University of Queensland. For the past 5 years she has worked across the academic and ED healthcare environments to conduct her own research as well as supporting clinicians, particularly nurses, to develop the skills and confidence to participate in and conduct research projects relevant to their clinical work. She has a heartfelt and passionate commitment to evidence-based practice in emergency departments and to helping clinicians describe and evaluate the amazing innovations they implement. Her wide experience has helped her develop a broadening national and international profile. She has co-authored in excess of 80 publications and supported 3 PhD candidates to completion with another 7 currently working towards their PhD qualifications. Her H-index is 17 (Scopus), google scholar is 21, with i10 index of 27.

Identifying barriers and developing strategy to improve uptake of a new ED to ward handover tool using behaviour change theory

Ms Kate Ruperto1, Ms Tiana-lee Elphick3, Ms Madeline Eyles3, Professor Kate Curtis1,2

1Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia, 2Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia, 3Research Central, Illawarra Shoalhaven Local Health District, Wollongong, Australia

Background

Clinical handover is fundamental to clinical practice and is recognised as a national priority. The clinical handover from the Emergency Department (ED) to inpatient ward across four hospitals in a Local Health District (LHD) was identified in a number of reportable clinical incidents.  To address this, an ED to inpatient ward electronic clinical handover tool was developed and implemented within the LHD to support ED to ward handover.

Aim

The aim of the research was to determine the facilitators and barriers of the ED-to-Ward Handover Tool implementation, to improve compliance.

Methods

An exploratory multi-method approach was used to identify barriers and facilitators to the implementation of an ED to Ward Handover tool. An audit of electronic medical records assessed use of the newly implemented ED to ward handover tool. A 13-item electronic survey using six domains based on the Theoretical Domains Framework (a behaviour change model known to improve sustainable uptake in the clinical environment) was distributed to the 3,000 nurses across the LHD. Both quantitative (five-point scale Likert scale questions), and qualitative (free text responses) data were collected to identify barriers and facilitators. Barriers were then mapped to the corresponding intervention strategies to inform a “re-implementation” plan.

Results

Uptake of the tool was mixed between both sites and wards, with compliance varying from 45-90% depending on site. The 300 respondents reported five barriers and five facilitators, with the majority of barriers in the beliefs domain. Barriers varied according to sites, and between emergency and ward contexts. The integration of data informed the strategy to improve compliance.

Conclusion

Behaviour change informed research has determined the facilitators and barriers to use of a newly implemented clinical handover tool, to inform an implementation strategy to improve compliance.

Funding

This study was funded by the NSW Ministry of Health, System Purchasing branch


Biography:

Kate Ruperto RN, MN (Critical Care), Grad. Dip Adult Education.

I have always had a passion for Emergency Nursing starting my career in 2000.  I worked in the UK in 2002-2003 in various London Emergency Departments as well as community settings, while also spending some time in other critical care areas within Australia while completing my masters.  It was always emergency nursing which interested me most and I have continued to work in this area as an RN, CNS, CNC and Nurse Educator.

I am very interested in the development of emergency nursing as a profession and supporting the individual practitioner in developing an Emergency Department career.  My current role allows me to be involved with the career development and education of other emergency nurses as well as support and develop practice.

Understanding, exploring and reviewing emergency department discharge processes: Insights from interviews with patients and clinicians

Prof. Margaret Fry1, Leahanna Stevens2, Michael Browne3, Arthrit Barnes2

1University of Technology Sydney / NSLHD, Sydney, Australia, 2Mersey Hospital , Tasmania, Australia, 3Hobart Hospital , Hobart, Australia

Timely patient discharge is important to ensure patient flow is optimised, resources are appropriately allocated and capacity for treating new patients is available in the emergency department. Equally important is discharge planning to ensure the safe transition and or transfer of care thereby preventing harm to patients, avoidable representations and low compliance.

The discharge process involves communication of healthcare information to optimise patient safety, self-management, and understanding and compliance with ongoing treatment. Across Australia there is no evidence of how discharge planning should be conducted in ED; the role of the emergency team in discharge planning; or expectations of discharge and the key issues for emergency clinicians that impact on transition of care. Therefore, the aim of this study was to explore perceptions and experiences in and of ED discharge planning processes with patients and clinicians.

Method: The design was a qualitative descriptive study. Data collection involved telephone and face to face interviews with emergency clinicians and patients.

