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Cooper A, Iten R, Leslie GD, Barrett D, Lane M, Mould J, Hamsanathan P, Stokes S, Falconer P, Wood M, Cheesman S, Gill FJ. Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods. Nurs Open 2024; 11:e2100. [PMID: 38366769 PMCID: PMC10873682 DOI: 10.1002/nop2.2100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
AIM The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. DESIGN Quasi-experimental mixed methods using co-production. METHODS Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays. RESULTS Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning. PATIENT OR PUBLIC CONTRIBUTION Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.
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Affiliation(s)
- Alannah Cooper
- School of Nursing, Faculty Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Rebecca Iten
- School of Nursing, Faculty Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | | | - David Barrett
- Postgraduate Medical EducationPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Marguerite Lane
- Nursing ResearchPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Jonathon Mould
- Postgraduate Medical EducationPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Prasanthy Hamsanathan
- Postgraduate Medical EducationPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Scott Stokes
- Kimberley Regional Paediatric ServiceBroome HospitalBroomeWestern AustraliaAustralia
| | - Pania Falconer
- School of Nursing, Faculty Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Nursing ResearchPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Margaret Wood
- Health consumer representativeChild and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Samantha Cheesman
- Health consumer representativeChild and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
| | - Fenella J. Gill
- Nursing ResearchPerth Children's Hospital, Child and Adolescent Health ServiceNedlandsWestern AustraliaAustralia
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Janerka C, Leslie GD, Mellan M, Arendts G. Review article: Prehospital telehealth for emergency care: A scoping review. Emerg Med Australas 2023. [PMID: 37102271 DOI: 10.1111/1742-6723.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
Telehealth has been successfully implemented in the prehospital setting to expedite emergency care, although applications are still in their infancy. With recent advances in technologies, it is not described how prehospital telehealth has evolved over the past decade. This scoping review aimed to answer the research question 'what telehealth platforms have been used to facilitate communication between prehospital healthcare providers and emergency clinicians in the past decade?'. The review was guided by Joanna Briggs Institute scoping review methodology and reported in accordance with the PRISMA checklist for scoping reviews. A systematic search of five databases and Google Scholar was undertaken using key terms 'prehospital', 'ambulance', 'emergency care' and 'telehealth', and results were limited to research articles published in English language between 2011 and 2021. Articles were included if they related to the research question and reported quantitative, qualitative, mixed-method or feasibility studies. A total of 28 articles were included in the review that reported feasibility (n = 13), intervention (n = 7) or observational studies (n = 8) involving 20 telehealth platforms. Platforms were commonly implemented to provide prehospital staff with medical support for general emergency care and involved a range of devices that were used to transmit video, audio and biomedical data. The benefits of prehospital telehealth to patients, clinicians and organisations were identified. Challenges to telehealth involved technical, clinical and organisational issues. Few facilitators of prehospital telehealth were identified. Telehealth platforms to facilitate prehospital to ED communication continue to develop but require technological advances and improved network connectivity to support implementation in the prehospital environment.
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Affiliation(s)
- Carrie Janerka
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Perth, Western Australia, Australia
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Gavin D Leslie
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Perth, Western Australia, Australia
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Mellissa Mellan
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Glenn Arendts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud 2023; 140:104465. [PMID: 36857979 DOI: 10.1016/j.ijnurstu.2023.104465] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT Patient-centred care in acute care settings - we have arrived! Is it sustainable?
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Affiliation(s)
- Carrie Janerka
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Curtin University, Western Australia, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Australia
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Abstract
In the context of pressures faced by the nursing profession including increasing patient acuity and global nursing shortages, the importance of nurse resilience has gained attention in research and practice. Resilience is viewed as a protective factor that enables individuals to avoid psychological harm and continue in their work. There is limited evidence on the impact of external factors such as work conditions on nurse resilience. This study aimed to explore how external factors influence nurse resilience and to incorporate this knowledge into an updated definition of nurse resilience. As part of a two-phase mixed methods study, focus groups were conducted to obtain qualitative data to explore nurse's perceptions of resilience and factors they felt affected their resilience. Data analysis identified three main themes derived from 10 subthemes: Perceptions of Resilience, Pressures and Challenges, and Support and Strategies contributed to understanding how external factors can affect nurse resilience. A range of factors emerged including the impact of workplace conditions, organizational philosophy, the performance of managers, and the teams nurses work within, which were not reflected in an earlier definition of nurse resilience derived through a concept analysis. These factors were incorporated in an updated definition of nurse resilience. Understanding resilience in the nursing profession and the external factors that affect it is critical to the development of effective research, policies, interventions, and work environments to protect nurse well-being, promote nurse retention, and ensure the provision of quality patient care.
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Affiliation(s)
- Alannah L Cooper
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia.,School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Gavin D Leslie
- School of Nursing, Curtin University, Bentley, Western Australia, Australia.,South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice, Curtin University, Bentley, Western Australia, Australia
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Gill FJ, Cooper AL, Laird P, Leslie GD. Aboriginal perspectives on recognising clinical deterioration in their child and communicating concerns to clinicians. J Pediatr Nurs 2022; 63:e10-e17. [PMID: 34801328 DOI: 10.1016/j.pedn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of family members of Aboriginal children about a) their involvement in recognising clinical deterioration in a hospital setting and b) the effectiveness of a poster designed to promote family involvement. BACKGROUND To assist in the early recognition and response to clinical deterioration for hospitalised children, many escalation of care processes now include family involvement. Little is currently known about the perspectives of Australian Aboriginal families in recognising deterioration in their child and raising the alarm, or if current escalation of care systems meet the needs of Aboriginal families. DESIGN Qualitative pragmatist approach using semi-structured interviews. METHODS Seven interviews were conducted with five mothers and two grandmothers of Aboriginal children who were inpatients at a children's hospital. Thematic analysis was undertaken. FINDINGS Two themes were identified: Theme one was: Family role in recognising and responding to clinical deterioration, with two subthemes of knowing when to worry and communicating concerns. Participants reported that some families needed more knowledge to recognise clinical deterioration. Communication barriers between families and clinicians were identified. Theme two was: Effective visual communication with three subthemes of linguistic clarity, visual appeal and content. CONCLUSIONS Additional strategies are needed to promote effective communication between clinicians and families of Aboriginal children in hospital. Posters were considered effective, particularly if including a cultural connection, images and simplified language. PRACTICE IMPLICATIONS These insights provide important information for health professionals and health service managers to be aware that additional communication strategies are required to support Aboriginal family involvement in recognising clinical deterioration and escalation of care.
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Affiliation(s)
- Fenella J Gill
- Nursing Research, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Nursing, Curtin University, Perth 6102, WA, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Alannah L Cooper
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
| | - Pamela Laird
- Physiotherapy Department, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; Breath Team, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, WA, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
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Gill FJ, Cooper A, Falconer P, Stokes S, Leslie GD. Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration. Aust Crit Care 2021; 35:668-676. [PMID: 34711495 DOI: 10.1016/j.aucc.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022] Open
Abstract
AIM The aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care. METHODS A three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing. RESULTS A prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW). CONCLUSION The development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system.
