ORCID Profile
0000-0002-0466-1960
Current Organisations
Vrije Universiteit Brussel
,
Southbank University
,
Griffith University
,
Southern Cross University
,
Edith Cowan University
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Publisher: Wiley
Date: 17-06-2019
DOI: 10.1111/JOCN.14933
Publisher: Wiley
Date: 12-08-2018
DOI: 10.1111/JAN.13783
Abstract: To describe contemporary routine practice regarding rapid pre-loading of intravenous fluid management prior to epidural analgesia during labour and birth. Midwives are the key health professionals providing care for women before, during and after an epidural in labour. Part of this management involves maternal hydration however, how midwives assess and manage maternal hydration and fluid management is not well understood. Prior to the administration of a low dose epidural for pain relief a rapid intravenous pre-loading of between 500-1000 mls of crystalloid fluids is administered to the pregnant women. Currently, there is limited evidence available to assess if intravenous pre-loading reduces maternal hypotension and foetal bradycardia. Anecdotal evidence suggests that wide variation in clinical practice in relation to volume of fluid administered, fluid status assessment and clinical documentation occurs. A retrospective medical health record review, in a regional Australian maternity hospital. A retrospective medical health record review chart review from women who received an epidural for pain relief during labour and birth (June-September 2015). Data from 293 charts were collected, including: maternal factors blood pressure distributions maternal fluid status types, concentration and timing of analgesia loading doses IV fluid loading volumes maternal hypotension, foetal outcomes and documentation of fluid balance charts. Wide variation in clinical practice was evident with midwives administering pre-loading fluid volumes ranging from 250-1000 ml. Midwifery assessment, documentation and practice pertaining to hydration was inconsistent and lacking. Management of intravenous fluids during labour is fragmented. Although fluid balance charts are used internationally to assess maternal hydration, documentation of fluid balance status was poor. Multi-professional collaboration between obstetrics, anaesthetics and midwifery is required to address this wide variation and reach consensus on best practice based on what evidence is currently available.
Publisher: Mark Allen Group
Date: 02-2011
Publisher: Elsevier BV
Date: 10-2019
Publisher: Informa UK Limited
Date: 04-2021
Publisher: BMJ
Date: 11-02-2020
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.NEDT.2018.05.009
Abstract: Critical care nurses have been involved in Rapid Response Teams since their inception, particularly in medically led RRTs, known as Medical Emergency Teams. It is assumed that critical care skills are required to escalate care for the deteriorating ward patient. However, evidence to support critical care nurses' involvement in METs is anecdotal. Currently, little is known about the educational requirements for nurses involved in RRT or METs. We aimed to identify and describe what nurses involved in a MET consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient. An exploratory descriptive design was used and data was collected at a session of the Australian and New Zealand Intensive Care Society Rapid Response Team (ANZICS-RRT) Conference held at The Gold Coast, Australia in July 2015. All conference delegates were eligible to take part. Conference delegates totalled 293 194 nurses, 89 doctors and 10 allied health professionals. Data collection took place in three phases, over a 90-minute period. First, demographic data were collected from all participants at the start of data collection. These data were collected using paper-based surveys. Second, extended response surveys that is, paper-based surveys that asked open-ended questions to elicit free text responses, were used to collect participants' in idual responses to the question: "What are the specific theoretical knowledge, skills and behavioural attributes required in a curricula to prepare nurses to be high functioning members of a MET?" Demographic, educational and work characteristics were descriptively analysed using SPSS (version 22). Participants perceptions of what knowledge, skills and attributes are required for nurses to recognise and respond to clinical deterioration were thematically analysed. Participants were predominantly female (88.3%, n = 91) with 54.4% (n = 56) holding a Bachelor of Nursing. Participants had a median of 20 years (IQR 16) experience as RNs, and a median of 14 years (IQR 13) experience in critical care. Participants formed part of METs frequently, with nearly half the cohort seeing clinically deteriorating patients more than once per day (37.9%, n = 33) or daily (10%, n = 9). Thematic analysis of survey responses revealed four main themes desired in Rapid Response Team Curricula: Clinical Deterioration Theory, Clinical Deterioration Skills, Rapid Response System Governance, and Professionalism and Teamwork. We suggest that a curriculum that educates nurses on the specific requirements of assessing, managing and evaluating all aspects of clinical deterioration is now required.
Publisher: Informa UK Limited
Date: 16-12-2021
Publisher: Mark Allen Group
Date: 02-2011
Publisher: Informa UK Limited
Date: 25-09-2022
DOI: 10.1080/13561820.2022.2104231
Abstract: Recognition and escalation of the deteriorating patient is multifaceted and relevant to all clinicians involved. However, little evidence exists exploring how clinicians from different professions make decisions about early signs of clinical deterioration and how this affects their actions. The aim of this study was to explore interprofessional clinicians' and students' experiences of responding to and escalating care of deteriorating patients. A convenience s le of clinicians and students from acute hospital settings in regional Australia participated in focus groups. Participants were able to identify barriers, facilitators, and strategies for improvement during the recognition and escalation of the deteriorating patient. Four themes were detected throughout the 38 focus group discussions: a Standardized Approach, Workplace Culture and Teamwork, Confidence and Experience, and Communication. Although standardization of systems and processes supported clinician's recognition and escalation of the deteriorating patient, use and misuse of the systems by some participants were identified as barriers to seeking assistance. Positive workplace culture and teamwork were important to promoting the escalation of care. Participants identified that experience in recognizing and responding to deteriorating patients increased their confidence.
Publisher: Elsevier BV
Date: 08-2010
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.AUEC.2018.08.001
Abstract: Lack of awareness about cultural and religious values and beliefs of patients presenting to Emergency Departments (ED) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade. The changing face of the Australian population requires that Australian health care carefully consider the dominant Western cultural paradigm currently influencing health care delivery. This predominance is particularly critical in the ED, as it is a common gateway into health care services. This scoping review explores the evidence of key components and impacts of culturally safe care (CSC) in the ED for staff and care consumers who identify as Muslim. A systematic search using electronic (five databases) and heading searching methods for primary research was undertaken followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, and the subsequent content was grouped, synthesized and tested for clinical salience using the six stages of the Arksey and O'Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature. Three studies were included in the analysis. Religious beliefs and practices are common among the in iduals who identify as Muslim. Such beliefs and practices could influence patients' understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. These ideals could also impact on a patient's care seeking behaviors and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in the ED locally and internationally. While many EDs may have procedure documents or staff care guidelines, it is unclear as to how these guides were derived, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers.
