ORCID Profile
0000-0002-4225-9120
Current Organisations
Sir Charles Gairdner Hospital
,
Curtin University
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Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16171
Abstract: Objective The aim of the present study was to provide a current snapshot of the body mass index (BMI) of the entire patient cohort of an Australian tertiary hospital on one day and compare these data with current published Australian and state (Western Australia) population norms. Methods A single-centre prospective point prevalence study was performed whereby BMI was calculated following actual measurement of patient weight (nurse) and height (physiotherapist) on one day during 2015. Variables were summarised descriptively, and one-way analysis of variance was used to investigate the relationship between continuous BMI and hospital speciality. Multivariate Cox proportional hazards regression was used to analyse the time to leaving hospital, where those who died were censored at their date of death. Results Data were collected from 416 patients (96% of the hospital population on that day). The mean (± s.e.m.) BMI across the whole hospital population was 26.6 ± 2.2 kg m–2, with 37% of patients having normal BMI, 8% being underweight, 32% being overweight, 19% being obese and 4% being severely obese. Comparison with both national and state population norms for 2014–15 reflected higher proportions of the hospital population in the underweight and extremely obese categories, and lower proportions in the overweight and obese categories. There was no significant difference in BMI across medical specialties. Conclusions Despite health warnings about the direct relationship between illness and being overweight or obese, the results of the present study reveal fewer hospitalised patients in these BMI categories and more underweight patients than in the non-hospitalised general Australian population. Being overweight or obese may offer some protection against hospitalisation, but there is a point where the deleterious effect of obesity results in more extremely obese in iduals being hospitalised than the proportion represented in the general population. What is known about the topic? Although there is significant current published data relating to general Australian population BMI, there is little pertaining specifically to the hospitalised population. Accordingly, although we know that as an affluent Western country we are seeing growing rates of overweight and obese people and relatively few underweight or undernourished people in the general population, we do not know whether these trends are mirrored or magnified in those who are sick in hospital. We also know that although caring for obese patients carries a significant burden, there is the suggestion in some healthcare literature of an ‘obesity paradox’, whereby in certain disease states being overweight actually decreases mortality and promotes a faster recovery from illness compared with underweight people, who have poorer outcomes. What does this paper add? This paper is the first of its kind to actually measure and calculate the BMI of a whole tertiary Australian hospital population and provide some comparison with published Australian norms. On average, the hospital cohort was overweight, with a mean (± s.e.m.) BMI of 26.6 ± 2.2 kg m–2, but less so than the general population, which had a mean BMI of 27.5 ± 0.2 kg m–2. The results also indicate that compared with state and national norms, underweight and extremely obese patients were over-represented in the hospitalised cohort, whereas overweight or obese patients were under-represented. What are the implications for practitioners? Although only a single-centre study, the case-mix and socioeconomic catchment area of the hospital evaluated in the present study suggest that it is a typical tertiary urban West Australian facility and, as such, there may be some implications for practitioners. Primarily, administrators need to ensure that we are able to accommodate people of increasing weight in our hospital facilities and have the resources with which to do so, because, on average, hospitalised patients were overweight. In addition, resources need to be available for managing the extremely obese if numbers in this subset of the population increase. Finally, practitioners may also need to consider that although the management of underweight and undernourished patients may be less of a physical burden, there are actually more of these patients in hospital compared with the general population, and they may require a different package of resource utilisation.
Publisher: Wiley
Date: 19-01-2021
DOI: 10.1111/NICC.12498
Abstract: The aim of this study was to see if a more sophisticated ventilator hyperinflation protocol might result in more sputum clearance compared to manual hyperinflation. Hyperinflation has been used to mobilize lung secretions in mechanically ventilated patients in the intensive care unit setting for almost 50 years. In the past decade, rather than using a bag external to the ventilator circuit to deliver hyperinflation (known as "bagging" or "manual hyperinflation"), a new technique has evolved using existing ventilator circuitry (known as "ventilator hyperinflation"). One conservative ventilator hyperinflation protocol has demonstrated equivalence with manual hyperinflation in sputum clearance. A randomized crossover study. Patients received manual hyperinflation and ventilator hyperinflation in two randomly ordered treatments on the same day by the same physiotherapist, using a ventilator hyperinflation protocol involving titration of hyperinflation according to airway pressure. Between 2013 and 2018, 48 patients were enrolled in the study. Physiotherapy treatment using ventilator hyperinflation yielded significantly more wet weight sputum (median 2.84 g, IQR 1.81, 4.22) than treatment using manual hyperinflation (median 1.5 g, IQR 0.73, 2.31, P < .001), without significant differences in secondary measures. A more sophisticated approach to the titration of the volume delivered using ventilator hyperinflation relative to the airway pressure resulted in greater wet weight sputum cleared during physiotherapy treatment. The results presented in this paper demonstrate that the application of ventilator hyperinflation using peak airway pressure rather than tidal volume may be superior in facilitating sputum clearance and improved oxygenation without patient harm.
