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To explore emergency department triage nurses' scope of practice and activities related to their triage role and management of patients located in emergency department waiting areas.
Exploratory, descriptive, observational study using naturalistic decision making.
Data were collected using semi-structured non-participant observation: researchers recorded their observations using a lapel microphone and recorder from 8 January to 7 May 2025. Fifteen triage nurses from three emergency departments in Melbourne, Australia were observed for 2 to 2.5 h each. Audio-recordings were transcribed verbatim and analysed using deductive content analysis. The HIRAID emergency nursing framework (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) was used as the coding frame.
Participants had a median of 10 (interquartile range 7.5–21) years nursing and 5 (interquartile range 3.2–13) years triage experience. During a total of 33 observation hours, there were 303 interactions, including 237 interactions with 169 different patients; the remainder were with carers or other clinicians. In total, 1183 tasks were coded ranging from 12 to 128 tasks per triage nurse. The most common tasks were: taking a history (n = 475); post-triage communication with patients, carers and other clinicians (n = 288); patient assessment including vital signs and focussed assessments (n = 165); and interventions including medications and psychological care (n = 134). All elements of taking a history, identifying red flags and assessment were more common during the triage process, with few instances during post-triage care. Interventions (medication administration, psychological care), diagnostics (pathology, imaging, urinalysis) and communication with patients, carers and other clinicians occurred during both triage and post-triage care.
Triage nurse practice is complex, multifaceted and extends beyond triage category allocation.
The traditional perspective that triage and post-triage care are linear and clearly divided is not fit for purpose in contemporary triage practice.
The scope of triage nurses' practice both in the context of triage of incoming patients and care of patients in ED waiting areas is poorly understood. The role of triage nurses extends far beyond rapid assessment and triage category allocation and triage nurses use a breadth of expertise and skills to maintain safety, promote comfort and expedite emergency care for patients in ED waiting areas. History, red flags and assessment were more likely during the triage process than post-triage, but interventions, diagnostics and communication spanned both triage and post-triage care. Future triage and waiting area models of care and educational preparation of triage nurses should be co-designed with triage nurses and consumers, so they reflect care as delivered rather than care as imagined.
Consolidated criteria for reporting qualitative research (COREQ).
No patient or public contribution.
In this paper, the development of an evidence-informed, data-driven strategy for implementation of the HIRAID emergency nursing framework in Thailand is reported. HIRAID stands for H istory including I nfection risk, R ed flags, A ssessment, I nterventions, D iagnostics, reassessment and communication.
This exploratory descriptive study was underpinned by the Knowledge-to-Action framework.
The study was conducted in Chiangrai Prachanukroh Hospital (CRH) in Northern Thailand. The identified problem was no standardised approach to patient assessment and management. Adaptation of knowledge to local context occurred by feasibility assessments and experience-based co-design. Surveys designed and analysed using the Behaviour Change Wheel and Theoretical Domains Framework were used to understand the barriers to knowledge use. Selecting, tailoring and implementing the intervention was guided by the Behaviour Change Wheel.
Practice environment and behavioural diagnostics surveys were completed by 49 nurses (response rate 100%) who identified 19 enablers and 33 barriers to HIRAID implementation at CRH. Enablers and barriers were mapped to seven intervention functions (education, modelling, persuasion, enablement, training, environment restructuring, incentivisation) and 19 behaviour change techniques most likely to be effective. The study methods and results culminated in an evidence-informed, data-driven HIRAID Thailand Implementation Strategy.
In-depth understanding of context-specific enablers and barriers, active engagement of end-users was critical to maximising likelihood of successful implementation. Development of an evidence-informed implementation strategy for a limited resource setting was achievable with robust application of theory, key stakeholder and end-user engagement and multi-agency collaboration.
Implementation of clinical interventions in emergency care settings is challenging, even in well-resourced settings. For end-users, knowledge that an intervention would improve patient care was a powerful enabler coupled with meaningful organisational support is critical to sustained implementation in complex nursing environments.
This study addresses the lack of standardised approach to patient assessment and management in the emergency department in a resource-limited setting. Application of robust theory is possible in middle-resource settings, and this study identified 19 behaviour change techniques that were distilled to develop a sustainable, context specific implementation strategy. Development of an evidence-informed implementation strategy for a limited resource setting with robust application of theory is possible with key stakeholder and end-user engagement and multi-agency collaboration.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore and describe registered nurses' perceptions of the patient and clinician characteristics, healthcare systems, and processes that contribute to deterioration resulting in a Medical Emergency Team (MET) review.
An exploratory descriptive qualitative study using semi-structured interviews.
A purposive sample of experienced registered nurses from acute medical and surgical wards in a large teaching hospital in Melbourne, Australia was recruited from July to August 2018. Semi-structured interviews were conducted, guided by a semi-structured interview schedule. Interviews were analysed using the 7 steps of Framework Method analysis: transcription, familiarisation, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework, and interpreting the data.
Twenty-one interviews were conducted with participants who had a median of 5.5 years' total nursing experience and 2 years' experience in their current ward. The major finding was The Downward Spiral of Clinical Deterioration theme characterised by a worsening spiral of clinical deterioration risk culminating in MET review. The Downward Spiral comprised four sub-themes: Physiological Age, not Chronological Age Matters; Delirium Demands Attention; Unclear Therapeutic Goals; 24/7 Risk in a 9-to-5 Service.
This integrates existing knowledge to explain how patient characteristics and healthcare systems and processes interact to contribute to clinical deterioration risk in the time between admission and MET review.
Identifying patients at increased risk of deterioration may assist with earlier, proactive intervention and improve patient outcomes associated with clinical deterioration in acute healthcare.
Recognising and responding to clinical deterioration remains a challenge in acute healthcare, associated with poor patient outcomes and consuming substantial resources. To date, registered nurses' perceptions of the factors leading to Medical Emergency Team review have not been described. The Downward Spiral of Clinical Deterioration describes how patient and clinician characteristics and healthcare systems and processes interact to increase clinical deterioration risk, culminating in Medical Emergency Team review. These findings may help researchers integrate disparate clinical deterioration models and concepts. Insights into how the safety of healthcare systems can be improved may assist administrators and clinicians in reducing the incidence of clinical deterioration in the future.
The study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
This study did not include patient or public involvement in its design, conduct, or reporting.
To understand the current evidence base regarding holistic nursing assessments performed by registered nurses in residential aged care homes in Australia, and identify the gaps in knowledge and potential areas for future research.
A scoping review informed by JBI guidelines and the PRISMA extension for Scoping Reviews.
The electronic databases Medline, EMBASE, CINAHL, Scopus and ProQuest Central were searched, alongside citation chaining and manual journal searches. Limits of English language and publication after the year 2000 were applied. Studies were screened against pre-defined eligibility criteria. Data were extracted and analysed using descriptive statistics and a narrative synthesis.
A total of 3987 studies were identified, of which 28 were categorised as comprehensive or multimodal assessment programmes, standalone assessment tools or assessment infrastructure papers. Key outcomes described included staff factors and resident emergency department transfers or hospitalisations. The key feature of existing nursing assessments across studies was education, which was generally associated with improved staff knowledge, confidence and efficiency. Apart from this, there was large heterogeneity among assessment interventions with inconsistent effects. Few studies focused on residents with dementia or palliative care needs.
There is currently no standardised, systematic approach to the holistic assessment of residents by registered nurses in Australia. This gap in assessment is especially evident for residents with dementia or palliative care needs.
This research highlights the need to develop standardised holistic nursing assessments to bridge this gap in practice.
No Patient or Public Contribution.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
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