ORCID Profile
0000-0001-5065-2726
Current Organisation
Deakin University
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Nursing | Clinical Nursing: Secondary (Acute Care) | Medical Devices | Computer Software | Preventive Medicine | Public Health and Health Services not elsewhere classified | Health Information Systems (incl. Surveillance) | Software Engineering
Nursing | Health and Support Services not elsewhere classified | Application Software Packages (excl. Computer Games) | Behaviour and Health | Integrated Circuits and Devices |
Publisher: Wiley
Date: 03-2010
DOI: 10.1111/J.1741-6787.2010.00185.X
Abstract: Given that changes in health care are now the norm, organizational change needs to be part of all nurses' curricula. Engaging students in learning how change happens by sharing real world ex les can make the learning meaningful for students and increase the likelihood that the knowledge will be applied to their practices.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2010
Abstract: A commonly recommended strategy for increasing research use in clinical practice is to identify barriers to change and then tailor interventions to overcome the identified barriers. In nursing, the BARRIERS scale has been used extensively to identify barriers to research utilization. The aim of this systematic review was to examine the state of knowledge resulting from use of the BARRIERS scale and to make recommendations about future use of the scale. The following objectives were addressed: To examine how the scale has been modified, to examine its psychometric properties, to determine the main barriers (and whether they varied over time and geographic locations), and to identify associations between nurses' reported barriers and reported research use. Medline (1991 to September 2009) and CINHAL (1991 to September 2009) were searched for published research, and ProQuest ® digital dissertations were searched for unpublished dissertations using the BARRIERS scale. Inclusion criteria were: studies using the BARRIERS scale in its entirety and where the s le was nurses. Two authors independently assessed the study quality and extracted the data. Descriptive and inferential statistics were used. Sixty-three studies were included, with most using a cross-sectional design. Not one study used the scale for tailoring interventions to overcome identified barriers. The main barriers reported were related to the setting, and the presentation of research findings. Overall, identified barriers were consistent over time and across geographic locations, despite varying s le size, response rate, study setting, and assessment of study quality. Few studies reported associations between reported research use and perceptions of barriers to research utilization. The BARRIERS scale is a nonspecific tool for identifying general barriers to research utilization. The scale is reliable as reflected in assessments of internal consistency. The validity of the scale, however, is doubtful. There is no evidence that it is a useful tool for planning implementation interventions. We recommend that no further descriptive studies using the BARRIERS scale be undertaken. Barriers need to be measured specific to the particular context of implementation and the intended evidence to be implemented.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.AUCC.2018.09.004
Abstract: The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO Twenty-four included studies reported varying methodologies, data collected, and medication management practices. Of these, 23 studies (95.8%) excluded patients with comorbidities commonly observed in clinical practice. This review identified low-level evidence for two practice recommendations: (i) concurrent administration of MgSO Although MgSO
Publisher: Wiley
Date: 24-11-2017
DOI: 10.1111/JOCN.13529
Abstract: To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients s led from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and prevention of delirium can contribute to improved patients safety and reduction in harm.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: John Wiley & Sons, Ltd
Date: 30-04-2013
Publisher: Wiley
Date: 03-09-2023
DOI: 10.1111/JOCN.16877
Publisher: Wiley
Date: 09-2009
Publisher: Wiley
Date: 25-07-2008
DOI: 10.1111/J.1365-2702.2008.02384.X
Abstract: This observational study sought to investigate the process of evidence use by health professionals during development of evidence-based clinical management tools. Studies conducted to explore the process of research use are scarce and knowledge of this process is essential for our understanding of the influences on research use in practice. A qualitative, non-participant, observational design. Behaviour and actions of two separate multidisciplinary teams were observed and audio-recorded during a combined total of seven meetings for the development of clinical management tools. Semi-structured, one-to-one interviews were conducted approximately half-way through the development process and following completion of the clinical management tools. Three major themes emerged from this research. First, the process of clinical management tool development and evidence use. Nurses assumed responsibility for coordination of development which focused on describing current practice. Second, the forms of evidence employed during the development process included the use of experiential knowledge, opinions and knowledge of the context, in addition to research evidence. However, reference to research evidence was limited and its incorporation into the instrument was infrequently observed. Third, the use of research evidence emerged with respect to how such evidence was employed. This study focused on real-life discussion and decision-making that occurred between health professionals when developing evidence-based clinical management tools. Health professionals may have a tendency to rely on their professional experience and current practice in preference to seeking and applying relevant research evidence. Nurses have an important role to play in the development of multidisciplinary evidence-based clinical management tools, but to actively participate in this process they need to be familiar with the relevant research evidence and have the skills and confidence to integrate the evidence into practice.
Publisher: Wiley
Date: 09-11-2018
DOI: 10.1111/HEX.12646
Publisher: BMJ
Date: 23-02-0007
DOI: 10.1136/BMJQS-2017-007292
Abstract: Meaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs. Describe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services. Naturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience s ling, a stratified s le of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing erse participation preferences: active control where the patient makes decisions shared control where the patient prefers to make decisions jointly with clinicians and passive control where the patient prefers clinicians make decisions. Of the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients’ participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity , that contributed to patient participation or non-participation in ward rounds. Participation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.IJMEDINF.2021.104654
Abstract: Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.
Publisher: SAGE Publications
Date: 03-08-2018
Abstract: In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging. The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting. The design is a qualitative descriptive design using semi-structured in idual and group interviews. This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited. Participants were interviewed using a conversational approach, guided by an ‘aide memoire’. A total of 19 clinicians participated in this study, with 12 interviewed in idually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying. Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.
Publisher: Wiley
Date: 06-04-2018
DOI: 10.1111/JOCN.14293
Abstract: To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes. Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of in iduals who provide continence care may help bridge the gap between evidence and practice. A qualitative exploratory descriptive design. Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes. Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively. The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological and biomedical research about incontinence, research about the fundamental elements of care, care-dependent in iduals' expectations about care, and values about dignity and care. The in-depth exploration led to an understanding of the basis for continence care practices that centre on cleaning, containing and concealing residents' incontinence in some nursing homes. There is a need to review the quality of education for the aged care workforce about incontinence to ensure it equips them with a broad understanding of the fundamentals of care and how to enact dignity in continence care through a resident-centred approach.
Publisher: Wiley
Date: 18-01-2023
DOI: 10.1111/JOCN.16627
Abstract: To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID‐19 pandemic. To minimise the transmission of COVID‐19, stringent infection prevention and control measures resulted in restricted hospital access for non‐essential workers and visitors, creating challenges for the provision of family‐centred care at the end of life. Qualitative descriptive approach based on naturalistic inquiry. At a large public hospital in Melbourne, Australia, in idual semi‐structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID‐19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting. Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements (ii) nurse‐family communication (iii) family‐centred care and interrupted connections (iv) well‐being and negative emotions and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy. Negative consequences for communication and the patient‐family connection at the end of life were felt deeply. The evolving COVID‐19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply. Technology‐facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family‐centred approach to care and emphasising the patient‐family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies. Bereaved family members contributed their first‐hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2010
Publisher: Elsevier BV
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 28-09-2015
Publisher: Maad Rayan Publishing Company
Date: 28-01-2016
Publisher: Wiley
Date: 02-03-2018
DOI: 10.1111/JOCN.14202
Abstract: To investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system. Delay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients' perspectives into account. Qualitative exploratory descriptive design was used. Purposive s ling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data. All patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system. Patient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns. Clinicians must promote a collaborative relationship and encourage patients to communicate their concerns. Given the perceived barriers to patient and family activated escalation systems use, resources being employed for their implementation could be redistributed to other areas of patient safety.
