ORCID Profile
0000-0001-9089-3583
Current Organisations
Alfred Health
,
Deakin University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Clinical Nursing: Secondary (Acute Care) | Nursing | Organisational, Interpersonal and Intercultural Communication | Public Health and Health Services | Health and Community Services | Library and Information Studies | Preventive Medicine | Aged Health Care | Clinical Pharmacy and Pharmacy Practice | Public Health and Health Services not elsewhere classified | Clinical Pharmacology and Therapeutics | Health Informatics | Anaesthesiology |
ANZSRC Socio-Economic Objective (SEO)
Nursing | Social Structure and Health | Health and Support Services not elsewhere classified | Communication Across Languages and Culture | Preventive Medicine | Health Related to Ageing | Nursing | Preventive medicine | Expanding Knowledge in Technology
Related Links
Publications
Doing the Right Thing at the Right Time
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context
Publisher: Wiley
Date: 08-2001
DOI: 10.1046/J.1440-172X.2001.00309.X
Abstract: Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.
A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit*
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
Why we do the things we do: applying clinical decision-making frameworks to triage practice.
Publisher: Elsevier BV
Date: 1999
DOI: 10.1016/S0965-2302(99)80103-9
Abstract: This paper discusses major themes presented in the published literature concerning clinical decision making and links these to the practice of emergency department nurse triage. Themes discussed include: approaches to decision research in nursing and medicine decision autonomy in nursing practice and clinical decision making under conditions of uncertainty. Some assumptions underpinning clinical decision-making frameworks are explored and the use of triage scales, algorithms and intuitive thought processes are discussed in terms of clinical practice. In addition, the strengths and limitations of each approach are outlined. It is argued that naturalistic research methods are necessary in order to describe the often uncertain and frequently chaotic environment in which triage decisions are made. This research must occur in order to evaluate and improve both the triage process and the outcomes of these decisions in practice.
The pre-Medical Emergency Team response: Nurses' decision-making escalating deterioration to treating teams using urgent review criteria
Publisher: Wiley
Date: 04-06-2020
DOI: 10.1111/JAN.14433
Abstract: To describe nurses' decision‐making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. A qualitative design comprising in idual in‐depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. A purposive s le of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi‐structured interviews. An inductive thematic analysis was conducted. Identified themes included: detecting the deterioration countering the problem getting a response and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated in idual workarounds and organizational structures to mitigate patient risk. This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail‐safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration. This is among the first study to investigate barriers influencing decision‐making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
The problem of postoperative pain: Issues for future research
Publisher: Wiley
Date: 09-11-2004
DOI: 10.1111/J.1440-172X.2004.00487.X
Abstract: Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.
An evaluation of interventions to improve outcomes for hospitalized patients in isolation: A systematic review.
Publisher: Elsevier BV
Date: 05-1970
DOI: 10.1016/J.AJIC.2021.09.002
Abstract: Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes. To summarize the effects of interventions to improve safety and outcomes for patients in isolation DESIGN: Systematic review (PROSPERO protocol registration - CRD42020222779). Acute hospital PARTICIPANTS: Intervention studies including patients in preventative or protective isolation in a single room. MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality. We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. S les sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed. There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients.
Correction: Burden of five healthcare associated infections in Australia.
Publisher: Springer Science and Business Media LLC
Date: 11-2022
The role of the medical emergency team in end-of-life care: A multicenter, prospective, observational study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2012
Managing residual gastric volumes: To return or discard?
Publisher: Elsevier BV
Date: 05-2001
Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey.
Publisher: Elsevier BV
Date: 11-2020
Adherence to evidence‐based pressure injury prevention guidelines in routine clinical practice: a longitudinal study
Publisher: Wiley
Date: 25-07-2017
DOI: 10.1111/IWJ.12798
Lateral positioning for critically ill adult patients
Publisher: John Wiley & Sons, Ltd
Date: 16-07-2008
Patient participation in inpatient ward rounds on acute inpatient medical wards: a descriptive study
Publisher: BMJ
Date: 23-02-0007
DOI: 10.1136/BMJQS-2017-007292
Abstract: Meaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs. Describe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services. Naturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience s ling, a stratified s le of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing erse participation preferences: active control where the patient makes decisions shared control where the patient prefers to make decisions jointly with clinicians and passive control where the patient prefers clinicians make decisions. Of the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients’ participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity , that contributed to patient participation or non-participation in ward rounds. Participation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
Reprint of: Patient participation in nursing bedside handover: A systematic mixed-methods review
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.IJNURSTU.2019.05.011
Abstract: Numerous reviews of nursing handover have been undertaken, but none have focused on the patient's role. To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Systematic mixed- methods review. Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Segregated synthesis of research of patients' perceptions revealed two contrasting categories patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource dealing with confidential and sensitive information and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barriers to enacting patient participation in bedside handover and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' discomfort encouraging patient participation and worries for sharing confidential and sensitive information. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and increasing the interpersonal approach during handover. Using research and QI projects allowed erse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses to achieve this and prepare patients to do this. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
Patients’ Perceptions of a Pressure Ulcer Prevention Care Bundle in Hospital: A Qualitative Descriptive Study to Guide Evidence-Based Practice
Publisher: Wiley
Date: 10-04-2017
DOI: 10.1111/WVN.12226
Abstract: Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients' perceptions of the intervention. To identify patients' perceptions and experiences of a PUPCB in hospital. This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery (b) understanding pressure ulcer prevention (PUP) enhances participation and (c) in idual factors impact patients' engagement in PUP. The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients' existing knowledge and beliefs, and perceived advantage of the intervention ability for human interaction and patient-related facilitators and barriers to participating in PUP care. This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients.
Danish Translation and Adaptation of the Context Assessment Index With Implications for Evidence-Based Practice
Publisher: Wiley
Date: 28-01-2019
DOI: 10.1111/WVN.12347
Abstract: Healthcare contexts are rapidly changing, with growing demand for health services to accommodate an aging population and financial pressures. Assessment of context in healthcare settings has been the subject of increasing debate. The Context Assessment Index (CAI) examines three interconnected contextual elements derived from the Promoting Action on Research Implementation in Health Services (PARIHS) framework to provide practitioners with an understanding of the context in which they work. (a) To describe the translation of the CAI into Danish and adapt the instrument for use in Danish hospitals and (b) to evaluate the psychometric properties of the Danish version of the CAI. Translation and adaptation included an expert panel and a translation and back-translation process. The CAI was then sent to 4,416 nurses in the Region Zealand, Denmark. There are two alternative measurement models to explain the factor structure of the CAI, the five-factor model and the three-factor model. To provide the best explanation for the data, both measurement models were examined using confirmatory factor analysis. The CAI was translated and modified based on expert review and usability testing. Completing the CAI were 2,261 nurses. For both models, factor loadings and fit statistics were acceptable, appropriate, and statistically significant, and the measurement models were confirmed (five-factor model: root mean square error of approximation [RMSEA] 0.07, comparative fit index [CFI] = 0.923 three-factor model: RMSEA 0.07, CFI = 0.924). Cronbach's alpha scores showed the models to have broadly acceptable scores (five-factor model 0.64-0.89 three-factor model 0.72-0.89). The three-factor model can advantageously be used when the PARIHS framework is part of the project. In a translation process, differences in cultural specificity, language, and working environment have to be considered. By understanding the context of practice, nurses may enable person-centered care and improve patient outcomes.
Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: A systematic review and metasynthesis of qualitative studies
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1097/AJP.0000000000000324
Abstract: Despite the availability of evidence-based guidelines for the management of low back pain (LBP) that contain consistent messages, large evidence-practice gaps in primary care remain. To perform a systematic review and metasynthesis of qualitative studies that have explored primary care clinicians’ perceptions and beliefs about guidelines for LBP, including perceived enablers and barriers to guideline adherence. Studies investigating perceptions and beliefs about LBP guidelines were included if participants were primary care clinicians and qualitative methods had been used for both data collection and analysis. We searched major databases up to July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis, and synthesized the results in narrative format. Seventeen studies, with a total of 705 participants, were included. We identified 3 key emergent themes and 8 subthemes: (1) guideline implementation and adherence beliefs and perceptions (2) maintaining the patient-clinician relationship with imaging referrals and (3) barriers to guideline implementation. Clinicians believed that guidelines were categorical, prescriptive, and constrained professional practice however, popular clinical practices superseded the guidelines. Imaging referrals were used to manage consultations and to obtain definitive diagnoses. Clinicians’ perceptions reflected a lack of content knowledge and understanding of how guidelines are developed. Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing LBP is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition.
The use of data for process and quality improvement in long term care and home care: A systematic review of the literature
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.JAMDA.2011.01.004
Abstract: Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.
Evidence-based practice in Australia: An unremitting challenge for quality!
Publisher: Wiley
Date: 21-05-2004
Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation
Publisher: Wiley
Date: 08-08-2019
DOI: 10.1111/JOCN.14967
Abstract: To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36 hr of their hospital admission in Australia. Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our s le comprised of 1,047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36 hr of hospitalisation. From our s le, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36 hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36 hr of hospitalisation. Our findings confirm that older adults, those with multiple comorbidities and in iduals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. Many older patients come to hospital with a community-acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.
Collaboration and co-production of knowledge in healthcare: Opportunities and challenges
Publisher: Maad Rayan Publishing Company
Date: 28-01-2016
From abstract to acclaim
Publisher: Elsevier BV
Date: 03-1996
DOI: 10.1016/S1036-7314(96)70350-8
Abstract: Increasing specialisation in the health-care sector requires nurses to be proficient communicators both within their own profession and among other health-care disciplines. Although the work environment provides numerous opportunities for oral communication, traditionally we have been taught written communication. Like scientific writing, an oral presentation demands a sense of planning, audience awareness and attention to detail. Yet, because of the different medium, other important factors must also be considered. While a reader may select passages or reread a report, the audience must listen in a linear way. Your voice and body, aided by visual displays, will have a different effect on the listener than the printed pages have on the reader. Therefore, it is important to concentrate on both the content and the method of presentation if the audience is to be left feeling inspired. This article outlines the planning of a presentation, development of visual aids and delivery of a polished performance.
Patient perceptions of deterioration and patient and family activated escalation systems—A qualitative study
Publisher: Wiley
Date: 02-03-2018
DOI: 10.1111/JOCN.14202
Abstract: To investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system. Delay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients' perspectives into account. Qualitative exploratory descriptive design was used. Purposive s ling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data. All patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system. Patient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns. Clinicians must promote a collaborative relationship and encourage patients to communicate their concerns. Given the perceived barriers to patient and family activated escalation systems use, resources being employed for their implementation could be redistributed to other areas of patient safety.
Comparative accuracy testing of non-contact infrared thermometers and temporal artery thermometers in an adult hospital setting
Publisher: Elsevier BV
Date: 05-2021
Situation awareness in undergraduate nursing students managing simulated patient deterioration
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.NEDT.2013.12.013
Abstract: Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice. To explore nursing students' situation awareness while engaging in simulated patient deterioration scenarios. The educational process of FIRST(2)ACT was the model for the nurse intervention. Situation awareness was measured quantitatively using the Situation Awareness Global Assessment tool. Four domains were measured: physiological perception (patient parameters), global perception (surroundings), comprehension (interpretation of information), and projection (forecasting outcomes). Clinical laboratories at each of three participating universities. Ninety-seven nursing students from three Australian universities. Between March and July 2012, students participated in three video-recorded simulation events, in which a trained actor played patient roles and groups of three students worked as teams. To measure situation awareness, following the simulation each team leader was taken to a separate room and asked to report on a question set regarding the patient's vital signs, bedside setting and medical diagnosis. Overall, situation awareness was low (41%). Of the four domains, physiological perceptions scored the lowest (26%) and projection the highest (59%). Final year nursing students may not have well developed situation awareness skills, especially when dealing with these types of scenarios. Education providers need to consider ways to assist students to fully develop this attribute. Findings suggest that this is an aspect of undergraduate nursing education that requires significant consideration by curriculum developers.
Patient preferences for participation in patient care and safety activities in hospitals
Publisher: Springer Science and Business Media LLC
Date: 21-11-2017
Vital sign abnormalities as predictors of clinical deterioration in subacute care patients: A prospective case-time-control study
Publisher: Elsevier BV
Date: 08-2020
Corrigendum to Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study [Nurse Educ. Today 34(5) (May 2014) 691-696]doi: 10.1016/j.nedt.2013.09.015.
Publisher: Elsevier BV
Date: 03-2016
Nurses' reassessment of postoperative pain after analgesic administration
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
Assessment of patient pain in the postoperative context
Publisher: SAGE Publications
Date: 11-2004
Abstract: Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient’s experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients’ pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses’ prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.
