ORCID Profile
0000-0002-3747-0087
Current Organisations
University of Melbourne Faculty of Medicine Dentistry and Health Sciences
,
University of Melbourne
,
Monash University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Public Health and Health Services | Public Health And Health Services Not Elsewhere Classified | Preventive Medicine | Nursing | Health And Community Services | Organisational, Interpersonal and Intercultural Communication | Other Language And Culture | Language, Communication and Culture not elsewhere classified | Clinical Nursing: Secondary (Acute Care) | Assessment And Evaluation | Social Change | Medical and Health Sciences not elsewhere classified | Mental Health Nursing | Surgery | Applied Linguistics And Educational Linguistics | Clinical Nursing: Primary (Preventative) | Social Change | Education Assessment and Evaluation | Library and Information Studies | Aged Health Care | Clinical Pharmacy and Pharmacy Practice | Other Language, Communication and Culture | Clinical Pharmacology And Therapeutics | Complementary/Alternative Medicine Not Elsewhere Classified | Sociology | Medical And Health Sciences Not Elsewhere Classified | Quality Management | Linguistics | Applied Linguistics and Educational Linguistics | Family Care | Pharmacology Not Elsewhere Classified | Paediatrics | Health Informatics | Clinical Nursing: Secondary (Acute Care) | Health Promotion | Specialist Studies in Education | Clinical Sciences Not Elsewhere Classified | Public Health and Health Services not elsewhere classified | Race And Ethnic Relations
ANZSRC Socio-Economic Objective (SEO)
Social structure and health | Health education and promotion | Health and support services not elsewhere classified | Communication Across Languages and Culture | The professions and professionalisation | Social Structure and Health | Communication not elsewhere classified | Evaluation of health outcomes | Public health not elsewhere classified | Health status (e.g. indicators of “well-being”) | Child health | Rural health | Child Health | Health Related to Ageing | Health not elsewhere classified | Changing work patterns | Public Health (excl. Specific Population Health) not elsewhere classified | Professions and Professionalisation | Expanding Knowledge in Technology | Mental health |
Related Links
Publications
Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context
Publisher: Wiley
Date: 08-2001
DOI: 10.1046/J.1440-172X.2001.00309.X
Abstract: Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.
A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit*
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
Pain assessment and management in paediatric oncology: a cross-sectional audit
Publisher: Wiley
Date: 18-12-2017
DOI: 10.1111/JOCN.13643
Abstract: To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations. Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality. A single-site cross-sectional audit. A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed. Pain related to medical treatment for cancer was common (n = 146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals (n = 75/146, 51%). Pain was mild (n = 26/75, 35%) and opioids were the mainstay of pain management interventions (n = 63/112, 56%). Adjuvants were an important component of pain management (n = 47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit (n = 38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children (n = 65/76, 87%). Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions. This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care.
Patients' experiences in Australian hospitals: A systematic review of evidence
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16053
Abstract: Objective Patients are uniquely positioned to provide insightful comments about their care. Currently, a lack of comparable patient experience data prevents the emergence of a detailed picture of patients’ experiences in Australian hospitals. The present study addresses this gap by identifying factors reported in primary research as relating to positive and negative experiences of patients in Australian hospitals. Methods Evidence from Australian qualitative studies of patients of all ages reporting their experiences in any hospital or day procedure centre was synthesised. A range of text words, synonyms and subject headings was developed and used to undertake a systematic search of seven electronic databases from January 1995 to July 2015 and the grey literature. Two reviewers independently screened the titles, abstracts or executive summaries and applied the inclusion criteria. Data were synthesised in a meta-narrative. Results Thirty-nine publications were included: 33 articles from database searches and six from the grey literature. Quality improvement researchers produced the dominant narrative and the nursing perspective was strong. Six themes emerged: ‘Reciprocal communication and information sharing’, ‘Interpersonal skills and professionalism’, ‘The care environment’, ‘Emotional support’, ‘Discharge planning and process’ and ‘Correct treatment and physical outcomes’. Conclusion Tangible opportunities to enhance the patient experience are apparent. Small changes to the way that the health system operates and is resourced and the way that health professionals engage with patients could substantially improve care. Ex les include inviting patients and carers to contribute to decision making and discussions about their treatment options and care preferences. What is known about the topic? Patient experience is identified as a key component of an optimal health system, along with improving the health of populations and reducing the per capita costs of care. The use of patient experience data has been associated with improved clinical effectiveness and patient safety. What does this paper add? Patient experience data are currently not routinely captured and difficulties exist as to where this information is available. These data are gathered using a variety of different methods that prohibit the development of a national picture. As a step towards overcoming this barrier, the present study identifies the common elements of healthcare experience reported by patients in Australia as being positive or negative. What are the implications for practitioners? Ensuring that patients and carers are active partners in their care is at the centre of a positive patient experience. Health professionals should provide patients with opportunities to make decisions about their care and ask questions, and to provide clear information before, during and after hospitalisation to enhance patients’ experiences in Australian hospitals.
Medicines Use Evaluation guideline
Publisher: Wiley
Date: 04-2020
DOI: 10.1002/JPPR.1652
Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country
Publisher: MDPI AG
Date: 22-02-2022
DOI: 10.3390/JCM11051149
Abstract: There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care (2) referral system for patients across transitions of care between different health professionals of the diabetes care team (3) tools for the provision of collaborative care and documentation of care (4) diabetes education and counselling by trained diabetes educators and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.
Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers’ and health professionals’ perspectives
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.IJNURSTU.2008.07.002
Abstract: In iduals are adherent to approximately 50% of their prescribed medications, which decreases when multiple, chronic conditions are involved. To examine factors affecting adherence to multiple prescribed medications for consumers with co-existing diabetes and chronic kidney disease (diabetic kidney disease) from the time of prescription to the time they took their medications. A descriptive exploratory design was used incorporating in-depth interviews and focus groups. The diabetes and nephrology departments of two metropolitan, public hospitals in Melbourne, Australia. A convenience s le of 23 consumers with diabetic kidney disease participated in an in-depth interview. Inclusion criteria involved English-speaking in iduals, aged > or =18 years, with co-existing diabetes and chronic kidney disease, and who were mentally competent. Exclusion criteria included impending commencement on dialysis, pregnancy, an aggressive form of cancer, or a mental syndrome that was not stabilised with medication. Sixteen health professionals working in diabetes and nephrology departments in Melbourne, Australia also participated in one of two focus groups. In-depth structured interviews and focus groups were conducted and analysed according to a model of medication adherence. Consumers were not convinced of the need, effectiveness and safety of all of their medications. Alternatively, health professionals focussed on the importance of consumers taking their medications as prescribed and believed that the risk of medication-related adverse effects was over-rated. Accessing prescribed medications and difficulties surrounding continuity of care contributed to consumers' unintentional medication non-adherence. In particular, it was hard for consumers to persist taking their ongoing medication prescriptions. Healthcare system inadequacies were highlighted, which affected relationships between consumers with diabetic kidney disease and health professionals. Acknowledging the barriers as perceived by consumers with diabetic kidney disease can facilitate effective communication and partnerships with health professionals necessary for medication adherence and medication safety.
International Code of Area Nomenclature
Publisher: Wiley
Date: 07-2008
Standard care in diabetic kidney disease: a survey of medical specialists in diabetes and nephrology outpatient clinics
Publisher: Wiley
Date: 25-05-2010
Patient perspectives and experiences of sexual health conversations and cardiovascular disease: A qualitative study
Publisher: Wiley
Date: 30-04-2021
DOI: 10.1111/JOCN.15820
Abstract: This study aimed to explore the experiences of in iduals discussing sexual well‐being with healthcare professions within the context of their cardiac illness to determine their sexual health information needs. Cardiovascular disease is the leading cause of morbidity and mortality worldwide and known to have a detrimental impact on sexual health. Despite sexual health being recognised as a fundamental component of well‐being, it may be a neglected aspect of care within the context of cardiovascular disease. A qualitative exploratory study conducted in accordance with COREQ guidelines. We conducted semi‐structured interviews with participants ( n = 13) aged between 30–77 years who had been diagnosed with a cardiovascular disease. Data were transcribed and subject to thematic analysis. Analysis revealed two major themes—Sexual healthcare information and expectations: I expect them to tell m e and Experiences of sexual adversity: it's really scary . Although participants expected and welcomed information in relation to their illness and sexual health, this was rarely received. Subsequently, when some participants experienced sexual adversity including erectile dysfunction, they felt anxious and distressed which impacted their intimated relationships. It was often when participants sought information associated with adversity that information was provided and this was primarily in relation to medication associated with assisting dysfunction. In iduals who have cardiovascular disease may require sexual health care. Nurses are well placed to provide information and education associated with cardiovascular disease and associated sexual well‐being to promote positive outcomes for in iduals and minimise distress around sexual adversity. Findings highlight the importance of providing clear and accurate information about sexual well‐being and function to patients experiencing cardiovascular disease. Provision of information should be considered an essential and routine aspect of care with patients being afforded opportunities to discuss concerns associated with their sexual well‐being.
Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study: Table 1
Publisher: BMJ
Date: 10-09-2014
DOI: 10.1136/BMJQS-2014-002835
Abstract: The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins. We report on an interventionist video-reflexive ethnographic (VRE) study that explored how clinicians used the built environment to achieve safe communication in an intensive care unit (ICU) in a metropolitan Sydney hospital. We conducted 40 semistructured interviews, 5 weeks of observation and four reflexive focus groups with a total of 87 participants (including medical, nursing, allied health and clerical staff). We found that the accessibility of staff and patients in the open spaces of the ICU was both a safety feature and a safety risk, enabling safe communication flow, but also allowing potentially unsafe interruptions. Staff managed interruptions while allowing for a safe degree of accessibility by creating temporary protected spaces, using physical markers such as curtains, tape and signs as well as behavioural cues, movement and the development of policies restricting activities at certain areas. Furthermore, clinicians were able to use the VRE method to gain insight into their own practices and problems, and to develop meaningful solutions for other problematic spaces. ICU staff enable safe communication in their wards by creating temporary spaces that are both 'connected' and 'protected'. The flexibility of these 'soft' strategies is especially well suited to the fast-paced clinical context of intensive care.
The missing evidence: a systematic review of patients' experiences of adverse events in health care
Publisher: Oxford University Press (OUP)
Date: 29-09-2015
Abstract: Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge gaps and any challenges encountered when capturing patient experience data. Key words, synonyms and subject headings were used to search eight electronic databases from January 2000 to February 2015, in addition to hand-searching of reference lists and relevant journals. Titles and abstracts of publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and collated. Thirty-three publications demonstrated patients identifying a range of problems in their care most commonly identified were medication errors, communication and coordination of care problems. Patients' income, education, health burden and marital status influence likelihood of reporting. Patients report distress after an AE, often exacerbated by receiving inadequate information about the cause. Investigating patients' experiences is h ered by the lack of large representative patient s les, data over sufficient time periods and varying definitions of an AE. Despite the emergence of policy initiatives to enhance patient engagement, few studies report patients' experiences of AEs. This information must be routinely captured and utilized to develop effective, patient-centred and system-wide policies to minimize and manage AEs.
Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention (Preprint)
Publisher: JMIR Publications Inc.
Date: 13-06-2023
Abstract: eople from ethnic minority backgrounds are more at risk of poor care and outcomes in health services, this inequity is widely recognised. We used an adapted, experience-based co-design (EBCD) process to facilitate collaboration between staff and ethnic minority patients to identify key safety issues and devise a tailored solution at a cancer service in New South Wales, Australia. Identifying health service contact points relevant to medication concerns between appointments or hospital admissions was a key issue identified in the workshop. The co-design process resulted in the creation of a communication tool: Making it Meaningful (MiM). This protocol presents a pilot study testing whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. This protocol is particularly significant as co-designed interventions are increasingly valued, but rarely documented in trials. o test whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. single-site, controlled before and after pilot study to determine the feasibility and acceptability of ‘MiM’. Forty patients from Chinese and Russian cultural backgrounds will be recruited 20 treatment and 20 control. These cohorts were selected as the co-design participants identified these communities are at particular risk of medication safety concerns. The intervention group will use the MiM tool during usual appointments ,while the control group will receive routine care. Telephone surveys will be conducted with patients at three time points to assess patient knowledge and self-efficacy in medication management, and the perceived usability and acceptability of the MiM. Qualitative interviews with staff will be conducted at pilot conclusion to explore practitioner perceptions of MiM feasibility and acceptability. sing Evidence Based Codesign (EBCD) we identified communication about medication, particularly between appointments, as a key issue. Increasing consumer engagement in medication management was identified as a strategy to reduce medication safety problems in cancer care the MiM was developed to address this issue. his study involves implementation and evaluation of the feasibility and acceptability of the MiM, together with preliminary data on patient knowledge about prescribed medications and confidence in medication management, with a view to expanding the study to test whether the intervention is effective in improving patient outcomes. his protocol is registered with Australian New Zealand Clinical Trials Registry RN: ACTRN12622001260718p
Older patients' engagement in hospital medication safety behaviours
Publisher: Springer Science and Business Media LLC
Date: 04-05-2021
DOI: 10.1007/S40520-021-01866-3
Abstract: Increasing age is associated with more medication errors in hospitalised patients. Patient engagement is a strategy to reduce medication harm. To measure older patients' preferences for and reported medication safety behaviours, identify the relationship between preferred and reported medication safety behaviours and identify whether perceptions of medication safety behaviours differ between groups of young-old, middle-old and old-old patients (65-74 years, 75-84 years, and ≥ 85 years). A survey, which included the Inpatient Medication Safety Involvement Scale (IMSIS) was administered to 200 older patients from medical settings, at one hospital. Data were analysed using descriptive statistics, Spearman's rho and the Kruskal-Wallis test. Patients reported a desire to ask questions (59.5% n = 119) and check with healthcare professionals if they perceived that a medication was wrong (86.5% n = 173) or forgotten (87.0% n = 174). Patients did not have particular preferences, which differed from their experiences in terms of viewing the medication administration chart and self-administering medications. Preferred and reported behaviours correlated positively (r = 0.46-0.58, n = 200, p ≤ 0.001). Young-old patients preferred notifying healthcare professionals of perceived medication errors more than middle-old and old-old patients (p ≤ 0.05). Older patients may prefer verbal medication safety behaviours like asking questions and notifying healthcare professionals of medication errors, over viewing medication charts and self-administering medications. The young-old group wanted to identify perceived medication errors more than other age groups. Older patients are willing to engage in medication safety behaviours, and healthcare professionals and organisations need to embrace this engagement in an effort to reduce medication harm.
Governing the Operating Room List
Publisher: Palgrave Macmillan UK
Date: 2007
A compilation of consumers' stories: The development of a video to enhance medication adherence in newly transplanted kidney recipients
Publisher: Wiley
Date: 28-12-2016
DOI: 10.1111/JAN.12886
Abstract: To describe the design, development and evaluation of a consumer-centred video, which was underpinned by the Theory of Planned Behaviour and it was created to educate newly transplanted kidney recipients about the importance of medication adherence. Kidney transplantation is a treatment whereby medication adherence is critical to ensure long-term kidney graft success. To date, many interventions aimed to improve medication adherence in kidney transplantation have been conducted but consumers remain largely uninvolved in the interventional design. Qualitative sequential design. Twenty-two participants who had maintained their kidney transplant for at least 8 months and three participants who had experienced a kidney graft loss due to non-adherence were interviewed from March-May 2014 in Victoria, Australia. These interviews were independently reviewed by two researchers and were used to guide the design of the story plot and to identify storytellers for the video. The first draft of the video was evaluated by a panel of seven experts in the field, one independent educational expert and two consumers using Lynn's content validity questionnaire. The content of the video was regarded as highly relevant and comprehensive, which achieved a score of >3·7 out of a possible 4. The final 18-minute video comprised 15 sections. Topics included medication management, the factors affecting medication adherence and the absolute necessity of adherence to immunosuppressive medications for graft survival. This paper has demonstrated the feasibility of creating a consumer-driven video that supports medication adherence in an engaging way.
Role discrepancy: is it a common problem among nurses?
Publisher: Wiley
Date: 30-05-2006
DOI: 10.1111/J.1365-2648.2006.03859.X
Abstract: This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences. The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested. A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician-Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis. Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment.
Nurses' reassessment of postoperative pain after analgesic administration
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
Assessment of patient pain in the postoperative context
Publisher: SAGE Publications
Date: 11-2004
Abstract: Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient’s experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients’ pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses’ prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.
Nurses' knowledge and attitudes regarding pain in Saudi Arabia
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.PMN.2014.05.014
Abstract: Unrelieved pain is a worldwide health care problem that can lead to unnecessary complications and increased health care expenditure. The aim of this study was to examine nurses' knowledge and attitudes toward pain in Saudi Arabia. A descriptive design was employed using the Nurses' Knowledge and Attitudes Survey regarding pain. The study took place in a tertiary teaching hospital in Saudi Arabia. All nurses employed in the hospital were eligible to participate. A total of 775 questionnaires were distributed to nurses working in acute care, intensive care, and nursing education and administration settings. In all, 593 respondents completed the questionnaires, representing a response rate of 76.5%. Data were analyzed using descriptive and inferential statistics. Most participants were from overseas (97.5%), speaking 23 different languages 36.5% of nurses held a bachelors of science degree in nursing or the equivalent. The mean score of correctly answered items in was 16.9 (95% confidence interval, 16.6-17.31) out of a total possible score of 40. Nurses demonstrated some misconceived attitudes such as not giving the required dose of morphine to a smiling patient despite the patient being in pain. It is of concern that the findings identified problems of inadequate knowledge and inappropriate attitudes regarding pain assessment and management in Saudi Arabia. Considering these problems, the development of pain programs and policies affecting national and international nurses is highly imperative.
A framework for planning and critiquing medication compliance and persistence research using prospective study designs
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.CLINTHERA.2009.02.021
Abstract: Medication compliance and persistence are important determinants of clinical outcomes. With the application of evidence-based therapy, it is increasingly important to ensure that studies that use compliance or persistence as a primary or secondary outcome are designed suitably and employ appropriate analyses to support the inferences made. The aim of this work was to describe the designs of medication compliance ersistence studies and provide guidance on appropriate analyses, with the ultimate goal of helping health providers and payers of health care understand the impact of compliance and persistence on health outcomes. MEDLINE, CINAHL, EMBASE, and all EBM Reviews databases were searched to locate key research articles about prospective medication compliance and persistence studies. Articles published between 1978 and 2008 were included in the search. Inclusion criteria included a focus on medication compliance and persistence, and prospective research designs. Articles that largely focused on retrospective study designs or were based on opinion rather than evidence were excluded. A systematic framework was developed that comprised a prospective checklist and a quantitative tool to assess the quality of studies. The key elements of the checklist included the following: title and abstract, introduction or background, objectives, methods and study design, statistical analysis and results, discussion, conclusions, and disclosure of conflicts of interest. For each element, ex les are provided to help readers make an informed decision about the design, value, and quality of a particular prospective study. The checklist and quantitative tool can be used to provide objective validation of the rigor of prospective research designs. It is anticipated that future research will follow a uniform approach to presentation and evaluation of data, thereby facilitating a clear understanding of the impact of compliance and persistence on health outcomes.
Testing an Educational Nursing Intervention for Pain Assessment and Management in Older People
Publisher: Oxford University Press (OUP)
Date: 08-2011
DOI: 10.1111/J.1526-4637.2011.01181.X
Abstract: This study aimed to examine the effectiveness of a structured educational nursing intervention on pain assessment and management in older hospitalized people. A non-equivalent control group interventional design. Geriatric evaluation and management units in two metropolitan Australian hospitals. In total, 192 patients participated, with 32 different patients recruited consecutively for the pre-intervention, intervention, and 3-month post-intervention stages from each unit. Nurses in the intervention group received a structured intervention comprising 6 hours of instruction and 2 hours of clinical demonstration. Nurses in the control group received "usual" staff development activities. Five assessment tools for pain were used: the visual analog scale, the Faces Pain Scale-Revised, the Short-Form McGill Pain Questionnaire, the Pain Assessment in Advanced Dementia Tool, and the Abbey Pain Scale. Data were also collected on nurses' use of pain assessment tools and their use of non-pharmacological and pharmacological methods of managing pain. Improvements were observed in pain intensity at rest and on movement in the intervention unit at the post-intervention stage and at the 3-month post-intervention stage. There was also a trend for patients to be prescribed analgesics on a fixed dose schedule following implementation of the program in the intervention unit. The comprehensive intervention enabled change in practice and improvements in pain intensity, and the assessment and management of pain. Future research is needed on implementing the intervention with a multidisciplinary team of health professionals in a subacute environment.
Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia
Publisher: Informa UK Limited
Date: 10-06-2013
DOI: 10.3109/13685538.2013.801951
Abstract: To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient's medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis. Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p = 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p = 0.05) to have complaints with their medications compared to patients who self-managed. Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.
The devil is in the detail - a multifactorial intervention to reduce blood pressure in co-existing diabetes and chronic kidney disease: a single blind, randomized controlled trial.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2010
Medication communication through documentation in medical wards: Knowledge and power relations
Publisher: Wiley
Date: 04-07-2014
DOI: 10.1111/NIN.12043
Abstract: Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals.
Complexities of communicating about managing medications—An important challenge for nurses: A response to Latter et al. (2007)
Publisher: Elsevier BV
Date: 07-2008
Moving from rhetoric to reality: patient and family involvement in bedside handover
Publisher: Elsevier BV
Date: 12-2014
Explaining nurses’ work behaviour from their perception of the environment and work values
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.IJNURSTU.2004.12.008
Abstract: The present study examined how the relationship between nurses' perception of their environment and their work values could explain their job performance and whether they intended to quit their jobs. A survey (N=346) and a focus group (N=6) were used to collect data. The results revealed that nurses' job performance was maintained in an environment where they received few professional incentives due to their professionalism. In contrast, negative environmental characteristics directly impacted on nurses' intention to quit their jobs. The present study provides new insights into nurses' work behaviour.
Effect of concomitant opioid analgesics and oral sucrose during heel lancing
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.EARLHUMDEV.2010.11.008
Abstract: A sub-analysis was conducted of data from a study of prolonged use of sucrose for hospitalized infants (N=50 infants) during heel lancing. Results showed that pain responses differed when opioid analgesics were administered concomitantly with sucrose (n=79 pain assessments), than when sucrose was administered alone (n=364 pain assessments).
Graduate nurses' communication with health professionals when managing patients' medications
Publisher: Wiley
Date: 11-02-2005
DOI: 10.1111/J.1365-2702.2004.01084.X
Abstract: The aim was to examine how graduate nurses communicated with other health professionals about their medication management activities in the acute care context. The objectives were to determine the types of information communicated about patients' medications and the communication processes used during interactions with other nurses, doctors and pharmacists. Graduate nurses are challenged with enormous responsibilities and their competence is constantly tested in an ever-changing arena. One of their responsibilities involves communicating with other health professionals about patients' medications. A qualitative exploratory research design was used for this study. Participant observation and semi-structured interviews were conducted to elicit information from 12 graduate nurses with university degrees employed in a metropolitan public hospital, in Melbourne, Australia. Graduate nurses were observed once for two hours and interviewed on the same day of the observation at a mutually convenient time. The purpose of these interviews was to clarify activities observed and to obtain further information. The results highlighted how work dynamics of the clinical setting had an impact on the ability of graduate nurses to communicate effectively with other nurses, doctors and pharmacists. These work dynamics included the availability of doctors and the structure of ward rounds. The results also demonstrated the value graduate nurses placed on communicating particular information such as evaluating the effect of medication changes and organizing discharge medication. Graduate nurses were effective in communicating about medication management activities when they initiated or were prepared for such interactions. When graduate nurses were not prepared, such as during impromptu ward rounds, they did not participate effectively and important information was not communicated. It is important to understand how collegial communication facilitates accurate exchange of information and effective decision-making to achieve optimal health care outcomes for patients.
Interventions to reduce medication errors in adult intensive care: A systematic review
Publisher: Wiley
Date: 06-08-2012
Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AENJ.2011.12.004
Abstract: To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 in iduals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13). The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.
