Can written nursing practice standards improve documentation of initial assessment of ED patients?

Introduction: There is wide variation in emergency nursing practice in terms of initial patient assessment and the interventions implemented in response to these patient assessment findings. It is hypothesised that written ED nursing practice standards will reduce variability in documentation standards related to initial patient assessment.

Aim: This study aimed to examine the effect of written ED nursing practice standards augmented by an in-service education programme on the documentation of the initial nursing assessment.

Method: A pre-test/post-test design was used. Initial patient assessment was assessed using the Emergency Department Observation Chart. All adult patients (>18 years) who presented with chest pain and who were triaged to the general adult cubicles were eligible for inclusion in the study. Random sampling was used to select the patients for the pre-test (n = 78) and post-test groups (n = 74).

Results: There was significant improvement in documentation of all aspects of symptom assessment except quality and historical variables: pre-hospital care, cardiac risk factors, and past medical history. Improvements in documentation of elements of primary survey assessment were variable. There were significant increases in documentation of respiratory effort, chest auscultation findings, capillary refill and conscious state. There was a significant 18.3% decrease in the frequency of documentation of respiratory rate and no significant changes in documentation of oxygen saturation, heart rate or blood pressure.

Conclusion: Written ED nursing practice standards were effective in improving the documentation of some elements of initial nursing assessment for patients with chest pain. Active implementation strategies are important to ensure effective uptake of written practice standards and the relationship between nursing documentation and actual clinical practice warrants further consideration using a naturalistic approach in real practice settings.

Learning and teaching assessment: reviewing the evidence

The authors have recently completed a research review on learning and teaching of assessment in social work which was commissioned by the Social Care Institute for Excellence (SCIE) and the Social Policy and Social Work Learning and Teaching Support Network (SWAPltsn) to support the development of the new social work award in England. This involved reviewing relevant literature from social work and cognate disciplines back to 1990 with the aim of identifying best practice in learning and teaching of assessment skills.

Although assessment has been recognised as a core skill in social work and should underpin social work interventions, there is no singular theory or understanding as to what the purpose of assessment is and what the process should entail. Social work involvement in the assessment process may include establishing need or eligibility for services, to seek evidence of past events or to determine likelihood of future danger, may underpin recommendations to other agencies, or may determine the suitability of other service providers. In some settings assessment is considered to begin from the first point of contact and may be a relatively short process, whereas elsewhere it may be a process involving several client contacts over an extended period of time. The assessment process may range from the collection of data on standardised proforma to a flexible approach depending on circumstances. These variations permeate the literature on the learning and teaching of assessment in social work and cognate disciplines.

Several different approaches to classroom based learning were proposed in the literature including case-based teaching, interviews with actors who have been trained to play 'standardised clients', and observation of children and families, as well as didactic lecturing and various uses of video equipment and computers. Furthermore learning by doing has long been one of the hallmarks of social work education, and there are a number of models proposed in which students learn about the assessment process through conducting assessments. The evidence to support these different approaches to learning and teaching is variable. Based on the evidence reviewed, recommendations as to what is good practice in learning and teaching about assessment will be presented.

Clinical decisions using the National Triage Scale: how important is postgraduate education?

Triage is the formal nursing assessment of all patients who present to an Emergency Department (ED). The National Triage Scale (NTS) is used in most Australian EDs. Triage decision making involves the allocation of every patient presenting to an ED to one of the five NTS categories. The NTS directly relates a triage category to illness or injury severity and need for emergency care. Triage nurses’ decisions not only have the potential to impact on the health outcomes of ED patients, they are also used, in part, to evaluate ED performance and allocate components of ED funding. This study was a correlational study that used survey methods. Triage decisions were classified as ‘expected triage’, ‘overtriage’ or ‘undertriage’ decisions. Participant’s qualifications were allocated to five categories: ‘nil’; ‘emergency nursing’; ‘critical care nursing’; ‘midwifery’; and ‘tertiary’ qualifications. There was no correlation between triage decisions and length of experience in emergency nursing or triage. ‘Expected triage’ decisions were more common when the predicted triage category was Category 3 (P< 0.001) and ‘overtriage’ decisions were less common when the predicted triage category was Category 2 (P< 0.0010). The frequency of ‘undertriage’ decisions decreased significantly when the predicted triage category was Category 3 (P< 0.001) or Category 4 (P< 0.001). There was no correlation between triage decisions and qualifications in the ‘nil’, ‘emergency nursing’ or ‘critical care nursing’ categories. A midwifery qualification demonstrated a positive correlation with ‘expected triage’ decisions (P = 0.048) and a negative correlation with ‘undertriage’ decisions (P = 0.012). There was also a positive correlation between a tertiary qualification and ‘expected triage’ decisions (P = 0.012).

