ORCID Profile
0000-0003-2704-150X
Current Organisations
Griffith University Logan Campus
,
Griffith University - Gold Coast Campus
,
University of Southern Queensland
,
University of New England
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Publications
Establishing the content validity of a new emergency department patient-reported experience measure (ED PREM): a Delphi study
Publisher: Springer Science and Business Media LLC
Date: 09-04-2022
DOI: 10.1186/S12873-022-00617-5
Abstract: Patient-reported experience measures aim to capture the patient’s perspective of what happened during a care encounter and how it happened. However, due to a lack of guidance to support patient-reported experience measure development and reporting, the content validity of many instruments is unclear and ambiguous. Thus, the aim of this study was to establish the content validity of a newly developed Emergency Department Patient-Reported Experience Measure (ED PREM). ED PREM items were developed based on the findings of a systematic mixed studies review, and qualitative interviews with Emergency Department patients that occurred during September and October, 2020. In iduals who participated in the qualitative interviews were approached again during August 2021 to participate in the ED PREM content validation study. The preliminary ED PREM comprised 37 items. A two-round modified, online Delphi study was undertaken where patient participants were asked to rate the clarity, relevance, and importance of ED PREM items on a 4-point content validity index scale. Each round lasted for two-weeks, with 1 week in between for analysis. Consensus was a priori defined as item-level content validity index scores of ≥0.80. A scale-level content validity index score was also calculated. Fifteen patients participated in both rounds of the online Delphi study. At the completion of the study, two items were dropped and 13 were revised, resulting in a 35-item ED PREM. The scale-level content validity index score for the final 35-item instrument was 0.95. The newly developed ED PREM demonstrates good content validity and aligns strongly with the concept of Emergency Department patient experience as described in the literature. The ED PREM will next be administered in a larger study to establish its’ construct validity and reliability. There is an imperative for clear guidance on PREM content validation methodologies. Thus, this study may inform the efforts of other researchers undertaking PREM content validation.
Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.IJNURSTU.2017.03.006
Abstract: Patient safety is critical to the provision of quality health care and thus is an essential component of nurse education. To describe first, second and third year Australian undergraduate nursing students' confidence in patient safety knowledge acquired in the classroom and clinical settings across the three years of the undergraduate nursing program. A cross-sectional online survey conducted in 2015. Seven Australian universities with c uses across three states (Queensland, New South Wales, South Australia). A total of 1319 Australian undergraduate nursing students. Participants were surveyed using the 31-item Health Professional Education in Patient Safety Survey (H-PEPSS). Descriptive statistics summarised the s le and survey responses. Paired t-tests, ANOVA and generalized-estimating-equations models were used to compare responses across learning settings (classroom and clinical), and year of nursing course. Participants were most confident in their learning of clinical safety skills and least confident in learning about the sociocultural dimensions of working in teams with other health professionals, managing safety risks and understanding human and environmental factors. Only 59% of students felt confident they could approach someone engaging in unsafe practice, 75% of students agreed it was difficult to question the decisions or actions of those with more authority, and 78% were concerned they would face disciplinary action if they made a serious error. One patient safety subscale, Recognising and responding to remove immediate safety risks, was rated significantly higher by third year nursing students than by first and second year students. Two broader aspects of patient safety scales, Consistency in how patient safety issues are dealt with by different preceptors, and System aspects of patient safety are well covered in our program, were rated significantly higher by first year nursing students than by second and third year students. One scale, Understanding that reporting adverse events and close calls can lead to change and can reduce recurrence of events, was rated significantly higher by third year students than first and second year students. In order are to achieve meaningful improvements in patient safety, and create harm free environments for patients, it is crucial that nursing students develop confidence communicating with others to improve patient safety, particularly in the areas of challenging poor practice, and recognising, responding to and disclosing adverse events, including errors and near misses.
Use of point-of-care subepidermal moisture devices to detect localised oedema and evaluate pressure injury risk: A scoping review
Publisher: Wiley
Date: 30-01-2023
DOI: 10.1111/JOCN.16630
Abstract: To map current literature on bedside clinicians' use of point‐of‐care subepidermal moisture devices to identify increased pressure injury risk. Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices. A scoping review. Arksey and O'Malley's six‐step framework and the PRISMA‐ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008–2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data. Nine studies were selected from 1676 sources. Two point‐of‐care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design. Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end‐users of point‐of‐care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research. International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation. Open Science DOI 0.17605/OSF.IO/AB6Y5 —7th of March 2022.