Results: Patient interviews (n=100) identified that the majority (93%) of patients understood their ED treatment, were confident to be discharged home (88%), and satisfied (90%) with ED care. The majority of patients’ understood their discharge diagnosis (86%) and were  provided with verbal (84%) discharge information. Discharge referral instructions were followed up by 60% of patients with 26% of patients re-presenting to ED.  The key themes to emerge from the face to face clinician interviews (n=21) were: 1) managing emergency department discharge processes; 2) working as a team and communication; 3) safe discharge and an enabling environment.

Conclusion: The study highlighted that the majority of patients were satisfied with ED care, complied with discharge healthcare information and confident to be discharged. However, clinicians emphasised a more systematic approach to ED discharge is needed to maximise safety, consistency, compliance and understanding of health information.


Biography:

Professor Fry is the Nursing and Midwifery Director Research and Practice Development for Northern Sydney Local Health District which is a conjoint Professorial Chair position with the University of Technology Sydney. She is also an adjunct professor with the School of Nursing University of Sydney. Professor Fry has 25 years emergency experience as a Clinical Nurse Consultant and authorised Nurse Practitioner (NSW).  Professor Fry has extensive emergency nursing experience and a proven research track with 137 peer reviewed publications and over $2.9million in grant, research tenders and or scholarship funding. Professor Fry’s program of emergency care research has established her as a national and international leader with strong clinical credibility. She has been involved, as Chief Investigator, in numerous research projects in emergency care evaluation, advanced nursing practice, and pain management and has undertaken significant workforce health services and practice research. Her program of research has led to significant Australian state and national emergency nursing practice change. Her recent program of research involves pain management, emergency care service utilisation, effective models of care, advanced nursing practice, the use of care bundles to support patient outcomes, and emergency discharge processes. In the acute in-hospital environment, she is working on interventions to reduce the occurrence of hospital acquired complications and representations

The implementation and usability of HIRAID, a structured approach to emergency nursing assessment

Professor Kate Curtis1,2,3,4,5, Dr Belinda Munroe2, Dr Connie Van1, Ms Tiana-Lee Elphick2

1Susan Wakil School of Nursing & Midwifery, The University of Sydney, Camperdown, , 2Illawarra Shoalhaven Local Health District, Wollongong, , 3The George Institute for Global Health, , , 4Illawarra Health and Medical Research Institute, , , 5Faculty of Science, Medicine & Health, University of Wollongong, ,

Background: Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients. HIRAID, an evidence-informed emergency nursing assessment framework, is known to improve emergency nursing patient-assessment in the simulated environment however has not been evaluated in the clinical setting.

Methods: A pre-post design was used to assess the usability and impact of HIRAID on emergency nurses self-efficacy in the emergency department (ED). Nursing and medical staff from three Australian EDs were surveyed. Descriptive and paired sample t-tests statistics were conducted.

Results: One hundred and twenty-two emergency nurses completed the pre-intervention self-efficacy survey and 63 completed the post-intervention self-efficacy and satisfaction survey. Forty-two and 17 medical officers completed the pre- and post-intervention satisfaction surveys respectively. Nursing staff self-efficacy levels were unchanged pre- and post-HIRAID implementation (Mean (SD): 8.8 (0.21) vs 8.7 (0.20)) as was medical staff satisfaction (Mean (SD):7.5 (1.43) vs 7.8 (1.07)), although there was a trend towards improved communication.

Conclusion: The HIRAID structured approach to patient assessment is acceptable, feasible, practical and appropriate for use in the clinical environment. Further research will demonstrate the direct effects of HIRAID on clinical performance.


Biography:

Professor Kate Curtis has been an Emergency Nurse since 1994 and is Clinical Nurse Consultant for Emergency at Illawarra Shoalhaven Local Health District. Kate is Professor of Emergency and Trauma Nursing at the University of Sydney and an honorary professorial fellow at the George Institute for Global Health. Kate’s translational research program focuses on improving the way we deliver care to patients and their families, and has attracted more than $4 million funding. Kate is the world’s most published author in the field of Trauma and Emergency Nursing and has mentored more than 40 clinicians in research projects.

