ORCID Profile
0000-0002-0574-0054
Current Organisation
Deakin University
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Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.AUCC.2007.05.001
Abstract: Educational preparation for critical care nursing in Australia varies considerably in terms of the level of qualification resulting in a lack of clarity for key stakeholders about student outcomes. The study aim was to identify and reach consensus regarding the desired learning outcomes from Australian post-registration critical care education programs as demonstrated through the graduate's knowledge, skills and attitudes. A Delphi technique was used to establish consensus between educators, managers, clinicians and students regarding learning outcomes expected of graduates with a Graduate Certificate, Graduate Diploma and Master level qualification in critical care nursing. A total of 164 critical care nurses (66 clinicians, 48 educators, 32 managers and 18 students) participated and 99 questionnaires were returned in the first round (response rate 60%). Fifty-seven questionnaires were returned for Round 2 (response rate 58%). Learning outcomes were obtained from the Australian College of Critical Care Nurses Competency Standards for Specialist Critical Care Nurses. Some statements included more than one characteristic, and these were split to create learning outcomes with one characteristic per item. A survey of Australian higher education providers of critical care education provided additional learning outcomes, for a total of 73 learning outcomes for the first Delphi round. Findings suggest that patient comfort, safety, professional responsibility and ethical conduct are deemed most important for all three levels of educational preparation. There was a lack of emphasis on clinical practice issues for all levels. Participants placed higher emphasis on learning outcomes related to complex decision-making, leadership, supervision, policy development and research for Graduate Diploma and Master level programs. The findings have implications for curriculum development and the profession with regards to the level of educational preparation required of critical care nurses and suggest that further work is required before clear recommendations can be made for desired educational outcomes from critical care nursing programs in Australia.
Publisher: Elsevier BV
Date: 05-2014
Publisher: Elsevier BV
Date: 12-1999
Publisher: Wiley
Date: 09-05-2019
DOI: 10.1111/JOCN.14893
Abstract: To examine patient acceptability of wearable vital sign monitoring devices in the acute setting. Wearable vital sign monitoring devices may improve patient safety, yet hospital patients' acceptability of these devices is largely unreported. A systematic review. Cumulative Index to Nursing and Allied Health Literature Complete, MEDLINE Complete and EMBASE were searched, supplemented by reference list hand searching. Studies were included if they involved adult hospital patients (≥18 years), a wearable monitoring device capable of assessing ≥1 vital sign, and measured patient acceptability, satisfaction or experience of wearing the device. No date restrictions were enforced. Quality assessments of quantitative and qualitative studies were undertaken using the Downs and Black Checklist for Measuring Study Quality and the Critical Appraisal Skills Programme Qualitative Research Checklist, respectively. Meta-analyses were not possible given data heterogeneity and low research quality. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was completed. Of the 427 studies screened, seven observational studies met the inclusion criteria. Six studies were of low quality and one was of high quality. In two studies, patient satisfaction was investigated. In the remaining studies, patient experience, patient opinions and experience, patient perceptions and experience, device acceptability, and patient comfort and concerns were investigated. In four studies, patients were mostly accepting of the wearable devices, reporting positive experiences and satisfaction relating to their use. In three studies, findings were mixed. There is limited high-quality research examining patient acceptability of wearable vital sign monitoring devices as an a priori focus in the acute setting. Further understanding of patient perspectives of these devices is required to inform their continued use and development. The provision of patient-centred nursing care is contingent on understanding patients' preferences, including their acceptability of technology use.
Publisher: Elsevier BV
Date: 08-2007
Publisher: Wiley
Date: 03-09-2023
DOI: 10.1111/JOCN.16877
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.JTCVS.2009.08.031
Abstract: Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management. Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial Po(2) to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours. Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%). Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction.
Publisher: Elsevier BV
Date: 05-2003
DOI: 10.1016/S0147-9563(03)00041-4
Abstract: The purpose of this study was to explore the extent and sources of variability of critical care nurses' hemodynamic decision making as a function of contextual factors in the immediate 2-hour period after cardiac surgery. A qualitative exploratory design with observation and interview was used. Eight critical care nurses were observed on different occasions in clinical practice for a 2-hour period. A brief interview immediately followed each observation to clarify observation data. Analysis of the data revealed that patient management decisions were made both by in idual nurses and by a team of nurses and health professionals. Team decision making (TDM) is described in this study as integrated or non-integrated and refers to an intra-professional nursing team. During displays of integrated TDM, the primary nurse, who was assigned to care for the patient, made most hemodynamic decisions and nurses who assisted the primary nurse deferred decisions. During displays of non-integrated TDM, nurses assisting the primary nurse assumed responsibilities for most patient-related decisions. Non-integrated TDM occurred more frequently when inexperienced cardiac surgical intensive care nurses were in the role of primary nurse, whereas integrated TDM was more common among experienced cardiac surgical intensive care nurses. This observed variability can occur in multiple ways and in hemodynamic decision making has implications for patient outcomes as behaviors of non-integrated TDM led to nurses sensing a loss of control of patient management.
