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Nurses play a critical role in improving outcomes for trauma patients

Photo: Health Times Magazine
Injury is a pandemic in Australia and with nurses at the forefront of emergency care, they play a critical role in ensuring positive outcomes for patients, says emergency clinical nurse consultant and academic, Professor Kate Curtis.

According to Professor Curtis, emergency department presentations have increased to more than 8 million per year in 2017-18, which is about 22,000 patients per day.

“Despite progress in emergency care, the field lags behind in applying a scientific approach to identifying critical knowledge gaps resulting in considerable variance in care.

“In 2018 the AIHW reported increased in-hospital adverse event rates, particularly for emergency admissions which were more than double that of non-emergency admissions.”

Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients, making the quality of their role critical.
“They are the first clinicians that patients see, so the quality of their initial assessment and treatment is vital.

“This assessment underpins clinical decisions and safe care by detecting and acting upon deterioration.

“The quality of this assessment is also crucial as emergency patients often have extended wait times for medical officer review.”

Across Australia, only 64% of urgent patients were seen within 30 minutes of arrival to the ED in 2017-18, says Professor Curtis - a decline since 2013–14.

“Nation-wide intervention in our EDs is required to improve emergency nursing assessment; reduce unwarranted variation in care; recognise and respond to clinical deterioration; reduce time to treatment and; escalate care to medical officers as needed

An emergency and trauma clinician for 26 years, Professor Curtis identified a need for improvement, and began undertaking research in order to generate evidence to change practice.

As a combined clinician and academic, Professor Curtis is dedicated to making real change, to improve outcomes for patients.

“As an example, when I was developing the Emergency Nursing Masters Curriculum for the University of Sydney, I identified there was no validated framework or ‘best way’ to guide the initial nursing assessment of the patient presenting to emergency.

“This is important because emergency nurses are required to assess and mange a diverse range of patients with different clinical presentations of varying degrees of clinical urgency. 

“Emergency nurses therefore need to make decisions under conditions of uncertainty, while working in an unpredictable environment.

“So, with a team of expert clinicians and educationalists I led the development, validation and implementation of an emergency nursing assessment framework. 

“Along with my colleague Dr Belinda Munroe, we demonstrated that using this new model improves emergency nurse’s self-efficacy, communication and detection of clinical and historical indicators of urgency.”

This model is now being embedded in all NSW emergency departments.

In Australia, injury is the leading cause of death and disability for healthy people aged under 45 years, often leaving them unable to work, in chronic pain, and/or experiencing depression.

“Injury happens in the blink of an eye and is life changing for the patient, their family and their social network

“We need to support our injured patients better. But the best thing we can do is prevent the injury from happening in the first place.”

When it comes to children, injuries are responsible for double the number of hospital admissions than respiratory, cardiovascular disease and cancer combined.

“Injury can change that child’s life for ever, meaning they may not grow up to have the opportunities of others, or be able to work in the profession they wanted to.

“And, up to 50% of parents of severely injured children get PTSD.

“So much injury is preventable, but in our most precious resource, injury rates have not changed in the past 10 years, and deaths have actually increased.”

Professor Curtis says working on the front line in the Emergency Department enables her to identify real world problems that need addressing for patients, staff and the way care is delivered.

While her academic appointment affords me the time to implement change, such as founding the Childhood Injury Prevention Alliance, a team of clinicians, researchers, industry partners and funders.

“CHIPA’s mission is to reduce the incidence and impact of childhood injury across Australia.

“The expertise of CHIPA’s members spans all aspects of the injury journey, from prevention to reintegration.”

Combined with the Paediatric Critical Injury Program, CHIPA’s work and advocacy prompted the federal government to pledge $0.9 million to develop a National Injury Prevention Strategy.

The National Injury Prevention Strategy will provide an evidence based strategic framework for injury prevention and safety to achieve a positive safety culture in Australia and the creation of safe environments.

“It will also include how to implement change, the funding required to do so, and ways to monitor the impact of injury prevention interventions,” says Professor Curtis.

“I am really excited to have been part of the team that demonstrated we need to act urgently to address the pandemic that is injury in Australia.”

Professor Curtis leads the Paediatric Critical Injury Research Program whose research discovered that childhood injury rates have not changed in 10 years, reflective of the fact that Australia has not enacted an injury prevention plan.

“We developed a position statement and recommendations to protect Australian children from injury.

“Our ultimate goal is to reduce the incidence and impact of injury in Australia.”

Professor Curtis says her vision is to use the synergies between her clinical and academic roles to maximise evidence implementation to improve access, equity and quality of emergency care, to result in the best possible patient and health service outcomes.

“I will engage with those at the coal-face to design and conduct clinically-relevant, evidence-informed emergency research and translate it to health practice and consumer-focused care.

“I also aim to also continue to build clinician capacity by nurturing clinicians’ translational research skills through mentorship and research supervision.”

But despite the exponential gains Professor Curtis’ dedication to research has brought to emergency care, she says she’ll continue to be hands on in her clinical role.

“I just love working clinically with patients and other emergency clinicians.

“I love being a nurse.”

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.