ORCID Profile
0000-0001-6820-020X
Current Organisation
The Hong Kong Polytechnic University School of Nursing
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Publisher: Emerald
Date: 07-04-2021
DOI: 10.1108/CCSM-01-2020-0012
Abstract: This paper aims to examine the critical role played by cultural flow in fostering successful expatriate cross-border transitions. The authors develop and test a model on the interplay among cultural intelligence, organizational position level, cultural flow direction and expatriate adaptation, using a data set of 387 expatriate on cross-border transitions along the Belt & Road area. The authors find that both organizational position level and cultural flow moderate the relationship between cultural intelligence and expatriate adaptation, whereby the relationship is contingent on the interaction of organizational position status and assignment directions between high power distance and low power distance host environments. Previous research has shown that higher levels of cultural intelligence are positively related to better expatriate adaptation. However, there is a lack of research on the effect of position difference and cultural flow on such relationship. Our study is among the first to examine how the interaction between cultural flow and organizational position level influences the cultural intelligence (CI) and cultural adjustment relationship in cross-cultural transitions.
Publisher: JMIR Publications Inc.
Date: 30-05-2022
Abstract: mmersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students’ competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. his systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. EDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students’ learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with i P /i & .05 was used to test for statistical significance using SPSS (version 28 IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15 95% CI 16.3%-67.7% i P /i =.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90% i P /i =.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. his review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger s le size and robust study design are required to evaluate the effects of IVR teaching. nternational prospective register of systematic reviews (PROSPERO) CRD42022313706 www.crd.york.ac.uk rospero/display_record.php?RecordID=313706
Publisher: Elsevier BV
Date: 03-2022
Publisher: Wiley
Date: 28-02-2013
DOI: 10.1111/JOCN.12113
Publisher: Springer Science and Business Media LLC
Date: 13-03-2022
DOI: 10.1007/S10784-022-09566-7
Abstract: Zoonotic viruses have sacrificed hundreds of millions of people throughout human history. There are currently 1.7 million unidentified viruses estimated to be circulating in mammal and bird populations. It is foreseeable that in the near future, another of these will transmit to people, heralding the start of the next pandemic—one potentially more deadly than COVID-19. At the core of this article is a call for pre-emptive protection of the natural environment and its regenerative systems as the first fundamental step in the prevention of future epidemics and pandemics. While zoonoses originate in nature, the predominant legal discipline, managing these crises, is international health law which is invoked reactively once an outbreak has been reported. In this paper, we identify the need for a legal shift in epidemic and pandemic responses. In particular, we call for the incorporation of international environmental agreements to prevent the initial viral spillover from animal to human populations. We propose a strategy of strengthening existing agreements and a coupling of legal disciplines, such as health and environmental law, emphasizing the need for synergies across legal disciplines to enhance the emergence and management of future pandemics and epidemics. We introduce Coupled Human and Natural Systems (CHANS) Law to frame the required integration across legal instruments to regulate inextricably human-nature connections and advocate for the development of a Convention on Epidemics and Pandemics.