Publisher: Future Medicine Ltd
Date: 06-2017
Abstract: Aim: To design a highly specific and sensitive multiplex real-time PCR assay for the differentiation of the pathogen Haemophilus influenzae from its nonpathogenic near-neighbor Haemophilus haemolyticus. Materials & methods: A comparison of 380 Haemophilus spp. genomes was used to identify loci specific for each species. Novel PCR assays targeting H. haemolyticus (hypD) and H. influenzae (siaT) were designed. Results & discussion: PCR screening across 143 isolates demonstrated 100% specificity for hypD and siaT. These two assays were multiplexed with the recently described fucP assay for further differentiation among H. influenzae. Conclusion: The triplex assay provides rapid, unambiguous, sensitive and highly specific genotyping results for the simultaneous detection of hypD and siaT, including fucose-positive H. influenzae (fucP), in a single PCR.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JCRC.2013.02.012
Abstract: This study aimed to report mortality, morbidity, and the relationship between these outcomes with physical function in patients who survived prolonged mechanical ventilation during an intensive care unit (ICU) admission. Records were reviewed for Western Australian residents admitted to an ICU in 2007 or 2008 who were ventilated for 7 days or longer and survived their acute care stay. Records were linked with data maintained by the Department of Health. A total of 181 patients (aged 52 ± 19 years) were included in this study. In the 12 months after discharge, 159 (88%) survived and 148 (82%) had been hospitalized. Compared with those who were ambulating independently when discharged from acute care, those who were not had more admissions (incident rate ratio, 1.81 95% confidence interval, 1.28-2.57) and a greater cumulative length of hospital stay (10 [37] vs 57 [115] days, P < .001) over the first 12 months after discharge. Time between admission to ICU and when the patient first stood correlated with the number of admissions (Rs = 0.320, P < .001) and cumulative length of stay (Rs = 0.426, P < .001) in the 12 months after discharge. For survivors of prolonged mechanical ventilation, physical function during acute care was associated with hospitalization over the following 12 months.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Springer International Publishing
Date: 2023
Publisher: Springer International Publishing
Date: 2023
Publisher: Scientific Research Publishing, Inc.
Date: 2016
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JCRC.2011.12.020
Abstract: The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge. A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood. A total of 190 patients were included. Before admission, 189 (99% 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47% 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge. After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-04-2019
DOI: 10.1097/SIH.0000000000000359
Abstract: Professional actors are often used to portray simulated patients during healthcare professional training. This study aimed to create an activity where physical therapy (PT) and theater arts (TA) students could address discrete learning outcomes in a common setting with mutual benefit. Mixed methods observational study of 246 university students (201 PT, 45 TA) undertaking a scenario involving the provision of a clinical history. All students completed a 5-question qualitative survey relating to the activity, and each group scored themselves and each other using an observer rubric rating performance from 1 (do not agree) to 10 (agree). For PT students, the range of means (SDs) across the five questions were significantly different ( P 0.001) with 6.2 (1.6) to 6.8 (1.4) for self-assessment and 8.2 (1.4) to 8.7 (1.1) for TA assessment of PT. For TA students, across all repetitions and all questions, the mean (SD) was 7.6 (1.5) for self-assessment and 7.9 (1.2) for PT assessment of TA, representing a significant difference ( P 0.001). After initial enactment, there was a significant improvement in TA self-assessment of performance ( P = 0.002), but thereafter, there was no significant difference over time ( P = 0.114). Qualitative data analysis revealed the following three themes common to both groups: worthiness, authenticity/realism, and anxiety/confidence. The PT students also identified history-taking skills and the importance of patient/PT relationships. The TA students identified learning around character portrayal, improvisation, and concentration. This study describes a simulation-based learning activity undertaken within existing infrastructure with complementary learning objectives for both TA and PT students that was realistic and engaging.
