HNO6004 Evidence And Research For Practice

Introduction

• This journal article illustrates the implications of the emergency department(ED) triage practice environment on the triage practice of nurses who triage clients with a mental illness.
• This was necessary due to the increasing number of mental patients in Australian emergency departments to improve their health care which brings about a positive impact to the entire Australian nation thereby making it a highly regarded journal.
• It was published in Australia.
• The information in the journal is very imperative as it enlightens on the need for the ED triage environment being set in a manner that ensures the mental patients are secure and their privacy not invaded (Broadbent, Moxham & Dwyer, 2014).
• The authors used information from the first authors Ph.D.
• They are experts in this field since they engaged in their own research and did not plagiarize the work of the other authors but only used the information to get their facts right.
• This research was done as part of the requirement at the college of emergency nursing in Australasia.
• The authors are Ph.D. holders who are very competent.
• The information about the authors brings about confidence in their research hence promotes the need to implement what is entailed in the journal to help in assisting the clients with mental illness.

Background Aims

• The background research question is how will the triage nurses ensure the triage emergency department environment to enhance better health care to the clients with mental illness?
• The key points in the background of this article are the mental health, triage nurses, health care, emergency department and the triage environment which are all used to bring about the significance of this study. The research is to enhance a triage environment with the infrastructure that favors the mental patient’s security and privacy so as to avoid exposing the patients to public scrutiny (Dobson & Dobson, 2016). The infrastructure should be one that enables the mental patients to be in an enclosed room which is visible to the triage nurses to observe their progress before seeing the specialist.
• The literature review entails the redesigning and occupying the new emergency departments. This was necessary due to the tension caused by the mentally ill patients in the waiting room environment as they wait to be attended to by the mental health specialist (Sandoval, 2016). For this reason, the emergency department triage environment should be designed in such a manner that it enhances the patient’s privacy, security and visualizing just to be sure they do not harm themselves.
• The significance of this study is to redesign the emergency departments so as to ease the processes in the ED and improve client health care (Townsend, 2014).
• This study explains how the triage nurses should not only engage nursing activities such as assessment of clients but also providing the required care to the patients and their families in their waiting rooms and how they should manage the patients with mental illness in the emergency department.
• The specific aims of the research were;
• To provide an emergency department environment that was easily accessible with necessary equipment that is safe for both the mentally ill patients and the triage nurses.
• To engage the architectures in the designing of emergency departments in such a manner that is private but visible to the triage nurses so as to enhance privacy of the mentally ill patients as they wait to be attended to by the clinician (Pich, et.al., 2017).

Methods

• The research was done through ethnographic design to observe how the triaging nurses offered their services at the triaging emergency department to the triaging patients who suffered from mental illness (Broadbent, et.al., 2014). It has also drawn findings from a broader ethnographic observation that was done to determine the relationship between the triage nurse and the triage mental specialists making the data very reliable and effective.
• Adequate time of eight weeks was used to engage the participants in data collection process. The study participants were the forty-five staff who were qualified to conduct triage during data collection. The participants were given roles to perform and they had three shifts in a day to make sure they collected quality data for the study. There was to be one nurse for the morning shift, two for the afternoon shift and finally one for the night shift hence no particular was left out since patients are brought into the hospital at any time.
• The ethnographic design is the best design since it reflects on the real evidence (Oliver, Lorenc & Innvær, 2014). This was enhanced through training of the nurses for triage training and was qualified for the triage process.
• The population where data was collected was well described and the sample to be used for the data collection process to represent the whole population of Australia.
• The sample was, therefore, a regional hospital in Australia that had a very large emergency department that consisted of around forty-four thousand sections that are well separated for clients.
• A desirable percentage of these patients were those with mental illness hence making it a good sample to be used to represent the whole population thereby making it an adequate sample size.
• The triage nurses took a sample of twenty eight clients to represent the whole population of the clients who were mentally ill since they could not collect data from all of them.

Critique of qualitative research article

Data collection

• The methods of collecting data were very appropriate for this kind of research since it was a qualitative research.
• The data collection process entailed different methods like observation, both the formal and informal interviews with the triage nurses and some field findings.
• All these methods used to collect data were imperative in achieving triangulation.
• A sufficient amount of data was collected within that specified period and it was adequate to bring about the required findings.
• The data collected had sufficient richness and relevance, for instance, the interview gave the researcher easy time to confirm the records of the observation made in the field hence making the recording process appropriate (Messac et.al., 2013).

Procedures

• The data collection and recording procedures were very accurate since they relayed first-hand information from the clients with mental illness.
• Tape recording and transcribing verbatim of interviews before analysis portrayed a fewer bias data.

Enhancement of trustworthiness

• The researchers engaged in some critical strategies that enhanced integrity and trustworthiness of the study which were very adequate as they ensured the ethical standards were well observed.
• The nurses who collected data like interviewing were engaged in triage training and it was ensured that they were fit for the triage activity. In addition to that their qualifications and experience was significant in generating confidence in their findings and interpretations.

