Rebekkah Middleton

Primary care patients' views on why they present to Emergency Departments - inappropriate attendances or inappropriate policy?

Peter M. Siminski et al. — Tue, 24 Jan 2012 19:18:19 PST

This study investigates why some patients with apparently less urgent conditions present to emergency departments (EDs). We report on a survey of "potential primary-care" ED patients, who were asked about their reasons for choosing the ED over GPs. The sample consisted of 397 patients (with a response rate of 99% = 397/400), recruited in the former Illawarra Health Area. The three main reasons selected were: self-assessed urgency; being able to see the doctor and having tests or X-rays done in the same place; and self-assessed seriousness or complexity. The results do not appear to be sensitive to two potential sources of bias (fixed question ordering and non-random sampling). The results suggest a number of potential policy levers for encouraging some people to present to GPs rather than EDs. However, the main conclusion is that the majority of "potential primary-care" patients appear to be presenting for appropriate reasons. Thus "inappropriate attendances" do not seem to be the cause of EDs being under stress. We also argue that the results are useful for drawing inferences more broadly than just in relation to the Illawarra.

Preparation for professional practice: enhancing practice

Roy A. Brown et al. — Tue, 24 Jan 2012 19:18:17 PST

The preparation of the new generation of practitioners should be seen as co-terminous with enhancing practice. In designing the undergraduate nursing curriculum, we have reflected on the concepts of enhancing practice, specifically reflecting the principles 1, 2 and 8 of practice development (Manley, McCormack & Wilson 2008). In the final semester the opportunity to embed these practice development principles in two separate but inter related subjects presents itself. In this workshop the facilitators will create an environment of creative curriculum implementation that recreates their journey to the development of these two subjects. Through the use of practice development tools and techniques participants will be enabled to share experiences of using PD in developing learning opportunities; reflect on the implications for creating learning opportunities and consider the value added for the student as they become newly registered nurses.

Utilising practice development principles in preparing the new RN for professional practice

Angela M. Brown et al. — Tue, 24 Jan 2012 19:18:16 PST

The preparation of the new generation of practitioners should be seen as an opportunity to promote and embed practice development. In designing our undergraduate nursing curriculum, we have reflected the concepts of practice, specifically reflecting the principles 1, 2 and 8 of practice development. (Manley, McCormack & Wilson 2008). In the final semester of 2010 we took the opportunity to embed these practice development principles into two separate but inter related subjects – Leadership in Health Care Practice and Transition to Professional Practice. We will present how we created an environment for creative curriculum implementation that outlines the journey to the development of these two subjects. We will explore the experience of delivery and share some student feedback. In sharing our reflections on the implications for creating learning opportunities that embrace practice development principles we will consider the value added for the student as they become newly registered nurses.

Primary Care: Where and Why

Kathleen M. Eagar et al. — Tue, 24 Jan 2012 19:18:14 PST

Suturing as an advanced skill for Registered Nurses in the emergency department

Rebekkah Middleton — Tue, 24 Jan 2012 19:18:12 PST

Objective: Many patients present to emergency departments (EDs) for wounds that require repair by suturing. This study looked at ascertaining the efficacy of Advanced Clinical Nurses’ (ACN) suturing dermal lacerations in tertiary, regional and rural ED settings. Design: Convenience sample; prospective questionnaire. Setting: Three mixed adult and paediatric EDs. These departments were tertiary, regional and rural regional EDs. Participants: Eighty patients requiring sutures for dermal lacerations that were repaired by an ACN. Of them 24 were men and seven were women. Mean age was 40.5 years, with a range of 21–58 years. Ten results from rural ED; six from regional ED; 15 from tertiary ED. Main outcome measure(s): Any differences between suturing standards in rural, regional and tertiary EDs; clinical results of suturing performed by ACNs; local medical officers’ satisfaction with wound repair. Results: A total of 31 responses were received. The lacerations were located on the face in 13 patients (42%), the scalp in 10 (32%), an extremity in 2 (6%), and on the trunk in 6 (20%). A total of 196 sutures were required. Local medical officers graded wound repair as ‘good’ in 24 cases (77%) and adequate in seven cases (23%). There were no wound healing complications reported. Conclusions: Nurses who complete a standardised training program in wound management and repair are capable of providing high-quality, definitive care for patients who present to EDs with dermal lacerations. This is true irrespective of whether the Registered Nurse is working in a rural, regional or tertiary ED.

