ORCID Profile
0000-0002-6089-8225
Current Organisations
School of Nursing & Midwifery, Griffith University, Menzies Health Institute QLD, and the Division of Surgery, Princess Alexandra Hospital
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School of Nursing & Midwifery, Griffith University, Menzies Health Institute QLD, and the Division of Surgery, Princess Alexandra Hospital: Brisbane, Queensland, AU
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Griffith University, School of Nursing and Midwifery, Menzies Health Institute QLD: Nathan, QLD, AU
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Publications
Impact of a learning circle intervention across academic and service contexts on developing a learning culture
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.NEDT.2010.07.010
Abstract: Partnerships between university schools of nursing and health services lead to successful learning experiences for students and staff. A purposive s le of academics and students from a university school of nursing and clinicians from three health institutions involved in clinical learning (n=73) actively participated in a learning circles intervention conducted over 5 months in south east Queensland. Learning circle discussions resulted in enhanced communication and shared understanding regarding: (1) staff attitudes towards students, expectations and student assessment (2) strategies enhancing preparation of students, mechanisms for greater support of and recognition of clinicians (3) challenges faced by staff in the complex processes of leadership in clinical nursing education (4) construction of learning, ideas for improving communication, networking and sharing and (5) questioning routine practices that may not enhance student learning. Pre-post surveys of hospital staff (n=310) revealed significant differences across three sub-scales of 'accomplishment' (t=-3.98, p<.001), 'recognition' (t=-2.22, p<.027) and 'influence' (t=-11.82, p<.001) but not 'affiliation'. Learning circles can positively enhance organisational learning culture. The intervention enabled participants to recognise mutual goals. Further investigation around staff perception of their influence on their workplace is required.
Pressure injury prevention in the perioperative setting: An integrative review
Publisher: Australian College of Perioperative Nurses
Date: 12-2018
Pre-operative self-efficacy education vs. usual care for patients undergoing joint replacement surgery: A pilot randomised controlled trial
Publisher: Wiley
Date: 09-04-2016
DOI: 10.1111/SCS.12223
Abstract: Hip and knee replacement is a major surgical procedure performed worldwide. Despite 20 or so years of clinical research and care guidelines, the management of acute postoperative pain continues to be a concern. A growing number of self-efficacy strategies are being included in education programs for patients to enable then to have a central role in managing their illness and symptoms. The purpose of this pilot study was to evaluate the feasibility of testing an education intervention to improve self-efficacy in patients undergoing hip or knee replacement. A single-blinded, parallel, pilot randomised control trial design was used. Ninety-one patients undergoing hip or knee replacement surgery were randomly assigned to an intervention or control group. Intervention group participants were given a DVD demonstrating self-efficacy activities to undertake four times before admission. Feasibility criteria related to recruitment, protocol adherence and missing data were assessed. Participants were assessed for pain, anxiety, self-efficacy and healthcare utilisation. In relation to recruitment, 55% of screened patients were eligible and of these 81% enrolled (n = 91). Exclusion following randomisation was 10% with missing data ranging from 0 to 20.7%. Nineteen per cent of participants were lost to follow up in the control group and 20% lost to follow up in DVD group. Protocol adherence to components of the intervention varied. Both groups were generally satisfied with pain management during hospitalisation, and there were no differences in groups on clinical outcome measures. Preliminary evidence for the benefits of self-efficacy-based education for patients undergoing hip or knee replacement was identified. Additional findings included a need to strengthen the intervention and reducing the number of data collection points to improve the protocol, missing data and numbers lost to follow up before a larger trial is undertaken.
Research, transformational leadership and knowledge translation: a successful formula
Publisher: Wiley
Date: 06-02-2013
DOI: 10.1111/SCS.12027
Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study
Publisher: Wiley
Date: 12-01-2020
DOI: 10.1111/JOCN.15620
Abstract: Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct‐care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians’ delay identification and action on patients’ clinical deterioration. To identify barriers and facilitators that influence clinicians’ absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework. The Theoretical Domains Framework guided: (a) semi‐structured interviews with clinicians, health consumers and family members undertaken at two sites (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines. Seven themes identified: (a) information transfer (b) ownership of patient care (c) confidence to respond (d) knowledge and skills (e) culture (f) emotion and (g) environmental context and resources. The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team‐based training. As a result, patient safety was compromised, and clinicians frustrated. These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration. Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision‐making.