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Affiliation(s)
- Fenella J Gill
- School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia; Perth Children's Hospital, Child & Adolescent Health Services, Western Australia, Australia.
| | - Alannah Cooper
- School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia; Perth Children's Hospital, Child & Adolescent Health Services, Western Australia, Australia.
| | - Pania Falconer
- School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia; Perth Children's Hospital, Child & Adolescent Health Services, Western Australia, Australia.
| | - Scott Stokes
- Kimberley Regional Paediatric Service, Broome Hospital, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
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Boylen S, Cherian S, Gill FJ, Leslie GD, Wilson S. Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth 2021; 18:1360-1388. [PMID: 32813387 DOI: 10.11124/jbisrir-d-19-00300] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to identify, critically appraise and synthesize evidence on the impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency. INTRODUCTION A key strategy to facilitate effective communication between limited-English-proficient migrant and refugee families and healthcare providers is the use of professional interpreters. Despite awareness of the importance of professional interpreters, interpreters are underutilized. This results in suboptimal care, including poor access to health care, increased risk of serious medical events, increased admission to hospital and inadequate health literacy. INCLUSION CRITERIA Limited-English-proficient migrant, refugee or asylum-seeker families with a hospitalized child aged 0 to 18 years, who had used a professional interpreter, were considered for this review. Comparators included standard care or no interpreter, and reported results of comparisons of the duration, frequency or mode of interpreter delivery. Outcomes were length of stay in hospital, unplanned readmission rates to hospital, non-attendance at hospital clinic appointments and ambulatory care, child and/or parent satisfaction with care in hospital, adherence to treatment, medication errors, and other adverse events relating to patient safety. The review considered all studies conducted using a quantitative approach. METHODS A three-step search strategy was used. Databases were searched in December 2018 for published and unpublished articles. Studies published in English were considered for inclusion. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used. RESULTS Six articles reporting results from three randomized controlled trials and one observational study were included. Studies were undertaken in the United States involving Spanish-speaking participants. Three studies were in emergency departments. There was a total of 1813 families, of whom 1753 had limited English proficiency. Migrant and refugee families with limited English proficiency reported greater satisfaction with aspects of care when a professional interpreter service was used compared with using ad hoc interpreters. Using professional in-person interpreters resulted in a shorter total emergency department throughput time compared to using professional interpreters via telephone. There was no difference in concordance of child's discharge diagnoses between parents assigned professional interpreters and those assigned bilingual physicians. Video interpretation provided better understanding of diagnoses than phone interpretation. CONCLUSION There is evidence that use of ad hoc interpreters or no interpreter is inferior to use of professional interpreters of any mode. Although video and in-person interpreters are more favorable for some outcomes, mode of delivery may not be as important as the fact that a professional interpreter is being used. The mode of professional interpreter delivery should be based on accessibility, availability, language requirements and patient preference. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42017058161.
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Affiliation(s)
- Susan Boylen
- 1School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia 2The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence 3Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia 4Division of Paediatrics, University of Western Australia, Perth, Australia
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Cooper AL, Brown JA, Leslie GD. The impact of organisational values on nurse resilience: A mixed-methods study. J Nurs Manag 2021; 29:2074-2083. [PMID: 33856073 DOI: 10.1111/jonm.13338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Abstract
AIM To investigate the impact of organisational values on nurse resilience. BACKGROUND Nurses encounter significant occupational adversity, which can result in negative psychological consequences. Investigating the role of resilience as a protective factor focuses on what enables some nurses to positively adapt in challenging work environments. Comparatively, little attention has been paid to organisational factors and nurse resilience. METHOD A two-phase mixed-methods design comprising a cross-sectional survey and focus groups. RESULTS Three hundred and ninety-four nurses responded to the survey with 25 participating in four follow-up focus groups. Significant associations were found between resilience levels and agreement with organisational values (p = .022) and agreement about the importance of values (p = .018). Three themes relating to organisational values were identified: pressures and challenges; supports and strategies; and impact of organisational values. CONCLUSIONS Organisational values may positively impact resilience if nurses concur with those values and believe they are shared by their employer. IMPLICATIONS FOR NURSING MANAGEMENT To promote nurse resilience, organisations and nurse leaders should consider developing, implementing and operating with a set of employee-adopted values, which need to be demonstrably upheld across the organisation.
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Affiliation(s)
- Alannah L Cooper
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia.,Nursing and Midwifery Research, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Janie A Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - Gavin D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
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Cooper AL, Brown JA, Leslie GD. Nurse resilience for clinical practice: An integrative review. J Adv Nurs 2021; 77:2623-2640. [DOI: 10.1111/jan.14763] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/04/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Alannah L. Cooper
- School of Nursing, Midwifery and Paramedicine Curtin University Bentley Western Australia Australia
- St John of God Subiaco Hospital Subiaco Western Australia Australia
| | - Janie A. Brown
- School of Nursing, Midwifery and Paramedicine Curtin University Bentley Western Australia Australia
| | - Gavin D. Leslie
- School of Nursing, Midwifery and Paramedicine Curtin University Bentley Western Australia Australia
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Brennan MC, Albrecht MA, Brown JA, Leslie GD, Ntoumanis N. Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial. Can J Diabetes 2021; 45:619-628. [PMID: 33648863 DOI: 10.1016/j.jcjd.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). METHODS This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 - scoret1]TREATMENT vs [scoret2 - scoret1]CONTROL). RESULTS We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, -0.38; highest density interval, -0.92 to 0.17]), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91]), diabetes distress (ES, -0.29; highest density interval, -0.77 to 0.15) and well-being (ES, 0.36; highest density interval, -0.12 to 0.8). CONCLUSIONS Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.
