Concurrent Session 2C
Tracks
Meeting Room 3
| Thursday, October 5, 2023 |
| 10:50 AM - 12:30 PM |
| Meeting Room 3 |
Details
Session chair: Kate Curtis
Speaker
Mrs Nicole Freeman
Clinical Midwife
Curtin University and King Edward Memorial Hospital
How nurses and midwives provide acute early pregnancy care in Australia
10:50 AM - 11:10 AMAbstract
Introduction:
In Australia, early pregnancy (< 20 weeks) complications are commonly assessed in an ED setting. Women, often emotionally distressed, report that the ED environment can be chaotic and lacking the privacy they need. Positive interactions between women and attending health professionals are critical to the provision of quality care at this time in pregnancy. The role and scope of practice of registered nurses (RNs) and midwives providing acute early pregnancy care in Australia is poorly documented.
Purpose:
To explore the literature on the role and scope of practice of RNs and midwives providing care for women with acute early pregnancy complications in Australia.
Methods:
A scoping review of the literature was conducted to synthesise what is reported about nursing and midwifery role and scope in acute early pregnancy care in Australia. The review was framed using JBI methodology and reported using the PRISMA-ScR checklist.
Outcome:
RNs and midwives’ role and scope of practice in acute early pregnancy settings in Australia can be summarised into four areas: provision of physical care, psychosocial support, care co-ordination, and communication. RNs have a prominent role and scope in acute early pregnancy care, reflecting the tendency for initial care to be provided in an ED. Midwives’ practice is less defined, focusing on the provision of emotional support and education.
Recommendations:
RNs and midwives should be supported to provide more comprehensive, individualised, and timely care in acute early pregnancy settings, maximising professional scope capacity to best meet women’s needs at this important time in pregnancy.
In Australia, early pregnancy (< 20 weeks) complications are commonly assessed in an ED setting. Women, often emotionally distressed, report that the ED environment can be chaotic and lacking the privacy they need. Positive interactions between women and attending health professionals are critical to the provision of quality care at this time in pregnancy. The role and scope of practice of registered nurses (RNs) and midwives providing acute early pregnancy care in Australia is poorly documented.
Purpose:
To explore the literature on the role and scope of practice of RNs and midwives providing care for women with acute early pregnancy complications in Australia.
Methods:
A scoping review of the literature was conducted to synthesise what is reported about nursing and midwifery role and scope in acute early pregnancy care in Australia. The review was framed using JBI methodology and reported using the PRISMA-ScR checklist.
Outcome:
RNs and midwives’ role and scope of practice in acute early pregnancy settings in Australia can be summarised into four areas: provision of physical care, psychosocial support, care co-ordination, and communication. RNs have a prominent role and scope in acute early pregnancy care, reflecting the tendency for initial care to be provided in an ED. Midwives’ practice is less defined, focusing on the provision of emotional support and education.
Recommendations:
RNs and midwives should be supported to provide more comprehensive, individualised, and timely care in acute early pregnancy settings, maximising professional scope capacity to best meet women’s needs at this important time in pregnancy.
Biography
Nicole Freeman is a Registered Nurse and Midwife with 30 years experience in both clinical, academic and research roles. Her current clinical practice is focused on the care of women and families presenting to hospital with acute gynaecological, early pregnancy and postnatal problems. She is currently undertaking a PhD exploring acute early pregnancy care in Australia.
Ms Baylie Trostian
PhD Candidate
University of Sydney
What assessment, interventions and diagnostics should women presenting to the ED with Early Pregnancy Bleeding receive and when? A Scoping Review
11:10 AM - 11:30 AMAbstract
Background: Bleeding in early pregnancy is a frequent reason women present to the ED. Common causes include ectopic pregnancy, threatened pregnancy and miscarriage. The care that women receive can have immediate and long-term health impacts.
Aim: To explore the evidence and best timing for assessment, intervention, and diagnostics for early pregnancy bleeding.
Methods: Electronic database and handsearching methods were used to locate primary research, reviews, and practice guidelines. Papers were included if they were human studies in English, related to early pregnancy bleeding, and discussed initial management. Data were tabulated, and mapped to assessment, intervention, and diagnostics. Data were grouped to categories and subcategories.
