Evaluation of an immersive simulation programme for mental health clinicians to address aggression, violence, and clinical deterioration.

This study investigated the effectiveness of high-fidelity immersive simulation education to support inter-professional hospital clinical staff in recognizing and responding to aggression, violence, and clinical deterioration of patients admitted with mental health issues. Increased incidents of aggression and violence have been reported in many clinical hospital settings, especially in mental health wards. Patients experiencing severe psychological distress/agitation can result in the escalation of physiological symptoms such as chest pain, difficulty breathing, traumatic injury, etc. Mental health staff do receive aggression prevention training and medical emergency team training. However, there is added complexity when dealing with a mental health patient who is exhibiting aggressive, violent behaviour while also experiencing a medical or psychological emergency. Therefore, mental health staff needed a combined training programme that enhanced their delivery of recovery focussed care, de-escalation, and medical emergency crisis resource management skills. This study used a prospective quasi experimental research design with repeated measures. Hospital clinical staff were immersed in two mental health emergency response and clinical deterioration scenarios and debriefing sessions. Self-efficacy was evaluated using a 10-item validated tool which addressed non-technical skills of Leadership, Management, Communication, and Teamwork. The sample consisted of 122 clinical staff, with the majority from mental health wards (52%; n = 63) who were nurses (68%; n = 83). Mean self-efficacy scores increased significantly across the three time points (F = 11.555; df = 2; P = 0.000). Post hoc pairwise comparisons showed that self-efficacy scores increased between pretest (mean 62.9; n = 122) and posttest 1 (mean 83.2; n = 122) and follow up, 3 months later (posttest 2; mean 81.9; n = 24). Between pre- and posttest 1, significant improvements in self-efficacy were observed for both the Leadership/Management domain (t = 8.2; df 119; P < 0.000; 95% CI 13.3-21.7) and the Communication/Teamwork domain (t = 8.0; df 119; P < 0.000; 95% CI 11.1-18.4). Immersive simulation with high fidelity education was found to be effective in improving hospital nursing and medical staffs' confidence, when responding to incidents of aggression/violence and clinical deterioration of a mental health patient.

Developing the Next Generation in Electronic Clinical Auditing: CoBRA Tool.

BACKGROUND: Although auditing is embedded into clinical culture, data collection tends to be retrospective, requires expertise, and is time consuming. LOCAL PROBLEM: Clinical audit data are needed in real time to manage patient safety issues. METHODS: An iterative approach was undertaken to develop the electronic audit tool with a cross-sectional survey used for evaluation. INTERVENTIONS: The Combined Bedside and Risk Assessment (CoBRA) audit tool captures patient safety risk and compliance such as falls, pressure injuries, and infections. RESULTS: More than 17 956 safety audits were collected on randomly selected inpatients. Monthly audits completion average is 96% (n = 614). Patient safety risk mitigation is available in real time. Stakeholders stated that the CoBRA tool was useful in educating patients on risks (n = 141; 78.3%), improved patient care (n = 120; 67.4%), and prompted staff to modify patient care based on CoBRA findings (n = 98; 54%). CONCLUSIONS: The electronic CoBRA process facilitates patient safety risk mitigation and data transparency.

Developing an evidence-based transition program for graduate nurses.

BACKGROUND: The catalyst to revise the graduate nurse program at an inner city hospital was a major service reconfiguration, which reduced services, staffing and graduate nurse positions. Parameters for the new program were that it was evidence-based and could function within the reduced resources. OBJECTIVE: Review current literature and design an evidence-based transition program. METHODS: Eight databases were searched for primary and secondary research and unpublished theses (2004-2014), which were then hand searched. Eighty-three articles were reviewed and 50 retained as they informed development of a program designed to actively promote the graduates' transition from undergraduate to independent health professional. RESULTS: Three key concepts emerged from the literature: the graduates' need for support, socialisation and facilitated learning opportunities. This article reviews the literature and outlines a program designed to maximise these concepts in an evidence-based transition program. Proposed evaluation tools are identified for use throughout the program.

Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review.