Publisher: Informa UK Limited
Date: 08-04-2023
Publisher: Wiley
Date: 18-05-2022
DOI: 10.1111/BIRT.12647
Abstract: Umbilical cord cl timing has implications for newborn health, which include increased iron stores up to 6 months of age. National and International cord cl ing guidelines differ as do health professionals' practices. The rationale for differences in cord cl ing practice is unclear. Studies on the knowledge, attitudes, and practices of maternity health care professionals about cord cl timing were synthesized. Similarities and differences between professional groups and understanding of the optimal timing of cord cl timing for term newborns were compared. An integrative review was undertaken. PubMed, Scopus, MIDIRS, CINAHL, and Google Scholar were searched. Publication date limits were set between January 2007 and December 2020. Quality appraisal was undertaken using the Critical Appraisal Skills Program (CASP) tools. Eighteen studies met inclusion criteria, as they included primary research studies that investigated maternity health care professionals' knowledge, attitudes, and practices about umbilical cord cl ing, and were written in English. Four main subject areas were identified: a) knowledge of optimal cord cl timing b) attitudes and perceptions of early vs deferred cord cl ing c) cord cl ing practice and d) rationale for cord cl ing practice. Different attitudes and practices were identified between midwifery and medical professionals in relation to cord cl timing together with health professional knowledge and practice gaps pertaining to optimal cord cl timing. Contemporary evidence should inform guidelines for clinical practice and be embedded into maternity health professional curricula and professional development programs.
Publisher: Mark Allen Group
Date: 03-2006
DOI: 10.12968/BJCA.2006.1.3.20741
Abstract: Over the last 15 years numerous political drivers have paved the way for the development of new and innovative models of practice in cardiac care. these were discussed in the first article of this two-part series. Part one introduced and described the elements of inspection, palpation and percussion in relation to per forming cardiac assessment. this paper offers practitioners an opportunity to develop and augment their knowledge of cardiac auscultation. It suggests and introduces a systematic model that may be used in clinical practice.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.AUCC.2018.08.001
Abstract: Position statements are used by large organisations such as the Australian College of Critical Care Nurses to publically present an official philosophy or beliefs and to propose recommendations. Position statements are increasingly used by health departments and healthcare facilities to allocate resources and to guide and audit nursing practice, yet there are limited resources on the process of their development. A position statement should help readers better understand the issue, communicate solutions to problems, and inform decision-making. It should be supported by the highest level of evidence available and reflect the organisation's governing objectives and goals. In this article, we describe the structured approach used to develop a position statement for Australian critical care nurse education. The formation of an expert advisory panel, synthesis of available evidence using Whittemore and Knafl's integrative review methodology, use of Donabedian's structure-process-outcomes quality framework as a theoretical approach, and multiple layers of consensus building and consultation enabled the development of an important critical care document and informed an implementation plan. The framework and processes we have outlined in this discussion article may provide a useful starting point for other professional organisations wishing to develop similar position statements.
Publisher: Elsevier BV
Date: 09-2019
Publisher: Elsevier BV
Date: 03-2003
Publisher: Wiley
Date: 12-2023
DOI: 10.1111/JAN.15478
Abstract: The study aimed to measure and describe the mental health impact of COVID‐19 on Australian pre‐registration nursing students. The COVID ‐19 pandemic has had a swift and significant impact on nursing students across the globe. The pandemic was the catalyst for the closure of schools and universities across many countries. This necessary measure caused additional stressors for many students, including nursing students, leading to uncertainty and anxiety. There is limited evidence available to identify the mental health impact of COVID‐19 on Australian pre‐registration nursing students currently. A cross‐sectional study was conducted across 12 Australian universities. Using an anonymous, online survey students provided demographic data and self‐reported their stress, anxiety, resilience, coping strategies, mental health and exposure to COVID‐19. Students' stress, anxiety, resilience, coping strategies and mental health were assessed using the Impact of Event Scale‐Revised, the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Brief Cope and the DASS‐21. Descriptive and regression analyses were conducted to investigate whether stress, anxiety, resilience and coping strategies explained variance in mental health impact. Ethical Approval was obtained from the University of New England Human Research Ethics Committee (No: HE20‐188). All participating universities obtained reciprocal approval. Of the 516 students who completed the survey over half ( n = 300, 58.1%) reported mental health concerns and most students ( n = 469, 90.9%) reported being impacted by COVID‐19. Close to half of students ( n = 255, 49.4%) reported signs of post‐traumatic stress disorder. Mental health impact was influenced by students' year level and history of mental health issues, where a history of mental health and a higher year level were both associated with greater mental health impacts. Students experienced considerable disruption to their learning due to COVID‐19 restrictions which exacerbated students' distress and anxiety. Students coped with COVID‐19 through focusing on their problems and using strategies to regulate their emotions and adapt to stressors. The COVID‐19 pandemic has considerably impacted pre‐registration nursing students' mental health. Strategies to support nursing students manage their mental health are vital to assist them through the ongoing pandemic and safeguard the recruitment and retention of the future nursing workforce. This study adds an Australian understanding to the international evidence that indicates student nurses experienced a range of negative psychosocial outcomes during COVID‐19. In this study, we found that students with a pre‐existing mental health issue and final‐year students were most affected. The changes to education in Australian universities related to COVID‐19 has caused distress for many nursing students. Australian nursing academics/educators and health service staff need to take heed of these results as these students prepare for entry into the nursing workforce. The study was designed to explore the impact of COVID‐19 on the mental health of undergraduate nursing students in Australia. Educators from several universities were involved in the design and conduct of the study. However, the study did not include input from the public or the intended participants.
