The implementation and usability of HIRAID, a structured approach to emergency nursing assessment

  • Kate Curtis
    Affiliations
    Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2006, Australia

    Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, NSW 2500, Australia

    Illawarra Health and Medical Research Institute, Building 32, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia

    The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW 2042, Australia
    Search for articles by this author
  • Belinda Munroe
    Affiliations
    Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, NSW 2500, Australia
    Search for articles by this author
  • Connie Van
    Affiliations
    Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2006, Australia
    Search for articles by this author
  • Tiana-Lee Elphick
    Correspondence
    Corresponding author at: Illawarra Shoalhaven Local Health District, Wollongong Hospital, Research Central, Loftus St, Wollongong, NSW 2500, Australia.
    Affiliations
    Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, NSW 2500, Australia
    Search for articles by this author
Published:November 04, 2019DOI:https://doi.org/10.1016/j.auec.2019.10.001

      Abstract

      Background

      Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients. HIRAID, an evidence-informed emergency nursing assessment framework, is known to improve emergency nursing patient-assessment in the simulated environment however has not been evaluated in the clinical setting.

      Methods

      A pre-post design was used to assess the usability and impact of HIRAID on emergency nurses self-efficacy in the emergency department (ED). Nursing and medical staff from three Australian EDs were surveyed. Descriptive and optimal pooled sample t-tests statistics were conducted.

      Results

      One hundred and two emergency nurses completed the pre-intervention self-efficacy survey and 63 completed the post-intervention self-efficacy and satisfaction survey. Forty-two and 17 medical officers completed the pre- and post-intervention satisfaction surveys, respectively. Nursing staff self-efficacy levels were unchanged pre- and post-HIRAID implementation (Mean (SD): 8.8 (0.21) vs. 8.7 (0.20)) as was medical staff satisfaction (Mean (SD):7.5 (1.43) vs. 7.8 (1.07)), although there was a trend towards improved communication.