BACKGROUND: Cancer care nursing is perceived as personally and professionally demanding. Developing effective coping skills and resilience has been associated with better health and wellbeing for nurses, work longevity and improved quality of patient care. OBJECTIVES: The objective of this systematic review was to identify personal and organizational strategies that promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy. METHODS: The search strategy identified published and unpublished studies from 2007 to 2013. Individual search strategies were developed for the 12 databases accessed and search alerts established. The review considered qualitative, quantitative and mixed methods studies that assessed personal or organizational interventions, programs or strategies that promoted coping and resilience. These included studies employing clinical supervision, staff retreats, psycho-educational programs, compassion fatigue resilience programs, stress inoculation therapy and individual approaches that reduced the emotional impact of cancer care work. The outcomes of interest were the experience of factors that influence an individual's coping and resilience and outcomes of validated measures of coping or resilience. Methodological quality of studies was independently assessed by two reviewers prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute. Standardized Joanna Briggs Institute tools were also used to extract data. Agreement on the synthesis of the findings from qualitative studies was reached through discussion. The results of quantitative studies could not be statistically pooled given the different study designs, interventions and outcome measures. These studies were presented in narrative form. RESULTS: Twenty studies were included in the review. Ten studies examined the experience of nurse's caring for the dying, the emotional impact of palliative care and oncology work and strategies to prevent burnout or avoid compassion fatigue, challenges in self-care, and processes nurses adopted to cope with work related stress. Six studies evaluated different interventions provided by organizations to improve coping and resilience. Evidence for the effectiveness of interventions was limited to three studies. The results are discussed under four headings: (i) preventative measures (ii) control measures (iii) unburdening and "letting go", and (iv) growing and thriving. CONCLUSION: This review identified a number of strategies to better prepare nurses for practice and maintain their psychological wellbeing. Although no firm conclusions can be drawn in respect to the most effective interventions, strategies with merit included those that: a) foster connections within the team; b) provide education and training to develop behaviors that assist in controlling or limiting the intensity of stress, or aiding recovery; and c) assist in processing emotion and learning from experiences. Although individuals must take responsibility for developing personal strategies to assist coping and resilience, organizational support is integral to equipping individuals to deal with work related challenges. IMPLICATIONS FOR PRACTICE: A range of formal and informal support is required to promote coping and resilience. IMPLICATIONS FOR RESEARCH: There is a need for large, well designed, multisite, experimental studies to evaluate the effectiveness of interventions that promote coping and resilience in adult palliative care or oncology nurses.

Challenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan area.

OBJECTIVE: To describe the organisational demands on staff when arranging interhospital transfers (IHTs) from an ED. METHOD: Prospective observational study of IHTs from three non-tertiary hospital EDs in the Perth metropolitan area. Data were collected over 14 consecutive days commencing 20 January, 26 March and 6 July 2010 for each respective site. Outcome measures were the time taken for transfer acceptance, the number of telephone calls required and the perceived degree of difficulty to arrange a transfer. RESULTS: We examined 229 (70%) of the 325 IHTs conducted during the study period. Transfers took 1-11 telephone calls to arrange (median 2). More calls were required for urgent (median 4, IQR 3.5-9.4, n = 69) than non-urgent IHTs (median 3, IQR 2-4, n = 160, P = 0.04). Four or more calls were required in 23.5% of cases (n = 54) with 20 (9%) of these involving critically ill patients. The median time to transfer acceptance was similar for urgent (10 min, IQR 4-24, n = 69) and non-urgent IHTs (10 min, IQR 5-23, P = 0.48, n = 155). A post-hoc analysis describing IHTs that took over 1 h to organise, showed that urgent transfers took 155 min (IQR 132-213) compared with 120 min for non-urgent IHTs (IQR 79-157; P = 0.07). Arranging an IHT was perceived to be challenging in 6% of cases with the clarity of decision-making, receiving staff understanding of the limitations of referral hospital services and the effect of delays of prime importance. CONCLUSION: While most IHTs are straightforward, critically ill transfers require considerable time, effort and teamwork to arrange.

Mortality of interhospital transfers originating from an emergency department in Perth, Western Australia.

BACKGROUND: Interhospital transfer (IHT) is an integral part of emergency practice and required to access specialist care. AIM: To identify factors that predict in-hospital mortality for IHT originating from an Emergency Department (ED). METHOD: A retrospective cohort study utilising linked health data from the ED Information System database, Death Register and the Hospital Morbidity Data examined all IHTs originating from a public hospital ED and transferred to a tertiary hospital ED (ED-ED IHT), January 1st 2002-December 31st 2006. RESULTS: There were 27,776 ED-ED IHTs. In-hospital mortality was 2.1% (95% CI 1.9-2.3%). Age, male sex, clinical deterioration by one or ≥2 levels on the Australasian Triage Scale (ATS) and circulatory or respiratory disease increased risk of mortality. Clinical improvement by one level on the ATS, injury or poisoning, digestive disease, transfer from 2004 to 2006 and exposure to access block reduced risk of mortality. Other than year of transfer, injury or poisoning, digestive and respiratory disease, these factors were also predictive of mortality within 1-day of transfer. CONCLUSION: Multiple factors influence mortality following IHT from an ED. Awareness of these factors helps to optimise risk reduction. The limited infrastructure and resourcing available in non-tertiary hospitals are important considerations.