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Publisher: Springer Science and Business Media LLC
Date: 10-06-2010
Publisher: Elsevier BV
Date: 06-2007
Publisher: Elsevier BV
Date: 06-2009
Publisher: Wiley
Date: 08-04-2010
DOI: 10.1111/J.1365-2702.2009.02993.X
Abstract: Objective. To implement and evaluate strategies suggested by general nurses to improve management of children and adolescents with mental health problems admitted to a paediatric unit of a general hospital. Background. The first phase of a study using a Participatory Action Research approach identified several concerns associated with general nurses providing care to young people with mental disorders in paediatric units of general hospitals, together with suggestions for strategies to address these issues. This paper describes the second and third phase of the Participatory Action Research study, involving the implementation and evaluation of these strategies. Design. Participatory Action Research. Methods. Actions that occurred during phase two of the Participatory Action Research study included revision and introduction of policies and procedures for mental health care in the unit, education and training sessions for paediatric nursing staff and opportunities to strengthen communication between existing mental health services. In phase three, two focus groups were conducted to explore current perceptions of mental health care delivery in the unit and evaluate change, following phase two. Results. Changes in clinical practice for paediatric mental health care were acknowledged by participants. Reflection has assisted nurses to better understand their strengths and weaknesses and to acknowledge and challenge the assumptions on which their ideas, feelings and actions about patients with mental health issues are based. Participants also recognised the existing skills and expertise they possess that are relevant to the management of young people with a mental health problem, although they continue to seek ongoing education and support in this field. Conclusions. This study demonstrates that through Participatory Action Research it is possible to enhance mental health nursing care in a rural paediatric unit. Relevance to clinical practice. Such changes have the potential to improve the experience of young people and their families whilst receiving treatment for mental health conditions in a general paediatric unit.
Publisher: Elsevier BV
Date: 09-2011
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/10903120801907216
Abstract: A minority of bystanders will initiate cardiopulmonary (CPR) when a family member collapses in the home. This study sought to better understand the psychological barriers to family-initiated CPR and to determine whether sociodemographic variables are influential. Twelve hundred and eight people were contacted via telephone and asked about their experience with CPR experiences and attitudes toward initiating CPR on a family member. Seventy-four percent of participants had learnt CPR and 68 percent were confident to initiate CPR on a family member. Men, people who had learnt CPR, and people with more than 11 years of education were the most confident groups. People older than 65 were the group least likely to have learnt CPR and least confident to initiate CPR. Participants confident to initiate CPR expressed concerns about fear of failing (37%) or indicated they had no concerns (30%). In contrast, those not confident were most concerned about performing CPR correctly (55%) and 30% were afraid of failing. CPR courses are not reaching those most likely to be called upon to use this skill. Moreover, even among those with CPR training, the desire to "get it right" and fear of failing impair confidence. Psychological barriers to performing CPR should be addressed in training courses, particularly for those groups with the least confidence, such as older people.
Publisher: Wiley
Date: 21-06-2017
DOI: 10.1111/SCS.12349
Abstract: Hospital avoidance programmes aim to reduce the number of emergency transfers from nursing homes to hospitals and facilitate early discharge for hospitalised residents. Nursing staff are at the forefront of these efforts, yet little is known about how the programmes affect them and their management of the deteriorating resident. This information is needed to inform hospital avoidance programmes and better understand their work. To examine nursing home nursing staff perceptions regarding their management of the deteriorating resident after the introduction of a hospital avoidance programme. A thematic analysis was conducted of focus group data collected from nursing staff 14 to 15 months after the introduction of a pilot hospital avoidance programme at an Australian nursing home. The programme was well received and filled a gap in nursing staff management of residents with deteriorating health by providing structure and support. Staff were more confident and focused on this area of their work. Nursing assistants felt more integrated into the system and were supported and learning from nurses. Workload remained heavy and there was a shift in how time was allocated, but nursing staff preferred to keep residents at the facility. Nursing staff welcomed the programme and benefitted from its implementation. However, strategies must be explored to accommodate the staffing needs associated with providing emergency and subacute care in the nursing home setting.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.NEPR.2014.12.004
Abstract: An important way to advance the profession of nursing, to promote best practice and to improve the quality of nursing care, is for nurses to publish. A publication track record is necessary to gain competitive research funding, build knowledge, disseminate new insights and advance the profession. However, academics often experience obstacles in publishing ranging from a pervasive teaching culture, lack of confidence in writing, and lack of strategies to write more strategically. The benefits of writing retreats have been discussed within the nursing and other academic literature but the specifics about the method as well as the unplanned benefits have not been explored. More exploration and discussion is needed about factors assisting writers to complete papers and successfully publish. This paper discusses a novel intervention which aimed to seed the beginnings of a flourishing scholarly community at a regional Queensland University. The paper also presents qualitative and quantitative evaluation data.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.NEDT.2014.04.004
Abstract: Learning the skills of child health nursing requires more than technical skill development. Humanistic attributes such as being genuine, accepting and empathic are imperative in gaining the trust of a child and in helping them feel comforted and safe in a health care setting. Interpersonal theory has a long history in nursing and numerous contemporary theories have drawn on the seminal work of Peplau to advance nursing practice. However, rarely has this theory been applied to simulation learning. This paper reports on an innovative simulation technique that blends interpersonal theory with puppets. Qualitative evaluation using focus group method with fifteen undergraduate nursing students revealed that the pedagogy had a positive impact on characteristics of the learner, the learning process and on interpersonal communication skills development. The study deepened insights about the educative process and led to learning impacts that suggest that puppet-based learning is a powerful medium to bridge theory and practice, bringing the importance of interpersonal theory to life for students.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.NEPR.2016.12.001
Abstract: The use of puppets in health care is emerging as a mode of simulation that combines elements of engaging with the child through play whilst at the same time providing education. This review examines the impact when nurses use play therapy or puppets as a simulation modality in nursing education and in the clinical paediatric nursing environment. Electronic search was conducted using CINAHL, PubMed, Scopus, Web of Science and PsycINFO data bases, between 1980 and January 2015 with the combinations of play therapy puppetry nursing education nursing simulation health professionals and puppets. Twelve articles were identified that highlight the use of puppet simulation in the education of nursing students and children in the healthcare environment. Puppet modelling and puppet simulation is predominantly adopted in the areas of health education and specifically diabetes education. Identified gaps in the use of puppet simulation in nursing, nurse education and puppet simulation as a three-way communication process thus identifying the need for further research on puppet simulation and its application and benefits in nursing and nurse education.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.IJNURSTU.2015.03.004
Abstract: The debate on whether in iduals want their family to be present during cardiopulmonary resuscitation continues to be a contentious issue, but there is little analysis of the predictors of the general public's opinion. The aim of this population based study was to identify factors that predict public support for having family present during cardiopulmonary resuscitation. Data for this cross-sectional population based study were collected via computer-assisted-telephone-interviews of people (n=1208) residing in Central Queensland, Australia. Participants supported family members being present should their child (75%), an adult relative (52%) or they themselves (51%) require cardiopulmonary resuscitation. Reasons cited for not wanting to be present were distraction for the medical team (30.4%), too distressing (30%) or not known/not considered the option (19%). Sex and prior exposure to being present during the resuscitation of adults and children were both predictors of support (p<0.05). Reasons for not wanting to be present differed significantly for males and females (p=0.001). In idual support for being present during cardiopulmonary resuscitation varies according to sex, prior exposure and if the family member who is being resuscitated is a family member, their child or the person themselves. A considerable proportion of the public have not considered nor planned for the option of being present during a cardiac arrest of an adult relative. Clinicians may find it useful to explain the experiences of other people who have been present when supporting families to make informed decisions about their involvement in emergency interventions.