Results

• The data analysis method that was used to analyze the data collected from the field was a constant comparative method which is an appropriate method for analyzing qualitative data. This type of analysis is a systematic and integrated approach since it is used to analyze narratives that consist of people’s ideas and their intuitions of the relevant data from the field (Palinkas, et.al, 2015).
• The analysis yielded various theories through analysis of one data and comparing it to other sources of data hence making it the most critical method for analyzing this data.
• The analytic procedure was not biased since the authors analyzed and compared them to other sources of data and did theoretical coding independently and later compared for the purpose of consistency and ensuring there is no biasness.

Findings

• The findings were effectively summarized into three categories that are the triage environment, the triage assessment, and the client management. The use of excerpts to support the arguments in the findings is marvelous and they are well quoted to show they are words said by someone during the research process and the person who said the words is indicated (Hamer & Collinson, 2014).
• The three themes in the findings adequately capture the meaning of the data like the triage environment highlights the requirements need in the environment and how best possible it should be located, the client management encompasses the emergency department nurses elaborating how they think the clients with mental illness should be well taken care of in a manner that is reassuring to them and their families (Sandoval, 2016).
• This, therefore, shows that the researcher satisfactorily conceptualized the themes in the data so as to enhance effective care and management of the clients with mental illness by structuring triage environment that ensures their privacy and safety as they wait to be attended to by the mental specialists.
• The analysis yielded a meaningful, insightful and provocative view of the case under study hence the need for the necessary changes.

Summary Assessment and Conclusion

• The study findings are very trustworthy and have important facts that make the reader have a lot of confidence in it since it has illustrated the research process accurately revealing a detailed literature review, data collection process, and analysis methods and discussed the findings effectively by providing facts and providing their basis of argument. It has clearly stated the desired architectural steps that will create a triage environment for the triage nurse to provide optimal health care to the mental patients (Grove, Burns & Gray, 2014). This enhances room for good communication as well as privacy and security of the patients which was the need for the study.
• The study has brought about meaningful evidence in the field of nursing like the need to have a triage environment to enable the nurses to manage the overcrowded waiting rooms effectively and enhance a rapid decision-making process. Furthermore, this reduces the tension caused by clients who are mentally ill in the waiting rooms as they wait to be attended to hence reducing the stress that arises between the client and the staff or nurses. In conclusion, mentally ill clients can be facilitated with better care through a good emergency department triage environment that suits them hence hospitals should adopt this strategy.

Relevance to Nursing and Case Study

Principles of evidence-based practice

Patient values

This research focuses its argument on the mental health patients hence the patient values. The patient should be the first priority hence hospital should be patient-centered. The patient-centered approach is very effective and essential especially in cases of complex diseases like mental health (Montori et.al., 2013). The nurses should, therefore, ensure they consider patient values and preferences before any other interest. For this reason, the research shows patient-centered approach leads to positive outcomes, rapid decision making and good communication with the staff and the clients thereby facilitating evidence-based practice.

Clinical expertise

Clinical expertise is one of the best evidence-based practices. It incorporates the acquired knowledge and skills that one has learned in health care activities and applying the experience gained to make informed clinical decisions (DiCenso et.al., 2014). Clinical expertise enhances the ability of the nurse to manage and improve the patients care. This research provides clinical expertise in managing the mental patients in the emergency department through their experience and qualifications to provide quality healthcare which is a significant role in the evidence-based practice. This can be enhanced through the application of the findings of the study in the research.

Available evidence

Evidence from other sources, for example, the scientific sources, case studies, and information from experts should be made available for the purposes of research. They provide enough evidence that can be referred to by the nurses to improve or provide better health care to clients who are mentally ill or rather those with complex conditions. The available evidence helps in improving the communication between the patient and the nurses hence reducing the unnecessary stress that is caused by the tension. They should consider incorporating the available evidence from the research into practice for the better health care facilities (Schneider & Whitehead, 2013).  

Context

For the evidence-based practice to be put into practice, then the context of the practice should be taken into account. For the implementation process of the evidence-based practice to be successful then a very supportive context should be considered (Hall & Roussel, 2016). The important aspects of the context should be drawn from the research findings and be implemented in the current practice to enhance better health care for the clients who are mentally ill.

Bibliography

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Broadbent, M., Mozham, L. J., & Dwyer, T.A. (2014). Implications of the emergency department environment on triage practice for clients with a mental illness in an Australian context.

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Grove, S. K., Burns, N., & Gray, J. (2014). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.

Hamer, S., & Collinson, G. (2014). Achieving Evidence-Based Practice E-Book: A Handbook for Practitioners. Elsevier Health Sciences.

Messac, L., Ciccarone, D., Draine, J., & Bourgois, P. (2013). The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies. Social science & medicine, 99, 176-186.

Montori, V. M., Brito, J. P., & Murad, M. H.. (2013). The optimal practice of evidence-based medicine: incorporating patient preferences in practice guidelines. 310(23), 2503-2504.

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Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K.. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544.

Pich, J. V., Kable, A., & Hazelton, M. . (2017). Antecedents and precipitants of patient-related violence in the emergency department: Results from the Australian VENT Study (Violence in Emergency Nursing and Triage). Australasian emergency nursing journal,

Sandoval, D. (2016). Implementing Change to Decrease the Emergency Department Visits for Pediatric Clients Referred to Mental Health Services.

Sandoval, D.. (2016). Implementing Change to Decrease the Emergency Department Visits for Pediatric Clients Referred to Mental Health Services.

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Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.