Nursing - Research Publications
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ItemSocio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery(BMC, 2007-11-10)BACKGROUND: People who have complex health care needs frequently access emergency departments for treatment of acute illness and injury. In particular, evidence suggests that those who are homeless, or suffer mental illness, or have a history of substance misuse, are often repeat users of emergency departments. The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations. Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital. METHODS: A retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital. Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a random effect. RESULTS: From 64,147 presentations to the emergency department the re-presentation rate was 18.0% (n = 11,559) of visits and 14.4% (5,894/40,942) of all patients. Median time to re-presentation was 6 days, with more than half occurring within one week of discharge (60.8%; n = 6,873), and more than three-quarters within two weeks (80.9%; n = 9,151). The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation (adjusted OR 3.09; 95% CI, 2.83 to 3.36). Similarly, the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not (adjusted OR 1.73; 95% CI, 1.63 to 1.84), patients who left part-way through treatment compared to those who completed treatment and were discharged home (adjusted OR 1.64; 95% CI, 1.36 to 1.99), and those discharged to a residential-care facility compared to those who were discharged home (adjusted OR 1.46: 95% CI, 1.03 to 2.06). CONCLUSION: Emergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter. Housing status and being a recipient of a government pension are the most significant risk factors. Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group.
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ItemFamily meetings in palliative care: Multidisciplinary clinical practice guidelines.(Springer Science and Business Media LLC, 2008-08-19)BACKGROUND: Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. METHODS: The guidelines were developed via the following methods: (1) A literature review; (2) Conceptual framework; (3) Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. RESULTS: The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. CONCLUSION: Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.
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ItemNo Preview AvailableProfessional issues in community practice(Allen & Unwin, 2007)
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ItemNo Preview AvailableHealth teaching(Allen & Unwin, 2007)
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ItemNo Preview AvailableHealth promotion(Allen & Unwin, 2007)
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ItemContinuity of care and general wellbeing of patients with comorbidities requiring joint replacement(Blackwell, 2007-01)Aim: This paper reports a study investigating the continuity of care and general wellbeing of patients with comorbidities who required an elective total hip or knee joint replacement. Background: Advances in medical science and improved lifestyles have reduced mortality rates in most western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of people will experience multiple chronic illnesses (comorbidities). Osteoarthritis is a common comorbidity and joint replacement surgery is frequently performed in people who have comorbidities that may require joint replacement surgery to relieve symptoms, creating a blend of acute and chronic needs. Method: A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery were recruited to obtain survey, interview and medical record audit data. Data was analysed for descriptive statistics and Ritchie and Spencer’s a theoretical method of qualitative analysis (Ritchie & Spencer, 1994). Findings: The findings demonstrate that the participants did not receive co-ordinated, continuity of care of their comorbidities prior to having surgery, during the acute care stay and following surgery. The acute care setting was primarily concerned with patient throughput following joint replacement surgery according to a prescribed clinical pathway. Pain, fatigue, insomnia and alterations in urinary elimination were chief sources of discomfort from preadmission to eight weeks postdischarge. Conclusion: These findings have implications for a comprehensive and coordinated approach to patients with comorbidities in need of acute care, in particular, joint replacement. Acute care, clinical pathways, and the specialisation of medicine and nursing, subordinated the general problem of patients with comorbidities. Models of chronic illness management and systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.