The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation
Publisher: The Royal Australian College of General Practitioners
Date: 12-2020
Abstract: Background and objectives General practitioners (GPs) require accurate medication information to care for recently discharged hospital patients. Pre-discharge medication reconciliation improves the accuracy of patient medication lists that GPs receive. This study aimed to explore GPs’ perceptions of the accuracy, completeness and timeliness of hospital discharge medication information, and how they undertake medication reconciliation. Methods Using a cross-sectional online survey, quantitative and qualitative data were collected from a convenience s le of GPs practising across the Gold Coast, Australia. Data were analysed using descriptive statistics and content analysis. Results Twelve GPs were recruited. Patient hospital discharge medication information was mostly accurate and complete, but delays in receiving this information affected the ability of GPs to undertake medication reconciliation. Discussion Receiving accurate and timely patient discharge medication information can reduce errors. Optimising the communication of medication information to GPs may improve patient safety.
Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis? (vol 128, 104189, 2022)
Publisher: Elsevier BV
Date: 06-2022
Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses' perceptions of their roles and responsibilities.
Publisher: Wiley
Date: 06-03-2022
DOI: 10.1111/JOCN.16275
Abstract: Safe medication management is a cornerstone of nursing practice. Nurses prepare patients for discharge which includes the ongoing safe administration of medications. Medication reconciliation at hospital discharge is an interprofessional activity that helps to identify and rectify medication discrepancies or errors to ensure the accuracy and completeness of discharge medications and information. Nurses have a role in medication safety however, their involvement in medication reconciliation at hospital discharge is poorly described. The study's aim was to describe acute care nurses' perceptions of their roles and responsibilities in medication reconciliation at hospital discharge, including barriers and enablers. Using focus groups, this exploratory descriptive study gathered qualitative data from nurses working in five acute care clinical units (medical, surgical and transit/discharge lounge) at a tertiary Australian hospital. The data were analysed using inductive content analysis and reported following the COREQ checklist. Thirty-two nurses were recruited. Three themes emerged from the data: nurses' medication reconciliation role involves chasing, checking and educating burden of undertaking medication reconciliation at hospital discharge team collaboration and communication in medication reconciliation. Nurses had a minor role in medication reconciliation at hospital discharge due to a lack of organisation clinical practice guidance and specialised training. Standardising interprofessional medication reconciliation processes and increasing nurses' involvement will help to streamline this task, reduce discharge delays, workload pressure and improve patient safety. Medication reconciliation at hospital discharge is an interprofessional patient safety activity, however little is known about nurse's role and responsibilities. This study reports nurses' important contribution to patient safety in terms of healthcare team coordination, medication checking and patient education. Supportive organisations and collaborative teams increased nurses' willingness to complete this activity.
The factors that act as barriers and enablers to the implementation of voluntary assisted dying services in acute care health settings: a systematic mixed studies review and secondary analysis
Publisher: Australian Nursing and Midwifery Federation
Date: 30-05-2022
The repositioning of hospitalized patients with reduced mobility: A prospective study
Publisher: Wiley
Date: 07-2015
DOI: 10.1002/NOP2.20
An education intervention care bundle to improve hospitalised patients’ pressure injury prevention knowledge: a before and after study
Publisher: Cambridge Media
Date: 12-2020
Predictors of pressure injury prevention strategies in at-risk medical patients: An Australian multi-centre study
Publisher: Elsevier BV
Date: 04-2017
Moisture accumulation detection technologies for identifying pressure injuries: a literature review
Publisher: Cambridge Media
Date: 12-2022
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.
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.
The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study
Publisher: Elsevier BV
Date: 02-2023
Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation
Publisher: Wiley
Date: 08-08-2019
DOI: 10.1111/JOCN.14967
Abstract: To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36 hr of their hospital admission in Australia. Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our s le comprised of 1,047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36 hr of hospitalisation. From our s le, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36 hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36 hr of hospitalisation. Our findings confirm that older adults, those with multiple comorbidities and in iduals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. Many older patients come to hospital with a community-acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.
