Use of protective lung strategies in the management of mechanically ventilated adult emergency department patients: A cross sectional survey

Sarah Cornish1, Rochelle Wynne2, Sharon Klim3, Anne-Maree Kelly4

1 Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021, sarah.cornish@wh.org.au
2 School of Health Sciences, University of Melbourne, Parkville, VIC 3010.
3 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021
4 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021

Background: Mechanical ventilation (MV) is a therapeutic intervention used in emergency departments (EDs) that has associated complications such as lung trauma and the development of acute respiratory distress syndrome (ARDS). In the last decade there has been increasing interest in the use of protective lung strategies (PLS), comprised of low tidal volume (6mL/kg) delivery, control of fraction of inspired oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) to reduce risks associated with MV. Australian ED nurses share ventilation decision-making with their medical colleagues. However, there is very little evidence describing nurses’ knowledge or application of PLS. The aim of this research was to determine clinical practice patterns and nurses knowledge regarding the implementation of PLS in the ED.

Methods: The study used a descriptive, exploratory design and online questionnaire. A convenience sample was recruited via the College of Emergency Nursing Australasia mailing list and snowball sampling. A three-part questionnaire was designed to identify demographic data, information on clinical practice patterns and nursing knowledge of PLS via validated case scenarios.

Results: The survey was completed by 157 nurses and PLS are being used in many EDs (n = 104, 75%). Clinical practice guidelines for mechanical ventilation were accessible to 62% (n =86) of participants. Formal tools are used by many clinicians to determine optimal tidal volume (n = 112, 80%). Nurses knowledge of PLS was sound and components of decision-making in relation to PLS consistent, however level of confidence and perceived autonomy when implementing PLS in the ED varied.

Conclusion: PLS are being used in Australian EDs in the clinical care of mechanically ventilated patients, which aligns with best available evidence. Australian ED nursing staff have good levels of knowledge of this approach to MV. There is a need for standardised evidence-based clinical practice guidelines that may improve nurses’ confidence in implementing such strategies, and also provide a benchmark for future clinical practice to facilitate the generation of evidence on this topic. Development of such a guideline may pave the way for ED nurses to independently manage invasively ventilated patients which presents an innovative approach to care delivery of these highly complex patients.

Biography

Sarah Cornish has been a passionate ED nurse for over 14 years and is working in the dual roles of Clinical Nurse Educator and Clinical Nurse Specialist in the ED at Sunshine Hospital, Melbourne, Victoria. Sarah has recently finished her Masters in Advanced Nursing Practice, by Minor Thesis, and has a particular interest for mechanical ventilation in the ED. Sarah was also awarded the honour of being the CENA Emergency Nurse of the Year in 2015.

The why and how of introducing a waiting room nurse role into the Emergency Department

Kelli Innes1,3, Professor Doug Elliott1, Professor Debra Jackson2, Associate Professor Virginia Plummer3, 4

1 University of Technology Sydney, 15 Broadway, Ultimo, N.S.W., 2007, kelli.innes@monash.edu
2 Oxford University Hospitals NHS Foundation Trust, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Hill Oxford, U.K., OX3 OFL.
3 Monash University Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, McMahons Road Frankston, Vic. 3199
4 Peninsula Health, Hastings Road Frankston, Australia 3199.

Introduction: Multiple factors, including increasing patient presentations and access block, are placing emergency departments (EDs) under increasing pressure. As a result waiting times are increasing, patient outcomes are compromised and EDs find meeting key performance indicators challenging. To improve patient care, transition and flow, some emergency departments (EDs) have introduced a waiting room nurse role, to enhance patient safety by commencing care early, identifying deteriorating patients and improving communication between patients and staff. There is however limited published literature on the benefits, challenges and effectiveness of this role. The aim of this research was to identify why and how the waiting room nurse was initially introduced into Australian EDs.

Method: Semi-structured interviews with five key informants were conducted (data saturation achieved), and supported by analysis of related government and health service documents, to identify and explore the rationale for development of the role and subsequent implementation.

