ORCID Profile
0000-0002-8467-0081
Current Organisations
Queensland University of Technology
,
Royal Brisbane and Women's Hospital
,
University of Queensland
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Nursing | Medicine, Nursing and Health Curriculum and Pedagogy | Nursing not elsewhere classified
ANZSRC Socio-Economic Objective (SEO)
Related Links
Publications
Direct quantification of leaf transpiration isotopic composition
Publisher: Elsevier BV
Date: 03-2012
Dew-induced transpiration suppression impacts the water and isotope balances of Colocasia leaves
Publisher: Springer Science and Business Media LLC
Date: 28-06-2018
DOI: 10.1007/S00442-018-4199-Y
Abstract: Foliar uptake of water from the surface of leaves is common when rainfall is scarce and non-meteoric water such as dew or fog is more abundant. However, many species in more mesic environments have hydrophobic leaves that do not allow the plant to uptake water. Unlike foliar uptake, all species can benefit from dew- or fog-induced transpiration suppression, but despite its ubiquity, transpiration suppression has so far never been quantified. Here, we investigate the effect of dew-induced transpiration suppression on the water balance and the isotope composition of leaves via a series of experiments. Characteristically, hydrophobic leaves of a tropical plant, Colocasia esculenta, are misted with isotopically enriched water to reproduce dew deposition. This species does not uptake water from the surface of its leaves. We measure leaf water isotopes and water potential and find that misted leaves exhibit a higher water potential and a more depleted water isotope composition than dry leaves, suggesting a ∼ 30% decrease in transpiration rate compared to control leaves. We propose three possible mechanisms governing the interaction of water droplets with leaf energy balance: increase in albedo from the presence of dew droplets, decrease in leaf temperature from the evaporation of dew, and local decrease in vapor pressure deficit. Comparing previous studies on foliar uptake to our results, we conclude that transpiration suppression has an effect of similar litude, yet opposite sign to foliar uptake on leaf water isotopes.
Lost in translation? Interpreting universal pressure injury prevention guidelines into a practical reference for intensive care
Publisher: Elsevier BV
Date: 03-2017
Interventions to meet the needs of family with a relative admitted to an adult critical care unit
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
A survey of safety culture in two Australian hospital tertiary hospital intensive care units: The SCATH-ICU study
Publisher: Elsevier BV
Date: 03-2017
Nursing care of the mechanically ventilated patient: What does the evidence say?. Part two
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.ICCN.2006.08.004
Abstract: The care of the mechanically ventilated patient is a fundamental component of a nurse's clinical practice in the intensive care unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly, yet is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient was explored with specific focus on patient safety: particularly patient and equipment assessment. This article, part two, examines the evidence related to the mechanically ventilated patient's comfort: patient position, hygiene, management of stressors (such as communication, sleep disturbance and isolation), pain management and sedation.
Reducing Pressure Injuries in Critically Ill Patients by Using a Patient Skin Integrity Care Bundle (Inspire)
Publisher: AACN Publishing
Date: 30-04-2015
DOI: 10.4037/AJCC2015930
Abstract: To test an interventional patient skin integrity bundle, the InSPiRE protocol, for reducing pressure injuries in critically ill patients in an Australian adult intensive care unit. Before and after design: patients receiving the intervention (InSPiRE protocol) were compared with a similar control group who received standard care. Data collected included demographic and clinical variables, skin assessment, presence and stage of pressure injuries, and score on the Sequential Organ Failure Assessment (SOFA). Overall, 207 patients were enrolled, 105 in the intervention group and 102 in the control group. Most patients were men (mean age, 55 years). The groups were similar on major demographic variables (age, SOFA scores, intensive care unit stay). Cumulative incidence of pressure injuries was significantly lower in the intervention group (18.1%) than in the control group (30.4%) for skin injuries ( [Formula: see text], P = .04) and mucous injuries (t = 3.27, P ≤ .001). Significantly fewer pressure injuries developed over time in the intervention group (log rank = 11.842, df = 1, P ≤ .001) and intervention patients had fewer skin injuries (> 3 pressure injuries atient = 1/105) than did control patients (> 3 pressure injuries atient = 10/102 P = .02). The intervention group, receiving the InSPiRE protocol, had a lower cumulative incidence of pressure injuries, and fewer and less severe pressure injuries that developed over time. Systematic and ongoing assessment of the patient's skin and risk for pressure injuries as well as implementation of tailored prevention measures are central to preventing pressure injuries.
A theory-based research literacy intervention for nurses
Publisher: Hindawi Limited
Date: 19-07-2022
DOI: 10.1111/NUF.12780
Abstract: Difficulties with understanding research literature can lead to nurses having low engagement with evidence-based practice (EBP). This study aimed to test the feasibility of an education intervention using an academic literacies approach to improve nurses' research literacy. An interactive workshop was devised utilizing genre analysis and tested in a pre ost pilot study. EBP self-efficacy was measured at baseline and posttest using the Self-Efficacy in Evidence-Based Practice instrument (26 items on an 11-point scale for total scores from 0 to 260). Research comprehension was measured with a 10-question quiz (range 0-10). When analyzed with a paired t-test, EBP self-efficacy increased significantly (MD: 56.9, SD: 39.9, t = 4.5, df = 9, p < .001). Research comprehension also improved (MD: 1.1 SD: 1.1, t = 2.9, df 9, p < .01). The workshop evaluations (n = 9) were overwhelmingly positive. This novel approach to research pedagogy aligns well with adult learning theory and social learning theory and is suitable for small group learning in continuing education. There is considerable potential for further work in this area. Genre analysis shows promise as a strategy for teaching nurses to understand research literature.
Neonatal skin injury scales: a scoping review with narrative synthesis protocol
Publisher: Cambridge Media
Date: 09-2022
Nursing care of the mechanically ventilated patient: What does the evidence say?. Part one
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.ICCN.2006.08.005
Abstract: The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.
Exploring compassion fatigue: How does compassion fatigue affect the intensive care nurse?
Publisher: Elsevier BV
Date: 02-2014
The experience of forging new emergency nursing curriculum development, through a course advisory network
Publisher: Elsevier BV
Date: 11-2008
Family presence during resuscitation
Publisher: Elsevier BV
Date: 02-2004
Perioperative factors and pressure ulcer development in postoperative ICU patients: A retrospective review
Publisher: Mark Allen Group
Date: 02-08-2018
DOI: 10.12968/JOWC.2018.27.8.475
Abstract: To identify variables during surgery that may contribute to the development of pressure ulcers (PUs) in postoperative, intensive care unit (ICU) patients within 72 hours of admission, as well as over their entire ICU admission. Furthermore, to investigate how these variables may impact on the number of PUs acquired. In a three-year retrospective audit, from 1 January 2014 to 31 December 2016, data from the electronic medical records of 3484 postoperative ICU patients in a major Australian metropolitan public hospital were retrieved and analysed to investigate associations between perioperative variables and PU occurrence. A total of 69 ICU admissions (1.98%) out of 3484 resulted in at least one PU developing within the ICU. No specific variables were associated with the development of a PU within 72 hours of the patient's ICU admission. Multiple regression Cox analysis showed that length of time in the operating theatre (OT) (p=0.045), surgical specialty (p .001), 1–4 hypotensive episodes (p=0.017) and hypotensive episodes (p .0005) were significantly associated with PU risk. Multivariable negative binomial regression demonstrated APACHE II score (p .01), OT time (p .01) and surgical specialty (p .01) were associated with PU number. There are many risks to skin integrity at the perioperative period, and these risks may exert their effect well into the ICU admission period. It is imperative to identify and mitigate these factors in order to reduce PU incidence, morbidity and mortality.
IMPOSE (IMProving Outcomes after Sepsis)-the effect of a multidisciplinary follow-up service on health-related quality of life in patients postsepsis syndromes-a double-blinded randomised controlled trial: Protocol
Publisher: BMJ
Date: 05-2014
An interventional skin care protocol (InSPiRE) reduces pressure injuries in critically ill patients in the intensive care unit
Publisher: Elsevier BV
Date: 02-2014
Caffeine consumption and withdrawal among patients in the intensive care unit
Publisher: Elsevier BV
Date: 04-2023
Channel leadership and performance for a closed-loop supply chain considering competition
Publisher: Elsevier BV
Date: 07-2023
Reliably measuring third year nursing students’ reflective thinking and critical reflection selfefficacy after high fidelity simulation
Publisher: OMICS Publishing Group
Date: 2015
The effect of warming on grassland evapotranspiration partitioning using laser-based isotope monitoring techniques
Publisher: Elsevier BV
Date: 06-2013
Text messaging to support off-campus clinical nursing facilitators: A descriptive survey
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.NEDT.2013.12.011
Abstract: Managing large student cohorts can be a challenge for university academics, coordinating these units. Bachelor of Nursing programmes have the added challenge of managing multiple groups of students and clinical facilitators whilst completing clinical placement. Clear, time efficient and effective communication between coordinating academics and clinical facilitators is needed to ensure consistency between student and teaching groups and prompt management of emerging issues. This study used a descriptive survey to explore the use of text messaging via a mobile phone, sent from coordinating academics to off-c us clinical facilitators, as an approach to providing direction and support. The response rate was 47.8% (n=22). Correlations were found between the approachability of the coordinating academic and clinical facilitator perception that, a) the coordinating academic understood issues on clinical placement (r=0.785, p<0.001), and b) being part of the teaching team (r=0.768, p<0.001). Analysis of responses to qualitative questions revealed three themes: connection, approachability and collaboration. This study demonstrates that use of regular text messages improves communication between coordinating academics and clinical facilitators. Findings suggest improved connection, approachability and collaboration between the coordinating academic and clinical facilitation staff.
A prospective pilot study evaluating the ‘cardiac decompensation score’ in the setting of intraaortic balloon counterpulsation
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.ICCN.2010.10.001
Abstract: The study objective was to determine whether the 'cardiac decompensation score' could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p<0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p=0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p=0.024). This pilot study indicates the 'cardiac decompensation score' to accurately represent changes in heart function specific to an in idual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.
Implementing best available evidence into practice for incontinence-associated dermatitis in Australia: A multisite multimethod study protocol
Publisher: Elsevier BV
Date: 02-2021
<p>Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review</p>
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/JMDH.S255785
Illness severity characteristics and outcomes of patients remaining on an acute ward following medical emergency team review: a latent profile analysis
Publisher: BMJ
Date: 19-01-2023
DOI: 10.1136/BMJQS-2022-015637
Abstract: Patients requiring medical emergency team (MET) review have complex clinical needs, and most remain on the ward after review. Current detection instruments cannot identify post-MET patient requirements, meaning patients remain undistinguished, potentially resulting in missed management opportunities. We propose that deteriorating patients will cluster along dimensions of illness severity and that these clusters may be used to strengthen patient risk management practices. To identify and define the number of illness severity clusters and report outcomes among ward patients following MET review. This retrospective cohort study examined the clinical records of 1500 adult ward patients following MET review at an Australian quaternary hospital. Three-step latent profile analysis methods were used to determine clusters using Sequential Organ Failure Assessment (SOFA) and Nursing Activities Score (NAS) as illness severity indicators. Study outcomes were (1) hospital mortality, (2) unplanned intensive care unit (ICU) admission and (3) subsequent MET review. Patients were unplanned (73.9%) and medical (57.5%) admissions with at least one comorbidity (51.4%), and complex combinations of acuity (SOFA range 1–17) and dependency (NAS range 22.4%–148.5%). Five clusters are reported. Patients in cluster 1 were equivalent to clinically stable general ward patients. Organ failure and complexity increased with cluster progression—clusters 2 and 3 were equivalent to subspecialty/higher-dependency wards, and clusters 4 and 5 were equivalent to ICUs. Patients in cluster 5 had the greatest odds for death (OR 26.2, 95% CI 23.3 to 31.3), unplanned ICU admission (OR 3.1, 95% CI 3.0 to 3.1) and subsequent MET review (OR 2.4, 95% CI 2.4 to 2.6). The five illness severity clusters may be used to define patients at risk of poorer outcomes who may benefit from enhanced levels of monitoring and targeted care.
Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID ‐19 pandemic
Publisher: Wiley
Date: 25-02-2022
DOI: 10.1111/IWJ.13755
Abstract: Wound documentation is integral to effective wound care, health data coding and facilitating continuity of care. This study evaluated the usability and effectiveness of an artificial intelligence application for wound assessment and management from a clinician‐and‐patient user perspective. A quasi‐experimental design was conducted in four settings in an Australian health service. Data were collected from patients in the standard group (n = 166, 243 wounds) and intervention group (n = 124, 184 wounds), at baseline and post‐intervention. Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively, and bivariate statistics were used to determine between‐group differences. Thematic analysis of interviews was conducted. Compared with the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% vs 70%, P .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99%). Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. The use of the application facilitated remote patient monitoring and reduced patient travel time while maintaining optimal wound care.
Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review
Publisher: Wiley
Date: 06-10-2016
DOI: 10.1111/WVN.12177
Abstract: Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention. The aim was to synthesize the best available evidence regarding the effectiveness of single strategies designed to reduce the incidence and prevalence of HAPUs development in ICUs. The search strategy was designed to retrieve studies published in English across CINAHL, Medline, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Mednar between 2000 and 2015. All adult ICU participants were aged 18 years or over. This review included randomized controlled trials, quasi-experimental and comparative studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. The review included 25 studies, and the meta-analysis revealed a statistically significant effect of a silicon foam dressing strategy in reducing HAPUs incidence (effect size = 4.62 95% CI: 0.05-0.29 p < .00001, effect size = 4.50 95% CI: 0.05-0.31 p = .00001, respectively) in critically ill patients. Evidence of the effectiveness of nutrition, skin-care regimen, positioning and repositioning schedule, support surfaces, and the role of education in prevention of HAPUs development in the ICU was limited, which precludes strong conclusions. The review provides an evidence-based guide to future priorities for clinical practice. In particular, a silicone foam dressing has positive impact in reducing sacrum and heel HAPUs incidence in the ICU.
Critical care nurses’ practices in the provision of end-of-life care
Publisher: Elsevier BV
Date: 02-2014
Maintaining skin health and integrity for staff wearing personal protective equipment for prolonged periods: a practical tip sheet
Publisher: Cambridge Media
Date: 06-2020
Subtle differences in CTL cytotoxicity determine susceptibility to hemophagocytic lymphohistiocytosis in mice and humans with Chediak-Higashi syndrome
Publisher: American Society of Hematology
Date: 27-10-2011
DOI: 10.1182/BLOOD-2011-05-356113
Abstract: Perforin-mediated cytotoxicity is important for controlling viral infections, but also for limiting immune reactions. Failure of this cytotoxic pathway leads to hemophagocytic lymphohistiocytosis (HLH), a life-threatening disorder of uncontrolled T-cell and macrophage activation. We studied susceptibility to HLH in 2 mouse strains (souris and beigeJ) and a cohort of patients with partial defects in perforin secretion resulting from different mutations in the LYST gene. Although both strains lacked NK-cell cytotoxicity, only souris mice developed all clinical and histopathologic signs of HLH after infection with lymphocytic choriomeningitis virus. The 2 strains showed subtle differences in CTL cytotoxicity in vitro that had a large impact on virus control in vivo. Whereas beigeJ CTLs eliminated lymphocytic choriomeningitis virus infection, souris CTLs failed to control the virus, which was associated with the development of HLH. In LYST-mutant patients with Chediak-Higashi syndrome, CTL cytotoxicity was reduced in patients with early-onset HLH, whereas it was retained in patients who later or never developed HLH. Thus, the risk of HLH development is set by a threshold that is determined by subtle differences in CTL cytotoxicity. Differences in the cytotoxic capacity of CTLs may be predictive for the risk of Chediak-Higashi syndrome patients to develop HLH.
Efficacy of Incontinence-Associated Dermatitis Intervention for Patients in Intensive Care: An Open-Label Pilot Randomized Controlled Trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2020
Reconsidering the transfer of patients from the intensive care unit to the ward: A case study approach
Publisher: Wiley
Date: 13-02-2007
DOI: 10.1111/J.1442-2018.2007.00294.X
Abstract: Evidence indicates that the poorly managed transfer of a patient from the intensive care unit (ICU) to the ward can lead to physical and psychological complications for the patient, and often require ICU readmission and rehospitalization. Reviewing this patient transfer process to improve the quality of care would be a positive step towards enhancing patients' recovery and providing skills to staff. The aim of this paper is to review case studies of transferring ICU patients to general wards in order to identify the shortcomings of this process. A literature review was conducted to evaluate current practices in the ICU transfer process. The results of this paper have clinical implications, suggest approaches to improve support for patients and their carers, and provide strategies to improve the transfer procedure.
Effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis: a systematic review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
DOI: 10.11124/JBISRIR-2016-003015
Abstract: Incontinence-associated dermatitis (IAD) is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes pain, redness, swelling and excoriation, and may lead to complications such as fungal skin infections and pressure injuries. It is important to prevent and treat IAD to avoid complications and improve patient outcomes. A number of products are available for protecting skin, but evidence on their effectiveness is limited. The current review aimed to establish the effectiveness of topical skin products in reducing the occurrence and/or severity of IAD. Adult patients over the age of 18 years with incontinence and/or diarrhea. Topical skin products as in idual interventions or part of a skin care regimen. Both published and unpublished study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after, prospective and retrospective cohort, case-control, analytical cross-sectional, descriptive study designs including case series, in idual case reports and descriptive cross-sectional studies across all care settings for inclusion. The primary outcome of interest was the absence or non-development, reduction or resolution, new development or increase in the occurrence of IAD or the increase in severity of IAD. The secondary outcome was any adverse effect caused by the skin care products used. A three-step search strategy to find both published and unpublished papers was utilized in this review. Studies were limited to those published in English from 1980 to 2016. Papers selected were assessed by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted using the standardized data extraction tool in JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes. Studies were assessed for methodological quality and statistical significance to determine validity and generalizability of study results. It was not possible to pool studies to conduct meta-analysis or test for heterogeneity. There were a limited number of clinical trials that compared products for efficacy in preventing and treating IAD. Assessment tools and severity scores used to measure skin damage outcomes were dissimilar and prone to subjectivity. It was difficult to ascertain superiority of any in idual product. Information on barrier protective efficacy, side effects and cost can be valuable to both clinicians and care providers. More randomized controlled trials on product effectiveness for prevention and treatment of IAD are highly recommended.
Acute skin failure in the critically ill adult population: A systematic review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Deforestation-induced warming over tropical mountain regions regulated by elevation
Publisher: Springer Science and Business Media LLC
Date: 14-12-2020
Fit testing and comfort evaluation of prophylactic dressing use for healthcare workers under N95/P2 respirators in one health service district in Australia
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JHIN.2022.02.016
Abstract: This study evaluated the use of prophylactic dressings (silicone foam, silicone tape, hydrocolloid) under N95/P2 respirators to determine which dressings fit successfully. The aim was to develop a health service protocol for one state in Australia. Data were collected during August and September 2021 as part of the Respiratory Protection Programme on 600 health workers using three types of prophylactic dressings. Five different types of respirators were used. Participant healthcare workers rated comfort on a four-point Likert scale. Successful fit was achieved by 63.6% of the respirator-dressing combinations. The best-performing respirator-dressing combination was the Trident® respirator with dressing Mepilex® Lite silicone foam (90.2% pass rate). High pass rates were found in the Trident® respirator with Mepilex® Border Lite with SofSicure silicone tape (79.1%) the 3M™ 1860 respirator with Mepilex® Border Lite with SofSicure silicone tape (74%) and the BSN orange duckbill respirator with Mepilex® Lite silicone foam (69.8%). The poorest-performing combination was the BYD™ respirator with Mepilex® Border Lite with SofSicure silicone tape (25.9% pass rate). Uncorrected chi-squared tests for association revealed significant associations between dressing type and outcome (P=0.004) and respirator type and outcome (P<0.001). Most respondents (82%) found the dressing combination markedly comfortable. When using prophylactic dressings under N95/P2 respirators, it is necessary to perform a fit test. In this study Trident® respirators had the highest probability of successful fit, while BYD™ respirators had the lowest. Combining Trident® respirators with Mepilex® Lite dressing was optimal. Most participants reported greater comfort with the dressings under the respirators.
Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.AUCC.2016.12.003
Abstract: Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards. The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The s le included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units. Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22% non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients. There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets.
Does size and shape matter for pressure injury development among patients in intensive care?
Publisher: Mark Allen Group
Date: 02-03-2023
Intraaortic balloon counterpulsation: Vasopressor weaning, the method of choice?
Publisher: Elsevier BV
Date: 11-2002
Implementation and evaluation of multilayered pressure injury prevention strategies in an Australian intensive care unit setting
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.AUCC.2021.03.005
Abstract: Pressure injuries are a ubiquitous, yet largely preventable, hospital acquired complication commonly seen in critically ill patients in the intensive care unit. The objectives of this study were to implement targeted evidence-based pressure injury prevention strategies and evaluate their effect through measurement of patient pressure injury observations. A prospective multiphased design was used in the intensive care unit of an Australian tertiary referral hospital using three study periods (period 1, weeks 1-18 period 2, weeks 19-28 and period 3, weeks 29-52). The interventions included staff-focused interventions and patient-focused interventions, with the latter defined in a work unit guideline. Weekly visual observations of critically ill patients' skin integrity were conducted by trained research nurses over 52 weeks from November 2015 to November 2016. The primary outcome measure was a pressure injury of any stage, identified at the weekly observation, and the effect of the intervention was evaluated through logistic regression. Reporting rigour has been demonstrated using the Standards for Quality Improvement Reporting Excellence checklist. Over the whole study, 15.4% (95% confidence interval [CI] = 12.6, 18.2%, 97/631) of patients developed a pressure injury, with the majority of these injuries (73.2%, 95% CI = 64.4%, 82.0%, 71/97) caused by medical devices. After adjustment for covariates known to influence hospital-acquired pressure injury development, pressure injury rates for period 3 compared with period 1 were reduced (odds ratio = 0.41, 95% CI = 0.20-0.97, p = 0.0126). We found the use of defined pressure injury prevention strategies targeted at both staff and patients reduced pressure injury prevalence.
Silicone adhesive multilayered foam dressings for pressure ulcer prevention
Publisher: Oxford University Press (OUP)
Date: 04-03-2021
DOI: 10.1111/BJD.19873
Kirkpatrick's Evaluation of Simulation and Debriefing in Health Care Education: A Systematic Review
Publisher: SLACK, Inc.
Date: 07-2018
DOI: 10.3928/01484834-20180618-03
Abstract: Simulation is an integral component of health care education. Research suggests a positive relationship between simulation and learning outcomes. Kirkpatrick's framework is a four-level model based on the premise that learning resulting from training programs can be classified into four levels: reaction, learning, behavior, and results. Evaluation of educational impact provides valuable feedback to educators that may assist with development and improvement of teaching methods. This review is based on the PRISMA guidelines for conducting a systematic review. Inclusion criteria included articles (a) written in the English language, (b) published between 2000 and 2016, (c) describing a debriefing intervention after high-fidelity patient simulation, and (d) based in health care. Thirteen studies met criteria for inclusion in the review. Results indicated a paucity of studies at the highest levels of evaluation, indicating an area where future research is needed to assist with the development and improvement of simulation education. [ J Nurs Educ . 2018 (7):393–398.]
Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Metaanalysis
Publisher: Elsevier BV
Date: 2019
Exploring pressure and body positioning
Publisher: Mark Allen Group
Date: 06-2017
DOI: 10.12968/JOWC.2017.26.SUP6B.1
Abstract: The abstract book contains the abstracts of keynote lectures, focus sessions, symposia, workshops, AIUC annual meeting, AISLEC annual meeting, EPUAP annual meeting, ETRS special session, sponsor symposia, oral presentations, poster presentations and the subject index.
Pressure injury prevention practice in Australian intensive care units: A national cross-sectional survey
Publisher: Elsevier BV
Date: 03-2023
Safety culture in intensive care internationally and in Australia: A narrative review of the literature
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.AUCC.2018.11.003
Abstract: Assessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs. A search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms 'safety culture', 'safety climate', 'safety attitude', 'intensive care', 'ICU' and 'critical care'. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the s le population included participants working in an adult intensive care, and the findings were reported in the context of intensive care. Of the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups. Though the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered.
The End of the Homosexual? (review)
Publisher: Informa UK Limited
Date: 02-10-2015
Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study
Publisher: Wiley
Date: 09-02-2015
DOI: 10.1111/IWJ.12406
Virtual Engagement of Families in the Intensive Care Unit During COVID-19: A Descriptive Survey of Family Members of Patients and Health Care Workers
Publisher: Mary Ann Liebert Inc
Date: 03-2022
Ambivalence and the experience of China-educated nurses working in Australia
Publisher: Wiley
Date: 16-08-2010
DOI: 10.1111/J.1440-1800.2010.00492.X
Abstract: Ambivalence and the experience of China-educated nurses working in Australia The last decade has seen an increase in research on the experience of immigrant nurses. There are two prevailing approaches in this body of work. One is a focus on the positive or negative aspects of the experience, and the other, a depiction of the experience as a linear movement from struggle to a comfortable state. Based on our study findings on the experience of China-educated nurses working in Australia, this study proposes that the concept of ambivalence is more appropriate in portraying the experience of immigrant nurses. Several sources of ambivalence experienced by the participants are represented: a disparity between expectation and reality, conflicting social and cultural norms, the dual reference points of comparison, ergent interests within families, and a sense that although it is unsatisfactory, it is hard to go back. We argue that immigration generates various forms of ambivalence and immigrant nurses must live with more or less ambivalence. The notion of ambivalence can explain a range of behaviours and situations beyond the scope of rational-choice explanations. To date, ambivalence as a theoretical concept in understanding the experience of immigrant nurses has been either ignored or insufficiently addressed in the literature.
Facilitating family focused intensive care nursing through action research
Publisher: Springer Science and Business Media LLC
Date: 09-2003
Evaluation of a closed loop blood sampling system in intensive care: A pilot randomised controlled trial. The enclose trial
Publisher: Elsevier BV
Date: 2022
The effectiveness of interventions to reduce peripheral blood culture contamination in acute care: a systematic review protocol
Publisher: Springer Science and Business Media LLC
Date: 30-11-2018
Factors influencing the provision of end‐of‐life care in critical care settings: development and testing of a survey instrument
Publisher: Wiley
Date: 27-11-2014
DOI: 10.1111/JAN.12576
Abstract: To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. A cross-sectional survey of critical care nurses. An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience s le of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.