Addressing training needs for community care assessment in remote Indigenous communities

Access to Home and Community Care services in Australia is based on the assessed needs of individual clients, with individual Home and Community Care organisations generally being responsible for initial assessment of eligibility and need. Home and Community Care funded services are expected to operate within the agency's program guidelines and to adhere to minimum service standards. However, service delivery contexts in remote areas of Australia present particular challenges for staff in the practice of assessment and care planning. This paper discusses the findings of a project which investigated approaches to assessment of client needs in remote Home and Community Care services. Some of the challenges of providing care in remote/Indigenous contexts are discussed. The research project highlighted that there was an inadequate knowledge base to assist staff with assessment and care planning in these cross-cultural contexts; a greater focus on developing the assessment skills of staff was needed. Subsequently, an education program incorporating the International Classification of Functioning, Disability and Health was developed for Home and Community Care assessment staff in remote communities. Rather than focusing on process skills and procedures, the program was designed to equip staff with a solid and consistent conceptual framework to assist with assessment and care planning.

Beyond pretence: new sensibilities for computing and communication technologies in teacher education

Making particular reference to schools’ traditional relationships with CCTS (and the kinds of ‘pretend’ and ‘artificial’ learning/assessment tasks that this relationship has historically produced), this paper details a research and teaching agenda focused on exploring the potential of having students work on tasks with value to local and/or school communities. The paper maps the informing theories and current practices of schools
participating in the ‘knowledge producing schools’ (KPS) agenda. Particular attention is given to the ways in which KPS schools are better positioned to respond to the needs of diverse student/community populations, particularly those students traditionally perceived as ‘at risk’.

Re-envisioning teacher education in the new media age: multiliteracies, multimodality and internet communication technologies

Multiliteracies pedagogy and research (New London Group, 1996) addresses the range of literacies needed by diverse students to effectively negotiate the increasing multimodality of texts, both inside and outside of schools. Yet, few university teachers understand how youth are able to express themselves, their experiences and lives, in new, empowering and perception-shifting ways as designers in the 21st century. Several theorists (Bruce, 2000; Lemke, 1998; Luke, 2000; Bolter, 1998; Glister, 1997) argue literacy education must be reconceptualised to recognize the importance of teaching and supporting multimedia literacy in a world where internet communication technologies (ICTs) incorporate all semiotic resources. Expression through multiple media and more recently hypermedia—is common to youth—but has often been demonized by historically logocentric approaches to teaching and assessment by privileging print, over all other forms of expression (Albright & Walsh, 2003; Lemke, 1998; McCloud, 1993). As digital media becomes more pervasive in a post-typographic world, tertiary education will need to engage with its representational resources for acquiring traditional school literacy and knowledge. This paper reports on initiatives in Multiliteracies instruction for both pre-service and in-service teachers to more adequately attend to the multisemiotic landscapes of students’ changing worlds in New Times (Hall, 1996).

Integrating errors into developmental assessment: 'time' for ages 8-13

It is widely agreed that measurement is of paramount importance to students’ overall development in mathematics. This paper describes a developmental ‘map’ of students’ understanding and skills in measurement, focussed on the topic of Time, that integrates correct and incorrect student ideas. The map is based on a Rasch analysis of data from a large-scale UK national survey for standardising assessment for children from 5 to 14 years of age. It is demonstrated how a partial credit strategy enables a developmental map to be constructed to show students’ strengths and weaknesses in a meaningful and useful summative and formative manner. This map provides evidence, of both a summative and a formative nature, which may enable teachers to craft appropriate and successful learning experiences for children.

Tapping global human resources in an MBA teaching team : insights with implications for management education worldwide

It is found that geographic diversity, respect for differing beliefs, encouraging feedback, active participation and interaction with the students, and techniques such as active listening, contribute an architecture and atmosphere to student learning, teacher effectiveness and program excellence in virtual education. One functioning teaching team in University of Maryland University College’s online MBA program provides the action research foundation underpinning the findings. A widely dispersed team of academics and assistants have documented the ways they enhance educational information for students in the program. Assessment activities, supplementary communications and biographical information contribute to student perception of the quality of management education in the program. Mechanisms for effectively tapping a global faculty team are discussed and are informative for administrators and academics alike.