Publisher: Mark Allen Group
Date: 05-2014
DOI: 10.12968/BJON.2014.23.SUP10.S4
Abstract: Gastrointestinal graft-versus-host disease (GI-GvHD) is extremely debilitating and is multifactorial in its causative factors, management and treatment. It is an exaggeration of normal physiological mechanisms wherein the donor immune system attempts to rid itself of the host. The inflammatory process that follows has the benefit of providing an anti-tumour effect for many diseases, but unfortunately in patients undergoing human stem-cell transplantation, the nature of the inflammation can result in disability, wasting and death. The aim of this article is to discuss the pathophysiology of this often misunderstood or misdiagnosed condition, as well as its signs and symptoms, management and considerations for nursing care. While the medical management is aimed at minimising GvHD through the reduction of T-cell production and proliferation and gastrointestinal decolonisation, the nursing care is often focused on the signs and symptoms that can have the most prominent impact on patients. GI-GvHD has serious life-threatening complications, namely wasting syndrome, diarrhoea and dehydration. The basis of signs and symptomology is easily recognisable owing to the stages of progression through the human stem-cell transplantation process. Oncology nurses are in a prime position to identify these serious risks, initiate treatment immediately and collaborate effectively within the multidisciplinary team to minimise GvHD onset and provide expert support to patients, family and caregivers.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.ICCN.2012.04.001
Abstract: The presentation of pulmonary embolism to the emergency department (ED) can prove challenging because of the myriad of potential disease processes that mimic its signs and symptoms. The incidence of pulmonary embolism and indeed the mortality associated with it is relatively high. Early diagnosis and treatment is crucial in off-setting the potential deleterious effects associated with this condition. The aim of this article is to present a nursing case review of a patient presenting to the ED with a diagnosis of pulmonary embolism. We chose to use a case review to highlight the nursing and medical care that was provided for a patient who presented to the emergency department acutely with dyspnoea, chest pain and pyrexia. The use of case reviews are useful in reporting unusual or rare cases and this format is typically seen more in medicine than in nursing. They can naturally take one of two formats-a single case report or a series of case reports in this case we opted to report on a single case. The gentleman in question was an ambulance admission to the ED with a three day history of chest pain, shortness of breath and one episode of syncope which brought him to the ED. Over the course of his admission a variety of treatment modalities were used successfully to alleviate the problem. More notable from a nursing perspective was the use of diagnostic tools as an interpretation to guide his care and provide a platform from which a deeper understanding and appreciation of the intricacies the critically ill patient often presents. We found the use of case review very enlightening in understanding the disease process and the decision-making that accompanies this. Whilst our patient was successfully rehabilitated home, we learnt a lot from the experience which has been most beneficial in supporting our understanding of pulmonary embolism.
Publisher: Informa UK Limited
Date: 02-01-2022
Publisher: Elsevier BV
Date: 03-2019
Publisher: Wiley
Date: 13-02-2008
DOI: 10.1111/J.1478-5153.2007.00257.X
Abstract: Tradition has led us to believe that a heavily sedated patient is a comfortable, settled, compliant patient for whom sedation will improve outcome. The current move witnessed in clinical practice today of limiting sedation has led health care in recent years to question the benefit and necessity of routine, continuous sedation for all patients requiring mechanical ventilation. However, as a result there has been a rise in the amount of agitation being reported as being experienced by patients with the daily withdrawal of sedation. The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that in idualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break.
Publisher: Informa UK Limited
Date: 27-08-2018
DOI: 10.1080/10376178.2018.1512876
Abstract: The reasons men come into nursing is because of career stability, career progression and financial security. The aim of this study was to explore the lived-experience of a group of male nursing students as to the attraction of nursing as a career choice. A descriptive phenomenological approach using Colaizzi's seven step data analysis within the phenomenological empirical framework was used. The central theme developed from the transcripts was Nursing is for Men. Seven sub-themes were identified from the significant statements which included: Nursing is for me wanting a new career the jobs in the bag striving to succeed Men together Family approval and Mate-ship realigned. The men in this study found the decision to become a nurse and undertake their nursing education challenging. Moreover, it was reconciling with family, friends and work colleagues that many felt was the biggest obstacle.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.ICCN.2005.01.003
Abstract: This small-scale study was undertaken to assess what knowledge nursing staff from a General Intensive Care Unit held with regard to noise exposure. To assess knowledge a self-administered multiple-choice questionnaire was used. Rigorous peer-review insured content validity. This study produced poor results in terms of the knowledge nurses held with regard to noise related issues in particular the psychophysiological effects and current legislation concerning its safe exposure. Non-parametric testing, using Kruskal-Wallis found no significant difference between nursing grades, however, descriptive analysis demonstrated that the staff nurse grade (D and E) performed better overall. Whilst the results of this study may seem self-evident in some respects, it is the problems of exposure to excessive noise levels for both patients and hospital personnel, which are clearly not understood. The effects noise exposure has on in iduals for ex le decreased wound healing sleep deprivation and cardiovascular stimulation must be of concern especially in terms of patient care but more so for nursing staff especially the effects noise levels can have on cognitive task performance.