Results: The role was primarily implemented to improve quality of care and decrease the potential for clinical risk for patients in the ED waiting room. The primary aim was to decrease waiting times by commencing interventions early, reassessing patients more frequently and improving communication with patients, relatives and the multidisciplinary team in the ED. Practice was commonly underpinned by standing orders. Education and preparation was not standardised, with nurses in the role having varied backgrounds and levels of experience. There was limited evaluation of the role noted by the key informants. Document analysis supported the findings of the key informant interviews.

Discussion: Although the waiting room nurse role was primarily developed to improve outcomes and safety, and decrease clinical risk, it remains unclear what the benefits and effectiveness of the position have been, given the limited evaluation. These findings supported the available literature that the scope of practice was commonly defined by standing orders, and preparation and education of nurses varied. Further evaluation of the role is recommended, to inform some standardisation in preparation and practice.

Biography

Kelli has an extensive background in emergency nursing and education. Currently a lecturer at Monash University where she teaches into the postgraduate emergency nursing stream and the undergraduate nursing program. She is also a PhD candidate at The University of Technology Sydney where she is evaluating the emergency department waiting room nurse role.

The rhythm and blues project: A proposed method of skill and knowledge maintenance in Advanced Cardiac Life Support (ACLS) training and recertification

Julie C Humphries1, Mingshuang Ding1, Hansel Addae-Bosomprah1

1 Queen Elizabeth II Jubilee Hospital, Cnr Kessels Rd & Troughton Rd, Coopers Plains  QLD 4108 Australia

Background: The Queen Elizabeth II Jubilee (QEII) hospital is an urban district hospital with an Emergency Department (ED) which has 45,000 attendances per year.  QE II ED has a simulation training faculty which delivers simulation education and the Hospital’s ACLS training program.  Our current ACLS course is a one day certification course that consists of theoretical and practical components followed by a multiple choice test at the end.

The ED, however, has a high throughput of residents and registrars who rotate from periods of 5 weeks up to 6 months.  It is not always possible to put the entire mass through the competencies of ACLS during the term.  Retention of knowledge is ACLS a problem well recognised from various studies.

A method called ‘Rhythm and Blues’ is currently employed in QEII ED.  This aids residents who are unable to attend the full day course or who have not attended any courses, to be able to confidently participate in life support events related to patient care and training.  Residents who have already attended the course ACLS participate with the view of skill and knowledge retention.

Objective: To compare the outcomes of different groups of clinicians who receive proposed ACLS training to standard ACLS training method at QE II ED.

Method: This is a cohort studies.  ED / Medical Wards/ ICU doctors and nurses who respond to Code blues and RRT and have a requirement to undergo ACLS training as per Metro South.  Each participant will be randomly assigned (Pick a straw) to The Rhythm and Blues arm of the study or the Metro South ACLS certification pathway.

As a baseline all participants will undergo the 4 hour Metro South ACLS certification course which is valid for 12 months, they will be provided with full copies of the Metro South ACLS manual for ongoing reading and referencing for underpinning knowledge.

The Rhythm and Blues arm of the study group will undergo the rhythm and Blues pathway which consists of 10minutes per week of ACLS refreshers based on the training program.

A typical Rhythm and Blues session shall begin with a quick introduction to the learning objectives for the session.  The participant is given a scenario in a simulated environment using a patient training mannequin and patient data monitoring screen.  There shall initially be a case introduction and a running rhythm which will change to different rhythms as the scenario changes.  Participants will be drilled on four to five different rhythms and scenarios per session in rapid succession with each scenario transitioning to the next with limited interruption.  The drill is expected to last not more than 10minutes using a stop clock.  If a participant “flies” through the drills for a particular session the time taken to complete the drill will be noted.  Conversely the participant may move on to the next set of drills until the 10minute mark is completed.  In effect a participant who performs very well through the course of the drill may perform as many drills as possible within the 10 minute interval.

Expected Outcomes: At this stage a pilot study looking at short and long term skill and knowledge retention using our rhythm and blues drills compared to the full day course is being developed.

