title: Expanding nurse initiated X-rays in emergency care using team-based learning and decision support.
abstract: BACKGROUND
  Triage nurse initiated X-rays (NIXRs) are safe and effective, however, little is known about the ability of other RNs, particularly those without postgraduate qualifications in emergency nursing, to order NIXRs. The aim of this study was to evaluate an innovative NIXR education programme for emergency nurses.
  
  
  METHODS
  The education programme was multi-faceted, delivered using Team-Based Learning (TBL) and augmented by a decision support checklist. Using a prospective exploratory design, 276 NIXR requests from June to December 2011 were audited. Three groups were compared: (i) RNs with and without postgraduate qualifications irrespective of how they were educated in NIXR, (ii) RNs with and without postgraduate qualifications who undertook the NIXR education programme, and (iii) RNs who did and did not undertake the NIXR programme irrespective of postgraduate qualifications.
  
  
  RESULTS
  There were 130 NIXRs by 28 RNs with postgraduate qualifications and 146 NIXRs by 12 RNs without postgraduate qualifications. Analysis of all RNs showed RNs without postgraduate qualifications had higher incidence of appropriate NIXRs (83.6% vs 66.2%, p=0.003) however when controlled for the NIXR education programme, statistical significance was lost (83.6% vs 67.5%, p=0.017). RNs who undertook the NIXR education programme had superior documentation of patient assessment findings and higher incidence of appropriate X-ray requests than RNs who did not undertake the NIXR education programme (80.4% vs 65.2%, p=0.042).
  
  
  CONCLUSIONS
  With appropriate educational preparation, RNs without postgraduate qualifications in emergency nursing can safely engage in NIXR. Structured education using TBL and a decision support checklist produces superior assessment and X-ray requests when compared to ad hoc education and role modelling.
authors.affiliation: Deakin University-Northern Health Clinical Partnership, c/- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia. julie.considine@deakin.edu.au
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.forename: Roslyn
authors.initials: R
authors.lastname: Payne
authors.forename: Stacey
authors.initials: S
authors.lastname: Williamson
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
mesh_terms: D057189:Checklist; D003661:Decision Support Techniques; D004506:Education, Nursing / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000193:education; D004638:Emergency Treatment / Q000451:nursing*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D011871:Radiology / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration*; D014739:Victoria