Publisher: Wiley
Date: 17-04-2008
DOI: 10.1111/J.1478-5153.2008.00272.X
Abstract: The transfer and/or retrieval of a critically patient is inherently dangerous not only for the patient but for staff as well. The quality and experience of unplanned transfers can influence patient mortality and morbidity. However, international evidence suggests that dedicated transfer/retrieval teams can improve mortality and morbidity outcomes. The initial aim of this paper is to describe an in-house competency-based training programme, which encompasses the STaR approach to develop members of our existing nursing team to be part of the dedicated transfer/retrieval service. The paper also presents audit data findings which examined the source of referrals, number of patients actually transferred and clinical status of those being transferred. Audit data illustrate that the most frequent source of referrals comes from Accident and Emergency and the Surgical Directorate with the most common presenting condition being cardio-respiratory failure or arrest. Audit data reveal that the number of patients actually transferred or retrieved is relatively small (33%) compared with the overall number of requests for assistance. However, 36% of those patients transferred had a level 2 or level 3 acuity status that necessitated the admission to a critical care area. A number of studies have concluded that the ill-experienced and ill-equipped transfer team can place patients' at serious risk of harm. Whether planned or unplanned, dedicated critical care transfer/retrieval teams have been shown to reduce patient mortality and morbidity.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.ICCN.2018.06.001
Abstract: Intra-abdominal hypertension is classified as either primary or secondary - primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg. Intestinal micro-circulation is significantly reduced by up to 50% with intra-abdominal pressures as low as 15 mmHg. Mucosal and submucosal tissue hypo-perfusion causes considerable damage to the intestinal cells, potentially resulting in bacterial translocation, endotoxin release, sepsis and multiple organ failure. The critical care nurse plays an important role in the early identification of intra-abdominal hypertension however, without this essential knowledge base and comprehension of intra-abdominal hypertension, clinical signs and symptoms may go unnoticed or be misinterpreted as signs of other critical illnesses.
Publisher: Wiley
Date: 29-09-2021
DOI: 10.1111/AJR.12804
Abstract: To investigate the impact of COVID‐19 on the mental health and well‐being of rural paramedics, police, community nursing and child protection staff. An online survey was distributed to investigate the sources of stress and support across in idual, task and organisational domains. The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. The main measures of well‐being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID‐19–related stress. The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2–3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. COVID‐19 has increased the workload and stress on rural front‐line community staff. The major sources of stress were related to organisations’ responses to COVID‐19 and not COVID‐19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.
Publisher: Wiley
Date: 2009
DOI: 10.1111/J.1478-5153.2008.00310.X
Abstract: The aim of this paper was to provide a narrative account of the communication skills used in an effective outreach consultation utilizing Neighbour's consultative model. Other consultation models were considered however, because of their overly comprehensive approach or emphasis on behaviour modification, these were deemed inappropriate. The nursing profession has endured significant changes of late and as a result is developing more autonomous roles in both the community and the acute health care settings. In the past, the term consultancy was used within the medical context nowadays, there are advance nurse practitioners for whom consultancy is an integral part of their role. Although every nursing interaction is in essence a consultation, the fact that nurses are taking up on new advanced roles highlights the necessity for nurses to develop their consultation skills even further. Therefore, it makes sense to explore what aspects of that consultancy role needs special consideration in order to ensure that positive outcomes are achieved. This paper has used a narrative account to uncover those salient skills needed to enhance the therapeutic relationship with a patient requiring the services of outreach. Furthermore, the application of a recognized consultation model was used to elucidate the underpinning knowledge of systematic history taking and assessment as well as demonstrating the communication skills and strategies needed to increase the patient's participation and empowerment throughout the consultation. Effective communication skills encompassed in a consultative model are integral to the success in safeguarding the well-being of patients requiring advanced levels of care. Prejudging or pre-empting information being conveyed can be detrimental to patient safety and may prolong or complicate treatment plans.