The impact of role discrepancy on nurses’ intention to quit their jobs
Publisher: Wiley
Date: 25-07-2006
DOI: 10.1111/J.1365-2702.2005.01508.X
Abstract: The purpose of this study was to investigate the impact of role discrepancy on nurses' intention to quit their jobs. Nurses experience role discrepancy, which refers to incompatibility between the roles nurses desire and expect to take, and the roles they actually engage in at work. However, there is a paucity of information as to how this role discrepancy affects nurses' intention to quit their jobs. A correlational design was used to investigate the impact of role discrepancy on nurses' intention to quit their jobs. A total of 346 Australian nurses participated in this study by completing questionnaires. The results were analysed by t-test, polynomial regression and response surface analysis. Nurses tended to experience role discrepancy, in particular, in decision making with hospital policies and provision of patient education. The overall results show that this role discrepancy contributes to nurses' intention to quit their jobs. Nurses' intention to quit their jobs also increased when they had a low desire to engage in nursing roles and when they only performed a few roles. When specific dimensions of nursing roles were examined, a role discrepancy in the use of nursing skills, such as participation in decision making and providing patient education and emotional support, had little impact on their turnover intention. On the contrary, a role discrepancy in task delegation practice showed a significant association with nurses' intention to leave their jobs. Role discrepancy has been experienced by many nurses, and this discrepancy partially contributes to nurses' intention to quit their jobs. To reduce nursing turnover, it is important to create a work environment where nurses are inspired to engage in various nursing roles and their work desires are reinforced by existing work opportunities.
Nurses and doctors communicating through medication order charts in critical care
Publisher: Elsevier BV
Date: 02-2001
DOI: 10.1016/S1036-7314(01)80018-7
Abstract: The structure and content of written forms of communication dynamically interact with the social and historical conditions underlying critical care nursing activities. One important form of documentation regularly used in the critical care area is the medication order chart. This paper considers the ways in which medication order charts are used to structure interactions among nurses and between nurses and doctors. The critical ethnographic study upon which this paper is based involved a research group of six nurses who worked in one critical care unit. Data collection methods involved professional journalling, participant observation and in idual and focus group interviews. Data analysis identified four major issues for consideration: imbalance between medical knowledge and legal authority the nurse as go-between and medication expert coaching the doctor and the self policing nurse. The critical care nurse's role extends beyond the traditional passive activity of medication administration. By exploring the power relations underlying this role, there is greater opportunity for improved nursing relationships and patient care.
Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals
Publisher: Springer Science and Business Media LLC
Date: 18-05-2008
MEDICINE NON‐ADHERENCE IN KIDNEY TRANSPLANTATION
Publisher: Wiley
Date: 20-03-2014
DOI: 10.1111/JORC.12063
Abstract: The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for ex le, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs.
Challenges of managing medications for older people at transition points of care
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.SAPHARM.2014.10.001
Abstract: In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem--that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.
Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review
Publisher: Wiley
Date: 07-2008
DOI: 10.1111/J.1365-2648.2008.04656.X
Abstract: This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes. Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997-2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered. The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months. Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent. Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases.
Documentation of medication management by graduate nurses in patient progress notes: A way forward for patient safety
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/S1322-7696(08)60533-8
Abstract: Nursing documentation provides evidence of nurses' management, the patient response, and evaluation of care. The aim of the study was to examine how graduate nurses document their medication management in the progress notes. A prospective clinical audit of patient medication charts and the progress notes made by 12 graduate nurses was undertaken. Graduate nurses were also in idually interviewed and asked clarifying questions about their medication management. Documentation was examined based on four areas: assessment, planning care, administration of medications, and evaluating outcomes of medications. Recorded information about assessment focused on cues of a biomedical rather than a psychosocial nature. Planning care involved non-specific documentation of discharge planning needs, and little information about communication with doctors, pharmacists, nurses, patients and next of kin. Administration of medications included details about the names of medications given to patients, but no information about medication education provided to patients during this time. Evaluation of outcomes of medication administration was poorly documented. Graduate nurses tended to focus on assessing medications before their administration without considering how the patient responded to treatment. Recommendations are proposed for improving the quality of graduate nurses' progress notes. These recommendations include implementing and evaluating protocols that link nurses' decision-making to documentation processes. Adopting a supportive multidisciplinary approach to quality improvement and providing education that emphasises written documentation of verbal communication are also recommended.
Testing the validity, reliability and utility of the Self-Administration of Medication (SAM) tool in patients undergoing rehabilitation
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.SAPHARM.2013.04.013
Abstract: Determination of patients' ability to self-administer medications in the hospital has largely been determined using the subjective judgment of health professionals. To examine the validity, reliability and utility of the Self-Administration of Medication (SAM) tool as an objective means to determine patients' ability to self-administer in a rehabilitation unit of a public teaching hospital in Melbourne, Australia. To assess validity of the SAM tool, associations were examined between the total SAM tool score and of the patients' competence to self-administer from the perceptions of the tool administrator, patients and nurses. Validity also was determined from a principal component analysis. Pearson correlations were calculated for how SAM scores related to scores obtained from the Functional Independence Measure (FIM) and Barthel Score Index (BSI). To assess the SAM tool's reliability, a Cronbach's alpha coefficient was calculated. Utility of the SAM tool was evidenced by documenting its administration time. One hundred patients participated in this study. The SAM tool had a Cronbach's alpha coefficient of 0.75 and took a mean time of 5.36 min to complete. The capability to self-medicate section of the SAM tool had strong correlations with the FIM (r = 0.485) and BSI (r = 0.472) data, respectively, and the total SAM tool had moderate and strong correlations with the nurses' (r = 0.315) and tool administrator's (r = 0.632) perceptions of patients' ability to self-administer, respectively. Bland-Altman and ROC curve analyses showed poor agreement between the total SAM tool score and the nurses' perceptions. The SAM tool demonstrated acceptable overall internal consistency. It only requires a short time to be completed and is more objective than seeking out health professionals' perceptions. Additional research is needed to further validate this approach to determining patients' ability to self-medicate.
Governance in operating room nursing: Nurses’ knowledge of individual surgeons
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.SOCSCIMED.2005.08.007
Abstract: This paper explores governance and control in operating room nurses' clinical practice. Traditionally, operating room nurses have been portrayed as "handmaidens" to the surgeons, a position which implies that nurses' bodies and the knowledge they use in practice are sites of discursive control by others. This paper unsettles this understanding by showing how operating room nurses studied ethnographically in an Australian setting are both disciplined by and actively shape practice through knowing surgeons' technical requirements for surgery, through inscribing them in discourses of time, and through having deep knowledge of the surgeons' "soul". We argue that as a form of governance, nurses' knowledge of surgeons is a subjugated form of knowledge, located low down on a hierarchy of knowledges. Furthermore, as a form of governance that has previously been unarticulated in the literature, it transcends the traditional lines of authority and control in the nurse-doctor relationship. The data in this paper are drawn from an ethnographic study that explored a range of nurse-nurse and nurse-doctor communication practices in operating room nursing.
Complex health service needs for people who are homeless
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10967
Abstract: Background. Homeless people face many challenges in accessing and utilising health services to obtain psychosocial supports offered in hospital and community settings. The complex nature of health issues is compounded by lack of accessibility to services and lack of appropriate and safe housing. Objective. To examine the perceptions and experiences of homeless people in relation to their health service needs as well as those of service providers involved with their care. Design. A purposive s ling approach was undertaken with a thematic framework analysis of semi-structured interviews. Participants. Interviews were undertaken with 20 homeless people who accessed the emergency department in an acute hospital in Melbourne, Australia and 27 service providers involved in hospital and community care. Results. Six key themes were identified from interviews: complexity of care needs, respect for homeless people and co-workers, engagement as a key strategy in continued care, lack of after-hour services, lack of appropriate accommodation and complexity of services. Conclusions. Findings revealed the complex and erse nature of health concerns in homeless people. The demand on hospital services continues to increase and unless government policies take into consideration the psychosocial demands of the communities most vulnerable people efforts to ert hospital demand will continue to fail. What is known about the topic? Homeless people have complex healthcare needs and are high users of emergency departments (EDs). The increasing demand on hospital services has led to a focus by the Australian State, Territory and Federal Governments on strategies to ert homeless people from presenting to the ED. What does this paper add? This paper gives an insight into the experiences of homeless people and health service provides who are directly involved in their care. This insight gives important focus on the health needs and service responses that currently exist and the ongoing challenges that face homeless people and the health professionals responding to those needs. What are the implications for practitioners? To adequately respond to the needs of homeless people safe and supportive accommodation is a crucial component of services required to try and break the cycle of representation to the emergency department. In idual engagement strategies with coordinated care between hospital and community are required to address the complex care needs and psychosocial issues.
Prescribed Doses of Opioids in Long-Term Care Facilities
Publisher: Elsevier BV
Date: 12-2015
Anxiety as a factor influencing satisfaction with emergency department care: Perspectives of accompanying persons
Publisher: Wiley
Date: 10-11-2009
DOI: 10.1111/J.1365-2702.2009.02873.X
Abstract: To measure levels of anxiety among people accompanying consumers to the emergency department and to explore how anxiety influences satisfaction with care. When people seek treatment in an emergency department they are often accompanied by a next-of-kin, family member or friend. While the accompanying person plays a vital role in providing psycho-social support to consumers, little is known about how they perceive the quality of care. Learning more about how accompanying persons perceive care may inform the development of strategies to enhance communication processes between staff, consumers and accompanying persons. DESIGN A prospective cross-sectional survey design. Data were collected from a consecutive s le of accompanying persons at one Australian metropolitan teaching hospital. Of all eligible in iduals approached, 128/153 (83.7%) returned completed questionnaires. The questionnaire comprised a series of open- and close-ended questions about perceptions of medical need, urgency and satisfaction with the overall visit. Anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A). There was a significant association between the accompanying person's levels of anxiety and satisfaction at point of discharge. In the satisfied group, mean VAS-A scores were 17.4 (SD 17.5) compared to 42.9 (SD 26.6) in the not satisfied group (p = 0.011). Moreover, those participants who were not satisfied with the visit did not show a significant reduction in VAS-A scores from triage to point of discharge. The lower the level of anxiety reported by accompanying persons when leaving the emergency department, the more satisfied they are likely to be with their emergency department visit. Ultimately, well informed and confident accompanying persons are beneficial for ensuring quality patient support. Asking accompanying persons about their anxiety level before discharge gives them the opportunity to pose clarifying questions and is, therefore, an effective way of improving their satisfaction with the emergency department visit.
Expanded practice roles for community mental health nurses: What do consumers and carers have to say?
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01612840701522069
Abstract: Community-based mental health as the primary focus of treatment has influenced more autonomous roles for mental health nurses. A limited literature suggests that this has resulted in the expansion of community mental health nursing into territory usually the exclusive domain of the medical profession. Consumers and carers are the two groups most affected by changes to service delivery however, their views regarding the changing role of community mental health nurses have not been sought. This paper presents the findings of a qualitative study involving indepth interviews with Australian consumers (n = 4) and carers (n = 6) designed to explore their views and opinions about the expanded practice roles of community mental health nurses. Four main themes were identified: accessibility and convenience relationship with clinicians beneficiaries of expanded nursing practice and, are nurses up to it? The findings suggest expanded practice roles are perceived positively by consumers and carers and therefore worthy of further investigation.
Using patients’ experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above
Publisher: BMJ
Date: 10-2014
DOI: 10.1136/BMJOPEN-2014-006599
Abstract: Evidence of patients’ experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia. The 45 and Up Study is a cohort of 265 000 adults aged 45 years and above in NSW. Patients who were hospitalised between 1 January and 30 June 2014 will be identified from this cohort using data linkage and a random s le of 20 000 invited to participate. A cross-sectional survey (including qualitative and quantitative components) will capture patients’ experiences in hospital and specifically of adverse events. Approximately 25% of respondents are likely to report experiencing an adverse event. Quantitative components will capture the nature and type of events as well as common features of patients’ experiences. Qualitative data provide contextual knowledge of their condition and care and the impact of the event on in iduals. Respondents who do not report an adverse event will report their experience in hospital and be the control group. Statistical and thematic analysis will be used to present a patient perspective of their experiences in hospital the characteristics of patients experiencing an adverse event experiences of information sharing after an event (open disclosure) and the other avenues of redress pursued. Interviews with key policymakers and a document analysis will be used to create a map of the current practice. Dissemination via a one-day workshop, peer-reviewed publications and conference presentations will enable effective clinical responses and service provision and policy responses to adverse events to be developed.
Communication related to medication incidents-A concept analysis and literature review.
Publisher: Wiley
Date: 15-11-2022
DOI: 10.1111/SCS.13044
Abstract: (1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts. Concept analysis. Twenty-three articles from seven scientific databases covering the years 2010-2020 and two official documents. Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive-inductively conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting. A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' in idual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept. The 128-item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues. The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.
Assessing outcome measures of oral anticoagulation management in children
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.THROMRES.2010.09.001
Abstract: The complexities of managing oral anticoagulation therapy in children have been well described and various management strategies have been designed to optimise clinical outcomes within this challenging population. To date, outcome measurements used within paediatric studies investigating oral anticoagulant management have focused upon achieving therapeutic range and examining the incidence of medication-related adverse events. Whilst the reporting of such data is a priority, the relatively small number of children participating in clinical studies of oral anticoagulant management and the difficulties associated with conducting multi-centre interventional trials in such populations limit the ability of researchers to measure the significance of interventions made. This review examines current methods of reporting outcomes for paediatric oral anticoagulation management and identifies how the inclusion of quality of life as an outcome measure may strengthen the methodology of research aimed at measuring the impact of management interventions within the field of paediatric oral anticoagulant therapy.
Complexities of medicines safety: Communicating about managing medicines at transition points of care across emergency departments and medical wards
Publisher: Wiley
Date: 11-09-2015
DOI: 10.1111/JOCN.12685
Abstract: To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals. Medicines errors are common at transition points of care. Little qualitative work has targeted communicating about medicines management across patients' journeys from admission through to discharge. A qualitative descriptive study was undertaken. In-depth, semi-structured interviews were conducted with patients and family members, and focus groups and interviews were undertaken with doctors, nurses and pharmacists (n = 103). These in iduals were situated in emergency departments and general medical wards. Data were analysed using thematic analysis. Four themes were identified: contextual environment of care, competing responsibilities of care, awareness of responsibility for safety, and interprofessional communication. Contextual environment of care was affected by time pressure and efficiency, and an overriding priority to move patients out of emergency departments. In competing responsibilities of care, a reactive focus was displayed in emergency departments while a proactive stance was demonstrated in medical wards. There was an awareness of responsibility for safety, whereby key stakeholders appreciated the chain of events involved, interpersonal communication affected patients and carers, and consequences existed for patient education related to lack of information. Interdisciplinary communication was associated with communication modalities used in encounters, compartmentalised thinking, and medicines changes relayed to external providers. Medicines management at transition points involved a complex interplay of dynamic features. This interplay infiltrated across erse environments, affecting patient care within and outside hospitals. Health professionals require greater appreciation of each other's roles at transition points of care. Prioritisation of high-risk patients is needed, such as those with cognitive impairment and multiple co-morbidities. Establishing workable protocols of communication etiquette and a structured approach to medicines activities may assist in pre-empting problems before they occur.
Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.AUCC.2018.07.003
Abstract: The objectives of this systematic review were the following: (i) to describe whether culturally sensitive communication is used by clinicians (nurses and physicians) when communicating with patients and families at the end-of-life in the intensive care unit and (ii) to evaluate the impact of culturally sensitive communication at the end-of-life. The systematic review question was how is culturally sensitive communication used by clinicians when communicating with patients and families at the end-of-life in the intensive care unit? A search of CINAHL, MEDLINE, Embase, and PsycINFO databases identified all peer-reviewed research evidence published in English between January 1994 and November 2017. Two authors independently assessed articles for inclusion. From the 124 articles resulting from the search, nine were included in this systematic review. Articles were independently assessed for quality by two authors using Caldwell et al.'s framework to critique health research. The data available in this systematic review were heterogeneous, with varied study designs and outcome measures, making the data unsuitable for meta-analysis. The most appropriate method for data synthesis for this systematic review was narrative synthesis. From the narrative synthesis, two major themes emerged: communication barriers and cultural and personal influences on culturally sensitive communication. Communication barriers were identified in eight studies, influencing the timing and quality of culturally sensitive communication at the end-of-life. Cultural and personal influences on communication at the end-of-life was present in eight studies. The findings of this systematic review show that clinicians lack the knowledge to enable effective interaction with culturally erse patients and families at the end-of-life.
Parental management of childhood complaints: Over-the-counter medicine use and advice-seeking behaviours
Publisher: Wiley
Date: 14-06-2010
DOI: 10.1111/J.1365-2702.2009.03092.X
Abstract: Aims and objectives. To explore parental management of childhood complaints with respect to factors associated with the purchase of over‐the‐counter medicines and sources of information accessed by parents. Background. The use of over‐the‐counter medicines is extensive, but this practice is not without risks. To ensure safe use, nurses and other healthcare providers need to understand parental reasons for purchase and sources of information they access regarding management practices. Design. A cross‐sectional survey. Method. Three‐hundred and twenty‐five parents of children (aged birth to 24 months) were recruited between September 2006–June 2007 from three recruitment sites across Melbourne, Australia. These included the following: outpatient clinics at a major paediatric hospital, maternal and child health centres and a childcare service of a tertiary education institution. Data were collected using a self‐administered questionnaire. Result. Most parents (82%) purchased over‐the‐counter medicines if suggested by the doctor and if it had been effective in the past. Doctors were the most frequently cited source of advice for management of complaints such as an ear ache (95%), wheeziness (90%) and rash (77%). Advice from maternal and child health nurses was frequently sought for sleep difficulties (60%), while family or friends were sought for advice on irritability or crankiness (47%) and teething pain (44%). Conclusions. The findings revealed the impact of healthcare provider recommendations on parental purchase of over‐the‐counter medicines. Parents mainly sought information and advice from doctors, followed by maternal and child health nurses and family or friends, which appeared to be dependent on the type of childhood complaint. Relevance to clinical practice. The use of over‐the‐counter medicines for symptom management is likely to increase with enhanced focus on self‐care. It is important for all healthcare providers to proactively provide accurate, consistent and evidence‐based information to parents regarding appropriate management of symptomatic and behavioural complaints.
Medication-related problems occurring in people with diabetes during an admission to an adult teaching hospital: A retrospective cohort study
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.DIABRES.2012.03.003
Abstract: To examine the characteristics of medication-related problems occurring in people with diabetes admitted to hospital and to identify risk factors for medication-related problems. A retrospective cohort study of medication-related problems occurring in patients admitted to an adult, inner-city Australian teaching hospital was conducted over two-years. The risk factors associated with medication-related problems were identified using random effect logistic regression. There were 9530 admissions of people with diabetes involving 5205 in iduals over a two-year period. Medication-related problems were associated with 686 (7.2%) admissions involving 571 in iduals (11.0%). The most common medication-related problems were medication errors (64.1%) associated with hypoglycaemia and unintentional overdose. Five factors were significantly associated with medication-related problems: female gender [odds ratio (OR) 1.30, 95% confidence intervals (CI) 1.11-1.52], age of 18-50 years (OR 2.32, CI 1.85-2.91), single marital status (OR 1.46, CI 1.24-1.74), mental and behavioural problems (OR 1.74, 1.43-2.11), and a comorbidity index score of at least one (OR 1.35-1.67). Five significant risk factors were associated with medication-related problems in people with diabetes admitted to hospital. These risks need to be considered when developing care plans and interventions to prevent medication-related problems for in iduals with diabetes.
Associations of postoperative delirium with activities of daily living in older people after major surgery: A prospective cohort study
Publisher: Wiley
Date: 21-06-2023
DOI: 10.1111/JOCN.16801
Abstract: To assess the association of postoperative delirium developed in the post‐anaesthetic care unit (PACU) with older patients' ability to perform activities of daily living (ADL) during the first five postoperative days. Previous studies have focused on the association between postoperative delirium and long‐term function decline, however the association between postoperative delirium and the ability to perform ADL, particularly in the immediate postoperative period, needs further investigation. A prospective cohort study. A total of 271 older patients who underwent elective or emergency surgery at a tertiary care hospital in Victoria, Australia, participated in the study. Data were collected between July 2021 and December 2021. Delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‐5). The Katz Index of Independence in Activities of Daily Living (KATZ ADL) scale was used to measure ADL. ADL was assessed preoperatively and daily during the first five postoperative days. The STROBE checklist was used to report this study. Results showed that 44 (16.2%) patients developed new episode of delirium. Postoperative delirium was independently associated with decline in ADL (RR = 2.83, 95% CI = 2.71–2.97 p 0.001). Postoperative delirium was associated with a decline in ADL among older people during the first five postoperative days. Screening for delirium in the PACU is essential to identify delirium during the early stages of postoperative period and implement a timely comprehensive plan. Delirium assessment of older patients in the PACU, and for at least the first five postoperative days, is strongly recommended. We also recommend engagement of patients in a focused physical and cognitive daily activity plan, particularly for older patients undergoing major surgery. Patients and nurses helped in data collection at a tertiary care hospital.
A retrospective descriptive study of medical record documentation of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds
Publisher: Elsevier BV
Date: 06-2023
Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: Implications for service delivery
Publisher: Springer Science and Business Media LLC
Date: 10-11-2007
Nurse practitioners and medical practice: Opposing forces or complementary contributions?
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1111/J.1744-6163.2009.00195.X
Abstract: The medical profession in Australia has expressed concern about the expansion of nursing practice into areas that are traditionally the domain of medicine. Particular apprehension is raised in relation to the prescription of medications. This paper will consider and critique the argument that the standard of care provided by a nurse practitioner would be of lesser quality than that provided by a medical practitioner. Despite the medical profession's opposition for nurse practitioner roles, there is little evidence suggesting that the quality of services offered by a nurse practitioner would be inferior. Available evidence suggests that care and treatment from nurse practitioners in primary health care is equal to that provided by medical practitioners.
Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis
Publisher: JMIR Publications Inc.
Date: 18-07-2019
DOI: 10.2196/12042
Examining the preparation and ongoing support of adults to take their medications as prescribed in kidney transplantation
Publisher: Wiley
Date: 16-10-2015
DOI: 10.1111/JEP.12270
Abstract: The shortage of kidney donors and benefits of kidney transplantation make graft success imperative. Medication adherence is critical to prevent the risk of graft rejection. This paper examines how adults are prepared and supported by renal transplant co-ordinators and pharmacists to take their medications as prescribed in kidney transplantation. Renal transplant co-ordinators and pharmacists of all five hospitals offering adult kidney transplantation in Victoria, Australia, were interviewed between November 2013 and February 2014. All data underwent qualitative descriptive analysis. Nine renal transplant co-ordinators and six pharmacists were interviewed. Although there was no standardized approach to education or other evidence-based strategies to facilitate medication adherence, there were similarities between sites. These similarities included printed information, pre-transplant education sessions, the use of medication lists and medication administration aids, intensive education in hospital and ensuring an adequate supply of medications post-discharge. Renal transplant co-ordinators and pharmacists recognized the importance of early patient education concerning immunosuppressant medication. However, each site had developed their own way of preparing a patient for kidney transplantation and follow-up in the acute hospital setting based on experience and practice. Other non-educational strategies involving behavioural and emotional aspects were less common. Differences in usual care reinforce the necessity for evidence-based health care for best patient outcomes.
Managing complex medication regimens: Perspectives of consumers with osteoarthritis and healthcare professionals
Publisher: SAGE Publications
Date: 05-2007
DOI: 10.1345/APH.1H623
Abstract: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable. To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from erse backgrounds. Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. In idual interviews were undertaken with 3 community medical practitioners. Consumers' management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as needed basis. Healthcare professionals discussed the importance of using nonpharmacologic measures to improve symptoms however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful. Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers' medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that “as needed” directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable s les, should examine trends related to consumers' experiences of symptomatic relief from chronic conditions and their understandings about medications.
