An exploration of Indonesian nurses' perceptions of barriers to paediatric pain management.

There is a dearth of research in Indonesia regarding pain management in children. Previous studies have identified that although a variety of research and clinical studies on all aspects of pain have been conducted in many countries, children continue to experience moderate to severe pain during hospitalization. Greater research efforts are needed to identify and explore the factors that impede effective pain management in children. To address this gap, the researchers conducted an exploratory descriptive qualitative study to capture Indonesian nurses' perceptions of barriers to paediatric pain management in two hospitals. Using purposive sampling, data were collected from 37 nurses through semi-structured, in-depth interviews. Findings indicated that nurses working in Indonesian paediatric wards felt that they were not able to provide effective pain care to hospitalized children. Nurses identified several organizational structural and cultural factors that were thought to hinder their provision of effective pain care to paediatric patients. These factors are embedded in nurses' clinical practice. The study findings can assist to inform relevant initiatives and strategies to improve clinical nurses' performance and competency in providing effective pain care to paediatric patients.

Registered nurse buddies: Educators by proxy?

The informal clinical teaching role of the buddy nurse seems to be a uniquely Australian title, with little consistency in terminology for informal nurse educator roles internationally. Not all registered nurses are professionally developed for the informal role of facilitating the clinical learning of students in clinical settings, yet these roles are expected by nursing professional bodies. In Australia the registered nurses (RN) experience of being a buddy nurse has been reported as lacking clarity, being unsupported and structureless. Whist there is a plethora of literature published about formal RN educator roles, little is available on the informal buddy nurse role. A view of the buddy nurse role in reference to the limited but available literature in the Australian context is offered in this paper. International perspectives are also gathered describing informal clinical education RN's roles with similar responsibilities to the Australian buddy nurse. The significance of this dialogue is to ignite debate about the role, potentially informing policy for the improved support of the role within the Australian nursing landscape.

Impact of teamwork on missed care in four Australian hospitals.

AIMS AND OBJECTIVES: Investigate effects of teamwork on missed nursing care across a healthcare network in Australia. BACKGROUND: Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events. DESIGN: A descriptive exploratory study. METHODS: Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care. RESULTS: The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care. CONCLUSION: Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed. RELEVANCE TO CLINICAL PRACTICE: These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally.

Sex differences in in-hospital mortality following a first acute myocardial infarction: symptomatology, delayed presentation, and hospital setting.

BACKGROUND: Women generally wait longer than men prior to seeking treatment for acute myocardial infarction (AMI). They are more likely to present with atypical symptoms, and are less likely to be admitted to coronary or intensive care units (CCU or ICU) compared to similarly-aged males. Women are more likely to die during hospital admission. Sex differences in the associations of delayed arrival, admitting ward, and mortality have not been thoroughly investigated. METHODS: Focusing on presenting symptoms and time of presentation since symptom onset, we evaluated sex differences in in-hospital mortality following a first AMI in 4859 men and women presenting to three emergency departments (ED) from December 2008 to February 2014. Sex-specific risk of mortality associated with admission to either CCU/ICU or medical wards was calculated after adjusting for age, socioeconomic status, triage-assigned urgency of presentation, blood pressure, heart rate, presenting symptoms, timing of presentation since symptom onset, and treatment in the ED. Sex-specific age-adjusted attributable risks were calculated. RESULTS: Compared to males, females waited longer before seeking treatment, presented more often with atypical symptoms, and were less likely to be admitted to CCU or ICU. Age-adjusted mortality in CCU/ICU or medical wards was higher among females (3.1 and 4.9 % respectively in CCU/ICU and medical wards in females compared to 2.6 and 3.2 % in males). However, after adjusting for variation in presenting symptoms, delayed arrival and other risk factors, risk of death was similar between males and females if they were admitted to CCU or ICU. This was in contrast to those admitted to medical wards. Females admitted to medical wards were 89 % more likely to die than their male counterparts. Arriving in the ED within 60 min of onset of symptoms was not associated with in-hospital mortality. Among males, 2.2 % of in-hospital mortality was attributed to being admitted to medical wards rather than CCU or ICU, while for females this age-adjusted attributable risk was 4.1 %. CONCLUSIONS: Our study stresses the need to reappraise decision making in patient selection for admission to specialised care units, whilst raising awareness of possible sex-related bias in management of patients diagnosed with an AMI.