Publisher: Wiley
Date: 12-2010
Publisher: Springer Science and Business Media LLC
Date: 06-08-2019
Publisher: Springer Science and Business Media LLC
Date: 16-06-2010
Publisher: Springer Science and Business Media LLC
Date: 08-02-2017
Publisher: Springer Science and Business Media LLC
Date: 09-06-2015
Publisher: Wiley
Date: 07-07-2022
DOI: 10.1111/JAN.15351
Abstract: Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes. Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital. A multi‐method qualitative study informed by frameworks of behaviour change and human‐centred co‐design. The purposive s le included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human‐centred co‐design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis. Analysis revealed a 5‐step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care (2) tailor care to the in idual and (3) see the big picture for the patient. The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
Publisher: Oxford University Press (OUP)
Date: 17-04-2017
Abstract: Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan's traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan's traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful s le of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care and the prospective adoption of the 'four harmonious friends' as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management unilateral decision-making the legitimization of karmic beliefs differential treatment of patients and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan's traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan's hospitals. Such a model must entail the institution of an 'indigenized' patient safety program, with patient safety research and reporting systems framed around local patient safety concerns and solutions, including religious and cultural concepts, values and perspectives.
Publisher: SAGE Publications
Date: 14-11-2019
Abstract: Researchers have shown beneficial influences of exclusive breastfeeding for women and infants. Therefore, the World Health Organization recommends exclusively breastfeeding infants for the first 6 months following birth. In Bhutan, researchers have found, through survey research, variable exclusive breastfeeding rates at 6 months. They have not, however, explored the experiences and views of participants in relation to breastfeeding. The aim was to explore first-time mothers’ views, intentions, and experiences related to exclusive breastfeeding. A qualitative, prospective, longitudinal, descriptive study was undertaken using semistructured, audio-recorded interviews at two points of time with first-time mothers prenatally during late third trimester ( n = 24) and at 6 weeks after birth ( n = 22). The framework approach to analysis was used to identify themes. Two themes (breastfeeding, but uncertainty about achieving exclusive breastfeeding and acceptance that breastfeeding is painful) were identified from interviews at term. Five themes were identified from interviews at 6 weeks after birth (lack of timely breastfeeding information and support from health professionals, misconceptions about exclusive breastfeeding, being unprepared for the reality of breastfeeding, limited control or choice over feeding, and adoption of cultural and traditional practices). The participants breastfed but did not practice exclusive breastfeeding due to a lack of timely breastfeeding information and inadequate breastfeeding support. While family elders supported breastfeeding, they also promoted the adoption of certain traditional and cultural practices, which affected exclusive breastfeeding.
Publisher: Wiley
Date: 06-03-2019
DOI: 10.1111/JAN.13963
Abstract: To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings. Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. A descriptive exploratory study design. Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty facilitating, framing and filtering information managing interruptions and knowing and involving patients. Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2016
Publisher: Longwoods Publishing
Date: 17-11-2009
Publisher: Wiley
Date: 07-06-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-12-2017
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JOCN.16810
Abstract: To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24‐h periods within the same week were audited at three time points: pre‐intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post‐intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi‐square test. A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre‐Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre‐Medical Emergency Team ( n = 2403) or Medical Emergency Team triggers ( n = 273). One or more nursing interventions were documented in 29.5% of audits with pre‐Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under‐recognised element of the organisational response to deteriorating patients. Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. No Patient or Public Contribution.
Publisher: Wiley
Date: 21-04-2019
DOI: 10.1111/JOCN.14874
Abstract: (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. Three-stage, mixed-methods, process and outcome evaluation. The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience s le of nurses observed during delivery of 80.5 hr of care to 38 patients the App (n = 32 patients) and in idual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. The App included three components: cognition and risk assessment tailored evidence-based strategies and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. Co-development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real-time access to assessment tools and tailored knowledge supported nurses' clinical decision-making workload and unfamiliarity were barriers to use.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.NEDT.2016.01.012
Abstract: Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills. To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations. Pilot study using an observational design. Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived) participant perceptions of feedback methods and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback. Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings. The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve visual-field synchronisation with participants' actual visual field, is recommended to further explore this technology for enhancing student performance.
Publisher: Wiley
Date: 28-08-2020
DOI: 10.1111/JOCN.15447
Publisher: Elsevier BV
Date: 05-2021
Publisher: Springer Science and Business Media LLC
Date: 18-05-2008
Publisher: SAGE Publications
Date: 28-07-2017
Abstract: This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) ‘Who is taking care of what? Trying to work together” (2) ‘Falling short of the mark’ (3) ‘A proper discharge’ and (4) ‘You adjust somehow.’ The themes that emerged from the studies reflected users’ experience of discharge and transitional care as a social process of ‘negotiation and navigation of independence (older people/carers), or dependence (health providers).’ Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users’ experiences of negotiation and navigation of independence/dependence.
Publisher: JMIR Publications Inc.
Date: 26-07-2022
DOI: 10.2196/39596
Abstract: Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. This qualitative descriptive study used focus group and in idual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional ide captured nurses’ feelings of ision related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as in iduals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
Publisher: Informa UK Limited
Date: 14-06-2021
Publisher: Springer Science and Business Media LLC
Date: 10-08-2009
Publisher: Springer Science and Business Media LLC
Date: 11-08-2009
Publisher: Wiley
Date: 21-06-2017
DOI: 10.1111/SCS.12355
Abstract: People with chronic kidney disease (CKD) face various problems including psychological, socioeconomic and physical effects associated with CKD and its treatment. They need to develop strategies to help them cope with CKD and life challenges. Religion and spirituality are important coping strategies, but their role in helping people cope with CKD and haemodialysis (HD) in Thailand is relatively unknown. To investigate the role of religion and spirituality in coping with CKD and its treatment in Thailand. An exploratory, qualitative approach was undertaken using semistructured in idual interviews. Purposive s ling was used to recruit participants. Face-to-face, in-depth in idual interviews using open questions were conducted during January and February 2012. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the framework method of qualitative data analysis. Twenty people receiving HD participated: age range 23-77 years, mean 53.7 (±16.38 SD). Ten were women. Participants reported use of religious and spiritual practices to cope with CKD and its treatment, including religious and spiritual explanations for developing CKD, karmic disease, making merit, reading Dharma books, praying and chanting to save life and making a vow to Pran-Boon. Religion and spirituality provide powerful coping strategies that can help Thai people with CKD overcome the associated distress and difficulties. Religion and spirituality cannot be separated in Thai culture because Thai people are both religious and spiritual.
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2018-022788
Abstract: To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan’s healthcare system. Qualitative exploratory descriptive inquiry. Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan. In total, 140 healthcare professionals and managers. Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies. The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting ‘good’ communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system. Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised.
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-055847
Abstract: Electronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being? The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope (2) developing initial program theories (3) searching the evidence (4) selecting and appraising the evidence (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. CRD42020131875.