Publisher: Wiley
Date: 22-02-2009
DOI: 10.1111/J.1478-5153.2008.00318.X
Abstract: The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an in idual's practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For ex le, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing in idually? What this paper presents is that reflection may not be best suited to advancing practice if the in idual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable in idual practitioners to advance their own practice as well as being a resource for others.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.ICCN.2006.03.002
Abstract: The theoretical underpinnings of patient empowerment were developed through the work of educators and community psychologists, working primarily with the socially disadvantaged. Empowerment is seen as a philosophy based upon the belief of the inherent worth and creative potential of each in idual. Therefore, the aim of this paper is to explore whether this creative potential associated with patient choice that encapsulates empowerment is applicable to the Intensive Care Unit.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.ICCN.2006.03.003
Abstract: Emphysema is caused by exposure to cigarette smoking as well as alpha(1)-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of 800 million pounds per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.
Publisher: MDPI AG
Date: 23-02-2022
DOI: 10.3390/SU14052585
Abstract: As the global energy market undergoes a wholesale transformation accelerated by the need to decarbonise, a rapid transition to renewable energy and the mass deployment of distributed energy resources, autonomous energy networks or microgrids are emerging as an attractive mechanism for the delivery of electricity to end users. Yet in Australia, at least, relatively little is known about key aspects of microgrids that are fundamental to their successful deployment, not least the more commercial and economic elements rather than the purely technical. Drawing on the extant global literature on microgrids, in this paper, we explore the most important of these aspects including business models, ownership and investment. Identifying the ambiguity, inconsistency and uncertainty evident in many of the feasibility studies currently in train across Australia, in this paper, we highlight specific areas for future research. These research areas must be addressed if the full potential of microgrids is to be realised in the context of a global energy transition both domestically and internationally.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Sciedu Press
Date: 26-03-2017
Abstract: Background and aim: Descriptive phenomenology is widely used in social science research as a method to explore and describe the lived experience of in iduals. It is a philosophy and a scientific method and has undertaken many variations as it has moved from the original European movement to include the American movement. The aim of this paper is to describe descriptive phenomenology in the tradition of Edmund Husserl. Integrative literature discussing the nature of descriptive phenomenology was used within this paper to elucidate the core fundamental principles of Husserlian descriptive phenomenology.Methods: This is a methodology paper that provides both an overview of the historical context and the development of descriptive phenomenology in the tradition of Husserl.Results and discussion: Descriptive phenomenology is explained from its historical underpinnings. The principles of the natural attitude, intentionality and the phenomenological reduction are described and using practical ex les illustrate how each of these principles is applied within a research context.Conclusions: Understanding the key philosophical foundations of Husserlian descriptive phenomenology as a research method can be daunting to the uninitiated. This paper adds to the discussion around descriptive phenomenology and will assist and inform readers in understanding its key features as a research method.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.AUCC.2011.10.001
Abstract: Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for ex le has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO(2)). The aim of this paper is to put forward the notion that SvO(2) provides valuable information about oxygen consumption and venous reserve important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified ex le of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO(2). SvO(2) monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO(2) monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO(2)) might be an attractive alternative to SvO(2) because of its less invasiveness and ease of obtaining a s le for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO(2) is less accurate than SvO(2) and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO(2) and SvO(2) and this is dependent on the presenting disease, in some cases SvO(2) will be significantly lower than ScvO(2). Whilst newer technologies have been developed to continuously measure cardiac output, SvO(2) monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO(2) or blood s les obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO(2), trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO(2) will be approximately 16% lower.