Results: A total 107 papers met inclusion criteria, consisting of 69 primary research, 32 reviews and six practice guidelines, the results of which were extracted and grouped to assessment (n=57), interventions (n=38) and diagnostics (n=96). There was consensus for many assessment practices including performing vital observations (n=38) and gathering a detailed medical and pregnancy-specific history (n=47). Administration of Rhesus Immunoglobulin was consistently recommended for any sensitising event, to protect against alloimmunisation and future pregnancy complications. However, definitions of sensitising events differed between sources, and ED compliance with administration was low. Transvaginal ultrasound was identified as the most appropriate imaging modality in determining pregnancy viability and location.
Conclusion: Early pregnancy bleeding management needs to be coordinated and based on current evidence. Guidelines should be updated to include assessment of medical and pregnancy specific history, systematic pain and bleeding assessment, physical examination, and ultrasound regardless of BhCG level.
Aim: To explore the evidence and best timing for assessment, intervention, and diagnostics for early pregnancy bleeding.
Methods: Electronic database and handsearching methods were used to locate primary research, reviews, and practice guidelines. Papers were included if they were human studies in English, related to early pregnancy bleeding, and discussed initial management. Data were tabulated, and mapped to assessment, intervention, and diagnostics. Data were grouped to categories and subcategories.
Results: A total 107 papers met inclusion criteria, consisting of 69 primary research, 32 reviews and six practice guidelines, the results of which were extracted and grouped to assessment (n=57), interventions (n=38) and diagnostics (n=96). There was consensus for many assessment practices including performing vital observations (n=38) and gathering a detailed medical and pregnancy-specific history (n=47). Administration of Rhesus Immunoglobulin was consistently recommended for any sensitising event, to protect against alloimmunisation and future pregnancy complications. However, definitions of sensitising events differed between sources, and ED compliance with administration was low. Transvaginal ultrasound was identified as the most appropriate imaging modality in determining pregnancy viability and location.
Conclusion: Early pregnancy bleeding management needs to be coordinated and based on current evidence. Guidelines should be updated to include assessment of medical and pregnancy specific history, systematic pain and bleeding assessment, physical examination, and ultrasound regardless of BhCG level.
Biography
Baylie Trostian has been a nurse since 2008 and midwife from 2014, working as both at Wollongong Hospital, and a lecturer at the University of Wollongong. Baylie is currently a PhD candidate, at the University of Sydney researching Emergency care of early pregnancy bleeding, and recipient of the Skellern Family Foundation Scholarship, that provides financial assistance to an outstanding PhD scholar. Baylie has worked as an emergency nurse and midwife nationally and internationally in Nepal and Guatemala. She is an early career researcher, with publications and conference presentations in education, and emergency care.
Professor Julie Considine
Professor and Chair In Nursing
Deakin University - Eastern Health
Assessment and Management of Children with Gastroenteritis Presenting to the Emergency Department
11:30 AM - 11:50 AMAbstract
Background
Acute gastroenteritis is a major cause of morbidity and mortality in children, with rates in Australia highest amongst children under five years. Current research and guidelines regarding gastroenteritis in children have not specifically included Australian Aboriginal children who have worse health outcomes than non-Aboriginal children.
Aim
To explore the assessment and management of children presenting to the emergency department (ED) with acute gastroenteritis.
Methods
A retrospective cohort study of 340 children aged 6 to 48 months who presented to a rural ED with gastroenteritis symptoms from the 1st January to the 31st December 2019.
Results
Management practices reflect that of current evidence-based recommendations. General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in the management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies.
Conclusion
ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. Highlighted are improvements in terms of the severity and acute manifestations of gastroenteritis amongst Australian Aboriginal children since previous studies. There was variability in the management of children with moderate dehydration and Australian Aboriginal children: it is unclear whether this indicates gaps in care or patient specific care. This study has highlighted areas for further research in this unique context.
