Nursing - Research Publications

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    A multicentre point prevalence study of delirium assessment and management in patients admitted to Australian and New Zealand intensive care units
    Ankravs, MJ ; Udy, AA ; Byrne, K ; Knowles, S ; Hammond, N ; Saxena, MK ; Reade, MC ; Bailey, M ; Bellomo, R ; Deane, AM (AUSTRALASIAN MED PUBL CO LTD, 2020-12)
    Objective: To characterise the assessment and management of delirium in patients admitted to intensive care units (ICUs) in Australia and New Zealand. Methods: We conducted a multicentre observational point prevalence study across 44 adult Australian and New Zealand ICUs. Data were extracted for all patients in the ICU in terms of assessment and treatment of delirium. ICU-level data were collected regarding the use of explicit protocols related to delirium. Results: We studied 627 patients, with 54% (336/627) having at least one delirium screening assessment performed. The Confusion Assessment Method for the ICU (CAM-ICU) was the most frequently used tool (88%, 296/336). Of patients assessed, 20% (68) were identified to have delirium. Eighteen per cent (111) of patients were administered a drug to manage delirium, with 41% (46) of those receiving a drug having no recorded assessment for delirium on that day. Of the drugs used to treat delirium, quetiapine was the most frequently administered. Physical restraints were applied to 8% (48/626) of patients, but only 17% (8/48) of such patients had been diagnosed with delirium. Most physically restrained patients either did not have delirium diagnosed (31%, 15/48) or had no formal assessment recorded (52%, 25/48) on that day. Conclusions: On the study day, more than 50% of patients had a delirium screening assessment performed, with 20% of screened patients deemed to have delirium. Drugs that are prescribed to treat delirium and physical restraints were frequently used in the absence of delirium or the formal assessment for its presence.
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    Safewards in Three Emergency Departments: Evaluation of the adaptation and impact of the Safewards Model in Emergency Departments
    Gerdtz, M ; Daniel, C ; Yap, C ; Knott, J ; Hamilton, B ( 2021-02-01)
    Safewards is a model of practice improvement that has been used to promote a therapeutic response to minimise conflict events in mental health in-patient settings. This pilot project (Safewards ED) evaluated the impact of nine modified Safewards interventions in three emergency departments (EDs) within 2 health services in Victoria, Australia. A mixed method approach including: (a) questionnaire, (b) focus groups, and (c) observational cohort studies of conflict events (code grey) and coercive interventions (restraint and medication used to manage patient behaviour); was used to evaluate the Safewards ED interventions 12 months before and 6 months after the implementation. The aim of the evaluation was to explore the applicability and impact of Safewards ED interventions.
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    Reframing palliative care to improve the quality of life of people diagnosed with a serious illness
    Hudson, P ; Collins, A ; Boughey, M ; Philip, J (WILEY, 2021-11-15)
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    Knowledge and Power Relations in Older Patients' Communication About Medications Across Transitions of Care
    Ozavci, G ; Bucknall, T ; Woodward-Kron, R ; Hughes, C ; Jorm, C ; Joseph, K ; Manias, E (SAGE PUBLICATIONS INC, 2021-12)
    Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients' experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough's Critical Discourse Analysis and Medication Communication Model. Older patients' medication knowledge and family members' advocacy challenged unequal power relations between clinicians and patients and families. Doctors' use of authoritative discourse impeded older patients' participation in the medication communication. Older patients perceived that nurses' involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.
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    Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial
    Mitchell, MJ ; Newall, FH ; Heywood, MG ; Sokol, J ; Williams, KJ (Sciedu Press, 2021-07-15)
    Background and objective: Aggression and high-risk behaviors, which can result in behavioral emergencies, are common in children with autism and can be magnified in the hospital environment. Children with autism, with or without intellectual disability, have complex communication needs which require a sophisticated level of knowledge, understanding and skill from health care professionals. Pediatric acute care nursing staff are often not trained and lack confidence in managing children with autism. The purpose of this study was to conduct a pilot and feasibility cluster randomized controlled trial (RCT) of simulation-based education for staff in managing behavioral emergencies with autism spectrum disorder (ASD) in the hospital setting.Methods: This study used a mixed method, to explore the acceptability and feasibility of delivering a large-scale cluster RCT and assess trial processes including recruitment, completion rates, contamination, and outcome measures. The simulation-based training format comprised two scenarios involving an adolescent with autism, intellectual disability and aggressive behaviors. Two pediatric wards of similar size and patient complexity were selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or web-based education materials only.  Results: The RCT design is feasible with recruitment, acceptability and completion rates reaching target. Self-perceived baseline levels of confidence in managing aggression in children were mid-range and lower for children with autism and intellectual disability. Forty to fifty percent of intervention participants rated the training highly in terms of developing skills and knowledge respectively. The mean group score for observer ratings of de-escalation across four simulations was 20 out of a possible 35. Data for ward aggression were not collected.Conclusions: Simulation-based education is an acceptable training format for acute care pediatric nurses. This study is feasible to conduct as a cluster RCT with some modifications to this protocol including assessment of baseline differences in confidence. Observer ratings of de-escalation skills indicated that more than one episode of training may be required for acute care pediatric staff to successfully de-escalate aggressive incidents. As such, we will use repeated simulation scenario exercises for each intervention group in the next trial.