Publisher: Wiley
Date: 16-11-2006
DOI: 10.1111/J.1365-2702.2006.01601.X
Abstract: The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Expert nursing practice can be argued to be central to high quality, holistic, in idualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the 'expert nurse' to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Nursing expertise which focuses on the provision of in idualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.ICCN.2005.07.003
Abstract: This paper explores the concept of expertise in intensive care nursing practice from the perspective of its relationship to the current driving forces in healthcare. It discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. It argues that nursing expertise which focuses on the provision of in idualised, holistic care and which is based largely on intuitive decision-making cannot and should not be reduced to being articulated in positivist terms. The principles of abduction or fuzzy logic, derived from computer science, may be useful in assisting nurses to explain in terms, which others can comprehend, the value of nursing expertise.
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1478-5153.2008.00324.X
Abstract: The aim of this paper was to review the current discourse in relation to intensive care unit (ICU) delirium. In particular, it will discuss the predisposing and contributory factors associated with delirium's development as well as effects of delirium on patients, staff and family members. Critically ill patients are at greater risk of developing delirium and, with an ageing population and increased patient acuity permitted by medical advances, delirium is a growing problem in the ICU. However, there is a universal consensus that the definition of ICU delirium needs improvement to aid its recognition and to ensure both hypoalert-hypoactive and hyperalert-hyperactive variants are easily and readily identified. The effects of ICU delirium have cost implications to the National Health Service in terms of prolonged ventilation and length of hospital stay. The causes of delirium can be readily classified as either predisposing or precipitating factors, which are organic in nature and commonly reversible. However, contributory factors also exist to exacerbate delirium and having an awareness of all these factors promises to aid prevention and expedite treatment. This will avoid or limit the host of adverse physiological and psychological consequences that delirium can provoke and directly enhance both patient and staff safety. Routine screening of all patients in the ICU for the presence of delirium is crucial to its successful management. Nurses are on the front line to detect, manage and even prevent delirium.
Publisher: Wiley
Date: 28-12-2018
DOI: 10.1111/NICC.12333
Abstract: Post-extubation dysphagia is a condition that is becoming a growing concern. The condition occurs in 3-62% of extubated patients and can be related to mixed aetiologies, such as neuromuscular impairment, critical illness and laryngeal damage. The risk factors for developing dysphagia in critically ill patients are under-diagnosed and perhaps underestimated. Recent studies recommend the implementation of a standardized swallowing screen to prevent aspiration and decrease pneumonia rate and mortality. The aim of this quality improvement initiative was the development of a bedside swallowing screening tool to assess effective swallowing post-endotracheal extubation. Post-extubation dysphagia can result in a delay in re-feeding, with the potential for malnutrition as well as overt and covert aspiration if swallowing is not effectively screened. It is apparent that ICU nurses commence the initial screen for swallowing in the absence of an evidence base of care. A review of current local and international practice guidelines excludes the process of an effective swallowing screen of the extubated patient. Previously, a referral to speech and language therapists would be required to assess swallowing only after an initial review by the ICU medical team. This often leads to delays if the referral is made outside normal working practice, such as weekends or evenings. The initial development of a swallowing screening tool is the first step to promoting a nurse-led/-initiated bedside swallow screening tool that will enhance patient care and patient safety. There is growing body of evidence regarding the incidence of post-extubation dysphagia. Currently, there are very few recognized bedside swallowing screening tools to identify patients at risk. The most serious complication associated with post-extubation dysphagia is aspiration pneumonia, which is the leading cause of nosocomial infection in the critically ill patient.