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Affiliation(s)
- Marian C Brennan
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Health Services, Diabetes Western Australia, Perth, Western Australia, Australia; Physical Activity and Well-being Research Group, Curtin University, Perth, Western Australia, Australia.
| | - Matthew A Albrecht
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Janie A Brown
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; St John of God Midland Public and Private Hospital, Perth, Western Australia, Australia; Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, Western Australia, Australia
| | - Gavin D Leslie
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nikos Ntoumanis
- Physical Activity and Well-being Research Group, Curtin University, Perth, Western Australia, Australia; Curtin School of Population Health/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Brennan MC, Brown JA, Ntoumanis N, Leslie GD. Barriers and facilitators of physical activity participation in adults living with type 1 diabetes: a systematic scoping review. Appl Physiol Nutr Metab 2020; 46:95-107. [PMID: 32835497 DOI: 10.1139/apnm-2020-0461] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To identify and map barriers and facilitators of physical activity (PA) in adults living with type 1 diabetes (T1D) in any care setting or environment. A scoping review was conducted in accordance with the PRISMA-ScR guidelines to address the aim of this review. Exclusion/inclusion criteria were determined a priori. Articles captured in the search were subject to title and abstract screening before full-text articles were assessed for eligibility against the exclusion/inclusion criteria. Included articles underwent critical appraisal before being charted, mapped, and discussed. Forty-six articles were included in the final synthesis. Most commonly, articles reported cross-sectional survey studies (46%), then qualitative designs (17%), and opinion or text (17%). Experimental studies accounted for 13% of included articles. Hypoglycaemia/fear of hypoglycaemia was the most commonly reported barrier and patient education the most commonly discussed facilitator. Quality appraisal revealed methodological issues among included articles. Higher quality research with theoretically sound behaviour-change interventions combined with targeted patient education is needed to address hypoglycaemia/fear of hypoglycaemia as a barrier to PA. Novelty: Hypoglycaemia and fear of hypoglycaemia were the most commonly reported barriers to PA in adults with T1D. Powered randomised controlled trials are required to establish efficacy of behaviour change interventions targeting these barriers to PA.
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Affiliation(s)
- Marian C Brennan
- School of Nursing, Midwifery and Paramedicine/Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.,Health Services, Diabetes WA, Subiaco, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, WA 6845, Australia
| | - Janie A Brown
- School of Nursing, Midwifery and Paramedicine/Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.,St John of God Midland Public and Private Hospital, Midland, WA 6056, Australia
| | - Nikos Ntoumanis
- School of Psychology/Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, WA 6845, Australia
| | - Gavin D Leslie
- School of Nursing, Midwifery and Paramedicine/Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
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Abstract
Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.
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Affiliation(s)
- Alannah L Cooper
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Clare S Rees
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Gavin D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Sandy-Hodgetts K, Carville K, Santamaria N, Parsons R, Leslie GD. The Perth Surgical Wound Dehiscence Risk Assessment Tool (PSWDRAT): development and prospective validation in the clinical setting. J Wound Care 2019; 28:332-344. [PMID: 31166854 DOI: 10.12968/jowc.2019.28.6.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The worldwide volume of surgery today is considerable and postoperative wound healing plays a significant part in facilitating a patient's recovery and rehabilitation. While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence (SWD) or breakdown of the incision site may occur despite advances in surgical techniques, infection control practices and wound care. SWD impacts on patient mortality and morbidity and significantly contributes to prolonged hospital stay. Preoperative identification of patients at risk of SWD may be valuable in reducing the risk of postoperative wound complications. METHOD A three-phase study was undertaken to determine risk factors associated with SWD, develop a preoperative patient risk assessment tool and to prospectively validate the tool in a clinical setting. Phases 1 and 2 were retrospective case control studies. Phase 1 determined variables associated with SWD and these informed the development of a risk assessment tool. Univariate analysis and multiple logistic regression were applied to identify predictors of surgical risk. Phase 2 used the receiver operator curve statistic to determine the predictive power of the tool. Phase 3 involved a prospective consecutive case series validation to test the inter-rater reliability and predictive power of the tool. RESULTS In addition to those already identified in the literature, one independent risk predictor for SWD was identified: previous surgery in the same anatomical location (p<0.001, odds ratio [OR] 4). Multiple combined factors were integrated into the tool and included: age (p<0.019, OR 3), diabetes (p<0.624, OR 2), obesity (p<0.94, OR 1.4), smoking (p<0.387, OR 2), cardiovascular disease (p<0.381 OR 3) and peripheral arterial disease (p<0.501, OR 3). The predictive power of the tool yielded 71% in a combined data sample. CONCLUSION Patients with previous surgery in the same anatomical location were four times more likely to incur a dehiscence. Identification of at-risk patients for complications postoperatively is integral to reducing SWD occurrence and improving health-related outcomes following surgery.
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Affiliation(s)
- Kylie Sandy-Hodgetts
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Medicine, University of Western Australia, UWA Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
| | - Keryln Carville
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Medicine, University of Western Australia, UWA Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
| | - Nick Santamaria
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Medicine, University of Western Australia, UWA Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
| | - Richard Parsons
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Medicine, University of Western Australia, UWA Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
| | - Gavin D Leslie
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Medicine, University of Western Australia, UWA Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
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Gill FJ, Leslie GD, Marshall AP. Parent escalation of care for the deteriorating child in hospital: A health-care improvement study. Health Expect 2019; 22:1078-1088. [PMID: 31309665 PMCID: PMC6803393 DOI: 10.1111/hex.12938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the implementation of an intervention for parents to escalate care if concerned about their child's clinical condition. DESIGN Mixed-methods health-care improvement approach guided by the Theoretical Domains Framework. METHODS Implementation of the 'Calling for Help' (C4H) intervention was informed by previously identified barriers and facilitators. Evaluation involved audit, review of clinical deterioration incidents, interviews and focus groups. SETTING Australian specialist paediatric hospital. PARTICIPANTS Convenience sample of 75 parents from inpatient areas during the audit, interviews with ten parents who had expressed concern about their child's clinical condition; five focus groups with 35 ward nurses. MAIN OUTCOME MEASURES Parent awareness and utilization of C4H, parent and nurse views of factors influencing implementation. RESULTS Parent awareness of C4H improved to 35% (25/75). Parent concern was documented prior to 21/174 (12%) clinical deterioration events. All interviewed parents and nurses who participated in focus groups were positive about C4H. Parents preferred to be informed about C4H by nurses, but nurses described this as time-consuming and selectively chose parents who they believed would benefit most. Parents and nurses described frustrations with and trepidation in escalating care. Nurses had used C4H to expedite urgent medical review. CONCLUSIONS There was an improvement in the level of parent awareness of C4H, which was viewed positively by parents and nurses alike. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required. Further strategies will be required for parents to feel confident enough to use C4H and to address interprofessional communication barriers.
