This paper aims to discuss the transition of new graduate nurses into the workforce, the preparation provided to equip them through the novice–beginner stage, and the theory–practice conundrum. Background: In Australia, new graduate transition programs have been in existence since the 1990s. While there is widespread acknowledgment that this period is pivotal for new graduate nurses entering the profession, there is a lack of consensus on the definition of best practice to achieve optimal preparation for new graduate nurses transitioning into the workforce. Methods: This discussion paper integrates the nursing literature on this topic with the extensive professional experiences of the authors, who are currently working as clinicians in metropolitan hospitals and hold academic positions at universities. Their insights are informed by the literature sourced from peer-reviewed English language journals, including reviews, empirical studies, and national and international reports. Discussion: Recruiting and retaining nurses presents a multifaceted challenge that requires the development of effective tools and strategies to build a sustainable workforce. Both the literature and the authors’ experiences highlight several key factors influencing the preparedness of new graduates. These factors include workplace culture, the demands placed on new graduates, and the support, education, and training they receive. The perspectives shared in this article offer valuable discussion points that can deepen our understanding of the current issues and contribute to the development of more effective solutions.

Background: Eye tracking technology, when used in nursing, helps to reduce medication errors by analyzing eye movements. In education, it provides insights into student learning, cognitive load, and instructional design, allowing for more personalized learning. Despite challenges such as the need for technical expertise, privacy concerns, and cost, eye tracking offers real-time feedback that enhances both teaching and learning effectiveness. Objectives: To explore the current evidence on the application of eye tracking technology in training nursing students for drug administration. Methods: Eligible studies included peer-reviewed empirical papers, both qualitative and quantitative, and reports published in English. Excluded were studies involving Non-Eye Glass Tracking, non-nursing students, or non-English articles. Searches were conducted in nine databases. The risk of bias was assessed using the JBI SUMARI tool, and the results were synthesized narratively, presented with the PRISMA-P flow diagram. Results: From 739 studies, 10 focusing on medication training were identified. Eye tracking helped to reveal differences in visual focus between novice and expert nurses, with certain interventions shown to improve attention and concentration. Conclusions: Eye tracking has strong potential in nursing education, especially for improving attention and enhancing situational awareness in medication administration. However, limitations such as small sample sizes, technical barriers, and a lack of long-term data remain. Future research should address these gaps with larger, more diverse samples and extended follow-ups.

Although safety is imperative in health care, medical practice carries a degree of uncertainty which in turn introduces risk, and perception of risk influences behaviour. Doctors worldwide are guided by professional practice frameworks, yet the perception of risk is subjective, meaning that individuals make their own judgements on its severity and consequences in ambiguous situations. The intent of this study was to develop a self-directed learning tool for medical students and doctors in training to prompt reflection on “what would I do” scenarios in ambiguous clinical emergency situations. We present the development and testing of scenarios based on the Australasian College for Emergency Medicine’s education and professionalism domains for use as a reflection tool in small group learning activities.

