title: Improving nurse initiated X-ray practice through action research.
abstract: BACKGROUND
  Due to increasing demands on hospital Emergency Departments (EDs), the role of registered nurses, with additional training, has been extended to include requesting X-ray examinations. The aim of this study was to evaluate nurse practice guidelines for requesting X-rays in the ED setting and to utilise inter-professional learning and change management theory to promote practice improvements.
  
  
  METHODS
  Three hundred and one nurse initiated X-ray (NIX) requests were randomly selected between January and March 2012, and reviewed for observance of local department guidelines and quality of clinical history. The results of this preliminary review were used to inform the investigating team in order to improve and support practice. A collaborative educational intervention utilising inter-professional learning and change management theory was implemented with an aim of improving the clinical history provided in NIX requests and development of a new policy to support clinical practice. A second review was repeated from February to April 2014 to evaluate the success of the educational intervention.
  
  
  RESULTS
  Observance of NIX guidelines improved from pre-intervention to post-intervention (48% vs. 90%, P > 0.001). Quality of clinical history also significantly improved in all four essential variable criteria: (1) mechanism of injury; (2) injury location; (3) side of injury; and (4) clinical question.
  
  
  CONCLUSIONS
  This study demonstrates that utilising inter-professional learning and change management theory can contribute to significant improvements in and support clinical practice of NIX in the emergency setting.
authors.affiliation: Radiology Department, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Thompson
authors.affiliation: Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Lecturer Medical Radiation Sciences, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buckley
mesh_terms: D001315:Australia; D004509:Education, Nursing, Continuing; D004636:Emergency Service, Hospital / Q000592:standards; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D009726:Nurses / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D011859:Radiography / Q000451:nursing / Q000592:standards*
keywords: Change management; NIX; X-ray request; clinical history; inter-professional learning; nurse initiated X-rays