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Rolls, S. (2006). An exploration of workplace violence in the emergency department: Are emergency nurses safe? Ph.D. thesis, , .
Abstract: This thesis arises from the author's experience of several years of working in the emergency department and being exposed to workplace violence from patients and their families. Emergency nurses in New Zealand experience workplace violence every day. Registered nurses and the institutions in which they work manage workplace violence to varying degrees and in an ad hoc manner. The author notes that New Zealand has no national guidelines, or consensus on the management of workplace violence in the health sector. This research explores emergency nurses' encounters during their work when they have experienced workplace violence. The purpose of this study is to demonstrate the experience and the consequences when nurses are confronted with episodes of violence while working in the emergency department. The essence of this research is gaining an understanding of how registered nurses have managed workplace violence and the impact of that violence on themselves, their colleagues, and the patients in the emergency department. Recommendations are made regarding nationally consistent guidelines, education on the management of workplace violence, improved security, and emergency department design. The discussion concludes with suggestions for further research on workplace violence in the health sector
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Ardagh, M., Wells, E., Cooper, K., Lyons, R., Patterson, R., & O'Donovan, P. (2002). Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: A controlled prospective trial. Access is free to articles older than 6 months, and abstracts., 115(1157).
Abstract: The aim of this study was to test the hypothesis that triaging certain emergency department patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. During the five weeks of the RAC clinic a total of 2263 patients attended the emergency department, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the emergency department. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The researchers found that the rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.
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Horner, C. (2008). Emergency health provision and maintaining competency. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 125-136). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter focuses on issues associated with rural nursing and the provision of emergency care for patient(s) located remotely from secondary hospital services. All emergencies have diverse characteristics, but the rural practitioner also contends with having sole practice, professional and geographical isolation, and the lack of regular experience. The chapter reviews the PRIME (Primary Response in Medical Emergency) recommendations and training, and looks in particular at the issues around the maintenance of competency for the rural nurse providing emergency on call health care that includes managing medical and accident emergencies in the absence of a medical practitioner.
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Grainger, P. C. (2007). Nursing documentation in the emergency department: nurses' perspectives. Master's thesis, Victoria University of Wellington, Wellington.
Abstract: Explores emergency nurses? perspectives and practices about the quality, importance and value of emergency nursing documentation in relation to their personal beliefs, past experiences and preferred systems of documentation; the practical and contextual factors that influence documentation practices within an emergency department (ED); their interests in documentation tools or systems; and their interests in relation to further development of documentation practices and systems. Conducts a qualitative descriptive study in which ten emergency nurses from one ED in New Zealand were interviewed using interactive interview methods, and asked to complete a Likert scale to identify the relevance of internationally- recognised general influences on documentation to their own practices in the context of an ED. Includes recommended routes to development through partnership, participation and process engagement, and strategies including document development, knowledge advancement and support.
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Lockett, J. (2020). Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: a qualitative descriptive study. Master's thesis, Victoria University of Wellington, Wellington. Retrieved May 21, 2024, from http://hdl.handle.net/10063/8992
Abstract: Explores what NZ Emergency Department (ED) nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. Uses a qualitative descriptive design to allow an examination of the first-hand perspectives of ED nurses, gaining meaningful insights into a phenomenon little explored. Interviews 16 ED nurses about future pandemic planning at ED, DHB and government level.
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Kuehl, S. (2008). Emergency Department re-presentations following intentional self-harm. Ph.D. thesis, , .
Abstract: The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm.
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Turnwald, A. B. (2006). Acute Hypercarbia in Chronic Obstructive Pulmonary Disease (COPD): Presentations to a New Zealand emergency department. Ph.D. thesis, , .
Abstract: A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home.
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Thompson, C. M. M. (2005). Caring for people with mental health problems who present at the emergency department: A nurse educator's journey.
Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.
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Rudd, J. (2005). From triage to treatment: An exploration of patient flow systems in emergency departments. Ph.D. thesis, , .
Abstract: To find an effective approach to managing or reducing waiting times for lower triage category patients processed through one particular metropolitan emergency department, an extensive search of the literature revealed several different patient flow processes. These approaches are discussed, in relation to suitability for the particular emergency department. The history of triage, including how and why it evolved, plus the realities of triage today are explored. Included are case examples of two patients on a journey through the department the way it is presently, and how it could be if particular approaches are introduced. Extending nursing practice by introducing nurse-initiated x-rays at triage and the introduction of a separate stream for minor category patients in a dedicated ambulatory care area is one approach that could improve waiting times for these patients. There would be the added advantage of improving triage compliance figures for category three patients. The additional costs involved in such a process could be offset by improved efficiency in terms of waiting times, improved triage compliance figures, happier patients and clinical staff, and an emptier waiting room.