Australian nurses' perceptions of the use of manual restraint in the Emergency Department: a qualitative perspective.

AIMS AND OBJECTIVES: To explore emergency nurses perceptions of the use of manual restraint. BACKGROUND: Manual restraint of patients has historically been an accepted practice, though little is known about the use of manual restraint in general hospitals. DESIGN: A qualitative, descriptive, exploratory, study was undertaken. METHOD: Fifteen semi-structured interviews with emergency nurses were completed. Data were analysed using qualitative thematic analysis procedures. RESULTS: The following themes were identified: 'part of the job', 'reasons for manual restraint', 'restraint techniques', 'consequences' and 'lack of documentation'. Manual restraint occurred frequently each shift and most were not documented. This may be due to nurse's perceptions that manually restraining a patient did not comprise formal restraint and was the only option. Nurses used manual restraint to manage patients who were violent and aggressive or to perform procedures. However, they reported a lack of education and training in manual restraint. Nurses identified several consequences for the patient, staff and the organisation as a result of these events including psychological and physical injuries. CONCLUSIONS: Empirical research of prevalence and issues surrounding manual restraint events is required to inform health care organisations and government to develop, implement and evaluate appropriate policies and strategies to ensure safety of patients and staff. The employment of peer support workers and professionals with expertise in mental health and dementia may aid in the reduction of manual restraint events and improve care of all patients within the Emergency Department. Research on manual restraint in health settings is also needed. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be aware that manual restraint is not just an accepted part of their work, but is a strategy of last resort that should be documented. Organisations must implement standardised educational programmes for nurses together with policies and processes to monitor and evaluate manual restraint events.

Interpersonal relationships between registered nurses and student nurses in the clinical setting--A systematic integrative review.

BACKGROUND: A significant proportion of undergraduate nursing education occurs in the clinical setting in the form of practising skills and competencies, and is a requirement of all nursing curriculum for registration to practice. Education in the clinical setting is facilitated by registered nurses, yet this interpersonal relationship has not been examined well. OBJECTIVE: To investigate the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse. DESIGN: Integrative review Review methods: The databases of MEDLINE, CINAHL and OVID were searched. Key words used included: Registered Nurse, Preceptor, Buddy Nurse, Clinical Teacher, Mentor, Student Nurse, Nursing Student, Interpersonal Relationships, Attitudes and Perceptions. Additional review of the literature was manually undertaken through university library textbooks. RESULTS: 632 abstracts were returned after duplicates were removed. Twenty one articles were identified for full text read (quantitative n=2, mixed n=6, qualitative n=14); of these, seven articles addressed the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse and these were reviewed. CONCLUSIONS: Providing education for registered nurses to enable them to lead student education in the clinical setting communicates the organizational value of the role. Registered nurses identified being supported in having the time-to-teach were considered important in facilitation of the clinical teaching role. The integrative review did not provide evidence related to the impact diverse clinical settings can have on the relationships between registered nurses and student nurses revealing an area for further examination.

Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department.

Abstract Aboriginal and Torres Strait Islander (ATSI) people experience challenges when accessing health care from the emergency department (ED). The aim of this project was to identify the perceived barriers and enablers to accessing health care at one Victorian Emergency Department for the local ATSI community. This qualitative explorative study collected data using focus groups or yarns to investigate the perceptions of the ATSI community presentations to the ED. Data were analysed following the standards of qualitative data analysis procedure. Three themes emerged organisational process, staff interactions and strategies for improvement. Information from this study will assist hospital and ED executives and practitioners to collaborate with the ATSI community in developing and implementing policy and practice changes that enable Aboriginal patients to be identified and receive culturally appropriate care.

A retrospective descriptive study of the characteristics of deliberate self-poisoning patients with single or repeat presentations to an Australian emergency medicine network in a one year period.