Alginate dressings for treating pressure ulcers
Publisher: John Wiley & Sons, Ltd
Date: 27-08-2014
Using Facebook to enhance commencing student confidence in clinical skill development: A phenomenological hermeneutic study
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.NEDT.2015.07.019
Abstract: The purpose of this study was to explore commencing nursing students' experience of Facebook as an adjunct to on-c us course delivery to determine its impact as a learning strategy for improving confidence in clinical skill development. Approaches supporting nursing students in the development of clinical skills have relied on 'real-life' clinical placements and simulated on-c us clinical laboratories. However students continue to report a lack of confidence in their clinical skills for practice. Social networking sites including Facebook are being used as a learning strategy to stimulate active and collaborative learning approaches. A hermeneutic phenomenological approach was used to provide an understanding of the experience of confidence in clinical skills development for nursing students. Data were collected through in-depth interviews with commencing students about their experience as learners using Facebook and their perceptions of the impact on their clinical skill development. Ten first-year student nurses at one university in south-east Queensland, Australia. Four themes emerged from the data including: 'We're all in this together' 'I can do this' 'This is about my future goals and success' and, 'Real time is not fast enough!'. These themes provide new meaningful insights demonstrating students' sense of confidence in clinical skills was increased through engagement with a dedicated Facebook page. The findings of this study have relevance to academics in the design of learning strategies for clinical courses to further support student confidence and engagement through peer collaboration and active learning processes.
Improving sepsis screening and care in a developing nation health setting: A description of implementation
Publisher: Wiley
Date: 03-11-2021
DOI: 10.1111/NHS.12884
Abstract: Evidence on sepsis screening and care in developing nations is insufficient to inform implementation practices in hospital wards. The aim of this multi‐method study was to describe and evaluate the implementation of a three‐step intervention (sepsis screening, alert activation, care) in five wards in Argentina in 2017. The implementation involved three stages: (1) context assessment, (2) development articipation in implementation strategies, and (3) evaluation of intervention adherence. Results were variable. The context assessment (Stage 1) demonstrated the value of education, proactivity towards care and team structures. Strategies developed (Stage 2) included sepsis screening and response guide, education, team rounding, posters, ch ions, audit/feedback and knowledge brokering. In Stage 3, staff screened 92% patients (506/547) for sepsis at ≥60% of set times only 33% (21/64) patients had a sepsis alert activated when needed. A similar proportion of patients who had alerts activated ( n = 16, 76%) or not ( n = 32, 74%) received at least one element of care. The use of implementation strategies resulted in adherence to some aspects of the intervention. Future research is needed to improve sepsis screening and alert activation and care in this setting.
Variations in sacral oedema levels over continuous 60-degree head of bed elevation positioning in healthy adults: An observational study
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.JTV.2022.11.001
Abstract: Subepidermal moisture (SEM) scanning is a novel technology that measures changes in localised oedema. Accumulation of subepidermal oedema is associated with early tissue damage that may lead to a pressure injury. The primary study objective was to observe the variations in sacral subepidermal oedema levels over a continuous period of 60-degree head of bed elevation positioning. Healthy adult participants were recruited in this prospective observational study. Participants were positioned at 60-degree head of bed elevation for 120 min and sacral SEM measurements were collected at baseline and in 20 min increments. A total of 20 participants with a mean age of 39.3 years (SD = 14.7) were recruited. The mean SEM delta value increased 6.3% from 0.46 SEM delta at baseline to 0.49 SEM delta after 120 min, however these differences are not statistically significant (p = .21). There were also no significant findings between SEM delta variations and demographic factors. In a s le of healthy in iduals, 120 min of continuous loading with a 60-degree head of bed elevation did not lead to a significant change in sacral subepidermal oedema levels. Further research on the response of healthy adult tissue under external forces associated with different angles of head of bed positioning may further contribute to our understanding pressure injury prevention.
Pressure injuries in Australian public hospitals: A cost of illness study
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.IJNURSTU.2022.104191
Abstract: Pressure injuries are a leading hospital adverse event, yet they are mostly preventable. Understanding their financial costs will help to appreciate the burden they place on the health system and assist in better planning and management of health expenditures to prevent pressure injuries. To estimate the cost of pressure injuries in Australian public hospitals in 2020 demonstrating its economic burden in a well-resourced health system. A cost of illness study with a 12-month time horizon was conducted. Resource use for the treatment of pressure injuries and productivity loss due to pressure injuries were derived using a bottom-up approach. Parameters of the cost estimates were obtained from secondary sources and literature syntheses. A simulation with 10,000 draws was used to generate statistical properties of the cost estimates. Based on a prevalence of 12.9%, the total cost of pressure injuries in Australian public hospitals was $9.11 billion [95% confidence intervals: 9.02, 9.21]. The two largest shares of costs were accounted for by the opportunity cost of excess length of stay of $3.60 billion [3.52, 3.68] and treatment costs of $3.59 billion [3.57, 3.60]. Productivity loss associated with pressure injuries amounts to $493 million [482, 504]. Hospital-acquired pressure injuries account for a total of $5.50 billion [5.44, 5.56], whereas pressure injuries present on admissions costed $3.71 billion [3.70, 3.72]. In terms of severity, Stage 2 pressure injuries contributed the most to total treatment costs, total excessive length of stay, and total loss of healthy life years. Australian society is willing to pay $1.43 billion [1.40, 1.45] to save 6,701 [6,595 6,807] healthy life years lost by pressure injury. Reducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia and will likely have similar benefits for other countries with comparable profiles. Australian public hospital study provides comprehensive analysis of the cost of pressure injury, including estimates of direct and indirect medical costs, and indirect non-medical costs - such as productivity and quality of life.