Publisher: Springer Science and Business Media LLC
Date: 22-05-2019
Publisher: Wiley
Date: 04-06-2023
DOI: 10.1111/JOCN.16767
Abstract: To synthesise evidence about informal carers' (carers) experience of their support needs, facilitators and barriers regarding transitional care of older adults with multimorbidity. Carers provide crucial support for older adults during care transitions. Although health practitioners are well positioned to support carers, system factors including limited healthcare resources can compromise the quality of care transitions. Scoping review. Searches were undertaken of the published literature. Five databases were searched including MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane Library. Two reviewers independently screened articles to identify relevant studies. Studies were retrieved from January 2000 to July 2022. Data were extracted and tabulated for study characteristics, support needs, facilitators and barriers. Key themes and patterns were synthesised across the studies. Eighteen studies including N = 3174 participants were retrieved. Most studies ( n = 13) employed qualitative designs. Five studies used surveys. Carers reported their need to: be involved in coordinated discharge planning advocate and be involved in decision‐making and receive community‐based follow‐up. Carers described facilitators and barriers in four themes: (1) relationships with the older adult and health practitioners, (2) being involved in coordinated discharge planning (3) communication and information strategies and (4) community‐based follow‐up. Synthesis of themes across all studies resulted in the identification of five areas of research: carers' health literacy community‐based care carers' involvement in transitional care planning inpatient and community health practitioners' communication skills and culturally erse carers' experiences. The review highlights the importance of quality communication and relationships between carers, older adults, health practitioners and health organisations. Although information and education are important there is a need for further research to examine systems that support communication between carers, older adults and health practitioners and health literacy for all carers including culturally erse carers.
Publisher: Wiley
Date: 21-06-2019
DOI: 10.1111/JAN.14087
Abstract: The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. A qualitative descriptive study. This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen only some were interested in taking more control and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. There was significant ersity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. Little is known about patient preferences for participation in medication administration and hospital discharge planning. In idual patient understanding of and interest in participation in medication administration varies. In accordance with in idual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2018
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.IJNURSTU.2018.06.002
Abstract: Falls are a major problem for patients and hospitals, resulting in death, disability and increased costs of healthcare. This study aimed to estimate the resource allocation across a partnership of large health services, in an attempt to understand the amount and variability of resource allocation to various falls prevention activities. A cross sectional survey using semi-structured interviews. Six tertiary health services in Australia. A collaboration of six health services, spanning twenty-eight hospitals, was formed to investigate falls prevention resource allocation. We interviewed 186 health service staff who were involved in falls prevention activities, such as projects, audits and risk management, clinical and operational managers responsible for falls prevention resource allocation and clinical staff on targeted acute, subacute and mental health wards. This study used a mixed methods, cross sectional, observational design. To collect data, we used key informant interviews with a purposive and snowball s led group of people working in the included health services. During interviews, study participants were asked where and how falls prevention resources and equipment were utilised and to estimate the time allocated to performing falls prevention activities. The opportunity cost of each activity was estimated. All costs were reported in Australian dollars. We estimate the annual opportunity cost of health service attempts to prevent in-hospital falls across the six health services to be AU$46,478,014. If we extrapolate this to a national level, health services would be consuming AU$590 million per year in resources trying to prevent falls in hospital. The areas of greatest resource consumption were physiotherapy (18%), continuous patient observers (14%), falls assessments (12%) and screens (8%), and falls prevention alarms (11%). Falls prevention alarms and falls risk assessment screening tools were also used only for falls prevention, and are potentially ineffective falls prevention strategies. Health services are investing considerable amounts of resource in attempting to prevent falls. However much of this resource is consumed in activities with weak or little evidence of effectiveness. Health services may be better served by considering tighter targeting, reduction or disinvestment in this area. This may release time and resources which could be used to provide interventions with a stronger evidence base, such as patient education using a structured patient education program or in other areas of practice where evidence of benefit exist.
Publisher: Wiley
Date: 07-05-2021
DOI: 10.1111/NHS.12844
Abstract: Nurses' awareness and acceptance of their professional responsibilities across the full breadth of safety and quality‐related practices and behaviors are critical for high quality healthcare delivery. The purpose of this study was to develop and psychometrically test a new instrument to measure nurses' perceptions of their responsibilities related to healthcare quality. Participants were registered nurses, enrolled in a postgraduate program at an Australian university, who completed the Likert scale instrument with items developed from nurses' professional practice standards. Steps of pilot testing, item reduction, and confirmatory factor analysis resulted in a five‐subscale, 55‐item instrument with acceptable goodness‐of‐fit indices and good internal consistency reliability. Test–retest reliability demonstrated acceptable temporal stability. The Nurses Responsibilities in Healthcare Quality Questionnaire demonstrated acceptable validity and reliability. The instrument may assist education providers and health service managers to identify gaps between nurses' beliefs and professional role expectations, and evaluate the impact of educational and clinical initiatives designed to develop nurses' knowledge, skills, and attitudes related to healthcare quality.
Publisher: Wiley
Date: 23-07-2007
DOI: 10.1111/J.1365-2753.2006.00743.X
Abstract: To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore. A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005. Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals. Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented. The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records. This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2019
Publisher: Hindawi Limited
Date: 10-2010
DOI: 10.1111/J.1365-2834.2010.01164.X
Abstract: To explore the nurse's role in the process of medication management and identify the challenges associated with safe medication management in contemporary clinical practice. Medication errors have been a long-standing factor affecting consumer safety. The nursing profession has been identified as essential to the promotion of patient safety. A review of literature on medication errors and the use of electronic prescribing in medication errors. Medication management requires a multidisciplinary approach and interdisciplinary communication is essential to reduce medication errors. Information technologies can help to reduce some medication errors through eradication of transcription and dosing errors. Nurses must play a major role in the design of computerized medication systems to ensure a smooth transition to such as system. The nurses' roles in medication management cannot be over-emphasized. This is particularly true when designing a computerized medication system. The adoption of safety measures during decision making that parallel those of the aviation industry safety procedures can provide some strategies to prevent medication error. Innovations in information technology offer potential mechanisms to avert adverse events in medication management for nurses.
Publisher: Wiley
Date: 12-2009
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2019-031831
Abstract: This study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP). This is a qualitative exploratory study using semistructured interviews. This study was conducted in a large metropolitan public healthcare organisation in urban Australia. Following purposive s ling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded. Eighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient’s carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions. Shared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients’ motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.
Publisher: Elsevier BV
Date: 02-2018
Publisher: Wiley
Date: 15-05-2014
DOI: 10.1111/JORC.12073
Abstract: Pain affects peoples' well-being and quality of life and is one of the most common symptoms experienced by people receiving haemodialysis (HD). To explore how Thai people receiving HD perceive pain, the effect of pain on their lives, and how they cope with and manage pain. Purposive s ling was used to recruit participants from two Thai outpatient haemodialysis facilities in Songkhla province. Face-to-face, in-depth in idual interviews using open-ended questions were conducted during January and February 2012. The interviews were audio-recorded and transcribed verbatim. Data were analysed using Ritchie and Spencer's Framework method. Twenty people receiving HD participated in the study: age range 23-77 years 10 were females. Three main types of pain emerged: physical pain, which occurred when needles were inserted during HD treatment and vascular access operations psychological pain due to unfulfilled hopes and dreams and changes in family roles and social pain. Perception of pain was influenced by the general populations' perceptions of chronic kidney disease. Participants used two main coping styles to manage pain: health-adjustment and health-behaviour styles. These two coping styles encompassed four specific coping strategies: religion, spirituality, accepting pain associated with HD treatment, and social support. Coping styles and strategies were influenced by Thai culture. The study elicited information that could help nursing staff understand how Thai people manage pain and the importance of cultural beliefs to their pain experience and coping strategies, which in turn can help nurses plan appropriate pain management.