BACKGROUND: A proportion of deliberate self-poisoning (DSP) patients present repeatedly to the emergency department (ED). Understanding the characteristics of frequent DSP patients and their presentation is a first step to implementing interventions that are designed to prevent repeated self-poisoning. METHODS: All DSP presentations to three networked Australian ED's were retrospectively identified from the ED electronic medical record and hospital scanned medical records for 2011. Demographics, types of drugs ingested, emergency department length of stay and disposition for the repeat DSP presenters were extracted and compared to those who presented once with DSP in a one year period. Logistic regression was used to analyse repeat versus single DSP data. RESULTS: The study determined 755 single presenters and 93 repeat DSP presenters. The repeat presenters contributed to 321 DSP presentations. They were more likely to be unemployed (61.0% versus 39.9%, p = 0.008) and have a psychiatric illness compared to single presenters (36.6% versus 15.5%, p < 0.001). Repeat presenters were less likely to receive a toxicology consultation (11.5% versus 27.3%, p < 0.001) and were more likely to abscond from the ED (7.5% versus 3.4%, p = 0.004). Repeat presenters were more likely to ingest paracetamol and antipsychotics than single presenters. The defined daily dose for the most common antipsychotic ingested, quetiapine, was less in the repeat presenter group (median 1.9 [IQR: 1.3-3.5]) compared with the single presenter group (4 [1.4-9.5]), (OR 0.85, 95% CI 0.74-0.99). CONCLUSION: Patients who present repeatedly to the ED with DSP have pre-existing disadvantages, with increased likelihood of being unemployed and having a mental illness. These patients are also more likely to have health service inequities given the greater likelihood to abscond from the ED and lower likelihood of receiving toxicology consultation for their DSP. Early recognition of repeat DSP patients in the ED may facilitate the development of individualised care plans with the aim to reduce repeat episodes of self-poisoning and subsequent risk of successful suicide.

Deliberate self-poisoning presenting to an emergency medicine network in South-East melbourne: a descriptive study.

Background. Deliberate self-poisoning (DSP) comprises a small but significant proportion of presentations to the emergency department (ED). However, the prevalence and patient characteristics of self-poisoning attendances to EDs in Victoria have not been recently characterised. Aim. To identify and compare the characteristics of adult patients presenting to the three EDs of Monash Health following DSP. Methods. Retrospective clinical audit of adult DSP attendances between 1st July 2009 and 30th June 2012. Results. A total of 3558 cases over three years were identified fulfilling the search criteria. The mean age of patients was 36.3 years with the largest numbers aged between 18 and 30 (38%). About 30% of patients were born overseas. Forty-eight percent were discharged home, 15% were admitted to ED short stay units, and 5% required ICU admission. The median ED length of stay was 359 minutes (IQR 231-607). The most frequently reported substances in DSP were benzodiazepines (36.6%), paracetamol (22.2%), and antipsychotics (12.1%). Exposure to more than one substance for the episode of DSP was common (47%). Conclusion. This information may help identify the trends in poisoning substances used for DSP in Victoria, which in turn may provide clinicians with information to provide more focused and targeted interventions.

Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department.

Abstract Aboriginal and Torres Strait Islander people experience challenges when accessing health care from the Emergency Department. The aim of this project was to identify the perceived barriers and enablers to accessing health care at one Victorian Emergency Department for the local Aboriginal and Torres Strait Islander community. This qualitative explorative study collected data using focus groups or yarns to investigate the perceptions of the Aboriginal and Torres Strait Islander community presentations to the Emergency Department. Data were analysed following the standards of qualitative data analysis procedure. Three themes emerged organisational process, staff interactions and strategies for improvement. Information from this study will assist hospital and Emergency Department executives and practitioners to collaborate with the Aboriginal and Torres Strait Islander community in developing and implementing policy and practice changes that enable Aboriginal patients to be identified and receive culturally appropriate care.

Perceptions of Australian emergency staff towards patients presenting with deliberate self-poisoning: a qualitative perspective.