Activities Patients and Nurses Undertake to Promote Patient Participation
Publisher: Wiley
Date: 19-05-2016
DOI: 10.1111/JNU.12219
Abstract: To describe and understand activities patients and nurses undertake to enact patient participation in nursing care. This observational study was conducted on two medical units at a public hospital in Australia. Twenty-eight nurse-patient dyads were observed for at least 4 hr. Data were collected from November 2013 to February 2014. Field notes were collected and were analyzed both inductively and deductively. Nurse-patient interactions promoted patient participation through dialogue and knowledge sharing. Less evident was patient involvement in planning or self-care. Nurses exerted control over patient care, which influenced the extent of patient participation. Patient participation appears to be difficult to enact. Nurses' controlling approach, influenced by organizational issues, was in conflict with a patient-centered approach to care. Nurse-patient communication is one aspect of patient-centered care enacted more frequently. Nurses may benefit from strategies at the in idual and organizational level to enhance their patient-centered practices. Fostering nurses' communication may enhance patient-centered practices in hospitals.
Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: Protocol of a systematic review and meta-synthesis of qualitative studies
Publisher: BMJ
Date: 21-04-2015
Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment
Publisher: Wiley
Date: 02-11-2017
DOI: 10.1111/HEX.12513
Balancing responsibilities, rewards and challenges: A qualitative study illuminating the complexity of being a rapid response team nurse.
Publisher: Wiley
Date: 05-01-2022
DOI: 10.1111/JOCN.16183
Abstract: To explore Rapid Response Team nurses' perceptions of what it means being a Rapid Response Team nurse including their perceptions of the collaborative and organisational aspects of the rapid response team (RRT). For more than 20 years, RRT nurses have been on the frontline of critical situations in acute care hospitals. However, a few studies report nurses' perceptions of their role as RRT nurses, including collaboration with general ward nurses and physicians. This knowledge is important to guide development and adjustment of the RRT to benefit both patients' safety and team members' job satisfaction. Qualitative focus group interviews. A qualitative approach was applied. Throughout 2018 and across three regions and three acute care settings in Denmark, eight focus group interviews were conducted in which 27 RRT nurses participated. Transcribed interviews were analysed using inductive content analysis. Reporting of this study followed the COREQ checklist. One overarching theme 'Balancing responsibilities, rewards, and challenges' was derived, comprising six categories: 'Becoming, developing and fulfilling the RRT nurse role', 'Helping patients as the core function of RRT', 'The RRT-call at its best', 'The obvious and the subtle RRT tasks', 'Carrying the burden of the RRT', and 'Organisational benefits and barriers for an optimal RRT'. Being a RRT nurse is a complex task. Nurses experience professional satisfaction and find it meaningful helping deteriorating patients. The inadequate resources available to train general ward staff how to manage basic clinical tasks are an added stress to nurses. Organisational managers need a better understanding of the necessary staffing requirements to attend patients' needs, train staff and handle the increasing acuity of ward patients. Failure to do so will be detrimental to patient outcomes and compromise RRT nurses' job satisfaction.
Influence of task properties and subjectivity on consistency of triage: A simulation study
Publisher: Wiley
Date: 04-2007
DOI: 10.1111/J.1365-2648.2007.04192.X
Abstract: This paper reports a study to determine nurses' levels of agreement using a standard 5-point triage scale and to explore the influence of task properties and subjectivity on decision-making consistency. Triage scales are used to define time-to-treatment in hospital emergency departments. Studies of the inter-rater reliability of these scales using paper-based simulation methods report varying levels of consistency. Understanding how various components of the decision task and in idual perceptions of the case influence agreement is critical to the development of strategies to improve consistency of triage. Simulations were constructed from naturalistic observation, cue types and frequencies were classified. Data collection was conducted in 2002, and the final response rate was 41 x 3%. Participants were asked to allocate an urgency code for 12 scenarios using the Australasian Triage Scale, and provide estimates of case complexity, levels of certainty and available information. Data were analysed descriptively, agreement between raters was calculated using kappa. The influence of task properties and participants' subjective estimates of case complexity, levels of certainty and available information on agreement were explored using a general linear model. Agreement among raters varied from moderate to poor (kappa=0 x 18-0 x 64). Participants' subjective estimates of levels of available information were found to influence consistency of triage by statistically significant amounts (F 5 x 68 <or=0 x 01). Strategies employed to optimize consistency of triage should focus on improving the quality of the simulations that are used. In particular, attention should be paid to the development of interactive simulations that will accommodate in idual differences in information-seeking behaviour.
Nurses' knowledge and attitudes regarding pain in Saudi Arabia
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.PMN.2014.05.014
Abstract: Unrelieved pain is a worldwide health care problem that can lead to unnecessary complications and increased health care expenditure. The aim of this study was to examine nurses' knowledge and attitudes toward pain in Saudi Arabia. A descriptive design was employed using the Nurses' Knowledge and Attitudes Survey regarding pain. The study took place in a tertiary teaching hospital in Saudi Arabia. All nurses employed in the hospital were eligible to participate. A total of 775 questionnaires were distributed to nurses working in acute care, intensive care, and nursing education and administration settings. In all, 593 respondents completed the questionnaires, representing a response rate of 76.5%. Data were analyzed using descriptive and inferential statistics. Most participants were from overseas (97.5%), speaking 23 different languages 36.5% of nurses held a bachelors of science degree in nursing or the equivalent. The mean score of correctly answered items in was 16.9 (95% confidence interval, 16.6-17.31) out of a total possible score of 40. Nurses demonstrated some misconceived attitudes such as not giving the required dose of morphine to a smiling patient despite the patient being in pain. It is of concern that the findings identified problems of inadequate knowledge and inappropriate attitudes regarding pain assessment and management in Saudi Arabia. Considering these problems, the development of pain programs and policies affecting national and international nurses is highly imperative.
An initial study on the agreement of body temperatures measured by infrared cameras and oral thermometry
Publisher: Springer Science and Business Media LLC
Date: 07-06-2021
DOI: 10.1038/S41598-021-91361-6
Abstract: The COVID-19 pandemic has led to the rapid adoption and rollout of thermal camera-based Infrared Thermography (IRT) systems for fever detection. These systems use facial infrared emissions to detect in iduals exhibiting an elevated core-body temperature, which is present in many symptomatic presentations of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the rollout of these systems, there is little independent research supporting their efficacy. The primary objective of this study was to assess the precision and accuracy of IRT screening solutions in a real-world scenario. The method used was a single-centre, observational study investigating the agreement of three IRT systems compared to digital oral thermometer measurements of body temperature. Over 5 days, 107 measurements were taken from in iduals wearing facial masks. During each entry, two measurements of the subject’s body temperature were made from each system to allow for the evaluation of the measurement precision, followed by an oral thermometer measurement. Each participant also answered a short demographic survey. This study found that the precision of the IRT systems was wider than 0.3 °C claimed accuracy of two of the systems. This study also found that the IRT measurements were only weakly correlated to those of the oral temperature. Additionally, it was found that demographic characteristics (age, gender, and mask-type) impacted the measurement error. This study indicates that using IRT systems in front-line scenarios poses a potential risk, where a lack of measurement accuracy could possibly allow febrile in iduals to pass through undetected. Further research is required into methods which could increase accuracy and improve the techniques viability.
Engaging patients and families in communication across transitions of care: An integrative review
Publisher: Elsevier BV
Date: 06-2020
Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A Review
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.HRTLNG.2009.04.002
Abstract: To examine the evidential basis underpinning the monitoring of skin temperature and core-peripheral temperature gradient as elements of hemodynamic assessment in critically ill and adult cardiac surgical patients. Twenty-six studies examining the efficacy of skin temperature or temperature gradient as markers of hemodynamic status were selected as part of an integrative review. Evidence pertaining to the efficacy of these parameters as markers of cardiac function is equivocal and has not been well appraised in the adult cardiac surgical population. Skin temperature and systemic vascular resistance are also affected by factors other than cardiac output. Skin temperature and core-peripheral temperature gradient should not be considered in isolation from other hemodynamic parameters when assessing cardiac status until they are validated by further large-scale prospective studies.
Evidence Use and Evidence Generation in Practice Development
Publisher: Wiley
Date: 14-02-2009
Initial psychometric testing and validation of the patient participation in pressure injury prevention scale
Publisher: Wiley
Date: 04-04-2017
DOI: 10.1111/JAN.13289
Abstract: The aim of this study was to develop the Patient Participation in Pressure injury Prevention (PPPIP) scale and undertake initial testing of some of its psychometric properties. Clinical practice guidelines recommend patient involvement in pressure injury prevention. There is some evidence that patients are willing to participate in this activity, but there are currently no instruments to measure this participation. This methodological study used data collected as part of a cluster randomized trial to develop and test the PPPIP scale. A s le of 688 of patients with complete PPPIP scale data was used. A stratified random subs le, (Subs le A) was created and the remainder became Subs le B. Item analysis, exploratory factor analysis and Cronbach's alpha reliability were undertaken in Subs le A. Confirmatory factor analysis and Cronbach's alpha reliability were undertaken in Subs le B. Data collection occurred between June 2014 - May 2015. In Subs le A (n = 320), inter-item correlations, item total correlations met the acceptance criteria and an exploratory factor analysis identified a one factor solution. In Subs le B (n = 368), the confirmatory factor analysis supported this one factor. In both subs les, the Cronbach's alpha was 0·86. This study provides preliminary evidence of acceptable reliability and validity of the PPPIP scale in two subs les of hospitalized patients who had limited mobility. It may be used in research and quality improvement activities. As a better conceptual understanding of patient participation emerges, the PPPIP scale may require refinement.
Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives
Publisher: Springer Science and Business Media LLC
Date: 02-05-2023
DOI: 10.1186/S12913-023-09285-Y
Abstract: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient’s readiness for discharge places a heavy reliance on a clinician’s judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians’ perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients’ discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
Patient and nurse preferences for nurse handover-using preferences to inform policy: A discrete choice experiment protocol
Publisher: BMJ
Date: 11-11-2015
It is not that simple nor compelling!: Comment on “translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies – Is there a simple answer to a complex question?”
Publisher: Maad Rayan Publishing Company
Date: 28-07-2015
Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting
Publisher: Wiley
Date: 06-03-2019
DOI: 10.1111/JAN.13963
Abstract: To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings. Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. A descriptive exploratory study design. Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty facilitating, framing and filtering information managing interruptions and knowing and involving patients. Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.
Registered Nurses’ experiences of patient participation in hospital care: supporting and hindering factors patient participation in care
Publisher: Wiley
Date: 04-07-2017
DOI: 10.1111/SCS.12486
Abstract: Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care. The aim of this study was to describe Registered Nurses' experiences with patient participation in nursing care including their barriers and facilitators for participation. The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data. Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme 'partnering with patients' was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients' heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside. It all came down to partnering with the patient and participants described how they made an effort to respect the patients' view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients' taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.
Piloting the feasibility of head-mounted video technology to augment student feedback during simulated clinical decision-making: An observational design pilot study
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.NEDT.2016.01.012
Abstract: Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills. To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations. Pilot study using an observational design. Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived) participant perceptions of feedback methods and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback. Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings. The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve visual-field synchronisation with participants' actual visual field, is recommended to further explore this technology for enhancing student performance.
Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JOCN.16810
Abstract: To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24‐h periods within the same week were audited at three time points: pre‐intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post‐intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi‐square test. A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre‐Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre‐Medical Emergency Team ( n = 2403) or Medical Emergency Team triggers ( n = 273). One or more nursing interventions were documented in 29.5% of audits with pre‐Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under‐recognised element of the organisational response to deteriorating patients. Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. No Patient or Public Contribution.
Use of an audit with feedback implementation strategy to promote medication error reporting by nurses
Publisher: Wiley
Date: 28-08-2020
DOI: 10.1111/JOCN.15447
Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives
Publisher: Wiley
Date: 03-04-2020
DOI: 10.1111/INM.12723
Team Clinical Supervision in Acute Hospital Wards: A Feasibility Study
Publisher: SAGE Publications
Date: 29-04-2013
Abstract: Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- ( n = 36) and postintervention ( n = 27), and focus groups ( n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.
Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: Study rationale and design
Publisher: Springer Science and Business Media LLC
Date: 28-08-2014
A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB™) on student learning
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.NEDT.2015.08.003
Abstract: High-fidelity simulation pedagogy is of increasing importance in health professional education however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 c uses. A population of 489 final-year nursing students in programs of study leading to license to practice. Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7% 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001. The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.