Biography

Mingshuang (Monica) Ding BMid;  MMidRes;  RM ;PhD Scholar Research Nurse/Midwife at the Emergency Department | QE II Jubilee Hospital AIA (Aeromedical Innovation Australasia) as a research Consultant Awarded academic title with Griffith University as a  Lecturer with in the School of Nursing and Midwifery.

Julie Humphries BNur; M(advance practice-emergency nursing); RNNurse Educator at the Emergency Department | QE II Jubilee Hospital.

Hansel Addae-BosomprahSenior Medical Officer at the Emergency Department | QE II Jubilee Hospital.

The pathway of succession plan to develop talent pool taking up the key nursing positions as vice-chairperson of department management sub-committees in the accident and emergency department of Pok Oi Hospital

Helen Y Y Leung1, S N Lee1, Billy W M Wong1, K L Ong1

1 Accident and Emergency Department, Pok Oi Hospital, Yuen Long, New Territories, Hong Kong SAR.

Introduction: 

Department Management Committee (DMC) is the core departmental clinical management to maintain department operational effectiveness and quality of service, Under DMC, Subcommittees of various domains are chaired by assigned staff of leadership. In 2014, a structural succession planning program was firstly initiated and developed in Pok Oi Hospital (POH) Accident and Emergency Department (A&E). It was a proactive program to prepare the next batch of leaders ready to take up the role of Vice-Chairpersons of DMC subcommittee in 2016.

Objectives: 

  1. To prepare competent and well-primed staff ready to take up the vice-chairperson positions in Subcommittee;
  2. To proactively develop a long-term strategic approach for nursing leadership capacity building to achieve success of professional and organizational workforce planning;
  3. To develop a culture that supports knowledge and skill transfer;
  4. To provide a workplace of development opportunities to attract and retain staff.

Methodology:

Step 1: Identify the key positions included in the succession plan

It is the focus of succession planning to maintain the operational effectiveness. In 2014, key positions to be included in the succession plan were identified in Senior Nursing Meeting for the next batch of Vice-chairpersons of the following ten subcommittees-

 Workplace Oasis & Communication
 Clinical Research
 Emergency Medicine Ward
 Inter-hospital Transfer
 Medical Equipment
 Workplace Violence
 Accreditation
 Medication Safety
 Patient Identification

 

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Step 2: Recognize potential talents for specific positions

The performance and expertise of individual nursing officer was reviewed. Successful succession plan is based on the selection of suitable candidate to meet the competency requirement for the specific position.

Step 3: Generate staff development plan

Nursing officers were shared and advocated with the plan details. Their feedback was invited and discussed. The support from Chairperson of related DMC Subcommittees was obtained. When the successors were selected and timeline was confirmed, the succession plan was finalized for announcement in July 2014.

Step 4: Implement the succession plan

In line with the schedule and enable uninterrupted delivery of service, the present Vice-Chairperson and the successor worked together since 2015. Relevant training were arranged for the successor.

Step 5: Provide stability and seamless transition of duty

Handover duty was completed in April 2016 and continuous support was provided to the staff taken up the new roles. Progress was closely monitored

Step 6: Evaluate the outcomes

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Result and Outcome

The plan began with strong staff engagement and steps to get the right person in the right place at the right time. It is not one event. For continuity of nursing leadership development, the succession planning will be operating year round and in long term as part of departmental activities.

Evaluation of the program has been starting since the Step One in 2014 and will be an ongoing process. Successors will offer helpful evaluation data if they are confident and well-prepared in their new roles after 2016.


Biography

Ms Helen Leung has been working in emergency nursing field for more than 25 years in three Accident and Emergency Departments (A&E) in Hong Kong. She is the Fellow of Hong Kong Council of Emergency Nursing, Member of Emergency Nursing Association and Hong Kong Society for Emergency Medicine and Surgery. Her present position is the Department Operations Manager of A&E in a District hospital.

