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Objective: To test the hypothesis that the incidence of animal bites increases at the time of a full moon. Design: Retrospective observational analysis. Setting: Accident and emergency department at a general hospital in an English city. Subjects: 1621 consecutive patients, irrespective of age and sex. Main outcome measures: Number of patients who attended an accident and emergency department during 1997 to 1999 after being bitten by an animal. The number of bites in each day was compared with the lunar phase in each month. Results: The incidence of animal bites rose significantly at the time of a full moon. With the period of the full moon as the reference period, the incidence rate ratio of the bites for all other periods of the lunar cycle was significantly lower (P <0.001). Conclusions: The full moon is associated with a significant increase in animal bites to humans.

No / Purpose: The College of Radiographers has called for ‘Red Dot’ schemes to evolve and has recommended the development of radiographer commenting. The implementation of a radiographer comment scheme assumes that radiographers previously participating in ‘red dot’ schemes have been accurately recognising radiographic abnormalities and are, therefore, able to comment upon, and describe, such radiographic appearances. Research evidence to support such an assumption is sparse. This study compares the ability of radiographers attending a short course on musculoskeletal trauma to ‘red dot’ and comment on A&E radiographic appearances. Methods: This study adopted a pre-test, post-test approach. One hundred and twenty one radiographers attending a short course on musculoskeletal trauma (Bradford Red Dot Course) were invited to undertake an assessment of their ability to recognise (‘red dot’) and describe (comment upon) radiographic abnormalities at the start and end of the short course. Results: One hundred and fifteen radiographers (n = 115/121; 95.0%) completed both the pre- and post-training assessments. Post-training mean scores per case improved on average by 9.8% [p = 0.012; 95% CI: 2.4, 17.1] for ‘red dots’ and 12.7% [p = 0.007; 95% CI: 3.8, 21.5] for commenting. However, the difference between mean ‘red dot’ and commenting scores remained similar with mean radiographer comment scores being 13.7% less than mean ‘red dot’ scores pre-training and 10.8% less post-training. Conclusions: The results of this study indicate that the accuracy of radiographer comments was significantly reduced when compared to the accuracy of ‘red dots’ for the same radiographic images. The clinical significance of these findings for departments wanting to move from a ‘red dot’ system to a radiographer commenting scheme is that without appropriate training and audit, the quality of service and assistance to the A&E department could be significantly reduced.

Professional practice change and the transfer of research into practice are critical issues for the public health field. The program of research presented here investigated the potential for practice change in dental hygienists’ and Emergency Department nurses’ provision of brief interventions targeting smoking (of tobacco) and alcohol consumption respectively. Smoking and risky alcohol consumption are two high prevalence public health issues that have a substantial impact on the burden of death and illness in Australia. Research on dental hygienists’ and nurses’ uptake of these interventions is limited and has largely focused on descriptions of perceived barriers. Little research has been conducted on the attitudes and motivations of health professionals to engage in these interventions. The present research was designed to address that gap. Specifically, two behaviours by dental hygienists and Emergency Department nurses were investigated: identification of patients at risk and provision of assistance to such patients. The program of research applied the Theory of Planned Behaviour to these behaviours in order to: 1) examine the role of dental hygienists and Emergency Department nurses in the provision of brief interventions for smoking and alcohol consumption respectively, 2) assess the ability of the Theory of Planned Behaviour to understand and predict health professionals’ identifying and assisting behaviour, 3) assess the ability of the theory to account for the influence of organisational factors on workers’ behaviour, and 4) design and evaluate a Theory of Planned Behaviour-based professional practice change intervention. This is the first research to apply the Theory of Planned Behaviour to these behaviours, to examine the potential of the theory to account for the influence of organisational factors on workers’ behaviour, and to trial an intervention targeting behaviour in an organisational setting. The four studies undertaken provided a comprehensive application of the Theory of Planned Behaviour. In the first study, a meta-analysis of published research examined the ability of the Theory of Planned Behaviour to predict behaviours in an organisational setting. This was the first meta-analysis of studies applying the Theory of Planned Behaviour applications to organisational settings. The findings were comparable to results of a meta-analysis of studies applying the theory to social and health behaviours, supporting the application of the theory to the organisational setting, and also highlighted the potential importance of perceived behavioural control for work behaviours. Studies 2 to 4 were designed to follow Ajzen and Fishbein’s (1975) 3-step methodology for applying the theory. In Study 2, the behavioural, normative, and control beliefs held by dental hygienists and Emergency Department nurses, and potentially relevant organisational factors, such as workload and available support, were identified through in-depth qualitative interviews. Study 3 measured the ability of the Theory of Planned Behaviour to predict dental hygienists’ and Emergency Department nurses’ frequency of identifying and assisting. The theory was most successful in predicting dental hygienists’ frequency of assisting patients who smoke. The self-efficacy dimension of perceived behavioural control was the strongest predictor of this behaviour. The findings for Emergency Department nurses indicated that subjective norms were an important predictor of intentions to identify and assist patients. The Theory of Planned Behaviour accounted for the influence of organisational factors on behaviour for both dental hygienists and nurses. Study 4 involved a randomised controlled trial which evaluated a professional intervention targeting dental hygienists’ assistance of patients who smoke. Trends indicated potential benefits of the intervention, but overall no significant changes in dental hygienists’ role adequacy, role legitimacy, and targeted control beliefs emerged. This outcome was attributed to ceiling effects and the influence of a media campaign that coincided with the intervention. The research presented here provides partial support for the application of the Theory of Planned Behaviour to professional practice change efforts. Specifically, the ability of the theory to explain the impact of organisational factors and identify variables most predictive of behaviour may provide valuable insight for prioritising future professional practice change efforts.