Acute gastroenteritis is a major cause of morbidity and mortality in children, with rates in Australia highest amongst children under five years. Current research and guidelines regarding gastroenteritis in children have not specifically included Australian Aboriginal children who have worse health outcomes than non-Aboriginal children.
Aim
To explore the assessment and management of children presenting to the emergency department (ED) with acute gastroenteritis.
Methods
A retrospective cohort study of 340 children aged 6 to 48 months who presented to a rural ED with gastroenteritis symptoms from the 1st January to the 31st December 2019.
Results
Management practices reflect that of current evidence-based recommendations. General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in the management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies.
Conclusion
ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. Highlighted are improvements in terms of the severity and acute manifestations of gastroenteritis amongst Australian Aboriginal children since previous studies. There was variability in the management of children with moderate dehydration and Australian Aboriginal children: it is unclear whether this indicates gaps in care or patient specific care. This study has highlighted areas for further research in this unique context.
Biography
Professor Julie Considine AO is the Deakin University Chair in Nursing at Eastern Health, one of Victoria’s largest health care services. Professor Considine is an internationally respected clinician, educator and researcher whose expertise spans both industry and academic sectors. Professor Considine's research is aimed at improving the quality and safety of patient care by optimising clinical decision-making, increasing use of research evidence in practice, and ensuring effective models of service delivery. Professor Considine is a foundation member of the Deakin University's Centre for Quality and Patient Safety Research and Institute for Health Transformation. She is a member of the Nursing and Midwifery Professional Council and Senior Leadership Team at Eastern Health. She is a Fellow of the Australian College of Nursing, Life Fellow of the College of Emergency Nursing Australasia, and is a Senior Editor of Australasian Emergency Care. Julie represents the College of Emergency Nursing Australasia on the Australian Resuscitation Council where she is also deputy convenor of the Education and Implementation subcommittee. She is also an Emeritus Member of the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Taskforce. In 2023, she was appointed an Officer of the Order of Australia (AO) (General Division) for distinguished service to medicine in the field of emergency nursing, to tertiary education, and to professional associations.
Mrs Melissa Heufel
Illawarra Shoalhaven Local Health District
Development of an Emergency Department end of life audit tool: A scoping review
11:50 AM - 12:10 PMAbstract
Background
Emergency Departments (ED) frequently care for patients at the end of life (EOL) and should have robust processes for reviewing delivery of care. Historically, death review processes had a strong focus on detecting adverse events as opposed to evaluating the quality of EOL care. This is improving with the development of audit tools, however most quality of EOL care audit tools exclude patients who die in the ED.
Aims
To examine and collate chart audit tools to assess the quality of EOL care of patients who die in the ED or in the subsequent hospital admission.
Methods
A scoping review of the literature was conducted. Primary and secondary research, along with grey literature were searched. Adult and paediatric populations were included. Databases Ovid Emcare, CINAHL and Medline were searched from 1961 to December 2022; followed by screening and appraisal. Articles were compared and data synthesised into categories.
Results
Fifty-eight articles were included generating three categories; contexts for EOL audit use, development and evaluation of audit tools, and audit characteristics / components. There was no one tool found that comprehensively reviewed both EOL and ED specific data. A draft audit tool was developed informed by this review.
Conclusion
The next steps of this research program are to test the proposed audit tool for validity, reliability, feasibility, and usability. We plan to examine EOL in our ED, and use the results to inform future studies to improve the delivery of quality EOL care in the ED.
Emergency Departments (ED) frequently care for patients at the end of life (EOL) and should have robust processes for reviewing delivery of care. Historically, death review processes had a strong focus on detecting adverse events as opposed to evaluating the quality of EOL care. This is improving with the development of audit tools, however most quality of EOL care audit tools exclude patients who die in the ED.
Aims
To examine and collate chart audit tools to assess the quality of EOL care of patients who die in the ED or in the subsequent hospital admission.
Methods
A scoping review of the literature was conducted. Primary and secondary research, along with grey literature were searched. Adult and paediatric populations were included. Databases Ovid Emcare, CINAHL and Medline were searched from 1961 to December 2022; followed by screening and appraisal. Articles were compared and data synthesised into categories.