Staff evaluation of the role of an Emergency Department nurse navigator

Melanie Jessup1, Paul Fulbrook 2, Frances Kinnear 3

1 The Prince Charles Hospital/Australian Catholic University, Rode Rd, Brisbane, Queensland, 4032; Melanie.Jessup@health.qld.gov.au
2 The Prince Charles Hospital/Australian Catholic University, Rode Rd, Brisbane, Queensland, Australia, 4032; Paul.Fulbrook@health.qld.gov.au
3 The Prince Charles Hospital, Rode Rd, Brisbane, Queensland, Australia 4032,:Frances.Kinnear@health.qld.gov.au

Aim: To evaluate the implementation of an emergency department (ED) Nurse Navigator role via staff feedback.

Background: It is well-documented that prolonged ED stays have an impact on patients, staff and quality of care. The challenge is to find innovative strategies to facilitate patient flow. Nurse Navigators have been suggested. However, their role in supporting staff in care delivery to facilitate efficient, timely movement of patients through ED has lacked rigourous evaluation.

As part of a mixed method, controlled observation study, a supernumerary ED Nurse Navigator was implemented on a week-off-week-on basis for a 20-week period. The Navigator’s role was to monitor patient timelines, highlighting those approaching target times, identifying and troubleshooting crisis areas, and undertaking time-consuming tasks, such as co-ordinating bookings and patient transfers, updating patient information, and facilitating referrals and decision-making; thus assisting patients’ movement through ED and freeing team leaders to focus on overall flow. Primary patient data and focus group feedback were collected during the study.

A key component of the final evaluation of the Navigator role was an online staff survey, conducted following completion of the study.

Method: Online survey data were collected in the 5-month period following the implementation phase of the Navigator role. Sixty-six respondents were included in the analysis [Table 1]. The Navigator Role Evaluation scale demonstrated very good internal consistency, with a Cronbach’s alpha coefficient of .94.

Results: Sum scores for the 24 items were calculated and then expressed as a percentage to indicate overall evaluation, with higher scores indicating more positive views [Table 6]. In terms of professional group, doctors’, nurses’, and other staff’s overall evaluations scores were similar. However, some within group differences between nursing grades were noted, with grade 5 RNs scoring significantly higher than higher grade RNs.

As additional comments, respondents reported differing levels of interaction and satisfaction with the Navigator role. Staff commented on the manner in which the incumbents enacted the role, its value to the department – both in terms of financial and overall flow benefits, its impact on both their own clinical role and on the department. Suggestions on how to augment the role included criteria for selection and training of the Navigator, and clarification of role and responsibility assignment.

Conclusion: Staff input into the evaluation of the Navigator role has yielded invaluable insider feedback for ensuing modification and has rendered a sense of departmental ownership.

Table 1. Respondents’ characteristics

 

Professional group

Years worked in study ED

 

Total (%)

< 1 1-5 Ø  5
Medical staff (n = 22, 33.3%) Senior Medical Officer 0 6 4 10 (15.2)
Junior doctor ACEM registered 2 7 2 11 (16.7)
Junior doctor non-ACEM registered 0 0 1 1 (1.5)
Nursing staff (n = 34, 51.5%) Grade 6 or above RN 0 2 9 11 (16.7)
Grade 5 RN 2 16 5 23 (34.8)

Other staff

(n = 10, 15.2%)

Administration staff

 

1 3 2 6 (9.0)

Wardsperson

 

0 1 0 1 (1.5)
Allied Health staff/HITH nurses 0 2 1 3 (4.5)
Total 5 (7.6) 37 (56.0) 24 (36.4) 66 (100) 

Table 2. Overall role evaluation by professional group

 

Professional group

 

Mean score (%)

Medical staff (n = 22, 33.3%) Senior Medical Officer (n = 10) 68.0

 

66.1

Junior doctor ACEM registered (n = 11) 64.6
Junior doctor non-ACEM registered (n = 1) 75.0
Nursing staff (n = 34, 51.5%) Grade 6 or above RN (n = 11) 59.6 67.2
Grade 5 RN (n = 23) 70.8

Other staff

(n = 10, 15.2%)

Administration staff (n = 6) 74.6

 

67.2

Wardsperson (n = 1) 55.0
Allied Health staff/HITH nurses (n = 3) 60.3

Biography

Dr Melanie Jessup RN, BN (Hons1), PhD, facilitates clinical research and supervises visiting researchers/higher degree students. She collaborates with multidisciplinary teams researching cystic fibrosis care, and efficacy of emergency department processes, enjoying current collaborations with Queensland Ambulance Service and CSIRO’s Australian eHealth Research Centre. She is developing a research program around falls: causes, context, and potential solutions, including multi-disciplinary assessment of patients presenting to ED post fall to circumvent admission.

