ORCID Profile
0000-0002-9193-8250
Current Organisation
University of South Australia
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Publisher: Wiley
Date: 10-05-2014
DOI: 10.1111/JOCN.12631
Abstract: To develop critical care nurse education practice standards. Critical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification. An eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds. For the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice. Of 105 experts who agreed to participate, 92 (88%) completed survey round I 85 (92%) round II and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance - median 7 (IQR 6-7) 14 were rated as having a moderate level of importance - median 6 (IQR 5-7) and nine were rated as having a low level of importance - median 4 (IQR 4-6)-6 (IQR 4-6). The majority of the panel rated graduate level of practice as 'demonstrates independently' or 'teaches or supervises others' for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient- and family-focused approach. The graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.AUCC.2011.12.056
Abstract: The aim of this paper is to review the differences and similarities in critical care nursing staffing, education and practice standards in the US, Canada, UK, New Zealand and Australia. A university library discovery catalogue, Science Direct, Scopus databases and professional websites were searched. Key terms used included, critical care, specialist, standards, competency, practice, scope, workforce, staffing, ratios, qualifications, adverse events, and patient outcomes. The search was limited to articles that referred to critical care environments including paediatric and neonatal settings. The database and hand search identified 40 relevant articles. Website searching resulted in a further 36 documents. A ersity of critical care nursing contexts and a lack of comparable workforce data made it difficult to quantify differences and similarities between countries. There is a general consensus about the importance of optimum staffing by registered nurses with a proportion of those holding relevant post-registration qualifications although there is no consistency in defining the educational preparation for a 'qualified' critical care nurse. Critical care nursing standards for the US, Canada, UK and New Zealand were predominantly developed by expert panels while the Australian standards were developed with a multi-methods study including observations of practice. All five standards documents were built upon national entry-to-practice nurse standards and contained similar constructs, although there was no construct common to all of the standards. There is a lack of evidence to support nursing staffing with post registration specialty qualifications. Existing standards are predominantly opinion based rather than supported by research. The expected standards for nursing practice are fundamentally similar.
Publisher: Elsevier BV
Date: 12-1999
Publisher: Wiley
Date: 24-11-2018
DOI: 10.1111/SCS.12545
Abstract: Problems experienced by older people with complex needs to live at home have been reported in the literature. This qualitative study builds on previous research and investigates enduring issues older people face when interacting with healthcare services. To gain an in-depth understanding of what is involved in providing good quality health care for older people who need support to live at home. We adopted an interpretive descriptive approach and conducted semi-structured interviews with older people (n = 7), carers (n = 8) and key informants (n = 11). Initial and secondary analysis of qualitative data was completed. Major themes emerged about meanings of partnership in health care, and invisibility of the older person as a partner in health care. Partnership in health care was understood to mean being treated as an equal, being involved in decision-making, and making contributions which impact on health care and health systems. The metaphorical concept of 'invisibility' related to the older person not being seen and heard as a partner in health care, as well as being a recipient of care. We concluded that older people who need support to live at home are not highly visible to health providers, policymakers and researchers as a central partner and consumer to be meaningfully engaged in shaping their health care. Opportunities to address persistent issues with quality of health care may in future be achieved through stronger partnerships between older people and health providers, to find new ways to improve the quality of care for older people.
Publisher: Wiley
Date: 19-02-2013
DOI: 10.1111/J.1478-5153.2012.00543.X
Abstract: To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. Following institutional ethics committee approval, purposive s ling was used to select participants for focus groups and in idual interviews who had experienced intensive care or coronary care. Seventeen participants provided data which created two main thematic categories the role of the critical care nurse and minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates talking and listening skills, relating to and dealing with stressed people, in idualizing care and patient and family advocacy. Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Cambridge Media
Date: 07-2019
Abstract: Aim To review the effects of bioimpedance spectroscopy (BIS) to measure dry weight (DW) in haemodialysis (HD)patients when compared to clinical examination. Methods The review was conducted according to the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MasARI). Meta-analysis was performed using Review Manager 5 software. The search was limited to English language papers published from 2005 to 2017. A standard JBI three-step search strategy was used. We searched all quantitative studies from major databases for investigations of the BIS for measuring DW in HD patients. Results A total of four randomised controlled trials (RCTs) met the inclusion criteria. These studies all involved patients with end-stage kidney disease (ESKD) receiving HD and the comparison of BIS versus physician’s clinical judgement using cardiovascular parameters and mortality outcomes. The meta-analysis of BIS when compared with clinical judgement found no significant differences in the reduction of the mortality rate, hospitalisation rate or other cardiovascular parameters after 12 months of the intervention only significant improvement in pre-dialysis systolic BP (WMD –5.41, 95% CI –9.00 to –1.82 p=0.003) was reported. However, in idual RCTs found that BIS is an effective intervention for HD patients in the reduction of the mortality rate (HR 0.100, 95% CI, 0.013 to 0.805 p=0.04) after 2.5 years of the intervention. Conclusion The small number of participants and restricted participant selection criteria all has considerable impact with regard to generalising these findings to wider HD populations.