Publisher: Wiley
Date: 03-2011
Publisher: Springer Science and Business Media LLC
Date: 13-01-2017
Publisher: Springer Science and Business Media LLC
Date: 12-05-2009
Publisher: Hindawi Limited
Date: 10-2007
DOI: 10.1111/J.1365-2934.2006.00737.X
Abstract: Given the shortage of critical care nurses, emphasis has been placed upon improving their working lives through the implementation of flexible work hours. This descriptive exploratory study evaluated the effects of the implementation of the 12-hour roster in a regional intensive care unit (ICU). Staff (n = 19) completed a survey 12 weeks following the implementation of the 12-hour roster. The study demonstrated widespread acceptance (92%) positive impact on physical and psychological well-being and increased work satisfaction (58%) for the nursing participants. Similarly, nurses working both the 8- and 12-hour rosters (75%), the doctors and allied health care workers all identified increased continuity of patient care as an outcome of the 12-hour shift. Participants strongly agreed that 12-hour rostering was a good recruitment (67%) and retention (75%) strategy. In an environment with considerable shortages of experienced critical care nurses, the use of flexible shift patterns such as the 12-hour roster was a positive recruitment and recruitment strategy.
Publisher: SAGE Publications
Date: 02-2006
DOI: 10.1258/095148406775322016
Abstract: Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical- isional (CD), or clinical-institute (CI). In all, 12 hospitals changed structure during the study period. There was slight evidence that CD structures were more efficient than TP structures but this was not supported by other evidence. There were no significant differences in efficiency in the first or second years following changes from either TP to CD or TP to CI structures. All four hospitals changing from CD to CI structure became significantly less efficient. This may be due to frequency rather than type of change as they were the only hospitals that implemented two structural changes. Hospitals that changed or did not change structure were similar in efficiency at the beginning and at the end of the study period, in overall efficiency during the period, and in trends toward efficiency over time. The findings challenge those who advocate restructuring hospitals on the grounds of improving cost efficiency.
Publisher: Wiley
Date: 16-09-2011
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.NEPR.2015.10.005
Abstract: Encouraging and permitting family members to stay together during cardiopulmonary resuscitation benefits the patient, family and staff. Health care professionals (HCP) attitudes and experiences are documented as barriers to initiating family presence during cardiopulmonary resuscitation (FPDR). The aim of this pilot study was to explore the influence of education on changing HCPs attitudes and intent to provide families with the option to be present at the next cardiac arrest. A purposive s le of 29 HCP from an acute care hospital participated in this quasi-experimental study. 18 of the original 29 HCP completed both the education package and the post-test questionnaire. The majority of participants in this study had previous experience with FPDR (62%) and supported FPDR (69%). While participants had slightly more positive attitudes towards FPDR post education, this change was not significant (p = 0.79). Similarly, participation in education did not change participants concerns about safety issues or increase participant's intention to invite a family member to be present at the next cardiac arrest. The majority of participants strongly supported the development of a dedicated family support person. Education has limited impact on change participant's attitudes or intentions to invite family to be present at the next cardiac arrest.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.RESUSCITATION.2010.11.031
Abstract: In-hospital cardiac arrests are commonly associated with poor outcomes and preceded by observable signs of clinical deterioration. Medical emergency teams (METs) have emerged to provide early specialist care intervention to critically ill patients. To determine the effect of MET implementation on hospital-wide mortality rates, cardiopulmonary arrests and admissions to the intensive care unit (ICU) in a regional Queensland hospital. A prospective cohort before and after interventional trial was conducted on adult and paediatric inpatients admitted in 2004-2008 at a 150 bed regional teaching hospital in Australia. MET was introduced in 2006 and attended clinically unstable patients. Response was activated by the bedside nurse or doctor according to predefined criteria. There were a total of 296 MET activations. After MET implementation, mean hospital-wide mortality rates decreased from 9.9 to 7.5 per 1000 admissions (relative risk reduction, RRR: 24.2% p = 0.003). Similarly, ICU admissions decreased from 22.4 to 17.6 per 1000 admissions (RRR: 21.4% p < 0.0001). There was also a significant decline in hospital-wide cardiopulmonary arrests post intervention (77 versus 42, RRR: 45.5% p = 0.0025) however this may be explained by the increase in the number of patients deemed not for resuscitation by the MET. Secondary analysis revealed evidence of MET underuse that may have affected the mortality findings. Implementation of the MET in a regional hospital was associated with statistically significant reductions in hospital-wide mortality rates, ICU admissions and cardiopulmonary arrests.
Publisher: Wiley
Date: 21-05-2009
DOI: 10.1111/J.1440-1584.2009.01061.X
Abstract: To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research. A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research. A 16-bed paediatric unit of a rural general hospital. A purposive convenience s le of all paediatric nursing staff (n = 20 of 24 nurses). In the first phase of this study, focus groups were conducted to explore the experiences of nurses. Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment. There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority.
Publisher: SAGE Publications
Date: 05-06-2009
Abstract: This article describes the equivalency testing results of a 12-week behavior change program on targeted determinates of physical activity (PA) and self-reported health status. Participants ( n = 192) were randomized to face-to-face, combined Internet and face-to-face, and Internet-only groups. Equivalency testing was used to examine differences and statistical equivalency across groups for all outcome measures (social support, self-efficacy, perceived health status, and motivational readiness for PA). Participants were assessed at baseline, postintervention, and 2 and 5 months postintervention. Motivational readiness for PA increased across all groups. The face-to-face and combined groups showed changes in social support however, they were not statistically different and were equivalent. There were no changes in self-efficacy or physical health status. Overall face-to-face and the Internet delivery modes show similar results. If Internet-based programs can be shown to be as effective as face-to-face, they may in turn be a more efficient and cost-effective delivery method.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.AENJ.2016.12.003
Abstract: It is well documented that the respiratory rate is the least accurately recorded vital sign. Despite nurses consistently confirming that they understand the physiological importance of the respiratory rate, more often than not, they estimate a value rather than count for an entire minute. Until recently, little has been known about why this phenomenon perpetuates. However, it has now been established that many emergency department registered nurses believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate. This discussion highlights the significance of recording accurate respiratory rates, as opposed to estimating a rate emphasizing that just four breaths either side of the normal range could be indicative of impending clinical deterioration.
Publisher: Wiley
Date: 06-02-2018
DOI: 10.1111/JOCN.14119
Abstract: To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting. Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area. A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework. Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis. Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene. The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home. Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies.
Publisher: Wiley
Date: 09-06-2017
DOI: 10.1111/NIN.12206
Abstract: The incidence of chronic illness is growing globally. As a result, there are fiscal and social implications for health delivery. Alongside the increased burden on health resources is the expectation that someone within the family will assume the responsibility of carer for those who are chronically ill. The expectation to assume the role of carer may be lified for family members who are also nurses. Currently, there is little research that investigates the impact of nurses who are carers for family with a chronic illness. Consequently, this qualitative study, based on face-to-face and telephone dialogue, was conducted using unstructured interviews. A phenomenological-hermeneutic approach utilizing the hermeneutic circle was employed to understand the meaning of the transcriptions. Hermeneutic phenomenology inspired by Heideggerian philosophy was used as a framework to clarify themes and build ways of understanding the phenomenon of 'Being' a nurse and a family carer. Themes identified in the analysis of the study included a personal world, a professional world and a practical world. This paper explicates the findings from examination of the personal world of 'Being' a nurse who is also a family carer. Analysis revealed there were three facets to this way of 'Being': a shared experience, a caring experience and a fraught experience. The findings of the study disclosed that participants were informed by experiences that were both enriching and conflicting. These insights can enlighten healthcare professionals to the tensions which exist for nurses who care for family so that these considerations are incorporated into in idualized and effective family-centred care.