Complexities of pain assessment and management in hospitalised older people: A qualitative observation and interview study
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.IJNURSTU.2012.05.002
Abstract: Pain continues to be a common problem for older hospitalised patients, but little is known about how the complexities of actual clinical practice affect pain assessment and management in these patients. To examine how pain was assessed and managed in older patients who were admitted to geriatric evaluation and management units. A naturalistic observational research design was used involving observations of interactions between nurses and patients, and follow-up interviews with nurses. Three observation periods were conducted between midnight and midday, which commenced at 03:30, 07:30, and 10:30, and three observation periods were conducted between midday and midnight, which commenced at 15:30, 18:30, and 22:30. Between 12 and 13 observations were conducted for each observation period, each ranging from 2 to 3h. The study was undertaken in two units, each located in an Australian public teaching hospital. Participants included registered nurses employed in the units, and patients in their care. Four major themes were identified: communication among nurses and between older patients and nurses strategies for pain management environmental and organisational aspects of care and complexities in the nature of pain. Nurses tended to use simple questioning with patients about the pain experienced. Despite the availability of 'as required' opioid medication for breakthrough or incident pain, nurses often preferred to wait to determine if pain was relieved following administration of fixed-dose paracetamol. Time of day impacted on how pain was managed due to availability of nursing staff. It was unit policy for doctors to reduce medications prescribed, which often extended to analgesics, and nurses were left to deal with patient tensions in addressing analgesic needs. Complexities were associated with the nature of pain experienced, in terms of perceived level of tolerable pain, the simultaneous presence of chronic and acute pain, location of pain, and differentiation of pain from discomfort. This study demonstrated the intricacies associated with how analgesic needs are addressed in older patients, especially those with communication deficits, the complex nature of older patients' painful experiences, and the precarious balance of attempting to treat pain effectively while avoiding adverse effects of analgesics.
Forum on historical biogeography: what is cladistic biogeography?
Publisher: Wiley
Date: 25-10-2005
Nephrologists' management of patient medications in kidney transplantation: results of an online survey
Publisher: Wiley
Date: 17-06-2015
DOI: 10.1111/JEP.12394
Abstract: Medication adherence is essential in kidney transplant recipients to reduce the risk of rejection and subsequent allograft loss. The aim of this study was to delineate what 'usual care' entails, in relation to medication management, for adult kidney transplant recipients. An online survey was developed to explore how nephrologists promote and assess medication adherence, the management of prescriptions, the frequency of clinic appointments and the frequency of clinical screening tests. Nephrologists from all acute kidney transplant units in Victoria, Australia, were invited to participate. Data were collected between May and June 2014. Of 60 nephrologists invited to participate, 22 completed the survey (response rate of 36.6%). Respondents had a mean age of 49.1 ± 10.1 years, with a mean of 20.1 ± 9.9 years working in nephrology and 14 were men. Descriptive analysis of responses showed that nephrologists performed frequent screening for kidney graft dysfunction that may indicate medication non-adherence, maintained regular transplant clinic visits with patients and emphasized the importance of medication education. However, time constraints during consultations impacted on extensive patient education and the long-term medication follow-up support was often delivered by the renal transplant nurse coordinator or pharmacist. This study highlighted that nephrologists took an active approach in the medication management of kidney transplant recipients, which may assist with facilitating long-term graft survival. Ultimately, promoting medication adherence needs to be patient centred, involving an interdisciplinary team of nephrologists, pharmacists and renal transplant nurse coordinators, working together with the patient to establish optimal adherence.
Achieving collaborative workplace learning in a university critical care course
Publisher: Elsevier BV
Date: 02-2003
DOI: 10.1016/S0964-3397(03)00006-5
Abstract: The purpose of this paper is to describe the development, implementation and evaluation of a new critical care curriculum based on the tenets of collaborative workplace learning. It also examines lecturers' and clinical educators' issues, and explores students' evaluations of the old curriculum compared with those of the new curriculum. Three data collection methods were used for this study. Comprehensive notes were maintained of the meetings conducted with lecturers, clinical educators and representative students during the development and implementation of the course. Three focus group interviews were conducted with students before the introduction of the new curriculum and three focus group interviews were conducted during first semester following implementation of the new curriculum. Quality-of-teaching surveys were also completed by two groups of critical care course students: one group before and one group following the introduction of the new curriculum. Major findings in this study included: developing a sense of ownership of the curriculum for clinical educators, clinical educators' difficulties with addressing their responsibilities, amalgamating theoretical learning with clinical practice, and tackling students' workload. This paper demonstrates the value of using the collaborative workplace learning approach in strategically addressing the challenges of developing and conducting a university critical care course.
Enabling sustained communication with patients for safe and effective management of oral chemotherapy: A longitudinal ethnography
Publisher: Wiley
Date: 18-11-2021
DOI: 10.1111/JAN.14634
A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: A feasibility randomized controlled trial
Publisher: Wiley
Date: 15-02-2012
DOI: 10.1111/J.1365-2648.2012.05950.X
Abstract: The aim of this study was to test the feasibility and impact of an intervention consisting of self-monitored blood pressure, medicine review, a Digital Versatile Disc, and motivational interviewing telephone calls to help people with diabetes and kidney disease improve their blood pressure control and adherence to prescribed medications. People with co-existing diabetes, kidney disease and hypertension require multiple medications to manage their health. About 50% of people are non-adherent to their prescribed medications with non-adherence increasing in the presence of chronic conditions. Randomized controlled trial. Patients aged ≥18 years with diabetes, chronic kidney disease and systolic hypertension were recruited from nephrology and diabetes outpatients' clinics of an Australian metropolitan hospital between 2008-2009. Participants were randomly allocated on a 1:1 basis to one of two groups in a randomized controlled trial: the intervention delivered over 3 months (n = 39) and usual care (n = 41), with follow-up at 3, 6 and 9 months postintervention. People collecting data and assessing outcomes were blinded to group assignment. Seventy-five participants completed the study. The intervention was acceptable and feasible for this cohort. There were no statistically significant differences between groups, although the mean systolic blood pressure reduction in the intervention group (n = 36) was -6·9 mmHg 95% CI (-13·8, -0·02) at 9 months postintervention. The study was feasible and statistically significant differences may be determinable in a larger s le to overcome the variability between groups, paying attention to recommendations for further research. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Register (ACTRN12607000044426).
'I will go to my grave fighting for grammar': Exploring the ability of language-trained raters to implement a professionally-relevant rating scale for writing
Publisher: Elsevier BV
Date: 10-2020
Impact of the perceived public image of nursing on nurses’ work behaviour
Publisher: Wiley
Date: 27-01-2006
DOI: 10.1111/J.1365-2648.2006.03729.X
Abstract: This paper reports a study comparing nurses' perceptions of their public image with their self-image, and examining how the relationship between their perceived public image and self-image was associated with their job performance and turnover intentions. The stereotypical public image of nursing is a major concern to nurses. However, it is relatively unknown how this image affects nurses. A few studies have investigated how nurses' interpretations of their public image affect their self-image and work behaviour. A convenience s le of 346 Australian nurses participated in a questionnaire study in 2003. The results were analysed by t-test, polynomial regression and response surface analysis. Six participants from the survey participated in a focus group to provide further interpretation of the findings. Nurses rated their aptitude for leadership more positively than they thought the public viewed them. In contrast, nurses rated their image as being caring less negatively than their perceived public image. Job performance was predicted by self-image relating to leadership aptitude. On the contrary, the relationship between self-image and perception of the public image as being caring predicted job performance. When nurses perceived their public image as caring less positively than their self-image, their job performance tended to improve. As for turnover intention, both self-image and perceived public images of having an aptitude for leadership and being caring were negatively related to intention to quit the job. To enhance nurses' job performance and reduce their turnover intentions, it is important to improve both the public image and self-image of nurses.
Nurse role and contribution to antimicrobial stewardship. An integrative review
Publisher: Elsevier BV
Date: 05-2020
Clinically significant pain is experienced by just over a third of all hospitalised patients, affecting around a half of surgical and a quarter of medical admissions
Publisher: BMJ
Date: 08-04-2015
A critical review of daily sedation interruption in the intensive care unit
Publisher: Wiley
Date: 08-04-2009
DOI: 10.1111/J.1365-2702.2008.02513.X
Abstract: Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions. To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice. Literature review. Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research-based studies, published in the English language between 1995-December 2006 and three conference abstracts were retrieved. Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA. The research indicates that DSI reduces ventilation time, length of stay in ICU, complications of critical illness, incidence of post-traumatic stress disorder and is reportedly used by 15-62% of ICU clinicians in Australia, Europe, USA and Canada. DSI improves patients' physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous s les, single-centre trials and retrospective design, thus limiting their generalisability. DSI may provide clinicians with a simple, cost-effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited and cannot be generalised to heterogeneous ICU populations internationally. More robust research is required to assess the potential impact of DSI on the physical and mental health of ICU survivors.
The 'time-out' procedure: An institutional ethnography of how it is conducted in actual clinical practice
Publisher: BMJ
Date: 12-04-2013
DOI: 10.1136/BMJQS-2012-001702
Abstract: The time-out procedure is a critically important communication interaction for the preservation of patient safety in the surgical setting. While previous research has examined influences shaping the time-out procedure, limited information exists on how actual time-out communication is performed by multidisciplinary surgical team members in the clinical environment. An institutional ethnographic study was undertaken. The study was conducted over three hospital sites in Melbourne, Australia. In total, 125 healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data were generated through 350 h of observation, two focus groups and 20 semi-structured interviews. An institutional ethnographic analysis was undertaken. Analysis revealed healthcare professionals adapted the content, timing and number of team members involved in the time-out procedure to meet the demands of the theatre environment. Habitually, the time-out procedure was partially completed, conducted after surgery had commenced and involved only a few members of the surgical team. Communication was restricted and stifled by asynchronous workflows, time restrictions, a hierarchical culture and disinclination by surgeons and anaesthetists to volunteer information and openly communicate with each other and nurses. Healthcare professionals became normalised to performing an abbreviated time-out procedure. Patient safety was relegated in importance as productivity, professional and hierarchical discourses configured the communication practices of surgical team members to limit active, open and direct communication. Examining how the time-out procedure was conducted in the clinical environment enables possibilities to emerge for facilitating compliance with hospital and WHO guidelines.
Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study
Publisher: MDPI AG
Date: 30-11-2022
Abstract: (1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A’s Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impact by improving the accuracy of delirium detection in the PACU and hence preventing adverse outcomes associated with delirium.
The power of routine and special observations: Producing civility in a public acute psychiatric unit
Publisher: Wiley
Date: 07-08-2008
DOI: 10.1111/J.1440-1800.2008.00406.X
Abstract: This study directly addresses controlling aspects of psychiatric nursing practice, which are currently marginalized in practice and research. We first consider the discursive tensions surrounding the mandated goal of social control in public acute psychiatric units, particularly referring to those units located within medical hospitals. We attest to the enduring social control mandate in psychiatric nursing and explore ways in which it is enacted. Specific nursing practices of 'doing the obs' while scanning the ward and 'special observations' are investigated as important activities of social control, based on findings from an ethnographic study in one acute psychiatric unit in Australia. These practices are acknowledged as key modes of nursing surveillance. Contrary to past work, they are regarded as productive for engendering civil conduct among patients in acute psychiatric settings. We reframe these activities of surveillance as liberal therapeutic practices in themselves, to the extent that they assist patients to achieve treatment goals and promote self-surveillance and self-control. Instead of effacing practices of control, we encourage nurses to discriminate between more and less liberal modes of control in everyday practice and to build their skills in liberal controlling strategies.
Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.AUCC.2016.08.001
Abstract: Patients admitted to Australian intensive care units are often critically unwell, and present the challenge of increasing mortality due to an ageing population. Several of these patients have terminal conditions, requiring withdrawal of active treatment and commencement of end-of-life (EOL) care. The aim of the study was to explore the perspectives and experiences of physicians and nurses providing EOL care in the ICU. In particular, perceived barriers, enablers and challenges to providing EOL care were examined. An interpretative, qualitative inquiry was selected as the methodological approach, with focus groups as the method for data collection. The study was conducted in Melbourne, Australia in a 24-bed ICU. Following ethics approval intensive care physicians and nurses were recruited to participate. Focus group discussions were discipline specific. All focus groups were audio-recorded then transcribed for thematic data analysis. Five focus groups were conducted with 11 physicians and 17 nurses participating. The themes identified are presented as barriers, enablers and challenges. Barriers include conflict between the ICU physicians and external medical teams, the availability of education and training, and environmental limitations. Enablers include collaboration and leadership during transitions of care. Challenges include communication and decision making, and expectations of the family. This study emphasised that positive communication, collaboration and culture are vital to achieving safe, high quality care at EOL. Greater use of collaborative discussions between ICU clinicians is important to facilitate improved decisions about EOL care. Such collaborative discussions can assist in preparing patients and their families when transitioning from active treatment to initiation of EOL care. Another major recommendation is to implement EOL care leaders of nursing and medical backgrounds, and patient support coordinators, to encourage clinicians to communicate with other clinicians, and with family members about plans for EOL care.
The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices
Publisher: Wiley
Date: 07-08-2023
DOI: 10.1002/PBC.30614
Abstract: Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment. To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices. A qualitative case study was conducted and involved semi‐structured interviews at two time points following transplantation (30 and 90 days) with parents ( n = 10) and naturalistic observations of pain‐related care provided to children ( n = 29) during HSCT therapy by their healthcare providers ( n = 10). Semi‐structured interviews were also conducted with healthcare providers ( n = 14). The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence‐based guidelines for the sustained, and often long‐term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain. There is a pressing need to create evidence‐based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
How graduate nurses use protocols to manage patients’ medications
Publisher: Wiley
Date: 04-08-2005
DOI: 10.1111/J.1365-2702.2005.01234.X
Abstract: The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications. Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making Design. A descriptive prospective qualitative design was used. Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed. Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications. Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved. Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.
Stressors and coping resources of Australian kidney transplant recipients related to medication taking: a qualitative study
Publisher: Wiley
Date: 20-03-2017
DOI: 10.1111/JOCN.13435
Abstract: To understand the stressors related to life post kidney transplantation, with a focus on medication adherence, and the coping resources people use to deal with these stressors. Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post surgery is a complex process. A descriptive exploratory study. Participants were recruited from five kidney transplant units in Victoria, Australia. From March–May 2014, patients who had either maintained their kidney transplant for ≥8 months or had experienced a kidney graft loss due to medication nonadherence were interviewed. All audio‐recordings of interviews were transcribed verbatim and underwent Ritchie and Spencer's framework analysis. Participants consisted of 15 men and 10 women aged 26–72 years old. All identified themes were categorised into: (1) Causes of distress and (2) Coping resources. Post kidney transplantation, causes of distress included the regimented routine necessary for graft maintenance, and the everlasting fear of potential graft rejection, contracting infections and developing cancer. Coping resources used to manage the stressors were first, a shift in perspective about how easy it was to manage a kidney transplant than to be dialysis‐dependent and second, receiving external help from fellow patients, family members and health care professionals in addition to using electronic reminders. An in idual well‐equipped with coping resources is able to deal with stressors better. It is recommended that changes, such as providing regular reminders about the lifestyle benefits of kidney transplantation, creating opportunities for patients to share their experiences and promoting the usage of a reminder alarm to take medications, will reduce the stress of managing a kidney transplant. Using these findings to make informed changes to the usual care of a kidney transplant recipient is likely to result in better patient outcomes.
Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement
Publisher: Wiley
Date: 12-01-2007
DOI: 10.1111/J.1365-2648.2006.04093.X
Abstract: The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For ex le, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis. A purposive s le of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study.
Publisher: MDPI AG
Date: 08-03-2021
Abstract: Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.
Rethinking ethnography: reconstructing nursing relationships
Publisher: Wiley
Date: 26-01-2001
DOI: 10.1046/J.1365-2648.2001.01660.X
Abstract: Critical ethnography is being adopted increasingly by nurses as a legitimate form of research methodology. This paper explores the research practices and dilemmas that emerge from this methodology using a recently completed ethnographic study of nurse-nurse and nurse-doctor interactions in a critical care hospital setting. Critical ethnography provides a useful methodology that facilitates mutual dialogue among participants. It may be limited, however, by the central role of researchers and by a tendency to negotiate participants' realities according to a particular 'truth'. These concerns have been strongly critiqued by poststructuralists using concepts such as discourse, subjectivity and power. By incorporating the notion of a poststructural analysis into critical ethnography, researchers are in a position to examine critically the tensions in their own practices, and their struggles with documenting and analysing ethnographic accounts. Six registered nurses comprised the participants of the research group. Through the method of professional journalling, the first author of this paper explored her professional interactions with doctors and other nurses in her role as a nurse in the critical care setting under investigation. Other methods included participant observation, and in idual and focus group interviews with nurse participants. ISSUES OF METHODOLOGICAL CONCERN: This paper considers three issues of methodological concern: researcher articipant subjectivity the movement from empowerment to reflexivity and the construction of one form of ethnographic 'truth'. These issues are discussed in reference to the research relationships with the nurse participants and the process of analysing ethnographic accounts. In working with critical ethnography using a poststructural analysis, we were able to generate valuable insights about previously hidden areas of relationships among nurse participants in a research group during all stages of the research process. It also provided a means of informing the analysis of ethnographic texts.
A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: Study protocol
Publisher: Wiley
Date: 10-11-2015
DOI: 10.1111/JAN.12565
Abstract: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. A critical ethnographic design will be used, incorporating non-participant observations, in idual semi-structured and focus-group interviews as several collecting methods. Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.
A structured literature review of pain assessment and management of patients with chronic kidney disease
Publisher: Wiley
Date: 30-06-2007
DOI: 10.1111/J.1365-2702.2007.01994.X
Abstract: This paper reviews the literature concerning nurses' assessment and management of pain in adult patients with chronic kidney disease, and proposes implications for clinical practice to support the control of pain in these patients. Chronic kidney disease is a worldwide public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with kidney disease often experience pain. Optimal pain assessment and management are key clinical activities however, inadequate pain control by health professionals persists. Renal failure compounds this problem because of the small margin between pain relief and toxicity, and the patient's concomitant health problems. The literature review uses 93 articles that were published in medical- and other health-related journals, including 12 medical and pharmaceutical studies specifically relating to pain control in adults with kidney disease. Very little research has been conducted on pain in patients with kidney disease prior to requiring dialysis or kidney transplantation for survival. However, past research showed pain is common and analgesics are underprescribed in patients on dialysis in end-stage kidney disease. The review indicates that an interest in nephrotoxicity and analgesic-induced morbidity dominates over an interest in pain relief in patients with kidney disease. Most analgesics are excreted renally or by the liver, and the use of simple analgesics such as paracetamol is cautioned. Findings from the literature review highlight specific difficulties relating to effective pain control in patients with chronic kidney disease. Research is required to identify and overcome barriers to effective pain management, including the development of specific tools to facilitate interventions that optimize analgesic outcomes in patients with chronic kidney disease.
Medication communication between nurses and patients during nursing handovers on medical wards: A critical ethnographic study
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.IJNURSTU.2012.02.008
Abstract: Communication is central to safe medication management. Handover is a routine communication forum where nurses provide details about how patients' medications are managed. Previous studies have investigated handover processes as general communication forums without specific focus on medication information exchange. The effects of social, environmental and organisational contexts on handover communication and medication safety have not been explored. To examine dominant and submissive forms of communication and power relations surrounding medication communication among nurses, and between nurses and patients during handover. A critical ethnographic approach was utilised to unpack the social and power struggles embedded in handover practices. The study was conducted in two medical wards of a metropolitan teaching hospital in Melbourne, Australia from January to November 2010. All registered nurses employed in the medical wards during the study time were eligible for participation. Patients were eligible if they were able to communicate with nurses about how their medications were managed. In total, 76 nurses and 27 patients were recruited for the study after giving written consent for participation. Participant observations, field interviews, video-recordings and video reflexive focus groups were conducted. Fairclough's critical discourse analytic framework guided data analysis. Nurse coordinators' group handovers in private spaces prioritised organisational and biomedical discourses, with little emphasis on evaluating the effectiveness of medication treatment. The ward spatial structure provided an added complexity to how staff allocation occurred. Handovers involving patients in the public spaces at the bedside facilitated a partnership model in medication communication. Nurses exercised discretion during bedside handovers by discussing sensitive information away from the bedside. Handovers across different wards during patient transfers caused communication breakdowns because information was not exchanged between bedside nurses. Nurse coordinators need to relinquish organisational control of the handover practice and appreciate the contribution of bedside nurses to patient information exchange. Bedside nurses need to be provided with opportunities to raise questions during the group handover. Designated meeting spaces need to be provided to reduce interruptions to the group handover process.
Disclosing clinical adverse events to patients: Can practice inform policy?
Publisher: Wiley
Date: 26-05-2010
Comprehensive identification of medication‐related problems occurring prior to, during and after emergency department presentation: An Australian multicentre, prospective, observational study
Publisher: Wiley
Date: 22-01-2020
Abstract: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications 581 MRPs were identified 287 (49.4%, 95% confidence interval [CI] 45.3-53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9-45.5%) had at least one MRP 31.4% (95% CI 28.4-34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4-14.8%) had MRPs that could be identified or managed by screening at ED discharge. Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.
More than a fleeting conversation: managing medication communication across transitions of care
Publisher: Wiley
Date: 31-07-2022
DOI: 10.5694/MJA2.51651
Patient engagement in admission and discharge medication communication: A systematic mixed studies review
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.IJNURSTU.2019.04.009
Abstract: To synthesise peer-reviewed research evidence concerning patients' perceptions of how they engage in admission and discharge medication communication, and barriers and enablers to engagement in medication admission and discharge communication. A systematic mixed studies review. Two search strategies were undertaken including a bibliographic database search, followed by citation tracking. Fifteen studies were included in this review. Study selection and quality appraisal were undertaken independently by two reviewers. One reviewer extracted data and synthesised findings, with input from team members to check the accuracy or confirm/question findings. Three themes were found during data synthesis. In the first theme 'desiring and enacting a range of levels of engagement', patients displayed medication communication by taking responsibility for sharing accurate medication information, and by seeking out different choices during communication. The second theme 'enabling patients' medication communication' uncovered various strategies to promote patients' medication communication, including informing and empowering patients, and encouraging family involvement. The final theme, 'barriers to undertaking medication communication' included challenges enacting two-way information sharing and patients' preference. Patients view patient engagement in admission and discharge medication communication as two-way accurate information-sharing however, they sometimes experience challenges undertaking this role or prefer a passive role in information-sharing. Various strategies inform and empower patients to engage in medication communication, however, further investigation is needed of patients' experiences and acceptability of these strategies, and of further strategies that empower patients. Enabling health care professionals' communication skills may promote a patient-centred approach to medication communication, and could enable patient engagement in medication communication.
Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia
Publisher: Elsevier BV
Date: 2022
Comparison of medication policies to guide nursing practice across seven Victorian health services
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15202
Abstract: Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to in idual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.
Interprofessional and Intraprofessional Communication about Older People’s Medications across Transitions of Care
Publisher: MDPI AG
Date: 08-04-2021
Abstract: Communication breakdowns contribute to medication incidents involving older people across transitions of care. The purpose of this paper is to examine how interprofessional and intraprofessional communication occurs in managing older patients’ medications across transitions of care in acute and geriatric rehabilitation settings. An ethnographic design was used with semi-structured interviews, observations and focus groups undertaken in an acute tertiary referral hospital and a geriatric rehabilitation facility. Communication to manage medications was influenced by the clinical context comprising the transferring setting (preparing for transfer), receiving setting (setting after transfer) and ‘real-time’ (simultaneous communication). Three themes reflected these clinical contexts: dissemination of medication information, safe continuation of medications and barriers to collaborative communication. In transferring settings, nurses and pharmacists anticipated communication breakdowns and initiated additional communication activities to ensure safe information transfer. In receiving settings, all health professionals contributed to facilitating safe continuation of medications. Although health professionals of different disciplines sometimes communicated with each other, communication mostly occurred between health professionals of the same discipline. Lack of communication with pharmacists occurred despite all health professionals acknowledging their important role. Greater levels of proactive preparation by health professionals prior to transfers would reduce opportunities for errors relating to continuation of medications.