Publisher: Informa UK Limited
Date: 05-11-2012
DOI: 10.3109/09593985.2012.732196
Abstract: The purpose of this observational study was to assess Guillain-Barre´ syndrome (GBS) patients' satisfaction with physiotherapy in the acute and sub-acute setting, and provide an overview of inpatient case management, including the number of complications. Twenty-seven patients admitted to Sir Charles Gairdner Hospital (SCGH) with GBS between 1 May 2005 and 30 April 2010 were considered for inclusion. Nineteen patients consented and a waiver of consent was granted for four other patients. Data were collected from case-note audit (n = 23) and telephone survey (n = 19) during June and July 2011. Participants receiving physiotherapy (n = 16) reported they were satisfied with management (87%), treatment frequency (88%), duration (94%), and timetabling (81%) of treatment and the professionalism and rapport (100%) of physiotherapists. Median length of hospital stay was 20 days (range 5-198) for 23 participants. Physiotherapists documented patient assessment within 2 days from admission (range 1-5). First functional improvements were documented on day 6 (median, range 2-34). Physiotherapists were most commonly first to mobilize patients to sit, stand, transfer, and walk (83%, 82%, 81%, and 90%, respectively). Twenty patients (87%) developed complications during their hospital stay, the most common being low back pain (61%). This study has demonstrated that GBS patients were satisfied with care provided by physiotherapy.
Publisher: AACN Publishing
Date: 2015
DOI: 10.4037/AJCC2015761
Abstract: Estimates of the height of patients in the intensive care unit are required to adhere to clinical guidelines for drug dosages, ventilatory support, and nutrition. The gold standard of standing height cannot be used because these patients are often unconscious and recumbent. The ability of physiotherapists or dietitians to measure height in unconscious, recumbent patients has not been evaluated. To compare the accuracy of physicians, physiotherapists, and dietitians in estimating the height of recumbent critical care patients by using existing practice methods. A total of 35 patients were recruited from the cardiothoracic preadmission clinic, where standing height is routinely measured by a physiotherapist. After surgery, in the intensive care unit, 1 physician, 2 physiotherapists, and 2 dietitians measured each recumbent patient’s height. Three methods were used: observation, whole-body measurement, and height estimated by using length of the forearm and the British Association for Parenteral and Enteral Nutrition normative chart. Difference from standing height was measured from zero and was compared across professions and methods, with zero indicating no difference. Overall, 17 physicians, 4 dietitians, and 9 physiotherapists consented to measure patients. After adjustments for method, measurements by physiotherapists did not differ significantly from the gold standard (P = .59), whereas those of physicians (P = .02) and dietitians (P & .001) did. Physiotherapists’ measurements of supine height of recumbent critical care patients, obtained by using a nonrigid measuring tape, are more accurate than measurements obtained by physicians and dietitians.
Publisher: Wiley
Date: 28-02-2017
DOI: 10.1111/TCT.12620
Abstract: Simulation-based learning (SBL) activities in the health sciences provide students with opportunities to interact with realistic patients and environments. This study aimed to develop and then implement a novel activity using simulation for a large group of mostly millennial physiotherapy students, to enhance their ability to communicate with a challenging patient and to assess their motivation to learn. Students enrolled in a second-year communication unit were invited to participate in a non-compulsory unique SBL activity in groups of four for 40 minutes, undertaking two 5-minute simulation scenarios and two debriefing sessions. On completion of the activity, 140 students scored their motivation to learn during the activity using the Instructional Materials Motivation Scale (IMMS) questionnaire. Of the physiotherapy students enrolled in the unit, 83 per cent took part in the SBL and 100 per cent of the participants completed the follow-up survey. Mean scores for each subscale ranged from 3.8 to 4.0, reflecting that students agreed more than moderately with the statements made in the scale. The median total IMMS score for all students was 149, well above the published median total score of the scale (108). Simulation-based learning activities provide students with opportunities to interact with realistic patients and environments DISCUSSION: The SBL activity model was successfully implemented and received positively by the students in terms of their motivation to learn. It gained the attention of participants by providing an opportunity to practise the non-technical skill of 'communicating with patients', previously learned in the classroom, in a simulated realistic environment and by using a design that seemed to consider the needs of the millennial generation.
