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OBJECTIVES: Violence in emergency healthcare is a persistent and concerning problem. The objective of the present study was to explore and understand rural nurses' views on the daily experience and impact of violence, and its perpetrators.METHODS: The present study took a descriptive exploratory approach. Two focus groups were held with nurses from an ED at a rural hospital in New South Wales, Australia.RESULTS: Violence occurred regularly and had a significant impact on staff. Nurses go to work expecting to search patients for weapons and be physically and verbally abused. Tolerating and being able to manage violence has become a rite of passage.CONCLUSIONS: The present study shows that rural workers, like metropolitan workers, feel experiences of violence are a routine part of their roles. Violence in healthcare is a societal issue, that cannot be solved without a multifactor approach that considers the characteristics of the perpetrators.

Objective To explore the patterns of and investigate the factors associated with rises in emergency department presentations in rural and metropolitan New South Wales from 2012 to 2018. Design A retrospective descriptive study of de-identified data from the New South Wales Emergency Department Data Collection. Setting New South Wales, Australia. Participants All individuals presenting to 99 New South Wales emergency departments, which continuously reported to the Emergency Department Data Collection between 2012 and 2018. A total of 2 166 449 presentations recorded throughout New South Wales in 2012 (rural 786 278; metropolitan 1 380 171) and 2 477 192 in 2018 (rural 861 761; metropolitan 1 615 431). Main outcome measures Total emergency department presentations, plus Poisson regression modelled annual changes in emergency department presentations over the period 2012-2018. Results Growth in emergency department presentations outpaced population growth in both rural and metropolitan New South Wales between 2012 and 2018. The patterns of age-standardised rates of presentations were broadly similar between rural and metropolitan areas, with highest rates observed in the youngest (0-4 years) and oldest (85+ years) cohorts. The rural sample also displayed a distinct third peak in ages 15-39 years, and rates were higher across all age groups. Rural New South Wales displayed disproportionately higher emergency department presentations in the two most deprived socio-economic status quintiles. While rural New South Wales displayed significant reductions in triage category 5 (non-urgent cases) over time, the relative proportion remained approximately double that of metropolitan sites. Conclusions There are differences between rural and metropolitan emergency department presentations relating to demographic factors, triage levels, acuity and admissions. Detailed local investigations are required to determine specific contextual issues that impact on emergency department demand.

Aim To examine the quality of evidence used to inform health policies. Policies on peripheral intravenous cannulas were used as exemplars. Design An organizational case study design was used, using the STROBE reporting guidelines. Methods Policy guidelines were sourced between June and September 2018 from health departments in Australia. Seven documents were compared regarding intravenous cannula dwell times and blood collection use. Evidence used in the documents was critiqued using assessment guideline from the Oxford Centre for Evidence Based Medicine. Results Large variations exist between policies regarding blood sampling and dwell time. Evidence used a variety of sources. Few references received an A evidence rating and policies differed in their interpretation of evidence.

To synthesize the evidence evaluating if blood samples are similar when obtained from peripheral intravenous cannula compared with venepuncture.A systematic review and meta-analysis was undertaken.Searches were conducted in databases for English language studies between January 2000-December 2018.The search adhered to the Meta-analysis of Observational Studies in Epidemiology guidelines. The methodological quality of studies was assessed using Joanna Briggs critical appraisal instruments. The overall quality of the evidence was assessed using the GRADE.Sixteen studies were identified. Findings suggest haemolysis rates are higher in blood sampled from peripheral intravenous cannula. However, haemolysis rates may be lower if a peripheral intravenous cannula blood sampling protocol is followed. For equivalence of blood test results, even though some results were outside the laboratory, allowable error and were outside the Bland-Altman Level of Agreement, none of these values would have required clinical intervention. With regard to the contamination rates of blood cultures, the results were equivocal.Further research is required to inform the evidence for best practice recommendations, including, if a protocol for drawing blood from a peripheral cannula is of benefit for specific patient populations and in other settings.Venepuncture can provoke pain, anxiety and cause trauma to patients. Guidelines recommend blood samples from peripheral intravenous cannula be taken only on insertion. Anecdotal evidence suggests drawing blood from existing cannulas may be a common practice. Further research is required to resolve this issue.目的: 在于综合证据,用以评价从外周静脉插管获得的血样与静脉穿刺法获得的血样是否相似。 设计: 进行了系统综述和荟萃分析。 资料来源: 在2000年1月至2018年12月期间,在数据库中进行了英语研究搜索。 综述方法: 这项研究遵循流行病学指导方针中观察性研究的荟萃分析。采用了Joanna Briggs的严格评价手段来评估研究的方法学质量。使用GRADE来评估证据的整体质量。 结果: 共确定了16项研究。研究结果表明,从外周静脉插管取样的血液中溶血度较高。然而,如果遵循外周静脉插管血液取样方案,溶血度可能会更低。为了血液检测结果的等效性,即使一些结果超出了实验室允许的误差和布兰德-奥特曼协议限制,这些数值都不需要临床干预。关于溶血培养的污染率,结果尚不明确。 结论: 需要进一步的研究来提供最佳实践建议的证据,包括外周静脉插管采血方案是否对特定患者群体和其他情况有益。 影响: 静脉穿剌术会引起疼痛、焦虑,并对患者造成创伤。根据指导方针,建议在插入时,只从外周静脉进行插管采血。轶事证据表明,现有插管采血可能是一种常见的做法。需要进一步的研究来解决这个问题。.