Publisher: Elsevier BV
Date: 04-2019
Publisher: SAGE Publications
Date: 07-2016
Abstract: Research within a phenomenological framework is aimed at understanding the lived experience of participants to capture the essences of their combined stories to provide new insights and truths surrounding a particular phenomenon. Essential to this process is the acquiring of data representative of the experience being researched. The art of unstructured interviews is to acknowledge and value participants’ stories as each participant traverses deeply personal experiences with the interviewer. This article examines the impact of factors that influence the successful interviewing of peers and explores how ignoring the foundational elements of “who, where, and how” may result in lean or even skewed data. Aimed at accessing the essence of a phenomenon through conversational interviews, the authors offer an adaptable framework that considers the additional elements of “space, language, role, and trust” which is aligned with the intent of phenomenological studies.
Publisher: Wiley
Date: 09-07-2008
DOI: 10.1111/J.1440-1584.2008.00959.X
Abstract: Rural Australians have higher rates of smoking than their urban counterparts, contributing to poorer health outcomes. In 2004, the Queensland Government introduced legislation to reduce the impact of environmental tobacco smoke on the community. The aims of the study were to describe smoking behaviours and associations between smoking behaviour and agreement with current anti-smoking laws. A total of 1208 people over the age of 18 years and living in rural, remote and very remote central Queensland participated in this telephone survey. About 22% (n = 130) of female and 21% of male (n = 125) participants identified themselves as smokers. No difference existed between the mean age of smokers (47.3 years) and non-smokers (47.1 years). While there is high level of support for smoking restrictions in public places (75%), attitudes vary with smoking status. Smokers were less likely than smokers to agree that the legislation would create a healthier environment, reduce exposure to passive smoking or agree that 'it is right to ban smoking in public places'. Smokers were significantly more likely to agree that the legislation had gone too far. The gradual implementation of the anti-smoking legislation is changing social beliefs on what are acceptable smoking practices. It is likely that the legislation within Queensland and the subsequent forced changes in social conditions for smokers will continue to reduce the number of people smoking and reduce exposure to environmental tobacco smoke.
Publisher: BMJ
Date: 02-2023
DOI: 10.1136/BMJOPEN-2022-066857
Abstract: The Early Detection of Deterioration in Elderly residents (EDDIE+) programme is a theory-informed, multi-component intervention aimed at upskilling and empowering nursing and personal care staff to identify and manage early signs of deterioration in residents of aged care facilities. The intervention aims to reduce unnecessary hospital admissions from residential aged care (RAC) homes. Alongside a stepped wedge randomised controlled trial, an embedded process evaluation will be conducted to assess the fidelity, acceptability, mechanisms of action and contextual barriers and enablers of the EDDIE+ intervention. Twelve RAC homes in Queensland, Australia are participating in the study. A comprehensive mixed-methods process evaluation, informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, will assess intervention fidelity, contextual barriers and enablers, mechanisms of action, and the acceptability of the programme from various stakeholder perspectives. Quantitative data will be collected prospectively from project documentation, including baseline context mapping of participating sites, activity tracking and regular check-in communication sheets. Qualitative data will be collected postintervention via semi-structured interviews with a range of stakeholder groups. The i-PARIHS constructs of innovation, recipients, context and facilitation will be applied to frame the analysis of quantitative and qualitative data. Ethical approval for this study has been granted by the Bolton Clarke Human Research Ethics Committee (approval number: 170031) with administrative ethical approval granted by the Queensland University of Technology University Human Research Ethics Committee (2000000618). Full ethical approval includes a waiver of consent for access to residents’ demographic, clinical and health services de-identified data. A separate health services data linkage based on RAC home addresses will be sought through a Public Health Act application. Study findings will be disseminated through multiple channels, including journal publications, conference presentations and interactive webinars with a stakeholder network. Australia New Zealand Clinical Trial Registry (ACTRN12620000507987).
Publisher: MDPI AG
Date: 28-04-2009
Publisher: Elsevier BV
Date: 08-2003
Publisher: Wiley
Date: 20-01-2011
Publisher: BMJ
Date: 07-08-2012
DOI: 10.1136/BMJ.E4547
Publisher: Wiley
Date: 06-2008
Publisher: Springer Science and Business Media LLC
Date: 30-05-2007
Publisher: SAGE Publications
Date: 11-2005
DOI: 10.1177/003335490512000614
Abstract: Children working in vehicle spray-painting, mechanical, and other trade workshops are at significant risk of exposure to organic solvents and, as a result, may be at significant risk of developing clinical and subclinical signs of neurotoxicity. This study reports on the association between exposure to solvents and neurobehavioral performance on a number of non-computerized tests for working children exposed to solvents in comparison with nonexposed working children and nonexposed children at school. A convenience cross-sectional s le of 300 male children aged 10–17 years was recruited for study. The exposed working group and the two nonexposed groups (working and nonworking school) were matched, as far as possible, on geographic location of residence and age. Neurotoxic effects were assessed through a questionnaire and the child's performance on a selection of neurobehavioral tests. Exposed working children scored worse on the overall neurotoxicity symptoms score (mean=6.8 standard deviation [SD]=3.6) compared with the nonexposed working children (mean = 1.3 SD=2.0) and school children (mean = 1.2 SD=1.8). Analysis of the non-computerized neurobehavioral tests demonstrated that exposed working children performed significantly worse than the two nonexposed groups on the motor dexterity and memory tests. Results of the mood test showed that exposed working children were more angry and confused than the nonexposed groups. There is an association between exposure to solvents and lower neurobehavioral performance, with significant neurobehavioral deficits among children exposed to solvents in comparison with working children not exposed to solvents and nonworking school children. Memory and motor dexterity appear to be particularly affected in solvent-exposed working children.