What emergency nurses consider the reasons possible primary care patients present to an Emergency Department for treatment

Rebekkah Middleton — Tue, 24 Jan 2012 19:18:11 PST

Objective: This thesis examines the opinions of emergency nurses towards the possible primary care patient. It aims to explore what emergency nurses consider the reasons possible primary care patients present to an Emergency Department for treatment. This thesis also compares these nursing perceptions to those of patients.

Background: Literature speaks of health professionals’ opinions towards patients who present to an Emergency Department who could potentially be seen by a General Practitioner or Medical Centre. This patient population are termed ‘possible primary care patients’ in this research. There is no literature that discusses nurses specifically and how nurses view the intention of this group of patients for presentation to an Emergency Department. With this in mind and with an interest in Emergency Departments and in particular emergency nurses, the researcher chose to focus on the beliefs of emergency nurses working in Emergency Departments within the former Illawarra Health Service towards primary care patients. For the purpose of the research, the patient population being examined were the possible primary care patients identified by the following criteria: any patient given a triage category 4 or 5 who self-presents, is not a planned return visit, and is unlikely to be admitted according to the Triage nurse assessing the patient.

Methods: Nursing staff working in the five Emergency Departments within the former Illawarra Area Health Service were given questionnaires to ascertain their perceptions of the reasons possible primary care patients present to an Emergency Department for care. Data were also collected about their department, sex, age, position held in the department, and length of time the nursing staff member had been working in an Emergency Department. These data were analysed to determine any differences in perception based on these variables.

Findings: Four key themes emerged from the data analysis. These were: despite demography, nurses generally considered free service provision to be the leading reason that possible primary care patients choose an Emergency Department for care; nurses holding positions of advanced practice or management did not consider cost to be an overwhelming factor for possible primary care patients when choosing to come to an Emergency Department when compared with nurses working as Registered Nurse (RN) or Enrolled Nurse (EN); rural nurses consider access to General Practitioners to be lacking; and nurses and patients have polar views of why possible primary care patients come to an Emergency Department for service delivery.

Conclusions: Emergency nurses consistently believe that possible primary care patients choose to present to an Emergency Department because it is a free service. This agreement occurs despite various demographic differences.

There were evidenced differences regarding reasons for presentation to an Emergency Department between nurses and presenting patients. Nurses focused on free delivery of medical care and lack of access to General Practitioner services. Patients however focused on the urgency of their illness/injury believing it needed immediate care.

Why patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differ

Malcolm R. Masso et al. — Tue, 24 Jan 2012 19:18:09 PST

Objectives: To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients. Methods: Survey of staff and primary care patients in five ED in New South Wales, Australia using questionnaire based on reasons identified in published studies. Results: Clinicians in the survey identify a broader spectrum of reasons for potential primary care cases presenting to the ED than the patients themselves report. Doctors reported on average 4.1 very important reasons and nurses 4.8 compared with patients 2.4 very important reasons. The main reasons identified by both doctors and nurses were similar and quite different to those identified by patients. Clinicians were more likely to emphasize cost and access issues rather than acuity and complexity issues. There was no difference within the clinician group between doctors and nurses nor by varying levels of experience. Furthermore doctors with significant experience in both primary care and emergency medicine did not differ from the overall clinicians' pattern. Conclusions: These data confirm that clinician perspectives on reasons for potential primary care patients' use of ED differ quite markedly from the perspectives of patients themselves. Those differences do not necessarily represent a punitive or blaming philosophy but will stem from the very different paradigms from which the two protagonists approach the interactions, reflecting the standard tension in a provider - consumer relationship. If policy is to be developed to improve system use and access, it must take both perspectives into account with respect to redesign, expectations and education.