Preventing pressure injuries among patients in the intensive care unit: insights gained
Publisher: Springer Science and Business Media LLC
Date: 22-08-2022
An exploration of the barriers and facilitators to evidence based practice and research utilisation in an Australian intensive care unit
Publisher: Elsevier BV
Date: 03-2018
Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study
Publisher: Wiley
Date: 17-12-2018
DOI: 10.1111/IWJ.13051
Development and Psychometric Testing of a Knowledge Instrument on Incontinence-Associated Dermatitis for Clinicians: The Know-IAD
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
DOI: 10.1097/WON.0000000000000837
Abstract: The purpose of this study was to describe the development and evaluation of the psychometric properties of an instrument used to assess clinician knowledge of Incontinence-associated dermatitis (IAD). The instrument was developed in three phases: Phase 1 involved item development Phase 2 evaluated content validity of the instrument by surveying clinicians and stakeholders within a single state of Australia and, Phase 3 used a pilot multisite cross-sectional survey design to determine composite reliability and evaluate scores of the knowledge tool. In Phase 1, the instrument was developed by five persons with clinical and research subject expertise in the area of IAD. In Phase 2, content validity was evaluated by a group of 13 clinicians (nurses, physicians, occupational therapists, dietitians, and physiotherapists) working in acute care across one Australian state, New South Wales, along with two consumer representatives. In Phase 3, clinicians, working across six hospitals in New South Wales and on wards with patients diagnosed with incontinence-associated dermatitis, participated in pilot-testing the instrument. During Phase 1, a group of local and international experts developed items for a draft tool based on an international consensus document, our prior research evaluating incontinence-associated dermatitis knowledge, and agreement among an expert panel of clinicians and researchers. Phase 2 used a survey design to determine content validity of the knowledge tool. Specifically, we calculated item- and scale-level content validity ratios and content validity indices for all questions within the draft instrument. Phase 3 comprised pilot-testing of the knowledge tool using a cross-sectional survey. Analysis involved confirmatory factor analysis to confirm the hypothesized model structure of the knowledge tool, as measured by model goodness-of-fit. Composite reliability testing was undertaken to determine the extent of internal consistency between constituent items of each construct. During Phase 1, a draft version of the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge tool (Know-IAD), comprising 19 items and ided into three domains of IAD-related knowledge: 1) Etiology and Risk, 2) Classification and Diagnosis, and 3) Prevention and Management was developed. In Phase 2, 18 of the 19 items demonstrated high scale content validity ratios scores on relevance (0.75) and clarity (0.82) and high scale-content validity indices scores on relevance (0.87) and clarity (0.91). In Phase 3, the final 18-item Know-IAD tool demonstrated construct validity by a model goodness-of-fit. Construct validity was excellent for the Etiology and Risk domain (root mean squared error=0.02) and Prevention and Management domain (root mean squared error=0.02) it was good for the Classification and Diagnosis domain (root mean squared error=0.04). Composite reliability (CR) was good in the Etiology and Risk domain (CR=0.76), Prevention and Management domains (CR=0.75), and adequate in the Classification and Diagnosis domain (CR=0.64). Respondents had good understanding of etiology and risk (72.6% correct responses) fairly good understanding of prevention and management of IAD (64.0% correct responses) and moderate understanding of classification and diagnosis (40.2% correct responses). The Know-IAD demonstrated good psychometric properties and provides preliminary evidence that it can be applied to evaluate clinician knowledge on IAD.
Risk factors for pressure injury development in critically ill patients in the intensive care unit: a systematic review protocol
Publisher: Springer Science and Business Media LLC
Date: 20-03-2017
Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis? (vol 128, 104189, 2022)
Publisher: Elsevier BV
Date: 06-2022
Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study
Publisher: Wiley
Date: 08-2017
DOI: 10.1111/IWJ.12630
Factors associated with critical care nurses’ engagement in end-of-life care practices
Publisher: Elsevier BV
Date: 02-2014
Patient, family-centred care interventions within the adult ICU setting: An integrative review
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.AUCC.2016.08.002
Abstract: Patient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting. An integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps. A systematic search of the following databases was conducted: MEDLINE CINHAL PsycINFO Cochrane Library Web of Science-Current Contents Connect Web of Science-Core Collection The Joanna Briggs Institute EBP Database ProQuest Sociological Abstracts and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included. Data extracted from the studies included authors, year, country of origin, design, setting, s le, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool. Forty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target s le Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC. Research into PFCC interventions is erse however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully in idualise quality patient care, a commitment and enactment of partnerships between health care professionals, patients, and family members is imperative.
The Experiences and Perceptions of Nurses Interacting With Research Literature: A Qualitative Systematic Review to Guide Evidence-Based Practice
Publisher: Wiley
Date: 02-11-2021
DOI: 10.1111/WVN.12542
Abstract: There is an evidence that some nurses struggle with reading and using research. This struggle becomes a barrier to engaging in evidence‐based practice (EBP). Personal beliefs, attitudes about research, and difficulties with research language and statistics have been reported as important variables in quantitative studies. The aim of this review was to explore nurses' experiences and perceptions of interacting with research literature for work or educational purposes. Studies eligible for inclusion were qualitative, published in English from years 2009–2020, and included registered nurses engaged in interaction with research literature for any work or educational purpose. The Joanna Briggs Institute’s qualitative systematic review methods were used. We included 11 qualitative studies with 186 participants. Most studies used focus groups or semi‐structured interviews to collect data. Overall, study quality was moderate. We extracted 29 findings, which were synthesized into five categories, and meta‐aggregated into one synthesis. Research is a complex field of engagement for nurses, who simultaneously value its contribution to their profession and feel the burden of unsupported expectations. Nurses perceive a double standard in their workplaces where expectations of using evidence in practice are often discussed, but EBP education and access to literature can be hard to access. Educators conducting research education should consider the complex emotional reactions this activity may engender in participants who may feel unprepared by their previous experience or education. Clinicians and workplace leaders trying to encourage the use of evidence in practice should consider the source of any reluctance to engage. An observed lack of engagement in their staff may be related to issues with understanding the materials.
The Experience of Agency Nurses Working in a London Teaching Hospital
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.ICCN.2005.09.007
Abstract: This Husserlian phenomenological study explored the lived experience of eight full-time agency nurses working in the environment of intensive care in London, United Kingdom. In-depth interviews were used to ascertain the participants' experiences of full-time agency nursing in intensive care. Colaizzi's [Colaizzi P. Psychological research as the phenomenologist views it. In: Vale R, King M, editors. Existential-phenomenological alternatives for psychology. London: Oxford University Press 1978, p. 48-71] method of data analysis was utilised. Thematic analysis identified three cluster themes: the shared experience of lacking confidence the shared experience of deskilling and the shared experience of feelings of isolation. The theme of the shared experience of lacking confidence identified the importance of support and understanding of agency nurses' needs in the ICU. The theme of the shared experience of deskilling illuminated participants concern at not having the opportunity to care for patients of higher acuity. The theme of the shared experience of feelings of isolation highlighted that often participants did not feel they "belonged to a team". Study findings suggest the need to include: the implementation of protocols within the clinical setting the provision of performance feedback to agency nurses and the consideration of ongoing structured professional development and education for ICU agency nurses.
Five illness severity classes of patient reviewed by MET responders: A latent profile analysis
Publisher: Elsevier BV
Date: 2022
Probiotics and diarrhoea management in enterally tube fed critically ill patients—What is the evidence?
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.ICCN.2010.07.001
Abstract: The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients. Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse. Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT). Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use. Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.
Optimising reflective capacity of nursing students after high fidelity simulation: A practical approach
Publisher: Bond University
Date: 05-07-2021
DOI: 10.53300/001C.25332
Abstract: Navigating simulation as a nursing student is challenging. It requires critical thinking, high levels of reflection and emotional investment. Reflection fatigue can result from knowing that reflection is important but feeling reluctant to expose oneself to critique. This practical discussion explores how nurse educators can optimise nursing students’ reflective thinking within simulation and develop debrief strategies that optimise critical reflection. Debrief is a teaching and learning episode within simulation that aims to challenge students to develop their thinking and practice, without compromising instruction. Much debrief practice tends towards instruction at the expense of student self-exploration, and preparation for assessment at the cost of critical reflection. The practical approach to debrief discussed here is a timely reminder to step back and re-assess the practice of debrief. This discussion will assist nurse educators to implement a debrief that supports reflection at the highest level. Four familiar strategies of teaching and learning, when combined within debrief, can optimise the reflective capacity of nursing students: role modelling and vicarious observation, scaffolding of reflective thinking, emotional processing, and student-centred reflection. The practical strategies presented are relevant to both Australian and international nursing higher education contexts.
A Two‐Arm Cluster Randomized Control Trial to Determine the Effectiveness of a Pressure Ulcer Prevention Bundle for Critically Ill Patients
Publisher: Wiley
Date: 21-03-2015
DOI: 10.1111/JNU.12136
Abstract: This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs). A two-arm cluster randomized experimental control trial. Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression. The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = .002) and Stage II PU development (p = .026). Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU PU incidence, severity, and total number of PUs per patient were reduced. Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome.
Staff perceptions of family access and visitation policies in Australian and New Zealand intensive care units: The WELCOME-ICU survey
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.AUCC.2021.06.014
Abstract: Family-centred critical care recognises the impact of a loved one's critical illness on his relatives. Open visiting is a strategy to improve family satisfaction and psychological outcomes by permitting unrestricted or less restricted access to visit their family member in the intensive care unit (ICU). However, increased family presence may result in increased workload and a risk of burnout for ICU staff. The objective of this study was to evaluate ICU staff perceptions regarding visiting hours and family access in Australian and New Zealand ICUs. Secondary outcomes included an evaluation of current visiting policies, witnessed events in ICUs, and barriers to implementing open visiting policies. A web-based survey open to all healthcare workers in Australia and New Zealand ICUs was distributed through local, state-based, and national critical care networks. Open visiting was defined as ICUs open for visiting >14 h per day. We received 1255 valid responses. Most respondents were nurses (n = 930, 74.1%) with a median critical care experience of 10 y. Most worked in open visiting ICUs (n = 749, 59.7%). Reported visiting hours varied greatly with a median of 20 h per day (interquartile range: 10-24 h). Open visiting was perceived as beneficial for the relatives, but less so for patients and staff (relatives: n = 845, 67.3%, patients: n = 561, 44.7%, staff: n = 257, 20.5%, p < 0.0001). Respondents from closed visiting units and nurses identified more risks from open visiting than other professional groups. Generally, staff preferred not to change from their current practice. We report that staff perceived open visiting as beneficial for relatives, but also identified risks to themselves, including increased workload, a risk of burnout, and a risk of occupational violence. Reluctance to change highlights the importance of addressing staff perceptions when implementing an open visiting policy.
Involving families in care within the Intensive Care environment: A descriptive survey
Publisher: Elsevier BV
Date: 10-1995
DOI: 10.1016/S0964-3397(95)81713-1
Abstract: A descriptive survey design was utilised within a general intensive care environment, to describe the attitudes of nurses and relatives towards the provision of care by relatives to their critically ill loved one. Triangulation was employed utilising a questionnaire comprising a Likert scale, a checklist of participatory care activities, open questions and biographical questions. The total nurse population of the intensive care unit (ICU) was surveyed. 27 questionnaires were returned (a response rate of 75%). Of a possible 45 relatives surveyed, 20 returned questionnaires (a response rate of 44.4%). A high proportion of both the nurse and the relative s les (96.3% and 85% respectively) indicated their agreement with the concept of involving relatives in the physical care of their critically ill loved one. The results highlighted issues of personal choice for in idual lay involvement and adequate information for families to become involved. For the nurse s le the major themes emergent were the problems of role adaptation for nurses and families involved, and building relationships. For the relative s le the categories emergent were adapting to the demanding ICU environment and identifying the parameters of their new caring role. The study suggests benefits, to both nurses and relatives, of lay participation in physical care of critically ill patients on the ICU environment.
Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales
Publisher: Sciedu Press
Date: 15-04-2013
EXPLORING BODY MORPHOLOGY AND SKIN MICROCIRCULATION IN PATIENTS WITH CRITICAL ILLNESS
Publisher: Elsevier BV
Date: 2020
Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.IJNURSTU.2022.104222
Abstract: Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61) the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: A systematic review protocol update
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Exploring pressures, tissue reperfusion and body positioning: A pilot evaluation
Publisher: Mark Allen Group
Date: 02-10-2017
DOI: 10.12968/JOWC.2017.26.10.583
Abstract: To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients and between ICU patients and healthy volunteers.
‘True Blood’ The Critical Care Story: An audit of blood sampling practice across three adult, paediatric and neonatal intensive care settings
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.AUCC.2015.06.002
Abstract: Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by s ling for diagnostic testing. Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood s ling and conservation strategies. Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood s les obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. A total of 940 blood s ling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood s ling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal s les taken (p<0.001). Adult patients had significantly more median [IQR] s les per day in comparison to paediatrics and neonates (adults 5.0 [2.4] paediatrics 2.3 [2.9] neonatal 0.7 [2.7]), which significantly increased median [IQR] blood s ling costs per day (adults AUD$101.11 [54.71] paediatrics AUD$41.55 [56.74] neonatal AUD$8.13 [14.95] p<0.001). The total volume of s les per day (median [IQR]) was also highest in adults (adults 22.3mL [16.8] paediatrics 5.0mL [1.0] neonates 0.16mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. There was significant variation in blood s ling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.
