1
|
Butler AE, Clark TJ, Glazner J, Giallo R, Copnell B. "We want to include him in that journey": A qualitative descriptive study of parental experiences and considerations for sibling inclusion in the paediatric ICU. Intensive Crit Care Nurs 2024; 83:103696. [PMID: 38608616 DOI: 10.1016/j.iccn.2024.103696] [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] [Received: 10/27/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU. RESEARCH METHODOLOGY/DESIGN This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis. SETTING Australian PICUs. FINDINGS Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources. CONCLUSIONS This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience. IMPLICATIONS FOR CLINICAL PRACTICE Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@AshleighEButler
| | - Tara-Jane Clark
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
| | - Judith Glazner
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Australia.
| | - Rebecca Giallo
- The Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia; Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@Bev_Copnell
| |
Collapse
|
2
|
Cardwell R, Nelson K, Duncan R, Copnell B, Moss C. Being effective and supervising for thesis success in nursing coursework master degrees: A qualitative descriptive study. J Adv Nurs 2024. [PMID: 38515222 DOI: 10.1111/jan.16164] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Master's degrees for nurses have various foci including clinical practice, leadership and education, with some programs consisting of coursework, while others offer hybrid study that combines coursework and research. Multiple formats are associated with offering the research component. The research component is often termed the minor thesis. Limited knowledge exists regarding the supervision of the research component. AIM(S) To capture the practices and perspectives of experienced nurse academics regarding effective supervision of the masters-level minor thesis in nursing coursework master degrees. THE STUDY Design Qualitative descriptive. Methods Semi-structured interviews with 28 experienced nurse academics recruited from 15 Australian and three New Zealand universities linked to the Council of Deans in Australia and New Zealand. Inclusion criteria were having experience of supervising masters-level minor theses and higher degrees. Interviews were face-to-face using the internet platform Zoom©. Thematic analysis was undertaken. Findings The analysis revealed three themes and associated sub-themes: (i) establishing the framework (setting up the student's research; building the student-supervisor relationship; setting clear expectations), (ii) supervisors' knowledge and actions: driving for success (supervisors' knowledge for a satisfactory and timely outcome; supervisors' actions to develop students' capabilities; supervisors' actions of drawing in other expertise) and (iii) supervisor savviness: Attending to the finer points of supervision for student success (using your attributes as a supervisor; being savvy to teach and engage students; creatively seeking a smooth process for student success). CONCLUSION The findings highlight three themes crucial to effective supervision of masters-level minor theses in nursing: Establishing a strong research framework, emphasizing supervisors' knowledge and proactive engagement and attending to nuanced aspects of supervision for student success. These insights contribute to deeper understanding of the multifaceted nature of supervising minor theses, providing a valuable foundation for refining supervisory practices and enhancing the educational experience within coursework nursing master degree programs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The findings highlight the supervisors' pivotal practices in guiding students through the minor thesis. These insights will be useful for inexperienced and experienced supervisors and for degree program directors. The findings should inform supervision training and supervision practices in the future. IMPACT The study addressed a gap in knowledge about what experienced supervisors do to be effective and achieve success in the research component in a hybrid master degree for registered nurses. Effective supervision for student success in the minor thesis requires supervisors to establish and maintain a project and supervisory framework with appropriate boundaries and that is attuned to both the supervisor and student capabilities and preferences. Supervisors have an active role in directing the focus, scale and scope of a minor theses in keeping with university requirements and the short timeframe. Supervisors pay attention to the development of multiple student literacies (research, academic, professional, feedback and cultural) as core aspects of the masters research journey. Supervisors use their savviness and customize supervision to student contexts and capabilities as they guide development to achieve student success. The research findings have implications for targeted supervisor training and enhancing educational strategies for research supervision of minor thesis students. REPORTING METHOD COREQ reporting was adhered to as the relevant EQUATOR guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Rachel Cardwell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Katherine Nelson
- La Trobe University, Bundoora, Victoria, Australia
- Victoria University of Wellington, Wellington, New Zealand
| | - Rachael Duncan
- Northern Clinical School, School of Nursing and Midwifery, La Trobe University, Epping, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryle Moss
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
3
|
Faulks F, Edvardsson K, Mogren I, Gray R, Copnell B, Shafiei T. Common mental disorders and perinatal outcomes in Victoria, Australia: A population-based retrospective cohort study. Women Birth 2024; 37:428-435. [PMID: 38216393 DOI: 10.1016/j.wombi.2024.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