Publisher: Elsevier BV
Date: 2023
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.AUCC.2016.07.003
Abstract: To provide a snapshot of the prevalence of abnormal body mass index (BMI) in a s le of intensive care unit (ICU) patients to identify if any medical specialty was associated with abnormal BMI and to explore associations between BMI and ICU-related outcomes. Obesity is an escalating public health issue across developed nations but there is little data pertaining to critically ill patients who require care that is expensive. Retrospective observational audit of 735 adult patients (median age 58 years) admitted to the Sir Charles Gairdner Hospital 23 bed tertiary ICU between November 2012 and June 2014. Primary outcome measure was patient BMI: underweight (<18.5kg/m Compared to the general population there was a higher proportion of obese patients within the cohort with the majority of patients overweight (33.9%) or obese (36.5%) and median BMI of 27.9 (IQR 7.9). There were no significant differences between specialties for BMI (p=0.103) and abnormal BMI was not found to impact negatively on mortality (ICU, p=0.373 hospital, p=0.330). Normal BMI patients had shorter length of MV than other BMI categories and the impact of BMI on ICU LOS was dependent on length of MV. Overweight patients ventilated for five days or more had a shorter LOS, and extremely obese non-ventilated patients had a longer LOS, compared to normal weight patients. Although the obesity-disease relationship is increasingly complex and data presented reflects categorical BMI for patients admitted to a single ICU site it may be important to consider the cost implications of caring for this cohort especially with regard to MV and LOS.
Publisher: SAGE Publications
Date: 27-11-2022
DOI: 10.1177/10398562211047211
Abstract: The stressful nature of the intensive care unit (ICU) environment is increasingly well characterised. The aim of this paper was to explore modifiers, coping strategies and support pathways identified by experienced Intensivists, in response to these stressors. Prospective qualitative study employing interviews with Intensivists in two countries. Participants were asked how they mitigated their emotional responses to the stressors of the ICU. Audio-recordings were transcribed and analysed by all researchers who agreed upon emerging themes and subthemes. A wide range of strategies were reported. Although several participants had sought professional help and all supported its utility, few disclosed accessing such help to others indicating stigma. Many felt a sense of responsibility for the well-being of other staff but identified barriers that suggest alternate support pathways are required. Further implications of these findings to training considerations are described. Several approaches were described as regularly employed by Intensivists to mitigate ICU environmental stressors. Intensivists perceive themselves to have limited training to provide support to others they also perceive stigma in seeking professional help.
Publisher: Oxford University Press (OUP)
Date: 11-2021
Abstract: The hospital intensive care unit (ICU) environment encompasses sick patients who present for care in health crisis. Healthcare in this setting is complex, often involving the co-ordination of multiple professional teams, all under significant time pressures. The sequelae for staff interacting in this dynamic and often volatile setting are variable, depending upon their coping skillset and their familiarity with the stressors. The primary aim of this study was to describe and in doing so, normalize the behavioural responses expressed by ICU doctors (Intensivists) in response to stressful workplace events. The secondary aim was to identify those responses that contributed to resilience. A prospective qualitative study of senior Intensivists using a semi-scripted iterative interview. Data were transcribed and thematically analysed with verbatim quotations selected to support coding choices. Nineteen experienced Intensivists from three sites in Australia and Israel participated. Clinicians described conscious, physiological and professional responses to stressors, including sense-making and taking time to process information with appropriate support. Two of the most important mitigation processes revealed were the use of reflective learning and preventative practice changes to prevent future errors. These were overlaid with the importance of disclosure and transparency in clinical work. Repeated exposure to stressful events potentiates burnout, wherein staff no longer experience satisfaction and enjoyment in what they do. This paper presents the behavioural responses that experienced Intensivists described in relation to stressful events in the ICU, including steps taken to mitigate the effects of these events on their personal well-being.