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Affiliation(s)
- Fenella J. Gill
- School of Nursing, Midwifery & Paramedicine, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Perth Children's HospitalChild & Adolescent Health ServicesPerthWestern AustraliaAustralia
| | - Gavin D. Leslie
- School of Nursing, Midwifery & Paramedicine, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Andrea P. Marshall
- School of Nursing and Midwifery Clinical ChairGold Coast HealthSouthportQueenslandAustralia
- School of Nursing and Midwifery and Menzies Health Institute QueenslandCentre for Health Practice InnovationSouthportQueenslandAustralia
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health ServiceGold Coast University HospitalSouthportQueenslandAustralia
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Davies H, Leslie GD, Morgan D, Dobb GJ. A comparison of compliance in the estimation of body fluid status using daily fluid balance charting and body weight changes during continuous renal replacement therapy. Aust Crit Care 2019; 32:83-89. [DOI: 10.1016/j.aucc.2017.12.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 12/16/2022] Open
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Rayner RL, Carville KJ, Leslie GD, Dhaliwal SS. Clinical purpura and elastosis and their correlation with skin tears in an aged population. Arch Dermatol Res 2019; 311:231-247. [PMID: 30783769 DOI: 10.1007/s00403-019-01899-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/20/2023]
Abstract
The previous research reported the results of a prospect cohort study that used logistic regression analysis to construct a risk prediction model for skin tears in individuals aged over 65 years. The model identified three baseline individual characteristics (male gender, history of STs, and history of falls) and two baseline skin manifestations (purpura and elastosis) that predicted the risk of dorsal forearm skin tears. This paper outlines the relationships between baseline skin manifestations and the risk of skin tears. Univariable logistic regression analysis was conducted of all the baseline data collected from the same-study participants to identify variables that significantly predicted purpura and elastosis at baseline. Amongst the 173 participants, 71 (41%) developed one or more skin tears, and in these participants, 52 (73.2%) displayed purpura, 41 (57.8%) had elastosis, and 30 (42.3%) exhibited both manifestations of the dorsal forearm at baseline. Four individual characteristics (age, history of skin tears, history of falls, and antiplatelet therapy) and three skin properties (pH, subepidermal low echogenicity band of the forearms, and skin thickness) were found to predict the risk of purpura. Conversely, three individual variables (age, gender, and smoking), three clinical skin variables (uneven skin pigmentation, cutis rhomboidalis nuchae, and history of actinic keratosis) and one skin property variable (collagen type IV) predicted the risk of skin elastosis. Progressive changes to the skin's structural and mechanical properties from the underlying effects of chronological ageing, and environmental and lifestyle-related influences increased the risk of purpura and elastotic skin manifestations and concomitantly increased risk of skin tears amongst participants.
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Affiliation(s)
- R L Rayner
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia. .,Silver Chain Group, 6 Sundercombe St, Osborne Park, WA, 6017, Australia. .,School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - K J Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Silver Chain Group, 6 Sundercombe St, Osborne Park, WA, 6017, Australia
| | - G D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - S S Dhaliwal
- School of Public Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
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Boxall SL, Carville K, Leslie GD, Jansen SJ. Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature. Phlebology 2019; 34:501-514. [PMID: 30674236 DOI: 10.1177/0268355519825590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.
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Affiliation(s)
- Sharon L Boxall
- 1 School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | - Keryln Carville
- 2 Curtin University and Silver Chain Group, Bentley, Australia
| | - Gavin D Leslie
- 1 School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
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Gill FJ, Leslie GD, Marshall AP. Barriers and facilitators to implementing a process to enable parent escalation of care for the deteriorating child in hospital. Health Expect 2018; 21:1095-1103. [PMID: 29962031 PMCID: PMC6250884 DOI: 10.1111/hex.12806] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To identify barriers and facilitators to implementing a parent escalation of care process: Calling for Help (C4H). DESIGN Audits, semi-structured interviews and focus groups guided by the Theoretical Domains Framework. SETTING Australian paediatric hospital where a parent escalation of care process was introduced in the previous 6 months. PARTICIPANTS Four children, 13 parents, 91 nurses and doctors including Medical Emergency Team (MET) members. MAIN OUTCOME MEASURES Parent awareness and involvement in escalating care and factors impacting implementation of C4H. RESULTS Two audits identified low level of parent awareness (16/88, 19% and 5/85, 6%). Parent involvement in escalation of care was documented in 11/62 (18%) events. The main facilitators included uniformly positive views that C4H was in the child's best interest, acknowledgement that parents had skills to recognize deterioration and would take action. C4H was considered to add to patient safety and being reviewed by the MET was a patient benefit. Key barriers were the low level of awareness, doubt about parent capabilities, concern about parents' information overload, anticipated overuse of resources, staff unease about possible repercussions and anticipated difficulty for parents to question staff with potential negative effects on parent-staff relationships. Overall C4H presents a challenge to traditional hospital hierarchy and culture. CONCLUSIONS Although there was a low level of awareness about C4H in practice, there was in-principle support for the concept. Initial strategies had primarily targeted policy change without taking into account the need for practice and organizational behaviour changes. Using a theoretical approach to identify key factors will enable a targeted approach to implementation.
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Affiliation(s)
- Fenella J. Gill
- School of Nursing, Midwifery and ParamedicineFaculty of Health SciencesCurtin UniversityPerthWAAustralia
- Perth Children's HospitalChild and Adolescent Health ServicesPerthWAAustralia
| | - Gavin D. Leslie
- School of Nursing, Midwifery and ParamedicineFaculty of Health SciencesCurtin UniversityPerthWAAustralia
| | - Andrea P. Marshall
- School of Nursing and Midwifery Clinical ChairGold Coast HealthSouthportQldAustralia
- Centre for Health Practice InnovationMenzies Health Institute QueenslandSouthportQldAustralia
- School of Nursing and MidwiferyGriffith UniversitySouthportQldAustralia
- Gold Coast Hospital and Health ServiceGold Coast University HospitalSouthportQldAustralia
- Nursing and Midwifery Education and Research UnitSouthportQldAustralia
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Gill FJ, Leslie GD, Marshall AP. Cover Image, Volume 21, Issue 6. Health Expect 2018. [DOI: 10.1111/hex.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Affiliation(s)
- Kylie Sandy-Hodgetts
- Clinical Trials Coordinator, Joondalup Health Campus, Adjunct Research Fellow, School of Anatomy, Physiology and Human Biology, University of Western Australia
| | - Keryln Carville
- Professor, Primary Health Care and Community, School of Nursing and Midwifery, Curtin University, Silver Chain Group
| | - Gavin D. Leslie
- Professor, Director of Research Training, School of Nursing and Midwifery, Curtin University
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22
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Leslie GD. Editor note - congratulations to Prof Claire Rickard. Aust Crit Care 2017; 28:173. [PMID: 26530411 DOI: 10.1016/s1036-7314(15)00131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Boxall SL, Carville K, Leslie GD, Jansen SJ. Treatment of anticoagulated patients with negative pressure wound therapy. Int Wound J 2017; 14:950-954. [PMID: 28294534 DOI: 10.1111/iwj.12737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023] Open
Abstract
There is a paucity of evidence surrounding the use of negative pressure wound therapy (NPWT) in patients receiving anticoagulant medication. Guidelines generally recommend caution regarding the use of NPWT in anticoagulated patients in general, but areas of particular risk are frequently not highlighted. The US Food and Drug Authority (FDA) reported six mortalities between 2009 and 2011 in patients receiving NPWT. These mortalities were associated with the use of NPWT over vascular graft sites. The coagulation status of these patients was not reported. It is the authors' recommendation that guidelines regarding the use of NPWT in anticoagulated patients highlight specific clinical situations of risk, although there is insufficient evidence to support the avoidance of NPWT in anticoagulated patients in general.
