ORCID Profile
0000-0001-7066-0133
Current Organisations
Deakin University - Melbourne Burwood Campus
,
Deakin University
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Publisher: SAGE Publications
Date: 14-05-2020
Abstract: Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. To explore critical care nurses’ knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice (2) observation of respiratory care delivery and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation and (2) frequency of endotracheal suctioning and mouth care. Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse atient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed ‘as required’ or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.
Publisher: Wiley
Date: 18-01-2023
DOI: 10.1111/JOCN.16627
Abstract: To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID‐19 pandemic. To minimise the transmission of COVID‐19, stringent infection prevention and control measures resulted in restricted hospital access for non‐essential workers and visitors, creating challenges for the provision of family‐centred care at the end of life. Qualitative descriptive approach based on naturalistic inquiry. At a large public hospital in Melbourne, Australia, in idual semi‐structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID‐19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting. Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements (ii) nurse‐family communication (iii) family‐centred care and interrupted connections (iv) well‐being and negative emotions and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy. Negative consequences for communication and the patient‐family connection at the end of life were felt deeply. The evolving COVID‐19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply. Technology‐facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family‐centred approach to care and emphasising the patient‐family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies. Bereaved family members contributed their first‐hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.NEDT.2012.11.008
Abstract: Australian universities have traditionally been able to supplement clinical education, for undergraduate nursing courses, delivered on placement with weekly clinical teaching in the simulated environment. The Objective Structured Clinical Assessment (OSCA) tool has been used in this simulated environment to assess clinical skills. Recently, however, online delivery of undergraduate nursing courses has become more common. The move from an internal mode of teaching to an online external mode is seen worldwide and poses challenges to staff and students as well as changing the teaching and learning culture of institutions (Philip and Wozniak, 2009). This cultural shift and the resulting diminishing timeframe for students to acquire and practice simulated clinical skills imply that it may become necessary to rethink assessment forms such as the OSCA assessment. This study examines whether or not the OSCA tool developed by Bujack et al. (1991a) is the best tool to be used in this new context, where online teaching is supplemented by very short, annual, intensive periods of study. Skills acquisition theories dictate that time is required to produce an ideal skills acquisition environment (Quinn, 2000) but the time constraints placed on students in such intensive periods of study could influence skills acquisition. This cross-sectional qualitative study used semi-structured interviews and focus groups to collect data. 65% of the nursing faculty participated in the study. The teaching of the Bachelor of Nursing (BN) occurred on two c uses and staff from both areas participated. This group of nurse academics was employed across the range of academic levels (from lecturer to professor) at the University. Data analysis followed a generic thematic analysis framework. Findings in this study show that there are a variety of attitudes and underpinning beliefs amongst staff in relation to the OSCAs. Doubts were raised in regard to the suitability of the use of the OSCA tool in this setting. It also became apparent during this study that the OSCA tool possibly serves purposes other than an assessment tool.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.IDH.2018.09.084
Abstract: Antimicrobial resistance and the rise of 'super bugs' has become a major threat to public health worldwide, with authorities warning of an 'apocalyptic future' unless addressed as a matter of urgency. Mass circulation media has traditionally taken an active role in informing the public of important public health issues and the measures needed to address these. The key objective of the larger project informing this article was to describe Australian media representations of the AMR crisis and its role in informing the public about the AMR crisis. Undertaken as an unobtrusive qualitative research enquiry, existing data from Australian media, the websites of select partisan groups and government health departments as well as discipline literature were sourced and analysed using content analysis strategies. Overall, media coverage was well informed, accurate, balanced, responsive to the issues at stake, and highlighted the seriousness of the issue without being alarmist. Intriguingly, reports relied heavily on the use of content and conceptual metaphors to frame their narratives. The media reports analysed in the context of this study were substantive and well informed. Just what impact they have had on the public in terms of improving its knowledge of the AMR issue or motivating behaviour change to mitigate the AMR crisis was unable to be ascertained. The strategic use of the media to galvanise an effective public response to the AMR crises thus requires further investigation.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.IDH.2019.02.002