Health Professionals' Views of Communication: Implications for Assessing Performance on a Health-Specific English Language Test
Publisher: Wiley
Date: 10-05-2012
DOI: 10.1002/TESQ.26
Australian mental health nurses' attitudes to role expansion
Publisher: Hindawi Limited
Date: 04-2009
DOI: 10.1111/J.1744-6163.2009.00210.X
Abstract: This study examined the attitudes of Australian community mental health nurses toward role expansion. This study used an exploratory descriptive design. An anonymous questionnaire was completed by 154 community mental health nurses in metropolitan and rural areas to explore their attitudes to expanded practice. Nurses demonstrated an overwhelmingly positive attitude toward expanded practice and considered all stakeholders, particularly consumers, would be the beneficiaries if nurses were legally able to undertake tasks such as prescribing medication. As a large proportion of the specialist mental health workforce, mental health nurses comprise a largely underutilized resource. With consumers identified as the primary beneficiaries of expanded practice, it is likely that nurses' motivation to pursue expanded practice roles will assist in the provision of improved mental health care.
Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.IJNURSTU.2008.11.001
Abstract: Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit. A prospective, longitudinal, cohort study of infants with a predicted length of stay > or =28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis. 55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%) 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded. There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.
Erratum: Re: Oral sucrose for procedural pain in sick hospitalized infants: A randomized-controlled trial (J. Paediatr. Child Health 2003; 39: 591-7) [3]
Publisher: Wiley
Date: 09-2005
Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults
Publisher: Informa UK Limited
Date: 03-2022
DOI: 10.1080/14740338.2022.2044786
Abstract: Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Outcomes were collected prospectively via telephone follow-up and audit. Data for 232 patients (mean age 80 years) were analyzed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09 95% CI 2.38─10.85), emergency department presentation (AOR 4.69 95% CI 1.55─14.21) and the composite outcome (AOR 6.83 95% CI 3.20─14.57). The number rather than the presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45 95% CI 1.05─1.99). PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.
Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well‐being: A realist review
Publisher: Wiley
Date: 21-04-2023
DOI: 10.1111/JOCN.16730
Abstract: To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well‐being. Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter‐personal interactions in healthcare settings. Multiple in idual and organisational‐level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. Five‐step realist review method and Realist And Meta‐narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre‐ and post‐technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery social supports skills implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well‐being. Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well‐being with the implementation of new technology into healthcare settings. Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. No patient or public contribution. CRD42020131875 ( www.crd.york.ac.uk rospero/display_record.php?RecordID=131875 ).
The role of irrational thought in medicine adherence: people with diabetic kidney disease
Publisher: Wiley
Date: 11-09-2009
DOI: 10.1111/J.1365-2648.2009.05077.X
Abstract: This paper is a report of a study conducted to examine how irrational thinking affects people's adherence to multiple medicines prescribed to manage their diabetic kidney disease. Approximately 50% of people are non-adherent to their prescribed medicines and the risk of non-adherence escalates as the number of prescribed medicines increases. Adherence to prescribed medicines can slow disease progression in diabetic kidney disease. A descriptive exploratory design was used. In-depth interviews were conducted with 23 participants recruited from a nephrology outpatient clinic in Australia in 2007. Data were analysed using a 'framework' method. Participants' mean age was 59 years, they had approximately six chronic conditions in addition to their diabetic kidney disease and were prescribed a median of ten medicines daily. Two major themes of irrational thinking--heuristics and denial--and subthemes were identified. Heuristics contributed to inaccurate risk assessment and biases affecting rational judgement concerning medicines, whereas denial was used to enhance coping necessary to manage this complex health condition. Participants underestimated their health risks because they had been taking medicines for many years and preferred not to dwell on their ill health. A large amount of irrational thinking was related to maintaining the emotional strength necessary to manage their comorbid conditions as best they could. Regular assessment and support of medicine adherence throughout the disease course is necessary to avert the development of counterproductive heuristics and denial affecting medicine adherence.
Toward a terrestrial biogeographical regionalisation of the world: historical notes, characterisation and area nomenclature
Publisher: CSIRO Publishing
Date: 04-07-2022
DOI: 10.1071/SB22002
Abstract: An interim hierarchical classification (i.e. biogeographical regionalisation or area taxonomy) of the world’s terrestrial regions is provided, following the work of Morrone published in Australian Systematic Botany in 2015. Area names are listed according to the International Code of Area Nomenclature so as to synonymise redundant names. The interim global terrestrial regionalisation to the subregion level recognises 3 kingdoms, 2 subkingdoms, 8 regions, 21 subregions and 5 transition zones. No new names are proposed for the regions however, Lydekker’s Line is renamed Illiger’s Line. We note that some regions still require area classification at the subregion level, particularly the Palearctic, Ethiopian and Oriental regions. Henceforth, the following interim global regionalisation may be used as a template for further revisions and additions of new areas in the future.
Medication communication during ward rounds on medical wards: Power relations and spatial practices
Publisher: SAGE Publications
Date: 06-06-2013
Abstract: Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with in idual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.
Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis (Preprint)
Publisher: JMIR Publications Inc.
Date: 26-08-2018
Abstract: ith the large amount of material that is readily available on the internet, there are endless opportunities for electronic health–literate patients to obtain and learn new information. Although novel, a Web- or mobile-based program can be a powerful way to engage adolescents and young adults (AYAs). The ongoing engagement of AYAs with chronic disease is vital not only to empower them but also to ensure a smooth transition from pediatric to adult health care. his study aimed to evaluate the current evidence on Web- or mobile-based interventions designed for AYAs. his review was registered with PROSPERO: CRD42018096487. A systematic search of MEDLINE Complete, EMBASE, and CINAHL Complete was conducted on April 10, 2019, for studies that examined the perspectives of transition-age patients about technology-based interventions, the process involved in intervention development, or the evaluation of intervention efficacy. For each study, the comprehensiveness of reporting was appraised. The Downs and Black checklist was used for intervention efficacy trials, the Standards for Reporting Qualitative Research checklist was used for qualitative work, and a 16-item tool developed by Tong et al was used for questionnaire research. he search uncovered 29 relevant studies, which included qualitative studies (n=14), intervention efficacy studies (n=7), questionnaire studies (n=4), mixed qualitative and questionnaire studies (n=2), and a mixed qualitative and pilot randomized controlled trial study (n=1). The reporting comprehensiveness score of questionnaires was rated considerably lower (n=6, 13%-57% [2/16-8/14]) than the scores of intervention efficacy trials (n=8, 48%-85% [13/27-23/27]) and qualitative research (n=17, 40%-93% [8.5/21-19.5/21]). AYAs were receptive to obtaining information via a website or mobile app. An intervention was more likely to be perceived as useful by AYAs when there was a concerted effort to involve AYAs and subject matter experts in the process of intervention design, as opposed to relying solely on the AYAs or the experts alone. The preferred medium of intervention delivery varied greatly for AYAs, ranging from static text to audiovisual materials. However, AYAs considered being concise was the most important aspect. Across different conditions, AYAs were interested in receiving information on erse topics, such as anxiety and stress management, dealing with insurance, and having social relationships. Patients also requested for disease-specific information, such as weather forecasts and pollen levels for patients with asthma and information related to the pretransplant period for organ transplant recipients. Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management. wing to the lack of intervention efficacy trials, no conclusion can be drawn if an intervention delivered via a mobile app is better than that delivered via a website. However, through this systematic review, it is confirmed that AYAs were receptive to receiving medical information electronically.
Observation of pain assessment and management - The complexities of clinical practice
Publisher: Wiley
Date: 11-2002
DOI: 10.1046/J.1365-2702.2002.00691.X
Abstract: Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions. This observational study sought to investigate nurse-patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings. Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions. Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients. These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.
Medication communication: a concept analysis
Publisher: Wiley
Date: 04-2010
DOI: 10.1111/J.1365-2648.2009.05225.X
Abstract: This paper is a report of a concept analysis of medication communication with a particular focus on how it applies to nursing. Medication communication is a vital component of patient safety, quality of care, and patient and family engagement. Nevertheless, this concept has been consistently taken-for-granted without adequate analysis, definition or clarification in the quality and patient safety literature. A literature search was undertaken using bibliographic databases, internet search engines, and hand searches. Literature published in English between January 1988 and June 2009 was reviewed. Walker and Avant's approach was used to guide the concept analysis. Medication communication is a dynamic and complex process. Defining attributes consider who speaks, who is silent, what is said, what aspects of medication care are prioritized, the use of body language in conversations, and actual words used. Open communication occurs if there is cooperation among in iduals in implementing plans of care. Antecedents involve environmental influences such as ward culture and geographical space, and sociocultural influences such as beliefs about the nature of interactions. Consequences involve patient and family engagement in communication, evidence of appropriate medication use, the frequency and type of medication-related adverse events, and the presence of medication adherence. Empirical referents typically do not reflect specific aspects of medication communication. This concept analysis can be used by nurses to guide them in understanding the complexities surrounding medication communication, with the ultimate goal of improving patient safety, quality of care, and facilitating patient and family engagement.
Pain and anxiety management in the postoperative gastro‐surgical setting
Publisher: Wiley
Date: 03-2003
DOI: 10.1046/J.1365-2648.2003.02570.X
Abstract: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.
On the International Code of Area Nomenclature (ICAN): a reply to Zaragüeta‐Bagils et al.
Publisher: Wiley
Date: 16-07-2009
The authors reply:
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Patient-, medication- and environment-related factors affecting medication discrepancies in older patients
Publisher: Elsevier BV
Date: 12-2016
Failures in communication through documents and documentation across the perioperative pathway
Publisher: Wiley
Date: 04-05-2015
DOI: 10.1111/JOCN.12809
Abstract: To explore how communication failures occur in documents and documentations across the perioperative pathway in nurses' interactions with other nurses, surgeons and anaesthetists. Documents and documentation are used to communicate vital patient and procedural information among nurses, and in nurses' interactions with surgeons and anaesthetists, across the perioperative pathway. Previous research indicates that communication failure regularly occurs in the perioperative setting. A qualitative study was undertaken. The study was conducted over three hospitals in Melbourne, Australia. One hundred and twenty-five healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data collection commenced in January 2010 and concluded in October 2010. Data were generated through 350 hours of observation, two focus groups and 20 semi-structured interviews. A detailed thematic analysis was undertaken. Communication failure occurred owing to a reliance on documents and documentation to transfer information at patient transition points, poor quality documents and documentation, and problematic access to information. Institutional ruling practices of professional practice, efficiency and productivity, and fiscal constraint dominated the coordination of nurses', surgeons' and anaesthetists' communication through documents and documentation. These governing practices configured communication to be incongruous with reliably meeting safety and quality objectives. Communication failure occurred because important information was sometimes buried in documents, insufficient, inaccurate, out-of-date or not verbally reinforced. Furthermore, busy nurses were not always able to access information they required in a timely manner. Patient safety was affected, which led to delays in treatment and at times inadequate care. Organisational support needs to be provided to nurses, surgeons and anaesthetists so they have sufficient time to complete, locate, and read documents and documentation. Infrastructure supporting communication technologies should be implemented to enable the rapid retrieval, entry, and dispersion of information.
The impact of interruptions on medication errors in hospitals: an observational study of nurses
Publisher: Hindawi Limited
Date: 22-05-2017
DOI: 10.1111/JONM.12486
Abstract: To explore interruptions during medication preparation and administration and their consequences. Although not all interruptions in nursing have a negative impact, interruptions during medication rounds have been associated with medication errors. A non-participant observational study was undertaken of nurses conducting medication rounds. Fifty-six medication events (including 101 interruptions) were observed. Most medication events (99%) were interrupted, resulting in nurses stopping medication preparation or administration to address the interruption (mean 2.5 minutes). The mean number of interruptions was 1.79 (SD 1.04). Thirty-four percent of medication events had at least one procedural failure, while 3.6% resulted in a clinical error. Our study confirmed that interruptions occur frequently during medication preparation and administration, and these interruptions were associated with procedural failures and clinical errors. Nurses were the primary source of interruptions with interruptions often being unrelated to patient care. This study has confirmed that interruptions are frequent and result in clinical errors and procedural failures, compromising patient safety. These interruptions contribute a substantial additional workload to medication tasks. Various interventions should be implemented to reduce non-patient-related interruptions. Medication systems and procedures are advocated, that reduce the need for joint double-checking of medications, indirectly avoiding interruptions.
Sedation management in Australian and New Zealand intensive care units: Doctors' and nurses' practices and opinions
Publisher: AACN Publishing
Date: 05-2010
DOI: 10.4037/AJCC2009541
Abstract: Objective To explore the use of sedatives and analgesics, tools for scoring level of sedation, sedation and pain protocols, and daily interruptions in sedation in Australian and New Zealand intensive care units and to examine doctors’ and nurses’ opinions about the sedation management of critically ill patients. Methods A cross-sectional Internet-based survey design was used. In total, 2146 members of professional critical care organizations in Australia and New Zealand were e-mailed the survey during a 4-month period in 2006 through 2007. Results Of 348 members (16% response rate) who accessed the survey, 246 (71%) completed all sections. Morphine, fentanyl, midazolam, and propofol were the most commonly used medicines. Newer medicines, such as dexmedetomidine and remifentanil, and inhalant medications, such as nitrous oxide and isoflurane, were rarely used by most respondents. Respondents used protocols to manage sedatives (54%) and analgesics (51%), and sedation assessment tools were regularly used by 72%. A total of 62% reported daily interruption of sedation 23% used daily interruption for more than 75% of patients. A disparity was evident between respondents’ opinions on how deeply patients were usually sedated in practice and how deeply patients should ideally be sedated. Conclusions Newer medications are used much less than are traditional sedatives and analgesics. Sedation protocols are increasingly used in Australasia, despite equivocal evidence supporting their use. Similarly, daily interruption of sedation is common in management of patients receiving mechanical ventilation. Research is needed to explore contextual and personal factors that may affect sedation management.
Patient and family engagement with hospital electronic systems: Juggling for co-existence
Publisher: Elsevier BV
Date: 03-2017
Delirium screening tools in the post-anaesthetic care unit: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 03-01-2022
DOI: 10.1007/S40520-021-02057-W
Abstract: Delirium is a serious neurocognitive disorder among surgical patients in the post-anaesthetic care unit (PACU). Despite the development of screening tools to identify delirium, it is not clear which tool is the most accurate and reliable in assessing delirium in the PACU. To examine the diagnostic accuracy of delirium screening tools used in the PACU. A systematic literature search of CINAHL, MEDLINE, Embase, PsycINFO and Scopus was conducted, using MeSH terms and relevant keywords, from databases establishment to 23 April 2021. Studies were assessed for methodological quality using the Standards for Reporting of Diagnostic Accuracy Studies (STARD) tool. A total of 1503 studies were screened from the database search, four studies met the inclusion criteria for this review. Six delirium screening tools used in the PACU were identified in the selected studies. Three studies evaluated screening tools in adult surgical patients without cognitive impairment and dementia. Two studies evaluated screening tools among patients who were scheduled for elective surgery. Review results indicated that two tools, the 4A's test (4AT sensitivity 96% specificity 99%) and the 3 min diagnostic interview for the Confusion Assessment Method (3D-CAM sensitivity 100% specificity 88%), had greatest validity and reliability as a screening tool for detecting delirium in the PACU. Results indicate the 4AT and the 3D-CAM are most accurate screening tools to detect delirium in the PACU. Further research is required to validate those tools among a broader surgical population, including patients with cognitive impairment, dementia and those undergoing emergency surgical procedures.
Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic
Publisher: Elsevier BV
Date: 05-2022
Agency nursing work in acute care settings: Perceptions of hospital nursing managers and agency nurse providers
Publisher: Wiley
Date: 06-06-2003
DOI: 10.1046/J.1365-2702.2003.00745.X
Abstract: There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. In idual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of in idual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 in iduals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how ergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.
Trajectory of sedation assessment and sedative use in intubated and ventilated patients in intensive care: A clinical audit
Publisher: Elsevier BV
Date: 09-2016
How safe is virtual healthcare?
Publisher: Oxford University Press (OUP)
Date: 31-03-2022
Professional journalling over time: position of the inside nurse–researcher in intensive care
Publisher: Elsevier BV
Date: 04-2000
Abstract: The purpose of this paper is to examine the use of professional journalling in an intensive care unit. In particular, this paper explores the power and contextual relations that shaped nurse-nurse and nurse-doctor decision-making, from the author's perspective as the inside nurse-researcher. A variety of research methods were used for this study, including professional journalling, participant observation, and in idual and focus group interviews. The author also worked as a clinical nurse specialist, as the inside nurse-researcher, in the unit under investigation. The results indicated that the power and contextual relations constructing nurse-nurse and nurse-doctor decision-making focused on two major issues. These concerned: drawing on particular forms of knowledge and acquiring differential visibility by the nurse in decision-making. The study demonstrated that professional journalling is an effective research method for helping nurses to question decision-making critically, not for examining the position of an inside nurse-researcher, and for supporting data obtained from other research methods.
Medication error trends and effects of person‐related, environment‐related and communication‐related factors on medication errors in a paediatric hospital
Publisher: Wiley
Date: 31-08-2018
DOI: 10.1111/JPC.14193
Towards patient-centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study
Publisher: Wiley
Date: 06-12-2022
DOI: 10.1111/JOCN.16162
Abstract: Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post‐discharge period. Little attention has been paid to exploring communication strategies facilitating patient‐centred medication communication at transitions of care from a discourse‐analytic perspective. To explore, through a discursive lens, strategies that enable patient‐centred medication communication at transitions of care. A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. Patient preferences and beliefs about medications were identified as important characteristics of patient‐centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications informative talk clarifying patients' concerns and encouraging talk for enhancing shared decision‐making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision‐making processes are crucial to patient‐centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.
From Other Journals December 2021
Publisher: Wiley
Date: 16-11-2021
Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis
Publisher: JMIR Publications Inc.
Date: 07-02-2023
DOI: 10.2196/39384
Abstract: In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic. This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia. We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed. Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations.
Nurses' strategies for managing pain in the postoperative setting
Publisher: Elsevier BV
Date: 03-2005
Snap‐shots of live theatre: the use of photography to research governance in operating room nursing
Publisher: Wiley
Date: 20-05-2003
DOI: 10.1046/J.1440-1800.2003.00166.X
Abstract: The use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of this paper is on how photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three 'snap-shots' of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims.
Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients
Publisher: Wiley
Date: 17-07-2023
DOI: 10.1111/BCP.15838
Abstract: Older adults are vulnerable to medication‐related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes. RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria. In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30‐day and 90‐day readmission and 3‐month and 12‐month mortality. Central nervous system sychotropics and fall risk PIMs were significantly associated with 30‐day hospital readmission (adjusted odds ratio [AOR] 1.53 95% confidence interval [CI] 1.09–2.15), and cardiovascular PPOs with 12‐month mortality (AOR 1.34 95% CI 1.00–1.78). Increased number of discharge medications was significantly associated with 30‐day (AOR 1.03 95% CI 1.00–1.07) and 90‐day (AOR 1.06 95% CI 1.03–1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90‐days after geriatric rehabilitation discharge. The number of discharge medications, central nervous system sychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.
Effectiveness of Primary Health Care Services in Addressing Mental Health Needs of Minority Refugee Population in New Zealand
Publisher: Informa UK Limited
Date: 03-2017
DOI: 10.1080/01612840.2017.1283375
Abstract: Many people are displaced from their country of origin and become refugees, mostly due to armed conflicts, political violence and human rights abuse. Refugees have complex mental, physical, and social health problems related to their traumatic background and the experiences they have endured during their refugee journey. The aim of this qualitative exploratory study was to examine the effectiveness of primary health care services in addressing mental health needs of Bhutanese refugee women resettled in New Zealand. This study included focus group discussion with Bhutanese women and men followed by interviews with health service providers. The findings of this study highlighted inadequacies and constraints in addressing Bhutanese refugee women's mental health needs in New Zealand and provided evidence for recommendations to address these inadequacies.
Nurse–doctor interactions during critical care ward rounds
Publisher: Wiley
Date: 20-07-2001
DOI: 10.1046/J.1365-2702.2001.00504.X
Abstract: This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. Data collection methods involved professional journalling, participant observation, and in idual and focus group interviews with the six participating nurses. Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.
Interventions to improve medication adherence in adult kidney transplant recipients: A systematic review
Publisher: Oxford University Press (OUP)
Date: 20-06-2015
DOI: 10.1093/NDT/GFU204
Abstract: In kidney transplantation, adherence to immunosuppressive therapy is paramount for long-term graft survival. This systematic review aimed to assess the effectiveness of interventions to improve medication adherence in adult kidney transplantation. Eight electronic databases were searched from inception to November 2013. Only primary intervention studies, which reported measurement of adherence to immunosuppressive medications after kidney transplantation, were included. The quality of all studies was assessed using the Consolidated Standards of Reporting Trials and Transparent Reporting of Evaluations with Non-randomized Designs checklists. A synthesis was undertaken to tease out the domains targeted by interventions: (i) educational/cognitive, (ii) counselling/behavioural, (iii) psychologic/affective and (iv) financial support. For each study, key information, such as population, location, methods of measurements, comparison group, type of intervention and outcomes, were extracted and tabulated. Twelve intervention studies were identified. Quality of studies ranged from 16.0 to 80.5%. Effective interventions were implemented for 3, 6 and 12 months. Medication adherence rates were greatly enhanced when multidimensional interventions were implemented whereas one-off feedback from a nurse and financial assistance programmes offered little improvement. Dose administration aids when used in conjunction with self-monitoring also improved adherence. The number of patients who had a drug holiday (at least 1-day interval without a dose) was higher in a once-daily regimen than a twice-daily regimen. The findings of this review suggest an intervention targeting behavioural risk factors or a combination of behavioural, educational and emotional changes is effective in enhancing medication adherence. Effectiveness of an intervention may be further enhanced if patients are encouraged to participate in the development process.
The problem of postoperative pain: Issues for future research
Publisher: Wiley
Date: 09-11-2004
DOI: 10.1111/J.1440-172X.2004.00487.X
Abstract: Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.
Medication-based Refill Adherence Among Pregnant Women Living With HIV in Nigeria
Publisher: Elsevier BV
Date: 11-2020
Medication errors in hospitalised children
Publisher: Wiley
Date: 06-10-2014
DOI: 10.1111/JPC.12412
Abstract: This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children's hospital, and to examine the types, causes and contributing factors of medication errors. A retrospective clinical audit was undertaken of medication errors reported to an online incident facility at an Australian children's hospital over a 4-year period. A total of 2753 medication errors were reported over the 4-year period, with an overall medication error rate of 0.31% per combined admission and presentation, or 6.58 medication errors per 1000 bed days. The two most common severity outcomes were: the medication error occurred before it reached the child (n = 749, 27.2%) and the medication error reached the child who required monitoring to confirm that it resulted in no harm (n = 1519, 55.2%). Common types of medication errors included overdose (n = 579, 21.0%) and dose omission (n = 341, 12.4%). The most common cause relating to communication involved misreading or not reading medication orders (n = 804, 29.2%). Key contributing factors involved communication relating to children's transfer across different clinical settings (n = 929, 33.7%) and the lack of following policies and procedures (n = 617, 22.4%). More than half of the reports (72.5%) were made by nurses. Future research should focus on implementing and evaluating strategies aimed at reducing medication errors relating to analgesics, anti-infectives, cardiovascular agents, fluids and electrolytes and anticlotting agents, as they are consistently represented in the types of medication errors that occur. Greater attention needs to be placed on supporting health professionals in managing these medications.
Utilisation of general practitioner telehealth services during the COVID-19 pandemic in regional Victoria, Australia (Preprint)
Publisher: JMIR Publications Inc.