PURPOSE Common mental disorders (non-psychotic mental health conditions which impact on day-to-day functioning) are increasingly common in childbearing women and may impact significantly on both maternal and neonatal outcomes. Our study examines the associations between common mental disorders and perinatal outcomes. METHODS We used routinely collected perinatal data (2009-2016) for this population-based retrospective cohort study (n = 597,522 singleton births). We undertook multiple logistic regression adjusting for key maternal medical conditions and sociodemographic factors to determine associations between maternal common mental disorders and adverse perinatal outcomes with confidence intervals set at 95%. RESULTS Women with common mental disorders were more likely to have an induction of labour and caesarean birth, have a postpartum haemorrhage (PPH), and be admitted to the Intensive Care Unit (ICU) than women without common mental disorders. Neonates of women with common mental disorders were more likely to have an Apgar score at five minutes of less than seven (a measure of neonatal wellbeing at birth), be born preterm and low birthweight, be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (SCN/NICU) and have a congenital anomaly than neonates of women without common mental disorders. CONCLUSION Common mental disorders during the perinatal period were associated with poorer perinatal outcomes for mothers and their neonates. Strategies that enable early recognition and response to maternal common mental disorders should be developed to mitigate the consequential impact on maternal and infant wellbeing.
Collapse
Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia.
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Mogren
- Obstetrics and Gynaecology, Senior consultant in Obstetrics and Gynaecology, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, SE-901 87 Umeå, Sweden
| | - Richard Gray
- Nursing, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Beverley Copnell
- Nursing, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
4
|
Faulks F, Shafiei T, McLachlan H, Forster D, Mogren I, Copnell B, Edvardsson K. Perinatal outcomes of socially disadvantaged women in Australia: A population-based retrospective cohort study. BJOG 2023; 130:1380-1393. [PMID: 37077044 DOI: 10.1111/1471-0528.17501] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016. DESIGN Population-based, retrospective cohort study. SETTING Victoria, Australia. POPULATION OR SAMPLE A total of 1 188 872 singleton births were included. METHODS Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures. MAIN OUTCOME MEASURES Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU). RESULTS Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section. CONCLUSIONS Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
Collapse
Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery/Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
5
|
Jessup RL, Bramston C, Putrik P, Haywood C, Tacey M, Copnell B, Cvetanovska N, Cao Y, Gust A, Campbell D, Oldenburg B, Mehdi H, Kirk M, Zucchi E, Semciw AI, Beauchamp A. Frequent hospital presenters' use of health information during COVID-19: results of a cross-sectional survey. BMC Health Serv Res 2023; 23:616. [PMID: 37308996 DOI: 10.1186/s12913-023-09504-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. METHODS Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. RESULTS The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. CONCLUSION Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes.
Collapse
Affiliation(s)
- Rebecca L Jessup
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia.
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
- School of Rural Health, Monash University, Warragul, Australia.
| | - Cassandra Bramston
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Polina Putrik
- Department of Family Medicine, Care and Public Health Research Institute, Maastrich University, Maastricht, Netherlands
| | - Cilla Haywood
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Mark Tacey
- Department of Medicine, University of Melbourne, Parkville, Australia
- Office of Research, Northern Health, Epping, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Natali Cvetanovska
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
- School of Rural Health, Monash University, Warragul, Australia
| | - Yingting Cao
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Anthony Gust
- Digital Health, Northern Health, Epping, Australia
| | - Donald Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, LaTrobe University, Melbourne, Bundoora, Australia
- Baker Heart and Diabetes Institute, Prahran, Australia
| | - Hala Mehdi
- Office of Research, Northern Health, Epping, Australia
| | - Michael Kirk
- Division of Medicine, Rockhampton Hospital, Rockhampton, Australia
| | | | - Adam I Semciw
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Alison Beauchamp
- School of Rural Health, Monash University, Clayton, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Australia
| |
Collapse
|
6
|
Zhong Y, McKenna L, Copnell B, Zhao W, Moss C. Professional Adaptation Experiences of Chinese Migrant Nurses in Australia: A Qualitative Study. West J Nurs Res 2023:1939459231167711. [PMID: 37021833 DOI: 10.1177/01939459231167711] [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] [Indexed: 04/07/2023]
Abstract
Chinese-educated nurses are increasingly important to the international labor market. This study aimed to examine how Chinese migrant nurses adapt and evolve professionally while pursuing nursing careers in Australia, using a qualitative descriptive approach. A total of 17 Chinese-educated nurses were recruited by purposive and snowball sampling in Australia during 2017. Data were collected by individual semi-structured interviews and analyzed using thematic analysis. Three central themes and eight subthemes were generated. Perceived differences in nursing involved: work options and flexibility, professional autonomy and independence, and freedom of expressing professional opinions. Elements comprising challenges to adaptation included communication barriers, nursing workload and responsibilities, and collegial relationships. Participants' professional transition journeys were accompanied by two key areas of self-evolution: Embracing the authentic self and embracing individual differences. Our findings have important implications for migrant-host nursing workforce integration in Australia and internationally.