The critical illness/injury of a family member warranting an admission to an A&E unit can predispose a family to psychological and physiological needs. The patient-centred-care approach rendered in an A&E unit focuses on the patient as a priority, resulting in the family’s needs being neglected during a crisis situation. Based on the Family Resilience Framework, the aim of this study was to assess the needs of the families of the critically ill/injured patients in an A&E unit. Based on the identified needs, recommendations were made with regard to a family-centred-care approach as a relevant resilience-based strategy suitable to these families. The research adopted a quantitative, non-experimental, exploratory and descriptive design. A purposive convenience sample of 100 participants was recruited over a period of four months. The data were collected by means of a structured interview schedule. The study revealed that the five main domains of family needs identified by the respondents as very important was, in order of priority, the need for communication, support, meaning, comfort and proximity. The findings supported the need to initiate and foster a family-centred-care approach in the A&E unit, which could guide the nurse practitioners in supporting the affected families, which in turn could enable these families to become resilient. Copyright / Dissertation (MCur)--University of Pretoria, 2010. / Nursing Science / unrestricted

This case study of the use of hospital accident and emergency records to safeguard children was triggered by Lord Laming’s inquiry into the care of Victoria Climbié, his follow up report, and government legislation since 1948. Research on the use of documentation for safeguarding children is limited, although serious case reviews consistently indicate, that across agencies, record keeping, and the sharing of pertinent information to identify patterns of maltreatment is poor. The social constructed meaning people place on hospital documentation relating to children’s safety and the perceived intentions of conveying that information within and between social environments are the focus of this research. A hermeneutic framework was used to identify how staff in A&E and other agencies perceive the use of A&E child records (birth -16 years). The investigation was in three stages (a) analysis of a purposive sample of 378 A&E children’s records, (b) a focus group with twelve A&E staff on the case study site and (c) another group with twelve members of the Local Operational Child Protection group. Colaizzi’s approach and the hermeneutic circle were the methods utilised to provide a rich description of the essential structure of the phenomenon. The results reveal that although written records are good tools for communication, records are not sufficiently child focused and risks factors are not always recognised. Consequently, the ability of the professional to provide information to safeguard children is limited. The data also highlights professional communication as the central theme, because this seemed to describe and unify the participants’ practices in a way that made sense. The findings of this study indicate that the behaviour of staff plays a crucial role in recording information. They are influenced by factors that are multi-faceted with the complexities of meanings that include social, economic, emotional, cultural, political and technical elements. A new theoretical framework to understand the complex interaction of professional perspectives within the varied situations that occur in clinical practice is proposed. This is underpinned by a constructivist epistemology. This provides an efficient method for evaluating the overall behaviour of the major components that affect documentation and communication, and highlights the recurring problems that arise from these areas when safeguarding children. Hence, this study provides an original contribution to knowledge concerning information sharing in the field of child protection. As a result of the findings of this study A&E records have been redesigned locally.

