title: A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness.
  
  
  BACKGROUND
  Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients.
  
  
  METHODS
  A pre-post design was used.
  
  
  METHODS
  The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention.
  
  
  RESULTS
  From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness.
  
  
  CONCLUSIONS
  The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care.
  
  
  CONCLUSIONS
  HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.|Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Munroe
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.|Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia.|Trauma Service, St George Hospital, Sydney, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.|Emergency Department, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Emergency Department, Blacktown Hospital, Blacktown, NSW, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Strachan
authors.affiliation: School of Nursing and Midwifery/Eastern Health, Deakin University, Geelong, Vic., Australia.
authors.forename: Julie
authors.identifier: http://orcid.org/0000-0003-3801-2456
authors.initials: J
authors.lastname: Considine
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hardy
authors.affiliation: Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Ruperto
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Fethney
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buckley
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D016529:Emergency Nursing / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D000066908:Simulation Training; D055815:Young Adult
keywords: clinical skills; communication; emergency nursing; emergency service, hospital; nontechnical skills; nursing assessment; nursing model; patient safety