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Affiliation(s)
- Sharon L Boxall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia.,Wound Management Innovation Cooperative Research Centre (WMI CRC)
| | - Keryln Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia.,The Primary Health Care and Community Nursing at Curtin is part of the School of Nursing, Midwifery and Paramedicine Silver Chain Group, Bentley, WA, Australia
| | - Gavin D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - Shirley J Jansen
- Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,University of Western Australia, Crawley, WA, Australia.,Health Sciences Research and Graduate Studies, Curtin University, Bentley, WA
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Sandy-Hodgetts K, Leslie GD, Parsons R, Zeps N, Carville K. Prevention of postsurgical wound dehiscence after abdominal surgery with NPWT: a multicentre randomised controlled trial protocol. J Wound Care 2017; 26:S23-S26. [PMID: 28182535 DOI: 10.12968/jowc.2017.26.sup2.s23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The effectiveness of negative pressure wound therapy (NPWT) in the prevention of postoperative surgical wound dehiscence (SWD) is the subject of much debate and remains to be determined. This study will identify individuals at risk of postoperative SWD and trial the use of NPWT as a prophylactic measure against the occurrence of SWD, compared with a non-NPWT standard surgical dressing (SSD). METHOD A prospective multicentre randomised controlled trial comparing NPWT dressing against standard surgical dressings (SSD) will be conducted. An intention-to-treat (ITT) approach will be used for the trial. AIMS The primary outcome is the prevention of postoperative SWD up to and including day 30 postoperative. Secondary outcomes are: prevention of surgical site infection (SSI) and economic analysis of treatment groups. CONCLUSION This study will determine the effectiveness of NPWT in the prevention of postoperative abdominal SWD in a predefined level of risk population. This level 1 study will provide further data for abdominal SWD risk classification, which is anticipated to inform preventive postoperative management. The study design uses a prospective real-world scenario in order to identify clinically significant differences between the intervention and control groups. TRIAL REGISTRATION This trial was prospectively registered on 10 December 2012 with Australian and New Zealand Clinical Trials Network (ANZCTR): 12612001275853.
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Affiliation(s)
- K Sandy-Hodgetts
- (PhD Scholar), Research Associate, Adjunct Research Fellow, School of Nursing and Midwifery, Curtin University, Perth, WA, Australia; and School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia; and Wound Management Innovation Cooperative Research Centre (WMICRC)
| | - G D Leslie
- Director of Research, School of Nursing and Midwifery, Curtin University, Perth, WA, Australia; and Wound Management Innovation Cooperative Research Centre (WMICRC)
| | - R Parsons
- PhD Senior Lecturer Statistics, School of Occupational Therapy & Social work, Curtin University, WA, Australia; and School of Pharmacy, Curtin University, WA
| | - N Zeps
- Director, Chrysalis Advisory, Adjunct Professor, School of Health Sciences, Curtin University, WA, Australia; and Centre for Comparative Genomics, Murdoch University, Perth, WA, Australia; and School of Pathology and Laboratory Medicine and Colorectal Cancer Research Unit, University of Western Australia, WA, Australia; and School of Medicine, University of Notre Dame Australia
| | - K Carville
- Professor of Primary Health Care and Community, School of Nursing and Midwifery, Curtin University, Perth, WA, Australia; and Wound Management Innovation Cooperative Research Centre (WMICRC); and Silver Chain Group, WA, Australia
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Sandy-Hodgetts K, Leslie GD, Lewin G, Hendrie D, Carville K. Surgical wound dehiscence in an Australian community nursing service: time and cost to healing. J Wound Care 2017; 25:377-83. [PMID: 27410391 DOI: 10.12968/jowc.2016.25.7.377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. METHOD Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. RESULTS Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. CONCLUSION SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. DECLARATION OF INTEREST The authors declare they have no competing interests.
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Affiliation(s)
- K Sandy-Hodgetts
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
| | - G D Leslie
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
| | - G Lewin
- Research Department, Silver Chain, Perth, Western Australia, Australia
| | - D Hendrie
- School of Public Health, Curtin University
| | - K Carville
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
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Gill F, Leslie GD, Grech C, Latour JM. Regarding “Development of a postgraduate interventional cardiac nursing curriculum” by Currey et al. Aust Crit Care 2016; 29:175. [DOI: 10.1016/j.aucc.2015.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022] Open
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Davies H, Leslie GD, Morgan D. A retrospective review of fluid balance control in CRRT. Aust Crit Care 2016; 30:314-319. [PMID: 27338750 DOI: 10.1016/j.aucc.2016.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION An effect of severe acute kidney injury (AKI) is the development of oliguria and subsequent retention of fluid. Recent studies have reported an association between fluid overload and increased mortality in critically ill patients. Achieving fluid balance control through haemofiltration is an important part of dialysis dose delivery in continuous renal replacement therapy (CRRT). AIMS (1) Compare the prescribed dose with the delivered dose of dialysis and haemofiltration for CRRT. (2) Identify how interruptions and delays in treatment delivery impact on fluid balance management. METHOD A retrospective cohort study was undertaken of daily fluid balance and fluid removal for patients who required CRRT. Each observation chart and prescription order for every treatment day was reviewed. Each patient was exposed to the same treatment mode, predilutional continuous veno-venous haemodiafiltration (CVVHDf). A comparison was made of fluid balance control delivered to the patient over 24h against the dose of fluid removal prescribed. RESULTS The observation charts of 46 consecutive patients were reviewed for total of 288 treatment days. Median number of days patients received CRRT was 5 (range 1-31). Median circuit life was 16h (range 0-66). Fluid removal targets did not occur in 75 (26%) treatment days. Median daily fluid removal shortfall was 300mL (range 25-3800mL). Mean number of daily treatment interruptions 1.25, SD±0.49. The most frequent cause of treatment downtime was circuit clotting (45%). Mean length of treatment down time was 3.71, SD±4.36h excluding delays attributed to assessment of renal function. CONCLUSION In over a quarter of treatment days prescribed fluid removal was not achieved. Frequency of interruptions and delays in resumption of treatment compromised fluid balance control. Daily targets for fluid removal which are not achieved contribute to fluid overload and may compromise the outcome of patients who require CRRT.