Collapse
Affiliation(s)
- Yaping Zhong
- School of Nursing and Midwifery, Monash University, Victoria, Australia
- Peter MacCallum Cancer Centre, Victoria, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| | - Wenjuan Zhao
- Department of Nursing Administration, Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cheryle Moss
- School of Nursing and Midwifery, Monash University, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| |
Collapse
|
7
|
Faulks MF, McLachlan H, Shafiei T, Forster D, Mogren I, Copnell B, Edvardsson K. Perinatal outcomes of socially disadvantaged women in Victoria, Australia: A population-based retrospective cohort study of 1,188,872 singleton births 1999-2016. Women Birth 2022. [DOI: 10.1016/j.wombi.2022.07.030] [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: 11/30/2022]
|
8
|
McKenna L, Shimoinaba K, Copnell B. Family-centered care and pediatric death in the emergency department: A qualitative study using framework analysis. J Pediatr Nurs 2022; 64:18-23. [PMID: 35131715 DOI: 10.1016/j.pedn.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/15/2021] [Accepted: 01/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Family-centered care is an important concept underpinning care of children. Although much researched in some settings, little research has explored specialist settings, or areas where both children and adults are cared for, such as the emergency department. METHODS This study sought to explore how nurses employ family-centered care in delivering care to children and families when a child dies in the emergency department. Using a descriptive, qualitative approach, semi-structured interviews were conducted with 24 emergency nurses from six Australian states. Interviews were audio-recorded and transcribed verbatim. Framework analysis was applied to examine alignment with family-centered care principles. FINDINGS Nurses described providing support and education, and encouraged families to engage in care decisions, including about ceasing resuscitation efforts. Commonly, senior staff members were allocated during emergencies to support parents. DISCUSSION Emergency nurses should be offered education on family-centered care, and research undertaken to explore families' experiences of their child dying in the emergency department. PRACTICE IMPLICATION Family-centered care should be a focus for the care of children and their families in the emergency department, regardless of the pressure from rapidly occurring events.
Collapse
Affiliation(s)
- Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Australia.
| | | | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Australia.
| |
Collapse
|
9
|
Edvardsson K, Hughes E, Copnell B, Mogren I, Vicendese D, Gray R. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009–2016. PLoS One 2022; 17:e0264512. [PMID: 35226688 PMCID: PMC8884496 DOI: 10.1371/journal.pone.0264512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/03/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia. Methods Our sample included all reported live singleton births in Victoria 2009–2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness. Results Of all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37–2.43), having gestational diabetes mellitus (1.57, 1.34–1.84), undergoing an unplanned caesarean section (1.17, 1.02–1.33), induction of labour (1.17, 1.05–1.30) and postpartum haemorrhage (1.15, 1.03–1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43–1.80), a low Apgar score at 5 minutes (1.50, 1.19–1.90), preterm birth (1.40, 1.20–1.63), and low birthweight (1.26, 1.06–1.49). Conclusion Women with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.
Collapse
Affiliation(s)
- Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- * E-mail:
| | - Elizabeth Hughes
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Ingrid Mogren
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- Department of Clinical sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
- The Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
10
|
Jessup RL, Bramston C, Beauchamp A, Gust A, Cvetanovska N, Cao Y, Haywood C, Conilione P, Tacey M, Copnell B, Mehdi H, Alnasralah D, Kirk M, Zucchi E, Campbell D, Trezona A, Haregu T, Oldenburg B, Stockman K, Semciw AI. Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study. BMJ Open 2021; 11:e049222. [PMID: 36927862 PMCID: PMC8718342 DOI: 10.1136/bmjopen-2021-049222] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance. DESIGN This convergent parallel mixed methods study comprised two parts. SETTING An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting. PARTICIPANTS A total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23-99). RESULTS Interrupted time-series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 67% across emergency triage categories. 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health-seeking behaviour: fear and/or avoidance of hospital care; use of telehealth for remote assessment; no fear or avoidance of hospital care; not leaving the house for any reason. CONCLUSIONS This study demonstrated reduced ED use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth.