Publisher: Springer Science and Business Media LLC
Date: 10-10-2018
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.AUCC.2013.11.001
Abstract: Medical Emergency Teams (METs) have been developed and implemented with the aim of improving recognition of and response to deteriorating patients. Yet, METs are often not activated or used effectively by nursing staff. The reasons for this are not fully understood. The aim of this study was to explore nurses' experiences and perceptions of using and activating a MET, in order to understand the facilitators and barriers to nurse's use of the MET. An interpretive qualitative approach was adopted to explore nurses' experiences and perceptions of using and activating the MET. This study was set in a large public teaching hospital in Southeast Queensland, Australia. Fifteen registered ward nurses who had cared for patients who had deteriorated on the ward, and as a result of this deterioration were admitted to the Intensive Care Unit (ICU) as an unplanned admission, were interviewed about their experiences and perceptions of using a MET. In-depth, semi-structured interviews were conducted with ward nurses who had cared for a patient who had deteriorated. Interviews were recorded and transcribed verbatim. The interviews were analysed thematically. Four themes relating to the participants' experiences and perceptions of using a MET emerged from the data. These themes were: (1) sensing clinical deterioration (2) resisting and hesitating (3) pushing the button and (4) support and leadership. This work identifies why nurses do not activate METs appropriately. This delay in MET activation potentially exposes the deteriorating patient to suboptimal care and increases the risk of adverse events.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.NEPR.2019.102689
Abstract: Ongoing advancement and documentation of professional development is required to maintain nursing registration and competency to practise in Australia and many other countries. All Australian registered nurses are required to undertake a minimum of 20 h of continuing professional development annually and demonstrate competence to practice this is a criterion for nursing registration. Many health care organisations nationally and internationally develop programs to support such processes, assisting nurses to formally document their ongoing education and commitment to best practice, and clearly demonstrate their ongoing continuing professional development. Such programs align with the MAGNET ® principles of providing structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. This study describes the implementation, evaluation and impact of the registered nurse professional recognition program undertaken by one Hospital and Health Service in South East Queensland using Donabedian's structure, process outcome framework. The registered nurse professional recognition program was implemented to invest in and develop the nursing workforce by providing an opportunity for registered nurses to assess and document their professional skills, knowledge and expertise that are critical to the provision of safe and cost-effective patient and family-centred care.
Publisher: Wiley
Date: 23-02-2006
DOI: 10.1111/J.1362-1017.2006.00158.X
Abstract: Over the last 10 years, numerous political drivers have paved the way for the development of new and innovative models of practice within the critical care environment. Many of these new models of practice required practitioners to perform detailed and comprehensive patient assessment. Within critical care, respiratory assessment is increasingly regarded as an essential element of a critical care practitioner's profile. However, the assessment of other body systems has been adopted more slowly. This article argues that skin and nail assessment should be ascribed a high priority within practitioners' scope of practice. The skin is the largest organ in the body. A wide range of diseases covering numerous pathologies and specialities manifest in changes in the skin and nails. There has been increasing realization and recognition that there is a connection between the skin and systemic disease. The skin and nails can therefore give valuable diagnostic clues to underlying disease. This article offers practitioners an opportunity to develop and augment their knowledge and understanding of skin and nail assessment and its application to the critically ill patient.
Publisher: Wiley
Date: 19-05-2020
DOI: 10.1111/INM.12737
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.AUCC.2008.05.051
Abstract: As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. Patients who are inpatients have more complex problems and a greater number of co-morbidities and are therefore more likely to suffer physiological deterioration. Procedures requiring inpatient stays are often more complex and associated with higher rates of mortality and morbidity. As patient acuity has increased research has highlighted that the care of the acutely ill ward patient is suboptimal. Suboptimal care implies a lack of knowledge regarding the significance of clinical findings relating to dysfunction of airway, breathing and circulation. This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. (1998) in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.
Publisher: Wiley
Date: 08-08-2022
DOI: 10.1002/JHM.12939
Publisher: Wiley
Date: 11-10-2021
DOI: 10.1111/INM.12938
Abstract: Globally, the impact of COVID‐19 on healthcare workers' mental health has been a major focus of recent research. However, Australian research involving nurses, particularly across the acute care sector, is limited. This cross‐sectional research aimed to explore the impact of pandemic‐related stress on psychological adjustment outcomes and potential protective factors for nurses ( n = 767) working in the Australian acute care sector during the COVID‐19 pandemic. Nurses completed an online questionnaire with psychometrically validated measures of pandemic‐related stress, psychological adjustment outcomes (depression, anxiety, and subjective well‐being), and protective factors (posttraumatic growth and self‐compassion). Descriptive analyses revealed that pandemic‐related stress was reported by 17.7% of the participants. Psychological adjustment outcome scores above normal for depression (27.5%) and anxiety (22.0%) were found, and 36.4% of the participants reported poor subjective well‐being. Regression analyses suggest that pandemic‐related stress predicted greater depression ( B = 0.32, SE = 0.02, 95% confidence interval [0.28, 0.35]) and anxiety ( B = 0.26, SE = 0.01, 95% confidence interval [0.24, 0.29]) and less subjective well‐being ( B = −0.14, SE = 0.01, 95% confidence interval [−0.16, −0.12]). Self‐compassion weakened the relationship between pandemic‐related stress and greater depression, however, exacerbated the relationship between pandemic‐related stress and less subjective well‐being. Posttraumatic growth reduced the negative relationship between pandemic‐related stress and psychological adjustment outcomes. These findings will inform strategies to facilitate psychological resources that support nurses' psychological adjustment, enabling better pandemic preparedness at both an in idual and organizational level.
Publisher: Informa UK Limited
Date: 20-06-2022
DOI: 10.1080/01612840.2022.2087011
Abstract: Many people diagnosed with or presenting with borderline personality disorder (BPD) attend the emergency department (ED) when in crisis, and are often referred to mental health nurses for further assessment, and to arrange appropriate follow-up (MHNs). Little is known about the knowledge, skills, confidence and competence of MHNs working with this group in these specialist roles. This study sought to describe the attitudes of MHNs working in EDs and crisis services towards people who present with symptoms characteristic of BPD and to explore their knowledge of the diagnostic criteria of BPD. A descriptive survey tool comprised of 23 questions was adapted from a previously used survey with clinicians in a mental health service in Australia. Fifty-four nurses who identified as MHNs and were currently employed in EDs or crisis settings completed the survey online. These MHNs were found to hold positive attitudes towards people with BPD including being optimistic about recovery and treatment. The experience and education of MHNs now employed in EDs may have contributed to positive attitudes and self-reported confidence relative to other nurses. Further research ought to focus on how MHNs assist people with a diagnosis of BPD who present in crisis meet immediate needs and facilitate access to effective ongoing care and treatment.