Publisher: Jaypee Brothers Medical Publishing
Date: 2016
DOI: 10.5005/JP-JOURNALS-10028-1206
Abstract: The intensive care unit (ICU) is an acute area requiring significant expertise and training. This study aimed to see if a novel package of simulation training of physiotherapists in ICU physiotherapy competencies would promote confidence and be less stressful compared to traditional training. The secondary aim was to see if simulation training was less costly in terms of training time and whether additional support staff hours required. Fifteen physiotherapists participated in the study, with two trainee cohorts (traditional, n = 5 simulation, n = 5) and supervising staff (n = 5). A simulation training program was implemented over 6 half days during 2013/2014. All participants then completed follow-up questionnaires. Data were also collected relating to training costs and cost of support provided to the trainee on commencement of independent work in the ICU. Respondents reported that simulation was extremely useful ( 4.75) and likely to reduce stress and improve confidence ( 3.8). All training components were useful ( 3.4) with simulation trainees perceiving the highest usefulness (4—4.8). Simulation training took less time per trainee (mean 3 vs 4.4 days), and less trainer time (total 9 vs 22 days). Costs incurred during 1st week of independent work were similar. This study has demonstrated that the delivery of a novel package of simulation scenarios was successful in improving the confidence of inexperienced physiotherapists moving into the ICU setting. The mode of up-skilling was also less expensive compared to the existing training model. Simulation may be useful for other health professionals in the critical care environment. Dennis D, Marsh L. Can Physiotherapists be trained to Work in Critical Care utilizing Clinical Simulation? J Postgrad Med Edu Res 2016 (3):136-140.
Publisher: Wiley
Date: 10-11-2018
DOI: 10.1002/MSC.1219
Abstract: The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data to collect data around the development of BP throughout hospital admission and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS). This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner). Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89 95% confidence interval (CI) 3.0 to 11.6 p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days CI 10.8 to 15.3) than those who did not (median 10 days CI 8.4 to 11.6 p = 0.034). Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.
Publisher: University of Otago Library
Date: 04-08-2017
Publisher: Springer Science and Business Media LLC
Date: 20-02-2018
Publisher: Springer International Publishing
Date: 2023
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.ICCN.2016.02.002
Abstract: The Australian health survey (2011-2012) reported that 63.4% of Australian adults were overweight or obese. Critical care medicine is expensive, with intensive care unit (ICU) services accounting for a substantial proportion of total hospital costs. These costs may be multiplied in the overweight cohort. The primary aim was to compare the body mass index (BMI) of a critically ill ICU patient cohort to Australian population norms in order to see if overweight people were over-represented. The secondary aim was to identify if any medical specialty was associated with overweight patients. A retrospective observational case note audit of 230 ICU patients between November 2012 and August 2013, with BMI as the primary outcome measure. Approximately 75% of the cohort were overweight or obese (median BMI 28.7 IQR 25.0-32.7) representing a rate 12% higher than Australian normative data. Based on population, this equates to an estimated additional 5279 unanticipated overweight or obese ICU patients at our facility during 2013. This study has shown that Australian ICU patients may have higher BMI than those of the general Australian population, and therefore there may be unanticipated costs associated with their care. No medical specialty was associated with higher BMI than another.
Publisher: Springer International Publishing
Date: 2023
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2011.06.001
Abstract: Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise in iduals who survive a prolonged intensive care unit (ICU) admission. To measure the incidence of falls and describe the characteristics of fallers among intensive care survivors. A comprehensive retrospective chart review was undertaken of 190 adults who were intubated and ventilated for ≥ 168 h and survived their acute care stay. Using a standardised form, several variables were extracted including falls during hospitalisation and risk factors such as age, severity of illness, and length of stay in intensive care and hospital. Thirty-two (17%, 95% confidence interval 11.5-22.2%) patients fell at least once on the in-patient wards following their ICU stay. Compared with non-fallers, fallers were younger (53.2 ± 17.9 vs. 44.1 ± 18.3 years p=0.009) and had a shorter duration of inotropic support in ICU (84 ± 112 vs. 56 ± 100 h p=0.040). The majority of fallers were aged less than 65 years (84%). Both fallers and non-fallers had similar APACHE II scores (20 ± 8 vs. 21 ± 7 p=0.673), length of stay in intensive care (14.2 ± 8.7 vs. 14.0 ± 9.7 days p=0.667) and hospital length of stay (43.9 ± 33.1 vs. 41.0 ± 38.8 days p=0.533). Falling during hospitalisation is common in intensive care survivors. Compared with non-fallers, fallers were younger and required inotropes for a shorter duration. Those who survive a prolonged admission to an ICU may benefit from specific assessment of balance and falls risk by the multidisciplinary team.