‘I knew I'd be taken care of’: Exploring patient experiences in the Emergency Department
Publisher: Wiley
Date: 19-06-2022
DOI: 10.1111/JAN.15317
Abstract: To explore adult Emergency Department patient experiences to inform the development of a new Emergency Department patient‐reported experience measure. Descriptive, exploratory qualitative study using semi‐structured in idual interviews with adult Emergency Department patients. Participants were recruited across two Emergency Departments in Southeast Queensland, Australia during September and October 2020. Purposive s ling based on maximum variation was used. Participants were recruited during their Emergency Department presentation and interviewed in 2‐weeks via telephone. Inductive thematic analysis followed the approach proposed by Braun and Clarke (2012). Thirty participants were interviewed, and four themes were inductively identified: Caring relationships between patients and Emergency Department care providers Being in the Emergency Department environment Variations in waiting for care and Having a companion in the Emergency Department . Caring relationships between patients and Emergency Department care providers included being treated like a person and being cared for, being informed about and included in care, and feeling confident in care providers. Being in the Emergency Department environment included being around other patients, feeling comfortable and having privacy. Variations in waiting for care included expecting a longer wait, waiting throughout the Emergency Department journey and receiving timely care. Having a companion in the Emergency Department included not feeling alone, and observing care providers engage with companions. Patient experiences in the Emergency Department are multifaceted, and themes are not mutually exclusive. These findings demonstrate consistency with the core experiential themes identified in the international literature. Strategies to improve patient engagement in shared decision‐making, and communication between patients and care providers about wait times will be critical to optimizing Emergency Department patient experiences, and person‐centred practice. These findings holistically conceptualize patient experiences in the Emergency Department which is the first step to developing a new Emergency Department patient‐reported experience measure.
Pressure injury prevention strategies in acute medical inpatients: an observational study
Publisher: Informa UK Limited
Date: 06-05-2016
DOI: 10.1080/10376178.2016.1190657
Abstract: Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients' pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning. An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The s le comprised adult medical inpatients with reduced mobility. A subs le of participants assessed at pressure injury risk on admission was drawn from this s le. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility. There was suboptimal planning and implementation of pressure injury prevention strategies for the s le and subs le. There was a significant relationship between planned and implemented support surfaces at both hospitals however, no relationship existed between the planned and implemented of regular repositioning at either site. The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.
Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 12-2023
The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines
Publisher: Elsevier BV
Date: 03-2021
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.
The experiences of the agency registered nurse: An integrative literature review
Publisher: Hindawi Limited
Date: 11-10-2019
DOI: 10.1111/JONM.12850
Abstract: To examine experienced registered nurses' motivations for choosing agency work, their experiences and perceptions of agency nursing and how they meet their regulatory professional development obligations. Agency registered nurses are employed by healthcare organizations to meet staffing shortfalls and contain costs. Using an integrative review framework, four databases (CINAHL, Medline, Embase and Scopus) were systematically searched between 2000 and 2017: study selection followed the Preferred Reporting Items for Systematic reviews and Meta-analyses. Our search identified 491 sources. From these, two primary qualitative sources were included in this review. Four themes were identified: orientation, allocation of the agency nurse, isolation in clinical practice and lack of education opportunities. Given the limited literature on agency nurses and how to support them, further research is required on this subject. Support for agency nurses is necessary, so they can seamlessly integrate with the healthcare team to provide safe patient care. This review may assist managers to identify strategies to effectively engage and support agency registered nurses in the acute care nursing team. The gaps identified highlight the need for further research to explore agency nurses' motivations, and support needs to inform future strategic workforce planning.
Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.NEDT.2017.02.004
Abstract: Medication errors are a patient safety and quality of care issue. There is evidence to suggest many undergraduate nursing curricula do not adequately educate students about the factors that contribute to medication errors and possible strategies to prevent them. We designed and developed a suite of teaching strategies that raise students' awareness of medication error producing situations and their prevention.
Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review
Publisher: Elsevier BV
Date: 04-2022
Identifying surgical wound care priorities from the perspectives of clinicians and health consumers in an Australian private healthcare context: a case study
Publisher: Cambridge Media
Date: 13-04-2020
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.
Delivery, barriers, and enablers to patient participation in inpatient cardiac rehabilitation following cardiac surgery: An integrative review
Publisher: Elsevier BV
Date: 05-2023
Patient participation in pressure injury prevention: giving patient's a voice
Publisher: Wiley
Date: 10-10-2014
DOI: 10.1111/SCS.12088
Abstract: Pressure injuries burden patients and healthcare organisations, with some preventative practices having little impact on prevalence reduction. Patient participation in care may be an effective pressure injury prevention strategy, yet patient preferences are unknown. The aim of this interpretive study was to describe patients' perceptions of their current and future role in pressure injury prevention. Semi-structured interviews were conducted with 20 adult inpatients recruited from four medical units, at two Australian metropolitan hospitals. Interview data were analysed using content analysis, with three categories emerging: 'experiencing pressure injuries' 'participating in pressure injury prevention' and 'resourcing pressure injury prevention and treatment'. These categories reflect the complex nature of participants' pressure injury experience. The findings suggest participants gather pressure injury knowledge from first-hand and vicarious experience knowledge they bring to hospital. Most participants preferred a proactive pressure injury prevention role. Many identified barriers in the healthcare environment that impeded their participation and affected their experience of pressure injuries and pressure injury prevention. If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners.