Publisher: Mark Allen Group
Date: 06-2007
DOI: 10.12968/BJOM.2007.15.6.23686
Abstract: Midwifery education in Australia has embraced competency-based learning models where assessment of clinical competency is fundamental to educational programmes. Both clinical and theoretical components of the programme need to be fulfilled and passed in order to register as a midwife. Concerns have been raised regarding competency-based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. It is the purpose of this paper to present the findings from a delphi study which aimed to gain consensus from experts regarding the appropriateness of using minimum requirements of birth and follow-through experiences for registration purposes in Australia. The delphi is stage two of a research project. Stage one involved a systematic review of literature to establish the evidence for measuring competency in midwifery practice using minimal requirements of stated clinical experience for registration purposes. The findings from this review concluded that no specific evidence exists for measuring competency in midwifery practice using minimum requirements of stated clinical experience for registration purposes. The results of the delphi indicate that there is consensus that prescriptive criteria should be incorporated to measure competence in midwifery students for registration purposes. Nevertheless, a number of significant issues were raised with regards to achieving minimum requirements in practice.
Publisher: Elsevier BV
Date: 08-2000
DOI: 10.1016/S1036-7314(00)70634-5
Abstract: In October 1998, the Australian College of Critical Care Nurses (ACCCN) launched a model to credential specialist level critical care nurses. This model was 'road tested' during a pilot study, when experienced critical care nurses were invited to apply to become the first Australian credentialled critical care nurses. The pilot study was designed to ensure all in iduals taking part in the process were surveyed regarding adequacy of the credentialling package and the credentialling process. Applicants were required to provide evidence of practise at the specialist level, as described in the Competency Standards for Specialist Level Critical Care Nurses. Evidence was presented via curriculum vitae, professional journal and supported by three peer reviewers and two referees. Each application was sent to a three-person assessor panel, which assessed the evidence in the application against the Competency Standards for Specialist Level Critical Care Nurses. A total of six applications from five states and one territory were received by April 1999. Five of the applicants were assessed to have met the Competency Standards and were awarded the credential, Australia Credentialled Critical Care Nurse (ACCN), which they will hold for a period of 3 years. Feedback from assessors, applicants, peer reviewers and referees involved in the pilot study has resulted in the further refinement of the credentialling package and processes. Australian critical care nurses will now have the opportunity to seek to be credentialled four times per year.
Publisher: Elsevier BV
Date: 08-2003
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.IJNURSTU.2014.12.002
Abstract: Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. Data were available for 136 patients (50% cancer 44% infection 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022 CI 1.445-122.788). It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered the number of cases of VTE was comparatively small, resulting in wide confidence intervals.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.COLEGN.2013.11.006
Abstract: Preparation of specialist critical care nurses in Australia is at graduate level, although there remains considerable variation in courses offered in relation to qualification, content, assessment and outcomes. As higher education providers must now comply with the Australian Qualifications Framework (AQF) a study was conducted to examine existing critical care courses and graduate practice outcomes. Twenty-two critical care courses were reviewed. Data sources included course provider, websites, course curricula and telephone interviews with course coordinators. A framework approach, was used consisting of five key stages: preliminary immersion of raw data, conceptualising a thematic framework, indexing, charting, mapping and interpretation of data. Analysis revealed considerable variations in course delivery and graduate practice outcomes. Most courses used professional competency standards as a framework for course curricula and clinical assessment, with inconsistency in their translation to graduate practice outcomes. Twenty-one courses included clinical assessment at graduate certificate level with no clinical assessment conducted at master level. The expected practice outcome for fifteen courses was safe practice with graduates not expected to practice at a specialist or team leadership level. Minimum graduate practice standards were not included in three courses as an expected outcome. The AQF requires graduate nurse education to be compliant with academic outcome standards. The findings of our study indicate variations between courses and subsequent graduate practice outcomes. It is therefore timely to establish national critical care education graduate practice standards.