INTRODUCTION/BACKGROUND: Attitude of staff towards patients who present to the emergency department following deliberate self-poisoning may be integral to the outcome of these events. There is little in-depth understanding of emergency staff perceptions about this vulnerable group. AIM: Explore staff perceptions about caring for patients who present to the emergency department following deliberate self-poisoning. DESIGN: Qualitative descriptive study. METHODS: Two open-ended questions enabled 186 clinicians to describe their perceptions about caring for people who present to the emergency department following deliberate self-poisoning. Data were analysed using qualitative data analysis procedures. RESULTS: Three themes emerged from the data representing staff perceptions about caring for patients who deliberately self-poisoned and included depends on the patient, treat everyone the same, and skilled and confident to manage these patients. CONCLUSION: Staff reported mixed reactions to patients presenting with deliberate self-poisoning. These included feelings of empathy or frustration, and many lacked the skills and confidence to effectively manage these patients. RELEVANCE TO PRACTICE: Health networks are required to ensure that emergency staff have specialist support, knowledge, skills, and guidelines to provide effective care for this vulnerable population.

Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department.

INTRODUCTION: Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. AIM: To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. METHOD: One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. RESULTS: The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. CONCLUSION: Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.

Australian Emergency Department health professionals' reasons to invite or not invite Family Witnessed Resuscitation: a qualitative perspective.

BACKGROUND: Debate continues regarding the effectiveness of Family Witnessed Resuscitation and little is known about the reasons why staff invite family presence. AIM: Explore why health professionals invite or not invite Family Witnessed Resuscitation. DESIGN: Descriptive qualitative study. METHOD: Three open-ended questions enabled 114 clinicians to describe why they would or would not invite family presence. Data were analysed using qualitative data analysis. RESULTS: Four themes representing factors that influenced staff decision to invite or not invite Family Witnessed Resuscitation were identified: motivating factors, personal choice, staff judgment, and organisational factors. Motivating factors described reasons to invite family presence, and staff and organisational factors were reasons to not invite family presence. CONCLUSION: Family presence can be beneficial for staff and family and is likely to be motivated by family-specific factors where this choice is appropriate for all stakeholders. Participants described factors that can impact on the appropriateness of inviting family presence and these need to be considered before an invitation is extended. RELEVANCE TO PRACTICE: To support all parties throughout the process it is imperative that a skilled support person be available to the family and that written policies and guidelines be available for staff.

A mixed method study to determine the attitude of Australian emergency health professionals towards patients who present with deliberate self-poisoning.

INTRODUCTION: Deliberate self-poisoning is one of the frequent presentation types to emergency departments. It has been reported that attitudes of emergency staff may have negative consequences for the wellbeing of the self-poisoning patient. AIM: Determine the attitude of nursing and medical staff towards patients who present with deliberate self-poisoning and to identify if differences exist between the two groups. DESIGN: Mixed-method. METHODOLOGY: The "Attitudes towards Deliberate Self-Harm Questionnaire" was distributed to all nursing and medical staff who had direct patient contact at three emergency departments (N=410). Total and factor scores were generated and analysed against variables age, gender, length of experience working in the emergency department, level of education and by profession. Two open ended questions asked staff to write their perceptions and stories about patients who deliberate self-poison and were analysed using qualitative data analysis. RESULTS: Forty-five percent of staff returned the questionnaire. The attitude of emergency nurses and doctors was positive towards patients who deliberately self-poison. Doctors had significantly higher total and Factor 2 'dealing effectively with the deliberate self-poisoning patient' scores than nurses. After adjusting for length of time working in the emergency department only Factor 2 'dealing effectively with the deliberate self-poisoning patient' remained statistically significant. Staff reported high levels of frustration, in particular to patients who represent. CONCLUSION/RELEVANCE TO PRACTICE: This information may be used to develop and implement educational strategies for staff to improve the experiences of and better support patients presenting to the emergency department who deliberately self-poison.

ICU survivors' utilisation of diaries post discharge: a qualitative descriptive study.