The authors reply
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Validation of a reflective thinking instrument for third-year undergraduate nursing students participating in high-fidelity simulation
Publisher: Informa UK Limited
Date: 03-01-2017
On the Use of Unmanned Aerial Systems for Environmental Monitoring
Publisher: MDPI AG
Date: 20-04-2018
DOI: 10.3390/RS10040641
Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective
Publisher: Wiley
Date: 20-12-2018
DOI: 10.1111/NICC.12331
Abstract: Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication.
Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care
Publisher: Wiley
Date: 23-07-2003
DOI: 10.1046/J.1442-2018.2003.00155.X
Abstract: When general ward registered nurses (RN) receive patients from an intensive care unit (ICU) they report that much of their time in the initial phases revolves around meeting family needs (Farvis, 2002). Families experience anxiety when leaving the security of the close monitoring seen in ICU (Leith, 1999) and their anxiety reduces their ability to play a key role in the patient's recovery (McShane, 1991 Leske, 1992) as it can impair their decision-making (Cagan, 1988 Halm et al., 1993). By reducing a family's anxiety, they may be more able to cope with the necessary transition to a general ward and support the patient's recovery. A literature search from 1990 onwards was performed within the CINAHL, Medline and Cochrane databases using the key words: intensive care, family, General System Theory, uncertainty, anxiety and transfer. Further articles were retrieved from citation references from the Web of Science or through the reference lists of retrieved literature. Library catalogues were searched using the same key words for books and book chapters. von Bertalanffy's General System Theory provides a framework for understanding the importance of family in a critical illness situation. Critical illness permits little or no time to adapt, thus reducing the family's ability to cope with the situation. Transfer out of ICU is a significant anxiety-producing event for families. Uncertainty in illness is reported in other illness situations to reduce family's adaptation to illness events, but has not been researched with an ICU cohort of families. Seven out of the top 10 needs of ICU families are information needs, highlighting the importance of communication regarding progress and future plans. Nurses require an increased awareness that transfer anxiety exists for families and to be knowledgeable about ways to reduce its occurrence. Research is required to evaluate the efficacy of interventions to reduce anxiety for families and examine the level of uncertainty in illness in this cohort.
Efficacy of a heel offloading boot in reducing heel pressure injuries in patients in Australian intensive care units: A single-blinded randomised controlled trial
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.ICCN.2022.103205
Abstract: To compare time to incidence, extent of incidence and severity of heel pressure injury with a heel off-loading boot (intervention) or pillows (control). Multi-centre, single-blinded randomised controlled trial of 394 critically ill patients. Patients were randomised to the intervention or control for heel offloading. Three hospital intensive care units two in greater Sydney, Australia and one in regional New South Wales, Australia. Time to intensive care unit-acquired pressure injury in heels of patients without pre-existing heel pressure injury within 28 days from intensive care unit admission. incidence of heel pressure injury within 28 days of intensive care unit admission severity of intensive care unit-acquired heel pressure injuries occurrence of plantar contractures (a change in ankle dorsiflexion of 5° or greater) within 28 days of admission. Within 28 days of admission, one pressure injury was recorded in the intervention group and 11 in the control group. Hazard of pressure injury incidence within 28 days of admission was significantly lower (p = 0.0239) in heels assigned to the intervention (hazard ratio 0.0896 [95% CI 0.0110, 0.727]). Odds of pressure injury incidence within 28 days of admission were significantly lower (p = 0.0261) in the intervention group (odds ratio 0.0883 [95% CI 0.0104, 0.749]). The pressure injury recorded in the intervention group was superficial (stage 1) whereas those recorded in the control group were more severe (stage 2 to 4). The heel-offloading boot used in this study significantly reduced heel pressure injury occurrence compared with heel offloading using pillows.
Cultivating Incontinence-associated Dermatitis Prevention Practices in an Australian Local Health District: A Quasi-experimental Study
Publisher: HMP Communications, LLC
Date: 05-11-2018
Developing a model of factors that influence meeting the needs of family with a relative in ICU
Publisher: Wiley
Date: 08-08-2018
DOI: 10.1111/IJN.12693
Abstract: To develop a model of factors influencing meeting family needs when a relative was admitted to the intensive care unit (ICU). Studies identify in idual factors impact on the needs of family members with a relative in ICU. No studies have reported on relationships between these factors and/or the extent of influence of multiple factors on family needs. Observational, correlational, and predictive study design. Data were collected from August 2013 to June 2014 using validated scales and a demographic tool. The setting was a large tertiary referral hospital in Brisbane, Australia. Structural equation modelling was undertaken. One hundred and seventy ICU family members participated. Factors included in the developed model were consistent with the literature. Family member anxiety had direct and significant influence on ICU family needs (β = 0.21). Gender was also found to have direct influence (β = 0.19), suggesting female family members were more likely to report needs being met. Family member coping self-efficacy (β = -0.40) and family member depression (β = -0.33) were mediating variables. Interventions to meet family needs within the ICU should take into account family member levels of anxiety, depression, and coping self-efficacy with consideration of gender. Further model validation is required to confirm findings.
An international consensus on device-related pressure ulcers: SECURE prevention
Publisher: Mark Allen Group
Date: 12-03-2020
DOI: 10.12968/BJON.2020.29.5.S36
Abstract: Catherine Milne and colleagues present the findings of their review, ccna2@juno.com
Patient, family-centred care interventions within the adult ICU setting: An integrative review
Publisher: Elsevier BV
Date: 03-2018
The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: A systematic review
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.IJNURSTU.2022.104216
Abstract: Incontinence-associated dermatitis is a common, under-recognized painful skin condition associated with poorer quality of life, increased nurse workloads, and costs. To systematically review economic evidence for the prevention and treatment of incontinence-associated dermatitis. Systematic review of quantitative research. PubMed, MEDLINE, EMBASE, Cochrane Library, York Centre for Reviews and Dissemination database, Econlit, Tufts' Cost-Effectiveness Analysis Registry, and Web of Science. A comprehensive search for studies on resource use (costs), health outcomes, and cost-effectiveness of interventions for incontinence-associated dermatitis was conducted. Screening, data extraction, and initial quality assessment were conducted independently by two reviewers, with disagreements/queries regarding quality settled through consensus with the larger team. Quality evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist and results narratively arranged. Seventeen studies (10 for prevention, one for treatment and six for both prevention and treatment) included. All studies measured resource use from a healthcare provider perspective 14 quantified resources in monetary terms. Considerable variation existed in the resource use data primarily due to differences in the type of resources counted, selected time horizons, valuation methods, and reporting approaches. Ten studies provided evidence of their intervention to be cost saving (or at least cost avoiding). Five studies on barrier products provided evidence to be cost saving: three for prevention, one for treatment, and one for both prevention and treatment. Two studies of cleanser and barrier products provided evidence to be cost saving for the prevention and treatment of incontinence-associated dermatitis. One study found a cleanser to be a cost saving preventative intervention. One bowel management system was found to be cost saving over time only, and one nurse education intervention was found to be cost saving for preventing and treating incontinence-associated dermatitis. One barrier product was found to be cost-effective for preventing and treating the condition. Finally, one study found a cleanser and barrier product was time saving for prevention. None of the studies incorporated a multi-attribute quality of life measure however, two studies included person-reported outcome measures for pain. A narrow range of resources (mainly products) were considered, and there was limited information on how they were counted and valued. Analyses relating to heterogeneity among patients/hospital wards or health facilities and uncertainty were lacking. Barrier products are possibly a more cost-effective treatment than others however, this evidence lacks certainty. Structured health economic evaluations are required for a reliable evidence-base on the interventions for incontinence-associated dermatitis. Most incontinence-associated dermatitis studies lack person-reported outcomes, costs beyond product/staff time, and economic evaluation.
Diarrhoea risk factors in enterally tube fed critically ill patients: A retrospective audit
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.ICCN.2010.08.001
Abstract: Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multi-factorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential s ling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r=0.422 p=0.02) and total diarrhoea frequency (r=0.313 p=0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.
The illness severity of patients reviewed by the medical emergency team: A scoping review
Publisher: Elsevier BV
Date: 09-2021
Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Publisher: Springer Science and Business Media LLC
Date: 26-02-2021
Research priorities for acute wounds in adults in Australia
Publisher: Cambridge Media
Date: 09-2021
The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJNURSTU.2019.103483
Abstract: Pressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a reported pressure injury prevalence of 12-33%. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. This systematic review evaluated the effectiveness of pressure injury prevention programs in reducing pressure injury prevalence and incidence in the adult intensive care population. It also critically appraised the program components and strategies used to implement these programs. We searched PubMed, EMBASE (embase.com), Ovid MEDLINE, EBSCOhost CINAHL, and Cochrane Library databases separately for papers published in English and Chinese from the year of 2000 to May 2018. After removing duplicates, two authors independently screened the title and abstracts, then full-text against the inclusion and exclusion criteria. Data was extracted by one author and checked by a second author. Quality appraisal was conducted by two authors by using the Quality Improvement Minimum Quality Criteria Set, and the Mixed Methods Appraisal Tool. Content analysis was used to categorise program components. Implementation strategies were grouped into six classifications: dissemination strategies, implementation process strategies, integration strategies, capacity building strategies, sustainability strategies, and scale up strategies. Twenty-one peer reviewed papers (12 quality improvement projects, and 9 research papers from 8 studies) were included. Pressure injury prevention programs with 2-11 components were commonly implemented. Common components of the programs included: clarification of staff roles, introducing new roles, repositioning, staff and patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition needs assessment, documentation, multidisciplinary team involvement, and mobilisation. Implementation strategies commonly used were education, audit and feedback, and standardising documentation. Five of the eight research studies and one of the quality improvement projects reported significant decrease in pressure injury prevalence, and/or increase in compliance to pressure injury prevention protocols and strategies. Two quality improvement papers reported cost savings of $1 million and £2.6 million respectively after the implementation of the programs. Much of the work on multicomponent pressure injury prevention programs has been undertaken as quality improvement projects and before and after research studies with limited rigour. However, positive outcomes and strong theoretical rationales for the components in the programs suggest that they are beneficial. This calls for future high-quality research such as randomised controlled trials to test the effectiveness of multicomponent interventions and their implementation strategies. Tweetable abstract: Some multicomponent pressure injury prevention programs were found to be effective however, higher level of research evidence is needed.
Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 12-05-2022
DOI: 10.1186/S13063-022-06322-9
Abstract: Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) ‘standard’ (in accordance with local hospital policy) CVAD dressings (control) or (2) ‘standard’ dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is ‘dressing failure’ defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021
The effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis: a systematic review protocol
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Validation of SMAP surface soil moisture products with core validation sites
Publisher: Elsevier BV
Date: 03-2017
Simulation debriefing based on principles of transfer of learning: A pilot study
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.NEPR.2017.08.002
Abstract: Upon completion of undergraduate nursing courses, new graduates are expected to transition seamlessly into practice. Education providers face challenges in the preparation of undergraduate nurses due to increasing student numbers and decreasing availability of clinical placement sites. High fidelity patient simulation is an integral component of nursing curricula as an adjunct to preparation for clinical placement. Debriefing after simulation is an area where the underlying structure of problems can consciously be explored. When central principles of problems are identified, they can then be used in situations that differ from the simulation experience. Third year undergraduate nursing students participated in a pilot study conducted to test a debriefing intervention where the intervention group (n=7) participated in a simulation, followed by a debriefing based on transfer of learning principles. The control group (n=5) participated in a simulation of the same scenario, followed by a standard debriefing. Students then attended focus group interviews. The results of this pilot test provided preliminary information that the debriefing approach based on transfer of learning principles may be a useful way for student nurses to learn from a simulated experience and consider the application of learning to future clinical encounters.
Interventions for improving the research literacy of nurses: A systematic review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Exploring medical device-related pressure injuries in a single intensive care setting
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.ICCN.2021.103155
Abstract: To report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries. A prospective observational design where observations of patients' skin integrity were conducted on one day each week for 52 weeks. The study was conducted in the 36-bed intensive care unit of a major metropolitan tertiary referral hospital in Queensland, Australia. The s le included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ. The primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded. Over the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI. The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09-1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02-1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18-3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01-1.09, p = 0.013). Device related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.
The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review
Publisher: Mark Allen Group
Date: 02-08-2019
DOI: 10.12968/JOWC.2019.28.8.512
Abstract: The objective of this review was to synthesise the literature and evaluate the incidence, prevalence and severity of medical device-related pressure ulcers (MDRPU) in adult intensive care patients. Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure ulcer (PU) as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using 1 2 statistic. We included 13 studies in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas category II followed by category I were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose. While MDRPU are common in intensive care patients, it is an understudied area. Inconsistency in the staging of MDRPU, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.