Date: 09-05-2022
Abstract: n March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the coronavirus disease 2019 pandemic. his study sought to assess utilisation patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic, with or without lockdown) in regional Victoria, Australia. e conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (videoconference vs. telephone) and by geographical, consumer and consultation characteristics were analysed. elehealth comprised 25.8% of GP consultations over the two-year period (n total = 2,025,615). After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (from 0% to 15% of all consultations), with a peak in August 2020 (55%). Thereafter, utilisation declined steadily to 31% in January 2021 and tapered off to 28% in June 2021. Telephone services and shorter consults were the most dominant form, and those aged 15-64 years had higher telehealth utilisation rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdown, and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. ur findings support the continuation of telehealth use in rural and regional Australia post-pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consults.
Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings
Publisher: Wiley
Date: 04-09-2015
DOI: 10.1111/HEX.12255
The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: A within-trial analysis of the border trial
Publisher: Wiley
Date: 06-10-2014
DOI: 10.1111/IWJ.12160
Quality of life assessment in children commencing home INR self-testing
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.THROMRES.2013.05.011
Abstract: Management of oral anticoagulant therapy (OAT) in children is complex and frequent testing of the International Normalised Ratio (INR) is a significant burden. This study evaluates the impact of a home INR self-testing (home ST) program on the quality of life (QoL) of children and their families. The aim of the study was to determine if participation in a home ST program improves QoL for children requiring long-term OAT and their families. Children aged eight to 18 years requiring long-term OAT and parents of children participated. Quantitative methods comprised three validated QoL questionnaires the anticoagulation specific PAC QL©, the PedsQL™ and the PedsQL FIM™. Questionnaires were completed before commencing home ST and 6-12 months later. Qualitative methods consisted of open-ended questions which participants answered when completing the questionnaires for the second time. Results of INRs tested at home were collected. Fifty-five parents and 35 children participated. The percentage of time the children's INRs were in their target therapeutic range was 71.3. Parents reported statistically significant improvements in QoL for themselves (mean increase 6.9), their family (mean increase 8.6) and their child (mean increase 11.1) following the commencement of home ST (difference p≤0.003 on all questionnaires). The children did not report a statically significant improvement in QoL. Parents reported significant improvement for their child's QoL, their QoL and the families' function following commencement of home ST. Children did not report a significant improvement in their QoL, but clearly identified satisfaction with home ST.
Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before‐and‐after study
Publisher: Wiley
Date: 07-09-2015
DOI: 10.1111/JEP.12445
Abstract: The implementation of automated dispensing cabinets (ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments (EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P = 0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting.
Medication errors and adverse drug events in an intensive care unit
Publisher: Elsevier BV
Date: 02-2007
Health care professionals’ views of implementing a policy of open disclosure of errors
Publisher: SAGE Publications
Date: 10-2008
DOI: 10.1258/JHSRP.2008.008062
Abstract: To understand the views of doctors, nurses, allied health professionals and health managers of open disclosure of medical errors. Semi-structured interviews were conducted with 131 health professionals to understand their experiences of implementing open disclosure in 21 providers in Australia. Health professionals are positive about open disclosure and are applying the model to patient- clinician communication encounters more generally. Workforce and systems competencies enable clinicians and health service managers to implement open disclosure principles and practices, although a propensity to hide errors, wavering commitment and to exacerbate the problem inhibits implementation as policy intends. The gap between policy objectives and their implementation limits the benefits to health professionals. Health services must develop organizing capabilities if open disclosure is to be implemented as intended. Activities should identify and address factors that impede implementation and enable workforce and system competencies to develop. These activities will allow health services to adapt central open disclosure policy to local conditions and to embed its principles and practices organization-wide.
Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting
Publisher: Wiley
Date: 22-08-2016
DOI: 10.1111/JOCN.13360
Abstract: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.
Medication use across transition points from the emergency department: Identifying factors associated with medication discrepancies
Publisher: SAGE Publications
Date: 20-10-2009
DOI: 10.1345/APH.1M206
Abstract: As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress. To identify the patient-, environment-, and medication-related factors involving unexplained medication discrepancies across transition points after ED presentation. Using a retrospective chart review design, a stratified, random s ling of data was undertaken over a 12-month period. Information was obtained from an electronic administrative database and medical records as patients moved from the ED to another transition point of care. Medication discrepancies were classified into 2 outcome groups: (1) no discrepancies and situations in which discrepancies were adequately explained and (2) discrepancies that had no adequate explanation. For the 12-month period, 210 randomly selected patients were included 73 (34.8%) had at least one unexplained medication discrepancy. Binary logistic regression modeling showed 4 factors that were statistically significant in determining the incidence of at least one unexplained medication discrepancy. Benefit card holders (in iduals who receive benefits from government insurance programs comparable to the US-based Medicare and Medicaid initiatives, which include the elderly, the disabled, low income earners, and unemployed persons) had 3.73 greater odds of experiencing an unexplained medication discrepancy (95% CI 1.72 to 8.07 p = 0.001). Patients prescribed 5 or more drugs at discharge from the ED had 12.22 greater odds of having at least one unexplained medication discrepancy (95% CI 5.52 to 27.08 p 0.001). Patients who were first seen by a physician within 1 hour of a change in working shift had 3.70 greater odds of having an unexplained medication discrepancy (95% CI 1.67 to 8.18 p = 0.001). For each additional minute of wait time for a physician, the odds of having an unexplained medication discrepancy increased by a factor of 1.01 (95% CI 1.00 to 1.01 p = 0.042). Patient-, environment-, and drug-related factors contribute to the risk of medication discrepancies across transition points from the ED.
Medication trends and documentation of pain management following surgery
Publisher: Wiley
Date: 03-2003
DOI: 10.1046/J.1442-2018.2003.00140.X
Abstract: The purpose of the present study was to examine prescribing and administering activities for sedative and analgesic medication in postoperative patients, and to describe nurses' documentation practices for pain management in nursing notes. A prospective audit was undertaken of medication order charts and nursing notes of 100 patients on the operation day and over the first four days following surgery. Almost all patients received some form of infusion, while the use of 'as required' analgesics varied from one-third to over two-thirds of patients during the postoperative period. Few patients were prescribed fixed-order analgesics or sedative medications. An audit of nursing entries found that nurses had documented inadequately in four major areas: pain assessment, use of non-pharmacological interventions, use of pharmacological interventions, and outcome of interventions. The findings contribute to improving our understanding of nurses' pain management and identify the need to use clinical judgement that is in idualized to patients' needs.
Foucault could have been an operating room nurse
Publisher: Wiley
Date: 25-07-2002
DOI: 10.1046/J.1365-2648.2002.02292.X
Abstract: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.
The concept of teamwork does not fully explain how interprofessional work occurs in intensive care
Publisher: Elsevier BV
Date: 11-2015
Challenges and opportunities of undertaking a video ethnographic study to understand medication communication
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/JOCN.12948
Abstract: To examine the challenges and opportunities of undertaking a video ethnographic study on medication communication among nurses, doctors, pharmacists and patients. Video ethnography has proved to be a dynamic and useful method to explore clinical communication activities. This approach involves filming actual behaviours and activities of clinicians to develop new knowledge and to stimulate reflections of clinicians on their behaviours and activities. However, there is limited information about the complex negotiations required to use video ethnography in actual clinical practice. Discursive paper. A video ethnographic approach was used to gain better understanding of medication communication processes in two general medical wards of a metropolitan hospital in Melbourne, Australia. This paper presents the arduous and delicate process of gaining access into hospital wards to video-record actual clinical practice and the methodological and ethical issues associated with video-recording. Obtaining access to clinical settings and clinician consent are the first hurdles of conducting a video ethnographic study. Clinicians may still feel intimidated or self-conscious in being video recorded about their medication communication practices, which they could perceive as judgements being passed about their clinical competence. By thoughtful and strategic planning, video ethnography can provide in-depth understandings of medication communication in acute care hospital settings. Ethical issues of informed consent, patient safety and respect for the confidentiality of patients and clinicians need to be carefully addressed to build up and maintain trusting relationships between researchers and participants in the clinical environment. By prudently considering the complex ethical and methodological concerns of using video ethnography, this approach can help to reveal the unpredictability and messiness of clinical practice. The visual data generated can stimulate clinicians' reflexivity about their norms of practice and bring about improved communication about managing medications.
Inappropriate medication use in hospitalised oldest old patients across transitions of care
Publisher: Springer Science and Business Media LLC
Date: 10-01-2019
DOI: 10.1007/S40520-018-01114-1
Abstract: Oldest old patients aged 85 years and over are at risk of experiencing potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) across transitions of care. Geriatricians also face enormous challenges in prescribing medications for these patients. A mixed-methods, sequential explanatory design was undertaken of electronic medical records and semi-structured interviews with geriatricians at a public teaching hospital. Data were collected at four time points using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START). Of 249 patients, the prevalence of at least 1 PIM varied between 36.9 and 51.0%, while the prevalence of at least 1 PPO varied between 36.9 and 44.6%. The most common PIM was use of proton pump inhibitors while the most common PPO was omission of vitamin D supplements in housebound patients or patients experiencing falls. Poisson regression analysis showed that PIMs were significantly associated with use of mobility aids, 1.430 (95% CI 1.109-1.843, p = 0.006), and number of medications prescribed at admission, 1.083 (95% CI 1.058-1.108, p < 0.001). PPOs were significantly associated with comorbidities, 1.172 (95% CI 1.073-1.280, p < 0.001), medications prescribed at admission, 0.989 (95% CI 0.978-0.999, p = 0.035), and length of stay, 1.004 (95% CI 1.002-1.006, p < 0.001). Geriatrician interviews (N = 9) revealed medication-related, health professional-related and patient-related challenges with managing medications. Inappropriate prescribing is common in oldest old patients. Greater attention is needed on actively de-prescribing medications that are not beneficial and commencing medications that would be advantageous. Tailored strategies for improving prescribing practices are needed.
Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy
Publisher: Wiley
Date: 30-09-2015
DOI: 10.1111/JOCN.12700
Abstract: To examine the perceptions of a group of culturally and linguistically erse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically erse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically erse people to improve their medication self-efficacy. A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically erse backgrounds have the appropriate skills to self-manage their complex medical conditions. Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.
Nurse management of vasoactive medications in intensive care: A systematic review.
Publisher: Wiley
Date: 28-11-2020
DOI: 10.1111/JOCN.15093
Abstract: To investigate how intensive care nurses prepare, initiate, administer, titrate, and wean vasoactive medications. The management of vasoactive medications is core business for intensive care nurses, but little is known on how nurses manage these ubiquitous and potentially harmful medications. A systematic review of the literature with narrative synthesis of data. The databases CINAHL Complete, Medline Complete and EMBASE were searched from 1965 to January 2019 with keywords under five concept headings and in a variety of configurations. This systematic review was conducted according to the PRISMA guidelines. Studies were assessed for quality and bias, and a modified narrative synthesis was used to analyse data, investigate findings and explore relationships within and between studies. The review identified 13 studies: two observational studies, two pre and post intervention studies, four survey studies, two quasi-experimental studies, one longitudinal time series, one prospective controlled trial, and one interview incorporating content analysis. Four studies on preparing and initiating vasoactive medications described a lack of standardisation in infusion preparation and inconsistencies in dosing units and patient weights. Five of six studies on vasoactive medication administration examined nurses' use of syringe changeovers to reduce patient haemodynamic compromise and there were three studies on titration and weaning. Further research on nurse management of vasoactive medications is needed to develop an evidence base for specialist education and standardised practices aimed at reducing risk for patient harm. Nurses working in intensive care units in many parts of the world are responsible for the management of vasoactive medications. There is great variation in practices that include preparation, initiation, administration, titration and weaning of vasoactive medications, which increases the risk for medication errors and adverse events in a vulnerable population of critically ill patients.
Pain assessment and management in critically ill intubated patients: a retrospective study
Publisher: Elsevier BV
Date: 08-2004
Trials and tribulations with electronic medication adherence monitoring in kidney transplantation
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.SAPHARM.2015.10.010
Abstract: Medication adherence in kidney transplantation is critical to prevent graft rejection. Testing interventions designed to support patients to take their prescribed medications following a kidney transplant require an accurate measure of medication adherence. In research, the available methods for measuring medication adherence include self-report, pill counts, prescription refill records, surrogate measures of medication adherence and medication bottles with a microchip-embedded cap to record bottle openings. Medication bottles with a microchip-embedded cap are currently regarded as the gold standard measure. This commentary outlines the challenges in measuring medication adherence using electronic medication monitoring of kidney transplant patients recruited from five sites. The challenges included obtaining unanimous stakeholder support for using this method, agreement on an index medication to measure, adequate preparation of the patient and training of pharmacy staff, and how to analyze data when periods of time were not recorded using the electronic adherence measure. Provision of this information will enable hospital and community pharmacists to implement approaches that promote the effective use of this adherence measure for optimal patient outcomes.
Pharmacists’ Interprofessional Communication About Medications in Specialty Hospital Settings
Publisher: Informa UK Limited
Date: 15-10-2015
DOI: 10.1080/10410236.2014.919697
Abstract: Effective communication between pharmacists, doctors, and nurses about patients' medications is particularly important in specialty hospital settings where high-risk medications are frequently used. This article describes the nature of communication about medications that occurs between pharmacists and other health professionals, including doctors and nurses, in specialty hospital settings. Semistructured interviews with, and participant observations of, pharmacists, nurses, and doctors were conducted in specialty settings of an Australian public, metropolitan teaching hospital. Twenty-one in iduals working in the settings of emergency care, oncology care, intensive care, cardiothoracic care, and perioperative care were interviewed. In addition, participant observations of 56 in iduals were conducted in emergency care, oncology care, intensive care, and cardiothoracic care. Detailed thematic analysis of the data was performed. Across all of the settings, pharmacy was less visible than medicine and nursing in terms of pharmacists' work performed, pharmacy documentation and resources, and pharmacists' physical visibility. Pharmacists, doctors, and nurses largely worked alongside one another rather than with each other. When collaboration occurred, the professional groups engaged in mostly reactive communication to accomplish specific medication tasks that needed completing. Interprofessional differences in attitudes toward medications and medication management communication behaviors were evident. Pharmacists need to engage in more proactive communication in order to reduce the risk of medication errors occurring.
Medication Adherence in People of Culturally and Linguistically Diverse Backgrounds: A Meta-Analysis
Publisher: SAGE Publications
Date: 04-05-2010
DOI: 10.1345/APH.1M572
The role of documents and documentation in communication failure across the perioperative pathway. A literature review
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.IJNURSTU.2011.05.009
Abstract: Communication practices of healthcare professionals have been strongly implicated in the cascade of events that unfold into poor outcomes for surgical patients. The purpose of this paper is to explore the role of documents and documentation in communication failure among healthcare professionals across the perioperative pathway. The perioperative pathway consists of 3 interconnecting, but geographically distinct domains: preoperative, intraoperative and postoperative. A comprehensive search of the literature was undertaken to provide a focused analysis and appraisal of past research. Electronic databases searched included the Cochrane Database of Systematic Reviews, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and PsycINFO from 1990 to end February 2011. Additionally, references of retrieved articles were manually examined for papers not revealed via electronic searches. Content analysis was used to draw out major themes and summarise the information. Fifty-nine papers were selected based on their relevance to the topic. The results highlight that documentation such as surgeons' operation notes, anaesthetists' records and nurses' perioperative notes, deficient in the areas of design, quality, accuracy and function, contributed to the development of communication failure among healthcare professionals across the perioperative pathway. The consequences of communication failure attributable to documentation ranged from inefficiency, delays and increased workload, through to serious adverse patient events such as wrong site surgery. Documents that involve the coordination of verbal communication of multidisciplinary surgical teams, such as preoperative checklists, also influenced communication and surgical patient outcomes. Effective communication among healthcare professionals is vital to the delivery of safe patient care. Multiple documents utilised across the perioperative pathway have a critical role in the communication of information essential to the immediate and ongoing care of surgical patients. Failure in the communicative function of documents and documentation impedes the transfer of information and contributes to the cascade of events that results in compromised patient safety and potentially adverse patient outcomes.
Medication management by graduate nurses: Before, during and following medication administration
Publisher: Wiley
Date: 05-05-2004
Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR Medication Adherence & Persistence Special Interest Group
Publisher: Springer Science and Business Media LLC
Date: 05-2013
DOI: 10.1007/S00198-013-2364-Z
Abstract: This study aims to systematically review, critically appraise and identify from the published literature, the most effective interventions to improve medication adherence in osteoporosis. A literature search using Medline, EMBASE, Cochrane library, and Cumulative Index to Nursing and Allied Health Literature was undertaken to identify prospective studies published between January 1, 1999 and June 30, 2012. We included studies on adult users of osteoporosis medications that tested a patient adherence intervention (e.g., patient education, intensified patient care, different dosing regimens) and reported quantitative results of adherence. The Delphi list was modified to assess the quality of studies. Of 113 articles identified, 20 studies fulfilled the inclusion criteria. The most frequent intervention was education (n = 11) followed by monitoring/supervision (n = 4), drug regimens (n = 2), drug regimens and patient support (n = 1), pharmacist intervention (n = 1), and electronic prescription (n = 1). Although patient education improved medication adherence in four studies, two large-scale randomized studies reported no benefits. Simplification of dosing regimens (with and without patient support program) was found to have a significant clinical impact on medication adherence and persistence. Monitoring/supervision showed no impact on medication persistence while electronic prescription and pharmacist intervention increased medication adherence or persistence. In conclusion, this review found that simplification of dosing regimens, decision aids, electronic prescription, or patient education may help to improve adherence or persistence to osteoporosis medications. We identified wide variation of quality of studies in the osteoporosis area. The efficacy of patient education was variable across studies, while monitoring/supervision does not seem an effective way to enhance medication adherence or persistence.
Homologous recombination is facilitated in starving populations of Pseudomonas putida by phenol stress and affected by chromosomal location of the recombination target
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.MRFMMM.2012.07.004
Abstract: Homologous recombination (HR) has a major impact in bacterial evolution. Most of the knowledge about the mechanisms and control of HR in bacteria has been obtained in fast growing bacteria. However, in their natural environment bacteria frequently meet adverse conditions which restrict the growth of cells. We have constructed a test system to investigate HR between a plasmid and a chromosome in carbon-starved populations of the soil bacterium Pseudomonas putida restoring the expression of phenol monooxygenase gene pheA. Our results show that prolonged starvation of P. putida in the presence of phenol stimulates HR. The emergence of recombinants on selective plates containing phenol as an only carbon source for the growth of recombinants is facilitated by reactive oxygen species and suppressed by DNA mismatch repair enzymes. Importantly, the chromosomal location of the HR target influences the frequency and dynamics of HR events. In silico analysis of binding sites of nucleoid-associated proteins (NAPs) revealed that chromosomal DNA regions which flank the test system in bacteria exhibiting a lower HR frequency are enriched in binding sites for a subset of NAPs compared to those which express a higher frequency of HR. We hypothesize that the binding of these proteins imposes differences in local structural organization of the genome that could affect the accessibility of the chromosomal DNA to HR processes and thereby the frequency of HR.
The transplant team's support of kidney transplant recipients to take their prescribed medications: a collective responsibility
Publisher: Wiley
Date: 06-06-2016
DOI: 10.1111/JOCN.13267
Abstract: To obtain an understanding of how health professionals support the kidney transplant patient to take their medications as prescribed long term. Kidney transplantation requires stringent adherence to complex medication regimens to prevent graft rejection and to maintain general well-being. Medication nonadherence is common in kidney transplantation, emerging in the first few months post-transplantation, leading to poor patient outcomes. Exploratory qualitative design. Five focus groups were conducted with a total of seven renal nurse transplant coordinators, two renal transplant nurse unit managers, seven nephrologists, seven pharmacists, four social workers, and one consumer representative representing all five hospitals offering adult kidney transplantation in Victoria, Australia in 2014. The views of two general practitioners who were unable to attend the focus groups were incorporated into the data set. All data underwent thematic analysis. Analysis revealed that adherence was a collective responsibility involving the whole of the transplant team and the patient via education blitz in hospital, identifying and managing nonadherence, promotion of self-advocacy, and the partnership between the patient and health professional. Patients were directed how to take their complex medications to be self-empowered, yet the partnership between the patient and health professional limited the patient's voice. Although medication adherence was a collective responsibility, communication was often one-way chiefly as a result of staffing and time constraints, hindering effective partnerships necessary for medication adherence. Expert skills in communication and adherence counselling are necessary to identify barriers affecting medication adherence. Patients need to be systematically screened, prepared and supported long-term within an accommodating healthcare system for the reality of caring for their transplanted kidney. Kidney transplant recipients require systematic preparation and quality long-term follow-up to adhere to their prescribed medications.
Corticosteroid-induced psychiatric disturbances: It is time for pharmacists to take notice
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.SAPHARM.2015.05.012
Abstract: Corticosteroids are widely used to relieve signs and symptoms arising from many diseases, including common inflammatory and autoimmune disorders affecting a number of organ systems. However, corticosteroids also induce significant adverse effects in particular, a range of severe psychiatric adverse effects may occur including delirium, depression, mania, psychosis and cognitive/memory impairment. These adverse effects occur in up to 60% of patients taking corticosteroids and recent studies show an increased rate of psychopathologies in this population. Long-term adverse effects on mood and behavior are severely debilitating, thereby influencing the quality of life, employment and health status of in iduals taking corticosteroids. Strategies used to manage corticosteroid-induced psychiatric disturbances through psychotropic drugs vary significantly. This commentary summarizes existing literature on mechanisms underlying corticosteroid-induced psychiatric adverse effects and evidence associated with using psychotropic drugs to manage these effects. Despite its importance, there is an absolute dearth in the literature examining pharmacists' understanding and perceptions of psychiatric adverse effects of corticosteroids. Educational programs need to be implemented so that pharmacists can counsel patients about how to recognize corticosteroid-induced psychiatric disturbances. Physicians do not consistently alert patients to watch for behavioral changes, and patients may feel that mood changes they experience fall within the category of 'normal behavior,' and thus are less likely to report them. Given that patients taking corticosteroids usually have complex medical histories, discussions of adverse effects with pharmacists are vital to improve health outcomes in this population.
Agency-nursing work: perceptions and experiences of agency nurses
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S0020-7489(02)00085-8
Abstract: This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, in idual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.
Associations between inappropriate medication use and (instrumental) activities of daily living in geriatric rehabilitation inpatients: RESORT study
Publisher: Springer Science and Business Media LLC
Date: 09-08-2022
DOI: 10.1007/S40520-021-01946-4
Abstract: Inappropriate medication use can affect functional independence in older adults. The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients. A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge. A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944). Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.
Governing time in operating rooms
Publisher: Wiley
Date: 03-04-2006
DOI: 10.1111/J.1365-2702.2006.01362.X
Abstract: This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as in iduals compete for control of its use. The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include questioning judgment and timing, controlling speed, estimating surgeons' use of time and coping with different perceptions of time. Time and speed were hotly contested by nurses. They used their personal knowledge of in idual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in in idual operating rooms. Knowledge of in idual surgeons was a source of power for operating room nurses. Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better.
Governing the surgical count through communication interactions: implications for patient safety
Publisher: BMJ
Date: 10-2006
Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers
Publisher: Wiley
Date: 18-11-2002
DOI: 10.1046/J.1365-2648.2002.02407.X
Abstract: Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. The study was limited by the fact that the final s le was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.