BACKGROUND: A growing body of evidence has confirmed that intensive care unit survivors encounter myriad of physical and psychological complications during their recovery. The incidence of psychological morbidity in intensive care survivors is increasingly being recognised. The causes of psychological morbidity are multi-factorial but may be associated with a complete lack of, or delusional recall of events in intensive care. Intensive care unit diaries are an initiative designed to enable survivors to help restore factual memories and differentiate those from delusional. PURPOSE: To explore survivors' and family members' perceptions and utilisation of diaries following discharge from hospital. METHOD: A single centre qualitative descriptive study was undertaken in a general intensive care unit in Western Australia. Participants were surveyed 3, 6 and 12 months following discharge from hospital. Eighteen participants completed one or more surveys. FINDINGS: Many of the participants who completed the surveys read their diaries but few made entries in them following discharge. Reading the diaries evoked mixed emotions for these participants; however they still viewed the diaries as a positive initiative in their recovery. Diaries enabled survivors to fill the memory gaps, make sense of their experience and reinforced the human connection when they were immersed in a technological environment. CONCLUSION: Use of patient diaries was received positively by the participants in this study. Diaries are a simple, cost effective initiative which enabled survivors to piece together the time they had lost, concreted their experience in reality and enabled them to retain a connection with their loved ones whilst immersed in a technological environment.

Characteristics of Aboriginal and Torres Strait Islander presentations to three Victorian emergency departments.

OBJECTIVES: Aboriginal and Torres Strait Islander (ATSI) people have significant health disparity compared with other Australians. The present study examines the characteristics of ATSI patients presenting to three EDs of a single healthcare network to determine whether any healthcare disadvantages exist. METHODS: This is a retrospective audit of 179,795 presentations to the ED from 1 July 2011 to 30 June 2012. Measures included socioeconomic status, general practitioner nomination, triage category status, primary diagnosis recorded, length of stay and the outcome of stay, including numbers leaving before and after medical treatment was commenced. RESULTS: ATSI people were found to live in the lower socioeconomic regions of the network's catchment area, were more likely to attend the ED (135.5 non-ATSI persons presenting per 1000 non-ATSI persons and 210.4 ATSI persons presenting per 1000 ATSI persons), less likely to nominate a general practitioner (73.3 vs 82.1%; OR 0.60, 95% CI 0.51-0.71), more likely to leave before (5.5 vs 4.0%; OR 1.40, 95% CI 1.09-1.80) or after treatment had commenced (3.2 vs 2.3%; OR 1.43, 95% CI 1.03-1.97), and were more likely to re-attend the ED than non-ATSI people (OR 1.24, 95% CI 1.06-1.46). CONCLUSION: ATSI people living in Melbourne's south-east have social and health utilisation inequities, which might have an impact on their health status.

The PICHFORK (Pain InCHildren Fentanyl OR Ketamine) trial comparing the efficacy of intranasal ketamine and fentanyl in the relief of moderate to severe pain in children with limb injuries: study protocol for a randomized controlled trial.

BACKGROUND: The effectiveness of intranasal (IN) fentanyl as an analgesic for painful pediatric limb injuries in the Emergency Department (ED) has been reported previously. However, efficacy of IN ketamine in sub-dissociative doses is not well studied in the ED setting. A non-blinded pilot study undertaken by this study group suggested that IN ketamine showed similar analgesic effectiveness to that reported with IN fentanyl in similar non-blinded studies. The aim of this randomized, controlled, equivalence trial is to compare the analgesic effect of sub-dissociative dose IN ketamine with IN fentanyl for children with isolated musculoskeletal limb injuries. METHODS/DESIGN: This is a prospective, randomized, controlled, double-blind equivalence trial of children agedthree to thirteen years and less than 50 kg body weight, with isolated musculoskeletal limb injury, presenting to the ED with moderate to severe pain, defined as a verbal response of at least six to a standard 11-point scale (0=none, 10=worst pain imaginable). Pain score, sedation, satisfaction with analgesic intervention, and adverse effects will be assessed over a 60 minute interval for each participant. Intranasal ketamine (1 mg/kg) or fentanyl (1.5 microgram/kg) will be administered via blinded syringe and mucosal atomization device in a standardized volume at 0.03 ml/kg, with a maximum volume of 1.5 ml divided equally to both nares. Participants will also receive 10 mg/kg ibuprofen orally. The primary outcome measure will be median change in pain score from pre-administration to 30 minutes post-administration. Non-parametric Mann-Whitney U tests will be computed to compare median change in the primary outcome measure for IN ketamine and fentanyl. A sample size of 36 participants per group is needed to detect the expected 40 mm reduction in pain rating with a 95% confidence interval (CI) no greater than ±10 mm at 30 minutes. Rescue analgesia will be given as IN fentanyl or intravenous morphine. DISCUSSION: This is the first randomized-controlled trial comparing the efficacy of these two analgesic agents via the intranasal route. If IN ketamine is found to be equally effective to IN fentanyl for this indication, it will provide another analgesic agent that may be considered for the relief of acute pain in children in the ED. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000795897.