Clinician Knowledge of Incontinence-Associated Dermatitis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
DOI: 10.1097/WON.0000000000000846
Abstract: This study examined clinicians' knowledge of incontinence-associated dermatitis (IAD) using the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge Tool (Know-IAD). A cross-sectional multicenter survey. The setting was 6 hospitals across 5 health districts in New South Wales, Australia. The participants were nurses (registered nurses and enrolled nurses), physicians, allied health (occupational therapists, dietitians, and physiotherapists), and students (nursing and allied health). Data about IAD knowledge were collected from November 2019 to January 2020. The Know-IAD, an 18-item validated instrument that measures knowledge of IAD in 3 domains (etiology and risk, classification and diagnosis, and prevention and management), was administered to a cross section of eligible clinicians. The participants anonymously completed hard copy surveys. Descriptive and exploratory analyses were conducted to quantify clinicians' knowledge about the etiology and risk, classification and diagnosis, and prevention and management of IAD. A mean knowledge score of 70% was considered to be satisfactory. Four hundred twelve respondents completed the survey. One hundred twenty nine respondents (31.3%) achieved 70% correct responses and greater for the entire set of items. For the etiology and risk domain, 348 respondents (84.5%) obtained a score of 70% correct responses and greater, 67 respondents (16.3%) achieved 70% correct responses and greater for the classification and diagnosis domain, and 84 respondents (20.4%) achieved 70% correct responses and greater for the prevention and management domain. Clinicians tend to have low knowledge and recognition of IAD, particularly in the areas of classification and diagnosis along with prevention and management. They tend to have higher knowledge of how IAD is caused and the risk factors. This study has identified knowledge gaps for further education that can improve assessment, prevention, and management of IAD.
Chronic disease health literacy in First Nations people: A mixed methods study
Publisher: Wiley
Date: 27-06-2021
DOI: 10.1111/JOCN.15757
Abstract: To explore chronic disease education, self‐management and health literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings. Chronic disease management requires good health literacy abilities to manage long‐term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people. A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines. Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February–November 2017. Quantitative data ( n = 200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data ( n = 20) were collected via face‐to‐face interviews to examine chronic disease education and self‐management experiences. Data were analysed separately then integrated to develop meta‐inferences. Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in in iduals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self‐management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self‐management were concurred with the low level of active engagement in health care. Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self‐management in contexts where health literacy abilities are challenged. Using yarning, and plain language visual aids, and teach‐back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self‐management.
Factors influencing the provision of end-of-life care in critical care settings
Publisher: Elsevier BV
Date: 05-2013
Effects of randomly orienting penny-shaped cracks on the elastic properties of transversely isotropic rocks
Publisher: Society of Exploration Geophysicists
Date: 11-2020
Abstract: Fractured reservoirs, as one kind of unconventional reservoirs, have great potential for oil and gas development, and their accurate characterization requires the development of rock-physics models that better simulate real fractured rocks. However, current models focus mainly on the elastic properties of rocks with aligned cracks, while the effects of randomly orienting cracks in transversely isotropic (TI) rocks are poorly studied even though such conditions are frequently encountered in the earth. To address this problem, we have derived models for the elastic properties of rocks with a TI background permeated by 3D inclined cracks and randomly orienting cracks. Then, based on the developed models, we comprehensively study the effects of the two inclination angles (i.e., the dip angle between the cracks and the isotropic plane and the rotation angle between the cracks and the plane normal to the isotropic plane, respectively) of 3D inclined cracks on the elastic properties of TI rocks. We determine that the two angles have significant influences on the elastic coefficients and hence the elastic velocities, and that their influences on the elastic properties are varying in different directions. We further investigate the effects of crack density and aspect ratio of randomly orienting cracks on the elastic properties of the fractured rocks with a TI background. The results show that the increasing crack density and crack aspect ratio reduce the elastic coefficients and velocities for rocks with randomly orienting cracks, in which the relations between compressional-wave velocities and the crack properties (i.e., crack density and crack aspect ratio) are obtained to aid the interpretation of the acquired acoustic exploration data. The proposed new models can greatly improve the modeling capability for the elastic properties of rocks with a TI background permeated by inclined and randomly orienting cracks.
Blood sampling in critical care: Every drop counts
Publisher: Elsevier BV
Date: 05-2016
Collaborative facilitation of debrief after high-fidelity simulation and its implications for reflective thinking: student experiences
Publisher: Informa UK Limited
Date: 30-01-2018
Reconfigurable computing system for image processing via the internet
Publisher: Elsevier BV
Date: 12-2007
An interventional skin care protocol (InSPiRE) to reduce incontinence-associated dermatitis in critically ill patients in the intensive care unit: A before and after study
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.ICCN.2016.12.001
Abstract: This study aimed to test the effectiveness of a bundle combining best available evidence to reduce the incidence of incontinence-associated dermatitis occurrences in critically ill patients. The study used a before and after design and was conducted in an adult intensive care unit of an Australian quartenary referral hospital. Data, collected by trained research nurses, included demographic and clinical variables, skin assessment, incontinence-associated dermatitis presence and severity. Data were analysed using descriptive and inferential statistics. Of the 207 patients enrolled, 146 patients were mechanically ventilated and incontinent thus eligible for analysis, 80 with 768days of observation in the after/intervention group and 66 with 733days of observation in the before group. Most patients were men, mean age 53 years. Groups were similar on demographic variables. Incontinence-associated dermatitis incidence was lower in the intervention group (15% 12/80) compared to the control group (32% 21/66) (p=0.016). Incontinence-associated dermatitis events developed later in the intensive care unit stay in the intervention group (Logrank=5.2, p=<0.022). This study demonstrated that the use of a bundle combining best available evidence reduced the incidence and delayed the development of incontinence-associated dermatitis occurrences in critically ill patients. Systematic ongoing patient assessments, combined with tailored prevention measures are central to preventing incontinence-associated dermatitis in this vulnerable patient group.
Incontinence-associated dermatitis: who is affected?
Publisher: Mark Allen Group
Date: 02-04-2021
DOI: 10.12968/JOWC.2021.30.4.261
Abstract: Intensive care unit (ICU) patients possess multiple risk factors for developing loss of skin integrity, particularly incontinence-associated dermatitis (IAD). IAD is an inflammatory skin condition resulting from repeated and prolonged contact with urine, faeces or both. This study aimed to measure the incidence and clinical characteristics of adult ICU patients with IAD. This was a prospective observational study conducted over three months in an adult ICU. Included patients were ≥18 years who experienced faecal incontinence during their intensive care admission. Patients were excluded if they had an ileostomy or colostomy, had IAD on admission, or were continent of urine and faeces. Skin inspections were performed every second day on all recruited patients by trained research nurses. Other data were collected from patient medical records. A total of 37 patients took part in the study. Incidence of IAD was 35.1% 13 patients who had incontinence developed IAD. The mean time to onset of IAD was 3.69 days, median 3 days (SD: 1.8, range: 2–8 days). Of the 13 patients who developed IAD, 12 (92.3%) patients were initially assessed as having category 1 IAD and one (7.7%) patient was initially assessed with category 2 IAD. Of the patients with category 1 IAD, one patient (7.7%) progressed to category 2 IAD severity. A larger s le is recommended to fully explore ICU patient characteristics and IAD development. The incidence of IAD in ICU patients was high at 35%, indicating this condition requires due consideration in ICU patients.
An evaluation of simulation debriefings on student nurses' perceptions of clinical reasoning and learning transfer: A mixed methods study
Publisher: Walter de Gruyter GmbH
Date: 2019
Abstract: To aim of this study was to explore undergraduate nursing student (n = 256) perceptions of clinical reasoning ability and learning transfer after participating in either a standard post simulation debriefing or a debriefing based on transfer of learning principles. Background: It is assumed that students will transfer what they have learned from simulation to real world practice, however, some students are unable to identify the relevance of simulated learning experiences if scenarios are dissimilar to clinical placement settings. The nature and extent what is able to be transferred from simulated to real settings is unclear, particularly in relation to complex processes such as clinical reasoning. Transfer of learning to a new situation involves deliberate cognitive effort, including reflection and mindful abstraction of central attributes of a problem. As reflection is a key element in learning transfer, the debriefing element of simulation was seen to be a platform for this study. Method: A convergent parallel mixed methods design used a pre-test, post-test survey and focus group interviews. Results: No statistically significant difference in post-test clinical reasoning scores between groups was found. There was a statistically significant improvement in 12 out of 15 criteria among the control group and in 8 of the criteria among the intervention group. Qualitative findings provided some evidence that learning had transferred to clinical settings. Evidence of “near” transfer was more evident than “far” transfer. Conclusion: Positive findings included that all students perceived they had transferred the skills of patient assessment and effective communication during episodes of patient care. The concept of a “framework” being verbalized by many of the intervention group during practice is a promising finding and may be a useful direction for further research focusing on the instructional demonstration of explicitly promoting a level of abstraction of problems and prompting participants to search for conceptual connections. This may indicate retained idea or concepts from the debriefing which may be useful in future practice.
Discharge practices for the intensive care patient: A qualitative exploration in the general ward setting
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.ICCN.2014.04.004
Abstract: To explore how registered nurses (RNs) in the general ward perceive discharge processes and practices for patients recently discharged from the intensive care unit (ICU). Patients discharged from the ICU environment often require complicated and multifaceted care. The ward-based RN is at the forefront of the care of this fragile patient population, yet their views and perceptions have seldom been explored. A qualitative grounded theory design was used to guide focus group interviews with the RN participants. Five semi-structured focus group interviews, including 27 RN participants, were conducted in an Australian metropolitan tertiary referral hospital in 2011. Data analyses of transcripts, field notes and memos used concurrent data generation, constant comparative analysis and theoretical s ling. Results yielded a core category of 'two worlds' stressing the disconnectedness between ICU and the ward setting. This category was ided into sub categories of 'communication disconnect' and 'remember the family'. Properties of 'what we say', 'what we write', 'transfer' and 'information needs' respectively were developed within those sub-categories. The discharge process for patients within the ICU setting is complicated and largely underappreciated. There are fundamental, misunderstood differences in prioritisation and care of patients between the areas, with a deep understanding of practice requirements of ward based RNs not being understood. The findings of this research may be used to facilitate inter departmental communications and progress practice development.
Implementing a pressure ulcer prevention bundle in an adult intensive care
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.ICCN.2016.04.005
Abstract: The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a ch ion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements.
End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice
Publisher: Elsevier BV
Date: 2019
Pressure Injury Prevention in a Saudi Arabian Intensive Care Unit
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
Translating evidence‐based nursing clinical handover practice in an acute care setting: A quasi‐experimental study
Publisher: Wiley
Date: 15-04-2021
DOI: 10.1111/NHS.12836
Abstract: Effective transfer of information during the nursing handover contributes to patient safety. This study aimed to translate the best practice nursing shift handover recommendations in an acute care setting using the Ottawa Model for Research Use and to explore its effect on patient adverse outcomes (falls, pressure injuries, and medication errors). Using a quasi‐experimental design, the study was conducted in four internal medicine wards in a major tertiary hospital. A total of 88 nurses and 110 patients participated in 152 handover observations. The findings showed clinically important increases in percentages and odds of nurses' compliance with shift handover recommendations after the intervention. The patient adverse outcomes after the intervention were compared to the corresponding period of previous year. A reduction was observed for all adverse patient outcomes with incident rate ratios of 0.762 ( p = 0.027) for falls, 0.624 for pressure injuries ( p = 0.010), and 0.782 for medication errors ( p = 0.023). Replicating this study's methodology across multiple clinical settings will increase the generalizability of findings and provide further evidence to inform nursing practice and policy.
A case study of thrombotic thrombocytopaenic purpura: A 'powerful poison'
Publisher: Elsevier BV
Date: 05-2004
DOI: 10.1016/S1036-7314(04)80004-3
Abstract: This paper presents the case of a previously well 72 year old man who spent 86 days in the intensive care unit (ICU) following a remarkable and explosive presentation of the rare condition thrombotic thrombocytopaenic purpura (TTP). TTP is an intravascular platelet aggregation disorder that, without treatment, is associated with significantly high mortality rates. This paper discusses TTP in terms of its presentation, pathophysiology, diagnosis and management. In addition to TTP, the patient developed a number of comorbidities during his stay in ICU. Particular attention is given to two major problems: acute renal failure and prolonged encephalopathy. These issues, along with the initial diagnosis of TTP, resulted in the patient remaining in ICU for a longer period than otherwise might have been expected. Despite many obstacles, the patient recovered and was discharged from hospital 116 days after initial presentation.
The Effectiveness of Interventions for Improving the Research Literacy of Nurses: A Systematic Review
Publisher: Wiley
Date: 30-09-2015
DOI: 10.1111/WVN.12106
Abstract: Internationally, a considerable body of research exists examining why nurses do not use evidence in practice. Consistently, the research finds that lack of knowledge about research or discomfort with understanding research terminology are among the chief reasons given. Research education is commonly included in undergraduate nursing degree programs, but this does not seem to translate into a strong understanding of research following graduation, or an ability to use it in practice. The objective of this review was to identify the effectiveness of workplace, tertiary-level educational, or other interventions designed to improve or increase postregistration nurses' understanding of research literature and ability to critically interact with research literature with the aim of promoting the use of research evidence in practice in comparison to no intervention, other intervention, or usual practice. A wide range of databases were searched for quantitative studies of registered nurses receiving educational interventions designed to increase or improve their understanding of research literature in tertiary or workplace settings. Two reviewers working independently critically appraised the relevant papers and extracted the data using Joanna Briggs Institute instruments. Data are presented as a narrative summary as no meta-analysis was possible. Searching identified 4,545 potentially relevant papers, and after the sifting of titles and abstracts, 96 papers were selected for retrieval. On examination of full-text versions, 10 of the 96 retrieved papers were found to meet the inclusion criteria. Included studies were low to moderate quality. Interactive or activity-based learning seems to be effective in terms of improving research knowledge, critical appraisal ability, and research self-efficacy. Utilizing a program with a strong base in an appropriate theory also seems to be associated with greater effectiveness, particularly for workplace interventions. The included studies strongly favored interactive interventions, and those utilizing theory in their construction. Therefore, these types of interventions should be implemented to improve the effectiveness of research education for nurses as well as their research literacy.
