Impact of a Structured Approach to Patient Assessment on Emergency Nursing Practice: A Convergent Parallel Mixed-Methods Study Using Full Immersion Simulation

Abstract

Background: In the emergency department, nurses are required to be competent at performing accurate and timely comprehensive patient assessments to determine the urgency and treatment needs of patients. Yet there is no evidence-informed structured approach available to teach emergency nurses how to perform comprehensive patient assessments. Aims: The aims of this thesis are to determine whether emergency nursing practice is improved by a structured approach to patient assessment and how to optimise future implementation of such approach into practice. Methods: An evidence-informed emergency nursing assessment framework and education intervention was devised to provide emergency nurses with a structured approach to patient assessment post triage. A convergent parallel mixed-methods study was conducted using full immersion simulation to test the effect of the intervention on emergency nursing practice. Thirty eight early-career emergency nurses were evaluated performing assessments of simulated emergency patients before and after completing the intervention. Data were also collected via surveys, interviews and focus groups. Changes from pre- to post-intervention were assessed using paired parametric and non-parametric tests. Inductive content analysis was used to analyse qualitative data. Quantitative and qualitative data were then integrated, guided by behaviour-change theory to optimise future uptake in the clinical setting. Findings: Increases were observed from pre- to post-intervention in the percentage of patient-history elements collected (p=0.02), critical indicators identified (p=0.02) and reported to medical officers (p<0.01), and reassessments performed (p=0.01). Competence in non-technical skills also improved (p<0.01), anxiety levels decreased (p<0.01) and self-efficacy in patient-assessment performance increased (p<0.01). An implementation strategy was designed to optimise sustainable implementation of the intervention into clinical practice. Conclusion: Education and application of an emergency nursing assessment framework improved the patient-assessment performance of early-career emergency nurses in the simulated setting and should be considered for implementation into clinical practice. Further evaluation in the clinical setting is recommended.