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To explore final year nursing student’s ability to transfer clinical judgement skills to the clinical practice setting following immersive simulation. Clinical judgement is considered a fundamental skill for nurses to ensure safe, quality care is delivered. In undergraduate nursing education where students have limited clinical experience, simulation-based education is an important educational strategy for introducing and developing these skills. Simulation allows for students to be exposed to repeated experiences and emotional responses to varying clinical situations. Despite this, there is a paucity of literature relating to students’ ability to transfer clinical judgement skills from the simulated environment into clinical practice. A naturalistic philosophical approach informed data collection in this qualitative phase of a larger study. Data were collected from students and nurse educators using semi-structured interviews as well as from facilitated simulation debriefs. Data were thematically analysed. Four themes were identified which related to student knowledge, self-awareness and the clinical context: Safely collecting the data; Understanding the data to safely make decisions; Emotional intelligence; and Role variation. Students and educators held similar views on many of these elements. Questioning was identified as a key component of nursing students’ clinical judgements. There were challenges in assessing students’ ability to link theory to practice in the clinical setting, despite evidence of this occurring in the simulated setting. Simulation prepares students for practice by exposing them to new experiences and stressors and therefore an effective educational technique for developing clinical judgement skills in this cohort.

Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED CONCLUSION :There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence.

Older people have a greater need for emergency medical care than others in the community, and the number presenting to emergency departments (ED) from residential aged care is increasing (Roberts, McKay and Shaffer 2008). In the case of elderly patients transferred from residential aged care facilities (RACF), many arrive via ambulance and are unable to give a coherent medical history or describe their treatment wishes.

The waiting room nurse role was introduced into emergency department waiting rooms in response to increased waiting times, poor patient outcomes and failure to meet key performance indicators. The aim of role was to decrease waiting times, reassess patients and improve communication. There is a paucity of literature relating to the role. The aim of the research was to explore nurses perception of the implementation of a nurse allocated to care for patients in emergency department waiting rooms.An exploratory sequential mixed-methods design was used. In Phase 1, data exploring factors contributing to the development of the role were collected from key informant (n=6) through semi-structured interviews. In Phase 2 waiting room nurses (n=8) from a major metropolitan and regional hospital in Victoria (Australia) were observed in clinical practice over 13 periods of observation. Phase 3 surveyed members of the College of Emergency Nursing Australasia, the peak professional body, on the implementation of the role across Australia and their perception of the role. There was a total of 197 survey responses.The key findings of the research were that nurses perceived the role contributed to care quality and patient safety in the waiting room. Waiting Room Nurses developed therapeutic relationships to deliver holistic patient-centred care and facilitated the flow of patients out the waiting room. Variations in preparation, experience and supporting policy were found. A number of challenges including role confusion, funding issues and high exposure to occupational stressors were noted.Integration of the results identified the characteristics and attributes of nurses performing the role, along with the organisational resources required. The activities of the WRN were found to be assessment, secondary triage interventions, communication and facilitating patient flow. Finally, expediting care, patient advocacy, therapeutic relationships, de-escalation, empowerment, improving care quality and safety and deliver of patient-centred care were identified as outcomes of the role.A standardised approach, with considerations for local priorities and work practices, to the preparation, education and supporting policies is required. In addition, policy relating to high exposure of WRNs to occupational stressors is necessary. Further research into the role is essential, including exploring patient outcomes and experiences of the role.

History taking is a vital component of patient assessment. Nurses need sound interviewing skills to identify care priorities. Verbal and non-verbal cues provide triggers to follow-up with appropriate questions during health assessment for development of appropriate care plans. This skill, however, is a difficult one for students to learn and develop. This paper reports on a study that explored the value of video-recording, facilitated review and debriefing following a simulated patient experience to enhance final year nursing students’ history taking and assessment skills. Scenarios, from commonly encountered situations, with imbedded cues were developed. Actors were employed as simulated patients from whom students took histories while being videotaped. Video-recordings were then reviewed by each student with a lecturer to highlight missed cues or areas where questioning could be developed. These were later analysed to explore cue identification. Finally, a focus group was conducted with participants to elicit feedback on the experience. Findings suggested that it was a valuable exercise. Students lacked prior appreciation for many aspects, such as lifestyle, on planning care. Some reported never having had opportunity during clinical placement to take a full history. Analysis of recordings identified commonly missed social cues and failure to fully explore emerging data.

In 2010 more than 180,000 people were living in residential aged care facilities in Australia with 75% of those in high level care.

Insufficient communication between RACF and the ED impede treatment and care, contributing to ED delays (Givens etal 2012). [...]any delay in providing care makes the recently introduced 'National Emergency Access Target, where patients are to be discharged, transferred out of, or admitted to the treating hospital within four hours (Department of Health and Ageing 2012), difficult to achieve.