Process evaluation of an intervention to test the effectiveness of foam border dressings in preventing hospital-acquired sacral pressure injuries (the EEPOC trial): A protocol
Publisher: Elsevier BV
Date: 02-2021
DOI: 10.1016/J.JTV.2021.11.003
Abstract: Prophylactic foam border dressings are recommended for high-risk patients in addition to standard pressure injury prevention protocols despite limited high-quality evidence regarding their effectiveness. This protocol describes the process evaluation that will be undertaken alongside a multisite randomised controlled trial investigating the clinical and cost-effectiveness of these dressings in reducing hospital-acquired sacral pressure injury incidence. This theory informed parallel process evaluation using qualitative and quantitative methods will be undertaken in medical and surgical units. To evaluate fidelity, recruitment, reach, dose delivered and received, and context, process data will include: research nurses' self-reported adherence to intervention protocols semi-structured interviews with participants and research nurses and focus groups with nursing staff participants' satisfaction and comfort with the dressings and perceived level of participation in pressure injury prevention and nurses' attitudes toward pressure injury prevention. The proportion of the target population recruited, participant characteristics, and adherence to intervention protocols will be reported using descriptive statistics. Chi square or t-tests will compare differences in demographic characteristics between groups, and non-participants, and multivariate modelling will investigate potential moderators on the trial outcomes. Analysis of qualitative data will be guided by the Framework Method, which provides a clear, systematic process for developing themes. This process evaluation will provide valuable insights into mechanisms of impact and contextual and moderating factors influencing trial outcomes. Process data will enhance reproducibility of the intervention and trustworthiness of findings, and inform clinicians, researchers, and policy makers about the extent to which foam border dressings can be feasibly implemented in clinical practice. ACTRN12619000763145p.
End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study
Publisher: Wiley
Date: 09-03-2023
DOI: 10.1111/JAN.15630
Abstract: To assess patients' and nurses' perceptions and experiences of subepidermal moisture scanning acceptability. Descriptive, qualitative, sub‐study, embedded within a pilot randomized control trial. Ten patients who were in the intervention arm of the pilot trial and 10 registered nurses providing care for these patients on medical‐surgical units participated in in idual semi‐structured interviews. Data were collected from October 2021 to January 2022. Interviews were analysed using inductive qualitative content analysis, and perspectives (patient and nurse), were triangulated. Four categories were found. The first category ‘Subepidermal moisture scanning is acceptable as part of care’ showed that patients and nurses were willing to use subepidermal moisture scanning and viewed subepidermal moisture scanning as non‐burdensome. The category ‘Subepidermal moisture scanning may improve pressure injury outcomes’ demonstrated that although subepidermal moisture scanning was believed to prevent pressure injuries, more research evidence about its benefits was required. ‘Subepidermal moisture scanning augments existing pressure injury prevention practices’, the third category, highlighted that subepidermal moisture scanning aligns with current pressure injury prevention practices while making these practices more patient‐centred. In the final category, ‘Important considerations when making subepidermal moisture scanning routine practice’, practical issues were raised relating to training, guidelines, infection control, device availability and patient modesty. Our study demonstrates that using subepidermal moisture scanning is acceptable for patients and nurses. Building the evidence base for subepidermal moisture scanning and then addressing practical issues prior to implementation, are important next steps. Our research suggests that subepidermal moisture scanning enhances in idualized and patient‐centred care, persuasive reasons to continue investigating subepidermal moisture scanning. For an intervention to be successfully implemented it must be both effective and acceptable, however, there is limited evidence of patients' and nurses' views of SEMS acceptability. SEM scanners are acceptable to use in practice for patients and nurses. There are many procedural aspects that need to be considered when using SEMS such as frequency of measurements. This research may have benefit for patients, as SEMS may promote a more in idualized and patient‐centred approach to pressure injury prevention. Further, these findings can assist researchers, providing justification to proceed with effectiveness research. A consumer advisor was involved in study design, interpretation of data and preparation of manuscript.