Abstract: Nurses should be conscious of healthcare associated infections, and the standard precautions required to reduce the risk of patients becoming infected. Patients with atopic dermatitis are often predisposed to a higher incidence of bacterial and viral infections. This study aims to explore and describe nurses' understanding and knowledge of their role in infection control and prevention precautions when caring for children with atopic dermatitis. Sixteen nurses were recruited from the dermatology clinic, medical wards and emergency department of a metropolitan tertiary referral children hospital for a qualitative exploratory descriptive study. Thematic and content analysis derived three themes from the data: "the importance of infection prevention and control when managing children with atopic dermatitis", "nurses focus on self-protection", and "educating families on infection prevention and control". Nurses' perceptions of their role emphasised the need to limit cross-infection between patients when children were admitted with exacerbations of atopic dermatitis. Participants articulated that in their own practice personal protective equipment (PPE) was often used for self-protection and to protect their uniform rather than to protect the child from cross-infection. The importance of providing family members with sufficient education to assist them in managing the child at home was also particularly salient. The importance nurses placed on educating patients and family members about home-management, preventing cross-infection and minimising the occurrence of future exacerbations of atopic dermatitis, highlights the potential to develop interventions to support greater consumer participation in infection prevention for children with chronic relapsing conditions such as atopic dermatitis.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 15-02-2022
DOI: 10.1111/JAN.15164
Abstract: One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. A descriptive cross‐sectional design was adopted in this study. Health care workers ( N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h ( SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning ain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
Publisher: SAGE Publications
Date: 03-11-2017
Abstract: The aim of this study was to explore the attitudes and behaviours of registered nurses and their colleagues around the adoption of standard precautions in order to determine strategies to promote adherence. A qualitative exploratory descriptive design used interviews and focus group to collect data. Registered nurses and registered midwifes from a tertiary metropolitan hospital took part in the study. A voluntary s le of 29 adults was recruited from the Australian nursing (n = 25) and midwifery (n = 4) workforce. There were six men (mean age = 36.83 years SD = 8.93) and 23 women (mean age = 41.36 years SD = 10.25). Participants were recruited through advertisement on notice boards and emails from unit managers. Thematic analysis revealed five themes but the focus here is on staff judgements which are against the guidelines. Participants indicated that where in their judgement the patient posed no risk and they judged themselves skilled in the procedure, they were justified in deviating from the guidelines. Some staff judgements appeared to be self-protecting, while others were irrational and inconsistent. Despite use of standard precautions being mandated, staff often deviated from them based on their own assessment of the situation or the patient. Any deviance from the guidelines is of concern but especially so when staff take it upon themselves to apply their own criteria or judgements. These results also suggest there may be some organisational inadequacies with regards to training and supervision of staff.
Publisher: Wiley
Date: 08-03-2021
DOI: 10.1111/JOCN.15625
Abstract: To review and synthesise the literature examining the patients' experience of faecal microbiota transplantation. Faecal microbiota transplantation is a common treatment for many conditions, including Clostridium Difficile infections. Patients' experience of treatments is an important influence on clinical decision‐making and treatment adherence. The PRISMA guidelines guided this systematic review. The review was registered with PROSPERO [CRD42020140446]. A search of Cumulative Index of Nursing and Allied Health Literature, Medline and Embase was conducted for studies published in English and French up to June 2020. Risk of bias was examined using Critical Appraisal Skills Program tools, and quality appraisal was performed independently by three reviewers. Primary outcome of interest was the patient experience of faecal microbiota transplantation. Data were synthesised using a narrative approach. The search identified 3316 citations, and 12 studies were included. Methodological quality of studies was moderate to low quality. Few studies have accurately explored the patients' experience of faecal microbiota transplantation: most focus on clinical outcomes or hypothetical scenarios regarding the patients' perspectives of faecal microbiota transplantation. Only one study was identified where the sole focus was the patients' experience of faecal microbiota transplantation. Patient's experience of faecal microbiota transplantation was erse and complex with physiological and psychological components dependent on the patient's medical condition, the administration method and the efficacy. Patients did not find faecal microbiota transplantation unappealing however, patients equally reported the procedural experience was unpleasant. Limited results and low quality evidence suggest that further evaluation of the patient experience of faecal microbiota transplantation would be beneficial. Identifying the patients' experience of faecal microbiota transplantation may inform recommendations regarding alternate treatment therapies and enable opportunities to provide quality care for patients that require faecal microbiota transplantation.