“Sorry I don’t speak your language, but my phone might!”

Mrs Dale E Reading1

1 Registered Nurse, Calvary Health Care ACT, PO Box 254 Jamison Centre ACT 2614, E – Dale.Reading@calvary-act.com.au

The Australian healthcare system is a dynamic web of services, providers and organisation structures; whose primary purpose to promote, restore and/or maintain health through the delivery of quality services to all people when and where they need them.

Australia is a multicultural society; this is reflected by the 136,000 people from 210 countries who became new citizens in 2014-15 (ABS, 2015). As Australia continues to expand its population; half of the new growth coming from overseas migration, which has a direct effect on the ability of healthcare services to provide adequate and appropriate care. The Australian Capital Territory has the third leading growth rate of individuals moving into its borders. The healthcare system is being actively challenged in providing high quality care for its cultural and linguistically diverse clients (CALD).  Many people living in Australia have low English proficiency, especially when it comes to communicating within the health care setting. The use of interpreting services requires organisation, which can increase wait time for patents to receive treatment, and carries with it a financial burden, which can make it less attractive to health care services.

CALD clients are an “at risk” group, because are less likely to seek primary health care on a regular basis and are less likely to seek preventative health care (Jacobs, Shepards, Suaya & Stone, 2004). They often find it difficult to find a suitable GP, who can accommodate their language and cultural requirements. It is fair to say, poor communication often results in lack of understanding about patient’s conditions and treatment regimes. This places CALD clients at a greater risk of poor health status and low health literacy (Sentell & Braun 2012). CALD clients are also at greater risk of health complications and have a lower overall satisfaction with the health care system.

There are many barriers to using traditional tools such as interpreter services, family members or friends. When a third, or outside party is involved in a discussion between patients and health care professionals there is a loss of privacy. This can cause patients to be less forthcoming about information for fear of embarrassment, breaking cultural practices or discrimination. In an emergency, it can be difficult to locate a suitable interpreter in a time critical environment. In this scenario, broken English may be used, although it carries a high risk for misinterpretation, which could lead to adverse outcomes.

As clinicians, we are faced with challenge of caring for CALD clients on a weekly, if not daily basis. The development of new applications for smart phones/tablets such as Google Translate or MediBabble provides innovative ways to overcome language barriers. Clinicians are able to converse with patients in timely manner with confidence. By utilising these tools one can help improve patient satisfaction, reduce wait times and maintain patient clinician confidentiality. However, there is some debate about the accuracy of these tools. Words can be misinterpreted by the app for another meaning, which can result in miscommunication and/or loss of information. There is a need for more research into this area because of the benefits of reducing clinical wait times and the potential for better health outcomes. In spite of this, these Apps are a great resource that are under utilised in the healthcare industry and there clinical potential warrants greater consideration.

References

Australian Bureau of Statistics 2015, Australian Demographic Statistics, cat. no. 1301.0, ABS, Canberra.

Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E.-L. (2004). Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services. American Journal of Public Health94(5), 866–869.

Sentell, T., & Braun, K.L., (2012), Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California, Journal of Health Communication, 1782 – 99 18p. doi:10.1080/10810730.2012.712621

Biography

As a second year registered nurse, I am being constantly exposed to the diverse challenges that working in an emergency department brings. I love these challenges and the busyness it entails. I am passionate about providing quality care in a genuine manner. Prior to doing my nursing degree, I worked within the field of youth work and spent a year living remotely in an indigenous community working with indigenous youth. This was an eye opening experience to cultural differences within our nation. The increasing number of clients from culturally and linguistically diverse (CALD) backgrounds presenting to the health care reminds me of the need to be sensitive to these differences in the care I provide to my patients.