Publisher: Elsevier BV
Date: 08-2007
Publisher: Springer Science and Business Media LLC
Date: 11-05-2013
Publisher: Wiley
Date: 02-11-2009
DOI: 10.1111/J.1447-0349.2009.00628.X
Abstract: Smoking is widely recognized as an important public health issue for the general population and in the mental health field where the rates are particularly high. Mental health nurses are well positioned to take an active role in encouraging and supporting people diagnosed with mental illness to cease smoking. Information about smoking behaviour and the attitudes of mental health nurses is necessary to develop strategies to prepare nurses for this important role. A cross-sectional study was conducted to examine the smoking behaviour and attitudes of mental health nurses in Queensland, Australia, through a random selection of mental health nurses (n = 289). Smoking rates (16%) in this study were lower than those for the Australian population. Smokers were significantly (P < 0.001) less likely to agree that health-care facilities should promote a healthy environment. All participants, but predominantly those who smoked (P < 0.001), supported the in idual's right to smoke. Participants believed they possessed appropriate skills to deliver the antismoking message effectively, although stronger beliefs were characteristic of non-smokers. Participants who smoked perceived that their smoking status assisted in facilitating interactions with consumers (P < 0.001). The findings have implications for the health promotion activities of mental health nurses.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Hindawi Limited
Date: 05-2013
DOI: 10.1111/JONM.12037
Abstract: To identify, from the perspectives of nurses, occupational stressors and ways in which they may be reduced. Nurses commonly experience high levels of occupational stress, with negative consequences for their physical and psychological health, health-care organisations and community. There is minimal research on reducing occupational stress. Six focus groups were conducted with 38 registered nurses using a qualitative exploratory approach. Participants were asked to identify sources of occupational stress and possible workplace initiatives to reduce stress. Sources of occupational stress were: high workloads, unavailability of doctors, unsupportive management, human resource issues, interpersonal issues, patients' relatives, shift work, car parking, handover procedures, no common area for nurses, not progressing at work and patient mental health. Suggestions for reduction included: workload modification, non-ward-based initiatives, changing shift hours, forwarding suggestions for change, music, special events, organisational development, ensuring nurses get breaks, massage therapists, acknowledgement from management and leadership within wards. The findings highlight the need to understand local perspectives and the importance of involving nurses in identifying initiatives to reduce occupational stress. Health-care environments can be enhanced through local understanding of the occupational stressors and productively engaging nurses in developing stress reduction initiatives. Nurse managers must facilitate such processes.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2011
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.AUCC.2021.05.005
Abstract: People with burn injury experiencing hypothermia are at risk of serious complications such as shock, multisystem organ failure, and death. There is limited information available for health professionals with regard to factors that contribute to restoration of normothermia after hypothermia in people with a major burn injury. The aim of the study was to identify factors that contribute to normothermia restoration after hypothermia in people with 10% or more total body surface area (TBSA) burn in the first 24 h of admission to a burn care hospital. The study was guided by the Gearing Framework for retrospective chart audit. The s le comprised medical charts of all adult people (n = 113) with a burn injury more than 10% of their TBSA admitted to a single-site burn care hospital intensive care unit in Victoria, Australia, between May 31, 2013, and June 1, 2015. Descriptive statistics were used to describe the s le, and logistic regression was conducted to predict variables contributing to return to normothermia in people with burn injury. Charts with incomplete data were excluded. The s le (n = 50) recorded a median initial temperature on admission to the emergency department (ED) of 35.4°C (range = 31.9-37.2°C) and took on an average of 6.2 (standard deviation [SD] = 4.96) hours to return to normothermia (36.5°C). Women took around 6 h longer than men to return to normothermia (mean = 11.14 h, SD = 5.58 mean = 5.38 h, SD = 4.41). Positive correlations were noted between TBSA%, the length of time between admission to the ED and the intensive care unit, and the hours taken to reach normothermia. Regression analysis suggests the initial recorded temperature on admission to the ED was the main predictor of the time body temperature takes to return to normothermia (β = .513, p < .001). This study provides information for practice changes by highlighting the need for guidelines and education programs for health professionals to ensure the delivery of optimum care to people with burn injury.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.AENJ.2013.11.002
Abstract: The practice environment of the emergency department (ED) refers to both the people and physical factors (architecture) in the environment in which health care is provided. ED triage practice environments are the very places where caring or the delivery of health care often begins. This paper examines the implications of the emergency department triage practice environment on the triage practice of nurses who triage clients with a mental illness. An observational ethnographic approach inclusive of participant observation, formal and informal semi structured interviews, examination of documents and the collation of field notes were the means of data collection. Data was analysed through constant comparison and theoretical coding. Nurses who work in ED triage are cognisant of environmental impacts as they undertake rapid client assessment and manage busy and noisy waiting rooms. The triage environment does influence the ED triage assessment and the management of clients who present seeking mental health care. Tensions arise when the architectural environment of an ED triage area affects client behaviour, the capacity to provide optimal client care and the ability to conduct a triage assessment that obtains the best data possible. Understanding the impact of the ED triage practice environment on people with a mental illness facilitates an understanding of how people from this client group can be better supported in a complex and busy ED environment.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.AUCC.2016.10.003
Abstract: Early warning systems (EWS) were developed as a means of alerting medical staff to patient clinical decline. Since 85% of severe adverse events are preceded by abnormal physiological signs, the patient bed-side vital signs observation chart has emerged as an EWS tool to help staff identify and quantify deteriorating patients. There are three broad categories of patient observation chart EWS: single or multiple parameter systems aggregated weighted scoring systems or combinations of single or multiple parameter and aggregated weighted scoring systems. This scoping review is an overview of quantitative studies and systematic reviews examining the efficiency of the adult EWS charts in the recognition of in-hospital patient deterioration. A broad search was undertaken of peer-reviewed publications, official government websites and databases housing research theses, using combinations of keywords and phrases. CINAHL with full text MedLine, PsycINFO, MasterFILE Premier, GreenFILE and ScienceDirect. Also, the Cochrane Library database, Department of Health government websites and Ethos, ProQuest and Trove databases were searched. Paediatric, obstetric and intensive care studies, studies undertaken at the point of hospital admission or pre-admission, non-English publications and editorials. Five hundred and sixty five publications, government documents, reports and theses were located of which 91 were considered and 21 were included in the scoping review. Of the 21 publications eight studies compared the efficacy of various EWS and 13 publications validated specific EWS. There is low level quantitative evidence that EWS improve patient outcomes and strong anecdotal evidence that they augment the ability of the clinical staff to recognise and respond to patient decline, thus reducing the incidence of severe adverse events. Although aggregated weighted scoring systems are most frequently used, the efficiency of the specific EWS appears to be dependent on the patient cohort, facilities available and staff training and attitude. While the review demonstrates support for EWS, researchers caution that given the contribution of human factors to the EWS decision-making process, patient EWS charts alone cannot replace good clinical judgment.
Publisher: Wiley
Date: 30-03-2004
Publisher: BMJ
Date: 21-06-2011
DOI: 10.1136/BMJ.D3442
Publisher: Elsevier BV
Date: 10-2012
Publisher: Elsevier BV
Date: 11-2010
Publisher: Elsevier BV
Date: 06-2016
Publisher: Wiley
Date: 31-10-2007
DOI: 10.1111/J.1478-5153.2007.00236.X
Abstract: Evidence indicates that hospital nurse-initiated defibrillation improves survival following cardiac arrest. Accordingly, hospitals are changing their policies to permit nurses to initiate defibrillation. However, if nurse-initiated defibrillation is to be successful implemented, nurses' beliefs about this practice need to be understood. Therefore, the aim of this study was to explore the attitudes of rural nurses towards defibrillation to assist in the development of nurse-initiated defibrillation programmes. This cross-sectional study examined the defibrillation beliefs of registered nurses in rural areas. A proportionally stratified s le of registered nurses (n = 436) were drawn from 51 rural acute care hospitals in Australia. Most (n = 224 52%) of the participants were not permitted to initiate defibrillation. A one-way between-groups multivariate analysis of variance showed that nurses who were permitted to initiate defibrillation held stronger positive beliefs towards defibrillation than nurses not permitted (10,410) = 13.88, p < 0.001. Nurses not permitted were more concerned about the challenge of learning rhythms, incurring litigation and harming the patient or themselves. If it is accepted that defibrillation will become an essential part of all nurses' roles, these beliefs should be explored and integrated into educational programmes as inappropriate beliefs about defibrillation may impede implementation and skills development.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.INJURY.2010.12.006
Abstract: Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. Experts agree that there are many factors that hinder the delivery of adequate pain management to patients with pain. The purpose of this study was to use the Theory of Planned Behaviour (TPB) model to identify the factors influencing Ambulance Paramedics' intention to administer morphine to patients with pain. Participants of this study were Advanced Care and Intensive Care Paramedics who were deemed competent in morphine administration. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. Whilst participants reported strong intentions to administer morphine they also reported negative attitudes towards the behaviour. The constructs of the TPB explained 26% of the variance in intention to administer morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into Paramedic's pain management behaviour.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2021
DOI: 10.1186/S12960-021-00562-7
Abstract: Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers ‘willingness’ to be seen by NPs warrants further investigation. Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. While just over 53% of the general public participants ( n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
Publisher: Elsevier BV
Date: 06-2011
Publisher: Wiley
Date: 08-2011
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.COLEGN.2013.02.005
Abstract: Occupational stress is common among nurses. Two factors that may influence stress levels are diet and physical activity. The purpose of this study was to investigate the diets and physical activity levels of nurses and to quantify the relationships between these behaviours and anxiety, depressed mood, stress, and burnout. Nurses (N = 52) from one regional hospital completed a survey assessing physical activity, nutrition, and psychological functioning. Almost two-thirds (65%) of participants had met recommended levels of both moderate and vigorous physical activity in the week prior. Participants met recommended levels for fruit, but not vegetable, consumption. Burnout and stress levels were close to norms for physicians and nurses. Scores for depressed mood, anxiety, and stress symptoms were within one standard deviation of norms for the Australian adult population. Several moderately sized correlations were found between the psychological constructs measured and both physical activity and nutrition. Although most of the participants were physically active and seemed to be consuming nutritious diets, some nurses may need encouragement to adopt similarly healthy behaviours.