Developing a validated occupational violence risk assessment tool for use in Australian EDs; Engaging with end-users

Ms CJ Cabilan1, Dr Rob Eley1,3, Dr Amy Johnston1,2

1Princess Alexandra Hospital, Department Of Emergency Medicine, Brisbane, Australia, 2University of Queensland, School of Nursing Midwifery and Social Work, Brisbane, Australia, 3University of Queensland, School of Medicine, Brisbane, Australia

Early detection of risk factors for occupational violence (OV) could mitigate incidences of OV in emergency departments (EDs) and enable more directed targeting of safety resources. For the purposes of early detection and intervention, OV risk assessment are best done at triage, the start of a hospital care journey. While a systematic review of evidence around key indicators of OV points to several potential recommendations surrounding risk assessment and tool development (1), it is imperative that further research be informed by end-users – triage nurses. Therefore, the objective of this qualitative study was to ascertain triage nurses’ perceptions of the potential components of an OV risk assessment tool, focusing on feasibility, potential impact and challenges to its implementation. The study was conducted according to the COREQ guidelines. Data were collected from focus groups and semi-structured interviews with 15 triage nurses of a major public ED. Data were analysed inductively using Braun and Clarke’s thematic analysis technique and research team consensus. Five themes were identified pertaining to: i) Assessing; Gathering and synthesising diverse pieces of information to inform decisions about OV risk, ii) Acting; Deciding, documenting and communicating OV risk, iii) Standardising; The clinical need to standardise and communicate risk iv) Supporting; Eliminating the subjectivity or ad hoc nature of OV risk assessment and supporting staff decisions independent of previous experience v) Challenges around implementation of such an OV risk assessment tool. These data will inform ongoing development of a risk assessment tool to inform resource allocation and enhance staff and patient safety in Australian EDs.

References:

  1. Cabilan C.J., Morales S, Johnston A.N.B. Occupational violence risk factors and risk assessment tools in the emergency department: A scoping review. Emergency Medicine Australasia. In press.

Biography:

Dr Amy Johnston currently holds a conjoint position between Metro South Hospital and Health Service, Department of Emergency Medicine (based at Princess Alexandra Hospital) and the School of Nursing, Midwifery and Social Work, University of Queensland. For the past 5 years she has worked across the academic and ED healthcare environments to conduct her own research as well as supporting clinicians, particularly nurses, to develop the skills and confidence they need to participate in and conduct research projects relevant to their clinical work. She has a heartfelt and passionate commitment to evidence-based practice in emergency departments and to helping clinicians describe and evaluate the amazing innovations they implement. Her wide experience has helped her develop a broading national and international profile. She has co-authored in excess of 80 publications and supported 3 PhD candidates to completion with another 7 currently working towards their PhD qualifications. Her H-index is 17 (Scopus), google scholar is 21, with i10 index of 27.

The Cardiac Arrest Nurse Leadership (CANLEAD) Trial: Does the implementation of a new cardiac arrest role facilitate cognitive offload for medical team leaders

Mr Jeremy Pallas1, Dr John Paul Smiles, Dr Michael  Zhang

1Nsw Health, Newcastle, Australia

Introduction: Optimal resuscitation for patients suffering cardiac arrest necessitates an efficient team approach. Historically, medical team leaders have been subject to disproportionately high cognitive burden that prevails in such complex and stressful resuscitation events.

Objective: This study aimed to explore whether the implementation of a new “Nursing Team Leader” role is an effective way of providing cognitive offload for the medical team leader in a cardiac arrest scenario.

Methods:  This randomised controlled trial used a series of point of care simulations run in the emergency departments of the John Hunter and Maitland Hospitals. Both medical and nursing participants were randomised to either Control (traditional team roles) or Intervention (prescribed nursing team leader) groups – each group was balanced with 6 participants. The Nursing team leader in the Intervention group had a pre-determined set of designated resuscitation tasks. Debriefing data was collected for thematic analysis and a quantitative evaluation of both task efficiency and self-reported cognitive load was attended using a video assisted ‘task time checklist’ and the NASA Task Load Index.

Results: A total of 20 cardiac arrest simulations with equal distribution in Control and Intervention groups were evaluated (totalling 120 participants). While there was no statistically significant improvement in perceived performance among participants in this study, the nursing team leader role was associated with significant cognitive offload for medical team leaders. The intervention groups were also able to perform numerous tasks more efficiently than the control including the timely application of the defibrillator, rapid assessment for reversible causes and management of CPR quality.

Conclusion: The incorporation of a dedicated nursing team leader role focused on the facilitation of high quality advanced life support is a practical and effective means of both facilitating cognitive offload for medical team leaders and improving general task efficiency in the setting of cardiac arrest.