Device-related pressure ulcers: SECURE prevention
Publisher: Mark Allen Group
Date: 02-2020
The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
The Skin Safety Model: Reconceptualizing Skin Vulnerability in Older Patients
Publisher: Wiley
Date: 18-11-2016
DOI: 10.1111/JNU.12176
Abstract: To develop a unique skin safety model (SSM) that offers a new and unified perspective on the erse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults. Discussion paper. A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014. There is a multiplicity of literature outlining the etiology, prevention, and management of specific iatrogenic skin injuries. Complex and interrelated factors contribute to iatrogenic skin injury in the older adult, including multiple comorbidities, factors influencing healthcare delivery, and acute situational stressors. A range of injuries can result when these factors are complicated by skin irritants, pressure, shear, or friction however, despite skin injuries sharing multiple antecedents, no unified overarching skin safety conceptual model has been published. The SSM presented in this article offers a new, unified framework that encompasses the spectrum of antecedents to skin vulnerability as well as the spectrum of iatrogenic skin injuries that may be sustained by older acute care patients. Current skin integrity frameworks address prevention and management of specific skin injuries. In contrast, the SSM recognizes the complex interplay of patient and system factors that may result in a range of iatrogenic skin injuries. Skin safety is reconceptualized into a single model that has the potential for application at the in idual patient level, as well as healthcare systems and governance levels. Skin safety is concerned with keeping skin safe from any iatrogenic skin injury, and remains an ongoing challenge for healthcare providers. A conceptual framework that encompasses all of the factors that may contribute to a range of iatrogenic skin injuries is essential, and guides the clinician in maintaining skin integrity in the vulnerable older patient.
End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study
Publisher: Wiley
Date: 09-03-2023
DOI: 10.1111/JAN.15630
Abstract: To assess patients' and nurses' perceptions and experiences of subepidermal moisture scanning acceptability. Descriptive, qualitative, sub‐study, embedded within a pilot randomized control trial. Ten patients who were in the intervention arm of the pilot trial and 10 registered nurses providing care for these patients on medical‐surgical units participated in in idual semi‐structured interviews. Data were collected from October 2021 to January 2022. Interviews were analysed using inductive qualitative content analysis, and perspectives (patient and nurse), were triangulated. Four categories were found. The first category ‘Subepidermal moisture scanning is acceptable as part of care’ showed that patients and nurses were willing to use subepidermal moisture scanning and viewed subepidermal moisture scanning as non‐burdensome. The category ‘Subepidermal moisture scanning may improve pressure injury outcomes’ demonstrated that although subepidermal moisture scanning was believed to prevent pressure injuries, more research evidence about its benefits was required. ‘Subepidermal moisture scanning augments existing pressure injury prevention practices’, the third category, highlighted that subepidermal moisture scanning aligns with current pressure injury prevention practices while making these practices more patient‐centred. In the final category, ‘Important considerations when making subepidermal moisture scanning routine practice’, practical issues were raised relating to training, guidelines, infection control, device availability and patient modesty. Our study demonstrates that using subepidermal moisture scanning is acceptable for patients and nurses. Building the evidence base for subepidermal moisture scanning and then addressing practical issues prior to implementation, are important next steps. Our research suggests that subepidermal moisture scanning enhances in idualized and patient‐centred care, persuasive reasons to continue investigating subepidermal moisture scanning. For an intervention to be successfully implemented it must be both effective and acceptable, however, there is limited evidence of patients' and nurses' views of SEMS acceptability. SEM scanners are acceptable to use in practice for patients and nurses. There are many procedural aspects that need to be considered when using SEMS such as frequency of measurements. This research may have benefit for patients, as SEMS may promote a more in idualized and patient‐centred approach to pressure injury prevention. Further, these findings can assist researchers, providing justification to proceed with effectiveness research. A consumer advisor was involved in study design, interpretation of data and preparation of manuscript.
Weaning from Ventilation in Paediatric Intensive Care: An Intervention Study
Publisher: Elsevier BV
Date: 08-2003
DOI: 10.1016/S0964-3397(03)00041-7
Abstract: To standardise the paediatric intensive care unit (PICU) team's approach to weaning paediatric patients from mechanical ventilation. The study employed a time series design over 2 years. A total of 220 patients (pre-intervention n=107 and post-intervention n=113) were studied. Independent variables measured in both the pre- and post-intervention groups included total ventilation time (TVT), weaning duration (WD), and length of stay (LOS), as well as quality indicators (weaning failure and reintubation rates). The pre-intervention analysis demonstrated an existing fluctuation between outcome variables. When outcome indicators were compared between the pre- and post-intervention groups, both TVT and LOS were longer post-intervention (median difference: TVT -15.8 hours, P<0.068 and LOS -23.75 hours, P<0.088). WD was comparable between groups (median difference: WD -1.5 hours, P<0.427). Quality indicators were better post-intervention. Kaplan-Meier survival analysis demonstrated that long-term ventilated patients post-intervention had a reduced probability of remaining ventilated. Weaning children from mechanical ventilation can be performed safely and effectively with the aid of collaborative guidelines. Although times were prolonged, the quality indicators were slightly improved, indicating that quicker was not always better. Long-term ventilated patients, in particular, would appear to benefit from weaning guidelines.
Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
End-of-life care in the intensive care setting: A descriptive exploratory qualitative study of nurses' beliefs and practices
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AUCC.2011.04.004
Abstract: End-of-life care is a significant component of work in intensive care. Limited research has been undertaken on the provision of end-of-life care by nurses in the intensive care setting. The purpose of this study was to explore the end-of-life care beliefs and practices of intensive care nurses. A descriptive exploratory qualitative research approach was used to invite a convenience s le of five intensive care nurses from one hospital to participate in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. Three major categories emerged from analysis of the interviews: beliefs about end-of-life care, end-of-life care in the intensive care context and facilitating end-of-life care. The first two categories incorporated factors contributing to the end-of-life care experiences and practices of intensive care nurses. The third category captured the nurses' end-of-life care practices. Despite the uncertainty and ambiguity surrounding end-of-life care in this practice context, the intensive care setting presents unique opportunities for nurses to facilitate positive end-of-life experiences and nurses valued their participation in the provision of end-of-life care. Care of the family was at the core of nurses' end-of-life care work and nurses play a pivotal role in supporting the patient and their family to have positive and meaningful experiences at the end-of-life. Variation in personal beliefs and organisational support may influence nurses' experiences and the care provided to patients and their families. Strategies to promote an organisational culture supportive of quality end-of-life care practices, and to mentor and support nurses in the provision of this care are needed.
Understanding contextual barriers and enablers to pressure injury prevention practice in an Australian intensive care unit: An exploratory study
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.AUCC.2018.02.008
Abstract: Skin integrity management is often a low clinical priority in the intensive care environment, possibly resulting in high pressure injury (PI) prevalence. This article reports the results of the first phase of a multiphased project, "Translating evidence-based pressure injury prevention strategies to the intensive care environment (SUSTAIN study)". The SUSTAIN study used a research translation framework to guide the assessment of research uptake, development, and monitoring of translational strategies to reduce PIs. The objective was to assess the enablers and barriers to research translation of evidence-based skin integrity management in one Australian tertiary referral intensive care unit (ICU). This exploratory study was conducted in an Australian metropolitan tertiary ICU on a s le of 204 registered nurses. Data were collected using (i) a descriptive cross-sectional cohort survey of barriers, enablers, and attitudes to PI prevention, (ii) a cross-sectional survey of PI knowledge, and (iii) focus groups to understand the local contextual factors impacting registered nurses' PI prevention practice. Participants reported a moderate to high ability to rise above barriers in PI prevention, a positive attitude towards PI prevention, and considered this a priority in their care of patients. High patient acuity emerged as a barrier to implementing timely PI prevention strategies. In the knowledge, test participants with postgraduate qualifications answered more statements correctly. Focus group data revealed four themes: (i) team ICU, (ii) processes of care, (iii) education for consistency, and (iv) the patient. It is essential that evidence-based PI prevention strategies are provided in the intensive care environment. Our findings indicate that despite positive attitudes and sound knowledge levels, high patient acuity is a significant barrier to evidence implementation.
End-of-life care practices of critical care nurses: A national cross-sectional survey
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.AUCC.2015.07.001
Abstract: The critical care context presents important opportunities for nurses to deliver skilled, comprehensive care to patients at the end of life and their families. Limited research has identified the actual end-of-life care practices of critical care nurses. To identify the end-of-life care practices of critical care nurses. A national cross-sectional online survey. The survey was distributed to members of an Australian critical care nursing association and 392 critical care nurses (response rate 25%) completed the survey. Exploratory factor analysis using principal axis factoring with oblique rotation was undertaken on survey responses to identify the domains of end-of-life care practice. Descriptive statistics were calculated for in idual survey items. Exploratory factor analysis identified six domains of end-of-life care practice: information sharing, environmental modification, emotional support, patient and family centred decision-making, symptom management and spiritual support. Descriptive statistics identified a high level of engagement in information sharing and environmental modification practices and less frequent engagement in items from the emotional support and symptom management practice areas. The findings of this study identified domains of end-of-life care practice, and critical care nurse engagement in these practices. The findings highlight future training and practice development opportunities, including the need for experiential learning targeting the emotional support practice domain. Further research is needed to enhance knowledge of symptom management practices during the provision of end-of-life care to inform and improve practice in this area.
Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/IWJ.13363
A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care pati
Publisher: Springer Science and Business Media LLC
Date: 06-2004
DOI: 10.1007/S00134-004-2203-Y
Abstract: To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. Randomised-controlled trial. University affiliated, tertiary referral hospital. One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. All patients received standard eye cleansing every 2 h. In addition to this, group one ( n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two ( n=50) had polyethylene covers only placed over the eye to create a moisture chamber. Corneal ulceration was determined using corneal fluorescein stains and mobile slit l evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.
Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.AUCC.2018.11.069
Abstract: Safety culture is significant in the complex intensive care environment, where the consequences of human error can be catastrophic. Research within Australian intensive care units has been limited and little is understood about the safety culture of intensive care units in Queensland. The aim was to evaluate and compare safety culture in the intensive care units of two metropolitan tertiary hospitals in Queensland. A cross-sectional survey, Safety Attitudes Questionnaire, was administered to all medical, nursing and allied health professionals in the research sites (A and B) during January and February 2016. Data were collated into six safety culture domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Comparison was made using t-tests and between demographic groups using generalising estimating equations. In total, 206 surveys were returned from 522 staff (39.5% response rate). The majority of respondents were nurses (80.6%). Site B scored all domains of the safety attitudes questionnaire significantly higher than Site A (p < 0.001). The scores for both site A and B were significantly higher in all domains (p < 0.001) than a previous Australian study conducted in 2013. Both sites returned low scores in the stress recognition domain. Medical staff perceived the teamwork climate as more positive than nursing staff (mean difference 16.6 [Wald χ Despite similar governance and external structures, differences were found in safety culture between the two research sites. This finding emphasises the importance of local, unit-level assessment of safety culture and planning of improvement strategies. This study adds to the evidence and implications for critical care clinical practice that these interventions need to be unit focused, supported by management and multidisciplinary in approach.
Profiling Emergency Nurse Practitioner Service An Interpretive Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
The concept of difference and the experience of China-educated nurses working in Australia: A symbolic interactionist exploration
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.IJNURSTU.2011.05.003
Abstract: The migration of registered nurses as a response to a global nurse shortage has seen a growth in research interest in this area. Much of the research focuses on differences in language and culture which are posed as the attributes of the immigrant nurse. In reporting on an analysis of data drawn from China-educated nurses working in the Australian health care system, this paper explores the social construction of difference and the related intersection of difference and racialisation. A symbolic interactionist approach informed 46 in-depth interviews with 28 China-educated nurses. The method of analysis was initial and focused coding and constant comparison of data. The focus of interpretation was on human action and interaction as contextual and thus structural factors were critical to the analysis. Two levels of meaning were depicted in this study: difference as "you are you and I am I" and difference as "incompetence". Negative meanings were ascribed to difference which in turn legitimised inequality and held the potential to perpetuate racism. We argue that it is problematic to conceptualise difference as in idual attributes. Difference needs to be contextualised and thus explored as a complex and socially constructed concept that in its application has social and political implications for immigrant nurses in Australia and elsewhere.