Publisher: Informa UK Limited
Date: 03-07-2020
Publisher: Wiley
Date: 25-07-2022
DOI: 10.1111/JOCN.16469
Abstract: The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing. Concept analysis. Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist . This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion. The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.NEDT.2022.105451
Abstract: Investigate the use of mobile technology to support Work Integrated Learning in undergraduate nursing programs. Integrative review with narrative synthesis. Electronic databases searched in February 2021 included CINAHL, ERIC, MEDLINE and APA PsychInfo. The methodological framework described by Whittemore and Knafl (2005) guided this integrative review. A total of five (5) studies published between 2017 and 2020 were analysed and synthesised. Data was categorised into two themes: 1) Accessibility of Learning Resources, and 2) Effective and Timely Communication. Convenient and easy access to Learning Resources at the point of care improved students' confidence and competence to perform clinical skills, thereby reducing student's anxiety and increasing satisfaction rates. The accessibility to educational and skills-based resources also promoted patient safety at the point of care. Effective and Timely Communication improved engagement and collaboration between students, clinical facilitators and academics, enabling a more supportive environment that improved student autonomy and motivation for self-directed learning. The Effective and Timely Communication of student progression and assessment strategies was found to improve student engagement and motivation to be independent learners. This review contributes important knowledge because internationally there is a need to increase knowledge and understanding of how to best support Work Integrated Learning experiences of student nurses. Mobile technology has been recognised as an innovative tool in education, further research investigating its use to support Work Integrated Learning in undergraduate nursing programs is required.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.IJOTN.2016.12.001
Abstract: Hip fractures are a major global health care issue, with the 1.26 million estimated cases in 1990 predicted to increase to 4.5 million by 2050. Varying models of care have been developed to improve outcomes following fragility hip fractures. Most of these care models embrace an interprofessional approach to care. Specialist orthopedic nurses play an important role in the management of fragility hip fracture patients and their contribution to the interprofessional health care team is an important predictor of patient outcomes. The Sunshine Coast Hospital and Health Service (SCHHS) is compromised of four hospitals in South East Queensland, Australia however only one large regional hospital provides specialist hip fracture services. Approximately, 350 older hip fracture patients present to the Sunshine Coast Hospital & Health Service (SCHHS) each year. We used Hospital Health round table (HHRT) data to identify and assess key performance care and management of hip fracture patient and outcomes at SCHHS. The HHRT is a nonprofit membership organisation of health services across Australia and New Zealand that aims to provide opportunity for Health Services to achieve best practice, collect analyse and publish information, identify ways to improve and promote collaboration and networking. Exemplars of best practice are also identified in the data so that organizations can adopt similar models of care. HHRT data identified underperformance in management of hip fracture patients in a number of quality indicators at the study site, including length of stay (LOS), time to surgery and relative stay index (RSI). Following review of HHRT data key stakeholders undertook a quality improvement project and formed the Hip Fracture Clinical Network Group (HFCNG). This was established in 2013 with the aim of improving outcomes and achieving key performance indicators for all elderly patients who sustain a hip fracture through active collaboration and regular communication between a broad group of key clinical stakeholders. Following the implementation of the initiative the Relative Stay Index reduced from 88% in 2012/13 to 78% in 2014/15, and the average LOS reduced from 10.4 days to 8.6 days. The percentage of patients receiving surgery within 2 days rose from 85% to 96% demonstrating consistent outperformance of the time to surgery key performance indicator of 80%. The percentage of patients discharged to their place of usual residence increased from 45% to 54%. The rate of complications reduced slightly from 69% to 66%. Rates of hospital acquired anaemia reduced from 20.7% to 15%. Detection of delirium rose over the reporting period from 22% to 34%, enabling rapid management. We noted during this period that there was no corresponding increase in readmission rates for this group of patients. These data reflect improvement to clinical documentation and the appropriate identification of cognitive changes. In this quality improvement report, we describe how key stakeholders were engaged to improve communication and collaboration, and how the use of a national benchmarking dataset enabled health care providers to identify care gaps and inconsistencies in clinical practice. This quality improvement project markedly improved collaboration, clinical practice and patient outcomes.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.AUCC.2018.09.007
Abstract: The objective of this study was to review and synthesise international literature to reveal the contemporary structures, processes, and outcomes of critical care nurse (CCN) education. An integrative review on specialist critical care education was guided by Whittemore and Knafl's integrative review steps: problem identification literature search and data evaluation, analysis, and presentation. Donabedian's Quality Framework (Structure-Process-Outcome) provided a useful analytical lens and structure for the reporting of findings. (1) Structures for CCN education incorporated transition-to-practice and ongoing education programs typically offered by hospitals and health services and university-level graduate certificate, diploma, and masters programs. Structural expectations included a standard core curriculum, clinically credible academic staff, and courses compliant with a higher education framework. Published workforce standards and policies were important structures for the practice learning environment. (2) Processes included incremental exposure to increasing patient acuity consistent and appropriately supported and competent hospital-based preceptors/assessors courses delivered with a flexible, modular approach curricula that support nontechnical skills and patient- and family-centred care stakeholder engagement between the education provider and the clinical setting to guide course planning, evaluation and revalidation and evidence-based measurement of clinical capabilities/competence. (3) Outcomes included articulation of the scope and levels of graduate attributes and professional activities associated with each level. The role of higher degree research programs for knowledge creation and critical care academic leadership was noted. Provision of high-quality critical care education is multifaceted and complex. These findings provide information for healthcare organisations and education providers. This may enable best practice structures and processes for critical care specialist training that meets the needs of industry and safely supports developing CCN expertise. There is an acknowledged tension between the expectations of governing bodies for policies, standards, and position statements to enhance quality and reduce care variance and the availability of high-quality evidence to underpin these across international contexts.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 07-2004
Publisher: Conscientia Beam
Date: 2017
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.IJOTN.2015.03.001
Abstract: The management of fragility hip fractures requires a collaborative multi-disciplinary approach to care to ensure optimal patient outcomes. It is important to rigorously evaluate the model of care and enable the delivery of evidence based optimal patient care. The aim of this study was to document an orthogeriatric model of care (OGMOC) at a major tertiary hospital: assessing how particular indicators within the patient's admission were influenced by the OGMOC. A retrospective case analysis of all patients with fragility hip fracture from two pre-intervention groups and three post-intervention groups was undertaken. Data from (i) length of stay in the emergency department (ii) length of stay in the orthopaedic unit (iii) time from admission to surgery and (iv) time from surgery to admission to rehabilitation were used. Implementation of the OGMOC resulted in: reduced time in the emergency department, quicker access to surgery, reduced length of acute hospital stay and an increase in the number of patients accessing the rehabilitation unit. This study contributes to the increasing body of evidence for best practice in the management of fragility hip fracture within an OGMOC.