Publisher: Wiley
Date: 03-08-2202
DOI: 10.1111/SDI.12909
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.AUCC.2009.05.002
Abstract: Advanced life support (ALS) assessments are performed to assess nurses' abilities to recognize cardiac arrest events, and appropriately manage patients according to resuscitation guidelines. Although there is evidence for conducting assessments after initial ALS education, there is little evidence to guide educators about ongoing assessments in terms of methods, format and frequency. The aim of this study was to determine methods used by educators to assess ALS skills and knowledge for nurses in Victorian intensive care units. This descriptive study used telephone interviews to collect data. Data were analysed using content analysis. Twenty intensive care educators participated in this study. Thirteen educators (65%) were employed in public hospitals, and 7 educators (35%) worked in private hospitals across 12 Level 3 (60%) and 8 Level 2 (40%) intensive care units. Results showed all educators used scenarios to assess ALS skills, with 12 educators (60%) including an additional theoretical test. There was variability in ALS assessment frequency, assessment timing in relation to initial/ongoing education, person performing the assessment, and the assessor articipant ratio. Nineteen educators (95%) reported ALS skill competency assessments occurred annually 1 educator (5%) reported assessments occurred every 2 years. Assessments were conducted during a designated month (n=10), numerous times throughout the year (n=8), or on nurses' employment anniversaries (n=2). All educators reported many nurses avoided undertaking assessments. Variability in ongoing ALS assessment methods was evident in Victorian intensive care units with some units applying evidence-based practices. Consideration should be given to the purposes and methods of conducting annual ALS assessments to ensure resources and strategies are directed appropriately. To encourage nurses to retain ALS skills and knowledge, regular practices are recommended as an alternative to assessments. However, further research is required to support this notion.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.AENJ.2016.09.001
Abstract: Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care. A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia. When controlled for length of stay, heart rate was the most frequently assessed vital sign per hour (median=0.9) whilst Glasgow Coma Score was the least frequently assessed vital sign per hour (median=0.5). Clinical deterioration (one or more vital signs fulfilling hospital medical emergency team activation criteria during emergency department care) occurred in 14.5% of patients. Of the 5466 vital sign measures, 19.6% were abnormal, 1.9% indicated clinical deterioration. Clinical deterioration occurred in one in seven patients, and one in five vital signs documented were outside of accepted normal ranges. Thus, emergency department physiological status has implications for patient safety and nursing practice, in particular clinical handover for patients requiring hospital admission.
Publisher: Elsevier BV
Date: 08-2001
DOI: 10.1016/S1036-7314(01)80030-8
Abstract: This article reports the types and complexity level of decisions made in everyday clinical practice by critical care nurses. It also reports factors that influence the complexity of those decisions. A combination of methods were chosen for the two phase study. In the first phase, 12 qualified critical care nurses documented decisions (over a 2 hour period) on a clinical decision recording form designed by the researcher. In the second phase, participants attended a semi-structured focus group. From the analysis, five types of decisions were identified assessment, intervention, organisation, communication and education. In addition to these documented decisions, three factors that influenced decision complexity were identified from a thematic analysis of the transcribed interviews communication, patient related and properties of the decision. Nurses reported that communication decisions were the most difficult to make. However, the concept of nurses knowing the patient reduced the level of decision complexity. It is suggested that this has important implications for decision making practices of nurses working in the area of critical care and potentially for patient outcomes.