The impact of distance on post-ICU disability
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.AUCC.2021.05.013
Abstract: Nonurban residential living is associated with adverse outcomes for a number of chronic health conditions. However, it is unclear what effect it has amongst survivors of critical illness. The purpose of this study is to determine whether patients living greater than 50 km from the treating intensive care unit (ICU) have disability outcomes at 6 months that differ from people living within 50 km. This was a multicentre, prospective cohort study conducted in five metropolitan ICUs. Participants were adults admitted to the ICU, who received >24 h of mechanical ventilation and survived to hospital discharge. In a secondary analysis of these data, the cohort was dichotomised based on residential distance from the treating ICU: <50 km and ≥50 km. The primary outcome was patient-reported disability using the 12-item World Health Organization's Disability Assessment Schedule (WHODAS 2.0). This was recorded at 6 months after ICU admission by telephone interview. Secondary outcomes included health status as measured by EQ-5D-5L return to work and psychological function as measured by the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association between distance from the ICU and moderate to severe disability, adjusted for potential confounders. Variables included in the multivariable model were deemed to be clinically relevant and had baseline imbalance between groups (p < 0.10). These included marital status and hours of mechanical ventilation. Sensitivity analysis was also conducted using distance in kilometres as a continuous variable. A total of 262 patients were enrolled, and 169 (65%) lived within 50 km of the treating ICU and 93 (35%) lived ≥50 km from the treating ICU (interquartile range [IQR] 10-664 km). There was no difference in patient-reported disability at 6 months between patients living <50 km and those living ≥50 km (WHODAS total disability % [IQR] 10.4 [2.08-25] v 14.6 [2.08-20.8], P = 0.74). There was also no difference between groups for the six major life domains of the WHODAS. There was no difference in rates of anxiety or depression as measured by HADS score (HADS anxiety median [IQR] 4 [1-7] v 3 [1-7], P = 0.60) (HADS depression median [IQR] 3 [1-6] v 3 [1-6], P = 0.62) health status as measured by EQ-5D (mean [SD] 66.7 [20] v 69.8 [22.2], P = 0.24) or health-related unemployment (% (N) 39 [26] v 25 [29.1], P = 0.61). After adjusting for confounders, living ≥50 km from the treating ICU was not associated with increased disability (odds ratio 0.61, 95% confidence interval: 0.33-1.16 P = 0.13) CONCLUSIONS: Survivors of intensive care in Victoria, Australia, who live at least 50 km from the treating ICU did not have greater disability than people living less than 50 km at 6 months after discharge. Living 50 km or more from the treating ICU was not associated with disability, nor was it associated with anxiety or depression, health status, or unemployment due to health.
Consumer knowledge and attitudes toward public reporting of health care–associated infection data
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.AJIC.2018.11.018
Abstract: There is little information regarding consumer knowledge of health care-associated infection (HAI). Furthermore, it is unclear how meaningful publicly reported HAI data is to consumers, how they may use it, and the most appropriate format for data presentation. The purpose of this study was to explore consumer knowledge and attitudes toward HAI and public reporting. A qualitative study design, characterized by a series of semistructured interviews, was undertaken with purposively selected, adult elective surgical inpatients at a large metropolitan acute hospital. Interviews were digitally recorded and transcribed verbatim. Analysis of the data were conducted using thematic analysis. Twenty interviews were conducted. The 5 major themes identified were: (1) awareness through experience, (2) focus on current illness, (3) patient contribution to infection prevention, (4) sources and mode of information, and (5) influence on choice of hospital. We found broad variation in knowledge, sources of information, and preferences for the type and delivery of information. A significant cohort of participants preferred not to be informed, whereas others were neutral or only mildly interested. If public reporting of HAI data is to be aimed at consumers, further engagement with consumers is crucial to ensure the information provided is fit for purpose.
Resident and family engagement in medication management in aged care facilities: a systematic review
Publisher: Informa UK Limited
Date: 14-06-2021
Understanding feedback report uptake: Process evaluation findings from a 13-month feedback intervention in long-term care settings
Publisher: Springer Science and Business Media LLC
Date: 12-02-2015
Getting evidence into practice: A contact sport
Publisher: Wiley
Date: 10-02-2005
Documenting and implementing evidence-based post-operative pain management in older patients with hip fractures
Publisher: Elsevier BV
Date: 05-2008
Carrots, sticks and sermons: Is feedback the answer to changing clinicians' behavior?
Publisher: Wiley
Date: 12-2007
Commentary: Review: Prone positioning improved oxygenation on ventilation more than supine positioning in ARDS
Publisher: BMJ
Date: 07-2008
DOI: 10.1136/EBN.11.3.82
Responding to medical emergencies: System characteristics under examination (RESCUE). A prospective multi-site point prevalence study
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.RESUSCITATION.2012.06.015
Abstract: To determine the point-prevalence of patients fulfilling hospital-specific Medical Emergency Team (MET) criteria and their subsequent outcomes. Inpatients from 10 hospitals with established METs were enrolled for a prospective, point-prevalence study. If MET criteria were present during a set of vital signs, the ward manager was notified. MET activations, unplanned Intensive Care Unit (ICU) admissions, cardiac arrests, Limitations of Medical Treatment (LOMT), hospital discharge and follow-up mortality data were collected. Of 1688 patients recruited, 3.26% (n=55) fulfilled MET criteria in a single set of vital signs. None of the 55 received MET review within 30 min of notification, 2 (3.6%) had MET review within the next 24h, none experienced cardiac arrests or unplanned ICU admissions during the follow-up period, and 13 (23.6%) had a LOMT order prior to fulfilling MET criteria. In-hospital mortality was significantly higher for patients fulfilling MET activation criteria (9.1%) compared to those that did not (2.6% p=0.005, RR=2.95 95% confidence interval (CI) 1.22-7.15), as was mortality at 30 days (RR=2.64 95% CI 1.37-5.11) and 60 days (RR=1.94 95% CI 1.11-3.40). The 30 day mortality in patients without an LOMT order was similar to patients without MET criteria (RR=0.94 95% CI 0.24-3.7). Approximately 1 in 30 hospitalised patients fulfilled MET criteria during data collection. The presence of MET criteria was associated with increased hospital, 30 and 60 day mortality, although much of this increased mortality seemed to be due to issues around end-of-life care. Despite ward manager notification, subsequent MET activation occurred infrequently in these hospitals with established METs. Further research is needed to assess factors that influence staff initiation of a MET call.
Communication related to medication incidents-A concept analysis and literature review.
Publisher: Wiley
Date: 15-11-2022
DOI: 10.1111/SCS.13044
Abstract: (1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts. Concept analysis. Twenty-three articles from seven scientific databases covering the years 2010-2020 and two official documents. Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive-inductively conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting. A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' in idual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept. The 128-item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues. The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.
Nurses' views of patient participation in nursing care
Publisher: Wiley
Date: 28-07-2015
DOI: 10.1111/JAN.12740
Abstract: To explore nurses' views of patient participation in nursing care on medical wards. Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals. Interpretive study. Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis. Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication. Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.
Interprofessional communication supporting clinical handover in emergency departments: An observation study
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.AENJ.2017.05.003
Abstract: Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents (2) Behaviours and interactions (3) Content and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers.
Triage nurses' clinical decision making. An observational study of urgency assessment
Publisher: Wiley
Date: 27-08-2001
Process evaluation of a cluster-randomised trial testing a pressure ulcer prevention care bundle: A mixed-methods study
Publisher: Springer Science and Business Media LLC
Date: 13-02-2017
Patients' perceptions of participation in nursing care on medical wards
Publisher: Wiley
Date: 02-06-2016
DOI: 10.1111/SCS.12237
Abstract: Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors thus, they may play a vital role in combating adverse event rates in hospitals. To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity. This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation s ling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis. Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted. Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.
Exploring patient preferences for involvement in medication management in hospitals
Publisher: Wiley
Date: 21-06-2019
DOI: 10.1111/JAN.14087
Abstract: The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. A qualitative descriptive study. This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen only some were interested in taking more control and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. There was significant ersity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. Little is known about patient preferences for participation in medication administration and hospital discharge planning. In idual patient understanding of and interest in participation in medication administration varies. In accordance with in idual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.
Managing patient deterioration: A protocol for enhancing undergraduate nursing students' competence through web-based simulation and feedback techniques
Publisher: Springer Science and Business Media LLC
Date: 28-09-2012
Women’s decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 17-01-2018
Connections, communication and collaboration in healthcare’s complex adaptive systems: Comment on “using complexity and network concepts to inform healthcare knowledge translation”
Publisher: Maad Rayan Publishing Company
Date: 09-12-2018
Nurses' role in medication safety
Publisher: Hindawi Limited
Date: 10-2010
DOI: 10.1111/J.1365-2834.2010.01164.X
Abstract: To explore the nurse's role in the process of medication management and identify the challenges associated with safe medication management in contemporary clinical practice. Medication errors have been a long-standing factor affecting consumer safety. The nursing profession has been identified as essential to the promotion of patient safety. A review of literature on medication errors and the use of electronic prescribing in medication errors. Medication management requires a multidisciplinary approach and interdisciplinary communication is essential to reduce medication errors. Information technologies can help to reduce some medication errors through eradication of transcription and dosing errors. Nurses must play a major role in the design of computerized medication systems to ensure a smooth transition to such as system. The nurses' roles in medication management cannot be over-emphasized. This is particularly true when designing a computerized medication system. The adoption of safety measures during decision making that parallel those of the aviation industry safety procedures can provide some strategies to prevent medication error. Innovations in information technology offer potential mechanisms to avert adverse events in medication management for nurses.
Bridging the Know-Do Gap in Health Care through Integrated Knowledge Translation
Publisher: Wiley
Date: 11-2012
Patient deterioration education: Evaluation of face-to-face simulation and e-simulation approaches
Publisher: Elsevier BV
Date: 02-2015
Managing complex medication regimens: Perspectives of consumers with osteoarthritis and healthcare professionals
Publisher: SAGE Publications
Date: 05-2007
DOI: 10.1345/APH.1H623
Abstract: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable. To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from erse backgrounds. Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. In idual interviews were undertaken with 3 community medical practitioners. Consumers' management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as needed basis. Healthcare professionals discussed the importance of using nonpharmacologic measures to improve symptoms however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful. Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers' medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that “as needed” directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable s les, should examine trends related to consumers' experiences of symptomatic relief from chronic conditions and their understandings about medications.
Introducing Voluntary Assisted Dying: Staff Perspectives in an Acute Hospital
Publisher: Maad Rayan Publishing Company
Date: 22-11-2020
Abstract: Background: Voluntary assisted dying (VAD) was legalised in Victoria, Australia in June 2019. Physicians can now assist patients to end their lives by providing drugs for self-administration at their voluntary and competent request (or for physician administration in limited circumstances). This study investigates the opinions of clinicians on the implementation of the legislation in one Victorian hospital. Methods: This exploratory survey study was conducted at a 600-bed acute hospital in Melbourne, Australia in Jan 2019. 382 clinicians completed one or more qualitative questions. Participants commented on VAD, potential workplace challenges and staff support required. Free-text responses were analysed using inductive content analysis. Results: Six themes: (1) Polarised views (2) Fear of conflict (3) Emotional burden (4) Vulnerable patients (5) Organisational challenges (6) Decision-making. There were erse views including objections to VAD for religious or ethical reasons, and whole-hearted support based on a compassionate response to suffering and the right of patients to self-determination. Participants feared conflict between colleagues, families and patients, and aggression towards staff. Clinicians called for educational and psychological support. There was concern that vulnerable patients may be coerced to opt for VAD to lessen the burden on families or the health system. Clinicians feared workloads would increase with the introduction of VAD. Patient decision-making capacity in this context must be firmly established before proceeding, and thorough assessments for depression, and optimal symptom management must be implemented before VAD is approved. A dedicated VAD team was suggested to support staff and manage VAD patients. Conclusion: Participants expressed polarised opinions about VAD and showed considerable anxiety about its introduction. Additional education and support are required to ensure that clinicians understand details of the legislation and their professional and personal options. Tolerance and respect for alternative viewpoints must be advocated within the organisation and more broadly.
Lateral positioning for critically ill adult patients
Publisher: Wiley
Date: 12-05-2016
A review of the role of emergency nurses in management of chemotherapy-related complications
Publisher: Wiley
Date: 06-08-2009
DOI: 10.1111/J.1365-2702.2009.02843.X
Abstract: To examine the role of emergency nurses in caring for patients who receive chemotherapy in ambulatory oncology settings. Reasons for emergency department presentations are examined, specific sources of clinical risk for patients receiving chemotherapy who require emergency care are discussed and cost implications of emergency department presentations related to chemotherapy are analysed. Given the increased administration of chemotherapy in ambulatory settings, emergency nurses play an important role in the management of patients undergoing adjuvant chemotherapy. Emergency departments are the major entry point for acute inpatient hospital care of complications arising from chemotherapy. Systematic review. Chemotherapy-related emergency department presentations have considerable clinical and cost implications for patients and the healthcare system. Strategies to improve emergency department management of chemotherapy complications and reduction in preventable emergency department presentations has significant implications for improving cancer patients' quality of life and reducing the cost of cancer care. Nurses are well placed to play a pivotal role in chemotherapy management and lead interventions such as a specialist oncology nursing roles that provide information and support to guide patients through their chemotherapy cycles. These interventions may prevent emergency department presentations for patients receiving chemotherapy in ambulatory settings. Patients receiving chemotherapy require access to specialised care to manage distressing symptoms, as they are at significant clinical risk because of immunosuppression and may not exhibit the usual signs of critical illness. A team approach both within and across nursing specialities may improve care for patients receiving chemotherapy and increase effective use of healthcare resources.