Collapse
Affiliation(s)
- Rebecca Leigh Jessup
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Victoria, Australia
- Allied Health, Northern Health, Epping, Victoria, Australia
- School of Rural Health, Monash University, Warrigal, Victoria, Australia
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
- School of Allied Health, Human Services and Sport, LaTrobe University, Bundoora, Victoria, Australia
| | - C Bramston
- Allied Health, Northern Health, Epping, Victoria, Australia
| | - A Beauchamp
- School of Rural Health, Monash University, Warrigal, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - A Gust
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
| | - N Cvetanovska
- School of Rural Health, Monash University, Warrigal, Victoria, Australia
| | - Y Cao
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Haywood
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Conilione
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
| | - Mark Tacey
- Office of Research, Northern Health, Epping, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia
| | - H Mehdi
- Office of Research, Northern Health, Epping, Victoria, Australia
| | | | - M Kirk
- Department of Medicine, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Emilliano Zucchi
- Transcultural and Language Services, Northern Health, Melbourne, Victoria, Australia
| | - D Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
- Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia
| | - A Trezona
- Trezona Consulting Group, Brunswick, Victoria, Australia
| | - T Haregu
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - K Stockman
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
- Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia
| | - Adam Ivan Semciw
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Victoria, Australia
- Allied Health, Northern Health, Epping, Victoria, Australia
- School of Allied Health, Human Services and Sport, LaTrobe University, Bundoora, Victoria, Australia
| |
Collapse
|
11
|
Zhai J, Weller-Newton JM, Shimoinaba K, Chen H, Copnell B. Transforming their lives: Post-traumatic growth experience in Chinese women with breast cancer - A grounded theory study. Health Care Women Int 2021; 45:286-300. [PMID: 34534046 DOI: 10.1080/07399332.2021.1959594] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Our research sought to explore post-traumatic growth experience among Chinese women with breast cancer. Constructivist grounded theory methodology was utilised to understand Chinese women's post-traumatic growth experience. 24 women with breast cancer were recruited from China. Data was collected through semi-structured, interviews. Three categories were developed from the data: renewing self-perception, encountering changes in relationships, and altering philosophical values and beliefs. The unique manifestations of post-traumatic growth highlight the need for development and adaption of the post-traumatic growth inventory to reduce cultural biases within the assessment tool and incorporate new culturally appropriate items.
Collapse
Affiliation(s)
- Jianxia Zhai
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- College of Nursing & Midwifery, Charles Darwin University, Melbourne, Victoria, Australia
- School of Health, Federation University Australia, Melbourne, Victoria, Australia
| | - Jennifer M Weller-Newton
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Department of Rural Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kaori Shimoinaba
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Hong Chen
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Baqeas MH, Davis J, Copnell B. Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review. BMC Palliat Care 2021; 20:88. [PMID: 34162388 PMCID: PMC8220432 DOI: 10.1186/s12904-021-00784-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Palliative care can be demanding and stressful for providers. There is increasing recognition in the literature of the impact of caregiving in palliative care settings, including compassion fatigue and compassion satisfaction. However, to date this literature has not been systematically reviewed. The purpose of this scoping review was to map the literature on compassion fatigue and compassion satisfaction among palliative care health providers caring for adult patients. METHODS Scoping review method guided by Joanna Briggs Institute guidelines was conducted using four electronic databases to identify the relevant studies published with no time limit. Following the title and abstract review, two reviewers independently screened full-text articles, and extracted study data. A narrative approach to synthesizing the literature was used. RESULTS Twenty studies were included in the review. Five themes emerged from synthesis: conceptualisation of compassion fatigue and compassion satisfaction; measurement of compassion fatigue and compassion satisfaction; consequences of compassion fatigue or compassion satisfaction and providing care for patients with life-threatening conditions; predictors or associated factors of compassion fatigue and compassion satisfaction among palliative care health providers; and strategies or interventions to support palliative care health providers and reduce compassion fatigue. CONCLUSIONS Limited studies examined the effectiveness of specific interventions to improve compassion satisfaction and reduce compassion fatigue among palliative care health providers. Further investigation of the impacts of compassion fatigue and compassion satisfaction on palliative care health providers and their work is also needed.