Publisher: Elsevier BV
Date: 05-2007
Publisher: Wiley
Date: 26-04-2017
DOI: 10.1002/NOP2.53
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.ICCN.2014.11.005
Abstract: To identify the relationship between one ex le of a rapid response system (RRS), specifically, an after-hours Clinical Team Co-Ordinator (CTC), and the incidence of Medical Emergency Team (MET) activations and, adverse and major adverse events in medical patients. A retrospective chart audit of patients' medical records was undertaken. The intervention group consisted of 150 randomly selected medical patients admitted during three months after the introduction of the CTC after-hours service. The control group consisted of 150 randomly selected medical patients admitted before the introduction of the after-hours CTC service. Multiple logistic regression was used to determine which of the potential predictors, along with the after-hours CTC service, were associated with adverse and major adverse events. A total of 130 patients (n=63, 42% control n=67, 45% intervention) exhibited physiological abnormalities that should have activated the MET yet it was only activated five times. In total there were 69 adverse events (n=32, 21% control n=36, 25% intervention) and 25 major adverse events (n=7, 5% control n=18, 12% intervention). There were more adverse and major adverse events identified after the introduction of the CTC after-hours service. Changes in heart rate and reduction in Glasgow Coma Scores (GCS) were significant predictors of an adverse event. A low urine output and a drop of two or more in the GCS were significant predictors of a major adverse event. The introduction of an after-hours CTC service in a specific clinical site was associated with an increase in the identification of adverse and major adverse events in medical patients. Further exploration of nurse-led rapid response systems should be undertaken in different clinical settings.
Publisher: Mark Allen Group
Date: 11-2010
DOI: 10.12968/BJCA.2010.5.11.79634
Abstract: Debbie Massey and Tara Meredithdescribe a practical, step-by-step approach for respiratory assessment, and outline why it is key that cardiovascular nurses are able to spot problems
Publisher: Elsevier BV
Date: 09-2018
Publisher: Informa UK Limited
Date: 02-01-2023
Publisher: Bond University
Date: 28-10-2021
DOI: 10.53300/001C.29569
Abstract: Interprofessional Education (IPE) is increasingly acknowledged as crucial for promoting and improving quality and safety in healthcare, building a collaborative, practice- ready workforce, and improving health outcomes. In the critical care environment, a Consensus Statement outlining best practice for IPE has been lacking. This absence of a best practice standard has h ered development, implementation, and evaluation of IPE activities in critical care. The Australia New Zealand Clinician Educator Network developed a Consensus Statement through a collaborative, multidisciplinary working group who met in person and online for the purposes of outlining the best practices underpinning IPE in critical care. These recommendations were developed for consideration by clinician educators in the critical care setting when planning, implementing, and evaluating IPE activities. This consensus statement recommends specific structural and processual requirements and evaluates outcomes using the domains of culture, education, quality and safety, based on current literature. The ultimate consequence of IPE in critical care is to improve patient outcomes and inform clinical education research, policies and procedures within a continuous improvement cycle.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IENJ.2019.01.005
Abstract: Sepsis is a significant and time-sensitive clinical concern for patients who present to Emergency Departments (EDs). Existing guidelines do not define nurses' roles in managing sepsis. This study explored ED nurses' experiences and perceptions around recognising and responding to patients with sepsis, and their awareness of sepsis screening and prognostic tools. The knowledge and insights gained from this study may be used to inform local and international ED policies, and enrich nursing educational packages that may be used to improve quality of patient care and patient outcomes. Qualitative design incorporating semi-structured interviews with 14 ED nurses was undertaken. Thematic and consensus-based content analyses were used to explore transcripts. Six key themes were identified (1) contribution of the organisation, (2) appreciation of knowledge, (3) appreciation of clinical urgency, (4) appreciation of importance of staff supervision, (5) awareness of the importance of staff experience, and (6) awareness of the need to seek advice. ED nurses' identified deficits in their capacity to recognise and respond to patients with sepsis, despite their vital role within the multidisciplinary team that cares for patients with sepsis. The knowledge and insights gained from this study can be used to inform ED policies, to enrich context-specific educational packages that aim to improve quality of patient care and outcomes and identify areas for further research. Development and implementation of a nurse-inclusive sepsis pathway may address many deficits identified in this study.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.AUCC.2022.01.008
Abstract: For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is erse and lacking a single approach to practice.
Publisher: Wiley
Date: 06-01-2022
DOI: 10.1111/JAN.15147
Abstract: Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. Systematic mixed studies review. Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from in idual, professional and organizational perspectives. The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 12-06-2021
DOI: 10.1111/JAN.14933
Abstract: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision‐making during insertion and perceptions of women. This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non‐participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18‐gauge catheter was considered more painful than a 16‐gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18‐gauge catheters mostly in hand or wrist (66%). Decision‐making about site, catheter gauge, dressing and attempts varied. Thirty‐four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non‐dominant arm as key reasons for the location of PIVC. Regular use of a large‐gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 22-07-2022
DOI: 10.1111/BIRT.12665
Abstract: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. Using a cross‐sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive s le of Australian midwives ( n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25‐question Likert scale survey and one open‐ended question. Qualitative answers were analyzed using consensus coding. Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision‐making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.
Publisher: Elsevier BV
Date: 09-2019
Publisher: Mark Allen Group
Date: 2006
DOI: 10.12968/BJCA.2006.1.1.20377
Abstract: Over the last fifteen years numerous political drivers have paved the way for the development of new and innovative models of practice within cardiac care. Many of these require practitioners to perform detailed and comprehensive patient assessments. Within nursing, respiratory assessment is increasingly regarded as an essential element of the practitioner's profile. However, the assessment of other body systems has been adopted more slowly. This paper argues that cardiac assessment should be routinely incorporated into the practitioner's scope of practice and offers them an opportunity to develop and augment their knowledge and understanding of cardiac assessment. It suggests and introduces a systematic model that may be used in clinical practice.