Publisher: CSIRO Publishing
Date: 05-03-2019
DOI: 10.1071/AH18215
Abstract: Objective The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC’s Elements 1–5 were used to evaluate end-of-life care. Results Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P 0.0001). Conclusion There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC’s Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic? Acute care settings provide the majority of end-of-life care. Despite the ACSQHC’s Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add? There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural ersity. What are the implications for practitioners? The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.WOMBI.2019.07.003
Abstract: In Bhutan, exclusive breastfeeding is not routinely practised according to the World Health Organisation recommendation, thereby placing infants and women at increased risk of morbidity and mortality. Research indicates that support from midwives is positively associated with longer breastfeeding duration. Previously, no studies had been conducted in Bhutan to explore midwives' perceptions of the barriers to the promotion of exclusive breastfeeding. To explore midwives' perceptions of the barriers to promoting exclusive breastfeeding among Bhutanese women. A qualitative exploratory descriptive study design was used, involving in idual semi-structured audio-recorded interviews. The Framework approach was utilised for data analysis. Five themes emerged from a total of 26 interviews. The themes were: 'cultural and traditional practices', 'women's return to work', 'midwives' advice in response to breastfeeding problems', 'shortage of staff in a busy maternity service' and 'lack of professional development about breastfeeding'. Midwives reported that upholding Bhutanese cultural and traditional practices by women and their families was a powerful barrier to the promotion of exclusive breastfeeding. Midwives experienced difficulty in promoting exclusive breastfeeding among women in the immediate postnatal period during women's short hospital stay. A shortage of midwives, coupled with a lack of professional development about breastfeeding promotion and support, were additional barriers to the promotion of exclusive breastfeeding. The study findings highlight the need for continuing professional development of midwives in relation to exclusive breastfeeding. Additionally, a review of the midwifery workforce model is recommended, to ensure midwives have time to provide women with breastfeeding support.
Publisher: SAGE Publications
Date: 02-01-2018
Abstract: This article contributes to the growing body of literature on the methods and techniques that might be used to help ensure the cultural integrity and rigor of research that has a cross-cultural dimension. Drawing upon our experiences while conducting a study investigating patient safety concerns in Bhutan, we will reflect on how the study was conceptualized and framed around the elements of the Bhutanese traditional cultural values how the researchers were positioned and how the intercultural perceptions, representations, languages, and attitudes influenced the fieldwork processes. It is anticipated that the approach described in this article will help qualitative researchers to understand how important it is to recognize and be responsive to the cultural and linguistic nuances of given research settings to achieve cultural integrity.
Publisher: Public Library of Science (PLoS)
Date: 22-06-2015
Publisher: Wiley
Date: 28-11-2015
DOI: 10.1111/JAN.12574
Abstract: To conduct a concept analysis of clinical practice contexts (work environments) that facilitate or militate against the uptake of research evidence by healthcare professionals in clinical practice. This will involve developing a clear definition of context by describing its features, domains and defining characteristics. The context where clinical care is delivered influences that care. While research shows that context is important to knowledge translation (implementation), we lack conceptual clarity on what is context, which contextual factors probably modify the effect of knowledge translation interventions (and hence should be considered when designing interventions) and which contextual factors themselves could be targeted as part of a knowledge translation intervention (context modification). Concept analysis. The Walker and Avant concept analysis method, comprised of eight systematic steps, will be used: (1) concept selection (2) determination of aims (3) identification of uses of context (4) determination of defining attributes of context (5) identification/construction of a model case of context (6) identification/construction of additional cases of context (7) identification/construction of antecedents and consequences of context and (8) definition of empirical referents of context. This study is funded by the Canadian Institutes of Health Research (January 2014). This study will result in a much needed framework of context for knowledge translation, which identifies specific elements that, if assessed and used to tailor knowledge translation activities, will result in increased research use by nurses and other healthcare professionals in clinical practice, ultimately leading to better patient care.
Publisher: Wiley
Date: 15-07-2020
DOI: 10.1111/JNU.12269
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJNURSTU.2018.12.008
Abstract: Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors. To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after subacute care admission. This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study. Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services' acute care hospitals. All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded. Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect. There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on subacute care admission (median 45 vs 66, p < 0.001). Prior to transfer, fewer early transfers had a limitation of medical treatment order in place during their subacute care admission (25.9% vs 48.7%, p < 0.001). The majority of both early and late transfers resulted in acute care hospital readmission (85.1% vs 77.7%, p = 0.204). For patients admitted to acute care, there was no difference in median acute care length of stay (6.5 vs 8 days, p = 0.367). Early transfer patients had fewer in-hospital deaths than late transfer patients (3.8% vs 16.1%, p = 0.004). The high rates of acute care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of care on transfer decisions warrants further investigation.
Publisher: Wiley
Date: 09-06-2013
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AENJ.2017.08.001
Abstract: Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia. Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration.
Publisher: Maad Rayan Publishing Company
Date: 11-03-2020
Abstract: Partnerships have various purposes and exist in many configurations. Although there has been a refocusing in health system research on forming strategic partnerships between researchers and knowledge users (KUs) to maximise the relevance and uptake of research in practice research knowledge frequently fails to reach KUs nor impact the community served. Whilst there have been many attempts to engage KUs, researchers and decisionmakers often promote a top down approach that has lacked insight into KUs’ specific needs and values. Bowen and colleagues uncovered a plethora of negative experiences from a group of Canadian health leaders involved in researcher partnerships. Their comments reflect their experiences seemingly at an earlier stage of a partnership so we were not surprised by their pessimism. However, our experience reflects an established research-health service partnership network where we collaborate and co-create for mutual benefit and with a shared purpose. The reason for its sustained success over several decades is the focus on co-creation of value between stakeholders. Reimagining must prioritise a paradigm shift towards value co-creation if partnerships are to create opportunities for innovation, productivity and impact.
Publisher: Wiley
Date: 10-04-2009
Publisher: SAGE Publications
Date: 21-09-2018
Abstract: Trust has been identified as a vital value in the nurse–patient relationship. Although increasingly the subject of empirical inquiries, the specific processes used by nurses to foster trust in nurse–patient relationships with older immigrants of non-English speaking backgrounds hospitalised for end-of-life care have not been investigated. To explore and describe the specific processes that nurses use to foster trust and overcome possible cultural mistrust when caring for older immigrants of non-English speaking backgrounds hospitalised for end-of-life care. A qualitative descriptive approach was used. Twenty-two registered nurses were recruited from four metropolitan health services in Melbourne, Australia. Research approval was granted by the Human Research Ethics Committees of the host institution and four participating health services. Thematic analysis revealed that fostering trust encompassed the following three commensurate stages: establishing trust, strengthening trust and sustaining trust. Underpinning the successful achievement of these stages was the nurses’ moral commitment (reflected in their intentional, conscious and conscientious approach) to fostering trust as an essential ingredient of quality end-of-life care. This study has shown that while professional competencies are important to providing quality end-of-life care to older immigrant patients of non-English speaking backgrounds, it is a nurse’s moral commitment to fostering trust that may ultimately lay the foundations for a trusting quality care relationship to be established and sustained. This study has captured the processes used by nurses to foster trust as an essential element of quality end-of-life care in older immigrants. The characteristics of trust and the different factors influencing its expression in erse cultural contexts are, however, under-researched. Accordingly, gaps remain in the knowledge and understanding of the specific cultural nuances and manifestations of trust across and within different cultures. This is an area that is germane to further cross-cultural and international collaborative scholarly inquiry and research.