Constraints on particle acceleration in SS433/W50 from MAGIC and H.E.S.S. observations
Publisher: EDP Sciences
Date: 04-2018
DOI: 10.1051/0004-6361/201731169
Abstract: Context. The large jet kinetic power and non-thermal processes occurring in the microquasar SS 433 make this source a good candidate for a very high-energy (VHE) gamma-ray emitter. Gamma-ray fluxes above the sensitivity limits of current Cherenkov telescopes have been predicted for both the central X-ray binary system and the interaction regions of SS 433 jets with the surrounding W50 nebula. Non-thermal emission at lower energies has been previously reported, indicating that efficient particle acceleration is taking place in the system. Aim. We explore the capability of SS 433 to emit VHE gamma rays during periods in which the expected flux attenuation due to periodic eclipses ( P orb ~ 13.1 days) and precession of the circumstellar disk ( P pre ~ 162 days) periodically covering the central binary system is expected to be at its minimum. The eastern and western SS 433/W50 interaction regions are also examined using the whole data set available. We aim to constrain some theoretical models previously developed for this system with our observations. Methods. We made use of dedicated observations from the Major Atmospheric Gamma Imaging Cherenkov telescopes (MAGIC) and High Energy Spectroscopic System (H.E.S.S.) of SS 433 taken from 2006 to 2011. These observation were combined for the first time and accounted for a total effective observation time of 16.5 h, which were scheduled considering the expected phases of minimum absorption of the putative VHE emission. Gamma-ray attenuation does not affect the jet/medium interaction regions. In this case, the analysis of a larger data set amounting to ~40–80 h, depending on the region, was employed. Results. No evidence of VHE gamma-ray emission either from the central binary system or from the eastern/western interaction regions was found. Upper limits were computed for the combined data set. Differential fluxes from the central system are found to be ≲ 10 −12 –10 −13 TeV −1 cm −2 s −1 in an energy interval ranging from ~few × 100 GeV to ~few TeV. Integral flux limits down to ~ 10 −12 –10 −13 ph cm −2 s −1 and ~ 10 −13 –10 −14 ph cm −2 s −1 are obtainedat 300 and 800 GeV, respectively. Our results are used to place constraints on the particle acceleration fraction at the inner jetregions and on the physics of the jet/medium interactions. Conclusions. Our findings suggest that the fraction of the jet kinetic power that is transferred to relativistic protons must be relatively small in SS 433, q p ≤ 2.5 × 10 −5 , to explain the lack of TeV and neutrino emission from the central system. At the SS 433/W50 interface, the presence of magnetic fields ≳10 μ G is derived assuming a synchrotron origin for the observed X-ray emission. This also implies the presence of high-energy electrons with E e − up to 50 TeV, preventing an efficient production of gamma-ray fluxes in these interaction regions.
Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review
Publisher: Wiley
Date: 25-06-2023
DOI: 10.1111/JOCN.16698
Abstract: The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. The process of obtaining consent for planned elective surgery manifests an in idual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. Scoping review. Arksey and O′Malley's ( International Journal of Social Research Methodology , 8 , 2005 and 19) five‐step scoping review methodology was used. Fifty‐three articles were included 39 primary and 14 secondary research publications. Three key findings were identified there is currently low‐level evidence about surgical consent processes to inform clinical practice junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub‐optimally and current knowledge gaps include capacity assessment, decision‐making and pre‐procedural consent checks. Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision‐making, pre‐procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.
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.