Publisher: Wiley
Date: 09-06-2021
DOI: 10.1111/JAN.14892
Abstract: To explore the experiences of strategic leads for nurse education as they sought to respond to the COVID‐19 pandemic. We utilised a qualitative interpretative approach to explore education leaders’ experiences of leading during the early months of the pandemic. Nineteen leaders with significant strategic responsibility for nurse education in Australia, Canada, New Zealand, Singapore and the United Kingdom were identified via purposive s ling and agreed to participate. Interviews were held between May and July 2020. Four overarching themes arose from the analysis: (1) Crisis driven adaptability & flexibility (2) Responsive, complex and changing communication (3) Making decisions for student and staff safety (4) Looking to the future stronger partnerships. Internationally, while nursing education leaders faced different problems, they shared a common goal amidst the crisis to remain student‐centred. They demonstrated they were able to face major challenges, respond to large scale logistical problems and make decisions under significant and ongoing pressure. In responding to the pandemic, nurse leaders shared knowledge and offered mutual support. This bodes well for future collaboration. The move to online learning accelerated an existing trend and it seems likely that this will continue. Given the pressures they experienced over an extended period, the sector may wish to consider how it prepares and supports existing and future leaders.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 03-1994
DOI: 10.1016/0964-3397(94)90082-5
Abstract: In the current climate of scarce financial resources health care managers have had to question the financial viability of a 36-hour stay in an ICU for patients undergoing cardiac surgery. The management of this group of patients has had to be reexamined. The solution to this problem appears to lie in the utilisation of a designated recovery area for the management of this group of patients. This paper is an audit of the first 100 cardiac patients who recovered in such a designated recovery unit. The audit examines types of operations performed, average length of time patients required artificial ventilation, blood loss in the first 4h, average length of stay in hospital, and postoperative complications. Possible methods of improving the utilisation of a recovery area in the management of postoperative cardiac patients are discussed. The conclusion is that utilisation of a designated recovery area for the immediate postoperative management of cardiac surgical patients is a financially viable alternative to an intensive care environment. More importantly, high quality service and care is maintained without increasing the utilisation of resources.
Publisher: Elsevier BV
Date: 2023
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.AUEC.2021.03.006
Abstract: Paediatric sepsis remains a leading cause of childhood death. Morbidity is high, with up to one third of children affected developing ongoing, sometimes lifelong sequelae. To address the major burden of sepsis on child health, there is need for a unified approach to care, as outlined in the Australian National Action Plan for sepsis. While the Surviving Sepsis C aign 2020 guidelines provided evidence-based recommendations for sepsis management in hospital, additional emphasis on families, pre-hospital recognition and post-sepsis care incorporating the multidisciplinary team is paramount to achieve quality patient outcomes. The role of families, paramedics and nurses in recognising and managing paediatric sepsis remains an under-represented area in current literature. The aim of this paper is to critically discuss key challenges surrounding the journey of paediatric sepsis, drawing on contemporary literature to highlight key areas pertinent to recognition and management of sepsis in children. Application of a holistic, patient-centred focus will provide an overview of paediatric sepsis, aiming to inform future development for enhanced healthcare delivery and identify critical areas for further research.
Publisher: Wiley
Date: 22-07-2019
DOI: 10.1111/NEP.13626
Abstract: To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data. Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of in idual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.
Publisher: Wiley
Date: 28-10-2010
DOI: 10.1111/J.1365-2702.2010.03394.X
Abstract: Aims. To conduct a literature review that explores the impact of rapid response systems on reducing major adverse events experienced by deteriorating ward patients. Background. Patients located on hospitals wards are frequently older, have multiple co‐morbidities and are often at risk of life‐threatening clinical deterioration. Rapid response systems have been developed and implemented to provide appropriate and timely intervention to these patients. Design. A comprehensive review of the literature. Methods. This review used the rapid response systems framework recently developed by experts in the area. Medline, CINAHL, Embase and Cochrane databases were searched from January 1995–June 2009. Sixteen papers were selected that most clearly reflected the research aim. Each paper was critically appraised and systematically assessed. Major themes and findings were identified for each of the studies. Results. The effectiveness of rapid response systems in reducing major adverse events in deteriorating ward patients remains inconclusive. Six studies demonstrated that the introduction of a rapid response systems positively impacted on patient outcomes, but three studies demonstrated no positive impact on patient outcomes. Nursing staff appear reluctant to use rapid response systems the rationale for this is unclear. However, the continued underuse and inactivation may be one reason why research findings evaluating rapid response systems have been inconclusive. Conclusions. The paper illustrates two important gaps in the literature. First, ‘r ‐up’ systems have not been subjected to formal evaluation. Second, rapid response systems are under‐activated and underused by nursing staff. There is an urgent need to explore the reasons for this and to identify interventions to improve the activation of these systems in an effort to promote safe and effective care to the deteriorating ward patient. Relevance to clinical practice. Rapid response systems are multidimensional models. They are relatively new innovations that have important implications for clinical research and implementation policy. This review contributes to the emerging debate on rapid response systems.