Triage nurses' clinical decision making : an observational study of urgency assessment

Background. Researchers have described both the various decision tasks performed by triage nurses using self-report methods and identified time as a factor influencing the quality of triage decisions. However, little is known about the decision tasks performed by triage nurses when making acuity assessments, or the factors influencing triage duration in the real world.

Aims. The aims of this study were to: describe the data triage nurses collect from patients in order to allocate a triage priority using the Australasian Triage Scale (ATS); describe the duration of nurses' decision making for ATS categories 2–5; and to explore the impact of patient and nurse variables on the duration of the triage nurses' decision making in the clinical setting.

Design. A structured observational study was employed to address the research aims. Observational data was collected in one adult emergency department located in metropolitan Melbourne, Australia. A total of 26 triage nurses consented and were observed performing 404 occasions of triage. Data was collected by a single observer using a 20-item instrument that recorded the performance frequencies of a range of decision tasks and a number of observable patient, nurse and environmental variables. Additionally, the nurse–patient interaction was recorded as time in minutes.

Results. It was found that there was limited use of objective physiological data collected by the nurses' in order to decide patient acuity, and large variability in the duration of triage decisions observed. In addition, analysis of variance indicated strong evidence of a true difference between triage duration and a range of nurse, patient and environmental variables.

Conclusion. These findings have implications for the development of practice standards and triage education. In particular, it is argued that practice standards should include routine measurement of physiological parameters in all but the collapsed or obviously unwell patient, where further delay may impede the delivery oftime-critical intervention. Furthermore, the inclusion of arbitrary time frames for triage assessment in practice standards are not an appropriate method of evaluating triage decision making in the real world.

Assessment of online reflections : engaging English second language (ESL) students

Online discussion boards are being used increasingly by tertiary educators as a tool for encouraging greater student interaction and developing learning communities. In particular, educators who have adopted a learner centered, socio-constructivist approach to teaching have sought to facilitate collaborative learning in which students reflect upon and share their experiences and perspectives, and construct knowledge together through developing shared meanings. This paper presents the findings of an electronic survey of the perceptions of 70 distance education EFL and ESL students concerning a compulsory assessment item involving contribution to an online course discussion board. The study revealed that the majority of the students enjoyed the assessment item and agreed that posting to the online course discussion board had allowed them to achieve a range of cognitive and social learning outcomes, as well as to develop some important graduate skills. In particular, ESL students reported the benefits of posting to the discussion board in terms of sharing their experiences with others and reducing the feeling of isolation. Further, when considering social outcomes, ESL students perceive the discussion board provided them with an opportunity to meet and develop a closer relationship with other students in the course and encouraged them to keep up with their studies.

Music education and minority groups cultural and musical identities in the 'newer' South Africa : white Afrikaners and Indians

Music Education, as well as cultural and musical identities are all being renegotiated, post-Apartheid, within the so-called 'newer' rather than the commonly known 'new' South Africa. The developing situation with certain minority groups is particularly interesting. Education in general has undergone much change since the first democratic elections in 1994: music education specifically has been affected by such change in terms of content, delivery and assessment. Within the South African context, cultural and musical identities are often intertwined with language, racial and even tribal identities, and discussing one implies the others. We are particularly interested here in the role of formal Music Education in relation to white Afrikaners and Indians as they renegotiate their cultural development, including musical aspects

Re-imagining science education : engaging students in science for Australia

The author stresses the need for schools and science teachers to develop new approaches to attract the imagination of students in Australia. He believes that changes in the nature of post-industrial societies and in the accessibility of science knowledge and youth expectations are the culprits of crisis in science education. He argues that schools and teachers should re-examine the purposes of school science. He suggests that science re-imagining needs to be supported by national effort, create teacher development and training initiatives and assessment.

A role for workforce competencies in evidence-based health promotion education

Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies.

Teamwork and assessment: a critique

Australian universities commonly cite "teamwork" as a graduate attribute and an integral part of their set of flexible and transferable skills suitable for different types of employment. This paper raises concerns as to whether teamwork as experienced in the university education system can claim to achieve the imparting of team skills. Pedagogically, learning through team work may be a useful educational tool however when the concept of 'teamwork' is explored a number of inconsistencies arise in the tertiary environment. The outcomes derived from team work do not generally satisfy the criteria for effective and efficient teamwork. However, it is suggested that to utilise teamwork as a learning tool for a graduate attribute the assessment criteria should take into consideration how the team worked together--the team dynamics.