Publisher: BMJ
Date: 02-03-2017
Publisher: Wiley
Date: 12-2005
Publisher: Hindawi Limited
Date: 10-2008
DOI: 10.1111/J.1365-2934.2007.00836.X
Abstract: To develop a theory that explains the 'realities' of part-time nursing. While little is known about the phenomenon of part-time nursing, increasing numbers of nurses work in part-time employment. Grounded theory. The problem that part-time nurses shared was an inability to achieve their personal optimal nursing potential. Motivators to work part-time, employment hours, specialty, in idual and organizational factors formed contextual conditions that led to this problem. Part-time nurses responded to the challenges through a process of adaptation and adjustment. Harnessing the full productive potential of part-time nurses requires support to limit the difficulties that they encounter. The developed theory provides a valuable guide to managerial action. Nurse Managers need to consider the developed substantive theory when planning and managing nursing workforces.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2009
Abstract: The current randomized trials comparing video-assisted thoracic surgery (VATS) lobectomy with open lobectomy for patients with early-stage non–small-cell lung cancer (NSCLC) have been of small size. We performed the present meta-analysis of the randomized and nonrandomized comparative studies in an attempt to assess the safety and efficacy of VATS lobectomy. Electronic searches identified 21 eligible comparative studies (two randomized and 19 nonrandomized) for inclusion. Two reviewers independently appraised each study. Meta-analysis was performed by combining the results of reported incidence of morbidity and mortality, recurrence, and 5-year mortality rates. The relative risk (RR) was used as a summary statistic. There were no significant statistical differences between VATS and open lobectomy in terms of postoperative prolonged air leak (P = .71), arrhythmia (P = .86), pneumonia (P = .09), and mortality (P = .49). VATS did not demonstrate any significant difference in locoregional recurrence (P = .24), as compared with the open lobectomy arm, but the data suggested a reduced systemic recurrence rate (P = .03) and an improved 5-year mortality rate of VATS (P = .04). There was no evidence to suggest heterogeneity of trial results. Fourteen studies reported VATS to open lobectomy conversion rate ranging from 0% to 15.7% (median = 8.1%). Both randomized and nonrandomized trials suggest that VATS lobectomy is an appropriate procedure for selected patients with early-stage NSCLC when compared with open surgery.
Publisher: Elsevier BV
Date: 11-2009
Publisher: Wiley
Date: 16-02-2010
DOI: 10.1111/J.1365-2702.2009.02988.X
Abstract: Aims and objectives. The aim of this paper is to examine the use of mental health triage scales in Australian emergency departments (EDs) and to explore the use of the Australasian Triage Scale (ATS) with existing mental health triage scales. Background. Since the introduction of mainstreaming and deinstitutionalisation in Australian mental health care, the number of clients presenting to Australian EDs has been increasing. It has become apparent that the lack of mental health descriptors in existing triage scales diminishes the ability of ED triage staff to accurately assess clients with a mental illness. In response to this, specialised mental health triage scales have been developed and introduced into practice. Concurrently, mental health descriptors have been incorporated into the ATS used across Australian EDs. Design. A review of English language literature was conducted. Method. The data bases Proquest, Synergy and CINAHL were searched using the key words ‘emergency department’, ‘triage’, ‘mental health’ and again using the term ‘emergency mental health triage’. Results. There is a paucity of literature surrounding the use of mental health triage scales in Australian EDs 18 articles were found to be directly relevant to the subject matter. Conclusion. Currently clients with a mental illness presenting to the ED may be triaged against one of four mental health triage scales. Research has shown that the mental health descriptors in the ATS are not as reliable as a specialised mental health triage scale. Relevance to clinical practice. This has implications for clinical practice on two levels. First, it affects the initial triage assessment in the ED and the ability for mental health clinicians to respond in a timely manner and this will have an impact on clinical outcomes. Second, the use of the mental health triage criteria in the ATS may misrepresent ED workloads and affect data pertaining to ED performance.
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 11-2002
DOI: 10.1016/S1036-7314(02)80028-5
Abstract: The current deficit of knowledge related to advanced nursing practice in Australian adult critical care settings presents a barrier to future role development. This paper reports the findings of one theme identified by a research study that explored issues related to the potential for a new advanced nursing practice role for these settings. The qualitative approach of focus group methodology was used to collect data from a purposive s le of regional Queensland critical care nurses (n = 26). Thematic content analysis of the data identified concepts that progressively contributed to five major themes. This paper will report the findings related to the theme that there is a need for a new advanced nursing practice role for adult critical care settings. Participants perceived that nurses are already practising at advanced levels that may predetermine a new role. There was believed to be a need for recognition of and legal sanction for critical care nurses' present practices that extend beyond the current scope of nursing practice. Participants proposed that critical care nurses may be more competent than inexperienced medical personnel in this environment and participants wanted consistent levels of autonomy for advanced practices. The current career structure was seen to be a failure and many participants perceived the lack of opportunities for critical care nurses to advance up the clinical career pathway as problematic in recruitment and retention issues. The findings of this study provide new information that makes an important contribution to further exploration of advanced nursing practice role development for Australian adult critical care settings.
Publisher: Wiley
Date: 10-11-2009
DOI: 10.1111/J.1365-2702.2008.02567.X
Abstract: To explore the experiences of general nurses towards caring for children with mental health issues and to identify strategies to improve management of these children. There has been an increase of children and adolescents with complex emotional and psychological disorders being admitted to paediatric units of general hospitals due to a lack of specialist child and youth mental health facilities. The study is situated in a 16 bed paediatric unit of a rural public hospital. As the closest inpatient child mental health unit of this kind is more than 600 km away, the paediatric unit admits children and adolescents with a primary psychiatric diagnosis. A participatory action research approach guided this study. Focus groups and in idual interviews were conducted with a purposive convenience s le of all nursing staff (n = 20) working in the paediatric unit. Verbatim interview transcripts were analysed to identify the major themes. Two main themes emerged from data analysis: (1) role preparation and adequacy (2) lack of support and resources. Participants suggested several strategies to address these concerns including: improving relationships with mental health services, professional development, and developing a greater appreciation for mental health interventions. There is a clear need for an increased understanding of mental health practices, an improved relationship between general and mental health services and continuing professional development to ensure nurses possess the skills and confidence to provide quality care to children admitted to a paediatric unit with a mental health diagnosis. Few general nurses have mental health training and, through no fault of their own, may be providing less than optimal care to children who are admitted with a mental health diagnosis. Through a desire to improve care, the following participatory action research project was instigated.
