Exploring nursing students’ perceptions on usefulness, ease of use, and acceptability of using a simulated Electronic Medical Record: A descriptive study

Background: Modernisation in the healthcare landscape has seen the spread of the integration of health information technology to replace paper-based systems with electronic medical record systems. Although this technology has become accessible in most health care settings globally, its adoption into nursing school curricula as a teaching tool and learning strategy is slow. Universities are now faced with a number of challenges to ensure nursing and midwifery students are well equipped to use this new technology upon graduation and to determine how best to integrate this new technology into undergraduate health education curricula. Objective: The purpose of this study was to develop an Interactive Simulated Electronic Medical Record (ISEMR) as a learning tool and assess students’ acceptability and intention to use the tool in their nursing education. Methods: A quantitative descriptive study was conducted in the cohort of second-year undergraduate nursing students enrolled in a clinical course in a Bachelor of Nursing program in Australia. This study was guided by the Technology Acceptance Model (TAM). Data were collected over one semester using a validated questionnaire to measure the students’ perceived ease of use, perceived usefulness, intention to use, and acceptability. Results: Of the 530 students enrolled in the course, 433 (82%) participated in the study. In accordance with the TAM the findings showed that perceived usefulness of the ISEMR in providing learning and experience for the future was significant in determining students’ intention to use it. Students who perceived the ISEMR easy to use were more likely to perceive usefulness. Conclusion: Integrating the Electronic Medical Record into the nursing curriculum will be beneficial in providing undergraduate nursing students with the opportunity to enhance critical thinking, improve documentation and enhance understanding and nursing skill. Findings from this study will drive learning and teaching approaches that will lead to growth in capability with health information technology

Tougher Laws, Too Few Prosecutions? A Mixed Methods Study of Nurses’ Experiences Regarding the Reporting of Occupational Violence to the Police

ProblemAssaults on nurses by patients are common. To deter occupational violence against nurses, assaults attract penalties of longer imprisonment in many jurisdictions (domestically and internationally). However, the deterrent value of harsher penalties has been questioned when many assaults are underreported.AimTo identify the barriers and enablers to the reporting and prosecution of assaults experienced by nurses.MethodsIn this study participants were recruited using a snowballing technique through health workforce emails, social media channels, and professional organisations. The investigator-developed survey prompted for categorical and open-ended responses. Descriptive and qualitative content analyses were used to analyse the study data.FindingsOf the N = 275 respondents, n = 237 nurses had been assaulted at work. Assaulted nurses were typically female, over 31 years old, had more than five years of nursing experience, and worked in an emergency department. Overwhelmingly, nurses indicated receiving poor support when they wanted to report an assault to the police. Dominant themes (N = 6) identified systemic barriers that hinder criminal reporting, which was found to be a consequence of organisational and policing lapses, and self-limiting nursing culture.DiscussionThis study identified several barriers for nurses to report and prosecute assaultive patients in Australia. The barriers point to a strong imperative for organisations that employ nurses and police to fulfil their responsibilities to enable and support assaulted nurses to prosecute.ConclusionThe study findings led to important recommendations for organisations and police to support, encourage, and empower nurses to prosecute assaultive patients, and ultimately deter violence

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

Digital Health Data Imperfection Patterns and Their Manifestations in an Australian Digital Hospital

Whilst digital health data provides great benefits for improved and effective patient care and organisational outcomes, the quality of digital health data can sometimes be a significant issue. Healthcare providers are known to spend a significant amount of time on assessing and cleaning data. To address this situation, this paper presents six Digital Health Data Imperfection Patterns that provide insight into data quality issues of digital health data, their root causes, their impact, and how these can be detected. Using the CRISP-DM methodology, we demonstrate the utility and pervasiveness of the patterns at the emergency department of Australia's major tertiary digital hospital. The pattern collection can be used by health providers to identify and prevent key digital health data quality issues contributing to reliable insights for clinical decision making and patient care delivery. The patterns also provide a solid foundation for future research in digital health through its identification of key data quality issues, root causes, detection techniques, and terminology

Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems

BACKGROUND: There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. METHODS: Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. RESULTS: Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. CONCLUSIONS: Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes

Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems

Abstract Background There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. Methods Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. Results Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. Conclusions Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes. </jats:sec

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

Council community directories as a source of information about local health services in rural Australia

Despite the existence of web based community directories information about local health services in rural Queensland is reported by service providers to be poor. A survey in four towns determined directory community use for health information. Although 60% of town residents use the internet, only 20% were aware of the existence of their town's community directory and less than 10% used it for health service information. Existing directories are neither user friendly nor comprehensive in content. For web-based directories to become valuable sources of information about local health services strategies are needed to improve access, content and awareness