Hydrogel dressings for treating pressure ulcers
Publisher: John Wiley & Sons, Ltd
Date: 29-07-2014
Preoperative and postoperative recommendations to surgical wound care interventions: A systematic meta-review of Cochrane reviews
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJNURSTU.2019.103486
Abstract: The increasing numbers of surgeries involving high risk, multi-morbid patients, coupled with inconsistencies in the practice of perioperative surgical wound care, increases patients' risk of surgical site infection and other wound complications. To synthesise and evaluate the recommendations for nursing practice and research from published systematic reviews in the Cochrane Library on nurse-led preoperative prophylaxis and postoperative surgical wound care interventions used or initiated by nurses. Meta-review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Library database. All Cochrane Systematic Reviews were eligible. Two reviewers independently selected the reviews and extracted data. One reviewer appraised the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews 2 checklist. A second reviewer independently verified these appraisals. The review protocol was registered with the Prospective Register of Systematic Reviews. Twenty-two Cochrane reviews met the inclusion criteria. Of these, 11 reviews focused on preoperative interventions to prevent infection, while 12 focused on postoperative interventions (one review assessed both pre-postoperative interventions). Across all reviews, 14 (63.6%) made at least one recommendation to undertake a specific practice, while two reviews (9.1%) made at least one specific recommendation not to undertake a practice. In relation to recommendations for further research, insufficient s le size was the most predominant methodological issue (12/22) identified across reviews. The limited number of recommendations for pre-and-postoperative interventions reflects the paucity of high-quality evidence, suggesting a need for rigorous trials to address these evidence gaps in fundamentals of nursing care.
Foam dressings for treating pressure injuries in patients of any age in any care setting: An abridged Cochrane systematic review
Publisher: Elsevier BV
Date: 12-2019
Wound care practices across two acute care settings
Publisher: Wiley
Date: 27-12-2020
DOI: 10.1111/JOCN.15135
A Neophyte's Journey through Qualitative Analysis Using Morse's Cognitive Processes of Analysis
Publisher: SAGE Publications
Date: 03-2008
DOI: 10.1177/160940690800700105
Abstract: Abstract: In the early stages of her master's thesis the author became increasingly concerned about how she would analyze the data for her planned critical interpretive study. She felt that she needed clear direction about the process of qualitative analysis but found the “how to” of theory development within qualitative data analysis poorly described and vague. A book chapter by qualitative researcher Janice Morse (1994) provided guidance. In it Morse outlined four cognitive and essentially sequential processes, which the author adapted to guide the analysis of data for her study.
Student evaluations of a year-long mentorship program: A quality improvement initiative
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.NEDT.2006.01.009
Abstract: Mentoring is an important teaching-learning process in undergraduate nursing curricula. There are relatively few studies specifically evaluating nursing students' perceptions of mentorship. In the period 1999-2002, 39 students were mentored during a year-long program. This descriptive, exploratory study used a quality improvement framework informed by the Deming cycle of Plan, Do, Check and Act [Deming, W.E., 1982. Quality, Productivity and Competitive Position. Massachusetts Institute of Technology, Cambridge] to evaluate the mentorship program from the students' perspective. Information was gathered through surveys, focus group discussions and interviews and analyzed to identify themes of responses. Identified themes were 'The doing of nursing', 'The thinking of nursing' and 'Being a nurse'. The study confirmed the value of mentorship in undergraduate nursing and highlighted the importance of skill competence as a basis for professional role identity by graduating students. The benefits of mentorship were derived from a long term, supportive relationship with the same registered nurse who was committed to the student's professional development.
Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.IJNURSTU.2022.104189
Abstract: Oedema measurement, also termed sub-epidermal moisture measurement is recommended as an adjunct pressure injury prevention intervention in international guidelines because it indicates early tissue damage. To determine the prognostic value of oedema measurement in predicting future pressure injury in adults in any care setting. Systematic review and meta-analysis. Participants were recruited from nursing homes or aged care facilities, hospitals, or post-acute facilities. Adults. A modified 2-week systematic review was undertaken. Study designs included cohort (prospective and retrospective), case-control, case series if relevant comparisons were reported, randomised controlled trials if the association between oedema measurement and pressure injury was reported, and registry data. Databases searched included: Medical Literature Analysis and Retrieval System Online, The Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica and the Cochrane Library from inception to 13 July 2021 with no language restrictions. Screening, data extraction using Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies - Prognostic Factors (CHARMS-PF) and quality assessment using Quality in Prognostic Factor Studies (QUIPS) were undertaken independently by ≥2 authors and adjudicated by another if required. Meta-analyses and meta-regression were undertaken. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Six studies (n = 483 total) were included. Two studies were set in nursing homes and four in either hospitals or post-acute facilities. Fives studies were prospective cohorts, and one was a randomised control trial. Two studies were assessed as low risk and four studies as moderate risk of bias. The pooled risk ratio in four studies (n = 388) for the relationship between oedema and pressure injury cumulative incidence was 18.87 (95% CI 2.13-38.29) and for time to pressure injury was 4.08 days (95% CI 1.64-6.52). Using GRADE, the certainty of the body of evidence was low for all outcomes. Meta-regression indicated that age, gender, and s le size were poor predictors for the association between oedema and pressure injury. Measuring oedema as a predictor for pressure injury development is showing promise but a stronger body of evidence that takes into consideration other prognostic factors is needed to better understand its benefit. PROSPERO CRD42021267834. Measuring oedema is a promising strategy to prevent pressure injuries but the certainty of evidence for this claim is low.
Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews
Publisher: Elsevier BV
Date: 11-2020
Sensitivity and specificity of a quick sequential [Sepsis‐Related] organ failure assessment sepsis screening tool
Publisher: Hindawi Limited
Date: 25-09-2021
DOI: 10.1111/IJCP.14874
Abstract: There is limited evidence on the diagnostic accuracy of a quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) sepsis screening (SS) tool in developing nation health settings. The aim of this study was to test the diagnostic accuracy of a qSOFA-based SS tool, and the predictive validity of the qSOFA score in hospital ward patients from Argentina. Prospective observational study. Patients (≥18 years, without sepsis) were recruited within 24-48 hours of admission to a 169-bed tertiary referral private hospital in Buenos Aires. The index test was the qSOFA-based SS tool, and the reference standard sepsis diagnosed at discharge blindly evaluated with reference to the Sepsis-3. In 1151 patients (median age 69.9 [IQR, 29.0]) 47 (4.1%) had sepsis, 413 (35.9%) had infection and 691 (60.0%) other diagnoses at discharge. The qSOFA-based SS tool (index test) had moderate sensitivity (60%), good specificity (89%), a very low positive (19%) and very high negative (98%) predictive value for sepsis diagnosed at discharge according to the Sepsis-3 criteria (reference standard). For the same outcome, the qSOFA score in isolation had a reasonable predictive validity area under receiver operating characteristics curve 0.77 (95% CI 0.70-0.83) P < 0.001. The qSOFA score could reasonably discriminate patients at risk of developing sepsis qSOFA-based screening may be valuable where no screening criteria are in place.
Mentor evaluation of a year-long mentorship program: a quality improvement initiative
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/S1322-7696(08)60521-1
Abstract: This paper presents 23 mentors' perceptions of their role in a year-long mentorship program during the period 1999- 2002. The majority of mentors were clinical specialists, had bachelor degrees and over five years clinical experience. The mentorship program was informed by the Deming Cycle of Plan, Do, Check and Act. This quality improvement framework was used to evaluate the mentorship program from the mentors' perspective. Information was gathered through surveys and focus group discussions. Responses were analysed to identify three themes of 'Enhancing student learning outcomes', 'Time and resources' and 'Personal and professional growth'. Mentors perceived their role as valuable in students' education and development. Despite concerns regarding adequate time and resources for an effective mentoring program, mentors acknowledged benefits to themselves in terms of personal and professional growth. Their vision and commitment to nursing was also evident in the perceived benefits of the program for the profession.
Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review
Publisher: Elsevier BV
Date: 04-2022
Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries: A Network Meta-analysis
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JAMDA.2018.10.010
Abstract: Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing. Systematic review and network meta-analysis. All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings. The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates. 40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18 95% confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16 95% CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group. There was substantial uncertainty around the point estimates however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.
Screening for sepsis in general hospitalized patients: a systematic review
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JHIN.2017.05.005
Abstract: Sepsis is a condition widely observed outside critical care areas. To examine the application of sepsis screening tools for early recognition of sepsis in general hospitalized patients to: (i) identify the accuracy of these tools (ii) determine the outcomes associated with their implementation and (iii) describe the implementation process. A systematic review method was used. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and Embase databases were systematically searched for primary articles, published from January 1990 to June 2016, that investigated screening tools or alert mechanisms for early identification of sepsis in adult general hospitalized patients. The review protocol was registered with PROSPERO (CRD42016042261). More than 8000 citations were screened for eligibility after duplicates had been removed. Six articles met the inclusion criteria testing two types of sepsis screening tools. Electronic tools can capture, recognize abnormal variables, and activate an alert in real time. However, accuracy of these tools was inconsistent across studies with only one demonstrating high specificity and sensitivity. Paper-based, nurse-led screening tools appear to be more sensitive in the identification of septic patients but were only studied in small s les and particular populations. The process of care measures appears to be enhanced however, demonstrating improved outcomes is more challenging. Implementation details are rarely reported. Heterogeneity of studies prevented meta-analysis. Clinicians, researchers and health decision-makers should consider these findings and limitations when implementing screening tools, research or policy on sepsis recognition in general hospitalized patients.