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Affiliation(s)
- Hugh Davies
- Clinical Nurse & Adjunct Research Fellow (Curtin University), Intensive Care Unit, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia.
| | - Gavin D Leslie
- Director Research & Development, School of Nursing & Midwifery, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - David Morgan
- Fiona Stanley Hospital, Murdoch Drive, Murdoch, Perth, Western Australia 6150, Australia
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Gill FJ, Leslie GD, Marshall AP. The Impact of Implementation of Family-Initiated Escalation of Care for the Deteriorating Patient in Hospital: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:303-13. [PMID: 27258792 DOI: 10.1111/wvn.12168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rapid response systems incorporate concepts of early recognition of patient deterioration, prompt reporting, and response which result in escalation of patient care. The ability to initiate escalation of care is now being extended to families of hospitalized patients. RESEARCH AIMS To identify the impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital? METHODS A systematic review of peer-reviewed publications was conducted. Databases were searched from January 2005 to May 2015 for articles reporting the implementation and evaluation of family involvement programs. Reference lists of retrieved articles were searched. RESULTS Ten articles (all descriptive studies) reported implementation and evaluation of response systems for patients and families to trigger an alert for help; five described a triaged response; five reported systems for families to directly activate the rapid response team. Five articles reported implementation in the pediatric setting. There were a total of 426 family-initiated calls, range 0.17 to 11 per month, with no deaths reported. All calls were deemed to be appropriate and three calls resulted in intensive care unit admissions. The basis of patient- or family-initiated calls stemmed from communication or systems breakdown. The large range in frequency of calls was associated with the process implemented, the strategies used and the calling criteria (up to four). Feedback from families was positive. There appeared to be a level of staff stress associated with introducing this process. LINKING EVIDENCE TO ACTION A variety of practice models and calling criteria were reported to either directly activate an existing rapid response team or trigger a separate response to patient- or family-initiated calls. The broader calling criteria and more comprehensive implementation strategies were associated with more patient- and family-initiated escalation of care calls. There is no systematically researched evidence to assess the value of family-initiated calls for deteriorating patients.
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Affiliation(s)
- Fenella J Gill
- NHMRC TRIP Fellow, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University, and Nurse Researcher, Princess Margaret Hospital for Children, Child & Adolescent Health Services, Perth, Western Australia, Australia
| | - Gavin D Leslie
- Professor Critical Care Nursing, Director Research & Development, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrea P Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery-Clinical Chair, Gold Coast Health Centre for Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
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Macduff C, Goodfellow LM, Nolfi D, Copeland S, Leslie GD, Blackwood D. Slipping through the net: the paradox of nursing's electronic theses and dissertations. Int Nurs Rev 2016; 63:267-76. [PMID: 26868368 DOI: 10.1111/inr.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The study's main aim was to gain in-depth understanding of how nurse scholars engage with electronic theses and dissertations. Through elicitation of opinions about challenges and opportunities, and perceptions of future development, the study also aimed to influence the design of a new international web-based forum for learning and sharing information on this topic. BACKGROUND Electronic theses and dissertations provide an opportunity to radically change the way in which graduate student research is presented, disseminated and used internationally. However, as revealed by a multi-national survey in 2011, many nurse scholars in vanguard universities have little awareness of how to find and exploit this ever-expanding global knowledge resource that is increasingly available free in full text format. Within this context more detailed understandings of nurse scholars' thinking and actions are required. METHODS A qualitative approach using a semi-structured interview guide was utilized to elicit perceptions from 14 nurse scholars. RESULTS Thematic analysis of the interviewees' responses identified six major themes: initial exposure and effect; searching; accessing; handling; using; and evaluation. Insights were gained about the value of these resources and behaviours in using them as exemplars for structure, format and methodology. CONCLUSION AND IMPLICATIONS FOR NURSING AND NURSING POLICY Despite the small study size, the findings added valuable new insights to the overview gained from the 2011 survey. These have been used to inform development of a new global initiative: the International Network for Electronic Theses and Dissertations in Nursing. Featuring an educational website (www.inetdin.net), this initiative aims to support and challenge nursing's policy makers, practitioners and especially educators to utilize this neglected but exponentially increasing wellspring of international nursing knowledge.
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Affiliation(s)
- C Macduff
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - L M Goodfellow
- School of Nursing, Duquesne University, Pittsburgh, PA, USA
| | - D Nolfi
- Duquesne University, Pittsburgh, PA, USA
| | - S Copeland
- Library Service, Robert Gordon University, Aberdeen, UK
| | - G D Leslie
- School of Nursing & Midwifery, Faculty of Health Science, Curtin Health Innovation Research Institute, Perth, WA, Australia
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Davies H, McKenzie N, Williams TA, Leslie GD, McConigley R, Dobb GJ, Aoun SM. Challenges during long-term follow-up of ICU patients with and without chronic disease. Aust Crit Care 2016; 29:27-34. [DOI: 10.1016/j.aucc.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022] Open
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Newall N, Lewin GF, Bulsara MK, Carville KJ, Leslie GD, Roberts PA. The development and testing of a skin tear risk assessment tool. Int Wound J 2015; 14:97-103. [PMID: 26691572 DOI: 10.1111/iwj.12561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 11/28/2022] Open
Abstract
The aim of the present study is to develop a reliable and valid skin tear risk assessment tool. The six characteristics identified in a previous case control study as constituting the best risk model for skin tear development were used to construct a risk assessment tool. The ability of the tool to predict skin tear development was then tested in a prospective study. Between August 2012 and September 2013, 1466 tertiary hospital patients were assessed at admission and followed up for 10 days to see if they developed a skin tear. The predictive validity of the tool was assessed using receiver operating characteristic (ROC) analysis. When the tool was found not to have performed as well as hoped, secondary analyses were performed to determine whether a potentially better performing risk model could be identified. The tool was found to have high sensitivity but low specificity and therefore have inadequate predictive validity. Secondary analysis of the combined data from this and the previous case control study identified an alternative better performing risk model. The tool developed and tested in this study was found to have inadequate predictive validity. The predictive validity of an alternative, more parsimonious model now needs to be tested.
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Affiliation(s)
- Nelly Newall
- Research Department, Silver Chain Group, Osborne Park, WA, Australia.,School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Gill F Lewin
- Research Department, Silver Chain Group, Osborne Park, WA, Australia.,School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - Keryln J Carville
- Research Department, Silver Chain Group, Osborne Park, WA, Australia.,School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Gavin D Leslie
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Pam A Roberts
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
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Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J 2015; 12:265-75. [PMID: 23692188 PMCID: PMC7950784 DOI: 10.1111/iwj.12088] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/11/2013] [Accepted: 04/14/2013] [Indexed: 12/21/2022] Open
Abstract
Postoperative wound healing plays a significant role in facilitating a patient's recovery and rehabilitation. Surgical wound dehiscence (SWD) impacts on mortality and morbidity rates and significantly contributes to prolonged hospital stays and associated psychosocial stressors on individuals and their families. A narrative review of SWD was undertaken on English-only studies between 1945 and 2012 using three electronic databases Ovid CINHAL, Ovid Medline and Pubmed. The aim of this review was to identify predisposing factors for SWD and assessment tools to assist in the identification of at-risk patients. Key findings from the included 15 papers out of a search of 1045 revealed the most common risk factors associated with SWD including obesity and wound infection, particularly in the case of abdominal surgery. There is limited reporting of variables associated with SWD across other surgical domains and a lack of risk assessment tools. Furthermore, there was a lack of clarity in the definition of SWD in the literature. This review provides an overview of the available research and provides a basis for more rigorous analysis of factors that contribute to SWD.