Biography:

Jeremy Pallas is currently working as the Clinical Nurse Consultant in the Emergency Department of the John Hunter Hospital. He has a keen interest in contemporary resuscitation with a focus on Acute Heart Disease and Trauma. Jeremy is passionate about the continual evolution of the modern emergency nurse and has a strong belief in the value of a well-educated and well supported clinician. Jeremy is also a simulation educator working in the Hunter New England Simulation Centre to facilitate and instruct on a number of different emergency training courses.

The contribution of time to first analgesic medication in Emergency Department length of stay

Dr. James Hughes1,2, Dr. Nathan Brown1,3, Ms Jacqui Chiu3, Mr Brandon  Allwood1, A/Prof Kevin Chu1,3

1Royal Brisbane And Women’s Hospital , Herston, Australia, 2Queensland Univerity of Technology, Kelvin Grove, Australia, 3University of Queensland, St Lucia, Australia

Background:  Pain is the most common presenting symptom in emergency department (ED) patients. Many factors such as workload and age, are known to affect the time taken to deliver analgesic medications (TTA), which in turn can impact on the patient’s ED length of stay (ED LOS).

Objective: To determine the independent contribution of TTA to ED LOS.

Methods:  A retrospective cohort study was conducted in a tertiary-referral, inner-city ED. The sample included adult patients who presented with pain and received analgesic medication(s).  Study participants were identified from a random selection of 2,000 adult patients who presented between August and October 2018. The relationship between ED LOS and TTA was described using bivariable and multivariable linear regression models with the latter adjusting for sex, triage category, ED location where patient was first seen by a clinician, departure destination, and workload metrics (average daily time to be seen, and daily access block).

Results:  Of the 2,000 randomly selected patients, 727 (36.4%) had pain as a symptom on arrival, 423 (21.2%) had analgesic medication administered. Median (IQR) age was 35 (25-52) years and 53.3% were female. Median (IQR) TTA was 62 (36–105) minutes and median (IQR) ED LOS was 218 (160–318) minutes.  TTA was found to be an independent predictor of ED LOS, contributing to 7.0% of the variance in ED LOS in the multivariable model.

Conclusion:  Providing analgesic medication faster to patients presenting in pain, in addition to previously demonstrated positive patient outcomes, may decrease their ED LOS.


Biography:

Dr. Hughes is an early career researcher who specialises in emergency care research. He has an extensive background as an emergency nurse and leader, working in some of Queensland’s busiest ED’s. Dr. Hughes completed his PhD in November 2018 on factors that influence pain care in the ED.  He is currently employed as a Nurse Researcher in the Emergency and Trauma Centre at the RBWH and Conjoint Senior Research Fellow in the School of Nursing at QUT, a position partially funded by the Emergency Medicine Foundation. His research interests include pain care, infection detection and care of the vulnerable patient.

Turning up the volume on suboptimal blood culture collection practices

Ms. Angela Hills1, Mrs Mercedes Ray1, Dr Jacqueline Harper2, A/Prof Jaimi Greenslade1,3, Dr. James Hughes1,3, Dr Julian  Williams1,4

1Royal Brisbane and Women’s Hospital, Herston, Australia, 2Pathology Queensland, Herston, Australia, 3Queensland University of Technology, Kelvin Grove, Australia, 4University of Queensland, St Lucia, Australia

Background: Blood cultures (BC) are one of the most common pathology tests ordered in the emergency department (ED). Quality of BC collection may be quantified through contamination rates, the number of sets per patient and the volume of blood cultured. Guidelines recommend a collection of 8 – 10 ml per culture bottle for a total of 40 ml per patient. Previous studies have demonstrated that suboptimal volume can lead to increased contamination and reduced true positive rates. This may lead to patients receiving un-necessary treatment or delays to directed antimicrobial therapy.

Aims: This study aimed to establish a reliable method of measuring the volume of blood in culture bottles taken in the ED, and then to employ this method to identify an association (if any) between BC volume, contamination and true positive rates sufficient to inform the design of a future interventional study.

Methods: This is a single site, prospective observational study. A customised device was used to record blood volume for all BC bottles sent to pathology for processing. The Kruskal – Wallace H test was used to examine the association between volume, true positive results and contamination.

Results: Preliminary results (first five weeks, n=541 BC bottles) demonstrated significant underfilling of BC bottles, with a median volume of 6mls (IQR 4mls – 10mls) per bottle and 165 (30.5%) bottles containing blood volume 4mls or less. Ongoing data collection and subsequent analysis will determine the relationship between BC volume and culture results.