Publisher: Elsevier BV
Date: 11-2005
Publisher: Elsevier BV
Date: 08-2008
Publisher: FapUNIFESP (SciELO)
Date: 10-2011
DOI: 10.1590/S0034-89102011005000059
Abstract: OBJECTIVE: To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS: The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts). RESULTS: Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days experienced sleep disruption on more than 50% of work days struggled to remain awake on 27% of work days and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study). Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS: Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.NEDT.2012.05.017
Abstract: Healthcare educators face numerous challenges including technological change, information overload, and the need to maintain clinical expertise and research knowledge across multiple specialities. Students also need to develop their capacity for critical thinking, using and discriminating between erse sources of knowledge in order to advance their own practice. To investigate student perceptions of the affordances of a novel web 2.0-based tool--the Web Resource Appraisal Process (WRAP), designed to support the development of critical thinking skills, and to identify how student's understanding of critical thinking and their use of web 2.0 resources might inform the cross-disciplinary development of the WRAP. A two phase, action research study of student perceptions of the WRAP and their ability to source and identify valid information sources. Implemented at the University of South Australia, development of the WRAP is an international project with the University of Westminster, UK. Students from international locations participated in the project. A mixed methods approach was adopted involving a two phase action research study. In phase one, student perceptions of the WRAP were obtained using a modified course feedback questionnaire. This informed the development of a subsequent questionnaire used to survey student perceptions of their usage of online resources, the ease of access of such resources and their approaches to determining their validity. Results suggest that students mainly use traditional resources when preparing work for assessment and they either do not understand the concept of, or do not exercise, critical thinking skills in such activities. However, the feedback from students using the WRAP, demonstrated that they found it instructive and useful. To ensure that practice developments are based on authoritative evidence, students need to develop critical thinking skills which may be facilitated by tools such as the WRAP.
Publisher: Wiley
Date: 10-09-2021
DOI: 10.1111/INM.12932
Abstract: COVID‐19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID‐19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID‐19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service‐delivery arrangements of support and therapeutic engagement.
Publisher: SLACK, Inc.
Date: 07-2014
DOI: 10.3928/00220124-20140620-02
Abstract: Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking. A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families—the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT). Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbach’s α 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887) intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements. The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program. J Contin Educ Nurs. 2014 (7):312–320.
Publisher: SAGE Publications
Date: 13-10-2013
Abstract: Midwives often work night and rotating shift schedules, which can lead to sleep disturbances, increased fatigue, and greater likelihood of accidents or errors. This study investigated the sleep of midwives ( n = 17) in an Australian metropolitan hospital. Midwives completed work and sleep logbooks and wore wrist actigraphs for 28 days. Midwives worked combinations of morning, afternoon, and/or night shifts on constant ( n = 6) or rotating schedules ( n = 11). They obtained less than recommended amounts of sleep, getting only 6–7 hr per 24-hr period. Morning shifts were associated with the lowest sleep durations, lowest subjective sleep quality, and highest postsleep fatigue ratings. Despite the significantly higher amount of wake after sleep onset (51 min), the sleep before afternoon shifts had significantly lower postsleep fatigue ratings and was rated as significantly higher quality than sleep before other shifts or days off. Those who were married or living with a partner reported significantly more sleep and lower postsleep fatigue than those who were separated or orced ( p .05). Seventy-one percent of midwives took naps, primarily before night shifts, with nearly 40% of nightshifts preceded by a nap. Average nap durations were nearly 1.5 hr. Midwives reported feeling moderately to very physically or mentally exhausted on 22–50% of all shifts and days off. Exhaustion was most common on night shift. This study suggests that midwives may be suffering from chronic sleep loss and as a consequence may be at risk of impairments in functioning that accompany fatigue.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEPR.2018.08.012
Abstract: This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-c us simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive s ling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.GERINURSE.2016.12.001
Abstract: Perceived experiences of health care for older people who need support to live at home can illuminate areas needing improvement in quality of care, and guide towards better ways to support ageing populations to live at home. This systematic review synthesized findings from the qualitative literature about perceived experiences of health care for older people who need support to live at home, from the perceptions of older people, carers and health providers. Searches of electronic databases and eligibility screening produced 46 included studies for review. Thematic synthesis revealed how health care impacts on the older person's sense of autonomy, both in health care decisions and everyday life. Autonomy is empowered by the older person's own capacity and by respectful conduct of health providers. Engagement between older people, carers and health providers is a negotiated interaction, affected by multiple factors.