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 11-2017
Publisher: Elsevier BV
Date: 11-2017
Publisher: Wiley
Date: 26-10-2019
DOI: 10.1111/NHS.12578
Publisher: Wiley
Date: 07-10-2021
DOI: 10.1111/NHS.12748
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.COLEGN.2012.03.008
Abstract: The use of Objective Structured Clinical Examination/Objective Structured Clinical Assessment (OSCE/OSCA) has been well documented. How assessors currently view the process, and if the OSCA tool still fulfils the assessment requirements, is unclear. In this study, the beliefs and expectations of assessors towards the assessment tool used in an undergraduate nursing degree to assess clinical skills was investigated. A cross-sectional study used semi-structured interviews and focus groups with 16 lecturers in nursing from a rural Australian university. This represents 65% of the total nurse academic staff employed there. The key issues that the academic staff raised reflect those from previous studies, such as the use of OSCA as formative assessment or a quality check process before the clinical practice. The OSCAs were seen as a good assessment tool, which gave students the opportunity to receive feedback on their performance in relation to clinical skills. The drawbacks identified in relation to the use of OSCAs were that the OSCA was seen as stressful to students. This drawback was thought to be further compounded if there was a lack of congruence regarding essential criteria between assessors. If not adequately addressed these drawbacks will erode the potential the OSCA tool has to foster uniformity, which was one of the main reasons for its implementation. .
Publisher: Wiley
Date: 23-06-2021
DOI: 10.1111/NHS.12857
Abstract: The SARS‐CoV‐2 or COVID‐19 pandemic has raised public awareness around disease protection. The aims in this study were to recruit participants from Australia and Germany to determine their use of personal protective equipment and COVID‐19 avoidance strategies using scales designed for this study. Principal components analysis with the Australian data revealed two factors in the Protection from Infection Scale, Self‐Care and Protective Behaviors, and a single factor in the Infection Avoidance Scale, with each scale demonstrating strong internal reliability. Data from German participants were used to confirm the scales' structure using confirmatory factor analysis. A comparison of the two data sets data revealed that Australian participants scored higher overall on protection and avoidance strategies but at the item level there were several commonalities, including self‐care behaviors people adopted to avoid contracting COVID‐19. With no foreseeable end to this pandemic, it is important that follow‐up studies ascertain whether the public continues to adopt high levels of PPE use and follows government advice or if pandemic fatigue sets in.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.NEPR.2017.09.011
Abstract: Adapting a course from face to face to blended delivery necessitates that assessments are modified accordingly. In Australia the Objective Structured Clinical Assessment tool, as a derivative from the Objective Structured Clinical Examination, has been used in the face-to-face delivery mode as a formative or summative assessment tool in medicine and nursing since 1990. The Objective Structured Clinical Assessment has been used at Charles Darwin University to assess nursing students' simulated clinical skills prior to the commencement of their clinical placements since 2008. Although the majority of the course is delivered online, students attend a one-week intensive clinical simulation block yearly, prior to attending clinical placements. Initially, the Objective Structured Clinical Assessment was introduced as a lecturer assessed summative assessment, over time it was adapted to better suit the blended learning environment. The modification of the tool from an academic to peer assessed assessment tool, was based on the empirical literature, student feedback and a cross-sectional, qualitative study exploring academics' perceptions of the Objective Structured Clinical Assessment (Bouchoucha et al., 2013a, b). This paper presents an overview of the process leading to the successful adaptation of the Objective Structured Clinical Assessment to suit the requirements of a preregistration nursing course delivered through blended learning. This is significant as many universities are moving their curriculum to fully online or blended delivery, yet little attention has been paid to adapting the assessment of simulated clinical skills. The aim is to identify the benefits and drawbacks of using the peer assessed Objective Structured Clinical Assessment and share recommendations for successful implementation.