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JOCN.16817
Abstract: This study aimed to capture and explore family caregivers' lived experience of caring for hospitalised patients with cancer during the lockdown. The unprecedented lockdown episodes due to COVID‐19 have brought significant changes in the hospital visiting policies and caregiving practices. As part of the precautionary measures for hospital visits, the bedside companion was restricted to one caregiver for patients with cancer in Shanghai hospitals. This study adopted a descriptive phenomenological approach. Data were collected among 20 family caregivers recruited from the Oncology department of a tertiary hospital in Shanghai in May 2022, using purposive s ling method and followed by unstructured, open‐ended interviews. Colaizzi's seven‐step data analysis method was used to analyse the data to reveal the emergent themes and subthemes of the phenomenon. Four themes were generated on family caregivers' lived experience of caring for hospitalised patients with cancer during the lockdown, including (1) Feeling scared for the patient (2) Living a life feeling trapped under COVID‐19 surveillance (3) Feeling neglected and unseen (4) Growing resilience and appreciation. The lockdown exacerbated the burden of family caregivers when they cared for the hospitalised patients with cancer during the lockdown period. However, positive reframing of the lived experience facilitated their coping with the challenging situation. Findings from this study highlighted the potential proactive roles the healthcare providers could play in improving family caregivers' health and supporting them during and beyond the COVID‐19 pandemic. The study adhered to relevant EQUATOR guidelines the study was reported according to the COREQ checklist. Family caregivers of patients with cancer were involved in data collection and member‐checking of the transcripts and interpretations of their experiences.
Publisher: Wiley
Date: 24-01-2005
DOI: 10.1111/J.1365-2702.2004.01040.X
Abstract: This study was undertaken to measure and analyse levels of acoustic noise in a General Surgical Ward. Measurements were undertaken using the Norsonic 116 sound level meter (SLM) recording noise levels in the internationally agreed 'A' weighted scale. Noise level data and observational data as to the number of staff present were obtained and recorded at 5-min intervals over three consecutive days. Results of noise level analysis indicated that mean noise level within this clinical area was 42.28 dB with acute spikes reaching 70 dB(A). The lowest noise level attained was that of 36 dB(A) during the period midnight to 7 a.m. Non-parametric testing, using Spearman's Rho (two-tailed), found a positive relationship between the number of staff present and the level of noise recorded, indicating that the presence of hospital personnel strongly influences the level of noise within this area. Whilst the results of this may seem self-evident in many respects the problems of excessive noise production and the exposure to it for patients, hospital personnel and relatives alike continues unabated. What must be of concern is the psychophysiological effects excessive noise exposure has on in iduals, for ex le, decreased wound healing, sleep deprivation and cardiovascular stimulation.
Publisher: Hindawi Limited
Date: 04-08-2021
DOI: 10.1111/NUF.12632
Publisher: Wiley
Date: 21-01-2010
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.ICCN.2013.08.004
Abstract: The aim of this study was to establish intensive care unit nurses' knowledge of delirium within an acute tertiary hospital within South East Asia. Delirium is a common, life threatening and often preventable cause of morbidity and mortality among older patients. Undetected and untreated delirium is a catalyst to increased mortality, morbidity, functional decline and results in increased requirement for nursing care, healthcare expense and hospital length of stay. However, despite effective assessment tools to identify delirium in the acute setting, there still remains an inability of ICU nurses' to accurately identify delirium in the critically ill patient especially that of hypoactive delirium. A purposive s le of 53 staff nurses from a 13-bedded medical intensive care unit within an acute tertiary teaching hospital in South East Asia were asked to participate. A 40 item 5-point Likert scale questionnaire was employed to determine the participants' knowledge of the signs and symptoms the risk factors and negative outcomes of delirium. The overall positively answered mean score was 27 (67.3%) out of a possible 40 questions. Mean scores for knowledge of signs and symptoms, risk factors and negative outcomes were 9.52 (63.5%, n=15), 11.43 (63.5%, n=17) and 6.0 (75%, n=8), respectively. Whilst the results of this study are similar to others taken from a western perspective, it appeared that the ICU nurses in this study demonstrated limited knowledge of the signs and symptoms, risk factors and negative outcomes of delirium in the critically patient. The implications for practice of this are important given the outcomes of untreated delirium.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.ICCN.2012.08.002