Publisher: SAGE Publications
Date: 05-04-2023
DOI: 10.1177/00207640231159297
Abstract: Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a ‘fast track assessment’ (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients. Mixed methods comprising of two phases – (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data. Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling ex les of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family. The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.
Publisher: National Institute of Industrial Health
Date: 2010
DOI: 10.2486/INDHEALTH.MSSW-01
Abstract: Investigations of mood and workload in health care settings have focussed primarily on nurses and junior doctors. Given the critical shortfall in the Australian midwifery workforce, and the specialised nature of midwifery as an occupation, it is important to understand how mood and workload are experienced by midwives. Twenty midwives (18F, 2M) in an Australian metropolitan hospital completed logbooks assessing daily fluctuations in subjective mood and workload. Participants also provided information about history of psychopathology and sleep quality. Results revealed that midwives were relatively stable in terms of mood but did experience increased fear and decreased happiness when at work. Further, workload factors significantly predicted mood at work. Specifically, when participants felt that their work was more demanding and frustrating and required more effort, or when they felt that they could not accomplish all that was expected, mood was negatively influenced. This supports the connection between workload and negative mood change in healthcare. Given the potential for mood to influence a multitude of functions relevant to safety, performance and psychosocial wellbeing it is important to understand the factors which influence mood, particularly in light of the current shortfall in the Australian healthcare workforce.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Association for Vascular Access
Date: 09-2016
DOI: 10.1016/J.JAVA.2016.02.002
Abstract: Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used for peripherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certain vein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veins available to determine the most optimal vessel to introduce a catheter. It is important that clinicians have an understanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominance on vein size to determine whether their clinical practice is appropriate. Methods: A scoping review of published literature was performed to determine existing knowledge regarding the diameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality (left or right arm) on vein size. Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at the midupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement to inform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant research examined the effect of laterality on vein diameter and 1 study was identified that reported the influence of hand dominance or vein type on the diameter of veins used for PICC insertion. Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion. Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins), although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Further research about the vasculature used for PICC insertion is needed to inform clinical practice.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.AUCC.2019.06.001
Abstract: Oral care for intubated patients in the intensive care unit (ICU) is known to reduce bacterial colonization in oropharyngeal cavities decrease development of ventilator associated pneumonia (VAP) and the associated costs of managing this complication (1-4). Provision of oral hygiene by nurses is a fundamental aspect of care in the ICU (5). However, such a basic nursing activity can be devalued or rendered invisible by nurses when there is a greater emphasis on managing and maintaining biotechnology and/or a failure to underpin practice with research evidence that demonstrates the importance of fundamental care (5). A Canadian study by Dale and colleagues (6) to explore clinicians' knowledge of, and experiences with, delivering oral care in intubated patients is a timely reminder that the complexity of performing oral care in the ICU should not be underestimated or undervalued.
Publisher: University of Technology, Sydney (UTS)
Date: 26-07-2016
Abstract: This article examines the legal challenges asylum seekers arriving by boat to Australia experience when seeking assistance with their claims and its impact on their mental health. The authors outline the experiences of asylum seekers in the “legacy caseload” group who have been waiting up to four years to have their protection claims assessed. The complex interplay between legal assistance to support refugee claims and the way those making claims inevitably struggle to understand, engage and participate in the process is analysed. It is argued that provision of legal assistance for this group will be essential to ensuring that the refugee status determination process is fair and allows asylum seekers to understand and participate more fully in the process. Recent changes to the assessment of claims combined with a reduction in funding for legal assistance create significant hurdles and combine to compound existing stress and emotional trauma leading to detrimental outcomes on the mental health of asylum seekers.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Association for Vascular Access
Date: 12-2013
DOI: 10.1016/J.JAVA.2013.08.001
Abstract: Background: Peripherally inserted central catheters (PICCs) are increasingly inserted by trained registered nurses, necessitating the development of specialized skills such as the use of ultrasound. The selection of an adequately sized vein is an important factor in reducing adverse events such as deep vein thrombosis. However, PICC nurses may receive minimal training in the use of ultrasound for vein measurement. Objective: We aimed to demonstrate the reliability of a vein measurement protocol using ultrasound by a PICC nurse trained in sonography. Methods: The diameter of the basilic, brachial, and cephalic veins in the left arms of healthy participants (n =12) were measured using ultrasound by a PICC nurse and a sonographer. A PICC nurse performed the measurement twice and the sonographer once the PICC nurse's results were compared for intra-rater reliability and compared with the sonographer for inter-rater reliability. The results were analyzed using intraclass correlation coefficients (ICCs). Results: Inter-rater reliability between the PICC nurse and the sonographer was adequate, the ICC for the brachial vein was 0.60 (95% confidence interval [CI], 0.06–0.87), basilic vein ICC was 0.87 (95% CI, 0.58–0.96) and cephalic vein ICC was 0.77 (95% CI, 0.39–0.93). Intra-rater reliability of the PICC nurse was higher the ICC for the brachial vein was 0.80 (95% CI, 0.44–0.94), basilic vein ICC was 0.92 (95% CI, 0.67–0.98), and cephalic vein ICC was 0.78 (95% CI, 0.40–0.93). Conclusions: Using a suitable protocol, a PICC nurse was able to measure vein diameter reliably when compared with a sonographer and consistently replicate these results.