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Affiliation(s)
| | - Keryln Carville
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
- Silver Chain Nursing Association, Perth, WA, Australia
| | - Gavin D Leslie
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
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Gill FJ, Leslie GD, Grech C, Boldy D, Latour JM. Developing and Testing the Standard of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT) for Critical Care Nursing Practice. J Contin Educ Nurs 2014; 45:312-20. [PMID: 24972098 DOI: 10.3928/00220124-20140620-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/16/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking. METHODS A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families-the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT). RESULTS Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbach's α > 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887); intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements. CONCLUSION The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program.
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Gill FJ, Leslie GD, Grech C, Boldy D, Latour JM. Development of Australian clinical practice outcome standards for graduates of critical care nurse education. J Clin Nurs 2014; 24:486-99. [DOI: 10.1111/jocn.12631] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Fenella J Gill
- Faculty of Health Science; School of Nursing and Midwifery; Curtin University; Perth WA Australia
- Child & Adolescent Health Services; Princess Margaret Hospital for Children; WA Australia
| | - Gavin D Leslie
- Critical
Care Nursing; Joint Appointment Royal Perth Hospital; Perth WA Australia
- Faculty of Health Science; School of Nursing & Midwifery; Curtin Health Innovation Research Institute; Curtin University; Perth WA Australia
| | - Carol Grech
- School of Nursing & Midwifery; University of South Australia; Adelaide SA Australia
| | - Duncan Boldy
- Faculty of Health Science; School of Nursing and Midwifery; Curtin University; Perth WA Australia
| | - Jos M Latour
- Faculty of Health, Education and Society; School of Nursing and Midwifery; Plymouth University; Plymouth UK
- Department of Pediatrics; Intensive Care Neonatology; Erasmus MC - Sophia Children's Hospital; Rotterdam The Netherlands
- Faculty of Health Science; School of Nursing and Midwifery; Curtin University; Perth WA Australia
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Gill FJ, Leslie GD, Grech C, Latour JM. Health consumers' experiences in Australian critical care units: postgraduate nurse education implications. Nurs Crit Care 2013; 18:93-102. [PMID: 23419185 DOI: 10.1111/j.1478-5153.2012.00543.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. BACKGROUND There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. METHOD Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. FINDINGS Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. CONCLUSION Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.
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Affiliation(s)
- Fenella J Gill
- Princess Margaret Hospital for Children, Child & Adolescent Health Services, Perth, WA, Australia.
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Gill FJ, Leslie GD, Grech C, Latour JM. Using a web-based survey tool to undertake a Delphi study: application for nurse education research. Nurse Educ Today 2013; 33:1322-8. [PMID: 23510701 DOI: 10.1016/j.nedt.2013.02.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 02/21/2013] [Accepted: 02/23/2013] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards. METHODS The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided. COLLECTING DATA AND PROVIDING FEEDBACK For each round, the SurveyMonkey's email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds. DISCUSSION An online survey provided numerous advantages over traditional survey approaches including high quality data collection, ease and speed of survey administration, direct communication with the panel and rapid collation of feedback allowing data collection to be undertaken in 12 weeks. Only minor challenges were experienced using the technology. Ethical issues, specific to using the Internet to conduct research and external hosting of web-based software, lacked formal guidance. CONCLUSIONS High response rates and an increased level of data quality were achieved in this study using web-survey software and the process was efficient and user-friendly. However, when considering online survey software, it is important to match the research design with the computer capabilities of participants and recognize that ethical review guidelines and processes have not yet kept pace with online research practices.
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Affiliation(s)
- Fenella J Gill
- Princess Margaret Hospital for Children, Child & Adolescent Health Services, Western Australia, 6008, Australia; School of Nursing and Midwifery, Faculty Health Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
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Leslie GD. New initiatives for Australian Critical Care. Aust Crit Care 2013. [DOI: 10.1016/j.aucc.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Leslie GD. WITHDRAWN: ECG quiz. Aust Crit Care 2013:S1036-7314(12)00184-1. [PMID: 23522869 DOI: 10.1016/j.aucc.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This article has temporarily being removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Williams TA, Leslie GD, Leen T, Mills L, Dobb GJ. Reducing interruptions to continuous enteral nutrition in the intensive care unit: a comparative study. J Clin Nurs 2013; 22:2838-48. [DOI: 10.1111/jocn.12068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Teresa A Williams
- Discipline of Emergency Medicine (M516); School of Primary; Aboriginal and Rural Health Care (SPARHC); The University of Western Australia and Research Fellow; ICU Royal Perth Hospital; Perth WA Australia
| | - Gavin D Leslie
- School of Nursing & Midwifery; Curtin Health Innovation Research Institute; Faculty Health Science; Curtin University; Perth WA Australia
| | - Tim Leen
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
| | - Lauren Mills
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
| | - Geoff J Dobb
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
- School of Medicine and Pharmacology ; The University of Western Australia; Perth WA Australia
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Leslie GD. Australian Critical Care receives impact factor. Aust Crit Care 2013; 25:149. [PMID: 22935691 DOI: 10.1016/j.aucc.2012.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gill FJ, Leslie GD, Grech C, Latour JM. A review of critical care nursing staffing, education and practice standards. Aust Crit Care 2012; 25:224-37. [DOI: 10.1016/j.aucc.2011.12.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 12/12/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022] Open
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Williams TA, Leslie GD, Dobb GJ, Roberts B, van Heerden PV. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains. J Neurosurg 2011; 115:1040-6. [PMID: 21800964 DOI: 10.3171/2011.6.jns11167] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ventriculitis associated with extraventricular drains (EVD) increases rates of morbidity and mortality as well as costs. Surveillance samples of CSF are taken routinely from EVD, but there is no consensus on the optimum frequency of sampling. The goal of this study was to assess whether the incidence of ventriculitis changed when CSF sampling frequency was reduced once every 3 days. METHODS After receiving institutional ethics committee approval for their project, the authors compared a prospective sample of EVD-treated patients (admitted 2008-2009) and a historical comparison group (admitted 2005-2007) at two tertiary hospital ICUs. A broad definition of ventriculitis included suspected ventriculitis (that is, treated with antibiotics for ventriculitis) and proven ventriculitis (positive CSF culture). Adult ICU patients with no preexisting neurological infection were enrolled in the study. After staff was provided with an education package, sampling of CSF was changed from daily to once every 3 days. All other management of the EVD remained unchanged. More frequent sampling was permitted if clinically indicated during the third daily sampling phase. RESULTS Two hundred seven patients were recruited during the daily sampling phase and 176 patients when sampling was reduced to once every 3 days. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was lower for the daily sampling group than for the every-3rd-day group (18.6 vs 20.3, respectively; p < 0.01), but there was no difference in mean age (47 and 45 years, respectively; p = 0.14), male or female sex (61% and 59%, respectively; p = 0.68), or median EVD duration in the ICU (4.9 and 5.8 days, respectively; p = 0.14). Most patients were admitted with subarachnoid hemorrhage (42% in the daily group and 33% in the every-3rd-day group) or traumatic head injuries (29% and 36%, respectively). The incidence of ventriculitis decreased from 17% to 11% overall and for proven ventriculitis from 10% to 3% once sampling frequency was reduced. Sampling of CSF once every 3 days was independently associated with ventriculitis (OR 0.44, 95% CI 0.22-0.88, p = 0.02). CONCLUSIONS Reducing the frequency of CSF sampling to once every 3 days was associated with a significant decrease in the incidence of ventriculitis. The authors suggest that CSF sampling should therefore be performed once every 3 days in the absence of clinical indicators of ventriculitis. Reducing frequency of CSF sampling from EVDs decreased proven ventriculitis.