      Conclusion

      The HIRAID structured approach to patient assessment is acceptable, feasible, practical and appropriate for use in the clinical environment. Further research will demonstrate the direct effects of HIRAID on clinical performance.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Australasian Emergency Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Australian Institute of Health and Welfare
        Emergency department care 2017–18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216.
        AIHW, Canberra2018
        • Fry M.
        Chapter 1: emergency nursing in Australia and New Zealand.
        in: Curtis K. Ramsden C. Shaban R. Fry M. Considine J. Emergency and trauma care: for nurses and paramedics. 2nd ed. Chatswood NSW: Elsevier, Australia2019
        • Kilcoyne M.
        • Dowling M.
        Working in an overcrowded accident and emergency department: nurses’ narratives.
        Aust J Adv Nurs. 2007; 25: 21-27
        • Munroe B.
        • Curtis K.
        • Considine J.
        • Buckley T.
        The impact structured patient assessment frameworks have on patient care: an integrative review.
        J Clin Nurs. 2013; 22: 2991-3005
        • Australian Commission on Safety and Quality in Health Care
        National Safety and Quality Health Service Standards..
        2nd ed. ACSQHC, Sydney2017
        • Keijzers G.
        • Thom O.
        • Taylor D.
        • Knott J.
        Clinical research priorities in emergency medicine.
        Emerg Med Australas. 2014; 26: 19-27
        • Considine J.
        • Curtis K.
        • Shaban R.Z.
        • Fry M.
        Consensus-based clinical research priorities for emergency nursing in Australia.
        Australas Emerg Care. 2018; 21: 43-50
        • Browning L.
        • Ryan C.S.
        • Thomas S.
        • Greenberg M.
        • Rolniak S.
        Nursing specialty and burnout.
        Psychol Health Med. 2007; 12: 248-254
        • Gallagher R.
        • Donoghue J.
        • Chenoweth L.
        • Stein-Parbury J.
        Self-management in older patients with chronic illness.
        Int J Nurs Pract. 2008; 14: 373-382
        • Hollingsworth E.
        • Ford-Gilboe M.
        Registered nurses’ self-efficacy for assessing and responding to woman abuse in emergency department settings.
        Can J Nurs Res. 2006; 38: 54-77
        • Fry M.
        • MacGregor C.
        Confidence and impact on clinical decision-making and behaviour in the emergency department.
        Australas Emerg Nurs J. 2014; 17: 91-97
        • Munroe B.
        • Curtis K.
        • Murphy M.
        • Strachan L.
        • Buckley T.
        HIRAID: an evidence-informed emergency nursing assessment framework.
        Australasian Emergency Nursing. 2015; 18: 83-97
        • Munroe B.
        • Curtis K.
        • Murphy M.
        • Strachan L.
        • Considine J.
        • Hardy J.
        • et al.
        A structured framework improves clinical patient assessment and non-technical skills of early career emergency nurses: a pre-post study using full immersion simulation.
        J Clin Nurs. 2016; 25: 2262-2274
        • Munroe B.
        • Buckley T.
        • Curtis K.
        • Murphy M.
        • Strachan L.
        • Hardy J.
        • et al.
        The impact of HIRAID on emergency nurses’ self-efficacy, anxiety and perceived control: a simulated study.
        Int Emerg Nurs. 2016; 25: 53-58
        • Hollingsworth E.
        • Ford-Gilboe M.
        Registered nurses’ self-efficacy for assessing and responding to woman abuse in emergency department settings.
        Can J Nurs Res. 2006; 38: 55-77
        • Cheung R.
        • Au T.
        Nursing students’ anxiety and clinical performance.
        J Nurs Educ. 2011; 50: 286-289
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Munroe B.
        • Curtis K.
        • Margerat M.
        • Strachan L.
        • Buckley T.
        HIRAID: an evidence-informed emergency nursing assessment framework.
        Australas Emerg Nurs J. 2015; 18: 83-97
        • Curtis K.
        • Murphy M.
        • Hoy S.
        • Lewis M.
        The emergency nursing assessment process—a structured framework for a systematic approach.
        Australas Emerg Nurs J. 2009; 12: 130-136
        • Graham I.D.
        • Logan J.
        • Harrison M.B.
        • et al.
        Lost in knowledge translation: time for a map?.
        J Contin Educ Health Prof. 2006; 26: 13-24
        • Curtis K.
        • Fry M.
        • Shaban R.Z.
        • Considine J.
        Translating research findings to clinical nursing practice.
        J Clin Nurs. 2017; 26: 862-872
        • Graham I.D.
        • Logan J.
        • Harrison M.B.
        • Straus S.E.
        • Tetroe J.
        • Caswell W.
        • et al.
        A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems.
        Implement Sci. 2017; 12: 77
        • Creswell J.
        • Piano Clark V.
        Designing and conducting mixed methods research.
        Sage Publications, Thousand Oaks, CA2011
        • Munroe B.
        • Curtis K.
        • Buckley T.
        • Lewis M.
        • Atkins L.
        Optimising implementation of a patient-assessment framework for emergency nurses: a mixed-method study.
        J Clin Nurs. 2018; 27: e269-e286
        • Michie S.
        • Atkins L.
        • West R.
        The Behaviour Change Wheel: a guide to designing interventions.
        Silverback Publishing, Great Britain2014
        • Curtis K.
        • Tzannes A.
        • Rudge T.
        How to talk to Doctors—a guide for effective communication.
        Int Nurs Rev. 2011; 58: 13-20
        • Baumberger-Henry M.
        Registered nurses’ perspectives on the new graduate working in the emergency department or critical care unit.
        J Contin Educ. 2012; 43: 299-305
        • Glynn P.
        • Silva S.
        Meeting the needs of new graduates in the emergency department: a qualitative study evaluating a new graduate internship program.
        J Emerg Nurs. 2013; 39: 173-178
        • All-Party Parliamentary Group on Global Health
        Triple Impact – how developing nursing will improve health, promote gender equality and support economic growth.
        (London)2016
        • Australian Institute of Health and Welfare
        Australia’s health 2018: in brief. Cat. No. AUS 222.
        AIHW, Canberra2018 (In Canberra)
        • Scott B.M.
        • Considine J.
        • Botti M.
        Unreported clinical deterioration inemergency department patients: A point prevalence study.
        Australas Emerg Nurs J. 2015; 18: 33-41
        • Dichtwald S.
        • Matot I.
        • Einav S.
        Improving the outcome of in-hospital cardiac arrest: the importance of being earnest.
        Semin Cardiothorac Vasc Anesth. 2009; 13: 19-30
        • Hogan H.
        • Healey F.
        • Neale G.
        • Thomson R.
        • Vincent C.
        • Black N.
        Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study.
        BMJ Qual Saf. 2012; 21: 737-745
        • Michie S.
        • Richardson M.
        • Johnston M.
        • Abraham C.
        • Francis J.
        • Hardeman W.
        • et al.
        The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.
        Ann Behav Med. 2013; 46: 81-95
        • Guo B
        • Yuan Y.
        A comparative review of methods for comparing means using partially paired data.
        Stat Methods Med Res. 2017; 26: 1323-1340