Publisher: Wiley
Date: 16-02-2016
DOI: 10.1111/JAN.12922
Abstract: To examine the relationship between physiological status at the emergency department-ward interface and emergency calls (medical emergency team or cardiac arrest team activation) during the first 72 hours of hospital admission. Ward adverse events are related to abnormal physiology in emergency department however the relationship between physiology at the emergency department-ward interface and ward adverse events is unknown. Descriptive and exploratory design. The study involved 1980 patients at three hospitals in Melbourne Australia: i) 660 randomly selected adults admitted via the emergency department to medical or surgical wards during 2012 and who had an emergency call and ii) 1320 adults without emergency calls matched for gender, triage category, usual residence, admitting unit and age. The median age was 78 years and 48·8% were males. The median time to the first emergency call was 18·8 hours and ≥1 abnormal parameters were documented in 34·9% of patients during the last hour of ED care and 47·1% of patients during first hour of ward care. Emergency calls were significantly more common in patients with heart rate and conscious state abnormalities during the last hour of emergency care and abnormal oxygen saturation, heart rate or respiratory rate during the first hour of ward care. Medical emergency team afferent limb failure occurred in 55·3% patients with medical emergency team activation criteria during first hour of ward care. The use of physiological status at the emergency department-ward interface to guide care planning and reasons for and outcomes of medical emergency team afferent limb failure are important areas for future research.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.ICCN.2007.09.001
Abstract: This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes. Postgraduate speciality education has proliferated within Australia over the past 20 years. However, there is little agreement regarding the expected characteristics, or relevant priorities, of these characteristics of graduates successfully completing these programmes of study. This study used a mixed-method approach comprising two phases. Initially a survey was mailed to volunteers between March and June 2005 to obtain priorities in educational outcomes for graduates of critical care programmes. This was followed by a stakeholder focus group in May 2006 to refine expected outcomes. Survey respondents rated educational outcomes that described professional and legal aspects of practice to ensure safe patient care as highest priority for programme graduates. Although most educational outcome statements were considered important for graduates from all levels of courses, increasing levels of practice was described for increasingly higher levels of programmes from Graduate Certificate to Masters Degree. This study provides an emerging description of the priorities of critical care nursing programmes, with priority given to professional and legal aspects of practice. Further delineation of priorities is necessary to inform ongoing educational development.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.NEPR.2017.03.008
Abstract: Team-Based Learning (TBL) is a teaching strategy designed to promote problem solving, critical thinking and effective teamwork and communication skills attributes essential for safe healthcare. The aim was to explore postgraduate student perceptions of the role of TBL in shaping learning style, team skills, and professional and clinical behaviours. An exploratory descriptive approach was selected. Critical care students were invited to provide consent for the use for research purposes of written reflections submitted for course work requirements. Reflections of whether and how TBL influenced their learning style, teamwork skills and professional behaviours during classroom learning and clinical practice were analysed for content and themes. Of 174 students, 159 participated. Analysis revealed three themes: Deep Learning, the adaptations students made to their learning that resulted in mastery of specialist knowledge Confidence, in knowledge, problem solving and rationales for practice decisions and Professional and Clinical Behaviours, including positive changes in their interactions with colleagues and patients described as patient advocacy, multidisciplinary communication skills and peer mentorship. TBL facilitated a virtuous cycle of feedback encouraging deep learning that increased confidence. Increased confidence improved deep learning that, in turn, led to the development of professional and clinical behaviours characteristic of high quality practice.
Publisher: CSIRO Publishing
Date: 18-07-2023
DOI: 10.1071/AH22203
Abstract: Objective To explore clinicians’ use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems. Method A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted. Results Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration. Conclusion Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians’ needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians’ roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced.
Publisher: Wiley
Date: 21-03-2017
DOI: 10.1111/JOCN.13597
Abstract: To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. A 96% response rate was achieved (n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.AENJ.2016.05.001
Abstract: The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration. To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients. Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience. Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration.
Publisher: Wiley
Date: 25-07-2006
DOI: 10.1111/J.1365-2702.2006.01392.X
Abstract: Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses' perceptions of assuming responsibility for such patients. An understanding of nurses' perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports. The aim of this study was to describe critical care nurses' perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. An exploratory descriptive study based on naturalistic decision-making. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called 'Framework' were used to analyse the interview transcripts. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making. Nurses' previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.ICCN.2005.06.005
Abstract: Critical care nurses' haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses' haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses' levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive s ling was used to recruit 38 nurses for inclusion in the study. The quality of nurses' decision-making was influenced by interplay between the complexity of patients' haemodynamic presentations, nurses' levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses' utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses' professional development and education.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.AUCC.2013.07.002
Abstract: Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown. To describe the workforce and workplace resources of adult CCUs in Victoria, Australia. This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010. A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met the international standards for a nursing workforce with critical care qualifications. The CCU/day procedure/HDU models had 24% of critical care qualified staff followed by CCU/cardiology ward model with 35% compared to an average of 54-80% of qualified staff in the other models of care of CCU. This pilot study has highlighted the heterogeneity in models of CCU and a shortage of qualified critical care nurses, particularly in the CCU/cardiology ward model. This may have implications for the quality of care delivered in CCUs.