Shift‐to‐shift nursing handover interventions associated with improved inpatient outcomes—Falls, pressure injuries and medication administration errors: An integrative review
Publisher: Wiley
Date: 11-04-2021
DOI: 10.1111/NHS.12825
Abstract: The aim of this integrative review was to identify which nursing handover interventions were associated with improved patient outcomes, specifically patients’ falls, pressure injuries and medication administration errors, in the hospital setting. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement was used to guide the review. A systematic search of seven electronic databases was conducted, and retrieved articles were assessed by two independent reviewers. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Eight studies met the inclusion criteria. The findings of this review indicate that improvements in handover communication had a clinically important positive effect on patient outcomes. Across the studies, reductions in falls varied from 9.3 to 80%, pressure injuries from 45 to 75%, and medication errors from 11.1 to greater than 50%. This review highlights that the implementation of bedside nursing handover and the adoption of standardized handover tools to improve nursing handover communication reduce patient adverse events, specifically falls, pressure injuries, and medication errors. These findings should be considered by clinicians to inform their clinical handover practice.
A prospective window into medical device-related pressure ulcers in intensive care
Publisher: Wiley
Date: 04-02-2014
DOI: 10.1111/IWJ.12026
Health literacy in Indigenous people with chronic disease living in remote Australia
Publisher: Springer Science and Business Media LLC
Date: 26-07-2019
Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study)
Publisher: Elsevier BV
Date: 11-2021
Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1097/CCM.0000000000003366
Abstract: To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites. MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury. Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0–25.9% and 16.9–23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4–27.5% all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6–36.8% and 12.2–24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0–23.8% and 12.4–15.5%. Five studies totalling 406 patients reported usable data on location 95% CI of frequencies of PIs were as follows: sacrum 26.9–48.0%, buttocks 4.1–46.4%, heel 18.5–38.9%, hips 10.9–15.7%, ears 4.3–19.7%, and shoulders 0.0–40.2%. Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.
Improving haemofilter longevity through the implementation of targeted strategies developed from analysis of machine derived data
Publisher: Elsevier BV
Date: 03-2018
Establishing an action research group to explore family-focused nursing in the intensive care unit
Publisher: Wiley
Date: 22-01-2007
The intensive care unit visiting study: A multisite survey of visitors
Publisher: Elsevier BV
Date: 11-2021
Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing
Publisher: Wiley
Date: 11-08-2014
DOI: 10.1111/JAN.12475
Abstract: This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables in iduals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education.
Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: Contributing factors
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.ICCN.2007.04.003
Abstract: Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned extubation, agitation, delirium and the impact of nurse-patient ratios in the ICU on these issues. Part 2 of the paper examines the evidence related to chemical and physical restraints from the perspective of the mechanically ventilated patient.
Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.ICCN.2007.04.002
Abstract: An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse-patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.
EFFECT OF BLOOD CONSERVATION PRACTICES ON REDUCING BLOOD SAMPLING VOLUMES AND OTHER CLINICAL SEQUELAE IN INTENSIVE CARE. A SYSTEMATIC REVIEW
Publisher: Elsevier BV
Date: 2020
Evaluation of a closed loop-blood sampling system in intensive care: A pilot randomised controlled trial. The ENCLOSE trial
Publisher: Elsevier BV
Date: 04-2023
Identifying contributing factors to tracheostomy stoma breakdown: a retrospective audit in a single adult intensive care unit
Publisher: Cambridge Media
Date: 23-04-2021
Nurse-led randomised controlled trials in the perioperative setting: A scoping review
Publisher: Australian College of Perioperative Nurses
Date: 16-03-2022
The effect of sub-epidermal moisture on pressure injury prevention strategies and incidence of pressure injuries: A feasibility pilot randomised controlled trial
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JTV.2022.07.008
Abstract: Sub-epidermal moisture scanning (SEMS) is a novel point-of-care technology that measures localised oedema and detects early tissue damage that may develop into a pressure injury (PI). It provides objective data that may assist PI prevention (PIP) decision making. This study aimed to determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to test the effectiveness of SEMS. This pilot RCT recruited medical and surgical patients at risk of developing a PI in one Australian hospital. All participants received routine PIP care and daily visual skin assessment to determine the presence of a PI. The intervention group also received daily SEMS. Clinical staff were told if the sub-epidermal moisture (SEM) value was abnormal but were not given advice for PIP. Blinding of patients, care staff and outcome assessors was not practical. Feasibility outcomes included recruitment, retention, intervention fidelity, and patient outcomes. Of 1185 patients screened prior to eligibility, 950 were excluded (80%) 235 were then assessed for eligibility and 160 met the inclusion criteria (68.1%) 100 were recruited (70.0%) and randomised and 99 completed the trial (intervention n = 50 control n = 49) with one person withdrawn due to inappropriate recruitment (100% retention). Of the 657 expected SEMS observations, 598 were completed (91% intervention fidelity). Only 34 of 454 (7.4%) patient outcome data points were missing. Most feasibility criteria were met, indicating a definitive trial to assess the effectiveness of SEMS in a medical-surgical patient population is realistic. However, recruitment may be resource intensive and require specific strategies.
End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content-informing practice
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.AUCC.2019.04.004
Abstract: The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training. The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia. Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen in iduals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained. Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content. This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units.
A New Quaternion Kalman Filter Based Foot-Mounted IMU and UWB Tightly-Coupled Method for Indoor Pedestrian Navigation
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 04-2020
Exploration into the factors influencing evidence uptake of delirium management in intensive care. A qualitative descriptive study
Publisher: Elsevier BV
Date: 2022
Time to listen: Chronic disease yarning with Aboriginal and Torres Strait Islander peoples living in remote Australia
Publisher: Elsevier BV
Date: 02-2021
Mechanical ventilation
Publisher: Elsevier BV
Date: 11-2006
Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Publisher: Springer Science and Business Media LLC
Date: 09-10-2020
Using a knowledge translation framework to identify barriers and supports to effective nursing handover: A focus group study
Publisher: Elsevier BV
Date: 06-2019
Factors influencing clinical performance of baccalaureate nursing majors: A retrospective audit
Publisher: SLACK, Inc.
Date: 06-2018
DOI: 10.3928/01484834-20180522-03
Abstract: Transition of nursing student to new graduate depends on successful completion of clinical work placement during an undergraduate course. Supporting students during the clinical placement is imperative. This study examined associations between grade point average, domestic or international status, course entry qualification, and single or dual nursing degree to successful completion of clinical placement. A retrospective audit of 665 students in a baccalaureate nursing program was conducted to examine factors influencing clinical performance of baccalaureate nursing students. A significant association between entry qualification, lower grade point average, international status, and receipt of a constructive note was found: χ 2 = 8.678, df = 3, p = .034, t (3.862), df = 663, p ⩽ .001, and Fisher's exact test = 8.581, df = 1, p = .003, respectively. Understanding factors that affect clinical performance may help early identification of students at risk and allow for supportive intervention during placement and subsequent program completion. [ J Nurs Educ. 2018 (6):333–338.]
Educating for health service reform: Clinical learning, governance and capability - A case study protocol
Publisher: Springer Science and Business Media LLC
Date: 27-05-2016
High-Fidelity Simulation: Descriptive Analysis of Student Learning Styles
Publisher: Elsevier BV
Date: 11-2016
Device-related pressure injuries in adult intensive care unit patients: An Australian and New Zealand point prevalence study
Publisher: Elsevier BV
Date: 11-2021
Registered Nurses’ experiences of reading and using research for work and education: a qualitative research study
Publisher: Springer Science and Business Media LLC
Date: 12-05-2022
DOI: 10.1186/S12912-022-00877-3
Abstract: Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice. This study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education. A qualitative descriptive study using online and in-person focus groups. Focus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis. Three distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles. This study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.
Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Exploring the information needs of patients who have undergone PCI
Publisher: Mark Allen Group
Date: 03-2009
DOI: 10.12968/BJCA.2009.4.3.40047
Abstract: In Australia percutaneous coronary intervention (PCI) rates have significantly increased over the last decade. However, often, in the hospital setting, there is little time for comprehensive patient education due to the urgency for coronary artery catheterisation, and short length of patient stay. Aim: The purpose of this study was to explore the information needs of first-time PCI patients four to six weeks post-procedure. Method and Results: This study was based on a naturalistic inquiry approach using semi-structured interviews with 10 participants and field notes as the methods of data collection. Data were analysed utilising Thomas’ (2003) five steps to a thematic analysis, incorporating a constant comparative approach. Four themes were identified: ‘Events leading up’ ‘Information prior’ ‘About the procedure’ and ‘Lifestyle’. Conclusions: Findings highlighted the numerous educational needs of participants for PCI across the continuum of their clinical admission and discharge. Furthermore, the study uncovered the need for a tailored approach to PCI patient information delivery. Findings also demonstrated the need to further identify and trial different information delivery methods and timing of PCI education to patients and their families.
Correction to
Publisher: Springer Science and Business Media LLC
Date: 14-08-2019
Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
The illness severity of ward remaining patients reviewed by the medical emergency team: A retrospective cohort study
Publisher: Wiley
Date: 09-03-2023
DOI: 10.1111/JOCN.16678
Abstract: Although progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety. This study sought to quantify the illness severity of ward patients after medical emergency team review. This retrospective cohort study examined the clinical records of 1500 randomly s led adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies. No direct patient contact was made during the data collection and analysis phases of the study. Patients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse‐to‐patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities. Patients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements. Profiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment.
Interventions to reduce peripheral blood culture contamination in acute care settings: A systematic review and meta-analysis
Publisher: Cold Spring Harbor Laboratory
Date: 27-07-2023
DOI: 10.1101/2023.07.26.23293230
Abstract: Blood culture contamination is a significant problem in acute care settings. Contamination of a blood s le with pathogens not present in the patient’s blood leads to increases in length of stay, overuse of antimicrobials, and increases in healthcare cost. Several interventions have been reported in different settings within the literature to decrease the contamination. However, their overall effectiveness is currently unknown. This systematic review aimed to identify interventions to reduce contamination from peripherally collected blood cultures and to evaluate the effectiveness of these interventions. Systematic review and meta-analysis In March 2019 we performed a systematic search of English language literature from academic databases, registers of clinical trials and grey literature for interventions aimed at reducing blood culture contamination in adult acute care settings. Studies meeting inclusion criteria were reviewed and data were extracted by two independent reviewers. A total of 6,302 articles were retrieved from searches. After removal of duplicates and screening against inclusion criteria 57 studies were included. The majority of the 57 studies had a medium to high risk of bias. These studies identified eight specific interventions (collection packs, dedicated collection teams, education, staff feedback, intervention bundle, sterile procedure, Initial Specimen Diversion Devices, or change of asepsis solution) used in acute care. Thirty-four studies were included in the meta-analysis. There was a wide variation in the definition of contamination which precluded many studies from being included in the meta-analysis. Dedicated collection teams (RR 0.40, 95%CI 0.21 – 0.76, I 2 87%, p .001) and initial specimen ersion devices (RR 0.43, 95%CI0.31 – 0.58, I 2 84%, p .001) were the most successful at reducing blood culture contamination. Heterogeneity was high across all studies and interventions. The use of dedicated collection teams or initial specimen ersion devices showed the most significant reduction in blood culture contamination however, other interventions such as intervention bundles, education or feedback, may have benefits in terms of ease of implementation, and have still been shown to lower blood culture contamination.
Understanding Skin Failure: A Scoping Review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2021
Measuring third year undergraduate nursing students' reflective thinking skills and critical reflection self-efficacy following high fidelity simulation: A pilot study
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.NEPR.2016.03.001
Abstract: Critical reflection underpins critical thinking, a highly desirable generic nursing graduate capability. To improve the likelihood of critical thinking transferring to clinical practice, reflective thinking needs to be measured within the learning space of simulation. This study was ided into two phases to address the reliability and validity measures of previously untested surveys. Phase One data was collected from in iduals (n = 6) using a 'think aloud' approach and an expert panel to review content validity, and verbatim comment analysis was undertaken. The Reflective Thinking Instrument and Critical Reflection Self-Efficacy Visual Analogue Scale items were contextualised to simulation. The expert review confirmed these instruments exhibited content validity. Phase Two data was collected through an online survey (n = 58). Cronbach's alpha measured internal consistency and was demonstrated by all subscales and the Instrument as a whole (.849). There was a small to medium positive correlation between critical reflection self-efficacy and general self-efficacy (r = .324, n = 56, p = .048). Participant responses were positive regarding the simulation experience. The research findings demonstrated that the Reflective Thinking and Simulation Satisfaction survey is reliable. Further development of this survey to establish validity is recommended to make it viable.
Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit: A literature review
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.AUCC.2012.03.003
Abstract: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care critical care staffing nurse staffing understaffing nurse-patient ratios adverse outcomes mortality ventilator-associated pneumonia ventilator-acquired pneumonia infection length of stay pressure ulcer/injury unplanned extubation medication error readmission myocardial infarction and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes this would be difficult to achieve in this field of research.
