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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.

Purpose This paper aims to illustrate the complexity of understanding and managing violent behaviour in health care. The authors will show how different perceptions of the reasons for violent behaviour, and linkages between violent behaviour and illness have contributed to the creation of a wicked problem and added significant complexity to the management of violence towards staff within health-care settings. This paper will conclude with a call for strong multi-disciplinary action to address this ongoing issue. Design/methodology/approach A narrative review was undertaken to explore the ways that violence has been perceived in health care and the ways in which the concept of violence has moved from being seen as a criminal issue to being within the realms of disease. This paper will show the importance of understanding who is perpetrating violence in health care, why and in what settings. It will expound on the idea that considering violence as a consequence of disease necessarily adds a layer of complexity to both individual and organisational responses to violence towards health-care staff. Findings Understanding the complexity in preventing and managing violence against health-care staff can assist policymakers and managers to develop multi-faceted approaches to violence prevention, including better recognition and understanding of perpetrators of violence. Originality/value This paper provides a unique perspective on thinking about violence in health care and the implications of its complexity.

Background Peripheral intravenous cannulas are commonly used for blood sampling. Conflicting evidence on the safety and reliability of blood sampling from peripheral intravenous cannulas provides little support to guide practice of clinicians. Aim To elicit views of nurses working in acute care of their opinions on the safety and efficacy of obtaining blood samples from peripheral intravenous cannulas. Methods A cross-sectional electronic survey was utilised. Participants included nurses working in Australian acute care services nationally. The STROBE checklist was followed. The survey was distributed by two professional nursing bodies to their members between September and December 2017. Content analysis was used to analyse open-ended responses. Findings Of the 338 participants who completed the survey, 269 provided comments. Themes supporting the use of peripheral intravenous cannulas for blood sampling included ‘efficiency’, ‘patient care’, ‘last resort’, and ‘other’. Reasons for not using a peripheral intravenous cannula for sampling provided themes of ‘PIVC use’, ‘dwell time’, ‘test type required’, ‘patency/insertion site care’, ‘preference’, and ‘other’. Discussion The choice regarding method of blood sampling is left to the discretion of individual practitioners. Diverse rationales were provided by respondents to support their practice in sampling blood. This may be influenced by variations in hospital policies and conflicting research evidence to support or refute the practice. Conclusion Blood sampling from peripheral intravenous cannulas or venepuncture is practiced differently between nurses based on multiple rationales. Research is needed to provide evidence for safe practice and support hospital policies.

Background: The prevalence of dementia is increasing with more healthcare workers being required to care for people living with this progressive neurological disorder. The knowledge level and attitude of healthcare workers caring for those living with dementia need to be assessed and resources targeted effectively to ensure best quality care is provided. Healthcare workers for the purpose of this paper include anyone employed to care for those living with dementia. Aim: To investigate the attitudes of healthcare workers towards people living with dementia. Methods: A survey of 110 healthcare workers was undertaken between October 2016 and December 2017, using the Dementia Attitude Scale to measure attitudes towards people living with dementia. Demographic data were collected by a survey to explore whether a person’s age; cultural background; qualification level; or experience level had an impact on their attitude towards people living with dementia. Results: The full survey was completed by n = 85 healthcare workers with the majority having strongly positive views about people living with dementia, with an average score of 88.31/100. However, a large number reported being afraid of people living with dementia (n = 76, 89.4%) and would avoid people with dementia who were agitated (n = 51, 61.4%). While 100% (n = 85) agreed or strongly agreed that it was possible to enjoy interacting with people living with dementia, they were more ambivalent with n = 26 (31.6%) strongly agreeing with the statement that working with people living with dementia is rewarding. A significant difference in attitude was found using one-way analysis of variance within groups due to age (p

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.

Background Sampling blood from a peripheral intravenous cannula offers an alternative to venepuncture. This practice can reduce frequency of venepuncture and patient discomfort. Opponents argue the practice increases the chance of haemolysis, risk of infection and device failure. Aim To describe the prevalence and practice of blood sampling from peripheral intravenous cannulas by Australian nurses. Methods This study used a descriptive cross-sectional design and data were collected using an electronic survey. The survey examined Australian nurses' practice of sampling blood from peripheral intravenous cannulas. Quantitative descriptive data was analysed and presented as frequencies, percentages, medians and ranges. Findings A total of 542 nurses participated in the survey. Of these, 338 (62.4%) completed the survey. The majority of responses came from the State of Victoria (n = 137, 40.5%) and one-third were emergency nurses (n = 112, 33.1%). Sampling of blood from peripheral intravenous cannulas occurred between 37.5% and 66.7% throughout the State and Territories of Australia. Peripheral intravenous cannula blood sampling was most common in the emergency department (n = 93, 53.4%). The most frequent reasons given were difficulty of access (n = 223, 66.0%) followed by patient comfort (n = 194, 57.4%). Discussion Blood sampling is required to diagnose and monitor treatment responses. A peripheral intravenous cannula offers the opportunity to sample blood without the need for venepuncture. Practice recommendations on when to sample blood and correct sampling technique are based on limited or conflicting evidence. Conclusion Findings from this study indicate it is common practice to draw blood samples from a peripheral intravenous cannula. Further research is required to examine the accuracy and safety of this practice to further inform policy.