Publisher: Frontiers Media SA
Date: 06-12-2022
DOI: 10.3389/FPSYG.2022.1041675
Abstract: Social prescribing of nature therapy “green social prescribing” facilitates access to local nature-based activities that improve biopsychosocial wellbeing outcomes, are affordable, accessible, and can be adapted to context. These are becoming increasingly popular and gray literature is emerging, however, peer-reviewed scientific evidence is exiguous. This scoping review aimed to identify and critique peer-reviewed evidence for green social prescribing interventions and develop recommendations for research and clinical practice. Included studies were published in peer-reviewed journals in English on/after 1 January 2000. Participants were community-living adults with mental illness Intervention was any green social prescribing program Comparator was not restricted/required Outcomes were any biopsychosocial measures and any/all Study Designs were included. Twelve databases were searched on 15 October 2022 these were Academic Search Premier, APA PsycArticles, APA PsycINFO, CINAHL, Cochrane Library, Google Scholar, JSTOR, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Mixed Methods Appraisal Tool was used to assess quality. Seven publications describing 6 unique studies (5 UK, 1 Australia) were identified including 3 mixed-methods, 2 qualitative, and 1 RCT. Participants included 334 adults (45% female, aged 35–70 years) s le sizes ranged from 9 to 164. All studies showed improvements in biopsychosocial wellbeing, and participants from most studies ( n = 5) reported increased connection to the earth and intention to further access nature. Participant demographics and diagnoses were poorly reported, and intervention activities and assessments varied considerably. However, MMAT scores were good overall suggesting these studies may reliably demonstrate intervention outcomes. We conclude that socially prescribed nature therapy can improve biopsychosocial wellbeing and is a potentially important intervention for mental illness. Recommendations for research and clinical practice are provided.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-02-2023
DOI: 10.34067/KID.0000000000000076
Abstract: Health professionals resisted practice change in environments of low infection where the perception of a need to change is small. Standardizing care of central venous catheters for hemodialysis requires breaking down silos of practice to benefit all patients. Knowledge of and adherence to guidelines, formal change management, and ongoing facilitation are required to implement standardized care. Implementation of a care bundle standardizing insertion, management, and removal practices to reduce infection related to central venous catheters (CVCs) used for hemodialysis was evaluated in a stepped wedge, cluster randomized controlled trial conducted at 37 Australian hospitals providing kidney services, with no reduction in catheter-related blood stream infection detected. This process evaluation explored the barriers, enablers, and unintended consequences of the implementation to explain the trial outcomes. Qualitative process evaluation using pre-post semistructured interviews with 38 (19 nursing and 19 medical) and 44 (25 nursing and 19 medical) Australian health professionals involved in hemodialysis CVC management. Analysis was guided by the process implementation domain of the Consolidated Framework for Implementation Research. Key influences on bundle uptake were that clinicians were open to change that was evidence-based and driven by guidelines and had a desire to improve practice and patient outcomes. However, resistance to change in environments of low infection, working in silos of practice, and a need for in idualized delivery of patient education created barriers to uptake. Unintended effects of increased costs and lack of interoperability of systems for data collection were reported. Because the trial was in progress at the time of qualitative data collection, perceptions of the bundle may have been influenced by the fact that practices of participants were being observed as a part of the trial. This national process evaluation revealed that health professionals who reported experiencing a benefit viewed the bundle positively. Those who already provided most of the recommended care or perceived that their patient population was not included in the research evidence that underpinned the interventions, resisted the implementation of the bundle. Potentially, formal change management processes using facilitation may improve implementation of evidence-based practice. Australian New Zealand Clinical Trials Registry, ACTRN12616000830493.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 02-2023
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.NEPR.2018.05.011
Abstract: Nurses are ideally positioned to recognise and respond to patient deterioration. However, premonitory signs of patient deterioration are often overlooked, not managed, or not communicated in a timely fashion. Education programs aimed at improving nurses' technical and non-technical skills have been developed, however, the outcomes of these educational strategies remain unclear. A quasi-experimental time series design was used in this study to evaluate the impact of a multi-modal education program (DeTER) on acute care nurses' technical and non-technical skill development and recognition and response to patient deterioration. Participants were asked to complete a survey on four occasions: one month prior to commencement of the DeTER program, immediately prior and post workshop attendance and two-three months' post workshop completion. Pre-intervention, data were collected on participants' demographic profile and their responses to the Clinical Emergency Recognition and Response Survey designed by (Buckley and Gordon, 2011). Post intervention these data were collected again and, in addition, respondents were asked to report on their recent experiences of deteriorating patients and report on their confidence in managing these incidents. Sixty staff consented to participate in the study and all completed the surveys at time 2 and 3. In total 32 staff (45%) responded at all time points. Participants included registered nurses (n = 51 85%), and enrolled nurses (n = 9 15%), on average they had worked for 10.4 years (sd = 11.1). Participants rated patient advocacy and assertiveness skills as the most useful aspects of the workshop. Recognition and response to deteriorating patients by ward nurses is a multifaceted process influenced by many factors. Our study supports the importance of multimodal educational strategies in sustaining changes to ward nurses' technical and non-technical skills over time.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 06-10-2023
DOI: 10.1111/BIRT.12773
Publisher: Elsevier BV
Date: 11-2021
Publisher: Informa UK Limited
Date: 05-04-2022
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEDT.2018.08.014
Abstract: The ongoing challenges of managing large student enrolments and increasing demand from students for online learning platforms and teaching strategies has helped drive tertiary implementation of asynchronous online discussion boards (AOD). However, supporting and assessing students in such a forum remains contentious. This explorative, mixed methods study examined and evaluated the usage and perceptions of a unique form of AOD used in a postgraduate nursing course. Student survey and semi-structured interviews with staff (n = 3) were used to explore the structures, processes and outcomes of inclusion of an AOD in this online course. Triangulation of themes emerging from the staff interviews, survey outcomes, and student free text responses enabled appraisal of AOD, focusing primarily on its contribution to course content and assessment. Students' survey responses (approx. 24% of the cohort n = 34) were largely positive. Themes that arose from the qualitative data included i) AOD to build a sense of student community, ii) AOD to encourage interaction with and deliberation of course content, iii) stimuli and challenges around assessing the discussion board, and iv) easy to use IT interface made it a more positive experience. Student responses suggested that scaffolding, feedback and sufficient time allocation were required. Many factors impacted on student interaction with the AOD, including a lack of time due to paid work and other coursework and assessments. Overall, staff and students reported the assessed AOD was a positive course component. It encouraged engagement with staff, other students and the subtleties of complex course content, critical appraisal and discussion of evidence, and application to clinical practice. Exemplars and explicit marking criteria setting out the need for informed contributions were considered crucial by all stakeholders.
Publisher: Wiley
Date: 06-08-2015
DOI: 10.1111/JAN.12743
Abstract: To identify and describe the factors that impact on the performance of scrub nurses' non-technical skills performance during the intra-operative phase of surgery. Non-technical skills have been identified as important precursors to errors in the operating room. However, few studies have investigated factors influencing non-technical skills of scrub nurses. Prospective observational study. Structured observations were performed on a s le of 182 surgical procedures across eight specialities by two trained observers from August 2012-April 2013 at two hospital sites. Participants were purposively selected scrub nurses. Bivariate correlations and a multiple linear regression model were used to identify associations among length of surgery, patients' acuity using the American Society of Anesthesiologists classification system, team familiarity, number of occasions scout nurses leave the operating room, change of scout nurse and the outcome, the non-technical skills performance of scrub nurses. Patient acuity and team familiarity were the strongest predictors of scrub nurses' non-technical skills performance at hospital site A. There were no correlations between the predictors and the performance of scrub nurses at hospital site B. A dedicated surgical team and patient acuity potentially influence the performance of scrub nurses' non-technical skills. Familiarity with team members foster advanced planning, thus minimizing distractions and interruptions that impact on scrub nurses' performance. Development of interventions aimed at improving non-technical skills has the potential to make a substantial difference and enhance patient care.