Publisher: Wiley
Date: 06-01-2011
DOI: 10.1111/J.1741-6787.2010.00212.X
Abstract: Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care. An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n=30). Observations focused on nurses' interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses. Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration. Nurses' abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error. Nurses displayed behaviours that increased medication administration quality and safety however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.AUCC.2008.10.002
Abstract: Tracheostomy is a well established and practical approach to airway management for patients requiring extended periods of mechanical ventilation or airway protection. Little evidence is available to guide the process of weaning and optimal timing of tracheostomy tube removal. Thus, decannulation decisions are based on clinical judgement. The aim of this study was to describe decannulation practice and failure rates in patients with tracheostomy following critical illness. A prospective descriptive study was conducted of consecutive patients who received a tracheostomy at a tertiary metropolitan public hospital intensive care unit (ICU) between March 2002 and December 2006. Data were analysed using descriptive and inferential tests. Of the 823 decannulation decisions, there were 40 episodes of failed decannulation, a failure rate of 4.8%. These 40 episodes occurred in 35 patients: 31 patients failed once, 3 patients failed twice and 1 patient failed three times. There was no associated mortality. Simple stoma recannulation was required in 25 episodes, with none of these patients readmitted to ICU. Translaryngeal intubation and readmission to ICU took place for the remaining 15 episodes. The primary reason for decannulation failure was sputum retention. Twenty-four patients (60%) failed decannulation within 24h, with 14 of these occurring within 4h. Clinical assessments coupled with professional judgement to decide the optimal time to remove tracheostomy tubes in patients following critical illness resulted in a failure rate comparable with published data. Although reintubation and readmission to ICU was required in just over one third of failed decannulation episodes, there was no associated mortality or other significant adverse events. Our data suggest nurses need to exercise high levels of clinical vigilance during the first 24h following decannulation, particularly the first 4h to detect early signs of respiratory compromise to avoid adverse outcomes.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.AENJ.2012.11.001
Abstract: Triage nurse initiated X-rays (NIXRs) are safe and effective, however, little is known about the ability of other RNs, particularly those without postgraduate qualifications in emergency nursing, to order NIXRs. The aim of this study was to evaluate an innovative NIXR education programme for emergency nurses. The education programme was multi-faceted, delivered using Team-Based Learning (TBL) and augmented by a decision support checklist. Using a prospective exploratory design, 276 NIXR requests from June to December 2011 were audited. Three groups were compared: (i) RNs with and without postgraduate qualifications irrespective of how they were educated in NIXR, (ii) RNs with and without postgraduate qualifications who undertook the NIXR education programme, and (iii) RNs who did and did not undertake the NIXR programme irrespective of postgraduate qualifications. There were 130 NIXRs by 28 RNs with postgraduate qualifications and 146 NIXRs by 12 RNs without postgraduate qualifications. Analysis of all RNs showed RNs without postgraduate qualifications had higher incidence of appropriate NIXRs (83.6% vs 66.2%, p=0.003) however when controlled for the NIXR education programme, statistical significance was lost (83.6% vs 67.5%, p=0.017). RNs who undertook the NIXR education programme had superior documentation of patient assessment findings and higher incidence of appropriate X-ray requests than RNs who did not undertake the NIXR education programme (80.4% vs 65.2%, p=0.042). With appropriate educational preparation, RNs without postgraduate qualifications in emergency nursing can safely engage in NIXR. Structured education using TBL and a decision support checklist produces superior assessment and X-ray requests when compared to ad hoc education and role modelling.
Publisher: Wiley
Date: 31-08-2011
DOI: 10.1111/J.1741-6787.2010.00198.X
Abstract: The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care. A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review. Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation. Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.ICCN.2014.09.003
Abstract: The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. University postgraduate critical care nursing programme. Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care.
Publisher: Elsevier BV
Date: 08-2010
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.AENJ.2014.03.002
Abstract: Team-based learning (TBL) is a highly structured educational strategy that improves student engagement, promotes deeper learning and builds professional skills but has had limited use in nursing education. To examine participant experiences of TBL using one-off teams in a hospital setting. A prospective exploratory design was used in an urban district hospital in Melbourne, Australia. The s le was 49 registered nurses. The intervention was a TBL-based education program focused on assessment and management of adult patients with isolated distal limb injuries. Data were collected using two instruments that evaluated participant experiences of the narrated slide presentation and participant experiences of learning of using TBL. Quantitative data were analysed using descriptive statistics and thematic analysis was used to analyse the qualitative data. The results revealed two key themes: "quality of learning" and "positive team experience". The presentation was accessed twice or more by 51% of participants. Participants perceived a high quality of learning: 95.5% stated that their learning expectations were met or exceeded. Three quarters of participants (77.5%) commented about the contribution of their team members. Participants in this study thought TBL provided them a positive learning experience, as in iduals and as teams. Education methodologies that focus on professional attributes and behaviours in addition to clinical skill are well suited to emergency nursing whereby nurses have to be theoretically prepared for practice and work well in teams. TBL has a natural synergy with the requirements of advanced nursing practice and offers a positive learning experience that enhances clinical outcomes.