Moments of disaster response in the emergency department

Karen Hammad1,2,

1 FCENA,

2 PhD Candidate, School of Nursing and Midwifery, Flinders University, karen.hammad@flinders.edu.au

Hospitals play an integral role as a place where people seek refuge and treatment following a disaster event. This means that nurses working in the emergency department (ED) are positioned as first responders triaging, treating and managing the care of the community affected by a disaster. Despite the role of nurses in disaster response there are relatively few research studies which report on the role and experiences of nurses who have participated in disaster response in the ED. Many of the publications which inform what we know about nursing in the ED during a disaster are narrative accounts following the response to a single event. The PhD study which this presentation reports on addresses this gap by exploring the collective experience of nurses who participated in disaster response within the ED, across a variety of different disaster events and in different geographical contexts. Grounded in the tradition of hermeneutic phenomenology, and informed by van Manen’s insights into a methodological approach the aim of this study was to generate meaning and understanding in the experience of working as a nurse in the ED during a disaster. This presentation will report on one aspect of the participant experience which emerged through thematic analysis as five distinct Moments of Disaster Response; notification, waiting, patient arrival, caring for patients and reflection.

Health service impact from mass-gatherings: A systematic literature review

Mr Jamie Ranse1,2,8, A/Prof Alison Hutton2, Mr Toby Keene3,4, Mr Shane Lenson3, Mr Matt Luther5, Ms Nerolie Bost6,7, Dr Amy Johnston,6,7 A/Prof Julia Crilly6,7, Mr Matt Cannon8, Ms Nicole Jones1, Ms Courtney Hayes1, Dr Brandon Burke9

1 University of Canberra, University Drive, Bruce ACT 2617
2 Flinders University, Sturt Road, Bedford Park SA 5042
3 Australian Catholic University, Antill Street, Watson ACT 2602
4 Australian Capital Territory Ambulance Service, Amberley Avenue, Majura ACT 2609
5 Calvary Health Care ACT, Mary Potter Circuit, Bruce ACT 2617
6 Emergency Department, Gold Coast Hospital and Health Services, Hospital Boulevard, Southport QLD 4215
7 Menzies Health Institute Queensland, Griffith University, QLD 4222
8 St John Ambulance Australia (New South Wales), Burwood NSW 2134
9 Canberra Hospital, Yamba Dr, Garran ACT 2605

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass-gathering events was the focus of this literature review.

Aim: This literature review aims to develop an understanding of the impact of mass gatherings on local health services.

Method: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation and hospital utilisation.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass-gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusions: There is minimal research focusing on the impact of mass-gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass-gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass-gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum.

Biography

Jamie is currently employed as the Discipline Lead for Nursing at the University of Canberra. His research interests are in the area of disaster and mass gathering health. Jamie is currently completing a Doctor of Philosophy at Flinders University, where he is research the experience of Australian nurses who assist in the out-of-hospital disaster environment. Jamie has over 40 publications in the area of disaster and mass gathering health. Jamie is an active member of a number of national and international nursing associations. He is a Fellow of the Australian College of Nursing and College of Emergency Nursing Australasia. He is currently the chair-elect of the WADEM Mass Gathering Section.

Hashtag – a fresh system for emergency nursing assessment

Antony Robinson1

1 Royal Darwin Hospital, Rocklands Drive, Tiwi, NT, 0810, Antony.Robinson@nt.gov.au

The ‘Hashtag System’ is a fresh way for conceptualising and teaching the emergency nursing assessment process. It enables nurses to combine the benefit of a systematic approach with the fluid prioritisation which is the art of emergency nursing.

Models such as HIRAID have advanced the conceptualisation of the emergency nursing assessment process, but imply a linearity which can evade the frontline nurse. Hashtag seeks to take advantages of such systems but make the model more memorable, usable, adaptable and expandable for both novice and experienced emergency practitioners. The importance of synthesis is integrated into the platform, encouraging nurses to develop higher level assessment skills.

This presentation will introduce the Hashtag System and offer resources for nurses to try the system in their own practice.