Publisher: Wiley
Date: 02-07-2007
DOI: 10.1111/J.1365-2648.2007.04316.X
Abstract: This paper is a report of a study to examine the construct validity of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale. The validity of instruments is critical in ensuring that data collected are sound and that the data measures what it purports to measure. When a new instrument is used in a different population or when it has been modified, it is useful to re-examine the construct validity of the instrument. A survey design was used in September 2004 with a s le of 615 undergraduate nursing students to test the factor structure of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale and to estimate its similarity to the factor structure reported for the original scale developed and tested in a group of Registered Nurses. Using Maximum Likelihood Factor Analysis and then Principal Axis Factoring, we were unable to obtain a similar factor structure to that originally identified for the scale. Our data resulted in a two-factor structure. One factor consisted of 16 items that reflected a positive attitude to nursing research and the other consisted of 14 items that reflected a negative attitude to nursing research. The substantially different factor structure identified suggests that this scale requires further refinement and testing. This case study highlights the importance of a systematic and comprehensive approach to determining construct validity of scales, thus enabling researchers to determine their suitability as data collection instruments.
Publisher: JMIR Publications Inc.
Date: 30-06-2022
Abstract: eading nurse education and research in the higher education (HE) sector has become increasingly challenging over the last decade with many universities in Australia and New Zealand having undergone academic restructuring. The future of HE faces many challenges including recruitment of suitably qualified staff to lead teaching and research and advance professional disciplines. Increasing cultural ersity of the Nursing workforce and the communities’ nurses serve, and the identification of cultural attributes in the context of racial inequities exposed by the pandemic and the climate emergency suggest different forms of leadership may be required in the future by those leading nurse education in the HE sector. Currently, there is a dearth of research evidence that identifies the qualities, behaviors, and characteristics (collectively identified as core attributes) required by nurse academic leaders. his research aims to identify an evidenced based set of core attributes that are required to lead the discipline of Nursing in the Australian and New Zealand HE sectors. his research is using a 2-phase sequential mixed methods design incorporating a scoping review and Delphi technique. In phase 1, a scoping review will be undertaken to identify the qualities, behaviors, and characteristics that can influence the evolution of the next generation of academic nurse leaders. A set of draft statements and questions will be prepared based on analysis of findings from the review. Phase 2 uses Delphi technique consisting of e-survey rounds with experts in leading nursing faculties in Australia and New Zealand. An Expert Advisory Group will consider the initial set of draft statements and questions from phase 1. Consistent with Delphi technique, a series of “rounds” will then occur using an e-survey method. Established leaders (Professors and Associate Professors who are members of the Council of Deans Australia and New Zealand) will rate their level of agreement to statements on the qualities, behaviors, and characteristics required to lead the discipline of nursing in the HE sector in Australia and New Zealand. he findings of the scoping review will identify what is currently known about the qualities, behaviors, and characteristics of academic nurse leaders. Quantitative and qualitative results from the Delphi study will initially be reported in separate manuscripts for publication. It is projected that a final paper will be prepared from aggregated research data and outline how the findings can inform the preparation of future academic nurse leaders. he generation of an evidenced-based set of core attributes will serve to inform the next generation of academic nurse leaders including informing recruitment processes and postgraduate nurse leadership programs. It is anticipated that the data sets and findings will be transferrable to other disciplines within HE to aid in future-proofing discipline-based expertise and leadership in the context of academic restructure. RR1-10.2196/40677
Publisher: Walter de Gruyter GmbH
Date: 12-2020
Abstract: The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management. A scoping review was guided by Arksey and O'Malley's (2005) 1 five-stage framework, investigated contemporary patient education programs (2007–2018) for chronic pain management in education content, formats of delivery, and tools used for evaluation. Content analysis and description were used for the outcome report. Seven quantitative studies were included. Education content consisted of General information, Cognitive behavior therapy (CBT), Self-management, and Pain neurophysiology (PN). Education delivery formats varied from workbook to workbook, face-to-face, online, when given for a group or in idual or in a combined way. In total, 19 tools were reported for the evaluation of the education programs. There is a variety in the education content and the delivery formats. The majority of programs showed effectiveness in patients’ chronic pain management based on their selected evaluation tools. This review showed that patient education programs can be useful in chronic pain management. The effectiveness of patient education programs focuses on the improved patients’ physical function and quality of life rather than the cessation of pain only.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15020