Publisher: Wiley
Date: 19-05-2011
DOI: 10.1111/J.1365-2648.2011.05687.X
Abstract: This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. The Clinical Nurse Research Consultant will address the research ractice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.AENJ.2014.12.002
Abstract: Despite many studies of family presence during resuscitation, no validated tool exploring the attitudes and beliefs of healthcare staff towards family presence has been published. The aim of this paper is to describe the development of a tool to accurately measure the attitudes and beliefs of emergency department staff towards family presence in the deteriorating adult patient, present the results of validity and reliability testing, and present the final validated tool. Twenty-nine items were developed, informed by themes from the literature and unvalidated published tools related to family presence during resuscitation. The tool was piloted on a s le of 68 emergency nursing and medical staff. Content validity and face validity were established using feedback from participants. Reliability was established by unidimensionality, exploratory factor analysis and internal consistency. Sixteen items were deleted from the original tool due to low item-to-total correlations and low communalities. Exploratory factor analysis of the remaining items revealed four factors with acceptable correlation coefficients and appropriate explanation of variance. Cronbach's alpha for each factor was >0.7 indicating a high degree of internal consistency. The four factors were labelled and arranged in a logical order to form the final tool, the Emergency Department Family Presence Survey.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.COLEGN.2013.08.004
Abstract: Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical outcomes in response to the high burden of disease from chronic heart failure (CHF). Programmes vary in model, duration, complexity of interventions and incorporation of evidence-based guidelines for programme delivery. Few studies have explored patient outcomes at 12 months from enrolment in a CHF. The aim of the current study was to explore the characteristics and clinical outcomes of patients enrolled in four high complexity CHF-MPs at 12 months after initial enrolment. A secondary aim was to explore the adoption of key evidence-based CHF management strategies in these programmes. After ethics approval, a multisite mixed methods design was implemented incorporating survey and chart audit. Programme characteristics and interventions used in four CHF-MPs were surveyed in Stage 1. Stage 2 involved a chart audit of patients enrolled in the programmes (N = 135) on or after the 1/1/07. Primary endpoints were all-cause hospitalisation and/or mortality at 12 months. Data were analysed using descriptive and inferential statistics. All programmes implemented a high complexity of evidence-based interventions consistent with national guidelines. However, documentation of New York Heart Association functional class was rare limiting quantifiable evaluation of response to therapy throughout programme enrolment. The majority of patients (73%) had severe systolic heart failure with high co-morbidities reflected in a mean Charlson's total co-morbidity score of 3 (± 2.1). The high rate of baseline evidence-based, pharmacothe- rapy (beta-blocker: 86%, n = 112 and ACE inhibitor: 76%, n = 103) was maintained at 12 months (71% and 84% respectively). At 12 months all cause hospitalisation and/or mortality was 57% (n = 77). The CHF-MPs in this study implemented complex evidence-based interventions resulting in high rates of key medication prescription. However, despite the implementation of several evidence-based interventions, over a period of 12 months, more than half of the patients were rehospitalised or died.
Publisher: Oxford University Press (OUP)
Date: 09-2005
DOI: 10.1016/J.EJCNURSE.2005.03.007
Abstract: Background: Critical care nurses caring for cardiac patients in the immediate postoperative period continually make decisions about the implications and treatment of their patients' haemodynamic status. Aim: The aim of this study was to describe the haemodynamic status of patients on admission to critical care and over the 2-h period following cardiac surgery. Methods: A quantitative, descriptive design was used. Data were collected using non-participant observation and an observation tool. The s le consisted of 38 patients. Results: Analysis of data revealed the dynamic nature of the haemodynamic status of postoperative cardiac patients. On admission, 60% of patients ( n = 23) were haemodynamically unstable. The instability in these patients ( n = 23) was due to hypotension (34%), bleeding (21%) and hypoxaemia (18%). During the 2-h recovery period, 55% of patients were hypotensive, 16% of patients had low cardiac output syndrome and 16% of patients had low systemic vascular resistance (SVR) syndrome. Twenty-one percent of patients experienced bleeding complications. Shivering was a clinically significant problem in terms of occurrence (23%) and duration ( X = 45, S.D. = 30 min). Twenty-nine percent of patients ( n = 11) had a profound deterioration in haemodynamic status, necessitating urgent interventions. Conclusion: Haemodynamic parameters indicate that 95% of patients in this study were haemodynamically unstable at some time during the initial 2-h recovery period. These findings inform resourcing decisions by organisations and have implications for nurses' assessment and interventional haemodynamic decision making.
Publisher: Wiley
Date: 23-10-2019
DOI: 10.1111/JOCN.14679
Abstract: To examine nursing handover of vital signs during patient care transition from the emergency department (ED) to inpatient wards. Communication failures are a leading cause of patient harm making communication through clinical handover an international healthcare priority. The transition of care from ED to ward settings is informed by nursing handover. Vital sign abnormalities in the ED are associated with clinical deterioration following hospital admission. Understanding the role and perceived value of vital sign content in clinical handover is important for patient safety. An integrative design was used. A search of electronic databases was undertaken using MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and SCOPUS. Identified records were screened to elicit further studies for inclusion. A comprehensive peer-review screening process was performed. Studies were included that described the surrounding issues of handover, vital signs, ED, transition of care and ward. Five studies were included in the final review, one specific to nursing and four specific to emergency medicine. Vital signs were perceived to be an important inclusion in clinical handover, and the communication of vital signs in handover was perceived to be indicators for patient safety and risk factors for future clinical deterioration. The ED environment had an influence on effective communication within handover. Vital signs were an important inclusion for clinical handover. Deficiencies in vital sign content were perceived to be risk factors for patient adverse events following hospital admission. The quality of vital sign information in clinical handover may be important for accurate decision-making. Vital signs are an important component of clinical handover and are perceived to be indicators for patient safety and risk of future adverse events.