Patients' reports of adverse events: a data linkage study of Australian adults aged 45 years and over
Publisher: BMJ
Date: 29-03-2017
DOI: 10.1136/BMJQS-2016-006339
Abstract: Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE. Data linkage was used to identify a random s le of 20 000 participants in the 45 and Up Cohort Study, out of 267 153 adults aged 45 years and over, who had been hospitalised in the prior 6 months. A cross-sectional survey was administered to these patients to capture their experiences, including whether they had an AE and received honest communication about it. Of the 18 993 eligible participants, 7661 completed surveys were received (40% response rate) and 474 (7%) reported having an AE. Most AEs related to clinical processes and procedures (33%), or medications and intravenous fluids (21%). Country of birth and admission through emergency were significant predictors of the occurrence of an event. An earlier admission in the prior 6 months or a transfer to another healthcare facility was also associated with more AEs. Of those who suffered an AE, 58% reported serious or moderate effects. Given the exclusions in our s le population (under 45 years), the AE rate reported by patients of 7% is similar to the approximately 10% rate reported in the general population by retrospective medical record reviews. AE data that include patient experience may provide contextual information currently missing. Capturing and using patient experience data more effectively is critical there may be opportunities for applying co-design methodology to improve the management of AEs and be more responsive to patients' concerns.
Managing pain in chronic kidney disease: patient participation in decision‐making
Publisher: Wiley
Date: 2008
DOI: 10.1111/J.1365-2648.2007.04488.X
Abstract: This paper is a report of a study to examine how decisions about managing pain were made between patients with chronic kidney disease and nurses, what affected the decision style and the types of analgesics and adjuvant therapies given for pain relief in relation to a particular decision style. While pain often accompanies chronic kidney disease, little is known of how decisions are made about managing pain in clinical practice. Lack of patient involvement in decision-making may lead to inadequate care provision. In some care situations, nurses have been more concerned with medication side effects than giving effective pain relief. An exploratory study was conducted, using observations and interviews with a purposive s le of 14 nurses and 53 patients in five adult renal units in Australia. The data were collected during 2004. Of the 103 pain activities observed, 78 involved a passive decision style between the nurse and patient, 19 involved a collaborative decision style, and six used an active decision style. The majority of routine analgesic and adjuvant medications administered involved a passive decision style. Most importantly, 25.6% of passive style decisions observed resulted in no administration of an analgesic or adjuvant medication however, all collaborative and active style decisions observed resulted in administration of an analgesic or adjuvant medication. Nurses need actively to encourage patient involvement in treatment decisions because this promotes effective pain control. More research is needed into how specific detailed information about pain treatments could improve patient participation in decision-making.
Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study
Publisher: JMIR Publications Inc.
Date: 26-07-2022
DOI: 10.2196/39596
Abstract: Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. This qualitative descriptive study used focus group and in idual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional ide captured nurses’ feelings of ision related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as in iduals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
Nurses' medication administration practices at two Singaporean acute care hospitals
Publisher: Wiley
Date: 03-2013
DOI: 10.1111/J.1442-2018.2012.00706.X
Abstract: This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.
Expanded practice roles for community mental health nurses in Australia: Confidence, critical factors for preparedness, and perceived barriers
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/01612840802129269
Abstract: As the momentum for nurse practitioner roles rapidly increases in Australia, little scholarly attention has been directed towards barriers to role expansion, the confidence necessary to undertake expanded practice roles (other than prescription of medication), or the educational preparation required for expanded roles. This paper reports on community mental health nurses' views regarding confidence to undertake expanded roles, their opinions regarding the necessary preparation for such roles, and barriers to role expansion. An questionnaire was administered to 296 community mental health nurses employed in metropolitan and rural settings in Victoria, Australia. In regards to various domains of expanded practice, nurses were least confident about prescribing but more than half (54%) reported that they would either "definitely" or "probably" feel confident. Over 90% reported "probably" or "definitely" feeling confident to make recommendations for involuntary treatment. Eighty-four percent and 79% reported similar levels of confidence in relation to ordering diagnostic tests and referring patients to medical specialists, respectively. Most (95%) agreed that extra educational preparation was necessary in relation to undertaking expanded practice roles successfully. Factors considered most strongly as barriers to expanded nursing practice included the medical profession, followed by fear of litigation, and government departments and policies.
Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: A qualitative study
Publisher: Wiley
Date: 13-09-2014
DOI: 10.1111/JOCN.12171
Abstract: To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed. These comorbidities are major contributors to disease burden globally. Self-management of in iduals with these coexisting diseases is much more complicated than that of those with single diseases and is critical for improved health outcomes. Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension. Patients aged ≥18 years with diabetes, CKD and systolic hypertension were recruited from outpatient clinics of an Australian metropolitan hospital between 2008-2009. An average of four motivational interviewing telephone calls was made with participants (n = 39) in the intervention arm of a randomised controlled trial. Data were thematically analysed using the modified Health Belief Model as a framework. Participants' motivation and confidence in taking prescribed medicines was thwarted by complex medicine regimens and medical conditions. Participants wanted control over their health and developed various strategies to confront threats to health. The perceived barriers of taking recommended health action outweighed the benefits of taking medicines as prescribed and were primarily related to copious amounts of medicines. Taking multiple prescribed medicines in coexisting diabetes, CKD and hypertension is a perpetual vocation with major psychosocial effects. Participants were overwhelmed by the number of medicines that they were required to take. The quest for personal control of health, fear of the future and the role of stress and gender in chronic disease management have been highlighted. Participants require supportive emotional interventions to self-manage their multiple medicines on a daily basis. Reducing the complexity of medicine regimens in coexisting diseases is paramount. In idualised psychosocial approaches that address the emotional needs of patients with regular follow-up and feedback are necessary for optimal chronic disease self-management.
Impact of Medication Reconciliation and Review on Clinical Outcomes
Publisher: SAGE Publications
Date: 21-07-2014
Abstract: Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
Incidence of complications in men undergoing transurethral resection of the prostate
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.COLEGN.2015.07.001
Abstract: To examine the link between medication use and the risk of bleeding complications following transurethral resection of the prostate from the second postoperative day until hospital discharge. Using a retrospective observational study design, the medical records of all patients who underwent transurethral resection of the prostate over a 24-month period were examined. Comprehensive data regarding patients’ medication history, comorbidities and complications that occurred either during or after surgery were collected from medical records. Inferential statistical analysis was used to examine associations between demographic and medication variables and the risk of complications. Complications arising after surgery occurred in 48/135 (36%) of patients. The most common complications postoperatively were hematuria, occurring in 41/48 (85%) and hematuria with clot retention, occurring in 24/48 (50%) of patients who suffered complications. There was a significant association between the number of medications prescribed and postoperative complications for hematuria, χ2 (12) = 21.50, p = 0.04 and for hematuria with clot retention χ2 (12) = 24.97, p = 0.015. Demographic data relating to patients’ age, comorbid state and the number of standard medications prescribed is associated with an increase in macroscopic hematuria and macroscopic hematuria with clot retention after transurethral resection of the prostate. These findings emphasize the importance of nursing practice in both preoperative and postoperative care of patients undergoing surgery. Nurses need to be very vigilant in assessing patients at risk of increased bleeding from a transurethral resection of the prostate by examining their medication regimen.
Healthcare professionals can assist patients with managing post-kidney transplant expectations
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.SAPHARM.2016.11.013
Abstract: Kidney transplantation is the preferred treatment option for end-stage kidney disease. However, transplantation is not a cure and the prospective recipient needs to carefully evaluate the risks and benefits of receiving a transplant before agreeing to have the transplant. The objective of this commentary is to demonstrate that many kidney transplant recipients have unrealistic expectations of what life after transplantation involves. After monitoring participants in a randomised controlled trial through the first 12 months post-transplantation, we question whether patients understood the impact of receiving a transplant. In our study, participants were not prepared for the considerable time and effort involved in adhering to their medications. Participants felt challenged by the constant hospital, pathology and pharmacy visits they were fearful that their transplant could reject and they struggled with adapting to their new way of living. This paper offers new insights into understanding the life of patients post transplantation and the challenges of informing patients about the consequences of kidney transplantation. Understanding the challenges faced by new transplant recipients can help health professionals educate patients about life post-transplantation so patients have a genuine understanding of what they are consenting to, which is likely to enhance medication adherence and ultimately, graft success.
Rethinking nurses' observations: Psychiatric nursing skills and invisibility in an acute inpatient setting
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/J.SOCSCIMED.2007.03.025
Abstract: In sociological, managerial and clinical investigations of psychiatric nursing, the skills of observing patients are compared unfavourably with nurses' ability to listen, to interview and to engage with patients. This paper examines how nurses in an acute psychiatry unit used observation as a significant part of their everyday assessments of patients, through a working shift. We argue that the knowledge generated in observations is essential to the nurses' gaze in this setting. Based on an ethnographic study of the assessment practices of 11 psychiatric nurses and the first author in an Australian hospital setting, we found that nurses' observations of patients were rich in situated assessment detail and a powerful strategy for producing civil conduct among patients. In particular, we noted how nurses deliberately obscured their practice of observation, in order not to provoke patients. While such discreet practice is productive for everyday clinical work, the invisibility of nursing observations undermines the status of acute inpatient psychiatric nurses. Devaluing of tacit practice may encourage experienced nurses to leave inpatient units, at a time when hospitals struggle to address nursing shortages worldwide. We recommend instead that the productive value of erse and situated practices be investigated and articulated.
How does implementation of an electronic medical record system impact nurses’ work motivation, engagement, satisfaction and well-being? A realist review protocol
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-055847
Abstract: Electronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being? The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope (2) developing initial program theories (3) searching the evidence (4) selecting and appraising the evidence (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. CRD42020131875.
Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.SAPHARM.2017.03.051
Abstract: Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings. An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically. The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings. Pharmacists, registered nurses and doctors were recruited from erse clinical wards following information sessions. Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies. Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making.
The effects of physical environments in medical wards on medication communication processes affecting patient safety
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.HEALTHPLACE.2013.12.017
Abstract: Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.
Standard setting in specific-purpose language testing: What can a qualitative study add?
Publisher: SAGE Publications
Date: 11-10-2015
Abstract: This paper explores the views of nursing and medical domain experts in considering the standards for a specific-purpose English language screening test, the Occupational English Test (OET), for professional registration for immigrant health professionals. Since in iduals who score performances in the test setting are often language experts rather than domain experts, there are possible tensions between what is being measured by a language test and what is deemed important by domain experts. Another concern is a lack of qualitative research on the process of the standard setting. To date, no published qualitative work has been identified about the contributions of domain experts in the standard setting for healthcare communication. In this study, a standard-setting exercise was conducted for the speaking component of the OET, using judgements of nursing and medical clinical educators and supervisors. In all, 13 medical and 18 nursing clinical educators and supervisors rated medical and nursing candidate performances respectively. These performances were audio-recorded OET role-plays that were selected across a range of proficiency levels. Domain experts were invited to comment on the basis of their decisions and the extent of alignment between these decisions and the criteria used to assess performance on the OET. Nursing and medical domain experts showed that they attended to all of the OET criteria in making their decisions about standards. However, clinical scenario simulation also invited judgements of clinical competence from participants, even where they knew that clinical competence should be excluded from their decision-making. Another concern related to the authenticity limitations of the role-play tasks as evidence of readiness to handle communication in the workplace. Overall, findings support the value of qualitative evidence from the standard setting in providing insight into the factors informing and impeding decision-making.
Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium: a qualitative descriptive study
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-047247
Abstract: To explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium. Qualitative descriptive. Two acute care hospital organisations in Melbourne, Australia. Nurses and doctors were invited to participate. Semi-structured focus groups and in idual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Participants were 42 health professionals n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety a last resort nursing workload a dilemma to medicate and anticipating worsening behaviours . Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications. The decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.
Inappropriate medications and physical function: a systematic review
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/20420986211030371
Abstract: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in erse environments. A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in erse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in erse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.
Errors in administration of parenteral medications are a serious safety problem in intensive care units
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.AUCC.2009.06.002
Abstract: This research review aimed to critically appraise the study by Valentin et al. on administration errors for parenteral medications in intensive care units.
Workforce development for better management of physical comorbidities among people with serious mental illness
Publisher: Wiley
Date: 02-10-2022
DOI: 10.5694/MJA2.51705
Fall incidence and fall prevention practices at acute care hospitals in Singapore: A retrospective audit
Publisher: Wiley
Date: 23-07-2007
DOI: 10.1111/J.1365-2753.2006.00743.X
Abstract: To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore. A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005. Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals. Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented. The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records. This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.
Effects of patient-, environment and medication-related factors on high-alert medication incidents
Publisher: Oxford University Press (OUP)
Date: 25-04-2014
Abstract: To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents. A retrospective chart audit design was conducted of medical records for patient admissions from 1 January 2010 to 31 December 2010. Five practice settings (cardiac care, emergency care, intensive care, oncology care and perioperative care) at a public teaching hospital in Melbourne, Australia. Patients were considered for inclusion if they were prescribed at least one high-alert medication and if they were admitted to one of five practice settings. High-alert prescribing and administering incidents were measured in each of the five practice settings. Generalized linear mixed modeling was used for data analysis. There were 6984 opportunities for high-alert medication incidents across the five clinical settings. The overall medication incident rate was 1934/6984 (27.69%). There were 1176 prescribing incidents (16.84%) and 758 administering incidents (10.85%). Statistical modeling showed that, in each of the five clinical settings, an increased number of ward transfers was associated with increased odds of prescribing incidents. In addition, statistical modeling demonstrated that an increased number of ward transfers was associated with increased odds of administering incidents in emergency care and perioperative care. Complex relationships were found in managing high-alert medications in specialty clinical settings. Employing measures to address patients' movements across ward settings can reduce high-alert medication incidents and improve quality of care.
Informal role expansion in Australian mental health nursing
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1111/J.1744-6163.2009.00199.X
Abstract: This study aims to determine the extent to which community mental health nurses are currently practicing beyond the traditional scope of nursing practice. A self-administered questionnaire was distributed to community mental health nurses in Victoria, Australia. The majority of participants reported routine involvement in practices that would normally be considered beyond the scope of nursing practice, such as prescribing, ordering diagnostic tests, and referral to specialists. The extent to which the current mental health service system is dependent upon nurses transgressing professional and legal boundaries warrants further study. Psychiatrists and community mental health nurses need to work collaboratively to understand their respective knowledge and skills and to be clear about how they take responsibility for client care.
Rethinking theatre in modern operating rooms
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1440-1800.2005.00246.X
Abstract: Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of in iduals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.
An estimate of the Geosat altimeter wind speed algorithm at high wind speeds
Publisher: American Geophysical Union (AGU)
Date: 15-11-1993
DOI: 10.1029/93JC02117
Measuring safety and quality in health care: Classic methods paper
Publisher: Elsevier BV
Date: 03-2011
Exploring the expanded practice roles of community mental health nurses
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01612840600943739
Abstract: Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality.
A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: A report of the ISPOR medication adherence & persistence special interest group
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JVAL.2013.04.014
Abstract: Numerous factors influencing medication adherence in chronically ill patients are well documented, but the paucity of studies concerning initial treatment course experiences represents a significant knowledge gap. As interventions targeting this crucial first phase can affect long-term adherence and outcomes, an international panel conducted a systematic literature review targeting behavioral or psychosocial risk factors. Eligible published articles presenting primary data from 1966 to 2011 were abstracted by independent reviewers through a validated quality instrument, documenting terminology, methodological approaches, and factors associated with initial adherence problems. We identified 865 potentially relevant publications on full review, 24 met eligibility criteria. The mean Nichol quality score was 47.2 (range 19-74), with excellent reviewer concordance (0.966, P < 0.01). The most prevalent pharmacotherapy terminology was initial, primary, or first-fill adherence. Articles described the following factors commonly associated with initial nonadherence: patient characteristics (n = 16), medication class (n = 12), physical comorbidities (n = 12), pharmacy co-payments or medication costs (n = 12), health beliefs and provider communication (n = 5), and other issues. Few studies reported health system factors, such as pharmacy information, prescribing provider licensure, or nonpatient dynamics. Several methodological challenges synthesizing the findings were observed. Despite implications for continued medication adherence and clinical outcomes, relatively few articles directly examined issues associated with initial adherence. Notwithstanding this lack of information, many observed factors associated with nonadherence are amenable to potential interventions, establishing a solid foundation for appropriate ongoing behaviors. Besides clarifying definitions and methodology, future research should continue investigating initial prescriptions, treatment barriers, and organizational efforts to promote better long-term adherence.
International variations in outcomes from sedation protocol research: Where are we at and where do we go from here?
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.ICCN.2010.05.002
Abstract: In this article, sedation protocol research in the intensive care environment is critically examined, focusing upon the differences in outcomes from research conducted on mechanically ventilated patients in various countries. Limitations of the current research are discussed, with suggestions of how sedation protocol research may be conducted in future. Also, the monitoring of important clinical factors is discussed so that clinicians can assess the impact upon patients of changes to sedation management practices within their own ICU.
Decision‐making models used by ‘graduate nurses’ managing patients’ medications
Publisher: Wiley
Date: 06-07-2004
Repeated doses of sucrose in infants continue to reduce procedural pain during prolonged hospitalizations
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Healthcare service provider perceptions of organisational communication across the perioperative pathway: A questionnaire survey
Publisher: Wiley
Date: 21-08-2013
DOI: 10.1111/J.1365-2702.2012.04228.X
Abstract: To gain understandings into service providers' perceptions of organisational communication and identify areas for improvement across the perioperative pathway. Effective communication among healthcare service providers is vital to the delivery of safe and quality patient care. Locally and internationally, research into sentinel and adverse events consistently demonstrate the perioperative environment and communication breakdown as recurring constituents in the generation of sentinel and adverse patient events. Prospective cross-sectional survey design. Using a whole population s ling method all service providers from across the perioperative pathway including surgeons, nurses, anaesthetists, theatre technicians, patient service assistants and receptionists were surveyed using the International Communication Association survey. Responses were analysed using descriptive statistics, univariate analysis of variance and independent s les t-tests. In total, 281 service providers from the perioperative pathway of three Australian public hospitals completed the survey. Respondents were dissatisfied with communication from top management and service providers employed in an operating room or postanaesthetic care unit perceived the communication of information to be inadequate. Further, analysis by service providers' occupation revealed nurses were less satisfied with channels of information than surgeons and anaesthetists were less satisfied with the timeliness of information than nurses. Restricted communication flow was evident as many areas of organisational communication were reported to be insufficient for the transmission of information. This research highlights the need for improved communication flow between service providers, and between management and service providers, working across the perioperative pathway. Areas identified for communication improvement can be used to prevent communication failures and promote effective communication strategies such as meetings, education, providing time for open communication and developing organisational policy and procedures.
Inter-hospital ‘patient expect’ calls of clinical handovers for expected patients transferred from rural to metropolitan hospitals: A retrospective clinical audit
Publisher: Elsevier BV
Date: 12-2016
Medication communication between nurses and doctors for paediatric acute care: An ethnographic study
Publisher: Wiley
Date: 10-03-2017
DOI: 10.1111/JOCN.13606
Abstract: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. Communication between health professionals influences medication incidents' occurrence and safe care. An ethnographic study was undertaken. Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands. Interdisciplinary education delivered in healthcare organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management.
Perspectives of a nurse, a social worker and a psychiatrist regarding patient assessment in acute inpatient psychiatry settings: A case study approach
Publisher: Wiley
Date: 11-11-2004
DOI: 10.1111/J.1365-2850.2004.00785.X
Abstract: This case study explores what informs and organizes the assessment of patients, as undertaken by a nurse, a social worker and a psychiatrist in public, metropolitan, acute mental health service settings. The research data are the transcripts of in-depth interviews with three experienced practitioners, one from each of the three disciplines. The analysis draws on Foucauldian concepts: discourse as constructed through practices of discipline and the gaze. We explored ex les of taken-for-granted assessment practices and their interplay with discourse. The findings suggest that participating practitioners use language in assessment in ways that support the powerful discourses of the professional disciplines. The competing discourse of management, associated with industry and economics, is evident in hospital admission processes, dictating the times and places of assessment. Professional and management discourses both effectively marginalize the perspective of another player in assessment, the patient.
Communication relating to family members' involvement and understandings about patients' medication management in hospital
Publisher: Wiley
Date: 14-02-2015
DOI: 10.1111/HEX.12057
Nursing educator perspectives of overseas qualified nurses' intercultural clinical communication: barriers, enablers and engagement strategies
Publisher: Wiley
Date: 03-06-2015
DOI: 10.1111/JOCN.12879
Abstract: To understand the intercultural communication experiences and associated communication training needs of overseas qualified nurses in the Australian healthcare system from the unique perspectives of nurse educators teaching in accredited bridging programmes. Overseas qualified nurses are an integral part of the nursing workforce in migration destination countries. Communication training needs are more complex when there are cultural, ethnic and language differences between nurses, other health professionals and patients. A qualitative, exploratory research design using semi-structured interviews. All (nine) organisations involved in conducting the Australian Health Practitioner Regulation Agency approved preregistration bridging programmes for overseas qualified nurses within the state of Victoria, Australia, were involved in the study. Participants were 12 nurse educators employed in these organisations. Thematic analysis was undertaken. Three macro themes emerged about the overseas qualified nurses' intercultural communication: (1) pre-existing barriers and enablers to intercultural communication, for ex le, nurses' reluctance to engage in communicative strategies that build rapport with patients, (2) transitional behaviours and impact on communication, including maintenance of perceived cultural hierarchies between health professionals and (3) development of communicative competence, including expanding one's repertoire of conversational gambits. The findings point to the domains and causes of communication challenges facing overseas qualified nurses in new healthcare settings as well as strategies that the nurse educators and nurses can adopt. Communication cannot be merely regarded as a skill that can be taught in a didactic programme. Comprehensive understanding is needed about the sociocultural dimensions of these nurses' orientation, which can impact on how they communicate in their new healthcare settings. The findings can act as triggers for discussion with overseas qualified nurses and other health professionals to raise awareness about the aspects of intercultural communication and to debate alternative viewpoints and explanations. They can also inform changes in the structure and content of the bridging programmes.
What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients
Publisher: Wiley
Date: 14-11-2013
DOI: 10.1111/JAN.12296
Abstract: To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. An exploratory design was used involving in idual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. Focus groups and in idual interviews were held between August 2010-September 2011 with a purposive s le of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.
The educational preparation of undergraduate nursing students in pharmacology: clinical nurses’ perceptions and experiences of graduate nurses’ medication knowledge
Publisher: Elsevier BV
Date: 11-2002
DOI: 10.1016/S0020-7489(02)00008-1
Abstract: This paper explores clinical nurses' perceptions and experiences of graduate nurses' pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses--all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses' pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.
Gatekeeping practices of nurses in operating rooms
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.SOCSCIMED.2009.04.023
Abstract: This paper explores the gatekeeping practices used by operating room nurses to control information flow in their everyday clinical practice. In nursing, gatekeeping appears only sporadically in the literature and usually emerges as a secondary concept rather than being the primary focus of studies. As gatekeeping is a communication practice that has the potential to impact directly on patient safety, a more in-depth exploration of its pervasiveness and effect needs to be undertaken. Accordingly, in this paper we aim to provide an in-depth understanding about gatekeeping practices in operating room nursing by drawing on a 'network' model of gatekeeping to highlight the power relationships between stakeholders and how information is controlled. To illustrate our points, we provide four different ex les of gatekeeping at an interpersonal level of interaction. Data are drawn from an ethnographic study in Australia that explored nurse-nurse and nurse-doctor communication at three different operating room departments. We explore the impact of gatekeeping on social and professional relationships as well as how it has practical and ethical ramifications for patient care and the organisation of clinical work. The findings show that nurses are selective in their use of gatekeeping, depending on the perceived impact on patient care and the benefit that is accrued to nurses themselves.
Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit
Publisher: Springer Science and Business Media LLC
Date: 28-09-2021
DOI: 10.1186/S12913-021-07033-8
Abstract: Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.
Practices and predictions of analgesic interventions for adults undergoing painful procedures
Publisher: Elsevier BV
Date: 11-2002
Whiteboards: Mediating professional tensions in clinical practice
Publisher: Equinox Publishing
Date: 26-10-2007
DOI: 10.1515/CAM.2007.020
Engaging children in managing their medications in hospital: does it really matter and is it a possibility?