Abstract: Objective The aim of the present study was to explore the potential of coronial inquest data to inform patient safety improvement in hospitals at a system level. Methods A retrospective analysis of 20 years of South Australian (SA) coronial inquest findings was performed using both qualitative content analysis methods and statistical descriptive analyses. Results In all, 113 cases were analysed. More than one-third of deaths (39%) were associated with emergency care. Analysis revealed 11 recurrent themes and two notable contributing factors that highlighted specific areas of concern for SA hospitals over that time period. The most common action recommended by coroners (49.6% n = 56 cases) was the review or development of policy, protocol, procedure or guidelines designed to improve patient care. In almost one-quarter (24%) of deaths reviewed, coroners alerted health authorities to poor standards of care and/or instructed in idual clinicians to review the standard of their clinical practice. Conclusions The analysis provided a retrospective review of coronial inquest data associated with hospital care over a 20-year period. The findings highlight specific areas of concern for patient safety over that time. More broadly, this analysis contributes to an emerging body of evidence in the Australian academic literature that demonstrates the value of systematic analysis of coronial data at a system level to inform patient safety improvement in Australian healthcare. What is known about the topic? Australian coroners have an important role to play in public health and safety. Many areas of social inquiry across Australia use coronial inquest data to identify recurrent hazards and assist in the development of relevant social policy. However, there is very little research reported in the academic literature that associates analyses of coronial data with patient safety improvement in healthcare. Although coronial recommendations made from in idual cases of avoidable death are considered by health authorities, there is no evidence in the academic or grey literature that any systematic analysis of coronial inquest data is undertaken at a national or state or territory level to contribute to patient safety improvement. The few cases that are reported in the Australian academic literature provide valuable evidence of the benefits in terms of identifying recurrent hazards and prompting practice change. What does this paper add? This paper provides a descriptive overview of 20 years of coronial inquest data associated with hospital care in one Australian state. It provides evidence of recurrent themes and noteworthy contributing factors that highlight specific areas of concern for patient safety in hospitals. The methods used in the analysis can be applied across other settings in Australian healthcare. In addition, the paper adds to an emerging body of research evidence in the Australian academic literature illustrating the benefits of reviewing coronial inquest data to inform patient safety initiatives. What are the implications for practitioners? Findings from this analysis can be used to further the knowledge and understanding of health practitioners working in hospital settings as to the type of patients, clinical incidents and medical management issues that have featured repeatedly in avoidable deaths reported by coroners.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.COLEGN.2014.08.001
Abstract: To investigate CaLD nurses' transition into the Australian workforce over the first 3 months of employment in tertiary hospitals. Descriptive mixed method design, informed by the critical paradigm. Survey questionnaire and a focus group were used for data collection. The existence of a specific hospital orientation program was identified as a crucial factor in participants' successful transition. Without a hospital based orientation program participants were more likely to experience failure to 'fit in'. This led to maladaptive behaviors where they did not actively seek, support or question practice through fear of drawing increased attention to themselves. WORKPLACE IMPLICATIONS: Results from the study raise serious implications for workplace safety of both the CaLD nurses and the patients they nurse. Government and health administrators need to invest in providing specific hospital orientation programs that support CaLD nurses' transition. The development of such hospital orientation programs need to be developed as to the specific learning requirements of these nurses or risk exposing them to maladaptive behaviors and potential adverse events as a result of this learned behavior.
Publisher: JMIR Publications Inc.