Background: Modernisation in the healthcare landscape has seen the spread of the integration of health information technology to replace paper -based systems with Electronic Medical Record (EMR) systems. Although this technology has become accessible in most healthcare settings globally, its adoption into nursing school curricula as a teaching tool and learning strategy is slow. Universities are now faced with a number of challenges to ensure nursing and midwifery students are well-equipped to use this new technology upon graduation and to determine how best to integrate this new technology into undergraduate health education curricula. Objective: The purpose of this study was to develop an Interactive Simulated Electronic Medical Record (ISEMR) as a learning tool and assess students' acceptability and intention to use the tool in their nursing education. Methods: A quantitative descriptive study was conducted in the cohort of second -year undergraduate nursing students enrolled in a clinical course in a Bachelor of Nursing program in Australia. This study was guided by the Technology Acceptance Model (TAM). Data were collected over one semester using a validated questionnaire to measure the students' perceived ease of use, perceived usefulness (PU), intention to use, and acceptability. Results: Of the 530 students enrolled in the course, 433 (82%) participated in the study. In accordance with the TAM, the findings showed that PU of the ISEMR in providing learning and experience for the future was significant in determining students' intention to use it. Students who perceived the ISEMR easy to use were more likely to perceive usefulness. Conclusion: Integrating the EMR into the nursing curriculum will be beneficial in providing undergraduate nursing students with the opportunity to enhance critical thinking, improve documentation, and enhance understanding and nursing skill. The findings from this study will drive learning and teaching approaches that will lead to growth in capability with health information technology. (c) 2024 Australian College of Nursing Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objective This study aim was to develop a predictive model of bed utilisation to support the decision process of elective surgery planning and bed management to improve post-surgical care.Methods This study undertook a retrospective analysis of de-identified data from a tertiary metropolitan hospital in Southeast Queensland, Australia. With a reference sample from 2 years of historical data, a model based on the Monte Carlo method has been developed to predict hospital bed utilisation for post-surgical care of patients who have undergone surgical procedures. A separate test sample from comparable data of 8 weeks of actual utilisation was employed to assess the performance of the prediction model.Results Applying the developed prediction model to an 8-week period test sample, the mean percentage error of the prediction was 1.5% and the mean absolute percentage error 5.4%.Conclusions The predictive model developed in this study may assist in bed management and the planning process of elective surgeries, and in so doing also reduce the likelihood of Emergency Department access block.

Whilst digital health data provides great benefits for improved and effective patient care and organisational outcomes, the quality of digital health data can sometimes be a significant issue. Healthcare providers are known to spend a significant amount of time on assessing and cleaning data. To address this situation, this paper presents six Digital Health Data Imperfection Patterns that provide insight into data quality issues of digital health data, their root causes, their impact, and how these can be detected. Using the CRISP-DM methodology, we demonstrate the utility and pervasiveness of the patterns at the emergency department of Australia's major tertiary digital hospital. The pattern collection can be used by health providers to identify and prevent key digital health data quality issues contributing to reliable insights for clinical decision making and patient care delivery. The patterns also provide a solid foundation for future research in digital health through its identification of key data quality issues, root causes, detection techniques, and terminology.

Problem: Assaults on nurses by patients are common. To deter occupational violence against nurses, as-saults attract penalties of longer imprisonment in many jurisdictions (domestically and internationally). However, the deterrent value of harsher penalties has been questioned when many assaults are under-reported. Aim: To identify the barriers and enablers to the reporting and prosecution of assaults experienced by nurses.Methods: In this study participants were recruited using a snowballing technique through health workforce emails, social media channels, and professional organisations. The investigator-developed survey prompted for categorical and open-ended responses. Descriptive and qualitative content analyses were used to ana-lyse the study data.Findings: Of the N = 275 respondents, n = 237 nurses had been assaulted at work. Assaulted nurses were typically female, over 31 years old, had more than five years of nursing experience, and worked in an emergency department. Overwhelmingly, nurses indicated receiving poor support when they wanted to report an assault to the police. Dominant themes (N = 6) identified systemic barriers that hinder criminal reporting, which was found to be a consequence of organisational and policing lapses, and self-limiting nursing culture. Discussion: This study identified several barriers for nurses to report and prosecute assaultive patients in Australia. The barriers point to a strong imperative for organisations that employ nurses and police to fulfil their responsibilities to enable and support assaulted nurses to prosecute.Conclusion: The study findings led to important recommendations for organisations and police to support, encourage, and empower nurses to prosecute assaultive patients, and ultimately deter violence.(c) 2023 Australian College of Nursing Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

AIM:The aim of this work is to identify factors that impact on early career nurses' intentions to remain in their current position and compare with what impacts on intention to remain in the profession.BACKGROUND:Early exits of nurses from a position and the profession are a result of evolving factors. A lack of longitudinal follow-up impedes knowledge about these factors or what proportion of temporary exits become permanent.METHOD:The study used prospective cohort survey design. The sample was obtained from non-probability convenience sampling of graduating nursing students from two universities. Data was collected across three time points over 12 months, commencing in November 2016.RESULTS:The professional turnover rate was 6.7% in total. Higher Work Environment, Support and Encouragement scores and Stress in personal life were the only predictors of intending to remain in the profession. Statistical modelling could not predict intention to remain in current position.CONCLUSION:There were differences identified when comparing intention to remain in a position and the profession. Nurses are satisfied with their career choice and intend to remain in the profession, although many are intending to move positions.IMPLICATIONS FOR NURSING MANAGEMENT:To effectively retain the nursing workforce, stakeholders must focus on the work environment, appropriate support and remuneration, and facilitate career progression.