A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.AUCC.2021.05.009
Abstract: Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically. The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU). A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100). In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff. Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children
Publisher: Wiley
Date: 12-11-2018
Tri-focal Model of Care Implementation: Perspectives of Residents and Family
Publisher: Wiley
Date: 15-07-2020
DOI: 10.1111/JNU.12269
International variations in outcomes from sedation protocol research: Where are we at and where do we go from here?
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.ICCN.2010.05.002
Abstract: In this article, sedation protocol research in the intensive care environment is critically examined, focusing upon the differences in outcomes from research conducted on mechanically ventilated patients in various countries. Limitations of the current research are discussed, with suggestions of how sedation protocol research may be conducted in future. Also, the monitoring of important clinical factors is discussed so that clinicians can assess the impact upon patients of changes to sedation management practices within their own ICU.
Providing timely quality care after-hours: Perceptions of a hospital model of care
Publisher: Elsevier BV
Date: 02-2019
Timing of emergency interhospital transfers from subacute to acute care and patient outcomes: A prospective cohort study
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJNURSTU.2018.12.008
Abstract: Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors. To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after subacute care admission. This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study. Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services' acute care hospitals. All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded. Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect. There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on subacute care admission (median 45 vs 66, p < 0.001). Prior to transfer, fewer early transfers had a limitation of medical treatment order in place during their subacute care admission (25.9% vs 48.7%, p < 0.001). The majority of both early and late transfers resulted in acute care hospital readmission (85.1% vs 77.7%, p = 0.204). For patients admitted to acute care, there was no difference in median acute care length of stay (6.5 vs 8 days, p = 0.367). Early transfer patients had fewer in-hospital deaths than late transfer patients (3.8% vs 16.1%, p = 0.004). The high rates of acute care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of care on transfer decisions warrants further investigation.
Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJMEDINF.2019.104036
Abstract: Use of electronic medical records (EMRs) in hospitals affects how in iduals communicate with each other. To examine how EMRs mediate communication between inpatients, their families, and health professionals to support patient and family engagement in care. The following electronic bibliographic databases were searched for relevant studies: Association for Computing Machinery Digital Library, CINAHL, Medline, the Cochrane Central Register of Controlled Trials, PsycInfo, and EMBASE. The search identified 850 papers, and of these, 32 met the inclusion criteria. Interactions with the EMR tended to be unidirectional in nature, where health professionals consulted with patients and families to update patient information. Engagement rarely extended to facilitating patient and family participation beyond consultation. There were few ex les of patient and family partnership and shared leadership, mainly with secure messaging and use of the patient portal. Strategies that worked in facilitating active engagement involved patients and families employing creative means of gathering information and directing this information to health professionals. Use of such strategies were rare and involved the attributes of particular in iduals, rather than considering the inherent culture of clinical settings. Further research is urgently needed to examine possibilities of patient and family involvement in treatment modalities, and partnership and shared governance in using the EMR.
Predictors of return to work in survivors of critical illness
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JCRC.2018.08.005
Abstract: To determine predictors of inability to return to work due to health six-months after intensive care admission and compare functional recovery between patients who had not returned to work and employed patients. Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress. Of 107 patients, 31 (29%) were unable to return to work due to health at six-months after ICU admission. Predictors of inability to return to work included longer hospital stay (odds ratio [OR], 1.05 95% confidence interval [CI], 1.02-1.08 P = .004) lower Glasgow Coma Scale (GCS) at admission (OR, 0.86 CI, 0.75-0.99 P = .03) and admission due to major trauma (OR, 8.83 CI, 2.57-30.38 P < .001). Compared to employed patients, those who had not returned to work reported higher levels of disability and psychological distress, and poorer health-related quality of life. Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.
The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.IJNURSTU.2017.06.014
Abstract: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Eight tertiary hospitals in Australia. Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.
Cultivating Value Co-Creation in Health System Research Comment on Experience of Health Leadership in Partnering with University-Based Researchers in Canada – A Call to Re-imagine Research
Publisher: Maad Rayan Publishing Company
Date: 11-03-2020
Abstract: Partnerships have various purposes and exist in many configurations. Although there has been a refocusing in health system research on forming strategic partnerships between researchers and knowledge users (KUs) to maximise the relevance and uptake of research in practice research knowledge frequently fails to reach KUs nor impact the community served. Whilst there have been many attempts to engage KUs, researchers and decisionmakers often promote a top down approach that has lacked insight into KUs’ specific needs and values. Bowen and colleagues uncovered a plethora of negative experiences from a group of Canadian health leaders involved in researcher partnerships. Their comments reflect their experiences seemingly at an earlier stage of a partnership so we were not surprised by their pessimism. However, our experience reflects an established research-health service partnership network where we collaborate and co-create for mutual benefit and with a shared purpose. The reason for its sustained success over several decades is the focus on co-creation of value between stakeholders. Reimagining must prioritise a paradigm shift towards value co-creation if partnerships are to create opportunities for innovation, productivity and impact.
A critical review of daily sedation interruption in the intensive care unit
Publisher: Wiley
Date: 08-04-2009
DOI: 10.1111/J.1365-2702.2008.02513.X
Abstract: Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions. To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice. Literature review. Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research-based studies, published in the English language between 1995-December 2006 and three conference abstracts were retrieved. Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA. The research indicates that DSI reduces ventilation time, length of stay in ICU, complications of critical illness, incidence of post-traumatic stress disorder and is reportedly used by 15-62% of ICU clinicians in Australia, Europe, USA and Canada. DSI improves patients' physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous s les, single-centre trials and retrospective design, thus limiting their generalisability. DSI may provide clinicians with a simple, cost-effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited and cannot be generalised to heterogeneous ICU populations internationally. More robust research is required to assess the potential impact of DSI on the physical and mental health of ICU survivors.
Implementing guidelines to improve medication safety for hospitalised patients: Experiences from western health, Australia
Publisher: Wiley
Date: 03-2007
Understanding how and why de-implementation works in health and care: Research protocol for a realist synthesis of evidence
Publisher: Springer Science and Business Media LLC
Date: 05-08-2019
Protocol-directed sedation versus non-protocol-directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients
Publisher: Wiley
Date: 06-01-2015
Understanding the workflow of nurses in acute and subacute medical wards: A time and motion study
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/JOCN.16835
Abstract: The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings. Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources. Time and motion cross‐sectional observational study and reported the study according to the STROBE guideline. Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real‐time task‐related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre‐determined tasks were recorded and included direct care, indirect care, documentation, medication‐related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded. Twenty‐one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May–July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication‐related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking. Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication‐related tasks. Local‐level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well‐established and should be an ongoing area of attention including observations and education provided in local settings.
Guest Editorial Special Issue on Sensors for Body Temperature Measurement and Monitoring in a Time of Pandemic
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2022
Nurse manager risk information management for decision-making: A qualitative analysis
Publisher: Elsevier BV
Date: 08-2018
Orgaran (Org 10172) or heparin for preventing venous thrombosis after elective surgery for malignant disease? A double-blind, randomised, multicentre comparison
Publisher: Georg Thieme Verlag KG
Date: 1993
Abstract: This double-blind, randomised, multicentre trial in 513 patients having elective surgery for intra-abdominal or intrathoracic malignancy compared the efficacy and safety of venous thrombosis (VT) prophylaxis using 750 anti-factor Xa units of Orgaran (a mixture of low molecular weight heparinoids) given subcutaneously (sc) twice-daily with that of twice-daily injections of 5,000 units Standard heparin. The main study endpoints were the development of postoperative VT detected by 125I-fibrinogen leg scanning, and the onset of clinically significant venous thromboembolism or bleeding. “Intent to treat” analysis showed a statistically non-significant trend towards less VT during Orgaran prophylaxis (10.4%) than after heparin (14.9%) and there was no difference in bleeding complications between the two study groups. Results remained similar if only patients who completed the intended course of therapy (“compliant patients”) were analysed. Other trials have shown that Orgaran prevents VT after hip surgery and stroke. We now show it is also safe and effective in patients having major surgery for cancer.
The effects of time pressure and experience on nurses' risk assessment decisions: A signal detection analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Nurses' critical event risk assessments: A judgement analysis
Publisher: Wiley
Date: 14-01-2009
DOI: 10.1111/J.1365-2702.2007.02191.X
Abstract: To explore and explain nurses' use of readily available clinical information when deciding whether a patient is at risk of a critical event. Half of inpatients who suffer a cardiac arrest have documented but unacted upon clinical signs of deterioration in the 24 hours prior to the event. Nurses appear to be both misinterpreting and mismanaging the nursing-knowledge 'basics' such as heart rate, respiratory rate and oxygenation. Whilst many medical interventions originate from nurses, up to 26% of nurses' responses to abnormal signs result in delays of between one and three hours. A double system judgement analysis using Brunswik's lens model of cognition was undertaken with 245 Dutch, UK, Canadian and Australian acute care nurses. Nurses were asked to judge the likelihood of a critical event, 'at-risk' status, and whether they would intervene in response to 50 computer-presented clinical scenarios in which data on heart rate, systolic blood pressure, urine output, oxygen saturation, conscious level and oxygenation support were varied. Nurses were also presented with a protocol recommendation and also placed under time pressure for some of the scenarios. The ecological criterion was the predicted level of risk from the Modified Early Warning Score assessments of 232 UK acute care inpatients. Despite receiving identical information, nurses varied considerably in their risk assessments. The differences can be partly explained by variability in weightings given to information. Time and protocol recommendations were given more weighting than clinical information for key dichotomous choices such as classifying a patient as 'at risk' and deciding to intervene. Nurses' weighting of cues did not mirror the same information's contribution to risk in real patients. Nurses synthesized information in non-linear ways that contributed little to decisional accuracy. The low-moderate achievement (R(a)) statistics suggests that nurses' assessments of risk were largely inaccurate these assessments were applied consistently among 'patients' (scenarios). Critical care experience was statistically associated with estimates of risk, but not with the decision to intervene. Nurses overestimated the risk and the need to intervene in simulated paper patients at risk of a critical event. This average response masked considerable variation in risk predictions, the need for action and the weighting afforded to the information they had available to them. Nurses did not make use of the linear reasoning required for accurate risk predictions in this task. They also failed to employ any unique knowledge that could be shown to make them more accurate. The influence of time pressure and protocol recommendations depended on the kind of judgement faced suggesting then that knowing more about the types of decisions nurses face may influence information use. Practice developers and educators need to pay attention to the quality of nurses' clinical experience as well as the quantity when developing judgement expertise in nurses. Intuitive unaided decision making in the assessment of risk may not be as accurate as supported decision making. Practice developers and educators should consider teaching nurses normative rules for revising probabilities (even subjective ones) such as Bayes' rule for diagnostic or assessment judgements and also that linear ways of thinking, in which decision support may help, may be useful for many choices that nurses face. Nursing needs to separate the rhetoric of 'holism' and 'expertise' from the science of predictive validity, accuracy and competence in judgement and decision making.
Knowledge and Power Relations in Older Patients’ Communication About Medications Across Transitions of Care
Publisher: SAGE Publications
Date: 16-10-2021
DOI: 10.1177/10497323211043494
Abstract: Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients’ experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough’s Critical Discourse Analysis and Medication Communication Model. Older patients’ medication knowledge and family members’ advocacy challenged unequal power relations between clinicians and patients and families. Doctors’ use of authoritative discourse impeded older patients’ participation in the medication communication. Older patients perceived that nurses’ involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.
Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
Publisher: BMJ
Date: 21-04-2022
DOI: 10.1136/BMJQS-2021-013785
Abstract: Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses’ CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (−2.18 days, 95% CI (−3.53 to –0.82)). Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. ACTRN12616000544471p
Challenges of pain management for the 21st century
Publisher: Wiley
Date: 02-06-2006
Editorial: Using theory and frameworks to facilitate the implementation of evidence into practice
Publisher: Wiley
Date: 05-2010
Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16265
Abstract: Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to in idual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.
Sedation protocols to reduce duration of mechanical ventilation in the ICU: A Cochrane Systematic Review
Publisher: Wiley
Date: 06-11-2016
DOI: 10.1111/JAN.12843
Abstract: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. Cochrane systematic review of randomized controlled trials. Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.
Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.NEDT.2013.09.015
Abstract: Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills. This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Mixed-method multi-centre study. High fidelity simulated acute clinical environment in three Australian universities. A convenience s le of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.