Publisher: Elsevier BV
Date: 11-2017
Publisher: SAGE Publications
Date: 06-06-2019
Abstract: Ventilator-associated pneumonia (VAP) is a common avoidable healthcare associated infection in ventilated critical care patients that can have a detrimental impact on patient recovery. To increase uptake at a local level, care bundles should be designed and implemented in collaboration with the end-users who will implement the bundle into practice. The aim in this study was to evaluate critical care nurses’ perceptions of the usability of a respiratory care bundle as an effective approach to VAP prevention. An exploratory descriptive qualitative study was conducted. A respiratory care bundle consisting of five components was implemented over a 4-week period. Following implementation, a focus group and semi-structured interviews were conducted to obtain nurses’ feedback on the useability of the care bundle. Seven intensive care nurses caring for ventilated patients participated in the study. Participants confirmed that using a care bundle provided a structured approach to nursing care of a ventilated patient and that the use of checklist reminders at the bedside was useful in a busy practice environment. Barriers to uptake and implementation of the bundle were that the unit culture did not prioritise preventative care and the need for a structured interdisciplinary approach to sedation and weaning of mechanical ventilation. To successfully imbed all elements of a respiratory care bundle into practice an interdisciplinary approach is needed in which there is a strong emphasis on preventative care. These findings highlight the advantages of involving end-users in the development of strategies to decrease VAP.
Publisher: Medical Journals Sweden AB
Date: 09-12-2022
DOI: 10.2340/JRM.V54.2752
Abstract: Objective: To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care.Design: Scoping review.Subjects: Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care.Methods: A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French during the period 2000-2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR).Results: A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care.Conclusion: Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration. LAY ABSTRACTMedical complications are associated with negative patient health outcomes and significant impact on healthcare utilization and delivery. A review was undertaken to scope available literature and explore medical complications as an important concept in relation to healthcare delivery and utilization for patients admitted to subacute care for inpatient rehabilitation. The results of the review highlighted that patients admitted for inpatient rehabilitation are at high risk of medical complications, with infections, neurological and cardiorespiratory complications being prominent. Patients admitted following stroke, traumatic brain injury/trauma or cancer are particularly vulnerable. The findings of this review emphasize the importance of including clinicians within the multidisciplinary rehabilitation team who have expertise in acute medicine and nursing, infection prevention and control, and recognition and response to clinical deterioration, to support the delivery of high-quality and safe care within inpatient subacute settings.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.AUCC.2018.10.003
Abstract: Violence in healthcare settings is a concern for healthcare professionals and patients. Media reports, and debate within the healthcare profession, and the academic literature infer that workplaces such as intensive care units are becoming exposed to increasing violence. Increases in the incidence of violent behaviour are sometimes attributed to the increased pressure on emergency departments to accelerate the throughput of patients to meet targets. To ensure the wellbeing of patients and staff, there is a need to evaluate the impact of such targets. The aim in this study was to evaluate the incidence and to describe the context in which patients' aggressive and violent behaviours occurred since the introduction of the National Emergency Access Target in a local tertiary Australian intensive care unit. A retrospective examination of events triggering violence-related emergency codes from 12 months before the introduction of the National Emergency Access Target up until 12 months after its implementation (2011-2013). A small increase in the number of Code Grey/Code Black activation was identified after the introduction of the target (before = 18, after = 29). Admissions following drug overdoses, isolated head trauma, and cardiac arrest were the presentations most likely to have been associated with a violence-related emergency call. Female registered nurses, male critical care registered nurses, and clinical nurse specialists were the most at risk of occupational violence. Male nursing staff members were found to be more likely to be involved in incidences of verbal violence (p < 0.003). Although there was a minimal increase in the overall number of emergencies triggered by violent behaviour, valuable information on the type of occupational violence occurring towards healthcare professionals and patients in this setting was found. We suggest that these findings add further important detail to the existing understanding of the problem of occupational violence. These detailed insights can further inform policy development, professional education, and practice.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.AJIC.2018.11.001
Abstract: Atopic dermatitis is a chronic, recurrent inflammatory skin disease, characterized by frequent exacerbations that can necessitate increased antibiotic use. A qualitative study was conducted at a specialist pediatric hospital to explore the perceptions of dermatology nurses on their role in antimicrobial stewardship when caring for children with atopic dermatitis. Thematic and content analysis derived that the awareness of nurses on antimicrobial stewardship was low, although they were implementing key elements in their clinical practice.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Stephane Bouchoucha.