ABSTRACT
BACKGROUND: Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department. METHODS: A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken. FINDINGS: Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department. CONCLUSIONS: Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.
ABSTRACT
BACKGROUND: Assessment technologies are often used to classify student and newly qualified nurse performance as 'pass' or 'fail', with little attention to how these decisions are achieved. Examining the design exigencies of classification technologies, such as performance assessment technologies, provides opportunities to explore flexibility and change in the process of using those technologies. OBJECTIVE: Evaluate an established assessment technology for nursing performance as a classification system. METHODS: A case study analysis that is focused on the assessment approach and a priori design exigencies of performance assessment technology, in this case the Australian Nursing Standards Assessment Tool 2016. FINDINGS: Nurse assessors are required to draw upon their expertise to judge performance, but that judgement is described as a source of bias, creating confusion. The definition of satisfactory performance is 'ready to enter practice'. To pass, the performance on each criterion must be at least satisfactory, indicating to the student that no further improvement is required. The Australian Nursing Standards Assessment Tool 2016 does not have a third 'other' category, which is usually found in classification systems. DISCUSSION: Introducing a 'not yet competent' category and creating a two-part, mixed methods assessment process can improve the Australian Nursing Standards Assessment Tool 2016 assessment technology. Using a standards approach in the first part, judgement is valued and can generate learning opportunities across a program. Using a measurement approach in the second part, student performance can be 'not yet competent' but still meet criteria for year level performance and a graded pass. CONCLUSION: Subjecting the Australian Nursing Standards Assessment Tool 2016 assessment technology to analysis as a classification system provides opportunities for innovation in design. This design innovation has the potential to support students who move between programs and clinicians who assess students from different universities.