Publisher: Wiley
Date: 10-04-2009
Publisher: Wiley
Date: 03-08-2202
DOI: 10.1111/SDI.12909
Publisher: Wiley
Date: 30-03-2020
DOI: 10.1002/NAU.24343
Publisher: Wiley
Date: 28-01-2014
DOI: 10.1111/SDI.12194
Abstract: Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.
Publisher: Oxford University Press
Date: 11-2013
DOI: 10.1093/MED/9780199642656.003.0061
Abstract: Despite great strides in evidence-based pain assessment and management strategies, infants and children still experience acute pain (including multiple painful procedures) and chronic pain during hospitalization. Translating best evidence on pain assessment and management into clinical practice remains a challenge. The knowledge- or evidence-to-practice gap in pain in children can be addressed by implementing strategies, underpinned by knowledge translation theories, frameworks, and models, to promote and sustain practice change. A range of factors related to the organizational context and in idual behaviour play a role in the adoption of new pain assessment and management practices.
Publisher: Elsevier BV
Date: 08-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Publisher: Elsevier BV
Date: 02-2019
Publisher: Wiley
Date: 14-01-2009
DOI: 10.1111/J.1365-2702.2007.02191.X
Abstract: To explore and explain nurses' use of readily available clinical information when deciding whether a patient is at risk of a critical event. Half of inpatients who suffer a cardiac arrest have documented but unacted upon clinical signs of deterioration in the 24 hours prior to the event. Nurses appear to be both misinterpreting and mismanaging the nursing-knowledge 'basics' such as heart rate, respiratory rate and oxygenation. Whilst many medical interventions originate from nurses, up to 26% of nurses' responses to abnormal signs result in delays of between one and three hours. A double system judgement analysis using Brunswik's lens model of cognition was undertaken with 245 Dutch, UK, Canadian and Australian acute care nurses. Nurses were asked to judge the likelihood of a critical event, 'at-risk' status, and whether they would intervene in response to 50 computer-presented clinical scenarios in which data on heart rate, systolic blood pressure, urine output, oxygen saturation, conscious level and oxygenation support were varied. Nurses were also presented with a protocol recommendation and also placed under time pressure for some of the scenarios. The ecological criterion was the predicted level of risk from the Modified Early Warning Score assessments of 232 UK acute care inpatients. Despite receiving identical information, nurses varied considerably in their risk assessments. The differences can be partly explained by variability in weightings given to information. Time and protocol recommendations were given more weighting than clinical information for key dichotomous choices such as classifying a patient as 'at risk' and deciding to intervene. Nurses' weighting of cues did not mirror the same information's contribution to risk in real patients. Nurses synthesized information in non-linear ways that contributed little to decisional accuracy. The low-moderate achievement (R(a)) statistics suggests that nurses' assessments of risk were largely inaccurate these assessments were applied consistently among 'patients' (scenarios). Critical care experience was statistically associated with estimates of risk, but not with the decision to intervene. Nurses overestimated the risk and the need to intervene in simulated paper patients at risk of a critical event. This average response masked considerable variation in risk predictions, the need for action and the weighting afforded to the information they had available to them. Nurses did not make use of the linear reasoning required for accurate risk predictions in this task. They also failed to employ any unique knowledge that could be shown to make them more accurate. The influence of time pressure and protocol recommendations depended on the kind of judgement faced suggesting then that knowing more about the types of decisions nurses face may influence information use. Practice developers and educators need to pay attention to the quality of nurses' clinical experience as well as the quantity when developing judgement expertise in nurses. Intuitive unaided decision making in the assessment of risk may not be as accurate as supported decision making. Practice developers and educators should consider teaching nurses normative rules for revising probabilities (even subjective ones) such as Bayes' rule for diagnostic or assessment judgements and also that linear ways of thinking, in which decision support may help, may be useful for many choices that nurses face. Nursing needs to separate the rhetoric of 'holism' and 'expertise' from the science of predictive validity, accuracy and competence in judgement and decision making.
Publisher: Wiley
Date: 25-04-2017
DOI: 10.1111/JOCN.13710
Abstract: (1) To explore graduate nurses' perceptions of the influence of multisource feedback on their performance and (2) to explore perceptions of Clinical Nurse Educators involved in providing feedback regarding feasibility and benefit of the approach. Graduate registered nurses are expected to provide high-quality care for patients in demanding and unpredictable clinical environments. Receiving feedback is essential to their development. Performance appraisals are a common method used to provide feedback and typically involve a single source of feedback. Alternatively, multisource feedback allows the learner to gain insight into performance from a variety of perspectives. This study explores multisource feedback in an Australian setting within the graduate nurse context. Multimethod study. Eleven graduates were given structured performance feedback from four raters: Nurse Unit Manager, Clinical Nurse Educator, preceptor and a self-appraisal. Thirteen graduates received standard single-rater appraisals. Data regarding perceptions of feedback for both groups were obtained using a questionnaire. Semistructured interviews were conducted with nurses who received multisource feedback and the educators. In total, 94% (n = 15) of survey respondents perceived feedback was important during the graduate year. Four themes emerged from interviews: informal feedback, appropriateness of raters, elements of delivery and creating an appraisal process that is 'more real'. Multisource feedback was perceived as more beneficial compared to single-rater feedback. Educators saw value in multisource feedback however, perceived barriers were engaging raters and collating feedback. Some evidence exists to indicate that feedback from multiple sources is valued by graduates. Further research in a larger s le and with more experienced nurses is required. Evidence resulting from this study indicates that multisource feedback is valued by both graduates and educators and informs graduates' development and transition into the role. Thus, a multisource approach to feedback for graduate nurses should be considered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2006
DOI: 10.1097/00005110-200604000-00008
Abstract: The evidence-based practice movement has highlighted the importance of translating research evidence into practice. However, the gap between research and practice points to the existence of significant barriers to research use. To identify the most commonly cited barriers to the use of research in practice, the findings arising from studies that used the Barriers to Research Utilization Scale are examined. Based on these findings, the authors discuss and make recommendations to assist nurse administrators in overcoming universally reported barriers to research use.
Publisher: Elsevier BV
Date: 03-2023
DOI: 10.1016/J.AUCC.2021.12.006
Abstract: The population worldwide is rapidly ageing, and demand for intensive care is increasing. People aged 85 years and above, known as the oldest old, are particularly vulnerable to critical illness owing to the physiological effects of ageing. Evidence surrounding admission of the oldest old to the intensive care is limited. The objective of this study was to systematically and comprehensively review and synthesise the published research investigating factors that influence decisions to admit the oldest old to the intensive care unit. This was a systematic review and narrative synthesis. Following a comprehensive search of CINAHL, Embase, and Medline databases, peer-reviewed primary research articles examining factors associated with admission or refusal to admit the oldest old to intensive care were selected. Data were extracted into tables and narratively synthesised. Six studies met the inclusion criteria. Three studies identified factors associated with admission such as greater premorbid self-sufficiency, patient preferences, alignment between patient and physicians' goals of treatment, age less than 85 years, and absence of cancer, or previous intensive care admission. Factors associated with refusal to admit were identified in all six studies and included limited or no bed availability, level of ICU physician experience, patients being deemed too ill or too well to benefit, and older age. Published research investigating decision-making about admission or refusal to admit the oldest old to the intensive care unit is scant. The ageing population and increasing demand for intensive care unit resources has lified the need for greater understanding of factors that influence decisions to admit or refuse admission of the oldest old to the intensive care unit. Such knowledge may inform guidelines regarding complex practice decisions about admission of the oldest old to an intensive care unit. Such guidelines would ensure the specialty needs of this population are considered and would reduce admission decisions that might disadvantage older people.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16265
Abstract: Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to in idual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.