Medical and surgical nurses' approach to patient pressure injury prevention education: An integrative review
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JOCN.16814
Abstract: Identify and synthesise the published literature on the approaches and practices nurses use during the delivery of pressure injury prevention (PIP) education to hospitalised medical and surgical patients. An integrated review. Whitmore and Knaff's (2005) five‐stage methodology guided this review: (1) research problem identification (2) literature search (3) data evaluation (4) data analysis and (5) results. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (2020) Statement was followed. The quality of included studies was assessed using the Mixed Method Appraisal Tool (2018). Extracted data were analysed using inductive content analysis. Journal publication dates from 1992 to 2022. Systematic searches of CINAHL (Cumulative Index of Nursing and Allied Health Literature) complete, Embase, PsycINFO (via Ovid) and Scopus databases were undertaken. A total of 3892 articles were initially identified, four quantitative and two qualitative studies were included. Articles were published between 2013 and 2022.Two themes were identified: responsibility and workplace culture determine nurses' approach to PIP education delivery and nurses tailor education strategies to address challenges and opportunities for PIP education delivery. Nurses require resources to facilitate approaches to PIP education with medical and surgical patients. In the absence of clear instruction to support nurses' practice, PIP education for patients is at best delivered in an informal and ad hoc manner. Nurses require accessible education resources to enable them to tailor the content and frequency of PIP education to patients in med‐surg settings. No patient or public contribution.
The meaningful experiences of being an Registered Nurse (RN) Buddy
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.NEDT.2007.12.001
Abstract: This paper describes the previously unexplored Buddy RN experience. Critical interpretive theory underpinned this exploratory study set in a large metropolitan teaching hospital in South East Queensland. Participants were five RNs who had been Buddies to undergraduate nursing student(s) in the previous 12 months. They were interviewed using semi-structured techniques and their transcribed interviews summarised to identify relevant verbatim data for participant checking. Common themes were generated via critical interpretive analysis and points of tension extrapolated. Four main points of tension were uncovered: Acknowledgement, Experience, Balance and Interruption. These revealed a number of paradoxes: the Buddy RN role is not professionally recognised by bodies that manage nursing nursing is still influenced by essentialist discourses which perpetuate outdated practices and attitudes to the detriment of the Buddy RN RNs are compelled to follow direction without question or dissent even though they are mandated by nursing's regulating body to be independent and accountable critical thinkers. A clear articulation of the Buddy RN role in the form of policy is required from nursing's regulating bodies. From this, health service management and universities can initiate the process of creating a framework for preparing, supporting, assessing and educating the Buddy RN.
Alginate dressings for treating pressure ulcers
Publisher: FapUNIFESP (SciELO)
Date: 10-2015
Hydrogel dressings for treating pressure ulcers (Review)
Publisher: Wiley
Date: 17-02-2015
The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study
Publisher: Wiley
Date: 22-05-2023
DOI: 10.1111/IWJ.14240
Abstract: Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point‐of‐care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120‐min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20‐min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one‐way repeated measures analysis of variance and an independent t ‐test were conducted. Slightly more male volunteers (n = 11 55%) were recruited and the s le mean age was 39.3 years ( SD 14.7) with an average body mass index of 25.8 ( SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18 95% confidence intervals: 0.02 to 0.35 P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.
Foam dressings for treating pressure ulcers
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2014
EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial
Publisher: Springer Science and Business Media LLC
Date: 31-01-2023
DOI: 10.1186/S13063-022-06999-Y
Abstract: Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. This is a multicentre, pragmatic, parallel group, randomised controlled trial. A s le size of 1320 was calculated to have % power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019
Development and psychometric testing of the Clinical Learning Organisational Culture Survey (CLOCS)
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.NEDT.2009.12.006
Abstract: This paper describes the development and psychometric testing of the Clinical Learning Organisational Culture Survey (CLOCS) that measures prevailing beliefs and assumptions important for learning to occur in the workplace. Items from a tool that measured motivation in workplace learning were adapted to the nursing practice context. The tool was tested in the clinical setting, and then further modified to enhance face and content validity. Registered nurses (329) across three major Australian health facilities were surveyed between June 2007 and September 2007. An exploratory factor analysis identified five concepts--recognition, dissatisfaction, affiliation, accomplishment, and influence. VALIDITY AND RELIABILITY: Internal consistency measures of reliability revealed that four concepts had good internal consistency: recognition (alpha=.914), dissatisfaction (alpha=.771), affiliation (alpha=.801), accomplishment (alpha=.664), but less so for influence (alpha=.529). This tool effectively measures recognition, affiliation and accomplishment--three concepts important for learning in practice situations, as well as dissatisfied staff across all these domains. Testing of additional influence items identify that this concept is difficult to delineate. The CLOCS can effectively inform leaders about concepts inherent in the culture important for maximising learning by staff.