Publisher: Elsevier BV
Date: 06-2018
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Springer Science and Business Media LLC
Date: 2007
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IJNURSTU.2017.06.001
Abstract: Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. This research project employed a classic grounded theory analysis of qualitative data. Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from in idual interviews and open-ended responses from an online questionnaire. Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2011.05.003
Abstract: The use of automated external defibrillators (AEDs) following a cardiac arrest in the out-of-hospital setting has demonstrated increased survival rates, likely because up to 71% of out-of-hospital cardiac arrests are associated with rhythm disturbances that are able to be treated with defibrillation. It is less clear whether the use of AEDs in the hospital setting would be effective because fewer patients (approximately 25%) have initial cardiac rhythms that respond to defibrillation and because survival may be compromised if the use of AEDs contributes to interruptions in the delivery of chest compressions. The authors of this study used data from the National Registry of Cardiopulmonary Resuscitation (NRCPR) to evaluate the association between survival after an in-hospital cardiac arrest and use of an AED. Data was drawn from patients 18 years of age or older, who had an index pulseless, in-hospital cardiac arrest in clinical area where an AED was available for patient treatment. The s le comprised 11,695 patients from 204 hospitals. The primary outcome measure was survival to hospital discharge. The authors also reported secondary outcomes such as return of spontaneous circulation (ROSC) for at least 20 min during the acute resuscitation survival at 24h and neurological status among those patients surviving to hospital discharge. Of the 11,695 patients with cardiac arrests, the majority (82.2% n=9616) were in a nonshockable rhythm, such as asystole or pulseless electrical activity (PEA). Only 17.8% (n=2079) of patients in the study were in a shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used on 4515 patients (38.6%). An overall survival to discharge rate of 18.1% (n=2117) was reported. The use of an AED was associated with lower survival rates (16.3% vs 19.3% adjusted rate ratio [RR], 0.85 95% confidence interval [CI], 0.78-0.92 P<0.001). AED use in those patients with asystole or PEA (unshockable rhythms) was associated with lower survival (10.4% vs 15.4% adjusted RR, 0.74 95% CI, 0.65-0.83 P .10). For cardiac arrest due to asystole or PEA the use (or not) of an AED did not influence the rates of ROSC. For cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia the rates of ROSC and survival at 24 h did not differ by AED use. AED use did not shorten the time to defibrillation and for those patients with ROSC, and was not associated with shorter CPR times or fewer administered defibrillations. Overall the authors concluded that the use of AEDs in hospitalised patients following cardiac arrest was not associated with improved survival.
Publisher: Elsevier BV
Date: 02-2018
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.NEPR.2015.05.007
Abstract: Simulation-based resuscitation education has emerged as a key to improving patient safety and numerous healthcare organisations have invested in high-fidelity simulation training centres. However, the high purchasing cost, limited portability, technical expertise and organisational skills required to coordinate these high-fidelity simulation centres are factors that limit their use as a wide-spread teaching and learning method. Creative innovation is required. The aim of this study was to pilot an inexpensive, portable, novel high fidelity humanistic simulation modality, for educating nurses and doctors in recognising and responding to the deteriorating patient. Analysis of five focus group discussions revealed the main theme of engagement in the simulation experience with three main subthemes of realism of the character, believability of the experience and being more connected. In conclusion, this innovative simulation modality offers a viable alternative for resuscitation training.
Publisher: Wiley
Date: 18-10-2012
Publisher: Springer Science and Business Media LLC
Date: 14-04-2007
Publisher: SAGE Publications
Date: 18-01-2012
Abstract: Objectives: It can be difficult to distinguish vestibular migraine (VM) from Menière’s disease (MD) in its early stages. Using vestibular-evoked myogenic potentials (VEMPs), we sought to identify test parameters that would help discriminate between these two vestibular disorders. Methods: We first recorded ocular and cervical VEMPs (oVEMP/cVEMP) to air-conducted clicks and bone-conducted vibration in 30 control participants, 30 participants with clinically definite VM and 30 participants with clinically probable VM. Results were compared with a group of 60 MD patients from a previous study. oVEMPs and cVEMPs were then recorded at octave frequencies of 250 Hz to 2000 Hz in 20 controls and 20 participants each with clinically definite VM and MD. Inter-aural litude asymmetry ratios and litude frequency ratios were compared between groups. Results: For click, tendon-hammer-tap and minishaker-tap VEMPs, there were no significant differences in reflex litudes or symmetry between controls, definite VM and probable VM. Compared with MD patients, participants with VM had significantly fewer reflex abnormalities for click-cVEMP, click-oVEMPs and minitap-cVEMPs. The ratio of cVEMP litude generated by tone bursts at a frequency of 0.5 kHz to that generated by 1 kHz was significantly lower for MD affected ears than for VM or controls ears. cVEMP asymmetry ratios for 0.5 kHz tone bursts were significantly higher for MD than VM. Conclusions: The 0.5/1 kHz frequency ratio, 0.5 kHz asymmetry ratio and caloric test combined, separated MD from VM with a sensitivity of 90.0% and specificity of 70.0%.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.COLEGN.2012.08.003
Abstract: Nursing is acknowledged as a stressful occupation, and the negative impact of high stress levels have been widely researched. Less attention has been paid to methods for coping with stress. The researchers conducted a study to explore and identify how nurses cope with work-related stress away from their work environments. Six focus groups were conducted with 38 nurses, including nursing directors, nurse unit managers, and ward nurses from a wide range of clinical areas. From the interview material, 11 coping strategies were identified: drinking alcohol, smoking, using the staff social club, using social networking websites, exercising, family activities, home-based activities, outdoor activities, avoiding people, displacement, and sleep. Although several adaptive strategies appear in this list (e.g., exercising, home-based activities), some nurses were using unhealthy behaviours to cope with work-related stress (e.g., drinking alcohol, smoking, displacement). This study clearly demonstrates the value of using qualitative approaches to understanding how nurses cope with stress. Knowledge produced locally, such as that generated for the hospital in this study, should serve as the foundation for organisational strategies to enhance the health of nurses.
Publisher: Wiley
Date: 04-09-2019
DOI: 10.1111/JAN.14176
Abstract: To understand the public's willingness or lack thereof, to be seen and treated by a nurse practitioner (NP) as the first point of contact when accessing healthcare services. This cross-sectional, population-based survey study used computer assisted telephone interviewing to elicit public opinions on the topic. Data were collected in July and August 2015 from calls randomly placed to Australian households. Survey questions were developed from previous surveys and pilot tested. Summative content analysis was used to analyse open-ended responses. Most respondents were always, or in some situations, willing to receive care from a nurse practitioner. The main themes identified from those willing to be seen by a nurse practitioner in any situation were, (a) appropriately qualified nurse practitioners, (b) the knowledge and experience to refer on if necessary. Description of situations from those unwilling to be seen by a nurse practitioner related to concern about appropriate care in a life-threatening condition. Respondents unwilling to consider any care from a nurse practitioner or care in an emergency situation, reveal a lack of understanding of their role in the wider healthcare team. As the number of nurse practitioners increase, professional groups and community awareness programmes should be focused on explaining and promoting their essential role. This study addresses the increasing healthcare requirements of ageing populations through understanding acceptance by society to the provision of care from health professionals other than medical practitioners. Most respondents were willing to be seen by a nurse practitioner for all or most of their healthcare needs. Lack of understanding of their scope of practice and role in the wider healthcare team, particularly in emergency situations, was reflected in responses. Those who would refuse care from a NP were in the minority. Appropriateness and acceptability of the roles of health professionals to provide quality care collaboration need consideration by policy makers.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY11071
Abstract: There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12–15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.NEDT.2010.12.024
Abstract: Cultural competence is now widely recognised as an essential characteristic for undergraduate nursing students. Clinical experience in foreign countries has become increasingly popular as a strategy to enhance cultural awareness and competence. However, published research articulating the experience and outcomes of these initiatives is relatively rare, particularly from an Australian perspective. This paper presents the findings of a qualitative, exploratory research project. In idual semi-structure interviews were conducted with eight undergraduate nursing students before, during and at the conclusion of a four week clinical placement in Surin, Thailand. Data analysis identified the following major themes: first interview - anticipation second interview - making a difference contrasting worlds and part of the group third interview - reality check and group dynamics. These findings suggest that international clinical experience has potential benefits beyond the development of cultural competence. The importance of caring in nursing and the importance of group dynamics were particularly valued by student participants.