Collapse
Affiliation(s)
- Manal Hassan Baqeas
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Jenny Davis
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| |
Collapse
|
13
|
Rad LL, Carter B, Curley MAQ, Copnell B, Tume LN. Is paediatric endotracheal suctioning by nurses' evidence based? An International Survey. Nurs Crit Care 2021; 26:372-379. [PMID: 33938114 DOI: 10.1111/nicc.12644] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endotracheal suction (ETS) is essential in intubated patients to prevent tube occlusion and is one of the most common nursing interventions performed in intensive care. AIMS AND OBJECTIVES To explore how paediatric ETS practices reflect evidence-based practice (EBP) recommendations in paediatric intensive care units (PICU) worldwide. STUDY DESIGN AND METHODS A cross-sectional electronic survey linked to a real patient suction episode. Nurses completed the survey following a recent ETS episode. Evidence-based practice (EBP) was defined based on four of the American Association for Respiratory Care (AARC) best evidence recommendations: pre-oxygenation before suction, use of a suction catheter no more than half the diameter of the tracheal tube, shallow depth of suction, and the continuous suction applied upon withdrawal of the catheter. Participants included PICU nurses who performed ETS in children (0-17 years) excluding preterm neonates. RESULTS Four hundred forty-six complete surveys were received from 20 countries. Most nurses (80%, 367/446) reported that their units had local guidelines for ETS. The most common reason for suctioning (44%) was audible/visible secretions. Over half of ETS episodes (57%) used closed suction. When exploring the individual components of suction, 63% (282/446) of nurses pre-oxygenated their patient prior to suction, 71% (319/446) suctioned no further than 0.5 cm past end of the endotracheal tube (ETT), 59% (261/446) used a catheter no more than half the diameter of the ETT, and 78% (348/446) used continuous negative pressure. 24% of nurses gave patients an additional bolus of sedative, analgesic, and/or muscle-relaxant medication prior to suction; this decision was not related to the child's history of instability with suction, as there was no significant difference in those who reported patients had a history of being unstable with suction (P = .80). 26% (117/446) of nurses complied with all four EBP components in the reported suctioning episode. CONCLUSIONS Considerable variation in paediatric endotracheal suctioning practices exists internationally. Although most nurses applied single components of evidence-based recommendations during ETT suctioning, just a quarter applied all four elements. RELEVANCE TO CLINICAL PRACTICE Nurses' need to consider and strive to apply EBP principles to common nursing interventions such as ETS.
Collapse
Affiliation(s)
- Laura L Rad
- PICU, Alder Hey Children's Hospital, Liverpool, UK
| | - Bernie Carter
- Children's Nursing, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.,Children's Nursing Research Unit, Alder Hey Children's Hospital NHSFT, Liverpool, UK
| | - Martha A Q Curley
- Pediatric Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Lyvonne N Tume
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Manchester, UK.,PICU, Alder Hey Children's Hospital, PICU, Liverpool, UK
| |
Collapse
|
14
|
McKenna L, Copnell B, Smith G. Getting the methods right: Challenges and appropriateness of mixed methods research in health-related doctoral studies. J Clin Nurs 2020; 30:581-587. [PMID: 33058330 DOI: 10.1111/jocn.15534] [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] [Received: 03/14/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
AIMS To examine issues around the use of mixed methods research in doctoral research in nursing and healthcare. We raise questions around challenges and appropriateness of this type of research methodology for doctoral students. BACKGROUND In recent years, mixed methods research has grown rapidly in health-related research. As an emerging research methodology, mixed methods research has much to offer doctoral researchers in health care who increasingly are faced with complex research issues. However, despite evolving as a research paradigm, researchers from both qualitative and quantitative perspectives have hotly debated application of mixed methods approaches. The body of supporting knowledge underpinning mixed methods research continues to grow and become refined. Evolving complexities pose new challenges for newly-enrolled doctoral students. DESIGN Discussion paper. METHOD Using a discursive approach, we raise questions around the challenges and appropriateness of this type of research methodology for doctoral students. RESULTS Mixed methods research poses a unique range of methodological challenges that need to be carefully considered by research students when choosing their research methodology. These include scope of methodological learning required, additional time for data collection and analysis, need to acquire additional skill sets, approaches to reporting study results, dissemination of findings and specific supervisory support and thesis examination issues. CONCLUSIONS Mixed methods approaches can make important contributions to clinical research. However, their application to doctoral studies is challenging and should only be considered where appropriate to answer the research question. RELEVANCE TO CLINICAL PRACTICE Mixed methods research approaches are commonly used in doctoral studies undertaken to understand clinical nursing practice and can make an important contribution to knowledge. However, there is a need for appropriate application of the methodology to ensure strong, appropriate research outcomes.