Publisher: MDPI AG
Date: 08-04-2022
Abstract: (1) Background: Immersive simulation-based learning is relevant and effective in health care professional pre-licensure training. Peer-assisted learning has reciprocal benefit for the learner and the teacher. A fully simulated model of fieldwork placement has been utilised at Curtin University since 2014, historically employing full-time faculty supervisors. Due to the COVID-19 pandemic in 2020, traditional clinical placement availability diminished. (2) Methods: This mixed-methods prospective observational study aimed to translate the existing faculty-led placement for penultimate-year physiotherapy students to a peer-taught model, thereby creating new teaching placements for final-year students. Final- and penultimate-year physiotherapy students undertook the fully simulated fieldwork placement either as peer learners or peer teachers. The placement was then evaluated using four outcome measures: The ‘measure of quality of giving feedback scale’ (MQF) was used to assess peer learner satisfaction with peer-teacher supervision plus/delta reflections were provided by peer teachers and faculty supervisors student pass/fail rates for the penultimate-year physiotherapy students. (3) Results: For 10 weeks during November and December 2020, 195 students and 19 faculty participated in the placement. Mean MQF scores ranged from 6.4 (SD 0.86) to 6.8 (SD) out of 7 qualitative data reflected positive and negative aspects of the experience. There was a 4% fail rate for penultimate-year students for the placement. Results suggested that peer learners perceived peer-led feedback was of a high quality there were both positives and challenges experienced using the model. (4) Conclusions: Physiotherapy students effectively adopted a peer-taught fully simulated fieldwork placement model with minimal faculty supervision, and comparable clinical competency outcomes.
Publisher: Wiley
Date: 27-04-2016
DOI: 10.1111/JOCN.13190
Abstract: To assess the consistency and safety of manual hyperinflation delivery by nurses of variable clinical experience using a resuscitator bag during physiotherapy treatment. Manual hyperinflation involves the delivery of larger than normal gas volumes to intubated patients and is routinely used by nurses in collaboration with physiotherapists for the management of retained sputum. The aim is to deliver slow deep breaths with an inspiratory hold without unsafe airway pressures, lung volumes or haemodynamic changes. In addition, nursing staff should be able to 'feel' differences in resistance and adjust their technique accordingly. Prospective observational study utilising the simulation of a mechanically ventilated patient. Thirty-three nurses delivered manual hyperinflation to a SimMan3G mannequin who had three distinct lung scenarios applied (normal asthma Acute Respiratory Distress Syndrome) in randomised order during simulated physiotherapy treatment. Respiratory rate, tidal volume (Vt ), mean inspiratory flow rate (Vt /Ti), and peak airway pressure data were generated. Over all scenarios, mean respiratory rate = 12·3 breaths/minute, mean Vt = 638·6 mls, mean inflation time = 1·3 seconds and peak airway pressure exceeded 40 cm H2 O in 41% of breaths, although only in 10% of breaths during the 'normal' lung scenario. Experienced nurses were able to manually hyperinflate 'normal' patients in a simulated setting safely. Despite their knowledge of barotrauma, unsafe airway pressures were delivered in some scenarios. Training with regard to safe airway pressures, breath hold and adequate volumes is recommended for all nurses undertaking the procedure. Nurses and physiotherapists must closely monitor the patient's condition during manual hyperinflation thereby recognising changes with regard to lung compliance and airway resistance, with nurses responding by altering their technique. The addition of a pressure manometer in the circuit may improve patient safety when performing manual hyperinflation.
Publisher: Springer International Publishing
Date: 2023
No related grants have been discovered for Diane Dennis.