Publisher: Wiley
Date: 25-07-2012
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.AUCC.2019.03.001
Abstract: Early warning system (EWS) validation studies are conducted predominantly in tertiary metropolitan facilities and are not necessarily applicable to regional hospitals. This study evaluates 12 EWSs for use in regional subcritical hospitals. This is a retrospective case-control study of patients who experienced severe adverse events (SAEs) in two regional private hospitals. Vital signs collected over 72 h preceding the SAE were applied to 12 EWSs representing three classes of EWSs. The EWS area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, and number of alerts were calculated. Data from 159 index and 172 control patients showed no significant differences in demographics, length of stay, and level of comorbidities. Only half of index patients achieved a medical emergency alert threshold score. On average, index patients triggered alerts 20.06 (22.67) hours preceding the SAE and alerted 2.25 (3.87) times over 72 h. The AUROC ranged from 0.628 to 0.747, with a single-parameter EWS having the lowest AUROC and an aggregated weighted EWS, the highest. The sensitivity of the EWS ranges from 0.359 to 0.692. The specificity was greater than 0.9 for all the EWSs tested. Based on the EWS sensitivity and AUROC, there is a lack of conclusive evidence of the efficacy of the 12 EWSs tested. However, because the adoption of the EWS in Australian hospitals is mandatory, the implementation of an aggregated weighted EWS, such as Compass, should be considered in subcritical regional private hospitals. Given that only half of SAE achieved an EWS medical alert threshold score, it is important that good clinical judgement be used with EWS.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/S1322-7696(08)60550-8
Abstract: There has been a trend of growth in part-time employment within the Australian nursing workforce and currently half of the profession work part-time. While the literature across disciplines has postulated reasons behind preferences for part-time employment, little is known about nurses' motivators to work part-time. In an era of nursing shortages that form considerable barriers to meeting healthcare service demands, a clear understanding of these motivators is critical for the effective planning and management of the nursing workforce. A grounded theory study that explored the phenomenon of part-time nursing found that nurses' motivators to work part-time were complex and identifiable with nursing, establishing that nurses' working time decisions are made in contexts that may be unique to the profession. This paper provides an exhaustive description and explanation of one cohort of part-time nurses that accounts for variations between nurses and provides an understanding of the complexity of factors that contribute to nurses' decisions to work part-time.
Publisher: Association for Vascular Access
Date: 03-2019
DOI: 10.1016/J.JAVA.2018.25.003
Abstract: PICC offers safe intravenous access for medium- to long-term use with inpatients. There is no association between overall complication rates and PICC material type. Oncology status is the strongest predictor of complications.
Publisher: Wiley
Date: 07-11-2007
DOI: 10.1111/J.1447-0349.2007.00496.X
Abstract: In Australian emergency departments, the triage of people with physical illness and injury is well developed and supported by the Australasian Triage Scale. The Australasian Triage Scale contains brief descriptors of mental illness and it is unknown if these provide the same reliability in triage decision-making for emergency triage nurses assessing people with a mental illness. Specialist mental health triage scales have been developed to cater for this deficit and to aid emergency staff who have lacked training in the assessment and management of people with a mental illness. A review of the development of mental health triage scales and their use in Australia identifies that using a mental health triage scale improves the competence and confidence of emergency department staff in triaging people with mental illness. Despite this, there is no consistent national approach to the emergency triage of people with a mental illness. There is ad hoc use of mental health triage scales and there are few reports of improvements in service provision to this client group as a result of the use of a mental health triage scale. These findings suggest that despite the intentions of the National Mental Health Strategy, a lack of equity remains in emergency departments in the provision of care to people with a mental illness who make up one in five of adult Australians. Consideration should be given to the introduction of a national approach to the use of a mental health triage scale in Australian emergency departments.
Publisher: Springer Science and Business Media LLC
Date: 27-04-2007
Publisher: Wiley
Date: 02-2010
Publisher: Wiley
Date: 12-2010
Publisher: Elsevier BV
Date: 2002
DOI: 10.1016/S0300-9572(01)00445-2
Abstract: Cardiopulmonary resuscitation (CPR) has been used in hospitals for approximately 40 years. Nurses are generally the first responders to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive. Speed and competence of the first responder are factors contributing to the initial survival of a person following a cardiac arrest. Attitudes of in idual nurses may influence the speed and level of involvement in true emergency situations. This paper uses the theories of reasoned action and planned behaviour to examine some behavioural issues with CPR involvement.
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/J.PEC.2007.02.013
Abstract: Limited research exists addressing issues of website development and attitudes towards websites that promote physical activity. This paper describes the design and process evaluation of a physical activity intervention, from a randomised trial (RT) that examined the effectiveness of delivery modes (face-to-face, Internet-mediated (combined Internet and face-to-face) and Internet-only). Evaluation surveys were completed at the end of the RT intervention (n=159), and a random s le (n=23) participated in focus group discussions. Differences were assessed using ANOVA, t-tests, and qualitative analysis. Face-to-face participants were more satisfied with their group allocation than the Internet groups. Internet groups reported accessing the Internet at home, and that they liked the self-paced nature of the website. Difficulties associated with time and motivation were raised by the Internet groups. No differences were found for content acceptability and credibility. Website usability scores were high for both Internet groups. These findings support the use of the Internet in terms of content satisfaction and usability however, issues were raised regarding the acceptability of an Internet-based program when traditional face-to-face delivery options are available. Identifying avenues to support user perceptions of 'motivation', and mechanisms for enhancing engagement and retention, and user acceptability are required.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/AH09708
Abstract: Objective.To assess differences in perceived health-related quality of life among in iduals who are normal weight, overweight and obese in the general population, with particular emphasis on mental health. Method.A cross-sectional study was conducted among the general adult population in Queensland, Australia. Participants (n = 1212) were selected randomly for computer-assisted telephone interview in July 2007. The s le ranged between 18 and 93 years, with a mean age of 51.10 years (s.d. = 15.92). Demographic and physical and mental health (SF-12) data were collected. Self-reported height and weight were used to classify participants into three groups based on their body mass index: normal weight overweight obese. The associations between body mass index categories and SF-12 scores were investigated. Results.In this population s le, excess weight was associated with poorer physical health. In addition, significant associations were observed between excess weight and poor mental health for particular age groups. Obesity had a significant association with poor mental wellbeing for in iduals who are aged 45 to 54 years. No sex differences were observed. Conclusion.The results provide additional evidence of the relationship between excess weight and mental wellbeing and highlight the need for health professionals to be cognisant of the potential for in iduals who are obese to have a higher risk of experiencing mental health problems. What is known about the topic?The body mass index of the general population is rising steadily. Being overweight or obese has a detrimental effect on physical health and is a major cause of preventable death. However, there are conflicting findings regarding the implications of excess weight on an in iduals’ mental health. What does this paper add?This paper substantiates the relationship between body mass index and health-related quality of life in the general adult population. Obesity was associated with poor mental wellbeing for in iduals between the ages of 45 and 54. What are the implications for practice?This study underscores the need for mental health and wellbeing to become part of standard assessment practice for in iduals who are overweight or obese, particularly those aged between 45 and 54 years.