Aim and objectives. Although many international sources in literature describe the treatment regimes for the management of adult female rape survivors, very few actually evaluate if the care that is implemented, are beneficial and supportive towards an optimal level of health. The researcher initiated this study to specifically determine what the experiences of adult female rape survivors were with regards to the management they received from health care workers in the emergency care environment. This information that was gathered was then incorporated into the writing of recommendations for health care services towards the improvement of patient-centred care. Method. A qualitative phenomenological methodology guided the research process in which ten semi-structured voluntary interviews was held with adult female rape survivors. This study was conducted in a private hospital in Gauteng, South Africa, which is at the top of the international statistics list for the incidence of rape. Findings. Patient management with regards to accessibility to health care services, the forensic examination and the use of medications proved to be a major concern. Participants in this study emphasized the value and importance of the physical presence of family members or significant others. A positive attitude from these support-givers improved the patient’s psychological state, memory and co-operation. Prolonged waiting times in all areas of management contributed to an increased level of anxiety, where as the prompt and competent interventions by empathetic multi-disciplinary team members had improved patient satisfaction. Various patient responses after the rape incident warranted that minimal, but yet effective and professional health care workers be involved in rape survivor management. Confidentiality and honest, effective communication that is based on patient preference, should guide all interventions. Conclusion. The medical management of adult female rape survivors in this hospital compared favorably to international standards, however, the need to improve the level of specific patient-centred care exists in order to ultimately facilitate a better quality of service provision. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Continuous professional development has become an essential part of contemporary nursing practice. Continuous professional development implies that accident and emergency (A&E) practitioners can never stop learning. A&E practitioners therefore must be prepared to seek new challenges and reflect honestly upon their performance and experiences and adjust their practice in order to obtain and maintain quality service delivery. Network sampling was done and a focus group was used to collect data. This study sought to identify components for a structured reflective tool to enhance continuous professional development of A&E practitioners. Reflection was seen as an important learning strategy and components for a structured reflective tool to enhance continuous professional development of A&E practitioners were identified. In addition essential elements that should be in place prior to the implementation of reflection into clinical practice were identified. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

The A&E unit is a unique environment with unique problems, including those problems pertaining to the documentation of the nursing care provided to the critically ill or injured patient. In such a hectic and turbulent environment where minutes can be the decider between life and death, saving the patient’s life takes priority over record keeping, and crucial information is not recorded. The aim of this study was to develop a nursing record tool to record the management of critically ill or injured patients in an accident and emergency (A&E) unit. The researcher used the collaborative inputs of three different groups of experts in the field of A&E nursing and record keeping to reach this aim. The study was descriptive, explorative and contextual in nature, and a qualitative approach was used. The A&E nurse practitioners views were incorporated into a final nursing record tool that could be used in the A&E unit for critically ill or injured patient for the first six hours of resuscitation. The compiled nursing record tool was comprehensive and included a prehospital management section to ensure the continuity of care in the emergency environment. Although more comprehensive as the current tool, the use of tick-off prompts shortened the time spend to complete this nursing record tool and, in doing so, increased the retaining of crucial information that could enhance the quality and ensure the continuity of care pertaining the critically ill or injured patient in the changing emergency environment. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Yes / Emergency Department demand continues to rise in almost all high-income countries, including those with universal coverage and a strong primary care network. Many of these countries have been experimenting with innovative methods to stem demand for acute care, while at the same time providing much needed services that can prevent Emergency Department attendance and later hospital admissions. A large proportion of patients comprise of those with minor illnesses that could potentially be seen by a health care provider in a primary care setting. The increasing number of visits to Emergency Departments not only causes delay in urgent care provision but also increases the overall cost. In the UK, the National Health Service (NHS) has made a number of efforts to strengthen primary healthcare services to increase accessibility to healthcare as well as address patients’ needs by introducing new urgent care services. In this review, we describe efforts that have been ongoing in the UK and France for over a decade as well as specific programs to target the rising needs of emergency care in both England and France. Like many such programs, there have been successes, failures and unintended consequences. Thus, the urgent care system of other high-income countries can learn from these experiments.