Moisture-associated skin-damage
Publisher: Elsevier BV
Date: 12-2020
Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.IJNURSTU.2022.104189
Abstract: Oedema measurement, also termed sub-epidermal moisture measurement is recommended as an adjunct pressure injury prevention intervention in international guidelines because it indicates early tissue damage. To determine the prognostic value of oedema measurement in predicting future pressure injury in adults in any care setting. Systematic review and meta-analysis. Participants were recruited from nursing homes or aged care facilities, hospitals, or post-acute facilities. Adults. A modified 2-week systematic review was undertaken. Study designs included cohort (prospective and retrospective), case-control, case series if relevant comparisons were reported, randomised controlled trials if the association between oedema measurement and pressure injury was reported, and registry data. Databases searched included: Medical Literature Analysis and Retrieval System Online, The Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica and the Cochrane Library from inception to 13 July 2021 with no language restrictions. Screening, data extraction using Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies - Prognostic Factors (CHARMS-PF) and quality assessment using Quality in Prognostic Factor Studies (QUIPS) were undertaken independently by ≥2 authors and adjudicated by another if required. Meta-analyses and meta-regression were undertaken. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Six studies (n = 483 total) were included. Two studies were set in nursing homes and four in either hospitals or post-acute facilities. Fives studies were prospective cohorts, and one was a randomised control trial. Two studies were assessed as low risk and four studies as moderate risk of bias. The pooled risk ratio in four studies (n = 388) for the relationship between oedema and pressure injury cumulative incidence was 18.87 (95% CI 2.13-38.29) and for time to pressure injury was 4.08 days (95% CI 1.64-6.52). Using GRADE, the certainty of the body of evidence was low for all outcomes. Meta-regression indicated that age, gender, and s le size were poor predictors for the association between oedema and pressure injury. Measuring oedema as a predictor for pressure injury development is showing promise but a stronger body of evidence that takes into consideration other prognostic factors is needed to better understand its benefit. PROSPERO CRD42021267834. Measuring oedema is a promising strategy to prevent pressure injuries but the certainty of evidence for this claim is low.
Student Facilitation of Simulation Debrief: Measuring Reflective Thinking and Self-Efficacy
Publisher: Elsevier BV
Date: 04-0004
Device related pressure injuries across the critical care lifespan
Publisher: Wiley
Date: 2023
DOI: 10.1111/NICC.12874
Physician and nurse research in multidisciplinary intensive care units
Publisher: AACN Publishing
Date: 11-2020
DOI: 10.4037/AJCC2020136
Abstract: Although clinical care is multidisciplinary, intensive care unit research commonly focuses on single-discipline themes. We sought to characterize intensive care unit research conducted by physicians and nurses. One hundred randomly selected reports of clinical studies published in critical care medical and nursing journals were reviewed. Of the 100 articles reviewed, 50 were published in medical journals and 50 were published in nursing journals. Only 1 medical study (2%) used qualitative methods, compared with 9 nursing studies (18%) (P = .02). The distribution of quantitative study designs differed between medical and nursing journals (P & .001), with medical journals having a predominance of cohort studies (29 articles [58%]). Compared with medical journal articles, nursing journal articles had significantly fewer authors (median [interquartile range], 5 [3-6] vs 8 [6-10] P & .001) and study participants (94 [51-237] vs 375 [86-4183] P & .001) and a significantly lower proportion of male study participants (55% [26%-65%] vs 60% [51%-65%] P = .02). Studies published in medical journals were much more likely than those published in nursing journals to exclusively involve patients as participants (47 [94%] vs 25 [50%] P & .001). Coauthorship between physicians and nurses was evident in 14 articles (14%), with infrequent inclusion of authors from other health care disciplines. Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.
Interventions to meet family needs of critically ill patients in an adult intensive care unit: A systematic review
Publisher: Elsevier BV
Date: 05-2012
Pressure injury prevalence in Australian intensive care units: A secondary analysis
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.AUCC.2021.10.009
Abstract: Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors. This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI. Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49-12.11), impaired mobility (OR: 3.13, 95% CI: 1.08-9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00-1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01-1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14-0.91). This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population.
Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study
Publisher: Wiley
Date: 08-12-2020
DOI: 10.1111/JAN.14690
Abstract: To achieve profession‐wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties). Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three‐round Delphi study (Survey Phase). Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in‐depth interviews of purposeful s le of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web‐based Delphi surveys), with draft standards reviewed profession‐wide. Responses comprised scoring using Likert scales to calculate content validity indexes for in idual standards with qualitative responses supporting decision‐making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of in idual and group feedback. The study was conducted 2014–2017. Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy‐three standards were validated, with final content validity indices of 92–100%. Scale‐level indices were 98%, strongly validating metaspecialty taxonomy. A research‐derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education. The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.
Securement to prevent device‐related pressure injuries in the intensive care unit: A randomised controlled feasibility study
Publisher: Wiley
Date: 28-06-2020
DOI: 10.1111/IWJ.13432
Pressure injury prevention for COVID-19 patients in a prone position
Publisher: Cambridge Media
Date: 06-2020
Identifying nurse sensitive indicators specific to haemodialysis nursing: A Delphi approach
Publisher: Elsevier BV
Date: 02-2020
Device-related pressure ulcers: SECURE prevention. Second edition
Publisher: Mark Allen Group
Date: 03-2022
What a difference a decade makes!
Publisher: Elsevier BV
Date: 2020
The provision of patient personal hygiene in the intensive care unit: A descriptive exploratory study of bed-bathing practice
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2010.08.001
Abstract: The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses' (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience RNs with 2-5 years ICU experience and RNs with greater than 5 years ICU experience. During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00h in 161 episodes (30%), took 15-30min to complete (n=195, 36.2%) and was completed within the last 8h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n=379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n=86, 16.1%) or other agents such as pre-packaged washcloths (n=65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey - falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs. This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.
Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries
Publisher: Oxford University Press (OUP)
Date: 19-04-2018
DOI: 10.1111/BJD.16327
Abstract: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a s le of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are sub ided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.
The viability and acceptability of a Virtual Wound Care Command Centre in Australia
Publisher: Wiley
Date: 24-05-2022
DOI: 10.1111/IWJ.13782
Abstract: The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision‐making, remote consultation, and monitoring. Fifty‐one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7 months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5 hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56‐88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient‐centred expert wound consultation service for chronic wound patients in the community.
Developing a postgraduate professional education framework for emergency nursing: a co-design approach
Publisher: Springer Science and Business Media LLC
Date: 12-03-2021
DOI: 10.1186/S12912-021-00560-Z
Abstract: Hospital and university service providers invest significant but separate resources into preparing registered nurses to work in the emergency department setting. This results in the duplication of both curricula and resource investment in the health and higher education sectors. This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. The study was informed by evidence-based co-design, using emergency nursing as an exemplar. Eighteen hours of co-design workshops were completed with 21 key clinical-academic stakeholders from hospital and university settings. Outcomes were matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education a new University-Industry Academic Integration Framework five agreed guiding principles of postgraduate curriculum development for university-industry curriculum co-design and a Graduate Certificate of Emergency Nursing curriculum exemplar. Industry-academic service provider co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability. The study developed strategies and exemplars for future use in any mutually determined academic-industry education partnership.
State‐wide prevalence of pressure injury in intensive care versus acute general patients: A five‐year analysis
Publisher: Wiley
Date: 17-03-2023
DOI: 10.1111/JOCN.16687
Abstract: The aim of this study was to analyse prevalence of pressure injury in intensive care versus non‐intensive care patients. Hospital‐acquired pressure injury is an enduring problem. Intensive care patients are more susceptible due to multiple risk factors. Several studies have indicated that intensive care patients are more likely than general patients to develop pressure injuries. Secondary data analysis. Eighteen general hospitals with intensive care units were included. The s le included all consenting patients. Logistic regression modelling was used to derive prevalence and effect estimates. STROBE reporting guidelines were followed. The s le comprised 15,678 patients 611 were in intensive care. The crude prevalence estimate of hospital‐acquired pressure injury was 9.6% in intensive care and 2.1% in non‐intensive care patients. The ≥Stage II hospital‐acquired prevalence estimate in was 8.6% intensive care and 1.2% in non‐intensive care patients. Intensive care patients were at markedly increased risk of hospital‐acquired pressure injury compared with non‐intensive care patients, with risk persisting after adjusting for pressure injury risk score. Risk of ≥ Stage II hospital‐acquired pressure injury was further elevated. Intensive care patients had a higher pressure injury risk level and developed a greater proportion of severe hospital‐acquired pressure injuries than non‐intensive care patients. In intensive care, most hospital‐acquired pressure injuries were found on the sacrum/coccyx and heels. There were significant differences between the hospital‐acquired pressure injury prevalence of intensive care versus non‐intensive care patients, which is consistent with previous studies. Overall, the prevalence of hospital‐acquired pressure injury in intensive care is relatively high, indicating that their prevention should remain a high priority within the intensive care setting. These results may be used for benchmarking and provide a focus for future education and practice improvement efforts. Neither patients nor the public were directly involved in the project.
Dryland ecohydrology and climate change: critical issues and technical advances
Publisher: Copernicus GmbH
Date: 09-08-2012
DOI: 10.5194/HESS-16-2585-2012
Abstract: Abstract. Drylands cover about 40% of the terrestrial land surface and account for approximately 40% of global net primary productivity. Water is fundamental to the biophysical processes that sustain ecosystem function and food production, particularly in drylands where a tight coupling exists between ecosystem productivity, surface energy balance, biogeochemical cycles, and water resource availability. Currently, drylands support at least 2 billion people and comprise both natural and managed ecosystems. In this synthesis, we identify some current critical issues in the understanding of dryland systems and discuss how arid and semiarid environments are responding to the changes in climate and land use. The issues range from societal aspects such as rapid population growth, the resulting food and water security, and development issues, to natural aspects such as ecohydrological consequences of bush encroachment and the causes of desertification. To improve current understanding and inform upon the needed research efforts to address these critical issues, we identify some recent technical advances in terms of monitoring dryland water dynamics, water budget and vegetation water use, with a focus on the use of stable isotopes and remote sensing. These technological advances provide new tools that assist in addressing critical issues in dryland ecohydrology under climate change.
Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.ICCN.2015.11.003
Abstract: To identify factors associated with critical care nurses' engagement in end-of-life care practices. Multivariable regression modelling was undertaken on 392 responses to an online self-report survey of end-of-life care practices and factors influencing practice by Australian critical care nurses'. Univariate general linear models were built for six end-of-life care practice areas. Six statistically significant (p<0.001) models were developed: Information sharing F(3, 377)=40.53, adjusted R(2) 23.8% Environmental modification F(5, 380)=19.55, adjusted R(2) 19.4% Emotional support F(10, 366)=12.10, adjusted R(2) 22.8% Patient and family centred decision making F(8, 362)=17.61 adjusted R(2) 26.4% Symptom management F(8, 376)=7.10, adjusted R(2) 11.3% and Spiritual support F(9, 367)=14.66, adjusted R(2) 24.6%. Stronger agreement with values consistent with a palliative approach, and greater support for patient and family preferences were associated with higher levels of engagement in end-of-life care practices. Higher levels of preparedness and access to opportunities for knowledge acquisition were associated with engagement in the interpersonal practices of patient and family centred decision making and emotional support. This study provides evidence for interventions to address factors associated with nurse engagement to increase participation in all end-of-life care practice areas.
Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
DOI: 10.1097/WON.0000000000000571
Abstract: The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. Prospective observational. The s le comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study s le and logistic regression analysis was used to identify patient characteristics associated with development of IAD. The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104 95% CI: 1.063-1.147, P .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.
Incontinence-associated dermatitis: A cross-sectional prevalence study in the Australian acute care hospital setting
Publisher: Wiley
Date: 26-06-2016
DOI: 10.1111/IWJ.12322
Algal-based wastewater treatment: Evaluation of nitrogenous byproducts in chlorinated effluent
Publisher: Elsevier BV
Date: 11-2021
Contextual factors to registered nurse research utilisation in an Australian adult metropolitan tertiary intensive care unit: A descriptive study
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.AUCC.2019.01.001
Abstract: Organisational and unit-level context can have a significant impact on implementation of evidence in practice, the latter being particularly important in the complex intensive care context. Evaluating the context may allow modifiable characteristics to be identified and addressed. The objective was to examine the relationship between dimensions of the context and research utilisation in one intensive care unit. This study used a quantitative cross-sectional survey. All registered nurses working in one Australian quaternary referral hospital intensive care unit were surveyed using the Alberta Context Tool and research utilisation instrument. Descriptive statistics were used, and bivariate analysis was undertaken to determine associations among demographic data, dimensions of context, and research utilisation. The survey response rate was 33% (67/205). Most respondents were women with a mean of 8 years of intensive care nursing experience. The dimensions of culture, evaluation, informal interactions, structural/electronic resources, and organisational slack (time and space) were positively correlated with research utilisation. Research utilisation was associated with numerous context dimensions, emphasising their effect on knowledge translation in this setting. Intensive care nurses are in a unique position to impact care delivery and provide evidence-based care to ensure optimal outcomes to patients at high risk of morbidity and mortality. Identified dimensions may be targeted and developed in future strategies to optimise the context for translating evidence into this complex practice environment.
Prevalence of pressure injury in adults presenting to the emergency department by ambulance
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.AUCC.2018.10.002
Abstract: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED). An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation. Pressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk. The results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended.
Related Organisations
Queensland University Of Technology Faculty Of Health
Location: Australia
Related Funding Activities
Discovery Projects - Grant ID: DP130100769
Start Date: 2013
End Date: 12-2017
Amount: $291,000.00
Funder: Australian Research Council
View Funded Activity