Standardising Initial Emergency Nursing Care: A Multicentre Implementation Evaluation
Access status:
Open Access
Type
ThesisThesis type
Doctor of PhilosophyAuthor/s
Ryan, Belinda AnneAbstract
Background
Emergency nurses are crucial for safe, high-quality care and are the first clinicians to assess and treat patients who present to the emergency department (ED), especially in rural settings. The HIRAID emergency nursing framework provides a standardised approach to ...
See moreBackground Emergency nurses are crucial for safe, high-quality care and are the first clinicians to assess and treat patients who present to the emergency department (ED), especially in rural settings. The HIRAID emergency nursing framework provides a standardised approach to post-triage patient assessment and management. Methods A multimethod implementation study evaluated HIRAID in 11 rural Australian EDs. A mixed-methods survey of emergency nurses identified enablers and barriers to implementation, using the Theoretical Domains Framework (TDF). Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were integrated and mapped to Behaviour Change Techniques (BCTs). HIRAID implementation was evaluated through a multimethod approach using the RE-AIM (reach, effectiveness, adoption, implementation quality, maintenance) framework. Evaluation included nurse surveys and interviews, audits of site implementation records, and medical records. Quantitative data were analysed with descriptive and inferential statistics, while inductive content analysis was used to analyse qualitative interview data. Results Enablers and barriers mapped to 10 TDF domains, and 20 BCTs, operationalised through 12 delivery modes, such clinical champions, and medical record modifications. HIRAID was implemented in 11 EDs, achieving high reach. Over 90% of nurses engaged in HIRAID education. Nurses (83%) reported using HIRAID documentation templates. Fidelity to strategies was low to moderate, but use was sustained at over 6 months. Improved accuracy of nursing documentation was demonstrated through medical record review (n=222), with audit scores increasing significantly across all areas of nursing documentation audited. Conclusion An evidence-based implementation strategy was effective for the sustained uptake of HIRAID in rural EDs. The intervention supported nursing practice and demonstrated clinical effectiveness.
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See moreBackground Emergency nurses are crucial for safe, high-quality care and are the first clinicians to assess and treat patients who present to the emergency department (ED), especially in rural settings. The HIRAID emergency nursing framework provides a standardised approach to post-triage patient assessment and management. Methods A multimethod implementation study evaluated HIRAID in 11 rural Australian EDs. A mixed-methods survey of emergency nurses identified enablers and barriers to implementation, using the Theoretical Domains Framework (TDF). Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were integrated and mapped to Behaviour Change Techniques (BCTs). HIRAID implementation was evaluated through a multimethod approach using the RE-AIM (reach, effectiveness, adoption, implementation quality, maintenance) framework. Evaluation included nurse surveys and interviews, audits of site implementation records, and medical records. Quantitative data were analysed with descriptive and inferential statistics, while inductive content analysis was used to analyse qualitative interview data. Results Enablers and barriers mapped to 10 TDF domains, and 20 BCTs, operationalised through 12 delivery modes, such clinical champions, and medical record modifications. HIRAID was implemented in 11 EDs, achieving high reach. Over 90% of nurses engaged in HIRAID education. Nurses (83%) reported using HIRAID documentation templates. Fidelity to strategies was low to moderate, but use was sustained at over 6 months. Improved accuracy of nursing documentation was demonstrated through medical record review (n=222), with audit scores increasing significantly across all areas of nursing documentation audited. Conclusion An evidence-based implementation strategy was effective for the sustained uptake of HIRAID in rural EDs. The intervention supported nursing practice and demonstrated clinical effectiveness.
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Date
2025Licence
The author retains copyright of this thesisRights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and HealthDepartment, Discipline or Centre
Nursing and MidwiferyAwarding institution
The University of SydneyShare