Publisher: Elsevier BV
Date: 11-2004
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/S1036-7314(06)80009-3
Abstract: A range of critical care nursing educational courses exist throughout Australia. These courses vary in level of award, integration of clinical and academic competence and desired educational outcomes this variability potentially leads to confusion by stakeholders regarding educational and clinical outcomes. The study objective was to describe the range of critical care nursing courses in Australia. Following institutional ethics approval, all relevant higher education providers (n=18) were invited to complete a questionnaire about course structure, content and nomenclature. Information about desired professional and general graduate characteristics and clinical competency was also sought. A total of 89% of providers (n=16) responded to the questionnaire. There was little consistency in course structure in regard to the proportion of each programme devoted to core, speciality or generic subjects. In general, graduate certificate courses concentrated on core aspects of critical care, graduate diploma courses provided similar amounts of critical care core and speciality content, while master's level courses concentrated on generic nursing issues. The majority of courses had employment requirements, although only a small proportion specified the minimum level of critical care unit required for clinical experience. The competency standards developed by the Australian College of Critical Care Nurses (ACCCN) were used by 83% of providers, albeit in an adapted form, to assess competency. However, only 60% of programmes used personnel with a combined clinical and educational role to assess such competence. In conclusion, stakeholders should not assume consistency in educational and clinical outcomes from critical care nursing education programmes, despite similar nomenclature or level of programme. However, consistency in the framework for speciality nurse education has the potential to prove beneficial for all stakeholders.
Publisher: Elsevier BV
Date: 08-1997
DOI: 10.1016/S1053-0770(97)90006-9
Abstract: To investigate the relationship between excessive endogenous production of nitric oxide (NO) and the low systemic vascular resistance (SVR) syndrome after cardiac surgery. Prospective, case-control. Cases defined by low SVR postoperatively ( 900 dyn/s/cm-5). Cardiothoracic intensive care unit (ICU) in a tertiary care hospital. Forty-four patients after cardiac surgery. Collection of plasma and urine s les after identification. Plasma and urine nitrate concentrations were measured as an index of endogenous NO production. Hemodynamic, inotropic, and outcome data were collected. Median nitrate concentrations did not differ between cases and controls (plasma, 58 mumol/L, v 62 mumol/L, p = 0.43 urine, 399 mumol/L v 404 mumol/L, p = 0.38). Times to extubation and intensive care unit (ICU) discharge were prolonged in patients with low SVR (17.8 hours v 8.7 hours, p = 0.021 2.5 days v 1.2 days, p = 0.019, respectively). No association between "low SVR syndrome" and endogenous NO production was found. Patients with low SVR after cardiac surgery required a longer period of inotropic and ventilator support, with delay in discharge from the ICU. The risk and cost implications of this syndrome support further research.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.NEPR.2015.01.011
Abstract: Australian nurses prepare for specialty practice by undertaking postgraduate theoretical and clinical education in partnership models between universities and hospitals. In our global healthcare system, nurses require advanced critical thinking and strong communication skills to provide safe, high quality patient care. Yet, few education programs focus on developing these skills. Team-Based Learning (TBL) is a specific educational strategy that encourages and rewards students to think critically and solve clinical problems in idually and in teams. The aim of this study was to investigate critical care nursing students' perceptions and experiences of TBL after it was introduced into the second half of their postgraduate specialty course. Following Ethics Committee approval, thirty-two students were invited to participate in an extended response questionnaire on their perceptions of TBL as part of a larger study. Data were analyzed thematically. Postgraduate students perceived their professional growth was accelerated due to the skills and knowledge acquired through TBL. Four themes underpinned the development and accelerated acquisition of specialty nurse attributes due to TBL: Engagement, Learning Effectiveness, Critical Thinking, and Motivation to Participate. Team-Based Learning offered deep and satisfying learning experiences for students. The early acquisition of advanced critical thinking, teamwork and communication skills, and specialty practice knowledge empowered nurses to provide safe patient care with confidence.