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Gabolinscy, B. (2005). Triage codes: A predictor of nursing care time in the emergency department. Ph.D. thesis, , .
Abstract: This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%). The author suggests that further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments.
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Blair, K. M. (2006). Recognising the sick patient: An emergency nurses view: A research paper.
Abstract: This paper reports on a literature review that examines how health professionals (mainly nurses) recognise the signs of physical deterioration in their patients. It includes discussion of how nurses' clinical decision making skills influence how physical deterioration is identified and determines what changes in the delivery of care could have an impact on emergency department patients at risk of life threatening deterioration.
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Kerr, R. C. (2006). Is the graduate nurse work-ready for emergency nursing?.
Abstract: In this research paper for a Master of Nursing (Clinical), the author suggests that graduate nurses can successfully adapt to emergency nursing when supported with intensive domain-specific transition programmes to complement the national nursing entry to practice (NETP) programme in New Zealand. This outcome conflicts with the present traditional emergency department recruitment strategy that nurses must have two years acute care experience. The graduate believes they are prepared for practice for any healthcare setting but do need time to resolve the rift between theory and practice. This research project confirms the perpetuation of experienced nurses' perceptions that graduates are not work-ready but are unrealistically expected to hit the floor running following ad hoc orientation ranging from three days to four weeks. By creating domain-specific programmes with a minimum twelve-week staged rotation orientation package, graduate nurses can be nurtured as emergency nurses. The influential role of the organisation and experienced nurses is vital to limit reality shock and complement NETP. Preceptorship and mentorship programmes promote the graduates' confidence in themselves to become competent team members. Limits to this research are the non-differentiation between nurses new to emergency nursing and the graduate nurse in the published studies. Assumptions have therefore been made regarding successful transition in regard to newly qualified registered nurses in the emergency department. Further study and evaluation applicable in the New Zealand context is also recommended by the author where anecdotally only a few emergency departments are involved in socialising graduate nurses into the workforce regardless of the urgent need for more first-year-of-practice clinical placements.
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McKerras, R. (2005). Waiting in the emergency department – it doesn't have to take all day. Ph.D. thesis, , .
Abstract: This thesis explores the nature of the emergency department environment as it continues to challenge emergency nurses to meet the health needs of an increasingly complex emergency department population. The emergency nurse is also facing conflict and challenge with regard to workplace safety and patient rights. The author suggests that, until recently, very little debate or consideration has been given to the moral dilemmas raised in the ability of emergency department staff to deliver timely and appropriate care in an overcrowded environment. She goes on to say that, in New Zealand, there is no national consistency with regard to the waiting crisis, no national guidelines and no national consensus putting the emergency nurse at risk. This thesis argues the need to acknowledge waiting times as a significant safety issue at a national level as increasing waiting times continue to impact on patient outcomes and nursing practice. It challenges current practice, in particular the role of the emergency nurse and the potential to legitimise expansion of the role to improve the patient experience of waiting in the emergency department.
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Richardson, S. (2005). Incorporation of research into clinical practice: The development of a clinical nurse researcher position. Nursing Praxis in New Zealand, 21(1), 33–42.
Abstract: The author backgrounds the development of the role of an innovative Nurse Researcher (Emergency Medicine) role at Christchurch Hospital. She describes the emergency department and the factors leading to the creation of the role. Specific nursing research projects are reviewed, and the nature of nursing in relation to research is discussed. The author argues that the nurse researcher is integral to the expansion of evidence-based nursing, and that the role of Clinical Nurse Researcher in the emergency department has resulted in a higher profile for research, and the gradual integration of research as a clinical skill with direct practical relevance.
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Richardson, S. (1999). Emergency departments and the inappropriate attender: Is it time for a reconceptualisation of the role of primary care in emergency facilities? Nursing Praxis in New Zealand, 14(2), 13–20.
Abstract: This paper reviews currently identified issues concerning emergency department attendance, and examines the core question of the role of primary care in the emergency department. Asks whether this is an appropriate use of emergency department resources, and if so, what the implications are for the role of the emergency nurse. Suggests the establishment of Minor Injury Units in New Zealand like those in the UK.
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