Publisher: SAGE Publications
Date: 03-2011
DOI: 10.1177/183335831104000102
Abstract: The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a s le of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/SH08007
Abstract: Objective: To investigate changes in mortality following HIV and AIDS in Australia. Methods: The results of a linkage between HIV/AIDS diagnoses and the National Death Index (NDI) to the end of 2003 were used to estimate mortality rates following HIV/AIDS. Standardised Mortality Ratios (SMRs) were calculated for deaths following HIV, with and without AIDS, in three periods of treatment before antiretroviral therapy (≤1989), pre- and early-HAART (1990–1996) and HAART (1997–2003). Crude mortality rates were calculated as the number of deaths per 1000 person-years. The total number of people living with HIV/AIDS was estimated. Results: There were 1789 deaths following HIV without AIDS and 6730 deaths after AIDS. For deaths following HIV without AIDS, the SMRs were 2.99, 1.22 and 1.6 during the periods before 1990, 1990–1996 and 1997–2003. For deaths after AIDS the SMRs were 137.84, 28.64 and 4.55 in the periods one to three, respectively. The crude death rate following HIV without AIDS increased from 16.8 before 1986 to 19.6 in 2003. Death rates after AIDS decreased from 958.7 up to 1986 to 60.4 in 2003. The number of new HIV diagnoses increased to 1276 in 1990 then decreased to 780 in 2003, while AIDS diagnoses increased to 950 in 1994 then decreased to 252 in 2003. The total number of people living with HIV was estimated to be 7873 in 1989, and 12828 in 2003. Conclusion: Mortality following AIDS decreased while deaths before AIDS remained low. The number of people living with HIV/AIDS has increased.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.GERINURSE.2015.06.001
Abstract: The aim is to describe nursing home nurses' perceptions around emergency transfers to hospital. Transfers are costly and traumatic for residents, and efforts are underway to avoid hospitalization. Nurses play a key role in transfers, yet their views are underreported. A systematic review of qualitative studies was undertaken, guided by Joanna Briggs Institute methods. From seven reviewed studies, it was clear nursing home nurses are challenged by the complexity of the transfer process and understand their need for appropriate clinical knowledge, skills and resources. Communication is important, yet nurses often use persuasive and targeted communication. Ambiguity, strained relationships and negative perceptions of residents' experiences around hospitalization contribute to conflict and uncertainty. Nurses are more confident when there is a plan. Transferring a resident is a complex process and special skills, knowledge and resources are required, but may be lacking. Efforts to formalize the transfer process and improve communication and collaboration amongst all stakeholders is needed and would be well received.
Publisher: Wiley
Date: 20-09-2012
DOI: 10.1111/J.1365-2702.2012.04275.X
Abstract: To identify the contextual knowledge and skills required for practice. Nursing practice in assisted reproductive technology (ART) makes a significant contribution to patient care. Despite this, the knowledge and skills integral to this area of practice have not been clearly articulated, particularly from an Australian perspective. A constructivist grounded theory design was used to gain the perspective of ART nurses in relation to how they understood their clinical practice as well as the issues and challenges that they faced. In idual in-depth interviews were undertaken with 15 registered nurses working in ART units across Australia. Constant comparative data analysis was used to determine the main categories. Contextual knowledge and skills was one category to emerge from this research, and this is the focus of this paper. The findings in respect of knowledge and skill included three main subcategories: required skills and knowledge acquisition of skills and knowledge and factors influencing acquisition. The role of the ART nurse which must be performed within the context and competency standards of nursing requires a framework that could define and contribute to specialised ART nursing practice standards. The nursing role is instrumental to effective ART treatment and care. The standard of clinical practice will depend in part on the ability of specialist nurses to articulate their practice, and their professional development needs to optimise quality and effectiveness. The results of this study demonstrate that contextual knowledge and skills are a key aspect of this specialised nursing role.
Publisher: Springer Science and Business Media LLC
Date: 30-01-2012
Abstract: The Indigenous population of Australia was estimated as 2.5% and under-reported. The aim of this study is to improve statistical ascertainment of Aboriginal women giving birth in New South Wales. This study was based on linked birth data from the Midwives Data Collection (MDC) and the Registry of Births Deaths and Marriages (RBDM) of New South Wales (NSW). Data linkage was performed by the Centre for Health Record Linkage (CHeReL) for births in NSW for the period January 2001 to December 2005. The accuracy of maternal Aboriginal status in the MDC and RBDM was assessed by consistency, sensitivity and specificity. A new statistical variable, ASV, or Aboriginal Statistical Variable, was constructed based on Indigenous identification in both datasets. The ASV was assessed by comparing numbers and percentages of births to Aboriginal mothers with the estimates by capture-recapture analysis. Maternal Aboriginal status was under-ascertained in both the MDC and RBDM. The ASV significantly increased ascertainment of Aboriginal women giving birth and decreased the number of missing cases. The proportion of births to Aboriginal mothers in the non-registered birth group was significantly higher than in the registered group. Linking birth data collections is a feasible method to improve the statistical ascertainment of Aboriginal women giving birth in NSW. This has ramifications for the ascertainment of babies of Aboriginal mothers and the targeting of appropriate services in pregnancy and early childhood.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Informa UK Limited
Date: 08-2013
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/350674
Abstract: Background . There is very little data describing the long-term health impacts of meditation. Aim . To compare the quality of life and functional health of long-term meditators to that of the normative population in Australia. Method . Using the SF-36 questionnaire and a Meditation Lifestyle Survey, we s led 343 long-term Australian Sahaja Yoga meditation practitioners and compared their scores to those of the normative Australian population. Results . Six SF-36 subscales (bodily pain, general health, mental health, role limitation—emotional, social functioning, and vitality) were significantly better in meditators compared to the national norms whereas two of the subscales (role limitation—physical, physical functioning) were not significantly different. A substantial correlation between frequency of mental silence experience and the vitality, general health, and especially mental health subscales ( P 0.005 ) was found. Conclusion . Long-term practitioners of Sahaja yoga meditation experience better functional health, especially mental health, compared to the general population. A relationship between functional health, especially mental health, and the frequency of meditative experience (mental silence) exists that may be causal. Evidence for the potential role of this definition of meditation in enhancing quality of life, functional health and wellbeing is growing. Implications for primary mental health prevention are discussed.
Publisher: Wiley
Date: 05-2009
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.AUCC.2019.01.002
Abstract: Patients experience physiological changes in the hours preceding adverse medical events, and patients or their family can be the first to identify ominous signs of clinical deterioration that have gone undetected by health professionals. Patient and family activated escalation systems provide consumers access to a referral system that can address their concerns. In Queensland, this escalation system is called Ryan's Rule and once activated, triggers an independent clinical review. This study aimed to access clinicians' and activators' experiences to develop an understanding of the incidence, contributing factors, and outcomes surrounding Ryan's Rule activations. The study involved a retrospective chart review of Ryan's Rule (n = 57) activations in a regional hospital, over a 24-month period. On average, there were 2.4 activations a month. There are three major findings: first, communication issues were central to more than half the activations, 35% of cases required no clinical intervention, with communication alone sufficient to achieve resolution. Second, this initiative was valued with 65% of activators stating that they would be comfortable calling again and having access to the escalation process was reassuring and improved communication between clinicians and patients. While clinicians doubted the appropriateness of activators use of the escalation tool, 15% of patients were transferred to receive a higher level of care. Lastly, clinicians labelled activations as a 'complaints' as opposed to a 'concern' and reasoned that a 'complaint' did not justify a full review of the consumer's perspective for the activation. Consumers who activated a Ryan's Rule were satisfied and valued the process. It provides a reassuring safety net, empowering them to speak up and initiate a clinical review. Clear communication among clinicians and between clinicians and consumers is essential. Clinicians are hesitant to fully embrace Ryan's Rule, and this discordance contributes to the failure to fully evaluate reasons for call activation.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.NEDT.2012.11.024
Abstract: Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours. To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking. Descriptive survey research design. Non-probability s ling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university. Survey. Factor analysis revealed four clearly differentiated factors, non-smoker's rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurse's perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights. Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Elsevier BV
Date: 11-2011
Publisher: Springer Science and Business Media LLC
Date: 24-05-2013
No related grants have been discovered for Trudy Dwyer.