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    The effect of alternative methods of cardiopulmonary resuscitation - Cough CPR, percussion pacing or precordial thump - on outcomes following cardiac arrest. A systematic review
    Dee, R ; Smith, M ; Rajendran, K ; Perkins, GD ; Smith, CM ; Vaillancourt, C ; Avis, S ; Brooks, S ; Castren, M ; Chung, SP ; Considine, J ; Escalante, R ; Han, LS ; Hatanaka, T ; Hazinski, MF ; Hung, K ; Kudenchuk, P ; Morley, P ; Ng, K-C ; Nishiyama, C ; Semeraro, F ; Smyth, M (ELSEVIER IRELAND LTD, 2021-05)
    BACKGROUND: Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques. METHODS: We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and 'related articles' (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty. RESULTS: We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group ('standard' CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest. CONCLUSION: Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output. PROSPERO REGISTRATION NUMBER: CRD42019152925.
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    Diagnosis of out-of-hospital cardiac arrest by emergency medical dispatch: A diagnostic systematic review
    Drennan, IR ; Geri, G ; Brooks, S ; Couper, K ; Hatanaka, T ; Kudenchuk, P ; Olasveengen, T ; Pellegrino, J ; Schexnayder, SM ; Morley, P (ELSEVIER IRELAND LTD, 2021-02)
    INTRODUCTION: Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. METHODS: We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to "emergency medical dispatcher", "cardiac arrest", and "diagnosis", among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. RESULTS: We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. CONCLUSION: The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.
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    GRADE notes: How to use GRADE when there is "no" evidence? A case study of the expert evidence approach
    Mustafa, RA ; Garcia, CAC ; Bhatt, M ; Riva, JJ ; Vesely, S ; Wiercioch, W ; Nieuwlaat, R ; Patel, P ; Hanson, S ; Newall, F ; Wiernikowski, J ; Monagle, P ; Schunemann, HJ (ELSEVIER SCIENCE INC, 2021-09)
    OBJECTIVES: One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist. In this brief report (GRADE notes), we describe our method of developing evidence-based recommendations when publisheddirect evidence was lacking. STUDY DESIGN AND SETTING: When direct published literature was absent, an expert evidence survey was administered to panel members about their unpublished observations and case series. Focus was on collecting data about cases and outcome, not panel opinions. RESULTS: Out of 26 questions prioritized by the panel for pediatric venous thromboembolism, 12 had no, very limited, or very low certainty of evidence to inform them. The panel survey was administered for these questions. CONCLUSIONS: Areas of sparse evidence often reflect key questions that are critical to address in clinical practice guidelines due to the uncertainty among health care providers. The expert evidence approach used in this study is one method for panels totransparently deal with the lack of published evidence to directly inform recommendations.
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    Perioperative Nurses' Perceptions Pre-Implementation of an Electronic Medical Record System.
    Njane, A ; Jedwab, R ; Calvo, R ; Dobroff, N ; Glozier, N ; Hutchinson, A ; Leiter, M ; Manias, E ; Nankervis, K ; Rawson, H ; Redley, B (IOS Press, 2021-12-15)
    The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses' perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.
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    An Interdisciplinary Partnership Approach to Improving the Digital Literacy Skills of Nursing Students to Become Digitally Fluent, Work-Ready Graduates.
    Lokmic-Tomkins, Z ; Cochrane, L ; Celeste, T ; Burnie, M (IOS Press, 2021-12-15)
    Digital transformation and the development of a digitally fluent nursing workforce are necessary for engagement with digital technologies in healthcare settings. For this purpose, educators aim to develop workforce-ready graduates equipped with disciplinary knowledge, expertise, and digital capabilities supportive of further professional development. Having identified a subset of nursing students with low levels of digital literacy, the nursing faculty engaged with library services and the academic skills unit to develop and embed a sustainable Nursing Digital Literacy Module in the graduate entry to practice nursing program. This paper reports on the model created and early evaluation of the student uptake of the module.