A Pilot Randomized Controlled Trial Using Prophylactic Dressings to Minimize Sacral Pressure Injuries in High-Risk Hospitalized Patients
Publisher: SAGE Publications
Date: 12-02-2017
Abstract: This pilot randomized controlled trial examined the effect of prophylactic dressings to minimize sacral pressure injuries (PIs) in high-risk hospitalized patients and assessed feasibility criteria to inform a larger study. Eighty patients were recruited at admission points (the emergency department and surgical care unit) or directly from participating wards in the general medical-surgical setting following the assessment of high risk of sacral PI. Participants were randomized into either the routine care or routine care and silicone foam border dressing group. Outcome assessment comprised digital photographs of each participant’s sacrum every 72 hr for evaluation by a blind-to-intervention assessor. Sixty-seven participants had at least one sacral photograph taken and assessed by a blind-to-intervention assessor. Three participants were assessed as having a Stage I PI. Although the use of photography was effective, feasibility criteria identified challenges related to bias, blinding, weight assessment, preparation of nursing staff, and s le size estimation.
Integrated versus nOn-integrated Peripheral inTravenous catheter. Which Is the most effective systeM for peripheral intravenoUs catheter Management? (The OPTIMUM study): a randomised controlled trial
Publisher: BMJ
Date: 05-2018
Management of a critical downtime event involving integrated electronic health record
Publisher: Elsevier BV
Date: 10-2020
The impact of an integrated electronic health record on nurse time at the bedside: A pre-post continuous time and motion study
Publisher: Elsevier BV
Date: 02-2020
Nursing students' perceptions of learning in practice environments: A review
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.NEDT.2011.03.010
Abstract: Effective clinical learning requires integration of nursing students into ward activities, staff engagement to address in idual student learning needs, and innovative teaching approaches. Assessing characteristics of practice environments can provide useful insights for development. This study identified predominant features of clinical learning environments from nursing students' perspectives across studies using the same measure in different countries over the last decade. Six studies, from three different countries, using the Clinical Leaning Environment Inventory (CLEI) were reviewed. Studies explored consistent trends about learning environment. Students rated sense of task accomplishment high. Affiliation also rated highly though was influenced by models of care. Feedback measuring whether students' in idual needs and views were accommodated consistently rated lower. Across different countries students report similar perceptions about learning environments. Clinical learning environments are most effective in promoting safe practice and are inclusive of student learners, but not readily open to innovation and challenges to routine practices.
Prophylactic dressing to minimize sacral pressure injuries in high-risk hospitalized patients: A pilot study
Publisher: Wiley
Date: 09-10-2015
DOI: 10.1111/JAN.12543
Abstract: In this paper, we describe a trial protocol used to assess feasibility related to: study administration (recruitment, randomization, retention, compliance, eligibility criteria, suitability of protocol instructions and data collection questionnaires) resource and data management (suitability of site, time and budget allocation, management of personnel and data) intervention fidelity (treatment dose, violations) and effect size. Pressure injury can lead to increases in hospital length of stay and cost. The sacrum is identified as one of the most common anatomical pressure injury sites for hospitalized patients. Silicone foam border dressings have been proposed as one strategy to reduce pressure injury incidence however, rigorous testing of benefit in a general medical-surgical population is required. Randomized controlled trial. Eighty patients will be recruited after assessment of high risk of pressure injury in a large tertiary hospital in south-east Queensland, Australia. Eligible, consenting participants will be randomly allocated to either a control group (routine care) or an intervention group (routine care and a sacral prophylactic dressing). The primary outcomes comprise feasibility criteria as identified above. The secondary measure is the presence and severity of sacral pressure injury via blind assessment of digital photographs. Research ethics approval was received in October 2013. Prophylactic dressings applied to the sacrum may be an effective method for reducing pressure injury in high-risk general medical-surgical patients. However, more rigorous studies to confirm benefit are required. This pilot study will determine the feasibility and effect size to inform a larger randomized controlled trial.
Development and validation of a survey designed to measure patient experience of and preference for surgical wound care discharge education: A pilot study
Publisher: Elsevier BV
Date: 08-2023
EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: The EEPOC Trial
Publisher: Research Square Platform LLC
Date: 12-2022
DOI: 10.21203/RS.3.RS-2227757/V1
Abstract: Background Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. Methods This is a multicentre, pragmatic, parallel group, randomised controlled trial. A s le size of 1,320 was calculated to have 90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years admitted to hospital within the previous 36 hours expected length of stay of ≥ 24 hours and assessed high risk for hospital acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using deidentified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate the costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. Discussion This trial aims to provide definitive evidence on the effect prophylactic dressings have on development of hospital acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on the results of the trial including acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 but has been significantly delayed due to COVID-19. Trial registration: ANZCTR, prospectively registered 22 May 2019: ACTRN12619000763145
Modification of a student feedback tool that provides feedback to staff in clinical contexts
Publisher: Wiley
Date: 15-09-2010
Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review
Publisher: Public Library of Science (PLoS)
Date: 13-09-2018
Clinical Progression Portfolio: A resource for enhancing learning partnerships
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.NEPR.2009.01.020
Abstract: Interactions between students and registered nurses are crucial opportunities for clinical learning. Success of this learning partnership is predicated on excellent communication, negotiation, and shared goal setting but these elements are often difficult to achieve. This paper describes the development and preliminary evaluation of the student Clinical Progression Portfolio (CPP). This pocket-size learning resource is carried by students and used as a point of reference to (1) enhance communication between students and registered nurses (2) provide a quick reference for the development and refinement of learning objectives and (3) offer a brief record of progress (via a succinct dot point process). An expert reference group evaluation revealed that the CPP provided a framework for students to initiate and support their clinical learning in partnership with clinicians.