Publisher: Elsevier BV
Date: 10-2014
Initial Medication Adherence - Review and Recommendations for Good Practices in Outcomes Research: An ISPOR Medication Adherence and Persistence Special Interest Group Report
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JVAL.2015.02.015
Abstract: Positive associations between medication adherence and beneficial outcomes primarily come from studying filling/consumption behaviors after therapy initiation. Few studies have focused on what happens before initiation, the point from prescribing to dispensing of an initial prescription. Our objective was to provide guidance and encourage high-quality research on the relationship between beneficial outcomes and initial medication adherence (IMA), the rate initially prescribed medication is dispensed. Using generic adherence terms, an international research panel identified IMA publications from 1966 to 2014. Their data sources were classified as to whether the primary source reflected the perspective of a prescriber, patient, or pharmacist or a combined perspective. Terminology and methodological differences were documented among core (essential elements of presented and unpresented prescribing events and claimed and unclaimed dispensing events regardless of setting), supplemental (refined for accuracy), and contextual (setting-specific) design parameters. Recommendations were made to encourage and guide future research. The 45 IMA studies identified used multiple terms for IMA and operationalized measurements differently. Primary data sources reflecting a prescriber's and pharmacist's perspective potentially misclassified core parameters more often with shorter/nonexistent pre- and postperiods (1-14 days) than did a combined perspective. Only a few studies addressed supplemental issues, and minimal contextual information was provided. General recommendations are to use IMA as the standard nomenclature, rigorously identify all data sources, and delineate all design parameters. Specific methodological recommendations include providing convincing evidence that initial prescribing and dispensing events are identified, supplemental parameters incorporating perspective and substitution biases are addressed, and contextual parameters are included.
Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention
Publisher: JMIR Publications Inc.
Date: 18-09-2023
DOI: 10.2196/49902
Expanded practice roles for community mental health nurses: A qualitative exploration of psychiatrists' views
Publisher: SAGE Publications
Date: 08-2007
DOI: 10.1080/10398560701344808
Abstract: Objective: The aim of this paper was to explore the perspectives of psychiatrists regarding the potential impact of expanded nursing practice roles on mental health care delivery. Method: In-depth interviews and a focus group were conducted with psychiatrists from metropolitan and rural Victoria, Australia, using a qualitative exploratory design. Results: Four main themes emerged: nurses’ preparation to undertake expanded practice power and autonomy of nurses final responsibility rests with psychiatrists and, the future of expanded nursing practice. Participant responses to these themes were varied and erse. Conclusions: Participant responses elucidate the complexity of the issues and suggest that a number of factors influence psychiatrists’ opinions of the expanded practice role.
Pain assessment and management practices in children following surgery of the lower limb
Publisher: Wiley
Date: 17-12-2009
DOI: 10.1111/J.1365-2702.2009.03068.X
Abstract: Aims. To examine paediatric nurses’ pain assessment and management practices in relation to postoperative care for children following surgery of a fractured lower limb and to compare these practices with evidence‐based guidelines. Background. Managing pain is one of the most challenging issues in current paediatric practice. The incidence of lower limb fractures is high in children, which often leads to pain and related complications in the postoperative period. Design. A retrospective clinical audit study. Methods. A retrospective audit of all medical records ( n = 106) was undertaken over two years of children aged 5–15 years who were admitted for surgical procedure for a fractured lower limb. An audit tool was developed to collect data related to children’s postoperative pain assessment and management on the day of operation to the third postoperative day. The study was undertaken in a tertiary paediatric hospital in Australia. Results. The retrospective audit revealed that assessment and management of children’s postoperative pain was inadequate. On average, 75% of children experienced some degree of pain 50% had moderate to severe pain. Nurses assessed pain less frequently compared to the number of times they were expected to assess pain postoperatively. Most analgesics were prescribed on an ‘as needed’ basis and patients received significantly lower amounts of analgesics than prescribed amounts. Conclusion. The clinical audit revealed that addressing children’s postoperative analgesic needs was not consistent with evidence‐based guidelines. Relevance to clinical practice. While this study was undertaken in only one hospital, the results are likely to be applicable to other children’s hospital settings. Nurses need to be proactive in promoting effective assessment and management of pain in children. The results of this study provide a useful guide for planning and implementing future strategies to improve postoperative pain management in children.
The barriers and facilitators people with diabetes from a nonEnglish speaking background experience when managing their medications: A qualitative study
Publisher: Wiley
Date: 26-12-2014
DOI: 10.1111/JOCN.12501
Abstract: To explore the barriers to and facilitators of effective medication management from the perspectives of people with diabetes from a nonEnglish speaking background, carers and health professionals. The barriers that people with diabetes experience managing their medications can adversely impact on health outcomes. People from nonEnglish speaking backgrounds are at risk of medication-related problems, although there is a paucity of research in this area. A qualitative research design using a purposive s ling approach. People with type 1 or type 2 diabetes from a nonEnglish speaking background, their carers, and health professionals who assisted these people and their carers to manage their medications were recruited from the diabetes outpatient clinic at an adult teaching public hospital in Melbourne, Australia. Participants were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim and analysed using a thematic framework method. Eleven people with diabetes, 10 carers and 10 health professionals were interviewed, and four key issues were identified: diabetes knowledge, diabetes impact, medication knowledge and medication management. The cost of medications, language barriers that hinder communication, forgetfulness, and poor knowledge and understanding emerged as barriers to effective medication management. Facilitators included the use of dose administration aids to manage medications, but current medication lists were not used. Findings revealed people with diabetes experienced a multitude of barriers when managing their medications, and, despite the problems people experienced, there appeared to be poor use of support aids to assist people to effectively manage their medications. The findings can be used to develop strategies aiming at improving how people from nonEnglish speaking backgrounds manage their medicines.
Understanding medication safety in healthcare settings: A critical review of conceptual models
Publisher: Wiley
Date: 10-07-2011
DOI: 10.1111/J.1440-1800.2011.00541.X
Abstract: Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.
The interplay of knowledge and decision making between nurses and doctors in critical care
Publisher: Elsevier BV
Date: 04-2001
DOI: 10.1016/S0020-7489(00)00055-9
Abstract: This paper explores the complex interrelationships between knowledge and decision making as nurses and doctors interacted with each other in a critical care unit, which comprised a combined general intensive care and cardiothoracic surgical unit. The critical ethnographic study upon which this paper is based, involved a research group of six nurses who worked in the unit. Nurses differentially valued their knowledge, depending on the situation, experience and level of medical input. They were also involved in decision making based on their differential visibility in the process. Nurses' specialised knowledge of the critical care unit played a major role in influencing how they interacted during decision making.
Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.IJNURSTU.2009.05.021
Abstract: There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes. This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care. A qualitative approach was used comprising naturalistic observation and semi-structured interviews. The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital. Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified s ling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed. The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of in idualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than in idualised patient assessment and management. These interactions were based on nurses' perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints. While some nurse-patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients' needs in relation to their medications and encourage opportunities for increased patient participation.
Pain Assessment and Management in Patients After Abdominal Surgery From PACU to the Postoperative Unit
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.JOPAN.2009.03.013
Abstract: The aim of this exploratory study was to determine the effectiveness of pain relief for surgical patients (N = 52) in transition from the PACU to the postoperative unit. The study also explored whether there was an association between a verbal numeric pain score (0 to 10) on discharge from the PACU and the duration of time until analgesia was administered in the postoperative unit. Information was obtained about pain management, time of discharge, and patient pain scores on discharge from the PACU, as well as pain scores and the time of first analgesic administered in the postoperative unit. Most patients were discharged from the PACU with a pain score in the mild range (0 to 4), indicating reasonable pain relief. An association existed between the pain score on discharge from the PACU and the duration of time to the first analgesic dose administered on the postoperative unit.
Effectiveness of an electronic inpatient medication record in reducing medication errors in Singapore
Publisher: Wiley
Date: 16-07-2014
DOI: 10.1111/NHS.12078
Abstract: This study examined the effectiveness of an inpatient electronic medication record system in reducing medication errors in Singaporean hospitals. This pre- and post-intervention study involving a control group was undertaken in two Singaporean acute care hospitals. In one hospital the inpatient electronic medication record system was implemented while in another hospital the paper-based medication record system was used. The mean incidence difference in medication errors of 0.06 between pre-intervention (0.72 per 1000 patient days) and post-intervention (0.78 per 1000 patient days) for the two hospitals was not statistically significant (95%, CI: [0.26, 0.20]). The mean incidence differences in medication errors relating to prescription, dispensing, and administration were also not statistically different. Common system failures involved a lack of medication knowledge by health professionals and a lack of a systematic approach in identifying correct dosages. There was no difference in the incidence of medication errors following the introduction of the electronic medication record system. More work is needed on how this system can reduce medication error rates and improve medication safety.
The uses of photography in clinical nursing practice and research: a literature review
Publisher: Wiley
Date: 21-10-2004
DOI: 10.1111/J.1365-2648.2004.03208.X
Abstract: The aim of this paper is to report a study to identify themes and provide a 'snap-shot' of the scope and uses of photography in clinical nursing practice and research. Despite the dominance of vision as a way of understanding the world in Western societies, the applications of photography in clinical nursing practice and research have not been well synthesized or reported in the literature. A computerized search of CINAHL database was performed using the terms photographs, photography, photographic, photovoice, videorecording and videotaping. Hand searching for additional citations was also undertaken. The identified papers on photography were categorized into broad themes that reflected the different applications to which photography had been applied: documentation and surveillance therapeutic intervention teaching, learning and evaluating performance research methods and descriptive and instructional literature. Approaches to the use of photography, as recorded in the nursing literature, are broad and include: wound surveillance, covert patient surveillance, photo essay, art therapy, self-portraits, life albums, simulated recall, participant observation, photovoice, photo hermeneutics, production of research scenarios, and video modelling. The most common applications of photography in nursing and related journals include photo elicitation to promote understanding in research, videorecording as a method of teaching and learning, and as a method of observation, with more creative approaches tending to be employed in health professions other than nursing. Few reports gave explanations of how researchers negotiated ethical concerns when seeking approval for studies in clinical settings, and few gave details of the processes of data analysis.
From Other Journals April 2022
Publisher: Wiley
Date: 21-03-2022
Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study
Publisher: Wiley
Date: 09-08-2020
DOI: 10.1111/NHS.12753
Although parents are generally satisfied with their child's postoperative care, children continue to experience moderate-to-severe pain postoperatively
Publisher: BMJ
Date: 18-02-2014
Perspectives of clinical handover processes: A multi-site survey across different health professionals
Publisher: Wiley
Date: 28-09-2016
DOI: 10.1111/JOCN.12986
Abstract: To examine the perspectives of health professionals of different disciplines about clinical handover. Ineffective handovers can cause major problems relating to the lack of delivery of appropriate care. A prospective, cross-sectional design was conducted using a survey about clinical handover practices. Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The s le comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Australia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover their perceived effectiveness of clinical handover involvement of patients and family members health professionals' ability to confirm understanding and to clarify clinical information role modelling behaviour of health professionals training needs adverse events encountered and possibilities for improvements. In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers. Complex barriers impeded the conduct of effective handovers, including insufficient opportunities for training, lack of role modelling, and lack of confidence and understanding about handover processes. Greater focus should be placed on creating opportunities for senior health professionals to act as role models. Sophisticated approaches should be implemented in training and education.
Eczema workshops reduce severity of childhood atopic eczema
Publisher: Wiley
Date: 23-04-2009
DOI: 10.1111/J.1440-0960.2009.00515.X
Abstract: An intervention study was conducted to assess the effectiveness of a nurse-led eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents. Ninety-nine new patients referred to the Dermatology Department of The Royal Children's Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to receive care from an eczema workshop or a dermatologist-led clinic. Patients were followed-up 4 weeks after the intervention. The primary outcome was the severity of eczema as determined by scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4-week follow-up visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4-week review the mean improvement in SCORAD was significantly greater in those patients attending the eczema workshop than those attending the dermatologist-led clinic (-9.93, 95% confidence interval -14.57 to -5.29, P < 0.001). Significantly more patients from the eczema workshop improved from moderate severity eczema at baseline to mild at review. There was greater adherence to eczema management in the eczema workshop compared with the dermatologist-led clinic. In this study, patients attending the eczema workshop had a greater improvement in eczema severity thanpatients attending a dermatologist-led clinic, supporting collaborative models of service provision.
Balancing safety with effective pain control in patients with chronic kidney disease
Publisher: Wiley
Date: 23-07-2007
What influences rural women's choices in maternity care: A qualitative exploratory study.
Publisher: Wiley
Date: 08-08-2021
DOI: 10.1111/NHS.12867
Abstract: Rural women are likely to experience difficulties accessing maternity care that is readily available in metropolitan areas. This limited access can impede women's ability to make informed choices that enhance safety and minimize harm. This study explored the experiences of women who had given birth in a rural environment and the factors that influenced their choices regarding their maternity care. Semistructured interviews were conducted with 10 women for this qualitative, exploratory study. These women had birthed within rural areas of Victoria, Australia, between May 2016 and May 2017. Thematic analysis was undertaken. Three main themes emerged: (i) being influenced by previous childbirth experiences, (ii) feeling safe and supported with their maternity care provider, and (iii) being supported in their birthing choices. The availability of maternity care providers and travel time to facilities limited the choices of rural women. This study provided valuable insights into what was behind the decisions of rural women's choices regarding their maternity care. To assist with making informed decisions regarding their maternity care, all available models of maternity care should be presented to rural women.
From Other Journals June 2022
Publisher: Wiley
Date: 19-05-2022
Quantifying the medication burden of kidney transplant recipients in the first year post-transplantation
Publisher: Springer Science and Business Media LLC
Date: 28-06-2018
DOI: 10.1007/S11096-018-0678-9
Abstract: Background Kidney transplantation is an effective treatment, but it is not a cure. Since the risk of graft rejection and the presence of comorbid conditions remain for a lifetime, medications are necessary. Objective To examine the prescription medication burden of adult kidney transplant recipients from 3- to 12-months post-transplantation. Setting All five adult kidney transplant units in Victoria, Australia. Method As part of a larger intervention study, we conducted a retrospective review of prescription refill records and medical records containing the history of medication changes of 64 participants who completed the study. The complexity of the medication management was studied, and we looked at the burden of maintaining the medications supply. Outcome measures Pill burden, administration frequency, dose changes frequency, immunosuppressive medication changes, the estimated out-of-pocket costs of medications and frequency of pharmacy visits. Results At 3 months, the average daily pill burden was 22 (SD = 9) whilst at 12 months, it was 23 (SD = 10). Some participants required long-term prophylaxis of fungal infections up to 4 times a day whilst those with diabetes had to manage up to 4 insulin doses a day. The average out-of-pocket cost per person and the frequency of pharmacy visits at 6, 9 and 12 months post-transplantation remained relatively unchanged. Conclusion The medication regimen prescribed for kidney transplant recipients is complex and for most patients, it did not simplify over time post transplantation. Strategies are needed to support patients in managing the complexity of their medication regimen following kidney transplantation.
Pharmacology content in undergraduate nursing programs: Is there enough to support nurses in providing safe and effective care?
Publisher: Elsevier BV
Date: 2009
Cladistic biogeographic analysis suggests an early Caribbean diversification in Mexico
Publisher: Springer Science and Business Media LLC
Date: 06-03-2007
DOI: 10.1007/S00114-007-0228-0
Abstract: The Great American Biotic Interchange has been the predominant paradigm for explaining biotic ersification in the Nearctic/Neotropical overlap or Mexican Transition Zone, which is commonly explained by the collision of the North and South American continental plates, which began in the Oligocene and fused both landmasses. In the most far-reaching cladistic biogeographical analysis of the area to date, evidence has been found supporting the existence of a remnant Caribbean region extending from eastern Mexico to southeastern USA, a hypothesis that challenges current views of the Great American Biotic Interchange and the Mexican Transition Zone. We show herein that an older terrane, which has drifted to the present day positions of Yucatan and Cuba, may be biogeographically linked to an early 'Gondwanan' biota of the Paleocene (ca. 60 Ma). The evidence indicates an east-west biotic ide in Mexico, existing before the collision and formation of Central America. The south-north ision of the country, previously recognized by several authors as associated with the Great American Biotic Interchange and the Mexican Transition Zone, is of a younger age.
Interventions to Reduce Medication Errors in Pediatric Intensive Care
Publisher: SAGE Publications
Date: 24-07-2014
Abstract: Objective: To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. Data Sources: Databases were searched from inception to April 2014. Study Selection and Data Extraction: Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. Data Synthesis: In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ 2 (5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79) IS: 0.37 (95% CI = 0.19, 0.73) ME: 0.36 (95% CI = 0.22, 0.58) PG: 0.82 (95% CI = 0.21, 3.25) PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). Conclusions: Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
Transcultural nursing in Australian nursing curricula
Publisher: Wiley
Date: 28-04-2003
DOI: 10.1046/J.1442-2018.2003.00146.X
Abstract: As a result of the fact that Australia is a multicultural society with many people who come from non-English speaking backgrounds (NESB), the objective of the present study was to discuss the extent to which transcultural nursing education is incorporated into undergraduate nursing curricula. A survey was undertaken to determine the availability of nursing modules for undergraduate nursing students through Australian university websites on "transcultural nursing" or related modules. Although the inclusion of these modules into nursing education provide an opportunity for nurses to perceive and respond to different patient behaviors in multicultural societies, it is not sufficient to understand the complexity of the health care needs of a multicultural society. The survey findings suggest that many universities have not included transcultural nursing modules in their nursing curricula. To address this problem, more transcultural nursing modules need to be introduced into nursing curricula and nursing academics need to refine their attitudes about the importance of cultural aspects of patient care within nursing education.
Development and validation of the self-administration of medication tool
Publisher: SAGE Publications
Date: 06-2006
DOI: 10.1345/APH.1G677
Abstract: Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes. In assessing the ability of patients to self-medicate, health professionals can identify areas in which patients need assistance, education, and intervention to optimize their health outcomes after discharge. To develop and validate a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized. Past research enabled us to develop the Self-Administration of Medication (SAM) tool. Using a Delphi technique of 3 rounds, a panel of expert health professionals established the content validity of the tool. For determining level of agreement in using the SAM tool, 56 patients were selected for each patient, 2 randomly selected nurses completed an assessment. Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other validated scales. The 29-item SAM tool had high content validity scores for clarity, representation, and comprehensiveness, with content validity index values ranging from 0.95–1.0. In testing the level of agreement between 2 nurses, out of 43 valid cases, 95.3% of nurses overwhelmingly agreed about the patients’ competence to self-administer their drugs. The intraclass correlation coefficient was 0.819 (95% Cl 0.666 to 0.902). Internal consistency for the SAM tool was high, with a Cronbach's alpha of 0.899. A moderate to strong correlation was obtained when comparing the SAM tool with other validated measures. The SAM tool is valid and reliable for quantifying patients’ ability to manage their regularly scheduled medications in the hospital setting.
The educational preparation of undergraduate nursing students in pharmacology: a survey of lecturers' perceptions and experiences
Publisher: Wiley
Date: 16-09-2002
DOI: 10.1046/J.1365-2648.2002.02335.X
Abstract: Nurses have key responsibilities in the administration and management of medication therapy and client education. It is of some concern therefore that the literature indicates that nurses are inadequately prepared in this area. This paper explores the perceptions and expectations of lecturers about teaching and learning pharmacology in preregistration nursing courses. Questionnaires were distributed to lecturers involved in teaching pharmacology to undergraduate nursing students during 2000. The questionnaire was distributed to all university c uses (n = 13) in Victoria, Australia, that are involved in undergraduate nursing education. The questionnaire was an adaptation of the survey instrument used in the Nursing and Medication Education [NAME] project and examined in this questionnaire: the integration of pharmacology teaching into nursing, range and depth of classroom-based pharmacology teaching, approaches to teaching and learning, nursing practice in a clinical context, related importance of patient education and communication skills, and the appropriate professional background of academics teaching pharmacology to preregistration nursing students. There was great variation between institutions as to the number of hours devoted to pharmacology and when it was offered. A number of respondents indicated that they were dissatisfied with the preparation of graduates and their knowledge base in pharmacology. The study was limited by a low response rate of 34%. A review of nursing curricula is required to improve the knowledge base of nurses in pharmacology and to facilitate their skills in life-long learning.
Patient-Centered Care Experiences of First-Generation, South Asian Migrants with Chronic Diseases Living in High-Income, Western Countries: Systematic Review
Publisher: Informa UK Limited
Date: 02-2023
DOI: 10.2147/PPA.S391340
Homelessness, health status and emergency department use: An integrated review of the literature
Publisher: Elsevier BV
Date: 11-2007
Communication and decision-making about end-of-life care in the intensive care unit
Publisher: AACN Publishing
Date: 30-06-2017
DOI: 10.4037/AJCC2017774
Abstract: Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians.
Impact of Interventions on Medication Adherence and Blood Pressure Control in Patients with Essential Hypertension: A Systematic Review by the ISPOR Medication Adherence and Persistence Special Intere
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JVAL.2013.03.1631
Abstract: To systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications. An electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data. Ninety-seven articles were identified for inclusion 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence. Interventions aimed at improving patients' knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.
Medication communication during handover interactions in specialty practice settings
Publisher: Wiley
Date: 16-07-2015
DOI: 10.1111/JOCN.12894
Abstract: To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. An exploratory qualitative design and observational study. Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.
Interventions to reduce medication errors in adult medical and surgical settings: a systematic review
Publisher: SAGE Publications
Date: 2020
Abstract: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. Activities to reduce medication errors in adult medical and surgical hospital areas Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.
Patients' Decision-Making Strategies for Managing Postoperative Pain
Publisher: Elsevier BV
Date: 06-2006
An Analysis of Clinical Handover Miscommunication Using a Language and Social Psychology Approach
Publisher: SAGE Publications
Date: 14-05-2015
Abstract: Clinical handover is a key communication event in patient care and a major contributing factor in adverse events in hospitals. Current research on handover emphasizes communication skills training. We investigate the intergroup context and systemic factors of the hospital environment that also affect handover. We explore the responses of 707 health professionals about handover practice. We invoke Coupland and colleagues’ integrative model of “miscommunication” to interpret these. Results support the model. Responses reflect a lack of communication competency, intergroup group relations, and the hidden ideology of the health care system. Health professionals in hospitals are often unaware of the socio-structural element in health care and so cannot bring about cultural change. We suggest that clinicians work with communication and interdisciplinary scholars to bring about system improvement.
The influence of patient acuity on satisfaction with emergency care: Perspectives of family, friends and carers
Publisher: Wiley
Date: 11-02-2008
DOI: 10.1111/J.1365-2702.2007.02052.X
Abstract: To investigate the factors that influence satisfaction with emergency care among in iduals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency. Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective however, in iduals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes. A prospective cross-sectional survey with a consecutive s le (n = 128 response rate 83.7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care. Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients' triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons. Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care. Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes.
Nurse-led clinics reduce severity of childhood atopic eczema: A review of the literature
Publisher: Oxford University Press (OUP)
Date: 19-09-2006
DOI: 10.1111/J.1365-2133.2006.07534.X
Abstract: The increasing prevalence and impact of atopic eczema in children in Western countries such as Australia substantiate the need to evaluate the current management of this illness. It has been well documented that the most important aspects in the management of atopic eczema are to allow adequate time for education and demonstration of treatments. However, current models of healthcare funding restrict the opportunity for patient education during medical consultation times. The contribution of nursing to patient care through nurse-led clinics has significant potential in the management of many common chronic illnesses, although atopic eczema has received minimal attention by researchers to date. To discuss the current clinical management of atopic eczema, and to identify the evidence surrounding the benefits of nurse-led clinics in managing patients with chronic illnesses. Systematic searches were undertaken using the Cochrane Library, MedLine, PUBMed and CINAHL from 1995 to 2005. Manual searches of references of retrieved articles identified two additional key studies from 1990 and 1993 which were also included in the review. In total, 22 relevant publications were identified. These included both primary research and descriptive studies that covered the medical management of eczema, patient education and improved patient outcomes. The evidence emerging from the literature indicates that the current management of eczema through doctor-led clinics could be improved, with doctors often lacking the time to offer sufficient patient education to manage chronic illnesses effectively. The literature supports the efficacy of nurse-led clinics in the management of chronic illnesses. The benefits of nurse-led clinics include increased patient satisfaction, longer consultations resulting in improved patient education and similar health outcomes when compared with care from a doctor. No studies were identified comparing nurse-led and doctor-led clinics in the management of eczema. The most effective way to manage atopic eczema is to provide adequate time for education and demonstration of treatments, which the literature suggests can be achieved through nurse-led clinics. The literature review supports an investigation researching the outcomes of a nurse-led clinic on reducing the severity of eczema in children.
