Biomedical subjects
M Walsh
Publications and source records attributed to M Walsh.
The A&E department and the nurse practitioner.
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Tradimus. Student's Bill of Rights. Clause III: myths and rituals.
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Avoiding another 'decade of disasters'.
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Education: a right or a privilege.
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Patient's choice: GP or A&E department?
In the fourth and final part of his series, Mike Walsh explores the reasons for patients choosing to attend A&E departments rather than their own general practice. Factors influencing this are complex, and include perceived need for specialised treatment, mistrust of the GP or not being included on a GP list at all, but the author warns nurses to guard against viewing 'inappropriate' attenders as malingerers; patient and staff definitions of what constitutes 'appropriate' can be very different. The series closes with the author suggesting that increased responsibilities placed upon GPs by the Government's reforms require health service managers to urgently review why a significant proportion of attenders did not have any kind of GP cover.
After Christmas cometh congress.
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The return of casualties.
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RCN Congress. Coming home to Harrogate.
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Why do people go to the A&E?
Mike Walsh introduces a four-part series on the factors influencing accident and emergency attendance by considering the attendance trends in Bristol Royal Infirmary A&E department in 1988. Important findings include objective evidence of increases in assault injuries associated with excessive alcohol intake at nights and weekends, and a disturbingly high rate of patients who register at A&E but do not wait to be seen by a doctor. The implications of these and other findings will be discussed in future papers in the series.
Geographical factors and A&E attendance.
Mike Walsh demonstrates how the technique of multiple regression analysis can be used to clarify the significance of several variables in determining the geographical factors which affect A&E attendance. The results indicate that travelling distance to A&E, social status of the catchment area and the proportion of the population in the 15-29 age group are significant factors in a complex equation.
Social factors and A&E attendance.
In the third part of his series on trends in A&E attendance, Mike Walsh focuses on the significance of social factors and finds considerable influence being exerted by employment status and gender. Unemployed people comprised a disproportionate number of attenders, while women formed the larger group suffering injuries related to accidents in the home. The author urges nurses to take social factors into consideration when planning care.
Delaying attendance at A&E departments.
In the first article of a new four-part series, Mike Walsh analyses the reasons why patients delay before attending an accident and emergency (A&E) department. Interviews with a sample of 200 A&E patients were conducted to find out why people attend when they do. Factors such as presence of a wound, access to the department and type of condition were found to be significant in their decision. The concepts of utilisation time, illness time and appraisal time are essential in understanding why patients may delay their attendance. Subsequent articles will address questions such as why people attend A&E rather than their GP, pain and anxiety in A&E, and patients' opinions of their experience.
A&E or the GP? How patients decide.
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Pain and anxiety in A&E attenders.
Little research has been carried out into pain and anxiety in the A&E department. In the third article in this series, a study of 200 patients is described which revealed that only a small number of A&E patients reported having no pain or anxiety while substantial numbers were reporting high pain and/or anxiety levels. A statistically significant linkage between high pain and anxiety levels was demonstrated. The author reviews what factors cause anxiety and fear in patients attending A&E and concludes that nurses can alleviate worry and pain by better communication.
Patients' views of their A&E experience.
The concluding article in this series will explore the patients' perspective of their A&E experience through the use of evaluative questionnaires. Developments in quality assurance and the impetus from the Patient's Charter have led to staff being more concerned with patients' evaluation of their experiences, and A&E is no exception. The study revealed that patients are poor predictors of their treatment but the majority are satisfied with their experience. A smaller study of patients who walked out before treatment showed that a third did not seek subsequent help. The author argues that the study supports the need for nurse triage and nurse practitioners.
Practice development units: a study of teamwork.
In this report of a study using the Team Climate Inventory (TCI) tool, the researchers explain how the tool can be used in preparation for creating a practice development unit (PDU). The TCI provides a picture of the level and quality of teamwork in a unit using a series of Likert scales. The ward in this study was found to lack the necessary level of teamwork for successful PDU development and the researchers show how this information shaped trust plans. They recommend that units contemplating PDU accreditation should assess their level of teamwork prior to proceeding with bids.
Evidence-based practice: is patient satisfaction evidence?
Patient satisfaction is a popular way of evaluating nursing practice, but there are doubts about its reliability and validity. This article describes a study which assessed the usefulness of one tool for measuring patient satisfaction--the Newcastle Satisfaction with Nursing Scale.