Using a critical reflection process to create an effective learning community in the workplace
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.NEDT.2012.03.001
Abstract: Learning circles are an enabling process to critically examine and reflect on practices with the purpose of promoting in idual and organizational growth and change. The authors adapted and developed a learning circle strategy to facilitate open discourse between registered nurses, clinical leaders, clinical facilitators and students, to critically reflect on practice experiences to promote a positive learning environment. This paper reports on an analysis of field notes taken during a critical reflection process used to create an effective learning community in the workplace. A total of 19 learning circles were conducted during in-service periods (that is, the time allocated for professional education between morning and afternoon shifts) over a 3 month period with 56 nurses, 33 students and 1 university-employed clinical supervisor. Participation rates ranged from 3 to 12 in iduals per discussion. Ten themes emerged from content analysis of the clinical learning issues identified through the four-step model of critical reflection used in learning circle discussions. The four-step model of critical reflection allowed participants to reflect on clinical learning issues, and raise them in a safe environment that enabled topics to be challenged and explored in a shared and cooperative manner.
Wang I, Walker R, Gillespie BM. Pressure injury prevention for surgery: results from a prospective, observational study in a tertiary hospital. Implementing pressure injury prevention in a perioperati
Publisher: Wiley
Date: 27-02-2019
DOI: 10.1002/AORN.12629
Characteristics of leadership that influence clinical learning: A narrative review
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.NEDT.2010.12.018
Abstract: Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the ersity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning.
Setting the surgical wound care agenda across two healthcare districts: A priority setting approach
Publisher: Elsevier BV
Date: 10-2020
Alginate dressings for treating pressure ulcers (Review)
Publisher: Wiley
Date: 21-05-2015
Foam dressings for treating pressure ulcers
Publisher: Wiley
Date: 12-10-2017
The effect of prone positioning on pressure injury incidence in adult intensive care unit patients: A meta-review of systematic reviews
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.AUCC.2021.10.003
Abstract: Numerous systematic reviews have examined the impact of prone positioning on outcomes, including pressure injury (PI). The objective of this meta-review was to synthesise the evidence on the effect of prone positioning on the incidence and location of PIs in adult intensive care unit patients. This is a meta-review of published systematic reviews. Five databases were searched data were extracted by three authors and adjudicated by a fourth. The AMSTAR-2 tool was used to quality appraise the selected articles, which was completed by three authors with a fourth adjudicating. Ten systematic reviews were synthesised. The cumulative incidence of PI in 15,979 adult patients ranged from 25.7% to 48.5%. One study did not report adult numbers. Only one review reported the secondary outcome of PI location. PIs were identified in 13 locations such as the face, chest, iliac crest, and knees. Using the AMSTAR-2, three reviews were assessed as high quality, six as moderate quality, and one as low quality. The high incidence of PI in the prone position highlights the need for targeted preventative strategies. Care bundles may be one approach, given their beneficial effects for the prevention of PI in other populations. This review highlights the need for proactive approaches to limit unintended consequences of the use of the prone position, especially notable in the current COVID-19 pandemic.
Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study
Publisher: European Respiratory Society (ERS)
Date: 23-06-2023
DOI: 10.1183/23120541.00098-2023
Abstract: Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Of the study s le (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86–6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69–6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio .7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
Related Organisations
School Of Nursing & Midwifery, Griffith University, Menzies Health Institute QLD, And The Division Of Surgery, Princess Alexandra Hospital
Location: Australia
School Of Nursing & Midwifery, Griffith University, Menzies Health Institute QLD, And The Division Of Surgery, Princess Alexandra Hospital: Brisbane, Queensland, AU
Location: Australia
Griffith University, School Of Nursing And Midwifery, Menzies Health Institute QLD: Nathan, QLD, AU
Location: Australia
NHMRC Centre For Research Excellence In Nursing, Griffith University
Location: Australia
Griffith University, School Of Nursing And Midwifery, Menzies Health Institute QLD
Location: Australia
Related Funding Activities
No related grants have been discovered for Rachel Walker.