Nurses' Pain Management Decisions In The Post Surgery Context: A Naturalistic Study
Funder
National Health and Medical Research Council
Funding Amount
$56,368.00
Summary
In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and h ....In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and how much medication should be administered. Previous work has consistently shown that nurses do not administer adequate medication, which often results in poor pain control. Several nurse-related reasons have been proposed for poor pain management, including the fear of addiction, the fear of producing difficulties in breathing, and inadequate education about the medications administered. The focus of previous work has relied on examining small areas in isolation. Primarily, researchers have examined information on the drug order charts following patient discharge from hospital. They have also relied on analysing nurses' views on pain management relating to hypothetical patient situations. Overall, the research fails to address the multiple and interconnected factors faced by the nurse which could impact on pain management. Sources of these factors may be the patient, nurse, medication or environment. Examples of these factors include the presence or absence of the doctor, nurses' communication with doctors and other nurses about patient care, layout of the hospital ward, ward management structure, and methods used by the nurse to assess patient pain. By identifying the complex factors that impinge on decisions for managing pain, this study will provide opportunities to address the barriers that prevent adequate pain management. Nurses will then be in a position to change their practice in order to improve the management of patients' pain.Read moreRead less
Evaluating The Safety Of Computer Decision Support Systems In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$300,389.00
Summary
Use of clinical software has many benefits. However it is also likely that clinical software will introduce new computer-generated errors that may harm patients. This project will evaluate the safety of software for prescribing in general practice. We will firstly examine mechanisms for errors generated by clinical software on its own, and then in the hands of typical users. The outcomes will have broad potential to guide the regulation, use and design of clinical software in general practice.
IMPLORE - Implementing An Opioid Stewardship Intervention To Reduce Opioid Use
Funder
National Health and Medical Research Council
Funding Amount
$2,352,236.00
Summary
Back pain is the leading cause for opioid use globally. Guidelines actively discourage opioid use for this condition but unfortunately it commonly ends up managed with opioid medicines. Urgent efforts are needed to reduce the burden of harm associated with excessive prescribing of opioids for back pain. This trial will evaluate a clinical care model that is grounded in research, and designed to curb opioid analgesic use and achieve better health outcomes for people with back pain.
Whiplash injury incurs a huge health burden on Australia as many people do not recover well. This project aims to implement and evaluate a Clinical Pathway of Care for whiplash injury that guides primary care providers in their assessment and treatment of people with acute whiplash. This will improve health ouctomes and recovery following the injury.
Development And Evaluation Of A Decision Aid For Women With A Breech-presenting Baby.
Funder
National Health and Medical Research Council
Funding Amount
$156,890.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby ( ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby (bottom rather than head first) in late pregnancy. A decision aid for breech presentation is timely because recent results of an international trial have dramatically altered women's options in the management of breech presentation. The trial of vaginal breech birth versus planned caesarean section (CS) found overwhelming evidence of reduced infant death and disability for women with a planned CS. Planned CS is now considered best practice for delivery of a breech presentation at birth. However, another treatment option for women with a breech presentation is turning the breech to head first before birth (called external cephalic version, ECV). Each of these options (ECV or planned CS) has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The breech decision aid developed in this project will be based on the best and most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women to a treatment option that best suits them, taking ~20 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less
Improving Palliative Care For People After Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$96,653.00
Summary
Stroke is a leading cause of death, disability and is a symptom burden worldwide. It impacts patients and their families in various ways, including physical, emotional, social, and spiritual aspects. Stroke outcome is uncertain and decision making complex. To date, there is no integrated concept for palliative care in stroke that addresses the appropriate moment to start palliative care for stroke patients.
Implementation Of A Novel Clinical Pathway Of Care For Common Musculoskeletal Disorders In Primary Care.
Funder
National Health and Medical Research Council
Funding Amount
$1,525,730.00
Summary
This project provides a solution to the burden musculoskeletal disorders in Australia. We will implement a novel clinical pathway of care that uses simple questionnaires to determine whether people will recover simply or require complex care. If simple, we provide people and their healthcare practitioner with guideline-based information developed by our expert team. If complex, we refer them to an expert physiotherapist who can undertake more complex assessments and direct care appropriately.
Improving The Synthesis Of Medical Research: The Evidence Synthesis Taxonomy Initiative
Funder
National Health and Medical Research Council
Funding Amount
$645,205.00
Summary
People who make decisions regarding the health of individuals or a society need trustworthy information to support these decisions, whether they be about the effectiveness of a strategy, the burden of a disease, the accuracy of a medical investigation or the preferences and values of a population. To produce trustworthy evidence, we need to collate and synthesise all of the information available. This work will improve the science behind evidence synthesis and the quality of evidence synthesis.
Australian Predicting Infectious ComplicatioNs In Children With Cancer (PICNICC) Project
Funder
National Health and Medical Research Council
Funding Amount
$694,980.00
Summary
Children undergoing cancer treatment are at an increased risk of infection. This is managed by admission to hospital for antibiotics which can be a frightening experience for the child, disruptive for their family and expensive for the healthcare system. While many need admission, a proportion of patients can be safely managed at home with oral or intravenous antibiotics. This project aims to identify these children, so as to improve their quality of life, and decrease cost of treatment.
Improving Patient Management Pathways In Age-Related Macular Degeneration
Funder
National Health and Medical Research Council
Funding Amount
$181,065.00
Summary
Age related macular degeneration (AMD) is the most common cause of vision impairment in Australians aged over 50 years. In recent years, there have been a number of diagnostic tests and new interventions developed for AMD, but it has proven challenging to communicate this information to all primary eye care practitioners. This project will investigate the reasons management guidelines are not always being followed, and develop online training to provide direct bench-to-bedside AMD education.