Abstract: The admission to the intensive care unit with a diagnosis of sepsis and/or septic shock is not uncommon. The aim of this article is to present a nursing case review of a patient admitted to the intensive care unit with a diagnosis of septic shock and the use of bedside acid-base formulae to inform clinical decision making. We chose to use a case review. This method is useful in reporting unusual or rare cases and is typically seen more in medicine than in nursing. The gentleman in question was a self-presentation with a short history of fever and worsening shortness of breath. His condition worsened where he required admission to the intensive care unit. The use of 'advanced' acid-base interpretation to guide his nursing care provided a platform from which to advance a deeper understanding of the intricacies the critically ill patient often presents. The use of case review is enlightening in understanding the disease process and the decision-making that accompanies this. The lessons learnt are applicable to a wider nursing audience because understanding acid-base physiology is beneficial in supporting and advancing critical care nursing practice.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.ICCN.2006.05.004
Abstract: The use of the Sengstaken-Blakemore tube as a life-saving treatment for bleeding oesophageal varices is slowly becoming the least preferred method possibly due to the potential complications associated with its placement. Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience as opposed to recognised evidence of best practice. Therefore, this paper focuses on the application of Lewin's transitional change theory used to introduce a change in nursing practice with the application of a guideline to enhance the care of patients with a Sengstaken-Blakemore tube in situ within a general intensive care unit. This method identified some of the complexities surrounding the change process including the driving and restraining forces that must be harnessed and minimised in order for the adoption of change to be successful.
Publisher: Oxford University Press (OUP)
Date: 25-01-2023
Abstract: Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6 SMD = −0.26, 95% confidence interval (CI): (−0.38, −0.14), I2 = 17%, P & 0.001] systolic blood pressure [n = 5 SMD = −0.46, 95% CI: (−0.84, −0.08), I2 = 90%, P = 0.02] and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. PROSPERO CRD42022300551.
Publisher: Sciedu Press
Date: 30-07-2017
Abstract: Background and objective: Descriptive phenomenology when used within the tradition of Husserl offers the qualitative researcher a unique perspective into the lived experience of the phenomena in question. Methods of data analysis are often seen as the theoretical framework for which these studies are then focused. However, what is not realised is that the data analysis tool is merely that a tool for which to delineate the in idual narratives. What is often missing is a research framework for which to structure the actual study. Therefore, the aim of this paper is to offer a reflective account of how the empirical-phenomenological framework shaped and informed a descriptive phenomenological study looking at the lived experience of male nursing students as they journey though the under-graduate nursing programme.Methods: A reflective narrative was used to examine and explore how the empirical-phenomenological framework can be used to support method construction within a descriptive phenomenological study.Results and conclusions: The empirical-phenomenological research framework aims to provide a practical method for understanding and valuing the range and depth of descriptive phenomenology, in particular the lived experience. Used in combination with specific phenomenological data analysis models the empirical-phenomenological framework is structured to support the qualitative research process.
Publisher: Wiley
Date: 21-01-2010
Publisher: Wiley
Date: 15-02-2011
DOI: 10.1111/J.1365-2702.2010.03392.X
Abstract: Aim. The aim of this paper is to offer an alternative knowing‐how knowing‐that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. Background. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. Design. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. Method. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing‐how knowing‐that framework which commonly used to classify the knowledge necessary for advanced nursing practice. Conclusion. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. Relevance to clinical practice. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing‐how knowing‐that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner’s work on expert practice. Therefore, if this is included into the knowing‐how knowing‐that framework, the knowing‐how becomes the knowledge that contributes to advancing and advanced practice and the knowing‐that becomes the governing action based on a deeper understanding of the problem or issue.