Association between frailty, delirium, and mortality in older critically ill patients: a binational registry study
Publisher: Springer Science and Business Media LLC
Date: 17-11-2022
DOI: 10.1186/S13613-022-01080-Y
Abstract: Frailty and delirium are prevalent among older adults admitted to the intensive care unit (ICU) and associated with adverse outcomes however, their relationships have not been extensively explored. This study examined the association between frailty and mortality and length of hospital stay (LOS) in ICU patients, and whether the associations are mediated or modified by an episode of delirium. Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 149,320 patients aged 65 years or older admitted to 203 participating ICUs between 1 January 2017 and 31 December 2020 who had data for frailty and delirium were included in the analysis. A total of 41,719 (27.9%) older ICU patients were frail on admission, and 9,179 patients (6.1%) developed delirium during ICU admission. Frail patients had significantly higher odds of in-hospital mortality (OR: 2.15, 95% CI 2.05–2.25), episodes of delirium (OR: 1.86, 95% CI 1.77–1.95), and longer LOS (log-transformed mean difference (MD): 0.24, 95% CI 0.23–0.25). Acute delirium was associated with 32% increased odds of in-hospital mortality (OR: 1.32, 95% CI 1.23–1.43) and longer LOS (MD: 0.54, 95% CI 0.50–0.54). The odds ratios (95% CI) for in-hospital mortality were 1.37 (1.23–1.52), 2.14 (2.04–2.24) and 2.77 (2.51–3.05) for non-frail who developed delirium, frail without delirium, and frail and developed delirium during ICU admission, respectively. There was very small but statistically significant effect of frailty on in-hospital mortality ( b for indirect effect: 0.00037, P 0.001) and LOS ( b for indirect effect: 0.019, P 0.001) mediated through delirium. Both frailty and delirium independently increase the risk of in-hospital mortality and LOS. Acute delirium is more common in frail patients however, it does not mediate or modify a clinically meaningful amount of the association between frailty and in-hospital mortality and LOS.
Perceptions held by healthcare professionals concerning organ donation after circulatory death in an Australian intensive care unit without a local thoracic transplant service: A descriptive exploratory study
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.AUCC.2021.06.013
Abstract: Organ donation rates continue to be low in Australia compared with demand. Donation after circulatory death (DCD) has been an important strategy to increase donation rates, facilitated by advances in cardiopulmonary support in intensive care units (ICUs). However, DCD may harbour greater logistical challenges and unfavourable perceptions amongst some ICU healthcare professionals. The aim of this study was to evaluate and understand DCD perceptions at an Australian tertiary hospital. This descriptive exploratory study was conducted at an Australian tertiary hospital. Participants were recruited voluntarily for interview via email and word-of-mouth through the hospital's ICU network. The study used a mixed-methods approach five close-ended questions were included in the form of Likert scales followed by a semistructured interview with open-ended questions designed to understand participants' perceptions of DCD. Interviews were recorded, transcribed, and thematically analysed. Sixteen participants were interviewed including eight intensive care doctors, four donation specialist nursing coordinators (DSNCs), and four bedside nurses. Likert responses demonstrated clinicians' support for both DCD and donation after brain death (DBD). Thematic analysis of the transcripts yielded three overarching themes including 'Contextual and environmental influences on DCD decision-making', 'Personal difficulties faced by clinicians in DCD decision-making', and 'Family influences on DCD decision-making'. Significant geographical separation between donation and organ retrieval teams, incurring significant resource utilisation, impacted the donation team's decision-making around DCD, as did a perceived disruption of ICU care to facilitate donation especially for cases where successful DCD was identified to be unlikely. Overall, DCD was as acceptable to participants as DBD. However, the geographical separation of this centre meant that logistical barriers potentially impacted the DCD process. Open lines of communication with transplant centres, local resourcing, and a culture of education, experience, and leadership may facilitate the DCD programs where distant retrieval is commonplace.
INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.IJNURSTU.2015.04.018
Abstract: Pressure injuries are a significant clinical and economic issue, affecting both patients and the health care system. Many pressure injuries in hospitals are facility acquired, and are largely preventable. Despite growing evidence and directives for pressure injury prevention, implementation of preventative strategies is suboptimal, and pressure injuries remain a serious problem in hospitals. This study will test the effectiveness and cost-effectiveness of a patient-centred pressure injury prevention care bundle on the development of hospital acquired pressure injury in at-risk patients. This is a multi-site, parallel group cluster randomised trial. The hospital is the unit of randomisation. Adult medical and surgical patients admitted to the study wards of eight hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility), (b) expected to stay in hospital for ≥48h, (c) admitted to hospital in the past 36h and (d) able to provide informed consent will be eligible to participate. Consenting patients will receive either the pressure injury prevention care bundle or standard care. The care bundle contains three main messages: (1) keep moving (2) look after your skin and (3) eat a healthy diet. Nurses will receive education about the intervention. Patients will exit the study upon development of a pressure injury, hospital discharge or 28 days, whichever comes first transfer to another hospital or transfer to critical care and mechanically ventilated. The primary outcome is incidence of hospital acquired pressure injury. Secondary outcomes are pressure injury stage, patient participation in care and health care costs. A health economic sub-study and a process evaluation will be undertaken alongside the trial. Data will be analysed at the cluster (hospital) and patient level. Estimates of hospital acquired pressure injury incidence in each group, group differences and 95% confidence interval and p values will be reported. To our knowledge, this is the first trial of an intervention to incorporate a number of pressure injury prevention strategies into a care bundle focusing on patient participation and nurse-patient partnership. The results of this study will provide important information on the effectiveness and cost-effectiveness of this intervention in preventing pressure injuries in at-risk patients. If the results confirm the utility of the developed care bundle, it could have a significant impact on clinical practice worldwide. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001343796.
A gaze through the lens of decision theory toward knowledge translation science
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Inter-professional clinical handover in postanaesthetic care units: Tools to improve quality and safety
Publisher: Oxford University Press (OUP)
Date: 15-07-2016
Abstract: To examine quality and safety in inter-professional clinical handovers in Post Anaesthetic Care Units (PACUs) and make recommendations for tools to standardize handover processes. Mixed methods combining data from observations and focus groups. Three PACUs, one public tertiary hospital and two private hospitals. Observations were made of 185 patient handovers from anaesthetists to nurses. Eight focus groups were conducted with 62 staff (15 anaesthetists and 47 nurses) across the study sites. Inter-professional clinical handovers in PACU's. Characteristics of the structure and processes that support safe inter-professional PACU handover practice. Characteristics of the process, content, activities and risks during anaesthetist to nurse patient handover into the PACU were integrated into four steps in the PACU handover process summarized by the acronym COLD (Connect, Observe, Listen and Delegate), a verbal communication tool (ISoBAR), a checklist of critical information for safe patient transfer into PACU and a matrix of factors perceived to increase handover risk. The standard structure and checklists for optimal content of patient handovers were derived from existing practices and consensus, hence, expected to provide ecologically valid and practical resources to improve quality and safety during clinical handovers in the PACU.
Patient Participation in Nursing Care on Medical Wards: An Integrative Review
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.IJNURSTU.2015.02.010
Abstract: Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. Integrative review. Three search strategies were employed in August 2013 a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO reference lists were hand-searched and forward citation searching was executed. After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies s ling patients nurses were included in three studies. Data were largely collected using self-reported perceptions two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, s ling issues and low response rates. On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation further nurse participants and observational data is required on medical wards.
The role of collaborative decision‐making in discharge planning: Perspectives from patients, family members and health professionals
Publisher: Wiley
Date: 05-07-2023
DOI: 10.1111/JOCN.16820
Abstract: To explore discharge planning with a range of key stakeholders in subacute care, including consumers. Qualitative descriptive study. Patients ( n = 16), families ( n = 16), clinicians ( n = 17) and managers ( n = 12) participated in semi‐structured interviews or focus groups. Following transcription, data were analysed thematically. The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient‐ and family‐centred decision‐making, early goal setting, strong inter‐ and intra‐disciplinary teamwork, and robust patient/family education. Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. Effective discharge planning processes are underpinned by effective inter‐ and intra‐disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post‐discharge. This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. COREQ guidelines were followed in reporting this study. No patient or public contribution in the design, data analysis or preparation of the manuscript.
Theory and practical guidance for effective de-implementation of practices across health and care services: a realist synthesis
Publisher: National Institute for Health and Care Research
Date: 02-2021
DOI: 10.3310/HSDR09020
Abstract: Health-care systems across the globe are facing increased pressures to balance the efficient use of resources and at the same time provide high-quality care. There is greater requirement for services to be evidence based, but practices that are of limited clinical effectiveness or cost-effectiveness still occur. Our objectives included completing a concept analysis of de-implementation, surfacing decision-making processes associated with de-implementing through stakeholder engagement, and generating an evidence-based realist programme theory of ‘what works’ in de-implementation. A realist synthesis was conducted using an iterative stakeholder-driven four-stage approach. Phase 1 involved scoping the literature and conducting stakeholder interviews to develop the concept analysis and an initial programme theory. In Phase 2, systematic searches of the evidence were conducted to test and develop this theory, expressed in the form of contingent relationships. These are expressed as context–mechanism–outcomes to show how particular contexts or conditions trigger mechanisms to generate outcomes. Phase 3 consisted of validation and refinement of programme theories through stakeholder interviews. The final phase (i.e. Phase 4) formulated actionable recommendations for service leaders. In total, 31 stakeholders (i.e. user atient representatives, clinical managers, commissioners) took part in focus groups and telephone interviews. Using keywords identified during the scoping work and concept analysis, searches of bibliographic databases were conducted in May 2018. The databases searched were the Cochrane Library, C bell Collaboration, MEDLINE (via EBSCO host ), the Cumulative Index to Nursing and Allied Health Literature (via EBSCO host ), the National Institute for Health Research Journals Library and the following databases via the ProQuest platform: Applied Social Sciences Index and Abstracts, Social Services Abstracts, International Bibliography of the Social Sciences, Social Sciences Database and Sociological Abstracts. Alerts were set up for the MEDLINE database from May 2018 to December 2018. Online sources were searched for grey literature and snowballing techniques were used to identify clusters of evidence. The concept analysis showed that de-implementation is associated with five main components in context and over time: (1) what is being de-implemented, (2) the issues driving de-implementation, (3) the action characterising de-implementation, (4) the extent that de-implementation is planned or opportunistic and (5) the consequences of de-implementation. Forty-two papers were synthesised to identify six context–mechanism–outcome configurations, which focused on issues ranging from in idual behaviours to organisational procedures. Current systems can perpetuate habitual decision-making practices that include low-value treatments. Electronic health records can be designed to hide or remove low-value treatments from choice options, foregrounding best evidence. Professionals can be made aware of their decision-making strategies through increasing their attention to low-value practice behaviours. Uncertainty about diagnosis or patients’ expectations for certain treatments provide opportunities for ‘watchful waiting’ as an active strategy to reduce inappropriate investigations and prescribing. The emotional component of clinician–patient relationships can limit opportunities for de-implementation, requiring professional support through multimodal educational interventions. Sufficient alignment between policy, public and professional perspectives is required for de-implementation success. Some specific clinical issues (e.g. de-prescribing) dominate the de-implementation evidence base, which may limit the transferability of the synthesis findings. Any realist inquiry generates findings that are essentially cumulative and should be developed through further investigation that extends the range of sources into, for ex le, clinical research and further empirical studies. This review contributes to our understanding of how de-implementation of low-value procedures and services can be improved within health-care services, through interventions that make professional decision-making more accountable and the prominence of a whole-system approach to de-implementation. Given the whole-system context of de-implementation, a range of different dissemination strategies will be required to engage with different stakeholders, in different ways, to change practice and policy in a timely manner. This study is registered as PROSPERO CRD42017081030. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
More than a fleeting conversation: managing medication communication across transitions of care
Publisher: Wiley
Date: 31-07-2022
DOI: 10.5694/MJA2.51651
Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication
Publisher: Wiley
Date: 27-05-2022
DOI: 10.1111/HEX.13524
Abstract: Communicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients' involvement in formal and informal modes of communication regarding managing medications. The aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication. The study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi‐structured interviews ( n = 50), observations (203 h) and in idual interviews or focus groups ( n = 25). Following thematic analysis, data were analysed using Fairclough's Critical Discourse Analysis. Data analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self‐created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients' medications across transitions of care and encouraged health professionals to seek out older patients' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters. Older patients' self‐created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients' key concerns about their medications, which hindered their active involvement in formal and informal communication. Older adults, family members and health professionals volunteered to be interviewed and observed.
Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.AUCC.2019.06.002
Abstract: When a relative is admitted to the intensive care unit (ICU), stress, anxiety, and failure to cope may place families, and the patient, at risk for adverse psychological outcomes. Family participation in patient care may improve patient and family outcomes. However, to date, little is known about how families perceive and participate in patient care in ICU, and there is limited research to guide clinicians about supporting family participation in this context. To describe family perspectives of participation in patient care in adult ICU. Using a qualitative design, observation and interview data were collected from a convenience s le of 30 family members in the ICU at two metropolitan hospitals in Melbourne, Australia. An independent third party was used to recruit potential participants. Naturalistic observations and semi-structured interviews explored families' actions and perceptions of participation. Data were integrated and subject to thematic analyses. The major theme Families as part of the healthcare team reflected family perspectives of their own significant contribution to supporting their relative's recovery while they were in ICU. Families' perception of their participation in patient care was characterised by three sub-themes: 1) Motivators for family participation 2) Family roles during recovery and 3) Influences on family participation. Families' perceived reassurance and companionship as important contributions to patient care. Families perceived their contribution to the patient's psychosocial and emotional well-being to be one of the most important aspects of participation. Nevertheless, their role in the healthcare team was influenced by several motivational factors. Results of this study can inform further research to test the effectiveness of clinical practice and educational interventions aligned with family preferences to promote participation and enhance patient and family-centered care in ICU.
Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia
Publisher: Elsevier BV
Date: 2022
Preventing ventilator-associated pneumonia (VAP) in critically ill patients
Publisher: Elsevier BV
Date: 11-2003
Trends and risk factors for omission of early thromboprophylaxis in Australian and New Zealand ICUs between 2009 and 2020
Publisher: Springer Science and Business Media LLC
Date: 04-2022
Comparison of medication policies to guide nursing practice across seven Victorian health services
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15202
Abstract: Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to in idual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
Evidence based practices are critical care nurses ready for it?
Publisher: Elsevier BV
Date: 08-2001
DOI: 10.1016/S1036-7314(01)80025-4
Abstract: In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.
Editorial: There is no I in TEAM: Working cooperatively to implement evidence into practice
Publisher: Wiley
Date: 12-2009
Interprofessional and Intraprofessional Communication about Older People’s Medications across Transitions of Care
Publisher: MDPI AG
Date: 08-04-2021
Abstract: Communication breakdowns contribute to medication incidents involving older people across transitions of care. The purpose of this paper is to examine how interprofessional and intraprofessional communication occurs in managing older patients’ medications across transitions of care in acute and geriatric rehabilitation settings. An ethnographic design was used with semi-structured interviews, observations and focus groups undertaken in an acute tertiary referral hospital and a geriatric rehabilitation facility. Communication to manage medications was influenced by the clinical context comprising the transferring setting (preparing for transfer), receiving setting (setting after transfer) and ‘real-time’ (simultaneous communication). Three themes reflected these clinical contexts: dissemination of medication information, safe continuation of medications and barriers to collaborative communication. In transferring settings, nurses and pharmacists anticipated communication breakdowns and initiated additional communication activities to ensure safe information transfer. In receiving settings, all health professionals contributed to facilitating safe continuation of medications. Although health professionals of different disciplines sometimes communicated with each other, communication mostly occurred between health professionals of the same discipline. Lack of communication with pharmacists occurred despite all health professionals acknowledging their important role. Greater levels of proactive preparation by health professionals prior to transfers would reduce opportunities for errors relating to continuation of medications.
Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration
Publisher: Oxford University Press (OUP)
Date: 20-06-2019
Abstract: To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. Prospective case-time-control study. Acute and subacute healthcare facilities from five health services in Victoria, Australia. Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and rapid response team calls during their entire hospital admission. Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.
An analysis of nursing students’ decision-making in teams during simulations of acute patient deterioration
Publisher: Wiley
Date: 05-06-2016
DOI: 10.1111/JAN.13009
Abstract: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. A descriptive exploratory design. Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience s le of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of in idual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Students recalled 11 types of decisions, including: information seeking patient assessment diagnostic intervention/treatment evaluation escalation prediction planning collaboration communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of in idual knowledge, leadership and communication.
Technologies for Fever Screening in the Time of COVID-19: A Review
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2022
Burden of five healthcare associated infections in Australia
Publisher: Cold Spring Harbor Laboratory
Date: 07-10-2021
DOI: 10.1101/2021.10.05.21264587
Abstract: Healthcare associated infections (HAIs) are associated with increased morbidity and mortality, but there are few data that quantify the burden of infection nationally in Australia. We used data from an Australian national point prevalence survey to estimate the burden of HAIs amongst adults in Australian public hospitals. The incidence based appropach, introduced by the ECDC Burden of Comunicable Diseases in Europe was used. We estimate that 170,574 HAIs occur in adults admitted to public hospitals in Australia annually, resulting in 7583 deaths. Hospital acquired pneumonia is the most frequent HAI, followed by surgical site infections, and urinary tract infections. We find that blood stream infections contribute a small percentage of HAIs, but contribute the highest number of deaths (3512), more than twice that of the second largest, while pneumonia has the highert impact on years lived with disability. This study is the first time the national burden of HAIs has been estimated for Australia from point prevalence data. The estimated burden is high, and highlights the need for continued investment in HAI prevention.
A systematic review of older patients’ experiences and perceptions of communication about managing medication across transitions of care
Publisher: Elsevier BV
Date: 02-2021
The clinical landscape of critical care: Nurses' decision-making
Publisher: Wiley
Date: 14-07-2003
DOI: 10.1046/J.1365-2648.2003.02714.X
Abstract: Many studies have tended to explore in idual characteristics that impact on nurses' decision-making, despite significant acknowledgement that context is a major determinant in decision-making. The few studies that have examined environmental influences have tended not to study real decisions in the dynamic and complex clinical environment. To investigate environmental influences on nurses' real decisions in the critical care setting. Naturalistic observations and semi-structured interviews were conducted with 18 critical care nurses in private, public and rural hospitals. Observations and interviews were recorded, transcribed verbatim and coded for themes using content analysis. All clinical decisions were strongly influenced by the context in which the decision was made. Three main environmental influences were identified: the patient situation, resource availability and interpersonal relationships. Time and risk guided all clinical decisions. Nurses established the state of the situation, the time constraints on decisions and the level of risk involved for both patient and nurse. Decision-making is a manifestation of the landscape and although an increased understanding of the landscape is required, more important is the need to measure the impact of contextual variables on nurses' decision-making in order to improve health care outcomes.
Protocol directed sedation versus non-protocol directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2012
Medical error and decision making: Learning from the past and present in intensive care
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.AUCC.2010.06.001
Abstract: Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area thought to be related to the rapidly changing patient status and complex diagnoses and treatments. The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care. Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein. Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events. It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.
A Delphi study to obtain consensus on medical emergency team (MET ) stand‐down decision making
Publisher: Wiley
Date: 22-08-2023
DOI: 10.1111/JOCN.16859
Abstract: A medical emergency team (MET) stand‐down decision is the decision to end a MET response and hand responsibility for the patient back to ward staff for ongoing management. Little research has explored this decision. This study aimed to obtain expert consensus on the essential elements required to make optimal MET call stand‐down decisions and the communication required before MET departure. A Delphi design was utilised. An expert panel of 10 members were recruited based on their expert knowledge and recent clinical MET responder experience in acute hospital settings. Participants were emailed a consent form and an electronic interactive PDF for each survey. Two rounds were conducted with no attrition between rounds. The CREDES guidance on conducting and reporting Delphi studies was used to report this study. Consensus by an expert panel of 10 MET responders generated essential elements of MET stand‐down decisions. Essential elements comprised of two steps: (1) the stand‐down decision that was influenced by both the patient situation and the ward/organisational context and (2) the communication required before actioning stand‐down. Communication after the decision required both verbal discussions and written documentation to hand over patient responsibility. Specific patient information, a management plan and an escalation plan were considered essential. The Delphi surveys reached consensus on the actions and communication required to stand down a MET call. Passing responsibility back to ward staff after a MET call requires both patient and ward safety assessments, and a clearly articulated patient plan for ward staff. Observation of MET call stand‐down decision‐making is required to validate the essential elements. In specifying the essential elements, this study offers clinical and MET staff a process to support the handing over of clinical responsibility from the MET to the ward staff, and clarification of management plans in order to reduce repeat MET calls and improve patient outcomes. Minimal research has been focussed on the decision to hand responsibility back to ward staff so the MET may leave the ward with safety plan in place. This study provided expert consensus to optimise MET stand‐down decision‐making and the ultimate decision to end a MET call. Communication of agreed patient treatment and escalation plans is recommended before leaving the ward. This study can be used as a checklist for MET responder staff making these decisions and ward staff responsible for post‐MET call care. The aim being to reduce the likelihood of potentially preventable repeat deterioration in the MET patient population. The CREDES guidance on conducting and reporting Delphi studies. None.
Exploring staff perspectives on caring for isolated hospitalised patients during the COVID-19 pandemic: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 03-2023
DOI: 10.1186/S12913-022-09000-3
Abstract: Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff. This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent. Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19 2) Impact of isolation on family 3) Challenges to patients’ health and safety 4) Impact on staff 5) Challenging standards of care 6) Contextual influences: policy, decision-makers and the environment. Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.
Sedation, analgesic and neuromuscular blocking agents self-reported practices by Canadian intensivists
Publisher: Elsevier BV
Date: 02-2006
Patients' Decision-Making Strategies for Managing Postoperative Pain
Publisher: Elsevier BV
Date: 06-2006
Nurses’ Perceived Barriers to Bedside Handover and Their Implication for Clinical Practice
Publisher: Wiley
Date: 31-07-2017
DOI: 10.1111/WVN.12241
Abstract: Bedside handover during the change of shift allows nurses to visualize patients and facilitate patient participation, both purported to improve patient safety. But, bedside handover does not always occur and when it does, it may not involve the patient. To explore and understand barriers nurses perceive in undertaking bedside handover. A cross-sectional survey was administered to 200 nurses working on medical wards, recruited from two Australian hospitals, one private and one public. As part of the survey, there was one open-ended question asking about perceived barriers to bedside handover. Content analysis was used to analyze data. Barriers were assessed using a determinant framework. The open-ended question was answered by 176 (88%) participants. Three categories were identified. First, censoring the message showed nurses were concerned about patients and third-parties hearing sensitive information. In the second category, disrupting the communication flow, nurses perceived patients, family members, other nurses and external sources, interrupted the flow of handover and increased its duration. Finally, inhibiting characteristics demonstrated that in idual patient and nurse views or capabilities hindered bedside handover. Barriers to bedside handover were determined to relate to in idual nurse factors, patient factors, social, political and legal factors, and guideline factors. Suggestions for enhancing bedside handover include debunking nurses' misconceptions, reflecting on nurses' viewpoints, using active educational approaches, and promotion of legal requirements to heighten nurses' confidence dealing with sensitive information. Regular patient rounding, and standardized handover may enable patient involvement in handover. Finally, reviewing the local context to ensure organizational processes support bedside handover is recommended.
The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2019
Engaging patients and families in communication across transitions of care: an integrative review protocol
Publisher: Wiley
Date: 18-03-2016
DOI: 10.1111/JAN.12953
Abstract: To describe an integrative review protocol to analyse and synthesize peer-reviewed research evidence in relation to engagement of patients and their families in communication during transitions of care to, in and from acute care settings. Communication at transitions of care in acute care settings can be complex and challenging, with important information about patients not always clearly transferred between responsible healthcare providers. Involving patients and their families in communication during transitions of care may improve the transfer of clinical information and patient outcomes and prevent adverse events during hospitalization and following discharge. Recently, optimizing patient and family participation during care transitions has been acknowledged as central to the implementation of patient-centred care. Integrative review with potential for meta-analysis and application of framework synthesis. The review will evaluate and synthesize qualitative and quantitative research evidence identified through a systematic search. Primary studies will be selected according to inclusion criteria. Data collection, quality appraisal and analysis of the evidence will be conducted by at least two authors. Nine electronic databases (including CINAHL and Medline) will be searched. The search will be restricted to 10 years up to December 2013. Data analysis will include content and thematic analysis. The review will seek to identify all types of patient engagement activities employed during transitions of care communication. The review will identify enablers for and barriers to engagement for patients, families and health professionals. Key strategies and tools for improving patient engagement, clinical communication and promoting patient-centred care will be recommended based on findings.
Families’ control preference for participation in patient care in adult intensive care
Publisher: Elsevier BV
Date: 02-2021
Knowledge transfer and utilization: implications for home healthcare pain management.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
DOI: 10.1111/J.1945-1474.2006.TB00590.X
Abstract: Implementation of research evidence into clinical practice is a complex and dynamic process that has become the subject of investigation in the field of "translation science" or "knowledge utilization." Research shows how in iduals, units, and organizations all influence the rate and extent of adoption of research evidence. Environmental factors also play an important role in this process. This article summarizes key lessons from translation science and examines the implications for the organization and delivery of home healthcare. The implementation of pain management guidelines is used as an ex le.