Collapse
Affiliation(s)
- Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia
| | - Graeme Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| |
Collapse
|
15
|
Zhai J, Weller-Newton JM, Shimoinaba K, Chen H, Copnell B. Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture. Qual Health Res 2020; 30:1674-1683. [PMID: 32564672 DOI: 10.1177/1049732320930195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.
Collapse
Affiliation(s)
- Jianxia Zhai
- Monash University, Melbourne, Victoria, Australia
| | - Jennifer M Weller-Newton
- Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
- McMaster University, Hamilton, Ontario, Canada
| | | | - Hong Chen
- Huashan Hospital, Fudan University, Shanghai, China
| | | |
Collapse
|
16
|
Alabdulaziz H, Moss C, Copnell B. Corrigendum to “Paediatric nurses’ perceptions and practices of family-centred care in Saudi hospitals: A mixed methods study” [Int. J. Nurs. Stud. 69 (2017) 66–77]. Int J Nurs Stud 2019; 97:134. [DOI: 10.1016/j.ijnurstu.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Zhai J, Newton J, Copnell B. Posttraumatic growth experiences and its contextual factors in women with breast cancer: An integrative review. Health Care Women Int 2019; 40:554-580. [PMID: 30794107 DOI: 10.1080/07399332.2019.1578360] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this article, we synthesize current research that examines determinants and manifestations of posttraumatic growth (the phenomenon of posttraumatic growth can be embodied in several domains) in women with breast cancer. The findings of the integrative literature review may contribute to facilitating person-centered oncology care by raising health care professionals' awareness and understanding of posttraumatic growth phenomenon among breast cancer survivors. The identification of factors contributing to posttraumatic growth and manifestations of posttraumatic growth are important in increasing the effectiveness of interventions in supporting women during their breast cancer journey. The methods proposed by Whittemore and Knafl ( 2005 ) were adopted to guide this integrative review. Quality assessment was conducted using recognized critical appraisal tools relating to quantitative and qualitative studies. Four main manifestations were synthesized from the literature: new perception of self; relatedness to others; new life philosophy; and spiritual and religious growth. Personal characteristics, illness factors, cognitive processing, coping strategies, social support, religion and spirituality, the body's role and physical activities were identified as influencing posttraumatic growth in women with breast cancer.
Collapse
Affiliation(s)
- Jianxia Zhai
- a Nursing and Midwifery , Monash University Melbourne , Melbourne , Victoria , Australia
| | - Jennifer Newton
- a Nursing and Midwifery , Monash University Melbourne , Melbourne , Victoria , Australia.,b School of Nursing , McMaster University , Hamilton , Onatrio , Canada
| | - Beverley Copnell
- c School of Nursing and Midwifery , Latrobe University , Melbourne , Victoria , Australia
| |
Collapse
|
18
|
Abstract
The increasing evidence that spirituality is a critical component for promoting health and well-being has made spirituality more significant to nursing practice. However, although nurses' perceptions of spirituality have been studied in western countries, there has been little research on this topic in Southeast Asian countries where religions other than Christianity predominate. This study explores Malaysian nurses' perceptions of spirituality and spiritual care and examines associations between socio-demographics and their perceptions. The Malaysian Nurse Forum Facebook closed group was used for data collection with 208 completed the online survey. The participants considered that spirituality is a fundamental aspect of nursing. Nonetheless, half of the respondents were uncertain regarding the use of the spiritual dimension for individuals with no religious affiliation. Significant differences were found between educational levels in mean scores for spirituality and spiritual care. There was also a positive relationship between perception of spirituality and spiritual care among the respondents. Despite the positive perceptions of nurses of spirituality in nursing care, the vast majority of nurses felt that they required more education and training relating to spiritual aspects of care, delivered within the appropriate cultural context.
