ORCID Profile
0009-0002-2480-8488
Current Organisations
University of Newcastle Australia
,
RMIT University
,
University of South Australia
,
University of Technology Sydney
,
St George Hospital
,
University of Sydney
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Publisher: JMIR Publications Inc.
Date: 26-06-2018
DOI: 10.2196/CARDIO.9424
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18251
Abstract: ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.
Publisher: Elsevier BV
Date: 05-2002
DOI: 10.1016/S1036-7314(02)80008-X
Abstract: Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2022
Publisher: Wiley
Date: 05-10-2018
DOI: 10.1111/JOCN.14654
Publisher: AACN Publishing
Date: 2003
Abstract: Nurses lack a comprehensive body of scientific knowledge to guide the palliative care of patients with nonmalignant conditions. Current knowledge and practice reveal that nurses in many instances are not well prepared to deal with death and dying. Focus groups were used in an exploratory study to examine the perceptions of palliative care among cardiorespiratory nurses (n = 35). Content analysis was used to reveal themes in the data. Four major themes were found: (1) searching for structure and meaning in the dying experience of patients with chronic disease, (2) lack of a treatment plan and a lack of planning and negotiation, (3) discomfort in dealing with death and dying, and (4) lack of awareness of palliative care philosophies and resources. The information derived from this s le of cardiorespiratory nurses represents a complex interplay between personal, professional, and organizational perspectives on the role of palliative care in cardiorespiratory disease. The results of the study suggest a need for nurses to be equipped on both an intellectual and a practical level about the concept of palliative care in nonmalignant disease.
Publisher: Informa UK Limited
Date: 10-2004
Abstract: Heart failure is a condition increasing in prevalence and responsible for high health care utilization, morbidity and mortality. Randomised controlled trials of nurse-coordinated interventions have determined self-care and the incorporation of the patient and their family in care planning as critical elements of service delivery. Coping with a chronic illness, such as heart failure, forces the in idual to adjust to changed physical, social and emotional functioning and to modify their lifestyle accordingly. Clinicians increasingly use models of care that focus care delivery on the community setting. In order to develop strategies to assist patients and their families with self-care it is important that clinicians understand the health-care seeking behaviours of all in iduals targeted in the community. Australia is a culturally erse nation, yet evaluations of models of care have been undertaken largely in in iduals from predominately Anglo-Celtic origins. The end result of this approach is failure to understand the full range of erse perspectives that in iduals hold that can have an impact on self-care behaviours. Consideration of cultural ersity should extend beyond language to a broader appreciation of cultural values, health seeking beliefs and engagement of culturally unique communities. The 'Understanding the cultural experiences of in iduals with chronic heart failure (CHF) in South East Health (DISCOVER) Study' seeks to uncover information on the health patterns, information needs and the adjustment process for overseas-born in iduals with heart failure. Such information will assist clinicians to tailor health care service delivery and ensure the delivery of appropriate, quality care. This manuscript provides the background, rationale and methods for this study.
Publisher: AMPCo
Date: 06-2009
DOI: 10.5694/J.1326-5377.2009.TB02636.X
Abstract: Implementing existing knowledge about cardiac rehabilitation (CR) and heart failure management could markedly reduce mortality after acute coronary syndromes and revascularisation therapy. Contemporary CR and secondary prevention programs are cost-effective, safe and beneficial for patients of all ages, leading to improved survival, fewer revascularisation procedures and reduced rehospitalisation. Despite the proven benefits attributed to these secondary prevention interventions, they are not well attended by patients. Modern programs must be flexible, culturally safe, multifaceted and integrated with the patient's primary health care provider to achieve optimal and sustainable benefits for most patients.
Publisher: Elsevier BV
Date: 05-2003
Publisher: Walter de Gruyter GmbH
Date: 06-2019
Abstract: Video has become a useful tool in Initial Teacher Education for self-evaluation and reflection by pre-service teachers (PSTs). The availability of 360degree video cameras and web-based applications, to review and annotate 360degree videos, allows PSTs greater flexibility to view and review their practice from a variety of perspectives. This study explores PSTs’ use of 360degree video for reflection on their teaching practice. 360degree video provides PSTs with the capacity to pan ‘around’ the video, and in doing so has supported PSTs to detach and reflect on their own practice. The findings suggest that the PSTs valued the additional perspectives afforded by the 360degree nature of the video, which had a particular impact on their understanding of their presence, interactions and explanations. Peer video viewing was also found to be a useful tool in supporting PSTs to ‘notice’ additional areas for improvement in their own practice.
Publisher: Elsevier BV
Date: 05-2004
DOI: 10.1016/S1036-7314(04)80005-5
Abstract: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.IJNURSTU.2011.02.021
Abstract: The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians. Qualitative study. Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken. Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine (2) reverence for health professionals and family and (3) juxtaposing traditional beliefs and self-management. Considering the influence of cultural values in developing health care plans and clinical decision making is important.