Date: 16-03-2023
DOI: 10.2196/40677
Abstract: Leading nurse education and research in the higher education (HE) sector has become increasingly challenging over the last decade with many universities in Australia and New Zealand having undergone academic restructuring. The future of HE faces many challenges including recruitment of suitably qualified staff to lead teaching and research and advance professional disciplines. Increasing cultural ersity of the Nursing workforce and the communities’ nurses serve, and the identification of cultural attributes in the context of racial inequities exposed by the pandemic and the climate emergency suggest different forms of leadership may be required in the future by those leading nurse education in the HE sector. Currently, there is a dearth of research evidence that identifies the qualities, behaviors, and characteristics (collectively identified as core attributes) required by nurse academic leaders. This research aims to identify an evidenced based set of core attributes that are required to lead the discipline of Nursing in the Australian and New Zealand HE sectors. This research is using a 2-phase sequential mixed methods design incorporating a scoping review and Delphi technique. In phase 1, a scoping review will be undertaken to identify the qualities, behaviors, and characteristics that can influence the evolution of the next generation of academic nurse leaders. A set of draft statements and questions will be prepared based on analysis of findings from the review. Phase 2 uses Delphi technique consisting of e-survey rounds with experts in leading nursing faculties in Australia and New Zealand. An Expert Advisory Group will consider the initial set of draft statements and questions from phase 1. Consistent with Delphi technique, a series of “rounds” will then occur using an e-survey method. Established leaders (Professors and Associate Professors who are members of the Council of Deans Australia and New Zealand) will rate their level of agreement to statements on the qualities, behaviors, and characteristics required to lead the discipline of nursing in the HE sector in Australia and New Zealand. The findings of the scoping review will identify what is currently known about the qualities, behaviors, and characteristics of academic nurse leaders. Quantitative and qualitative results from the Delphi study will initially be reported in separate manuscripts for publication. It is projected that a final paper will be prepared from aggregated research data and outline how the findings can inform the preparation of future academic nurse leaders. The generation of an evidenced-based set of core attributes will serve to inform the next generation of academic nurse leaders including informing recruitment processes and postgraduate nurse leadership programs. It is anticipated that the data sets and findings will be transferrable to other disciplines within HE to aid in future-proofing discipline-based expertise and leadership in the context of academic restructure. PRR1-10.2196/40677
Publisher: Wiley
Date: 21-03-2018
DOI: 10.1111/INM.12325
Abstract: The mental deterioration of the so called 'legacy caseload' (asylum seekers who arrived in Australia by boat between August 2012-December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self-harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma-informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.
Publisher: Informa UK Limited
Date: 08-2014
Publisher: Informa UK Limited
Date: 15-12-2016
DOI: 10.1080/10376178.2015.1111154
Abstract: Remote telemonitoring is utilised to provide specialised care to people with heart failure living in rural locations. There is limited research into the patients' experience of telemonitoring. This literature review was completed to examine the available evidence and inform the development of a telemonitoring service. Cochrane Database of Systematic Reviews Medline CINAHL database, Joanna Briggs Institute, AMED, EMBASE were searched using the key words. A thematic analysis was applied. Forty-six studies reviewed, 11 met inclusion criteria. In idual health status, use of technology, and effect on lifestyle influenced the patient experience. Limited literature was available addressing the patient experience of telemonitoring and no studies were found that specifically investigated the experiences of patients with heart failure in rural locations. Further research is required to examine the patient/user perspective of this type of service, and explore the feasibility of including telemonitoring in usual care.
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 02-2015
Publisher: Hindawi Limited
Date: 16-10-2018
DOI: 10.1111/HSC.12668
Abstract: Police are increasingly being called upon to respond to people experiencing suicidal crisis. Such incidents are a challenging aspect of modern policing. This paper reports on an integrative review study that aimed to investigate police responses to in iduals displaying suicidal or self-harming behaviours. Six electronic databases were searched for peer-reviewed articles published between 2007 and 2017 relating to police responses to in iduals in suicidal crisis. The review identified 12 studies that met the inclusion criteria. A content analysis was conducted to identify and describe the key characteristics emerging from the literature, which identified four themes: "characteristics of in iduals" "the use of violence and weapons" "contact with police prior to suicide" and, "police officer training". Findings from this study indicate that in iduals involved in incidents of suicidal and self-harm crisis with police are often male, aged between 35 and 40 years, single and/or having relationship issues, with a history of mental health issues and in recent contact with police prior to the incident of suicidal crisis-either as a victim or a perpetrator. The results highlight that large proportions of in iduals in suicidal crisis within a community located incident are likely to present with violent or aggressive behaviour and in many situations are armed with a weapon used to either threaten or injure police and/or bystanders or self-harm. Training and education can have a positive impact from the perspective of police responding to in iduals in suicidal crisis. Limitations in the current evidence are identified and implications for future research are outlined.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.NEDT.2013.02.016
Abstract: The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards. The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided. For each round, the SurveyMonkey's email tool was used to distribute an in idualized email invitation containing the survey web link. The distribution of panel responses, in idual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds. An online survey provided numerous advantages over traditional survey approaches including high quality data collection, ease and speed of survey administration, direct communication with the panel and rapid collation of feedback allowing data collection to be undertaken in 12 weeks. Only minor challenges were experienced using the technology. Ethical issues, specific to using the Internet to conduct research and external hosting of web-based software, lacked formal guidance. High response rates and an increased level of data quality were achieved in this study using web-survey software and the process was efficient and user-friendly. However, when considering online survey software, it is important to match the research design with the computer capabilities of participants and recognize that ethical review guidelines and processes have not yet kept pace with online research practices.