Publisher: Wiley
Date: 10-01-2012
Publisher: SAGE Publications
Date: 07-07-2016
Abstract: Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful s le of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by “doing the ground work,” “facilitating families,” “fostering trust,” and “allaying fear.” Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a “good death” at the end of their lives requires highly nuanced and culturally informed nursing care.
Publisher: Informa UK Limited
Date: 06-05-2016
DOI: 10.1080/10376178.2016.1192953
Abstract: Death anxiety is a known phenomenon in older people of culturally and linguistically erse backgrounds (CALD) hospitalised for end-of-life (EOL) care . Little is known about how nurses assuage death anxiety in this population. To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care. Advanced as a qualitative descriptive inquiry, a purposeful s le of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes. Nurses used three key strategies: recognising death anxiety delineating its dimensions and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used. Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15202
Abstract: Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to in idual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
Publisher: Oxford University Press (OUP)
Date: 20-06-2019
Abstract: To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. Prospective case-time-control study. Acute and subacute healthcare facilities from five health services in Victoria, Australia. Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and rapid response team calls during their entire hospital admission. Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.
Publisher: SAGE Publications
Date: 06-2006
DOI: 10.1345/APH.1G677
Abstract: Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes. In assessing the ability of patients to self-medicate, health professionals can identify areas in which patients need assistance, education, and intervention to optimize their health outcomes after discharge. To develop and validate a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized. Past research enabled us to develop the Self-Administration of Medication (SAM) tool. Using a Delphi technique of 3 rounds, a panel of expert health professionals established the content validity of the tool. For determining level of agreement in using the SAM tool, 56 patients were selected for each patient, 2 randomly selected nurses completed an assessment. Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other validated scales. The 29-item SAM tool had high content validity scores for clarity, representation, and comprehensiveness, with content validity index values ranging from 0.95–1.0. In testing the level of agreement between 2 nurses, out of 43 valid cases, 95.3% of nurses overwhelmingly agreed about the patients’ competence to self-administer their drugs. The intraclass correlation coefficient was 0.819 (95% Cl 0.666 to 0.902). Internal consistency for the SAM tool was high, with a Cronbach's alpha of 0.899. A moderate to strong correlation was obtained when comparing the SAM tool with other validated measures. The SAM tool is valid and reliable for quantifying patients’ ability to manage their regularly scheduled medications in the hospital setting.
Publisher: Wiley
Date: 31-07-2018
DOI: 10.1111/JORC.12257
Abstract: Despite sexual dysfunction (SD) being common among, and affecting quality of life in people with end-stage kidney disease (ESKD) receiving dialysis, sexuality is not a subject that patients and nephrology nurses usually discuss. To explore Thai nephrology nurses' perceptions about discussing sexual health issues with patients receiving dialysis. A phenomenological approach was applied and data were collected using semi-structured in idual interviews. Purposive s ling was used to recruit 20 participants from four Southern regional hospitals in Thailand between April and June 2016. Recruitment continued until data saturation was reached. Data were analysed using Colaizzi's method. Participants were aged between 27 and 53 years: mean 42.95 (±7.62 SD). Nineteen were female and sixteen were married. Five themes emerged: (1) improving knowledge in order to enhance confidence before discussing sexuality with patients (2) gaining patients' trust before discussing sexuality (3) finding an appropriate time to discuss sexuality (4) organising a suitable setting in which to discuss sexuality and (5) feelings of appreciation for helping patients and their partners overcome their sexual health issues. These findings provide an understanding of Thai nurses' perceptions about the challenges in communicating with patients experiencing ESKD regarding sexual health problems and concerns. The findings suggest that sexual health education and training would enhance the confidence of Thai nephrology nurses in initiating sexuality-related discussions with their patients.
Publisher: Scientific Research Publishing, Inc.
Date: 2019
Publisher: Wiley
Date: 22-04-2022
DOI: 10.1111/JAN.15269
Abstract: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Anonymous, online, cross‐sectional survey. The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) ( p = .024), and awareness of strategies for the eight‐factor framework ( p = .019) were significant enablers of comprehensive harm prevention. Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward.
Publisher: Wiley
Date: 31-01-2021
DOI: 10.1111/AJAG.12904
Abstract: To examine residential aged care (RAC) staff awareness of and engagement with dementia‐specific support services and education. A cross‐sectional survey of staff (n = 179) from 36 Victorian RAC facilities. 60% (n = 107) of respondents were aware of dementia‐specific support services, but only 27% (n = 48) accessed services in the previous 2 years. Approximately 77% (n = 137) were aware of dementia‐specific education, with 66% (n = 115) completing education in the previous 2 years. A significantly higher proportion of registered nurses had accessed dementia‐specific support services in the past 2 years compared with enrolled nurses and personal care assistants ( P 0.001). A relatively large proportion of RAC staff were unaware of available dementia‐specific support services and education. While approximately two thirds accessed such education, only one in four accessed dementia‐specific support services. To optimise the quality of care for people with dementia, strategies to increase awareness of and access to these resources are warranted.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2011
Publisher: Wiley
Date: 18-03-2016
DOI: 10.1111/JAN.12953
Abstract: To describe an integrative review protocol to analyse and synthesize peer-reviewed research evidence in relation to engagement of patients and their families in communication during transitions of care to, in and from acute care settings. Communication at transitions of care in acute care settings can be complex and challenging, with important information about patients not always clearly transferred between responsible healthcare providers. Involving patients and their families in communication during transitions of care may improve the transfer of clinical information and patient outcomes and prevent adverse events during hospitalization and following discharge. Recently, optimizing patient and family participation during care transitions has been acknowledged as central to the implementation of patient-centred care. Integrative review with potential for meta-analysis and application of framework synthesis. The review will evaluate and synthesize qualitative and quantitative research evidence identified through a systematic search. Primary studies will be selected according to inclusion criteria. Data collection, quality appraisal and analysis of the evidence will be conducted by at least two authors. Nine electronic databases (including CINAHL and Medline) will be searched. The search will be restricted to 10 years up to December 2013. Data analysis will include content and thematic analysis. The review will seek to identify all types of patient engagement activities employed during transitions of care communication. The review will identify enablers for and barriers to engagement for patients, families and health professionals. Key strategies and tools for improving patient engagement, clinical communication and promoting patient-centred care will be recommended based on findings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Wiley
Date: 21-04-2023
DOI: 10.1111/JOCN.16730
Abstract: To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well‐being. Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter‐personal interactions in healthcare settings. Multiple in idual and organisational‐level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. Five‐step realist review method and Realist And Meta‐narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre‐ and post‐technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery social supports skills implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well‐being. Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well‐being with the implementation of new technology into healthcare settings. Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. No patient or public contribution. CRD42020131875 ( www.crd.york.ac.uk rospero/display_record.php?RecordID=131875 ).