Does participating in a clinical trial affect subsequent nursing management? Post-trial care for participants recruited to the INTACT pressure ulcer prevention trial: A follow-up study
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.IJNURSTU.2017.02.022
Abstract: Participation in a clinical trial is believed to benefit patients but little is known about the post-trial effects on routine hospital-based care. To describe (1) hospital-based, pressure ulcer care-processes after patients were discharged from a pressure ulcer prevention, cluster randomised controlled trial and (2) to investigate if the trial intervention had any impact on subsequent hospital-based care. We conducted a retrospective analysis of 133 trial participants who developed a pressure ulcer during the clinical trial. We compared outcomes and care processes between participants who received the pressure ulcer prevention intervention and those in the usual care, control group. We also compared care processes according to the pressure ulcer stage. A repositioning schedule was reported for 19 (14.3%) patients 33 (24.8%) had a dressing applied to the pressure ulcer 17 (12.8) patients were assessed by a wound care team and 20 (15.0%) were seen by an occupational therapist. Patients in the trial's intervention group were more likely to have the presence of a pressure ulcer documented in their chart (odds ratio (OR) 8.18, 95% confidence intervals (CI) 3.64-18.36) to be referred to an occupational therapist OR 0.92 (95% CI 0.07 0.54) to receive a pressure relieving device OR 0.31 (95% CI 0.14 0.69) or a pressure relieving mattress OR 0.44 (95% CI 0.20 0.96). Participants with Stage 2 or unstageable ulcers were more likely than others to have dressings applied to their wounds (p=<0.001) and to be referred to an occupational therapist for protective devices (p=0.022). Participants in the intervention group of a clinical trial were more likely to receive additional post trial care and improved documentation compared with those in the control group but documentation of pressure ulcer status and care is poor.
Hospital staff well‐being during the first wave of COVID‐19: Staff perspectives
Publisher: Wiley
Date: 23-10-2020
DOI: 10.1111/INM.12804
The perspective of allied health staff on the role of nurses in subacute care
Publisher: Wiley
Date: 23-07-2018
DOI: 10.1111/JOCN.14553
Abstract: To explore allied health staff perceptions on the role of nurses in subacute care wards. A consequence of earlier discharge from acute hospitals is higher acuity of patients in subacute care. The impact on nurses' roles and required skill mix remains unknown. In the same way, nurses' integration into the rehabilitation team is ambiguous. Descriptive qualitative inquiry. Semistructured interviews conducted with 14 allied health staff from one subacute care facility in Melbourne, Australia. Interviews were audio-recorded and transcribed verbatim. Analysis using the framework approach. Three main themes were evident: (a) the changing context of care: patient acuity, rapid patient discharge and out-dated buildings influenced care (b) generalist as opposed to specialist rehabilitation nurses: a ide between traditional nursing roles of clinical and personal care and a specialist rehabilitation role and (c) interdisciplinary relations and communication demonstrated lack of respect for nurses and integrating holistic care into everyday routines. Allied health staff had limited understanding of nurses' role in subacute care, and expectations varied. Power relationships appeared to h er teamwork. Failure to include nurses in team discussions and decision-making could hinder patient outcomes. Progressing patients to levels of independence involves both integrating rehabilitation into activities of daily living with nurses and therapy-based sessions. Promotion of the incorporation of nursing input into patient rehabilitation is needed with both nurses and allied health staff. Lack of understanding of the nurses' role contributes to lack of respect for the nursing contribution to rehabilitation. Nurses have a key role in rehabilitation sometimes impeded by poor teamwork with allied health staff. Processes in subacute care wards need examination to facilitate more effective team practices inclusive of nurses. Progressing patients' independence in rehabilitation units involves activities of daily living with nurses as much as therapy-based sessions.
Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: A multi‐site prospective cohort study
Publisher: Wiley
Date: 04-02-2020
DOI: 10.1111/JOCN.15125
Abstract: To examine the relationship between resuscitation status and (i) patient characteristics (ii) transfer characteristics and (iii) patient outcomes following an emergency inter-hospital transfer from a subacute to an acute care hospital. Patients who experience emergency inter-hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in-hospital mortality (15%). This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Data were extracted by medical record audit. Three resuscitation categories (full resuscitation limitation of medical treatment (LOMT) orders or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Resuscitation status was 63.5% full resuscitation 23.1% LOMT order and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute care and more likely to return to subacute care. Two-thirds of patients in subacute care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.
Exploring staff perceptions of organ donation after circulatory death
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.AUCC.2019.05.001
Abstract: Solid organ donation remains low in Australia however, donation after circulatory death (DCD) bolsters rates and is associated with good short- and long-term clinical outcomes among recipients, especially in lung and kidney recipients. However, its reintroduction is met with resistance within hospitals. The aim of the present study was to develop a greater understanding of DCD perceptions among staff involved. This descriptive exploratory study incorporated open-ended and scaled questions with intensive care staff at a public tertiary teaching hospital in Australia. Interviews were digitally recorded and transcribed verbatim before thematic analysis. Quantitative responses were assessed using a 10-point Likert scale. Twelve participants were interviewed. Responses to the Likert scale questions were averaged. Donation after brain death was unanimously accepted (average = 10.0), whereas DCD acceptance was lower but remained supported (average = 8.8). Interview responses generated five themes, each containing subthemes. Respondents had concerns with DCD where perceptions existed that DCD would increase family distress, from either timeframes not being met or logistical delays. A second major source of concern stemmed from personal conflict relating to their role. There was difficulty transitioning from primarily sustaining life or facilitating palliation alone to advocating for DCD, especially where there was perceived potential for deviations from standard palliation in analgesia, sedation, and investigations. Overall, concerns were overcome by reliance on a supportive work environment, rationalisation of concerns over time, and reliance on protocols. Supportive leadership within the hospital's intensive care unit meant DCD occurred with minimal institutional resistance. However, some in idual concerns surrounding DCD were identified. These may be present and lified in other centres. More study is required in centres where institutional resistance to DCD is identified so that DCD may be further promoted to expand the donor pool.
Staff perceptions on the use of a sedation protocol in the intensive care setting
Publisher: Elsevier BV
Date: 11-2004
DOI: 10.1016/S1036-7314(04)80020-1
Abstract: Sedation protocols are increasingly being investigated as a method of achieving improved patient outcomes whilst guiding the decision making of both nursing and medical practitioners. However, only a limited number of studies have investigated the perceptions of staff towards a sedation protocol during its implementation. This study was designed to survey the perceptions of staff regarding the implementation of a sedation protocol in an Australian intensive care unit (ICU). Questionnaires were distributed to all multidisciplinary team members who had used the sedation protocol. The response rate was 50% (n=70). The questionnaire combined the use of visual analogue scales plus a comments section to obtain qualitative data. The results revealed that staff perceived sedation management to be enhanced with the use of a protocol and therefore should be incorporated into routine clinical practice. Staff perceived that providing clear guidelines that facilitated decision making and assisted beginner practitioners enhanced sedation management. In addition, there was a perceived improvement in the patient outcomes, including a decrease in the frequency of over-sedation resulting in a reduced ICU stay. Positive perceptions may assist in the introduction of other interventional protocols. Other protocols may target areas where variability in clinical decision making exists, despite research evidence that supports specific therapeutic interventions. Further studies addressing protocol implementation for clinical interventions are warranted in other ICU settings.
Observation of pain assessment and management - The complexities of clinical practice
Publisher: Wiley
Date: 11-2002
DOI: 10.1046/J.1365-2702.2002.00691.X
Abstract: Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions. This observational study sought to investigate nurse-patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings. Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions. Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients. These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.
The impact of disability in survivors of critical illness (vol 43, pg 992, 2017)
Publisher: Springer Science and Business Media LLC
Date: 15-09-2017
DOI: 10.1007/S00134-017-4937-3
Abstract: In the Results section, under the subheading "Return to work or usual activities", the second sentence should read.
Critical care nurse satisfaction with levels of involvement in clinical decisions
Publisher: Wiley
Date: 03-1996
DOI: 10.1111/J.1365-2648.1996.TB00021.X
Abstract: This research reports the results of a survey of 230 Australian critical care nurses. The respondents were asked to rate how frequently they were involved in 10 common critical care decisions and their levels of satisfaction with their involvement for each decision task. It was found that level of task satisfaction was positively correlated with level of task involvement, thus supporting the hypothesis that nurse task decision autonomy is associated with nurse task satisfaction. The paper argues for the importance of differentiation between task satisfaction and work satisfaction in research of these issues.
Commentary: Review: A single dose of oral naproxen or naproxen sodium reduced acute postoperative pain in adults
Publisher: BMJ
Date: 04-2005
DOI: 10.1136/EBN.8.2.53
The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.IJNURSTU.2016.09.015
Abstract: Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. Pragmatic cluster randomised trial. Eight tertiary referral hospitals with >200 beds each in three Australian states. 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old at risk of pressure ulcer because of limited mobility expected to stay in hospital ≥48h and able to read English. Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients' participation in pressure ulcer prevention care: keep moving look after your skin and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and in idual participant level, was measured by daily skin inspection. Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure ulcers developed (pressure ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33 p=0.198). No adverse events or harms were reported. Although the pressure ulcer prevention care bundle was associated with a large reduction in the hazard of ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure ulcer prevention care bundle was effective but the s le size too small to detect this.
Skin temperature as a noninvasive marker of haemodynamic and perfusion status in adult cardiac surgical patients: An observational study
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.ICCN.2008.05.003
Abstract: Foot temperature has long been advocated as a reliable noninvasive measure of cardiac output despite equivocal evidence. The aim of this pilot study was to investigate the relationship between noninvasively measured skin temperature and the more invasive core-peripheral temperature gradients (CPTGs), against cardiac output, systemic vascular resistance, serum lactate, and base deficit. The study was of a prospective, observational and correlational design. Seventy-six measurements were recorded on 10 adults postcardiac surgery. Haemodynamic assessments were made via bolus thermodilution. Skin temperature was measured objectively via adhesive probes, and subjectively using a three-point scale. The study was conducted within a tertiary level intensive care unit. Cardiac output was a significant predictor for objectively measured skin temperature and CPTG (p=.001 and p=.004, respectively). Subjective assessment of skin temperature was significantly related to cardiac output, systemic vascular resistance, and serum lactate (p<.001, respectively). These results support the utilisation of skin temperature as a noninvasive marker of cardiac output and perfusion. The use of CPTG was shown to be unnecessary, given the parallels in results with the less invasive skin temperature parameters. A larger study is however required to validate these findings.
The authors reply:
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Family involvement in managing medications of older patients across transitions of care: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 29-03-2019
Patient participation in nursing bedside handover: A systematic mixed-methods review
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.IJNURSTU.2017.10.014
Abstract: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role. To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Systematic mixed- methods review. Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Segregated synthesis of research of patients' perceptions revealed two contrasting categories patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource dealing with confidential and sensitive information and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Using research and QI projects allowed erse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
Enteral nutrition feeding practices by intensive care nurses: A retrospective evaluation
Publisher: Wiley
Date: 19-02-2022
DOI: 10.1111/NICC.12609
Abstract: Enteral nutrition (EN) is an integral component of standard management of critically ill patients in intensive care. However, achieving adequate nutrition in this environment continues to present many challenges. A descriptive exploratory design using a retrospective review of medical records. The aims of this study were to describe nursing practice associated with EN feeding and identify barriers to optimal nutritional delivery in the intensive care unit (ICU). Patients admitted to a major Australian metropolitan health service ICU during a 6‐month period, and who received EN for at least 72 hours, were eligible for inclusion. Documented text from patient medical records was analysed using content analysis. Numerical data were analysed using SPSS software (version 25.0). Descriptive and inferential statistics were calculated. A total of 150 patients were included in the study. The mean time from admission to EN commencement was 12.6 hours, with 59.3% commenced within 12 hours of admission. Only 9.3% of patients commenced EN at the target rate. Of the 150 patients, 24 (16%) received 80% of nutrition targets within 72 hours of admission. Patients who had EN commenced within 12 hours of admission and at the target rate were significantly more likely to achieve nutritional requirements ( P = .01). Patients who received an initial dietitian review within 24 hours of admission were more likely to achieve nutrition requirements ( P = .01). Commencing EN on time and meeting target volumes remains challenging in the ICU patient. Airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation provide barriers to optimal nutrition delivery to critically ill patients. Tackling these barriers may require interdisciplinary interventions. Providing adequate nutrition to critically ill patients is challenging. This study provides evidence that day's one and two are problematic to EN delivery particularly concerning airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation. Highlighting the need for further research into these aspects of nutrition management.