Biography

Antony Robinson is the acting Clinical Nurse Consultant – Education at Royal Darwin Hospital Emergency Department. He has worked in Australia, Solomon Islands, United Kingdom, Timor Leste and Indonesia.

GET BACK TO SCHOOL: Symbiotic relationships between emergency nurses and nursing students

Katie L. East1,2, Amanda L. Harley1,2, Elicia L. Kunst2, Dr Amy N.B. Johnston1,3,

1 Gold Coast University Emergency Department,1 Hospital Boulevarde, Southport, Queensland, 4215, Australia
2 Southern Cross University, Southern Cross Drive, Billinga, Queensland, 4225, Australia
3 Menzies Health Institute Queensland, Griffith University QLD 4222 Australia

Two emergency nurses will provide an experiential account of working clinically in a metropolitan emergency department while simultaneously teaching undergraduate nursing students in various university settings. They will outline the impact these distinct roles have had on them professionally and personally, the importance of shaping and inspiring the future of nursing, and of their contribution to the development and implementation of professional development in nursing.  These areas are critical as the scope and capability of the nursing workforce continues to expand. The presentation will deliver two different perspectives on the world of academia, juggling class schedules, rostering, developing course material, the horrors of pre-reading, managing unprepared students, social media and reading 45 versions of the same essay without wanting to scream.

A diverse range of nursing experience and current practice is needed to enable student engagement and learning. With a focus on an introduction to online learning and their recent experiences of world travel combined with online teaching, they will also discuss rostering and working around two demanding jobs. An emphasis will be the importance of the teacher/student relationship, the difficulties faced by the teacher in this era of awkward Facebook friending from students, and the importance of technology and how it can be of benefit in the classroom or lab setting. The presenters will emphasise their belief that teaching needs to be exciting and engaging, as well as informative and most importantly benefiting student development. They will discuss their role of job sharing in the academic environment and the positive and negative effects that this may have on their students. Critically, they will also outline how their academic role is beneficial to them as clinicians in the emergency department setting, expanding their horizons as well as those of their colleagues. The importance of management support for ongoing clinical development for those looking to work in both fields simultaneously will also be highlighted.  The speakers will talk on the difficulty faced when failing a student, and the confrontation of reading student evaluations of teaching and how this positively and negatively influences the approach to teaching.

This presentation will also focus on the tension between theory and practice and the need to demonstrate to students the best evidence based practice while engaging in real life scenarios to encourage and enhance critical thinking skills.  The speakers will explain how coming from different backgrounds they both have a realistic and functional approach to engaging the students in appropriate and well-structured learning, incorporating fun while teaching the students to embrace and enhance their critical thinking skills.  In addition, the presenters often challenge the students with hard moral dilemmas and accurate clinical scenarios in order to encourage the student to think outside of the box instead of relaying what the text book tells them to do.

The presentation aims to expand the horizons of listeners and engage the audience by encouraging and empowering them to explore new and exciting ideas of education .  The speakers would like to take you on a fun filled journey through their experiences dealing with nursing students both in and out of the emergency setting and the triumphs, hurdles and pitfalls that come with the territory.

Biography

Katie East was the winner of the 2015 ICEN best rapid fire talk and is an experienced clinical nurse working at Gold Coast University Hospital Emergency Department and teaching at Southern Cross University. Katie is also a rural and isolated practice nurse. She has worked from the Cape of Queensland to the mining town of Broken Hill. As part of her ED work she has developed experience in forensic nursing; offering support to patients in locations such as the Southport Watch house. She has recently entered the world of academic teaching and offers a fresh perspective on teacher-student relationships and the struggles involved.

Amanda Harley is an experienced nurse and qualified secondary teacher who has juggled ED clinical work and academic teaching for 5 years. She currently works at Gold Coast University Hospital Emergency Department and both Southern Cross University and Griffith University. She has a Masters in Emergency Nursing and is passionate about developing students, engaging their ability to think critically and prepare effectively for practice. She brings a plethora of clinical environment teaching experience to her tertiary role, with teaching and facilitation experience in a variety of settings and from around the world.