Conclusion: Enquiry into the quality of blood cultures sent to pathology for testing has identified significant deviation from current volume guidelines, with substantial underfilling. The relationship between this underfilling and culture outcomes is currently being explored. Any identified association between BC underfilling and suboptimal test performance should be communicated to BC collectors so practice may be improved.


Biography:

Mercedes is an experienced emergency nurse, having worked in senior positions in two of Queensland’s busiest hospitals. She is a passionate advocate for the improvement of patient care and has recently taken up the role of Clinical Nurse – Research within the Emergency and Trauma Centre at RBWH to work on the Bugs in Bottles project, a multidisciplinary research project aimed at improving the quality and use of blood cultures in the emergency department.

Angela Hills is a registered nurse working on the front line of health care at the Royal Brisbane and Women’s Emergency and Trauma Center. Angela places great emphasis on efficient and evidence-based care and became interested in clinical research with the hopes of improving practices in the emergency setting. Her interests include the treatment and diagnosis of sepsis and has recently joined a team looking into the quality of blood cultures in the emergency department.

It all starts with “how….?” Supporting the journey towards a PhD (part 2)

Dr Amy Johnston1,2, Mrs Tracey Millichamp1,3

1School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia, 2Dept Of Emergency Medicine, Princess Alexandria Hospital, Queensland Health, Woolloongabba, Australia, 3Redland Hospital Emergency Department, Queensland Health, Cleveland, Australia

A PhD can be many things, descriptive, data-driven, methodological, explorative and so many more – but it is always BIG. So many capable nurses who are undertaking unique and innovative research and extending existing knowledge as a part of their clinical roles, sometimes even publishing that research(1), are put off the logical step of enrolling in a PhD because it just seems so intimidating. This presentation will provide a framework for starting to explore research higher degree studies. It will set out the requirements for a PhD thesis (it’s not always just a very very big book), the processes to set in place at the start to help ensure successful completion of a research higher degree, some general information about entry requirements, the difference between a PhD and a professional doctorate (yes there is a difference), finding supervisors and developing a project (or using a project that you are already doing in a professional role) to ensure you complete.

This presentation is a personal account of supporting nurses’ journeys toward and through PhD study and a generic supervisor’s guide to help you, the potential PhD student, prepare for the start of your PhD adventure.

Expand your worldview, explore your boundaries and exceed your own expectations.

1Henly, S. J., et al., (2015). Emerging areas of nursing science and PhD education for the 21st century. Nursing outlook, 63(4)


Biography:

Dr Amy Johnston currently holds a conjoint senior research fellow/senior lecturer position between Metro South Hospital & Health Service, Department of Emergency Medicine (based at Princess Alexandra hospital) and School of Nursing, Midwifery and Social Work. She works across the academic and healthcare environments to conduct her own research as well as supporting clinicians to develop the skills and confidence to participate in, and conduct research projects relevant to their clinical work. Amy is a neurobiologist and nurse with extensive teaching and research experience and a particular interest in Emergency Department service delivery and patient flow. She also has an enduring interest in the scholarship of clinical learning and teaching, particularly focused on the biosciences. She has been contributing to nursing bioscience teaching for more than 25 years (since the inception of nursing degree programs in Australia).

It all starts with “why….?” The journey towards a PhD

Mrs Tracey Millichamp1,2

1School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia, 2Redland Hospital Emergency Department, Queensland Health, Cleveland, Australia

A PhD is commonly considered to be a journey, a research apprenticeship, that can build new understanding and extend existing knowledge by the use of original approaches to problems, exploration of understanding and testing and unique ways of thinking and writing (Trafford & Leshem 2009).

But what does this actually mean? What is the reality of a PhD?  Especially for someone used to working clinically and  earning a reasonable living. How do you find someone to help/supervise you? What university do you go to? How much does it cost? Where do you start with a research project that will ultimately produce 80,000 words? And, more importantly, why would you chose to spend 4-8 years producing those words?

This presentation is a personal account of a journey toward PhD study and a beginner’s guide to help you prepare for the start of your PhD adventure.

Expand your worldview, explore your boundaries and exceed your own expectations.

Trafford, V. & Leshem, S (2009).  Doctorateness as a threshold concept.  Innovations in Education and Teaching International.  Vol 46 (3), pp. 305-316.


Biography:

Tracey Millichamp is Clinical Nurse Consultant in the Emergency Department at Redland Hospital. She has lead and participated in a number of research projects in the ED environment including improving medication safety, decreasing violence in the ED, clinical handover and implementing models of care. Tracey is currently completing a PhD in medication safety, nursing and the ED.