Publisher: Wiley
Date: 08-12-2014
DOI: 10.1111/NICC.12145
Abstract: The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative's experiences of supporting and being supported in the ICU. Understanding the relatives' experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Two emergent themes were identified from the reflective story - fear of the technological environment and feeling hopeless and helpless. The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate.
Publisher: Wiley
Date: 21-01-2010
Publisher: Hindawi Limited
Date: 02-01-2021
DOI: 10.1111/NUF.12545
Publisher: Hindawi Limited
Date: 03-05-2021
DOI: 10.1111/NUF.12588
Publisher: Wiley
Date: 21-01-2010
Publisher: JMIR Publications Inc.
Date: 06-03-2023
DOI: 10.2196/39989
Abstract: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students’ competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students’ learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P .05 was used to test for statistical significance using SPSS (version 28 IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15 95% CI 16.3%-67.7% P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90% P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger s le size and robust study design are required to evaluate the effects of IVR teaching. International prospective register of systematic reviews (PROSPERO) CRD42022313706 www.crd.york.ac.uk rospero/display_record.php?RecordID=313706
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEPR.2018.04.014
Abstract: Male-female communication within nursing is often fraught with difficulties especially for male nurses as the try and assimilate themselves into a female dominated profession. It is clear that men and women possess different communication styles. Men tend to be forthright and to the point. Women on the other hand often view the world as a network of connections, as a negotiation for closeness and support and therefore centred on maintaining solidarity. The aim of this study was to explore the lived-experience of a group of male nursing students using Colaizzi's seven step data analysis within the phenomenological empirical framework. The central theme "Men are from Mars" identified two subthemes which included: calling a spade a spade in world of shovels and conscientious objector from the margins. Communication for the men in this study was difficult. The participants were sensitive of what and how they communicated could be misinterpreted which often left them feeling isolated. They were often perplexed how the female students spoke to and about each. The men on the other hand were open and honest in the way they communicated with each other there was not misinterpretation the men knew exactly where they stood with each other.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4414565
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.ICCN.2014.02.003
Abstract: The aim of this survey was to assess registered nurse's perceptions of alarm setting and management in an Australian Regional Critical Care Unit. The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. A total population s le of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms. This study contributes to what is known about alarm fatigue, setting and management within a critical care environment. In addition it gives an insight as to what nurses' within a regional context consider the key factors which contribute to alarm fatigue. Clearly nursing burnout and potential patient harm are important considerations for practice especially when confronted with alarm fatigue and desensitisation. Therefore, promoting and maintaining an environment of ongoing intra-professional communication and alarm surveillance are crucial in alleviating these potential problems.
Publisher: Wiley
Date: 29-06-2007
DOI: 10.1111/J.1478-5153.2007.00229.X
Abstract: The aim of this small-scale study was to measure, analyse and compare levels of acoustic noise, in a nine-bedded general intensive care unit (ICU). Measurements were undertaken using the Norsonic 116 sound level meter recording noise levels in the internationally agreed 'A' weighted scale. Noise level data were obtained and recorded at 5 min over 3 consecutive days. Results of noise level analysis indicated that mean noise levels within this clinical area was 56.42 dB(A), with acute spikes reaching 80 dB(A). The quietest noise level attained was that of 50 dB(A) during sporadic intervals throughout the 24-h period. Parametric testing using analysis of variance found a positive relationship (p <or= 0.001) between the nursing shifts and the day of the week. However, Scheffe multiple range testing showed significant differences between the morning shift, and the afternoon and night shifts combined (p or= 0.05). While the results of this study may seem self-evident in many respects, what it has highlighted is that the problem of excessive noise exposure within the ICU continues to go unabated. More concerning is that the prolonged effects of excessive noise exposure on patients and staff alike can have deleterious effect on the health and well-being of these in iduals.
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: Hong Kong
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Martin Christensen.