Patient involvement in surgical wound care research: A scoping review
Publisher: Wiley
Date: 14-06-2020
DOI: 10.1111/IWJ.13395
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 of a Wound Assessment Tool for Use in Adults at End of Life: A Modified Delphi Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2023
Feasibility and acceptability of implementing a patient education pressure injury prevention care bundle in acute care: an interview study
Publisher: Cambridge Media
Date: 09-2021
Kennedy Terminal Ulcers
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/NJH.0000000000000563
Abstract: Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. Using the Arksey and O’Malley scoping review framework, we systematically searched the Cochrane Library, CINAHL, EMBASE, MEDLINE, and ProQuest databases and 5 guideline repositories between 1983 and 2018. The following search terms were used: Kennedy ulcers , Kennedy terminal ulcers , terminal ulcer , skin failure , and Skin Changes at Life’s End . Data were extracted using a purposely developed data collection tool. Initial searches yielded 2997 sources, with 32 included in this review. Most Kennedy terminal ulcer literature was published by nurses in the United States. Kennedy terminal ulcer prevalence data are limited, with no validated assessment tools available. Kennedy terminal ulcers may be misclassified as pressure injuries, potentially resulting in financial penalties to the institution. This scoping review revealed significant knowledge and clinical practice gaps in patient assessment, management, and treatment of Kennedy terminal ulcers. Timely patient education may help them to make informed care and quality end-of-life decisions. Further research is needed to inform clinical practice to improve patient care.
Non-Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital
Publisher: Wiley
Date: 09-2011
DOI: 10.1002/J.2055-2335.2011.TB00859.X
Abstract: The inconsistent definition of non‐therapeutic medication omissions, under‐reporting, and a poor understanding of their associated factors h er efforts to improve medication administration practices. To examine the incidence of non‐therapeutic medication omissions among acutely ill medical and surgical adult patients and to identify the patient‐, drug‐ and system‐related predictors of these omissions. A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The s le was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p 0.001) and the number of medication administration episodes (p 0.001) were statistically significant predictors of non‐therapeutic medication omissions. The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error.
Developing and validating a hierarchical model of external responsiveness: A study on RFID technology
Publisher: Springer Science and Business Media LLC
Date: 27-05-2014
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
Pressure injury prevention practice in Australian intensive care units: A national cross-sectional survey
Publisher: Elsevier BV
Date: 03-2023
Human connectedness in nursing: A case study
Publisher: Informa UK Limited
Date: 04-2013
DOI: 10.5172/CONU.2013.44.1.45
Abstract: Human connectedness is a powerful human need. Human connectedness occurs when an in idual is actively engaged with another person, activity, object or environment, resulting in a sense of well-being. Nurses and patients, through their daily interactions share a commonality of emotions derived from the human experience. This case study describes one nurses' experience of human connectedness with a patient and how, through the use of reflection, this translated into better patient care and colleague interaction.
Repositioning for pressure injury prevention in adults
Publisher: Wiley
Date: 02-06-2020
Repositioning for pressure injury prevention in adults: An abridged Cochrane systematic review and meta-analysis
Publisher: Elsevier BV
Date: 08-2021
An education intervention to improve nursing students' understanding of medication safety
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.NEPR.2014.11.001
Abstract: Medication safety is a significant issue. Whilst medication administration is a routine task, it is a complex nursing activity. It is recognised in the literature that medication related adverse events are most often related to systems failures associated with the complex process of medication administration. This paper examines student's perceived effectiveness of an educational intervention, designed to demonstrate the complex and multidisciplinary factors of systems related failures in medication administration. The intervention was underpinned by adult and experiential learning concepts and used a problem-based learning approach. A series of short digital recordings were developed along with discussion points to illustrate multidisciplinary interactions involved in medication administration. A small s le of second and third year undergraduate nursing students (n = 28) evaluated the effectiveness of the educational resource. Our findings suggest that such resources are effective in demonstrating the complexity of medication related error and were authentic to practice. An educational intervention using problem based learning afforded nursing students the opportunity to engage with the systems factors that contribute to medication errors. Interventions that highlight these factors may play an important role in raising awareness of these issues and encourage students to carry this knowledge into clinical practice.
Patient experiences of, and preferences for, surgical wound care education
Publisher: Wiley
Date: 09-12-2022
DOI: 10.1111/IWJ.14030
Abstract: The aim of this study was to describe patients' experiences of, and preferences for, surgical wound care discharge education and how these experiences predicted their ability to self‐manage their surgical wounds. A telephone survey of 270 surgical patients was conducted across two hospitals two weeks after discharge. Patients preferred verbal (n = 255, 94.8%) and written surgical wound education (n = 178, 66.2%) from medical (n = 229, 85.4%) and nursing staff (n = 211, 78.7%) at discharge. The most frequent education content that patients received was information about follow‐up appointments (n = 242, 89.6%) and who to contact in the community with wound care concerns (n = 233, 86.6%). Using logistic regression, patients who perceived that they participated in surgical wound care decisions were 6.5 times more likely to state that they were able to manage their wounds at home. Also, patients who agreed that medical and/or nursing staff discussed wound pain management were 3.1 times more likely to report being able to manage their surgical wounds at home. Only 40% (107/270) of patients actively participated in wound‐related decision‐making during discharge education. These results uncovered patient preferences, which could be used to optimise discharge education practices. Embedding patient participation into clinical workflows may enhance patients' self‐management practices once home.