Collapse
Affiliation(s)
- Mohd Arif Atarhim
- Department of Nursing, 5th Floor, Kompleks Pendidikan Perubatan Canselor Tuanku Ja'afar, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, The National University of Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Susan Lee
- School of Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, VIC, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| |
Collapse
|
19
|
Butler AE, Copnell B, Hall H. The impact of the social and physical environments on parent–healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study. Intensive Crit Care Nurs 2019; 50:28-35. [DOI: 10.1016/j.iccn.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
|
20
|
Abstract
Background As understandings of the impacts of end-of-life experiences on parents’ grief and bereavement increase, so too does the inclusion of bereaved parents into research studies exploring these experiences. However, designing and obtaining approval for these studies can be difficult, as guidance derived from bereaved parents’ experiences of the research process are limited within the current literature. Methods We aimed to explore bereaved parents’ experiences of research participation in a larger grounded theory study exploring experiences of the death of a child in the paediatric intensive care unit. Data were obtained during follow-up phone calls made to 19 bereaved parents, five of whom provided data from their spouse, 1 week after their participation in the study. Participants were asked to reflect on their experiences of research participation, with a focus on recruitment methods, timing of research contact, and the location of their interview. Parents’ responses were analysed using descriptive content analysis. Results Our findings demonstrate that despite being emotionally difficult, parents’ overall experiences of research participation were positive. Parents preferred to be contacted initially via a letter, with an opt in approach viewed most favourably. Most commonly, participants preferred that research contact occurred within 12–24 months after their child’s death, with some suggesting contact after 6 months was also appropriate. Parents also preferred research interviews conducted in their own homes, though flexibility and parental choice was crucial. Conclusions Findings from this study offer further insight to researchers and research review committees, to help ensure that future studies are conducted in a way that best meets the unique needs of bereaved parents participating in research.
Collapse
Affiliation(s)
- Ashleigh E Butler
- The Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute of Child Health, London, UK. .,School of Nursing and Midwifery, Monash University, Melbourne, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| |
Collapse
|
21
|
McKinley DF, Kinney SB, Copnell B, Shann F. Long-Term Effects of Saline Instilled During Endotracheal Suction in Pediatric Intensive Care: A Randomized Trial. Am J Crit Care 2018; 27:486-494. [PMID: 30385540 DOI: 10.4037/ajcc2018615] [Citation(s) in RCA: 9] [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: 11/01/2022]
Abstract
BACKGROUND Saline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units. OBJECTIVE To compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit. METHOD An unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours. Children were randomly assigned to receive no saline, 0.225% saline, or 0.9% saline during routine endotracheal suctioning. RESULTS The primary outcome was the number of hours of invasive mechanical ventilation; oxygen therapy and length of stay in the unit were secondary outcomes. There were 138 children randomly assigned to the no-saline group, 141 to the 0.225% saline group, and 148 to the 0.9% saline group. In Kaplan-Meier intention-to-treat analysis, the median (interquartile range) number of hours of invasive mechanical ventilation was 32 (20-68), 43 (21-86), and 40 (20-87) in the no-saline, 0.225% saline, and 0.9% saline groups, respectively. Although the no-saline group received fewer hours of invasive ventilation, oxygen therapy, and intensive care than the other groups combined, the differences were not statistically significant. CONCLUSION Using no saline was at least as effective as using either 0.225% or 0.9% saline in endotracheal suctioning. The optimal policy may be to routinely use no saline with endotracheal suctioning in children but allow the occasional use of 0.9% saline when secretions are thick.
Collapse
Affiliation(s)
- Dianne F. McKinley
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Sharon B. Kinney
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Beverley Copnell
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Frank Shann
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| |
Collapse
|
22
|
|
23
|
Butler AE, Hall H, Copnell B. Gradually Disengaging: Parent-Health care Provider Relationships After a Child's Death in the Pediatric Intensive Care Unit. J Fam Nurs 2018; 24:470-492. [PMID: 29938568 DOI: 10.1177/1074840718783470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When a child dies in the intensive care unit, many bereaved parents want relationships with their child's health care staff to continue in the form of follow-up care. However, the nature of these relationships and how they change across the parents' bereavement journey is currently unknown. This article explores early and ongoing relationships between parents and health care staff when a child dies in intensive care. Constructivist grounded theory methods were used to recruit 26 bereaved parents from four Australian pediatric intensive care units into the study. Data were collected via audio-recorded, semistructured interviews and analyzed using the constant comparative methods and theoretical memoing. Findings show that these relationships focus on Gradually disengaging, commonly moving through three phases after the child dies: Saying goodbye, Going home, and Seeking supports. These findings provide guidance to health care staff on what families need as they leave the intensive care unit and move through bereavement.