A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial
Publisher: Wiley
Date: 27-05-2015
DOI: 10.1111/IWJ.12101
Use of the Screening Tool of Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) in hospitalised older people
Publisher: Wiley
Date: 03-12-2015
DOI: 10.1111/AJAG.12186
Abstract: To determine the prevalence and nature of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in patients aged 65 years and over. A retrospective clinical audit was undertaken (N = 200) in an Australian metropolitan teaching hospital. The prevalence of at least one PIM was 51% (n = 101) whereas the prevalence of at least one PPO was 74% (n = 147). The most common PIM was prescribing aspirin to patients with no history of coronary, cerebral or peripheral arterial disease or occlusive arterial events. The most commonly detected PPO was the failure to prescribe statins to patients with a documented history of coronary, cerebral or peripheral vascular disease. Overall, 80 (24%) of the 335 PIMs identified were possibly associated with an adverse clinical outcome experienced by patients. Inappropriate prescribing continues to be a problem as shown by complexities associated with the risk-benefit trade-offs of managing medications in older patients.
Older patient participation in discharge medication communication: an observational study
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-064750
Abstract: To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication. Observational study. An Australian metropolitan tertiary hospital. 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge. Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio. The median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04). Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.
Codesigning consumer engagement strategies with ethnic minority consumers in Australian cancer services: the CanEngage Project protocol
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-048389
Abstract: Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to preventing healthcare harm include questioning health professionals, raising concerns about possible mistakes or risks in care and encouraging patients and caregivers to report suspected errors. Patients from ethnic minority backgrounds are particularly vulnerable to unsafe care, but current engagement strategies have not been developed specifically for (and with) this population. Using an adapted approach to experience-based codesign (EBCD) to support the target population, the aim of the project is to codesign consumer engagement interventions to increase consumer engagement and safety in New South Wales and Victorian cancer inpatient, outpatient and day procedure services. A mixed-method project will be undertaken at six study sites. Our EBCD approach includes a preparatory phase in which we will provide training and support to the codesign participants, in addition to recruiting and training consumer cofacilitators for the codesign workshops. The project will follow the EBCD process of gathering and synthesising observational data from each cancer service, with interview data from consumers and staff. With the resulting in-depth understanding of the safety threats commonly experienced by ethnic minority consumers in each site, we will work through feedback events and codesign groups with consumers and staff to determine how they can be more involved with their care to minimise the potential for patient harm. Consumer engagement interventions will be coproduced in each of the six participating services that are tailored to the ethnic minority populations served. Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee. The project will provide strategies for ethnic minority consumers to engage with cancer services to minimise healthcare-associated harm that may be applied to erse healthcare settings.
Family involvement in managing medications of older patients across transitions of care: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 29-03-2019
Bacterial contamination of oral sucrose solutions [2]
Publisher: BMJ
Date: 06-02-2007
Communication between patients with chronic kidney disease and nurses about managing pain in the acute hospital setting
Publisher: Wiley
Date: 10-10-2007
DOI: 10.1111/J.1365-2702.2007.02075.X
Abstract: The aim of this paper is to examine communication between patients with chronic kidney disease and nurses about managing pain in the acute hospital setting. While pain often accompanies chronic kidney disease, little is known about managing pain in actual clinical practice. A single group, non-comparative design was used. Research methods included observations and interviews to examine pain communication in all five adult renal units in the state of Victoria, Australia. A thematic approach was used to analyse the data. Observations and interviews were carried out with 14 nurses and 53 patients and 103 incidents of pain communication occurred during observations. Three themes were identified: complexity of pain, knowledge about pain management and contextual characteristics of the renal units. The nature of the patients' pain and effects of analgesics on the body shaped the complexity of pain in chronic kidney disease. Various causes of pain contributed to difficulties in management. Patients had acute pain from surgical procedures, in particular, phantom limb pain. They also had chronic pain arising from leg cr s, restless leg syndrome, and muscle and bone pain. Knowledge about pain management comprised the use of written resources about analgesics and information exchange among health professionals. Contextual characteristics involved the perceived urgency of pain communication and environmental stressors. The findings emphasize the need to capture dynamic processes of pain management in patients with chronic kidney disease to facilitate understandings about complex communication needs of this vulnerable group. Specific analgesic and non-pharmacological guidelines for patients with chronic kidney disease should be developed and made available in practice to facilitate effective pain management. Change ch ions of renal units are needed to support nurses in dedicating specified time for communicating with patients about managing pain.
The functions and roles of questioning during nursing handovers in specialty settings: an ethnographic study
Publisher: Informa UK Limited
Date: 21-11-2017
DOI: 10.1080/10376178.2016.1258316
Abstract: Nursing handovers are an important component of patient safety and quality in communicating across transitions of care. To determine the functions and roles of questions in nursing handovers, and of how questions contribute to handover quality improvement in specialty settings of an Australian tertiary hospital. An ethnographic research design was employed. Participant observations were conducted which were audiorecorded and transcribed. Question-response sequences and the roles of questions in the handovers were coded. Questions served many functions, and included: requests for information, requests for confirmation, other initiations of repair, outloud utterances, understanding checks, requests for action and agreement, and knowledge checks. Questioning was mostly used to transmit patient-related information, and nurses could use questioning to jointly construct understandings about patients. Future research should examine how questions function in erse clinical environments, such as rural and regional hospitals, and how questioning occurs in multidisciplinary handover situations.
Pain management strategies used during early childhood immunisation in Victoria
Publisher: Wiley
Date: 14-03-2013
DOI: 10.1111/JPC.12161
Abstract: The study aims to identify pain management practices used during scheduled childhood immunisation. A survey of members of the Australian Nurses Federation (Victorian Branch) Immunisation Nurses Special Interest Group. Questions included frequency of use of pain reduction strategies during immunisations for infants, toddlers and children, injection techniques and existence of an articulated pain management policy. The survey was emailed to 274 Immunisation Nurses Special Interest Group members with registered email addresses, and 125 (46%) completed the survey. Nineteen respondents (15.2%) stated their main place of employment had a pain management policy during immunisations and 20 (16.0%) respondents were not sure. Distraction strategies were frequently used during immunisation for all age groups, with 95 (76.0%) replying that distraction was used often or always. Breastfeeding during immunisation for infants younger than 6 months was used occasionally (n = 54, 44.6%), often (n = 11, 9.1%) or never (n = 55, 45.5%) and was used even less frequently for infants aged 6-12 months. Sucrose or other sweet solutions were almost never used for infants prior to, or during, immunisation. As a reward, lollies were frequently given to children after immunisations. Topical anaesthetics were almost never used in any age groups. Over half the respondents used a rapid injection technique 55 (44.7%) used a slow technique and four respondents aspirated the needle before injections. Many distraction strategies were used during and following immunisation but sweet solutions, breastfeeding or topical anaesthetics were rarely used. Use of these strategies where feasible, should be facilitated in erse settings where immunisations take place.
The educational preparation of undergraduate nursing students in pharmacology: perceptions and experiences of lecturers and students
Publisher: Elsevier BV
Date: 09-2002
DOI: 10.1016/S0020-7489(02)00018-4
Abstract: This paper explores the perceptions and experiences of lecturers and undergraduate nursing students relating to teaching and learning issues in pharmacology. A total of 14 focus group interviews were conducted at 10 university settings, which involved seven academic staff and seven student interviews. The focus group interviewing method was used because it enabled all participants to have 'a say', facilitated the expression of erse views, and allowed participants to express themselves without fear that their views would be openly criticised. Student participants comprised second and third year undergraduate nurses while lecturer participants involved course coordinators, subject coordinators, and bioscience and nursing lecturers. The 'framework' method was used for data analysis, which involved the following stages: familiarisation, identifying a thematic framework, indexing, charting, and finally, mapping and interpretation. Four major themes emerged from discussions with lecturers and students: teaching considerations, learning considerations, the relationship between pharmacology knowledge and clinical practice, and the features of an 'ideal' programme in pharmacology. The findings highlighted that potential conflicts existed among academic staff relating to the balance of pharmacology and nursing content in curricula, which often led to over-laden curricula. Potential conflicts also existed between lecturers and students about the value placed on a separate pharmacology subject as opposed to an integrated pharmacology programme. In summary, there is still much scope for educational initiatives to improve students' knowledge of pharmacology and medication management.
Patients' and family members' views on how clinicians enact and how they should enact incident disclosure: the 100 patient stories qualitative study
Publisher: BMJ
Date: 25-07-2011
DOI: 10.1136/BMJ.D4423
Communicating about the management of medications as patients move across transition points of care: an observation and interview study
Publisher: Wiley
Date: 14-01-2016
DOI: 10.1111/JEP.12507
Abstract: As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.
Overseas qualified nurses' communication with other nurses and health professionals: An observational study.
Publisher: Wiley
Date: 30-06-2019
DOI: 10.1111/JOCN.14942
Abstract: To understand the interprofessional and intraprofessional communication patterns of overseas qualified nurses as they coordinate care for patients in Australian hospitals. Numerous studies have informed the transitioning experiences of overseas qualified nurses with non-English-speaking backgrounds working in English-speaking workplaces. Only a few observational studies have involved examining the intercultural communication experiences of overseas qualified nurses, and none have considered their intra- and interprofessional communication patterns. A qualitative design was adopted, using participant observation and discourse analysis. This study was from January 2017 to March 2017. Thirteen overseas qualified nurses working in acute, subacute and interventional cardiology settings in a Melbourne metropolitan hospital were shadowed over a period of 12 weeks to collect data that inform their communication patterns. The COREQ checklist was used. This observational study informed by genre analysis revealed that intra- and interprofessional communication occurred more commonly under the clinical communication goals of coordinating care and less commonly under facilitating intervention. Communication strategies ranged from structured interactions with use of communication tools to unstructured ad hoc interactions. Analysis of the discourse patterns demonstrated that effectiveness of interactions was affected by hesitancy, lack of assertion and few strategies to manage inadequate or aggressive communication by other team members. Poor clinical communication with peers was not always caused by the nurses from non-English-speaking backgrounds. Positive interpersonal interactions with laughter, language-switching and small talk were evident in interactions with nurses from similar cultural backgrounds but were rare with local colleagues. The linguistic evidence from this study shows variations in communication competency between participants, which emphasises the importance of not viewing overseas qualified nurses' communication training needs as homogenous. With the growing multicultural nature of healthcare teams, this study underscores the need for intercultural communication training for team integration and patient safety. Continuous professional development should incorporate intercultural communication training to ensure team effectiveness within nursing teams as well as interprofessional teams.
Nurses’ job dissatisfaction and turnover intention: Methodological myths and an alternative approach
Publisher: Wiley
Date: 03-08-2005
DOI: 10.1111/J.1442-2018.2005.00232.X
Abstract: Job dissatisfaction and turnover are recurring themes in nursing. The current international nursing shortage has resulted in increased interest in investigating the causes of nurses' job dissatisfaction and turnover, and in developing countermeasures to address these issues. This paper involves a review of quantitative nursing studies, which investigated the causes of nurses' job dissatisfaction and turnover intention, and identifies commonly held myths that may inhibit more nurse-centered strategies from being developed. These myths are based on an assumption that a nurse-environment relationship is a one-way interaction in which nurses passively respond to their environment. The paper introduces the person-environment fit theory as an alternative framework, which challenges the assumption by suggesting it is the relationship between person and environment, rather than environmental characteristics alone, that affects nurses' occupational behavior. This theory enables nurse researchers to develop a more mutual approach involving the nurse and environment.
Challenges to consumers travelling with multiple medicines
Publisher: Oxford University Press (OUP)
Date: 08-06-2015
DOI: 10.1111/JPHS.12097
Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients
Publisher: Wiley
Date: 17-12-2015
DOI: 10.1111/INM.12113
Abstract: Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those in iduals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and in idual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.
A cluster randomised controlled feasibility study of nurse-initiated behavioural strategies to manage interruptions during medication administration
Publisher: Oxford University Press (OUP)
Date: 05-03-2019
Abstract: To examine the feasibility of a behavioural e-learning intervention to support nurses to manage interruptions during medication administration. A cluster randomised feasibility trial. The cluster trial included four intervention and four control wards randomly selected across four metropolitan hospitals in Sydney, Australia. We observed 806 (402 pre-intervention and 404 post-intervention) medication events, where nurses prepared and administered medications to patients within the cluster wards. The primary outcome measured was the observed number of interruptions occurring during administration, with secondary outcomes being the number of clinical errors and procedural failures. Changes in the use of behavioural strategies to manage interruptions, targeted by the e-learning intervention, were also assessed. No significant differences were found in the number of interruptions (P = 0.82), procedural failures (P = 0.19) or clinical errors per 100 medications (P = 0.32), between the intervention and control wards. Differences in the use of specific behavioural strategies (engagement and multitasking) were found in the intervention wards. This behavioural e-learning intervention has not been found to significantly reduce interruptions, however, changes in the use of strategies did occur. Careful selection of clinical settings where there is a high number of predictable interruptions is recommended for further research into the impact of the behavioural e-learning intervention. An increase in the intensity of this intervention is recommended with training undertaken away from the clinical setting. Further research on additional consumer-sensitive interventions is urgently needed.
Use of over-the-counter medicines for young children in Australia
Publisher: Wiley
Date: 2010
DOI: 10.1111/J.1440-1754.2009.01609.X
Abstract: Aim: To describe over‐the‐counter (OTC) medicine use by Australian parents for children aged birth to 24 months types of medicines used and indications for use. Methods: A cross‐sectional survey of parents was conducted using a self‐administered over‐the‐counter medicine use questionnaire. A total of 640 questionnaires were distributed to parents of children who attended a hospital outpatient clinic, maternal and child health centre, or a childcare service in Melbourne, Australia. Results: A total of 325 questionnaires were completed (50.1%). Of these, 98.2% of parents had reportedly purchased at least one OTC medicine for their child in the previous 12 months. The most commonly purchased medicines were: paracetamol (acetaminophen) (95.9%), choline salicylate (47.3%), ibuprofen (36.4%), and cough and cold products (46.7%). Paracetamol was commonly used for a high temperature (82.4%) and non‐specific pain (62.3%). Over 40% of parents had used cough and cold products to treat cold and flu symptoms. Nineteen (6.1%) parents had used OTC medicines to induce sleep or settle their child. Conclusions: Most parents had used at least one OTC medicine to manage childhood symptoms. Of concern is that over 40% of parents had used cough and cold products for their young child, despite a lack of evidence surrounding their efficacy. In order to minimise risks associated with OTC medicine use, particularly cough and cold products, health‐care providers need to continue the provision of current evidence‐based information to parents regarding safe and appropriate use of medicines for their child.
Use of the Screening tool of older person's prescriptions (STOPP) in older people admitted to an Australian hospital
Publisher: Wiley
Date: 30-06-2015
DOI: 10.1111/AJAG.12054
Abstract: To determine the prevalence of potentially inappropriate medications (PIMs) in older people aged 65 years and over who were admitted to hospital, and to examine the medications and medication classes that comprised these PIMs with use of the Screening Tool of Older Person's Prescriptions. Using a retrospective clinical audit design, the medical records of 100 older patients were randomly selected and examined for the prevalence and characteristics of PIMs. The audit was undertaken of patients admitted over a 12-month period to an Australian public teaching hospital. In total, 92 in idual occurrences of PIMs were detected, and 54 patients had at least one PIM. The most common type of PIM experienced related to prescribed medications that adversely affected in iduals who were prone to falls. Many older patients experienced a PIM during their hospital admission, where the risk of an adverse event could outweigh the clinical benefit.
Culturally sensitive communication in healthcare: A concept analysis
Publisher: Elsevier BV
Date: 06-2019
Analgesics Administered During Minor Painful Procedures in a Cohort of Hospitalized Infants: A Prospective Clinical Audit
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.JPAIN.2008.12.011
Abstract: A number of evidence-based consensus statements relating to pain in infants include recommendations concerning effective pain management during painful procedures. Yet numerous studies have shown that procedural pain remains poorly managed in neonatal intensive care units. The aim of this prospective clinical audit was to ascertain analgesics administered during skin-breaking, minor painful procedures occurring over the entire course of a hospitalization in a cohort of infants with a length of stay of 28 days or more. Data were collected on aspects relating to utilization of oral sucrose specifically for minor painful procedures as well as administration of opioid analgesics or other strong analgesics on the day the procedures were performed. A total of 3605 minor painful procedures were recorded for 55 infants during the study period, a mean of 65 minor procedures per infant. The majority of procedures recorded were heel lance (71%), followed by intravenous catheter insertion or venepuncture (14%). Either oral sucrose was specifically administered or background opioid analgesics were being administered during 85% of all minor painful procedures. These results show considerably higher frequency of analgesic use during acute minor painful procedures compared with similar studies of pain management practices in neonatal intensive care units. This study ascertained analgesics administered to sick infants during minor painful procedures during a prolonged hospitalization. Oral sucrose or morphine was administered during the most painful procedures, whereas 15% of procedures were performed with no analgesics. This illustrates a vast improvement compared with similar studies.
Homelessness: Patterns of emergency department use and risk factors for re-presentation
Publisher: BMJ
Date: 03-08-2011
Abstract: To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an in idual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.
Medication Use and Fall-Related Hospital Admissions from Long-Term Care Facilities: A Hospital-Based Case–Control Study
Publisher: Springer Science and Business Media LLC
Date: 06-2017
DOI: 10.1007/S40266-017-0472-8
Abstract: Falls are a leading cause of preventable hospitalizations from long-term care facilities (LTCFs). Polypharmacy and falls-risk medications are potentially modifiable risk factors for falling. This study investigated whether polypharmacy and falls-risk medications are associated with fall-related hospital admissions from LTCFs compared with hospital admissions for other causes. This was a hospital-based, case-control study of patients aged ≥65 years hospitalized from LTCFs. Cases were patients with falls and fall-related injuries, and controls were patients admitted for infections. Conditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between polypharmacy (defined as the use of nine or more regular pre-admission medications) and falls-risk medications (categorized as psychotropic medications and those that can cause orthostatic hypotension) with fall-related hospital admissions. There was no association between polypharmacy and fall-related hospital admissions (adjusted OR 0.97, 95% CI 0.63-1.48) however, the adjusted odds of fall-related hospital admissions increased by 16% (95% CI 3-30%) for each additional falls-risk medication. Medications that can cause orthostatic hypotension (adjusted OR 1.25, 95% CI 1.06-1.46), but not psychotropic falls-risk medications (adjusted OR 1.02, 95% CI 0.88-1.18) were associated with fall-related hospital admissions. The association between medications that can cause orthostatic hypotension and fall-related hospital admissions was strongest among residents with polypharmacy (adjusted OR 1.44, 95% CI 1.08-1.92). Polypharmacy was not an independent risk factor for fall-related hospital admissions however, medications that can cause orthostatic hypotension were associated with fall-related hospital admissions, particularly among residents with polypharmacy. Falls-risk should be considered when prescribing medications that can cause orthostatic hypotension.
The influence of intensive care unit culture and environment on nurse decision-making when managing vasoactive medications: A qualitative exploratory study.
Publisher: Wiley
Date: 24-10-2022
DOI: 10.1111/JOCN.16561
Abstract: Nurses working in intensive care units make autonomous decisions to manage high-risk vasoactive medications in critically ill patients. Noradrenaline (norepinephrine) is a vasoactive medication commonly administered to patients in intensive care units. The influence of unit culture and environment on nurse-decision-making on noradrenaline (norepinephrine) management is unknown. The study aimed to investigate nurses' perceptions of the impact of interpersonal interactions, socialisation, and the intensive care environment on decision-making when managing noradrenaline (norepinephrine). An exploratory qualitative study applied thematic analysis to focus group data. A purposive s le of nineteen nurses participated in four focus groups at two intensive care units in Melbourne, Australia, from March to June 2021. The COREQ checklist was used to guide study development and no patients or members of the public were involved in focus groups. Three themes were generated from the researcher's interaction with data, Nursing and Medications Culture and Decision-making and a Safe Practice Environment. Nurses reported decision-making challenges associated with learning to manage noradrenaline (norepinephrine) early in their intensive care career and discussed feelings of isolation due to staffing resources, and the configuration of the intensive care environment. Nurses developed titration and weaning strategies to support decision-making in the absence of evidence-based algorithms. Empathetic patient allocation early in nurses' intensive care careers facilitated a safer learning environment, and reduced isolation inherent in single room intensive care units. Nurses developed and used titration and weaning strategies, often learnt from other clinicians to manage practice uncertainty. Management of noradrenaline (norepinephrine) is core business for intensive care nurses worldwide. Development of titration and weaning strategies by nurses indicated unmet need for guidelines to support decision-making. Identifying contextual elements that impact nurse management of high-risk medications can guide development of environments, resources and policies that support nurse decision-making, and reduce nurse anxiety and disempowerment.
Detection of medication-related problems in hospital practice: A review
Publisher: Wiley
Date: 20-06-2013
DOI: 10.1111/BCP.12049
Self‐administration of medication in hospital: patients’ perspectives
Publisher: Wiley
Date: 30-03-2004
Patients' and family members' experiences of open disclosure following adverse events
Publisher: Oxford University Press (OUP)
Date: 24-07-2008
Abstract: To explore patients' and family members' perceptions of Open Disclosure of adverse events that occurred during their health care. We interviewed 23 people involved in adverse events and incident disclosure using a semi-structured, open-ended guide. We analyzed transcripts using thematic discourse analysis. Four States in Australia: New South Wales, Victoria, Queensland and South Australia. Twenty-three participants were recruited as part of an evaluation of the Australian Open Disclosure pilot commissioned by the Australian Commission on Safety and Quality in Health Care. All participants (except one) appreciated the opportunity to meet with staff and have the adverse event explained to them. Their accounts also reveal a number of concerns about how Open Disclosure is enacted: disclosure not occurring promptly or too informally disclosure not being adequately followed up with tangible support or change in practice staff not offering an apology, and disclosure not providing opportunities for consumers to meet with the staff originally involved in the adverse event. of participants' accounts suggests that a combination of formal Open Disclosure, a full apology, and an offer of tangible support has a higher chance of gaining consumer satisfaction than if one or more of these components is absent. Staff need to become more attuned in their disclosure communication to the victim s perceptions and experience of adverse events, to offer an appropriate apology, to support victims long-term as well as short-term, and to consider using consumers' insights into adverse events for the purpose of service improvement.
'She's manipulative and he's right off': A critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting
Publisher: Wiley
Date: 06-2006
DOI: 10.1111/J.1447-0349.2006.00407.X
Abstract: Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the erse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as erse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society.
A patient-centred care and engagement program in intensive care reduces adverse events and improves patient and care partner satisfaction
Publisher: Elsevier BV
Date: 03-2019
Factors associated with readmission in chronic kidney disease: Systematic review and meta‐analysis
Publisher: Wiley
Date: 09-07-2023
DOI: 10.1111/JORC.12437
Abstract: Risk factors associated with all‐cause hospital readmission are poorly characterised in patients with chronic kidney disease. A systematic review and meta‐analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease. Studies involving adult patients were identified from four databases from inception to 31/03/2020. Random‐effects meta‐analyses were conducted to determine factors associated with all‐cause 30‐day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups. Eighty relevant studies (chronic kidney disease, n = 14 studies dialysis, n = 34 studies and transplant, n = 32 studies) were identified. Meta‐analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30‐day readmission. Other risk factors identified included increasing body mass index (kg/m 2 ) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow‐up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist. Risk‐reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.
Related Organisations
University Of Melbourne Faculty Of Medicine Dentistry And Health Sciences
Location: Australia
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