Publisher: Elsevier BV
Date: 2020
Publisher: Elsevier BV
Date: 03-2017
Publisher: Informa UK Limited
Date: 25-09-2022
Publisher: Wiley
Date: 04-11-2019
DOI: 10.1111/INM.12553
Abstract: Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision-making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer-reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.
Publisher: Mark Allen Group
Date: 12-2004
DOI: 10.12968/PNUR.2004.15.12.17220
Abstract: Bob Sanderson and Debbie Massey present the results of an audit of hypertension management in one general practice
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.ICCN.2009.03.005
Abstract: As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. Patients who are inpatients have more complex problems and a greater number of co-morbidities and are therefore more likely to suffer physiological deterioration. Procedures requiring inpatient stays are often more complex and associated with higher rates of mortality and morbidity. As patient acuity has increased research has highlighted that the care of the acutely ill ward patient is suboptimal. Suboptimal care implies a lack of knowledge regarding the significance of clinical findings relating to dysfunction of airway, breathing and circulation. This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. [McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998 (7148):1853-8] in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus, it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.
Publisher: Informa UK Limited
Date: 04-07-2018
DOI: 10.1080/10376178.2018.1507677
Abstract: Organisational culture is a critical part of a positive and productive working environment and often presents as an area of ongoing development. The MAGNET recognition program awards recognition to organisations that have positive organisational cultures that meet the standards and criteria. However, the broad impact of MAGNET on hospital culture outside of America remains unclear. In this study, we explore the impact of MAGNET designation on organisational culture within the nursing context. An integrative literature review was performed using a systematic search of Medline (Ovid), Embase (Elsevier) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL Ebsco) databases and a combination of subject headings and key words for organizational culture, organizational change and MAGNET hospital, as well as reference chaining was conducted. Using a constant comparative process key categories, themes and subthemes emerged. Twenty-nine key studies were identified and were evaluated utilising two study quality appraisal tools National Health and Medical Research Council (NH&MRC) levels of evidence and the Polit and Beck critical appraisal tool. Three key categories emerged from the data: (1) nurse practice environment (2) structure and process models (3) measurement scales. A key finding was that MAGNET designation appears to enhance organisational culture for nurses and the framework used to introduce MAGNET helps to empower nurses to direct organisational culture in their facility. Conclusion and Implications for Nursing and Health Policy: MAGNET appears to have a positive impact on organisational culture, particularly for nurses. However, lack of standardised evaluation tools used to assess organisational culture associated with MAGNET designation limits comparability of the studies. Generally, the quality of evidence used to develop recommendations was poor to very poor. More, well designed studies undertaken outside of the USA are required. Impact Statement: An in-depth integrative review exploring the impact of MAGNET designation on organisational culture has not been undertaken. In this paper, we have used an integrative review methodology to identify, examine, thematically group and critically evaluate published literature around the impact of MAGNET designation on organisational culture within designated hospitals.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.NEDT.2017.02.024
Abstract: Objective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for 'real world' clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations. To implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course. A set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined. The online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received but did not impact on performance. Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear ex le of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 16-07-2020
DOI: 10.1186/S12884-020-03102-8
Abstract: Parents today have several options for the management of their infant’s cord blood during the third stage of labour. Parents can choose to have their infant’s cord cl ed early or to have deferred cord cl ing. If the cord is cl ed early, cord blood can be collected for private cord blood banking or public cord blood donation for use later if needed. If cord cl ing is deferred, the placental blood physiologically transfuses to the neonate and there are physiological advantages to this. These benefits include a smoother cardiovascular transition and increased haemoglobin levels while not interfering with the practice of collecting cord blood for gases if needed. The aim of this study is to explore Australian maternity health professionals’ perspectives towards cord cl timing, cord blood banking and cord blood donation. Fourteen maternity health professionals (midwives and obstetricians) from both private and public practice settings in Australia participated in semi-structured interviews either in person or by telephone. Interviews were transcribed and data analysed using thematic analysis. Overall there was strong support for deferred cord cl ing, and this was seen as important and routinely discussed with parents as part of antenatal care. However, support did not extend to the options of cord blood banking and donation and to routinely informing parents of these options even when these were available at their birthing location. Formalised education for maternity health professionals is needed about the benefits and implications of cord blood banking and cord blood donation so that they have the confidence to openly discuss all options of cord cl timing, cord blood banking and cord blood donation to facilitate informed decision-making by parents.
Publisher: Wiley
Date: 27-08-2020
DOI: 10.1111/JNU.12591
Publisher: MDPI AG
Date: 04-12-2020
Abstract: Social Prescribing (SP) involves linking in iduals with mental illness to local health and welfare services to improve quality of life (QoL) and biopsychosocial wellbeing. SP programs address psychosocial wellbeing by linking in iduals to group activities. Forest Therapy (FT) is a group nature walk with prescribed activities that promote mindfulness, relaxation, and shared experience. Improvements in psychological and physical wellbeing have been demonstrated in FT, but psychosocial impacts have not been widely investigated. This study will implement an SP FT intervention and assess the impacts on QoL and biopsychosocial wellbeing. Participants will include 140 community-living adults with mental illness at Sydney/Gold Coast, Australia. A stepped-wedge cluster randomised design will be used each participant will complete a 10-week control period followed by a 10-week FT intervention. Weekly 90-min FT sessions will be conducted in groups of 6–10 in local nature reserves. Validated tools will measure self-report QoL and biopsychosocial wellbeing pre- and post-control and intervention periods, and 5-week follow-up. Blood pressure and heart rate will be measured pre- and post-FT sessions. Hypothesised outcomes include improvements in QoL and biopsychosocial wellbeing. This study is the first to assess SP FT, and may provide evidence for a novel, scalable mental illness intervention.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2021
DOI: 10.1186/S12913-021-07128-2
Abstract: Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis C aign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs. This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses’ perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables. In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% ( IQR = 46.7–66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score. Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.
Publisher: Informa UK Limited
Date: 08-04-2023
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Debbie Massey.