Publisher: Elsevier BV
Date: 12-1997
DOI: 10.1016/S1036-7314(97)70416-8
Abstract: Opioid tolerance is well-described physiologically but its mechanistic basis remains incompletely understood. An important site of opioid action in vivo is the presynaptic terminal, where opioids inhibit transmitter release. This response characteristically resists desensitization over minutes yet becomes gradually tolerant over hours, and how this is possible remains unknown. Here, we delineate a cellular mechanism underlying this longer-term form of opioid tolerance in cultured rat medium spiny neurons. Our results support a model in which presynaptic tolerance is mediated by a gradual depletion of cognate receptors from the axon surface through iterative rounds of receptor endocytosis and recycling. For the μ-opioid receptor (MOR), we show that the agonist-induced endocytic process which initiates iterative receptor cycling requires GRK2/3-mediated phosphorylation of the receptor's cytoplasmic tail, and that partial or biased agonist drugs with reduced ability to drive phosphorylation-dependent endocytosis in terminals produce correspondingly less presynaptic tolerance. We then show that the δ-opioid receptor (DOR) conforms to the same general paradigm except that presynaptic endocytosis of DOR, in contrast to MOR, does not require phosphorylation of the receptor's cytoplasmic tail. Further, we show that DOR recycles less efficiently than MOR in axons and, consistent with this, that DOR tolerance develops more strongly. Together, these results delineate a cellular basis for the development of presynaptic tolerance to opioids and describe a methodology useful for investigating presynaptic neuromodulation more broadly.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Informa UK Limited
Date: 02-05-2020
DOI: 10.1080/07481187.2020.1758243
Abstract: We analyzed 10 years of Australian coronial inquest documents on people who died by suicide or suspected suicide following recent contact with the police. We identified 149 cases of suicide or suspected suicides via coronial websites, 34 of which contained recommendations. We developed four themes from these recommendations, the most common of which was for police to change current practices or policies and modify police officer training. Coroners considered effective working relationships with external stakeholders able to assist police an important means of reducing risk of suicide.
Publisher: Elsevier BV
Date: 05-2000
Publisher: Elsevier BV
Date: 05-2013
Publisher: Elsevier BV
Date: 11-2001
DOI: 10.1016/S1036-7314(05)80055-4
Abstract: The Lyell McEwin Health Service (LMHS) is a major public hospital located in the northern suburbs of Adelaide, a region where the death rate from ischaemic heart disease (IHD) is higher than the expected death rate in the population. A retrospective case note study conducted at this hospital investigated the duration that patients with unstable angina pectoris (UA) or acute myocardial infarction (AMI) spent in the emergency department (ED) before admission to the critical care unit (CCU) and the factors that contributed to delays of greater than 70 minutes. All patients admitted to the LMHS over an 18 month period with a discharge diagnosis related group (DRG) for AMI and UA were included in the study. A total of 667 case notes were examined 403 of these cases met the inclusion criteria for the study. The mean duration between arrival in the ED and subsequent admission to the CCU was found to be 161 minutes. DRG was a major factor in the length of time spent in the ED. The mean duration for patients with AMI was 124 minutes, whilst for UA the duration was 190 minutes (difference = 66 minutes, p males, p=0.015), and mode of transport to the ED (arrival by ambulance mean duration 30 minutes < private transport, Recommendations arising from this study included that a system be established to enable the rapid assessment of all patients suspected of suffering AMI and UA, inclusive of their expeditious transfer to the CCU. In addition, a staff development programme was proposed to ensure medical and nursing staff became aware of a bias in this hospital toward transferring male patients in a shorter timeframe than females with the same DRG.
No related grants have been discovered for Carol Grech.