Assessing health professionals' perceptions of family presence during resuscitation: a replication study.

BACKGROUND: Family witnessed resuscitation is the practice of enabling patients' family members to be present during resuscitation. Research is inconsistent as to the effectiveness or usefulness of this initiative. AIM: To evaluate the performance of two scales that assess perceptions of family witnessed resuscitation among a sample of health professionals, in an Australian non-teaching hospital, and explore differences in perceptions according to sociodemographic characteristics and previous experience. DESIGN: Descriptive, replication study, using a cross-sectional survey. METHOD: An anonymous survey was distributed to 221 emergency department clinicians. Sociodemographic characteristics and perceptions of family witnessed resuscitation using the Family Presence Risk-Benefit and Family Presence Self-confidence Scales were assessed. Exploratory factor analysis was used to evaluate the performance of the scales. RESULTS: One hundred and fourteen doctors and nurses returned the survey (response rate of 51.6%). Both Scales were found to have a single factor structure and a high level of internal consistency. Approximately two-thirds of participants considered that family presence was a right of patients and families, and almost a quarter of respondents had invited family presence during resuscitation on more than five occasions. We found no significant differences in scale scores between doctors and nurses. CONCLUSION: Our findings confirm the validity of the Family Presence Risk-Benefit and Family Presence Self-Confidence Scales in the Australian context, and highlight the need to support clinicians in the provision of family witnessed resuscitation to all families.

Tertiary paediatric hospital health professionals' attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children.

AIMS AND OBJECTIVES: To ascertain health professionals' knowledge, attitudes and beliefs towards lesbian, gay, bisexual and transgender parents seeking health care for their children in a paediatric tertiary hospital setting which practises family-centred care. BACKGROUND: Lesbian, gay, bisexual and transgender parents are often reluctant to disclose their sexual orientation to health professionals for fear of discrimination and compromised quality of care. Staff knowledge, attitudes and beliefs can influence disclosure by parents, but little is known about knowledge, attitudes and beliefs in paediatric tertiary hospital staff towards lesbian, gay, bisexual and transgender parents accessing care for their children. DESIGN: Descriptive comparative study of health staff using a cross-sectional survey. METHODS: A set of validated anonymous questionnaires was used to assess knowledge about homosexuality, attitudes towards lesbians and gay men, and gay affirmative practice. Three open-ended questions were also used to assess beliefs about encouraging disclosure of lesbian, gay, bisexual and transgender parenting roles and how this may impact on care. RESULTS: Of the 646 staff surveyed, 212 (32.8%) responded. Knowledge and attitudes were significantly associated with professional group, gender, Caucasian race, political voting behaviour, presence of religious beliefs, the frequency of attendance at religious services, the frequency of praying, and having a friend who was openly lesbian, gay, bisexual and transgender. CONCLUSION: This study highlighted that staff working in a tertiary paediatric hospital setting, with family-centred care models in place, held attitudes and beliefs that may impact on the experience of hospitalisation for lesbian, gay, bisexual and transgender parents, and the quality of care received by their children. RELEVANCE TO CLINICAL PRACTICE: To promote equitable care to all families, organisations should ensure that family-centred care policies and guidelines are adopted and appropriately implemented. In addition to formal education, affirmative health service action and innovative methods may be required.