Physical activity levels and torso orientations of hospitalized patients at risk of developing a pressure injury: An observational study
Publisher: Wiley
Date: 30-09-2015
DOI: 10.1111/IJN.12188
Abstract: Pressure injury guidelines recommend regular repositioning yet patients' mobility and repositioning patterns are unknown. An observational study using activity monitors was undertaken to describe the 24 h activity patterns of 84 hospitalized patients at risk of developing a pressure injury. The vast majority of participants' time was spent in the sedentary activity range (94% ± 3%) followed by the light range (5% ± 4 %). Patients changed their posture a median of 94 (interquartile range 48) time in the 24-h period (range 11-154), or ≈ 3.8 times per hour. Although a main focus for pressure injury prevention has been on repositioning, this study shows that patients with restricted mobility are actually moving quite often. Therefore, it might be appropriate to focus more attention on other pressure injury prevention strategies such as adequate nutrition, appropriate support surfaces and good skin care.
Variations in sacral sub-epidermal moisture measurements in hospitalized medical and surgical patients: A longitudinal observational sub-study
Publisher: Elsevier BV
Date: 09-2023
Defining and Describing Terminal Ulcers in Adults at End of Life: An Integrative Review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2022
A systematic mixed studies review of patient experiences in the ED
Publisher: BMJ
Date: 04-03-2021
DOI: 10.1136/EMERMED-2020-210634
Abstract: Understanding patient experiences is crucial to evaluating care quality in EDs. However, while previous reviews describe the determinants of ED patient experiences (ie, factors that influence patient experiences), few have described actual patient experiences. The aim of this systematic mixed studies review was to describe patient experiences in the ED from the patient’s perspective. Embase, Medline, ProQuest Nursing and Allied Health, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched, with publication dates limited between 1 January 2001 and 16 September 2019. Studies describing adult patient experiences in the ED were included. Studies describing patient satisfaction, proxy-reported experiences or child/adolescent experiences were excluded. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (2018 version). An inductive, convergent qualitative synthesis of the extracted data was undertaken following Thomas and Harden’s (2008) methods. Fifty-four studies were included and of those, only five (9%) studies included a standardised definition of patient experience. Two inter-related themes emerged: Relationships between ED patients and care providers and Spending time in the ED environment . The first theme included four subthemes regarding respect, communication, caring behaviours and optimising patient confidence. A key finding related to the potential for power imbalances between patients and their care providers. The second theme included two subthemes regarding physical aspects of the ED environment and patients’ waiting experience. Patients attributed more importance to the waiting experience itself rather than the duration they had to wait. Patients in the ED have unique and complex experiences. Greater research is needed to understand the relational and environmental factors that contribute to power imbalances between patients and care providers, how to support more positive waiting experiences, and developing a standardised definition of patient experience in the ED. CRD42020150154.
Social networking as a learning tool: Nursing students' perception of efficacy
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.NEDT.2013.11.006
Abstract: The pedagogical use of social networking technology in education is of growing interest to academics as a potential teaching and learning tool. However, the educational use of social networking sites such as Facebook is still under explored. Nursing students often perceive bioscience subjects as difficult and lack self-efficacy in their ability to be successful. In this case, as the final assessment for a bioscience related subject approached, students became increasingly anxious about their ability to perform in the assessment item. To better support students, a Facebook group was formed. The aim of the study was to examine students' perceptions of the efficacy of using Facebook as a tool to support study. A convenience s le of BN students (n=533 across 3 c uses), enrolled in the subject Medications and Safe Administration, were invited to join. 373 BN students joined the group (70% of the student cohort). A solution-focussed orientation underpinned the management of the group. A descriptive, online survey was administered following release of students' results for the final assessment item to assess students' perceptions of how effective the group had been in helping them learn. The survey contained both quantitative and qualitative questions. Responses were received from 89 students (24%). Survey data were analysed descriptively and qualitative data were analysed thematically by the academic team. Students perceived the group to be an innovative method of study support that guided learning by enhancing self-efficacy in their learning. Students also described how it was useful in promoting peer learning and engaging with academics. Social media platforms such as Facebook have the potential to enhance students' self-efficacy in learning and can support students to develop their learning to a deeper level.
Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
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.
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