Background: This study explored the experience of nurses encountering challenging patient behaviour while working at a rural hospital-based haemodialysis unit. Methods: Focus groups were conducted with haemodialysis nurses at a rural hospital. Five participants across two focus groups were asked questions regarding their experiences of challenging patients, including impacts that the experiences may have had on their ongoing professional practice. Transcripts of the focus groups were analysed thematically. Findings: Three themes arose from the focus group discussion - experiencing challenging behaviour, long-term relationships with patients, and nursing professionalism. Participants described challenges arising when caring for patients who were aggressive, did not comply with self-management, or caused avoidable logistical challenges. Long-term caring relationships presented challenges as patients could become emotionally dependent upon one nurse, making it difficult to share workloads with other nurses. Participants reported decreased confidence, being near tears, being angry, and experiencing 'burnout' when caring for patients with difficult behaviour over extended periods. Participants managed challenging behaviours by identifying triggers, allocating staff to specific patients, and trying to understand the patient's motivation for action. 'Not taking work home' and 'not taking things personally' were ways in which nurses attempted to look after their own wellbeing, although this was not always possible. Participants stressed the importance of working as a team and having supportive management and inter-professional relationships. Significance: Participants' perceptions of working in the nursing profession were more related to their ability to work as a team and manage challenging behaviour exhibited by patients in a supportive environment than the presence of patients exhibiting challenging behaviour.

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。.

Aims To explore the relationship between blood sampling techniques and haemolysis. Background Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas. Design A prospective cohort study. Reporting followed the STROBE checklist. Methods A trained observer was used to record blood sampling techniques over a 10-week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis. Results Most of the blood samples were not haemolysed (n = 324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector. Conclusion There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates. Relevance to clinical practice There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half-filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care.

Issue addressed: Men in the Northern Suburbs of Launceston, Tasmania, experience substantially poorer health outcomes and socio-economic disadvantage than most Australians. They are often described as "hard-to-reach," meaning difficult to engage in research, health promotion, policy and planning. This paper summarises the OPHELIA process to combine health literacy profiling with engagement of local men in health promotion, and their experience of the process and outcomes. Methods: Interviews were conducted to explore the experiences of middle-aged men with the OPHELIA process and subsequent interventions. Results: Local data and health literacy profiling revealed experiences of isolation, lack of trust in the system, medication non-adherence, mental illness and chronic pain, which formed the basis for generation of ideas to improve their well-being and understanding of health. Tailored interventions were implemented, including suicide prevention, "Numeracy for Life" and "Healthy Sheds" courses. Interviews with six participants revealed that the process contributed to a sense of worth, social support and ability to break "old habits." Conclusions: Prioritising the lived experience of "hard-to-reach" men through the OPHELIA process resulted in co-design of interventions that were valued by participants. So what? Health literacy profiling and genuine community engagement can empower vulnerable, under-represented communities to co-design, and engage in, health promotion.

A diagnosis of younger onset dementia requires specific care tailored to the individual and the family. Dementia care workers often do not have the skills and experience necessary to offer this care within the residential and community environment. This article reports the development of an interactive resource to educate those employed to care for people living with younger onset dementia. Prescription for Life, a talking e-Flipbook was developed and piloted in two states of Australia. Feedback from the pilots was incorporated in the resource prior to a national rollout. The project was supported by an expert panel, including experts from national aged care providers.

Background In Australia there is no national examination to assess student competency with respect to critical thinking skills on graduation from undergraduate registered nurse program. Objectives To describe the use of Rasch analysis for the validation of a tool that measures critical thinking in nursing students in Australia. Design A cross sectional survey was used to assess students' critical thinking. Settings One Australian university. Participants Seventy-four first year and third year nursing students participated in the project. Methods Nursing students at one university were requested to undertake a multiple choice question survey to determine their level of critical thinking. The survey tool was validated using Rasch analysis software. Results Rasch analysis enabled identification of the difficulty of each question, enabling the assessment to identify difference between students and for each student cohort. The use of Rasch analysis demonstrated marked differences in the students' critical thinking abilities, showing higher levels of critical thinking for third year students with greater ability to answer the more difficult questions. Conclusion Rasch analysis enables the matching of test questions to the cognitive skill level of students, and is a useful tool for validating multiple choice questionnaires. Use of this method of analysis can provide a robust assessment in which questions are matched to the level of the learner and enable differentiation between high and low achieving students.

Summary Mandatory Aboriginal and Torres Strait Islander health units are included in all nursing education programmes in Australia to improve students' knowledge, skills and attitudes towards Indigenous people in order to help address health inequities. This research explores content expectations of nursing students required to undertake Aboriginal and Torres Strait Islander health studies as part of a Bachelor of Nursing Degree at a rural university campus. A cross-sectional survey was undertaken to examine students' opinions of course content of an Aboriginal health and wellbeing unit. Two hundred and ninety-four students across the three years of the degree were asked to complete the anonymous survey. Two hundred and forty-six students (83.6%) completed the survey. One hundred and thirty-nine students had completed, and 107 students were yet to undertake the unit. Qualitative content analysis of an open-ended survey question was used to interrogate the data. Four themes emerged from the data: cultural competence, disease implications and management, nursing care and other issues. Content expectations were consistent for students who were yet to undertake (pre) or had completed (post) the unit. Content expectations included Aboriginal and Torres Strait Islander culture (pre 30.4%–post 29.8%), Aboriginal and Torres Strait Islander health issues (pre 20.0%–post 23.7%) and understanding nursing care related issues (pre 15.7%–post 17.1%). Data findings were significant for enhancing the current unit. Students express the need for a safe learning environment in which to challenge beliefs and opinions. Course facilitators need to be sensitive to student populations and include content relevant to the programme being studied. Cultural immersion experiences may improve confidence in nursing Aboriginal and Torres Strait Islander people.