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.
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
A Randomised Controlled Trial Of A Decision Aid For The Management Of Pain In Labour And Childbirth
Funder
National Health and Medical Research Council
Funding Amount
$267,375.00
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 regarding the management of pai ....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 regarding the management of pain in labour and childbirth. A decision aid for managing the pain of childbirth is both practical and timely because there is a strong evidence base on labour analgesia but a lack of evidence-based information for women. For example, brochures on epidural analgesia outline the advantages of epidurals such as complete amelioration of pain, but do not present any information on adverse obstetric outcomes such as the doubling of risk for an instrumental birth. Most women are willing to experience pain in childbirth but do not want pain to overwhelm them. The decision aid will include a range of available drug and non-drug options for pain relief in labour and childbirth. Each of the options 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 pain management decision aid developed in this project will be based on the best most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women with their pain management options that best suit them, taking ~30 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
A Randomised Controlled Trial Of A Bowel Cancer Screening Decision Aid For Adults With Low Education And Literacy
Funder
National Health and Medical Research Council
Funding Amount
$237,277.00
Summary
The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information ....The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information has rapidly increased within healthcare. In particular, the use of patient decision aids to support and inform health decisions is rapidly increasing. The need to improve information in screening programs has been particularly highlighted and decision aids provide an evidence based approach to achieve this. However, whilst there is level 1 evidence that decision aids improve the decision making process for consumers, research has been carried out almost exclusively among educated participants with high literacy. There is concern that the needs of adults with low education and limited literacy have been ignored. The proposed study is 2 phased. Phase I will test optimal quantitative risk communication formats for adults with low education and literacy. Phase 2 will evaluate a tailored low literacy decision aid for FOBT screening. The trial will test whether the decision aid can increase knowledge of screening, increase involvement in decisions and improve the quality of decision making among adults with low education, and will examine its impact on screening intentions and behaviour. This is a highly significant study. Screening providers need better ways to inform consumers of screening programs that are accessible to a diverse audience and equitable across the target population. This study will have direct implications for use in the national bowel cancer screening program.Read moreRead less
Adolescent Population Health: Application Of Best-Worst Scaling Discrete Choice Experiments To Value Health States For Use In Economic Evaluation
Funder
National Health and Medical Research Council
Funding Amount
$178,779.00
Summary
Historically, economic evaluations of health care treatment and preventive programs developed for adolescents have failed to incorporate adolescent values about their preferred health outcomes. This project will apply a novel approach known as Best-Worst Scaling to ascertain adolescent specific values for health states for incorporation into economic evaluation, thereby enabling the views of adolescents to be incorporated directly into the health care priorities decision-making process.
How Consumers Negotiate Between Complementary And Conventional Health Systems - A Qualitative Study Of Depression
Funder
National Health and Medical Research Council
Funding Amount
$251,645.00
Summary
This project explores how people with depression negotiate their health care between the complementary and conventional health systems. We will interview consumers about their experiences and present these findings to focus groups of general practitioners, naturopaths and educators. Our findings will be used to assist in getting the best possible education and health policy for doctors, naturopaths and the community to ensure safe use of medicines.
Promoting Activity For Frail Aged In Post-acute Hospital Settings: A Randomised Controlled Trial Of Accelerometry
Funder
National Health and Medical Research Council
Funding Amount
$542,119.00
Summary
Keeping older people in hospital actively mobile is a vital objective of high quality aged care. Using accelerometers, the Centre for Research in Geriatric Medicine at the University of Queensland, and its partner, the CSIRO e-health Research Centre, are trialing a method of promoting activity in older rehabilitation patients. Potentially, a system of _activity management� could solve an age old problem in hospital care of older people.
Cancer Trials Australia-OnLine: A Tool For Cancer Patients To Find Open Clinical Trials And Consider Trial Participation
Funder
National Health and Medical Research Council
Funding Amount
$525,604.00
Summary
We will develop and evaluate a website for consumers which will interface with the ACTR to provide up to date information on currently recruiting cancer trials. Aims are: a) to increase awareness of cancer trials, and facilitate discussion between doctors and patients about participation in a clinical trial, and b) to support cancer consumers to make an informed decision about enrolling in a trial. A randomized trial will assess the effectiveness of the site in achieving these aims.