Publisher: Springer Science and Business Media LLC
Date: 23-01-2022
Publisher: Springer Science and Business Media LLC
Date: 22-06-2022
DOI: 10.1007/S13394-022-00424-Y
Abstract: Learning progressions have become increasingly prevalent in mathematics education as they offer a fine-grain map of possible learning pathways a child may take within a particular domain. However, there is an opportunity to build upon this research in ways that consider learning from multiple perspectives. Many current forms of learning progressions describe learning pathways without explicit consideration of how related skills and contexts directly or indirectly enhance or influence learning. That is, the structured and unstructured learning contexts that can help children develop conceptual understanding in a range of STEM contexts. We consider learning progressions from multiple perspectives, which will be particularly important for supporting learning in early years, play-based contexts. We propose a novel theoretical perspective, termed Bounded Learning Progressions (BLP), which demonstrates the connection and influence ways of reasoning have on the progression of learning in specific domains, bounded by the context in which learning develops. We suggest that this approach provides a broader perspective of children’s learning capabilities and the possible connections between such abilities, acknowledging the critical role context plays in the development of learning.
Publisher: Emerald
Date: 28-10-2013
DOI: 10.1108/JHOM-11-2011-0119
Abstract: – This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance. – A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units. – This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised. – The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect. – While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation. – This paper addresses a significant problem in health service governance, namely the ide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.
Publisher: Research Outreach
Date: 16-02-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2004
DOI: 10.1097/00005082-200401000-00011
Abstract: Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues. To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program. A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002. Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting. In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2023
DOI: 10.1007/S10798-023-09840-Y
Abstract: This study examines the impact of a learning design focussed on providing guided autonomy within a virtual makerspace on the spatial thinking, anxiety and learning creativity of participating students. The learning design deployed within the virtual makerspace was consistent with the learning principles espoused by Self-Determination Theory in that it allowed students to develop autonomy and make many important decisions in their own learning, created erse opportunities for the relatedness through authentic opportunities to work with others, and ensured a sense of competence through the provision of ‘just in time’ training and support. Through a within-subjects pre- ost-test design, the study showed a significant improvement in spatial reasoning across the cohort (n = 340). The most notable gains were for students with low but not very low pre-test scores before the intervention. Improvements in creativity and anxiety were also reported by students following the program. Given the research showing the importance of spatial reasoning to future success in STEM educational and career trajectories, these results suggest that well designed makerspace learning may be particularly useful in addressing an important learning gap for disadvantaged students.
Publisher: Informa UK Limited
Date: 05-2007
DOI: 10.5172/CONU.2007.25.1-2.50
Abstract: Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an in idual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies. The Understanding the cultural experiences of in iduals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and in idual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While in idual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups. Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This s le reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will assist clinicians to tailor health care service delivery for older people with HF, across multiple ethnic backgrounds.
Publisher: BMJ
Date: 25-11-2020
DOI: 10.1136/EMERMED-2019-208568
Abstract: The aim of this study was to compare the incidence of airway haemorrhage between participants who received manual cardiopulmonary resuscitation (CPR) and those who had received mechanical CPR using the LUCAS device. A retrospective cohort study was conducted by means of a medical chart review. All non-traumatic cardiac arrest patients that presented to the ED, from May 2014 to February 2018, were recruited. The groups were stratified according to those who had the majority of CPR performed using the LUCAS and those who had the majority of CPR performed manually. The primary outcome was the proportion of participants with airway haemorrhage, defined as blood observed in the endotracheal tube, pharynx, trachea or mouth, and documented in the doctor or nursing notes. Logistic regression analysis was performed to adjust for confounders. 12 of 54 (22%) participants in the majority LUCAS CPR group had airway haemorrhage, compared with 20 of 215 (9%) participants in the majority manual CPR group, a difference of 13% (95% CI 3% to 26%, p=0.02). The unadjusted odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.8 (95% CI 1.3 to 6.1). After adjusting for confounders, the odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.5 (95% CI 1.1 to 5.7). The LUCAS mechanical CPR device is associated with a higher incidence of airway haemorrhage compared with manual CPR. Limitations in the study design mean this conclusion is not robust.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.HLC.2010.01.009
Abstract: Acute atrial fibrillation (AF) is a commonly encountered problem in emergency departments. In this web-based questionnaire study, 242 emergency physicians and 77 cardiologists in Australasia managed seven hypothetical acute AF scenarios. We found wide variation in practice within and between specialties, and a significant proportion of responses inconsistent with best practice guidelines.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.CLINTHERA.2015.08.021
Abstract: Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect in iduals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to in idual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that in idual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions.
No related grants have been discovered for Glenn Paull.