Publisher: Wiley
Date: 06-12-2018
DOI: 10.1111/JOCN.14076
Abstract: To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses' assessment decisions (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.AUCC.2021.05.014
Abstract: For over a decade, patients experiencing clinical deterioration have been attended to by specialised nurses, the most senior of which are intensive care unit liaison nurses (ICU LNs) or critical care outreach nurses. These roles have evolved without consistent and formal recognised educational preparation. To continue to advance patient safety, an understanding of the educational requirements for these vital roles is required. The aim of this study was to ascertain nurses' perceptions of the curriculum required to perform the roles of ICU LNs or critical care outreach nurses within an acute care sector rapid response system. An exploratory descriptive study was conducted at an international rapid response system conference in 2016 following ethics approval. Using convenience s ling, extended response surveys were completed by nurses with rapid response system leadership experience and roles. Data were analysed using content analysis according to a priori themes of theoretical knowledge, skills, and attributes. Seventy-seven registered nurses volunteered to take part in the study, forming 14 groups, each with four to seven members. Participants identified key concepts for desired theoretical knowledge, practical skills, and personal attributes. Professional behaviours were more frequently emphasised than theoretical knowledge or practical skills, suggesting personal attributes were highly valued in these leadership roles. A curriculum designed to prepare patient safety leadership roles of the ICU LN or critical care outreach nurse has been identified. These findings can inform the development of postgraduate courses and training requirements, along with position descriptions and expectations of employers regarding the skill set expected in these leadership roles.
Publisher: Elsevier BV
Date: 11-2009
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.AJIC.2013.11.011
Abstract: This prospective observational study measured idle central venous catheter (CVC)-days (no medical indication), and ward clinicians' adherence to evidence-based practices for preventing short-term central line-associated bloodstream infections (CLABSIs). In 340 patients discharged from ICU over a 1-year period, 208 of 794 CVC-days (26.2%) were idle. Interventions to prevent CLABSIs were poorly implemented. Ward clinicians need education regarding risk management strategies to prevent CLABSIs, and clear accountability processes for prompt catheter removal are recommended.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.AUCC.2012.08.001
Abstract: Traditional dedicated coronary care units (CCU) are being decommissioned and cardiology precincts are evolving. These precincts often have cardiac and non-cardiac patients with a erse array of acuity levels. Critical care trained cardiac nurses are frequently caring for lower acuity patients resulting in a deskilling of this experienced workforce. The aim of this paper was to discuss the implications of restructuring CCUs on nursing workforce and patient outcomes. An integrated literature review was conducted. The following databases were searched for articles published between January 2000 and December 2011: Ovid Medline, CINHAL, EMBASE and Cochrane. Additional studies obtained from the articles searched and policy documents from key professional organisations and government departments were reviewed. This review has highlighted the association between workforce, qualifications and quality of care. Studies have shown the relationship between an increase in critical care qualified nursing staff and an improvement in patient outcomes. Inadequate staffing levels were also shown to be associated with an increase in adverse events. Cardiology precincts have the potential to adversely impact on critical care trained cardiac nursing workforce and patient outcomes. The implications that these new models have on the critical care cardiac nurse workforce are crucial to health care reform, quality of in-hospital care, sentinel events and patient outcomes.
Publisher: Wiley
Date: 22-03-2017
DOI: 10.1111/JOCN.13733
Abstract: To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. Descriptive exploratory study using nonparticipatory observation. Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research.
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1111/JOCN.12641
Abstract: To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance (2) data are collected using the same framework as most organisation's rapid response system activation criteria and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy.
Publisher: Wiley
Date: 21-12-2015
Publisher: Wiley
Date: 04-01-2021
DOI: 10.1111/JOCN.15599
Abstract: To explore the use and student outcomes of Team‐Based Learning in nursing education. Team‐Based Learning is a highly structured, evidence‐based, student‐centred learning strategy that enhances student engagement and facilitates deep learning in a variety of disciplines including nursing. However, the breadth of Team‐Based Learning application in nursing education and relevant outcomes are not currently well understood. A scoping review of international, peer‐reviewed research studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews. The following databases were searched on 7 May 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO and Education Resources Information Center. Search terms related to nursing, education and Team‐Based Learning. Original research studies, published in English, and reporting on student outcomes from Team‐Based Learning in nursing education programmes were included. Of the 1081 potentially relevant citations, 41 studies from undergraduate ( n = 29), postgraduate ( n = 4) and hospital ( n = 8) settings were included. The most commonly reported student outcomes were knowledge or academic performance ( n = 21) student experience, satisfaction or perceptions of Team‐Based Learning ( n = 20) student engagement with behaviours or attitudes towards Team‐Based Learning ( n = 12) and effect of Team‐Based Learning on teamwork, team performance or collective efficacy ( n = 6). Only three studies reported clinical outcomes. Over the last decade, there has been a growing body of knowledge related to the use of Team‐Based Learning in nursing education. The major gaps identified in this scoping review were the lack of randomised controlled trials and the dearth of studies of Team‐Based Learning in postgraduate and hospital contexts. This scoping review provides a comprehensive understanding of the use and student outcomes of Team‐Based Learning in nursing education and highlights the breadth of application of Team‐Based Learning and variability in the outcomes reported.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.AUCC.2012.07.001
Abstract: Australian critical care nurses generally undertake assessment of resuscitation competencies on an annual or biannual basis. International resuscitation evidence and guidelines released in 2010 do not support this practice, instead advocating more frequent retraining. To review the evidence for annual assessment of resuscitation knowledge and skills, and for the efficacy of resuscitation training practices. A search of the Medline and CINAHL databases was conducted using the key search words/terms 'resuscitation' 'advanced life support' 'advanced cardiac life support' 'assessment' 'cardiac arrest', 'in-hospital cardiac arrest', 'competence', 'training', 'ALS', 'ACLS' 'course' and 'competency'. The search was limited to English language publications produced during the last 10 years. The International Liaison Committee On Resuscitation worksheets were reviewed for key references, as were the reference lists of articles from the initial search. There is little evidence to support the current practice of annual resuscitation competency assessments. Theoretical knowledge has no correlation with resuscitation performance, and current practical assessment methods are problematic. Both knowledge and skills decline well before the 12-month mark. There is emerging support in the literature for frequent practice sessions using simulation technology. The current practice of annual assessments is not supported by evidence. Emerging evidence for regular resuscitation practice is not conclusive, but it is likely to produce better outcomes. Changing practice in Australia also represents an opportunity to generate data to inform practice further.