Results
Fifty-eight articles were included generating three categories; contexts for EOL audit use, development and evaluation of audit tools, and audit characteristics / components. There was no one tool found that comprehensively reviewed both EOL and ED specific data. A draft audit tool was developed informed by this review.
Conclusion
The next steps of this research program are to test the proposed audit tool for validity, reliability, feasibility, and usability. We plan to examine EOL in our ED, and use the results to inform future studies to improve the delivery of quality EOL care in the ED.
Biography
Melissa Heufel is a Clinical Nurse Specialist in the Wollongong Hospital Emergency Department, a large regional referral hospital in NSW and PhD candidate at The University of Sydney. Melissa worked as a Registered Nurse in a small Palliative Care Unit before she began her career in the Emergency Department. The contrast in delivery of end of life care in these two very different clinical environments sparked her passion for investigating how best-practice end of life care can be achieved in the Emergency Department. Melissa's research is focused on investigating and integrating best-practice models of care to improve end of life care for patients who present to the Emergency Department.
Mrs Melissa Heufel
Illawarra Shoalhaven Local Health District
Development of an Emergency Department End of Life audit tool: Content validation study
12:10 PM - 12:30 PMAbstract
Background
End of Life (EOL) care delivery in the Emergency Department (ED) is a rapidly growing area of clinical practice and should have processes for reviewing delivery of care. A scoping review revealed that existing audit tools do not incorporate the ED phase of care, a draft audit tool was developed based on the findings. Validation of the proposed tool is required to ensure the tool is meaningful and appropriate.
Aim
To test the proposed ED end of life care audit tool for content validity.
Methods
Items were refined and content validity was calculated using the Content Validity Index (CVI) with a group of eleven experts in emergency, palliative care and various research disciplines. Surveys were created and managed in REDCap™ and participants were asked to rate each item based on relevance. Participants were also asked to provide additional free-text feedback regarding overall clarity and comprehension of the items.
Results
There were 90 items included in the CVI analysis. CVI testing were performed until items were eliminated, revised, or included as appropriate based on the item CVI score. There was a total of 18 items that required revision and further CVI testing and a total of 10 items were eliminated.
Conclusion
Content validation of the ED EOL Care audit tool items was achieved using the CVI. The next steps of this research program are testing the audit tool for feasibility, reliability and usability so that we can examine EOL care in our ED.
End of Life (EOL) care delivery in the Emergency Department (ED) is a rapidly growing area of clinical practice and should have processes for reviewing delivery of care. A scoping review revealed that existing audit tools do not incorporate the ED phase of care, a draft audit tool was developed based on the findings. Validation of the proposed tool is required to ensure the tool is meaningful and appropriate.
Aim
To test the proposed ED end of life care audit tool for content validity.
Methods
Items were refined and content validity was calculated using the Content Validity Index (CVI) with a group of eleven experts in emergency, palliative care and various research disciplines. Surveys were created and managed in REDCap™ and participants were asked to rate each item based on relevance. Participants were also asked to provide additional free-text feedback regarding overall clarity and comprehension of the items.
Results
There were 90 items included in the CVI analysis. CVI testing were performed until items were eliminated, revised, or included as appropriate based on the item CVI score. There was a total of 18 items that required revision and further CVI testing and a total of 10 items were eliminated.
Conclusion
Content validation of the ED EOL Care audit tool items was achieved using the CVI. The next steps of this research program are testing the audit tool for feasibility, reliability and usability so that we can examine EOL care in our ED.
Biography
Melissa Heufel is a Clinical Nurse Specialist in the Wollongong Hospital Emergency Department, a large regional referral hospital in NSW and PhD candidate at The University of Sydney. Melissa worked as a Registered Nurse in a small Palliative Care Unit before she began her career in the Emergency Department. The contrast in delivery of end of life care in these two very different clinical environments sparked her passion for investigating how best-practice end of life care can be achieved in the Emergency Department. Melissa's research is focused on investigating and integrating best-practice models of care to improve end of life care for patients who present to the Emergency Department.