Publisher: Wiley
Date: 04-02-2020
DOI: 10.1111/JOCN.15125
Abstract: To examine the relationship between resuscitation status and (i) patient characteristics (ii) transfer characteristics and (iii) patient outcomes following an emergency inter-hospital transfer from a subacute to an acute care hospital. Patients who experience emergency inter-hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in-hospital mortality (15%). This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Data were extracted by medical record audit. Three resuscitation categories (full resuscitation limitation of medical treatment (LOMT) orders or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Resuscitation status was 63.5% full resuscitation 23.1% LOMT order and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute care and more likely to return to subacute care. Two-thirds of patients in subacute care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.
Publisher: SAGE Publications
Date: 13-12-2018
Abstract: Conducting research with dying persons can be controversial and challenging due to concerns for the vulnerability of the dying and the potential burden on those who participate with the possibility of little benefit. To conduct an integrative review to answer the question ‘What are dying persons’ perspectives or experiences of participating in research? A structured integrative review of the empirical literature was undertaken. Cumulative Index Nursing and Allied Health Complete, PsycINFO, MEDLINE, Informit and Embase databases were searched for the empirical literature published since inception of the databases until February 2017. From 2369 references, 10 papers were included in the review. Six were qualitative studies, and the remaining four were quantitative. Analysis revealed four themes: value of research, desire to help, expression of self and participation preferences. Dying persons value research participation, regarding their contribution as important, particularly if it provides an opportunity to help others. Participants perceived that the potential benefits of research can and should be measured in ways other than life prolongation or cure. Willingness to participate is influenced by study type or feature and degree of inconvenience. Understanding dying persons’ perspectives of research participation will enhance future care of dying persons. It is essential that researchers do not exclude dying persons from clinically relevant research due to their prognosis, fear or burden or perceived vulnerability. The dying should be afforded the opportunity to participate in research with the knowledge it may contribute to science and understanding and improve the care and treatment of others.
Publisher: Wiley
Date: 09-01-2023
DOI: 10.1002/NOP2.1578
Abstract: To examine patients' perceptions of care quality following a same‐day procedure in the cardiac catheterization laboratory and understand the extent to which they were prepared for discharge. Single‐centre, mixed‐methods study. Postdischarge, online survey of patients who underwent a same‐day procedure in the cardiac catheterization laboratory ( n = 150) and one‐on‐one interviews with 13 of these patients. Survey responses were positive with mean scores between 4.39–4.83 out of five and 63.3% of respondents ( n = 95) extremely likely to recommend the service to others. Interview data analysis identified three themes: the care experience, information and education for safe discharge, and follow‐up needs. Participants spoke highly of their interactions with clinicians and were satisfied with their care experience. Mode and content of information delivered varied, with some participants lacking guidance about postdischarge health management and clarity about follow‐up plans. Participants were patients.
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-021120
Abstract: There is a growing body of evidence to indicate that both primary and subsequent caesarean sections are associated with increased maternal and perinatal morbidity. Efforts to reduce the number of clinically unnecessary caesarean sections are urgently required. Our objective is to systematically review published evidence on the effectiveness of maternity service organisational interventions, such as models of maternity care, that aim to reduce caesarean section rates. Databases will be searched, including the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS. Search terms related to caesarean section and organisational intervention will be used. Research published before 1980 will be excluded and only randomised controlled trials, cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies will be included. Data extraction and quality assessments will be undertaken by two authors. Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences. CRD42016039458.
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/NHS.12930
Abstract: This study explored clinician perceptions of women's participation in decision‐making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi‐structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician‐led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision‐making about antiemetic treatments: (i) information gathering (ii) developing an understanding (iii) using knowledge and (iv) making decisions. Clinician attitudes and perspectives, as well as their self‐reported styles of communication and negotiation, influenced how they engaged with women during decision‐making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision‐making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician‐related barriers to shared decision‐making.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2011
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.IJNURSTU.2022.104178
Abstract: Harm prevention research has seldom considered the complex demands on nurses negotiating multiple interrelated factors that contribute to preventable harms common in hospitalized patients. Best practice guidelines are available for in idual risk factors, but few consider multiple factors that contribute to risk. As a consequence, duplication, contradiction, gaps, and volume of information limit harm prevention guideline use by nurses in daily practice. To systematically synthesise best-evidence recommendations from clinical practice guidelines to support nurses to deliver comprehensive harm prevention during acute hospitalization. An integrative review process was used to systematically identify, examine, evaluate and synthesise clinical nursing guidelines to prevent harm to hospitalized patients. The search strategy developed with an expert librarian used a combination of targeted searching for guidelines published on websites, and forward and backward citation searching. Guidelines included were those most recently published, relevant to the international nursing context, and addressing one or more of eight factors contributing to preventable harms. The AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence) tool was used for critical appraisal of guidelines regarding appropriateness to target users (i.e., nurses), trustworthiness, and implementable in acute hospitals. EndNote and NVIVO 12 were used to manage the high volume of extracted data and facilitate analysis. Analyses involved using the framework method to code data for relevance to an eight-factor harm prevention framework steps for inductive thematic analyses were used for synthesis. Iterations of the thematic model were refined by sharing with hospital patient safety experts, who endorsed the final model. 154 guidelines met inclusion criteria, providing 7,429 recommendations. Synthesis involved mapping of recommendations across the eight-factor framework that informed a hierarchy of risk for harm prevention activity. Six themes represented nursing care strategies across the eight-factors that could be integrated into local practice contexts. The themes are framed into a model for nurse comprehensive harm prevention. The complexity and volume of guidance for comprehensive harm prevention necessitates contemporaneous, integrated, and accessible guidance to support nurses' decision-making in their daily care provision. This research provides an integrated model to assist nurses to identify patients most vulnerable to multiple preventable harms during hospitalization and guide a comprehensive harm prevention strategy to keep them safe in hospital. Review of nursing guidelines generates integrated model to help identify patients most vulnerable to multiple preventable harms during hospitalization.
Publisher: Wiley
Date: 24-01-2019
DOI: 10.1002/HPM.2729
Abstract: The aim of the study was to explore what policies and guidelines related to patient safety have been developed and operationalized in the Bhutanese healthcare system. The study was conducted as a qualitative exploratory descriptive inquiry using policy and guidelines document review/analysis. Quality care and patient safety policy and guidelines documents were manually collected from the Ministry of Health and three different levels of hospitals (national referral, regional referral, and district hospitals) and reviewed. All data were analyzed using content analysis strategies, and their presentation organized according to the policy statement and/or clause/excerpts on patient safety. The review revealed that the policy and guidance documents implemented in the Bhutanese healthcare system were developed as a minimum standard for quality assurance, not those of patient safety as such. The findings of this study reveal that Bhutan is in the middle of a paradigm shift-shifting from a conventional approach of quality assurance to a new paradigm of patient safety. The evidence obtained from this study suggests that the development of high-quality guidance documents is important to improve patient safety in the Bhutanese healthcare system.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2014
Publisher: Elsevier BV
Date: 02-2019
Publisher: BMJ
Date: 03-2017
Publisher: SAGE Publications
Date: 05-12-2013
Abstract: Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the ultimate purpose and significance of the research is unclear. In light of these considerations, it is contended that the notion of moral distress ought to be abandoned and that concerted attention be given to advancing inquiries that are more conducive to improving the quality and safety of moral decision-making, moral conduct and moral outcomes in nursing and healthcare domains.