Publisher: Wiley
Date: 25-07-2008
DOI: 10.1111/J.1365-2702.2007.02219.X
Abstract: To examine the impact and obstacles that in idual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.
Publisher: Elsevier BV
Date: 2005
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.AENJ.2015.07.001
Abstract: Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited. To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care. A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random s ling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages. The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7% 68.8% 55.3% 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044). A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes.
Publisher: Elsevier BV
Date: 11-2007
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.HEALUN.2014.11.017
Abstract: The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing. A consensus conference with workgroup sessions, consisting of 77 nurse participants with clinical experience in cardiothoracic transplantation, was arranged. This was followed by subsequent discussion with the ISHLT Nursing, Health Science and Allied Health Council. Evidence and expert opinions regarding key issues were reviewed. A modified nominal group technique was used to reach consensus. Consensus reached included: (1) a minimum of 2 years nursing experience is required for transplant coordinators, nurse managers or advanced practice nurses (2) a baccalaureate in nursing is the minimum education level required for a transplant coordinator (3) transplant coordinator-specific certification is recommended (4) nurse practitioners, clinical nurse specialists and nurse managers should hold at least a master's degree and (5) strategies to retain transplant nurses include engaging donor call teams, mentoring programs, having flexible hours and offering career advancement support. Future research should focus on the relationships between staffing levels, nurse education and patient outcomes. Delineation of roles and guidelines for education, certification, licensure and staffing levels of transplant nurses are needed to support all nurses working at the fullest extent of their education and licensure. This consensus document provides such recommendations and draws attention to areas for future research.
Publisher: Wiley
Date: 30-09-2016
DOI: 10.1111/JOCN.13010
Abstract: To explore nurses' documentation of physiological observations in acute care emergency department, medical and surgical units. In Australia, physiological observations include respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness. There is a clear relationship between abnormal physiological observations and adverse events. Nurses have highest level of responsibility for accurate measurement, interpretation and documentation of physiological observations. A descriptive exploratory design was used and the study data were collected using a prospective point prevalence approach between 25 July 2012-22 August 2012. The study was conducted in the emergency department, two 30-bed medical units and one 30-bed surgical unit of a 578 bed public health service in Melbourne, Australia. All adult patients aged ≥18 years present during data collection periods were eligible for inclusion. Patients in the emergency department resuscitation area were excluded. Patient characteristics and physiological observations for the preceding 24 hours in ward patients or eight hours in emergency department patients were collected. One hundred and seventy-eight patients were included 38 emergency department patients, 84 medical patients and 56 surgical patients. The median age was 72·5 years and 43·8% were males. The most frequently documented physiological observations were respiratory rate, oxygen saturation, heart rate and systolic blood pressure. The least frequently recorded physiological observations were temperature and conscious state. One or more abnormal physiological parameters was documented in 79·8% (n = 142) patients evidence of reporting abnormalities was documented in 19·7% of patients (n = 28/142). When controlled for length of stay, physiological observations were more frequently documented in the emergency department. There was variability in the number of parameters documented and frequency of physiological observations documented by nurses. Physiological abnormalities that do not necessarily fulfil rapid response team activation criteria are common in acute care patients and provide nurses with an opportunity for early recognition of deteriorating patients.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.AUCC.2015.01.003
Abstract: Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.
Publisher: Wiley
Date: 13-10-2015
DOI: 10.1111/WVN.12115
Abstract: Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model a four-item efficiency model and a three-item knowledge model. In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.
No related grants have been discovered for Judy Currey.