Nurses' perceptions of a pressure ulcer prevention care bundle: A qualitative descriptive study
Publisher: Springer Science and Business Media LLC
Date: 21-11-2016
Sedation management in Australian and New Zealand intensive care units: Doctors' and nurses' practices and opinions
Publisher: AACN Publishing
Date: 05-2010
DOI: 10.4037/AJCC2009541
Abstract: Objective To explore the use of sedatives and analgesics, tools for scoring level of sedation, sedation and pain protocols, and daily interruptions in sedation in Australian and New Zealand intensive care units and to examine doctors’ and nurses’ opinions about the sedation management of critically ill patients. Methods A cross-sectional Internet-based survey design was used. In total, 2146 members of professional critical care organizations in Australia and New Zealand were e-mailed the survey during a 4-month period in 2006 through 2007. Results Of 348 members (16% response rate) who accessed the survey, 246 (71%) completed all sections. Morphine, fentanyl, midazolam, and propofol were the most commonly used medicines. Newer medicines, such as dexmedetomidine and remifentanil, and inhalant medications, such as nitrous oxide and isoflurane, were rarely used by most respondents. Respondents used protocols to manage sedatives (54%) and analgesics (51%), and sedation assessment tools were regularly used by 72%. A total of 62% reported daily interruption of sedation 23% used daily interruption for more than 75% of patients. A disparity was evident between respondents’ opinions on how deeply patients were usually sedated in practice and how deeply patients should ideally be sedated. Conclusions Newer medications are used much less than are traditional sedatives and analgesics. Sedation protocols are increasingly used in Australasia, despite equivocal evidence supporting their use. Similarly, daily interruption of sedation is common in management of patients receiving mechanical ventilation. Research is needed to explore contextual and personal factors that may affect sedation management.
Commentary: Review: Several interventions prevent ventilator associated pneumonia in critically ill patients
Publisher: BMJ
Date: 10-2003
DOI: 10.1136/EBN.6.4.112
Critical care nurses' decision-making activities in the natural clinical setting
Publisher: Wiley
Date: 2000
Assessing the reliability of the Sedation-Agitation Scale between nurses and doctors in a New Zealand ICU
Publisher: Elsevier BV
Date: 11-2008
Six-year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single-site observational study of pain management
Publisher: Wiley
Date: 24-09-2021
DOI: 10.1002/EJP.1652
Profiling Nurse Practitioner practice patterns at a major urban acute health service
Publisher: Elsevier BV
Date: 06-2018
Nurses' reflections on problems associated with decision-making in critical care settings
Publisher: Wiley
Date: 02-1997
DOI: 10.1046/J.1365-2648.1997.1997025229.X
Abstract: The present study investigated nurses' perceptions of the problems associated with their decision-making in critical care settings. This paper reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis "due to knowledge base', "lack of time to make decisions', "lack of time to implement decisions', and "personal values conflicts with other staff'. Nearly one-third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses disharmony with medical staff concerning decision autonomy issues, especially with junior doctors time constraints on nursing care: the demands of new intensive care technology upon the nurses' knowledge bases and the need for in-service education to address this problem. The paper concludes with arguments for the use of in-depth interviews to further study these issues.
The study protocol of: ‘Initiating end of life care in stroke: clinical decision-making around prognosis’
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Organ donation within the intensive care unit: A retrospective audit
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.AUCC.2018.12.006
Abstract: Despite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation. The aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU). A retrospective audit examined electronic records of 280 potential organ donors aged 18-80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis. Of the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%) however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%). This study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.
What would Florence think of midwives and nurses in 2020?
Publisher: Elsevier BV
Date: 09-2020
Consumer Engagement in Perioperative Clinical Trials
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-09-2022
DOI: 10.1213/ANE.0000000000006209
Abstract: Consumer engagement (patient and public involvement) in perioperative medicine research is in its infancy. The patient experience and family/carer perspectives can provide an extra layer of insight to give more understanding as to what, why, and how we do research. Patients who have undergone surgery have a unique understanding of the issues, concerns, wants, and needs that they learned as a patient—they, therefore, can be considered as a professional given their experience(s)—thus warranting recognition as a partner in research. Knowledge of the consumer engagement literature and availability of resources should support anesthesia researchers aiming to include these perspectives in their research. This includes several existing engagement frameworks and assessment tools. We provide a framework for consumer engagement for adoption into anesthesia and other perioperative research. By incorporating the patient or caregiver into the design, funding application(s), data collection, and interpretation of the findings can be beneficial to all. This includes promoting knowledge and access to clinical trials, the wording of participant consent and information forms, methods of data collection, selection of important outcomes, and dissemination of results.
Pain assessment in critical care: What have we learnt from research
Publisher: Elsevier BV
Date: 06-2003
DOI: 10.1016/S0964-3397(03)00027-2
Abstract: Despite an ongoing acknowledgement in the literature that pain is a significant problem within the critical care environment, this issue has not been adequately addressed by critical care nurses. This paper examines strategies for changing pain management practices in critical care, including reviewing documentation practices, the utilisation of guidelines and algorithms to augment clinical decision making, and increasing educational opportunities available to critical care nurses. It is recommended that pain assessment be given a higher priority within the clinical context, particularly as inadequate pain assessment and management has been linked to increased morbidity and mortality within critical care. Importantly, critical care nurses need to not only be aware of research-based pain management practices, but also lead the way in implementation and continuous evaluation as a measure of decreasing patient pain in the future.
Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic
Publisher: Elsevier BV
Date: 05-2022
Periarticular analgesia for postoperative pain following total hip replacement
Publisher: Wiley
Date: 14-11-2014
Periarticular analgesia for postoperative pain following total knee replacement
Publisher: Wiley
Date: 11-11-2014
Piloting a Nurse-Led Critical Care Outreach Service to Pre-Empt Medical Emergency Team Calls and Facilitate Staff Learning
Publisher: MDPI AG
Date: 27-02-2023
Abstract: A nurse-led critical care outreach service (NLCCOS) can support staff education and decision making in the wards, managing at-risk patients with ward nurses to avoid further deterioration. We aimed to investigate the characteristics of patients identified as at-risk, the types of treatments they required to prevent deterioration, the education initiated by the NLCCOS, and the perceived experiences of ward nurses. This prospective observational pilot study using mixed methods took place in one medical and one surgical ward at a university hospital in Denmark. Participants were patients nominated as at-risk by head nurses in each ward, the ward nurses, and nurses from the NLCCOS. In total, 100 patients were reviewed, 51 medical and 49 surgical patients, over a six-month period. Most patients (70%) visited by the NLCCOS had a compromised respiratory status, and ward nurses received teaching and advice regarding interventions. Sixty-one surveys were collected from ward nurses on their learning experience. Over 90% (n = 55) of nurses believed they had learned from, and were more confident with, managing patients following the experience. The main educational areas were respiratory therapy, invasive procedures, medications, and benefits of mobilization. Further research needs to measure the impact of the intervention on patient outcomes and MET call frequency over time in larger s les.
Patient engagement in clinical communication: an exploratory study
Publisher: Wiley
Date: 13-01-2016
DOI: 10.1111/SCS.12279
Abstract: Existing practice strategies for actively involving patients in care during hospitalisation are poorly understood. The aim of this study was to explore how healthcare professionals engaged patients in communication associated with care transitions. An instrumental, collective case study approach was used to generate empirical data about patient transitions in care. A purposive s le of key stakeholders representing (i) patients and their families (ii) hospital discharge planning team members and (iii) healthcare professionals was recruited in five Australian health services. In idual and group semi-structured interviews were conducted to elicit detailed explanations of patient engagement in transition planning. Interviews lasted between 30 and 60 minutes and were digitally recorded and transcribed verbatim. Data collection and analysis were conducted simultaneously and continued until saturation was achieved. Thematic analysis was undertaken. Five themes emerged as follows: (i) organisational commitment to patient engagement (ii) the influence of hierarchical culture and professional norms on patient engagement (iii) condoning in idual healthcare professionals' orientations and actions (iv) understanding and negotiating patient preferences and (v) enacting information sharing and communication strategies. Most themes illustrated how patient engagement was enabled however, barriers also existed. Our findings show that strong organisational and professional commitment to patient-centred care throughout the organisation was a consistent feature of health services that actively engaged patients in clinical communication. Understanding patients' needs and preferences and having both formal and informal strategies to engage patients in clinical communication were important in how this involvement occurred.
Commentary: Mechanical ventilation with heated humidifiers or with heat and moisture exchangers with microbiological filters did not reduce ventilator associated pneumonia in adults
Publisher: BMJ
Date: 07-2006
DOI: 10.1136/EBN.9.3.82
Examining subacute nurses’ roles in a changing healthcare context
Publisher: Wiley
Date: 18-03-2020
DOI: 10.1111/JOCN.15235
Using Evidence to Improve Patient Safety and the Quality of Health Care
Publisher: Wiley
Date: 28-01-2011
Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation
Publisher: Springer Science and Business Media LLC
Date: 02-02-2018
Burden of five healthcare associated infections in Australia
Publisher: Springer Science and Business Media LLC
Date: 13-05-2022
DOI: 10.1186/S13756-022-01109-8
Abstract: Healthcare associated infections are of significant burden in Australia and globally. Previous estimates in Australia have relied on single-site studies, or combinations thereof, which have suggested the burden of these infections is high in Australia. Here, we estimate the burden of five healthcare associated infections (HAIs) in Australian public hospitals using a standard international framework, and compare these estimates to those observed in Europe. We used data from an Australian point prevalence survey to estimate the burden of HAIs amongst adults in Australian public hospitals using an incidence-based approach, introduced by the ECDC Burden of Communicable Diseases in Europe. We estimate that 170,574 HAIs occur in adults admitted to public hospitals in Australia annually, resulting in 7583 deaths. Hospital acquired pneumonia is the most frequent HAI, followed by surgical site infections, and urinary tract infections. We find that blood stream infections contribute a small percentage of HAIs, but contribute the highest number of deaths (3207), more than twice that of the second largest, while pneumonia has the higher impact on years lived with disability. This study is the first time the national burden of HAIs has been estimated for Australia from point prevalence data collected using validated surveillance definitions. Per-capita, estimates are similar to that observed in Europe, but with significantly higher occurrences of bloodstream infections and healthcare-associated pneumonia, primarily amongst women. Overall, the estimated burden is high and highlights the need for continued investment in HAI prevention.
The impact of disability in survivors of critical illness
Publisher: Springer Science and Business Media LLC
Date: 22-05-2017
DOI: 10.1007/S00134-017-4830-0
Abstract: To use the World Health Organisation's International Classification of Functioning to measure disability following critical illness using patient-reported outcomes. A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation's Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU. We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001] being separated or orced [OR 2.87 (CI 1.35, 6.08), P = 0.006] increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day] and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P < 0.002), and reduced health-related quality of life (P < 0.001). Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or orce and a longer duration of mechanical ventilation. NCT02225938.
Towards patient-centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study
Publisher: Wiley
Date: 06-12-2022
DOI: 10.1111/JOCN.16162
Abstract: Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post‐discharge period. Little attention has been paid to exploring communication strategies facilitating patient‐centred medication communication at transitions of care from a discourse‐analytic perspective. To explore, through a discursive lens, strategies that enable patient‐centred medication communication at transitions of care. A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. Patient preferences and beliefs about medications were identified as important characteristics of patient‐centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications informative talk clarifying patients' concerns and encouraging talk for enhancing shared decision‐making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision‐making processes are crucial to patient‐centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.
Nurses' strategies for managing pain in the postoperative setting
Publisher: Elsevier BV
Date: 03-2005
Establishing the prevalence of healthcare-associated infections in Australian hospitals
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJOPEN-2018-024924
Abstract: A healthcare-associated infection (HAI) data point prevalence study (PPS) conducted in 1984 in Australian hospitals estimated the prevalence of HAI to be 6.3%. Since this time, there have been no further national estimates undertaken. In the absence of a coordinated national surveillance programme or regular PPS, there is a dearth of national HAI data to inform policy and practice priorities. A national HAI PPS study will be undertaken based on the European Centres for Disease Control method. Nineteen public acute hospitals will participate. A standardised algorithm will be used to detect HAIs in a two-stage cluster design, random s le of adult inpatients in acute wards and all intensive care unit patients. Data from each hospital will be collected by two trained members of the research team. We will estimate the prevalence of HAIs, invasive device use, single room placement and deployment of transmission-based precautions. Ethics approval was obtained from the Alfred Health Human Research Ethics Committee (HREC/17/Alfred/203) via the National Mutual Assessment. A separate approval was obtained from the Tasmanian Health and Medical Human Research Committee (H0016978) for participating Tasmanian hospitals. Findings will be disseminated in in idualised participating hospital reports, peer-reviewed publications and conference presentations.
Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: Testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis
Publisher: Springer Science and Business Media LLC
Date: 11-07-2017
Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: A protocol
Publisher: Springer Science and Business Media LLC
Date: 19-05-2015
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