AIMS To explore and collate solutions for occupational violence from emergency department (ED) staff. BACKGROUND Despite publications highlighting the progressively worsening issue of occupational violence in EDs and its detrimental impacts, few strategies aimed to reduce or manage it have been discussed in the literature. METHODS This was a cross-sectional study involving ED staff. Participants completed an electronic survey that prompted interventions for occupational violence. Free-text data were analysed and logically categorized using validated techniques. RESULTS Participants (N = 81) suggested 24 interventions: 12 were classified as prevention strategies, 10 as response strategies and two as recovery strategies. Prevention and response strategies for occupational violence targeted key participants: patients, staff and ED environment. Recovery strategies centred around staff management of the personal impacts of incidences of occupational violence and on systems in place to support them after occupational violence incidents. CONCLUSION Solutions to occupational violence should be multifaceted encompassing prevention, response and recovery for patients, staff and the ED environment. IMPLICATIONS FOR NURSING MANAGEMENT No single, universal intervention can be endorsed to reduce or mitigate the impacts of occupational violence in EDs. However, a combination of the interventions (strategies) discussed in this paper can be recommended.

Background Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) is an immersive 1 day in-hospital injury awareness and prevention programme designed to educate high-school students on the consequences of a variety of risk-taking behaviours. This multisite contemporary analysis examined differences in programme effect and temporal changes on participant knowledge and attitudes. Methods Metropolitan and rural schools were invited to attend the programme at one of the 11 hospital sites throughout Queensland, Australia. Pre-post study design with participant questionnaires provided at three time periods: immediately preprogramme and postprogramme, and 4 months later. The questionnaire used scenarios to determine a participant's opinion on the safety of drugs/alcohol, driving and risk-taking activities, using Likert scales. Results A total of 5999 students participated in the programme between 1 January 2018 and 31 December 2019. Responses to all questions related to safety, harm or risk followed a similar pattern. The immediate postcourse responses demonstrated significant increased awareness of risk or change in action, followed by a decay at 4 months to within 10% of preprogramme levels. Public school students, males and students from Central and North Queensland demonstrated lower risk-aversion (p<0.05). Conclusion This study demonstrated across more than 100 school sites, the positive change in knowledge and student participant attitudes towards risk-taking behaviours after attending the P.A.R.T.Y. programme. The need to address the significant decay at the 4-month follow-up was identified. Findings offered potential for tailoring of messaging to target key demographic groups/topics where the decay was greatest.

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED-in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction;P= 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed. What is known about this topic? Much has been written about the introduction of electronic medical records (EMRs) in emergency departments. This work sits alongside a substantial body of evidence outlining the relationship between process measures of ED performance and important patient outcomes. However, much less is known about the impact of digital transformation on the complex adaptive system that is the EDii and the impact of digitisation on the vulnerable group of patients who require emergency admission to hospital. What does this paper add? The objective of this case study was to describe the effect of a rapid rollout of an integrated EMR. This EMR simultaneously transformed care delivery both in the ED and the inpatient space and impacted on the politically and clinically sensitive performance and outcome measures of the EDii in a large tertiary hospital. The present study is the first that specifically examined the effect of digitisation at the EDii. What are the implications for practitioners? The understanding that digital deceleration will occur, but that with good patient outcome monitoring worsening of key patient outcomes is not likely to occur, now holds a key place in digital transformation planning. The measures of the EDii examined in this case study provide a foundation for this montoring.

Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients' self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients' ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED. Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes. Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=-0.137, P=0.011). Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients' understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.

Introduction Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. Materials and methods This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months. Results There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001). Conclusions Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury. Prevention Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.

BACKGROUND Approximately 5%-8% of emergency department (ED) presentations are due to a dermatological condition. This study aimed to identify and characterise patients with skin conditions presenting to a busy ED. METHODS A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed. Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations. A prospective survey was conducted on low priority triage (triage 4 and 5) patients identifying reasons presenting to the ED. RESULTS Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016. Of the dermatology presentations, 41.5% were female and had an average age of 47. The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer. Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology. Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED. CONCLUSION Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology. This data may help ED clinicians decide on the discharge disposition of these patients. There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.

Objectives To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). Conclusion Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.

Aim To identify the factors influencing employment outcomes and settings for early career nurses. Background A shortage of nurses attracted to work in out-of-hospital settings exists. Despite this, not all nursing graduates can secure work as a nurse. Information on the factors that impact wider graduate employment is available. However, a nursing perspective is missing, especially for hard to recruit to areas. Methods A prospective cohort study was conducted. Participants were 293 final-year undergraduate nursing students, recruited from two universities. Data were collected over 12 months, commencing November 2016. Results English as a first language was the greatest predictor of employment for graduates. Previous health care experience and workplace preferences predicted employment in the out-of-hospital setting. Conclusions Misalignment between English language requirements and industry expectations about language may lead to bias in recruitment of graduate nurses with English as their second language. Recruitment to out-of-hospital settings may be promoted by having health care experience and targeting those with a preference. Implications for Nursing Management Reviewing current employment policies to ensure they reflect the need for cultural diversity in the nursing workforce is critical. Additionally, research that aims to understand how preferences for out-of-hospital settings are developed will help target graduate employment strategies.

Background: Despite the introduction of a range of safety policies and sharps equipment designed to protect healthcare workers, rates of percutaneous injuries from occupational exposure to sharps remains high. This study examined the availability and use of various types of sharps devices in a tertiary hospital emergency department, to understand clinician choice between non-safety and safety devices; and to document their safe and unsafe use of sharps. Methods: This mixed methods study consisted of areview of stock levels, a survey of staff usage, and a content analysis of semi-structured interview data to explore factors which impact on staff preferences for different sharps devices. Results: Staff identified a range of sharps risks, as well as barriers and enablers to the use of safety devices. Availability of, and preference for, familiar devices influenced choice of devices used in clinical practice, despite awareness of associated risks. Conclusions: This understanding of equipment use and the factors that motivate such use have informed the first stage of the knowledge-to-action cycle. Knowledge translation, should include the development of policies to help reduce the risk of sharps injury. Culture change and ongoing skills development might help to overcome entrenched procedures and increase voluntary engagement with safer sharps. (C) 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

ObjectiveInjuries are a major burden on the Australian healthcare system. Power tool usage is a common cause of accidental injury. A better understanding of the trends of power tool injuries will inform prevention strategies and potentially mitigate costs. MethodsThe ED databases from two level 1 hospitals were reviewed for presentations between 2005 and 2015 resulting from accidental injury with power tools. A subgroup of patients presenting to one hospital between 2016 and 2017 were interviewed about the activities and circumstances that led to their injuries, and followed up 3 months later to assess outcomes. ResultsA total of 4057 cases of accidental injury from power tool use were identified. Power saws and grinders contributed to 54% of injuries. Most injuries were located on an upper limb (48%) or the head and neck (30%). Over half (54%) of all head injuries were associated with metal and wood fragments to the eye from grinders, drills and saws. Hospital admission rates were highest for patients aged >60years. Injuries to females were <5% of all presentations, but 40% of those caused by lawnmowers. Among the 200 patients interviewed, lapses in concentration during use, and modification and inappropriate use of a power tool were the main contributors to injury. Recovery periods >3 months were common. ConclusionsAccidental injuries from power tool use have a considerable impact on ED resources and can affect the long-term quality of life of those injured. Effective education about safe usage and protection may prevent many injuries.