Publisher: Wiley
Date: 14-09-2011
DOI: 10.1111/J.1755-6686.2011.00232.X
Abstract: Researchers have explored the experiences of patients on haemodialysis (HD) however, most studies do not include Thai patients. Thus, the way Thai patients experience and adapt to HD is unknown. To conduct a pilot study to explore how HD affects Thai patients with end stage renal disease (ESRD) and understand HD patients' perspectives about adapting to being dependant on HD. Data were collected using semi-structured interviews that focused on problems, feelings, thoughts, attitudes and ways of adapting to HD. Grounded theory (GT) method was selected to guide data collection and analysis. Five patients (age range 24-66 years mean 45.40 years mode = 24) participated in the study. Four main coping processes emerged during data analysis: planning, adjustment and avoidance, belief in religion and superstition and living with hope. In addition, the patients reported a range of adverse effects of HD including fluid restriction, fatigue, effects on sexual activity, altered body image, fear of dying, stress and depression and suicide. Thai patients with ESRD felt treatment, including HD, adversely affected their lives and required physical, psychological and social changes to enable them to cope. They reported use of a range of strategies to deal with the adverse effects.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2012
Publisher: Springer Science and Business Media LLC
Date: 13-09-2012
Abstract: This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information. Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.
Publisher: Wiley
Date: 15-10-2020
DOI: 10.1111/AJAG.12734
Publisher: Maad Rayan Publishing Company
Date: 05-2021
Abstract: Background: Context is recognized as important to successful knowledge translation (KT) in health settings. What is meant by context, however, is poorly understood. The purpose of the current study was to elicit tacit knowledge about what is perceived to constitute context by conducting interviews with a variety of health system stakeholders internationally so as to compile a comprehensive list of contextual attributes and their features relevant to KT in healthcare. Methods: A descriptive qualitative study design was used. Semi-structured interviews were conducted with health system stakeholders (change agents/KT specialists and KT researchers) in four countries: Australia, Canada, the United Kingdom, and the United States. Interview transcripts were analyzed using inductive thematic content analysis in four steps: (1) selection of utterances describing context, (2) coding of features of context, (3) categorizing of features into attributes of context, (4) comparison of attributes and features by: country, KT experience, and role. Results: A total of 39 interviews were conducted. We identified 66 unique features of context, categorized into 16 attributes. One attribute, Facility Characteristics, was not represented in previously published KT frameworks. We found instances of all 16 attributes in the interviews irrespective of country, level of experience with KT, and primary role (change agent/KT specialist vs. KT researcher), revealing robustness and transferability of the attributes identified. We also identified 30 new context features (across 13 of the 16 attributes). Conclusion: The findings from this study represent an important advancement in the KT field we provide much needed conceptual clarity in context, which is essential to the development of common assessment tools to measure context to determine which context attributes and features are more or less important in different contexts for improving KT success.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2018
Publisher: Wiley
Date: 13-01-2016
DOI: 10.1111/SCS.12279
Abstract: Existing practice strategies for actively involving patients in care during hospitalisation are poorly understood. The aim of this study was to explore how healthcare professionals engaged patients in communication associated with care transitions. An instrumental, collective case study approach was used to generate empirical data about patient transitions in care. A purposive s le of key stakeholders representing (i) patients and their families (ii) hospital discharge planning team members and (iii) healthcare professionals was recruited in five Australian health services. In idual and group semi-structured interviews were conducted to elicit detailed explanations of patient engagement in transition planning. Interviews lasted between 30 and 60 minutes and were digitally recorded and transcribed verbatim. Data collection and analysis were conducted simultaneously and continued until saturation was achieved. Thematic analysis was undertaken. Five themes emerged as follows: (i) organisational commitment to patient engagement (ii) the influence of hierarchical culture and professional norms on patient engagement (iii) condoning in idual healthcare professionals' orientations and actions (iv) understanding and negotiating patient preferences and (v) enacting information sharing and communication strategies. Most themes illustrated how patient engagement was enabled however, barriers also existed. Our findings show that strong organisational and professional commitment to patient-centred care throughout the organisation was a consistent feature of health services that actively engaged patients in clinical communication. Understanding patients' needs and preferences and having both formal and informal strategies to engage patients in clinical communication were important in how this involvement occurred.
Publisher: Wiley
Date: 31-03-2020
DOI: 10.1111/JOCN.15236
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/303816
Abstract: Researchers strive to optimize data quality in order to ensure that study findings are valid and reliable. In this paper, we describe a data quality control program designed to maximize quality of survey data collected using computer-assisted personal interviews. The quality control program comprised three phases: (1) software development, (2) an interviewer quality control protocol, and (3) a data cleaning and processing protocol. To illustrate the value of the program, we assess its use in the Translating Research in Elder Care Study. We utilize data collected annually for two years from computer-assisted personal interviews with 3004 healthcare aides. Data quality was assessed using both survey and process data. Missing data and data errors were minimal. Mean and median values and standard deviations were within acceptable limits. Process data indicated that in only 3.4% and 4.0% of cases was the interviewer unable to conduct interviews in accordance with the details of the program. Interviewers’ perceptions of interview quality also significantly improved between Years 1 and 2. While this data quality control program was demanding in terms of time and resources, we found that the benefits clearly outweighed the effort required to achieve high-quality data.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2018
Publisher: Wiley
Date: 04-09-2019
DOI: 10.1111/JAN.14165
Abstract: To conduct a concept analysis of clinical practice contexts (work environments) in health care. Context is increasingly recognized as important to the development, delivery, and understanding of implementation strategies however, conceptual clarity about what comprises context is lacking. Modified Walker and Avant concept analysis comprised of five steps: (1) concept selection (2) determination of aims (3) identification of uses of context (4) determination of its defining attributes and (5) definition of its empirical referents. A wide range of databases were systematically searched from inception to August 2014. Empirical articles were included if a definition and/or attributes of context were reported. Theoretical articles were included if they reported a model, theory, or framework of context or where context was a component. Double independent screening and data extraction were conducted. Analysis was iterative, involving organizing and reorganizing until a framework of domains, attributes. and features of context emerged. We identified 15,972 references, of which 70 satisfied our inclusion criteria. In total, 201 unique features of context were identified, of these 89 were shared (reported in two or more studies). The 89 shared features were grouped into 21 attributes of context which were further categorized into six domains of context. This study resulted in a framework of domains, attributes and features of context. These attributes and features, if assessed and used to tailor implementation activities, hold promise for improved research implementation in clinical practice.
Publisher: Elsevier BV
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 11-07-2017
Publisher: Elsevier BV
Date: 05-2016
Publisher: Springer Science and Business Media LLC
Date: 19-05-2015
Start Date: 06-2013
End Date: 12-2016
Amount: $92,853.00
Funder: Australian Research Council
View Funded ActivityStart Date: 11-2012
End Date: 12-2018
Amount: $93,343.00
Funder: Australian Research Council
View Funded ActivityStart Date: 03-2018
End Date: 10-2023
Amount: $2,962,655.00
Funder: Australian Research Council
View Funded Activity