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Affiliation(s)
- Teresa A Williams
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Nedlands, Australia.
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Elliott D, McKinley S, Alison J, Aitken LM, King M, Leslie GD, Kenny P, Taylor P, Foley R, Burmeister E. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 2011; 15:R142. [PMID: 21658221 PMCID: PMC3219014 DOI: 10.1186/cc10265] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/27/2011] [Accepted: 06/09/2011] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery. METHODS A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge. RESULTS Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores. CONCLUSIONS This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register ACTRN12605000166673.
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Affiliation(s)
- Doug Elliott
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Sharon McKinley
- University of Technology, Sydney and Northern Sydney Local Health Network, Sydney,15 Broadway, Ultimo, 2007, Australia
| | - Jennifer Alison
- Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, Australia
| | - Leanne M Aitken
- Princess Alexandra Hospital and Griffith University, 199 Ipswich Road, Woolloongabba, 4102, Australia
| | - Madeleine King
- School of Psychology, University of Sydney, Fisher Road, Sydney, 2006, Australia
| | - Gavin D Leslie
- School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University and Royal Perth Hospital, Kent Street, Bentley, 6102, Australia
| | - Patricia Kenny
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Penny Taylor
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Rachel Foley
- Critical Care Nursing Professorial Unit, University of Technology, Sydney and Northern Sydney Local Health Network, 15 Broadway, Ultimo, 2007, Australia
| | - Elizabeth Burmeister
- Nursing Practice and Development Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia
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Leslie GD. Re: Explicit declaration of ethical approval for clinical research. Aust Crit Care 2011; 24:90. [DOI: 10.1016/j.aucc.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Williams TA, Leslie GD. Challenges and possible solutions for long-term follow-up of patients surviving critical illness. Aust Crit Care 2011; 24:175-85. [PMID: 21514838 DOI: 10.1016/j.aucc.2011.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surviving critical illness can be life-changing and present new healthcare challenges for patients after discharge from hospital. Optimisation of recovery, rather than mere survival, is an important goal of intensive care. Observational studies have identified decreased quality of life and increased healthcare needs for survivors but loss to follow-up can be high with possible selection bias. Patients in need of support may therefore not be included in study results or allocated appropriate follow up support. AIM To examine the frequency and reasons patients admitted to general ICUs who survive critical illness are excluded from study participation or lost to follow-up and consider the possible implications and solutions. METHOD The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies (2006-2010) were included if they described follow-up of survivors from general ICUs. RESULTS Ten studies were reviewed. Of the 3269 eligible patients, 14% died after hospital discharge, 27% declined, and 22% were lost to follow-up. Reasons for loss to follow-up included no response, inability to contact the patient, too ill or admitted to another facility. CONCLUSION The most appropriate method of care follow-up has yet to be established but is likely to involve an eclectic model that tailors service provision to support individual patient needs. Identifying methods to minimise loss to follow-up may enhance interpretation of patients' recovery, lead to improvements in clinical practice and inform healthcare service decisions and policy.
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Affiliation(s)
- Teresa A Williams
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
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Abstract
BACKGROUND Having intensive care patients sit out of bed improves their respiration and psyche and reduces complications of immobilization. OBJECTIVES To compare seating interface pressures to determine a preferred seating surface for patients sitting out of bed. METHOD The study was conducted in 2 phases among intensive care patients with impaired mobility who could sit out of bed. Pressure mapping was used to test seating surfaces in a non-randomized crossover design. In phase 1, three surfaces were compared: (1) regular chair (TotaLift-II), (2) regular chair with gel overlay, and (3) alternative chair (Hausted APC). A new surface, informed from phase 1, was designed and compared with the regular chair surface in phase 2. The number of cells recording pressures of 200 mm Hg or higher (excessive pressure) for 30 minutes was compared between surfaces. RESULTS In phase 1, the alternative chair had fewer excessive pressures than did the regular chair in 67% of seating episodes among 18 patients (P < .001), but the alternative chair lacked practical utility. In phase 2, the new seating surface was compared with the regular surface using the regular chair frame for 20 patients. Among patients with excessive pressures, most (93%) had fewer excessive pressures recorded on the new surface than on the regular surface (P < .001). CONCLUSION Results from this study provided important data for development of a new seating surface for intensive care patients sitting out of bed. The new surface promotes patients' comfort and probably reduces risk of pressure ulcers.
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Affiliation(s)
- Teresa Ann Williams
- Royal Perth Hospital, The University of Western Australia in Perth, Western Australia.
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Leen T, Williams TA, Campbell L, Chamberlain J, Gould A, McEntaggart G, Leslie GD. Early experience with influenza A H1N109 in an Australian intensive care unit. Intensive Crit Care Nurs 2010; 26:207-14. [PMID: 20599382 PMCID: PMC7125814 DOI: 10.1016/j.iccn.2010.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 05/19/2010] [Accepted: 05/19/2010] [Indexed: 11/12/2022]
Abstract
Influenza is a common seasonal viral infection that affects large numbers of people. In early 2009, many people were admitted to hospitals in Mexico with severe respiratory failure following an influenza-like illness, subtyped as H1N1. An increased mortality rate was observed. By June 2009, H1N1 was upgraded to pandemic status. In June–July, Australian ICUs were experiencing increased activity due to the influenza pandemic. While hospitals implemented plans for the pandemic, the particularly heavy demand to provide critical care facilities to accommodate an influx of people with severe respiratory failure became evident and placed a great burden on provision of these services. This paper describes the initial experience (June to mid September) of the pandemic from the nursing perspective in a single Australian ICU. Patients were noted to be younger with a higher proportion of women, two of whom were pregnant. Two patients had APACHE III comorbidity. Of the 31 patients admitted during this period, three patients died in ICU and one patient died in hospital. Aerosol precautions were initiated for all patients. The requirement for single room accommodation placed enormous demands for bed management in ICU. Specific infection control procedures were developed to deal with this new pandemic influenza.
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Affiliation(s)
- Tim Leen
- ICU, Royal Perth Hospital, Perth, Western Australia, Australia.
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Leslie GD. Respiratory care and ventilator management: Key aspects to critical care nursing. Aust Crit Care 2010; 23:49. [PMID: 20471556 DOI: 10.1016/j.aucc.2010.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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