Collapse
Affiliation(s)
- Ashleigh E Butler
- 1 Louis Dundas Centre for Children's Palliative Care, University College London Institute for Child Health, UK
| | - Helen Hall
- 2 Monash University, Frankston, Victoria, Australia
| | | |
Collapse
|
24
|
Carr BL, Copnell B, McIntyre M. Differences in meconium stained amniotic fluid in an Australian population: A retrospective study. Women Birth 2018; 32:e259-e263. [PMID: 29954687 DOI: 10.1016/j.wombi.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/23/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meconium stained amniotic fluid commonly occurs postdates ( >40 weeks gestation) indicating fetal maturity. Previous literature indicates that different ethnicities mature at different rates. AIM To compare the rate of meconium stained amniotic fluid of Australian-born and non-Australian born women. METHODS A retrospective correlation study design was implemented, using data collected in the birth outcomes system at one tertiary hospital. Data was collected from all women who gave birth to a term (>/=37 weeks gestation), singleton, liveborn baby between January 1st to December 31st, 2014. Maternal country of birth was used for comparison. Categorical data was analyzed using Chi-Square test for Independence. Continuous variables were assessed for normality, and differences were compared using an Independent t-test or a Mann-Whitney U test. All tests were two-tailed and p<0.05 was considered statistically significant. RESULTS 3,041 women were included; 1131 Australian-born and 1910 non-Australian born. Meconium stained amniotic fluid occurred more frequently in non-Australian born women compared to Australian-born women (23.5% vs. 19.8 p=0.02). Their babies were significantly smaller (Mean=3265g, Standard Deviation 463.8 vs Mean=3442g, Standard Deviation 499.2, p<0.001), with no difference in gestational length (Mean=39.4, Standard Deviation 1.28 vs Mean=39.5, Standard Deviation 1.18, p=0.06). Increasing gestational age had the strongest association with meconium stained amniotic fluid; >/=42 weeks gestation occurring 3.52 (95% Confidence Interval: 2.00, 6.22, p=<0.001) more than <40 weeks gestation. CONCLUSION Maternity health services should record ethnicity and region of birth to provide individualised care as women born overseas often have poorer perinatal outcomes when compared to Australian-born women.
Collapse
Affiliation(s)
- Bethany L Carr
- Monash University, School of Nursing and Midwifery, McMahons Rd, Frankston 3199, VIC, Australia; Monash Medical Centre, Women's & Children's Program, 246 Clayton Rd, Clayton 3168, VIC, Australia.
| | - Beverley Copnell
- La Trobe University, School of Nursing and Midwifery Centre, Plenty Rd & Kingsbury Dve, Bundoora 3086, VIC, Australia
| | - Meredith McIntyre
- Monash University, School of Nursing and Midwifery, McMahons Rd, Frankston 3199, VIC, Australia
| |
Collapse
|
25
|
Grimston M, Butler AE, Copnell B. Critical care nurses' experiences of caring for a dying child: A qualitative evidence synthesis. J Adv Nurs 2018; 74:1752-1768. [PMID: 29729652 DOI: 10.1111/jan.13701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
AIM To synthesize qualitative research examining the experience of critical care nurses caring for a dying child. BACKGROUND Caring for a dying child remains one of the most difficult aspects of nursing, potentially leading to personal and professional distress. A thorough understanding of this experience for critical care nurses allows for improved delivery of care and support for the nurse. DESIGN A qualitative evidence synthesis was undertaken, informed by Thomas and Harden's thematic synthesis methodology. DATA SOURCES Studies were retrieved from CINAHL Plus, Scopus, OVID Medline, and Embase, alongside hand-searching reference lists in February 2016. REVIEW METHODS Two reviewers independently assessed each study using a multistep screening process and performed critical appraisal of each included study. Data were extracted onto a predeveloped tool and analysed using thematic analysis. RESULTS There is a blurred line between the role of the nurse as a person or a professional while caring for the child and family throughout hospitalization and during and after the death. Each stage of care involves tasks and emotions that highlight the changing dominance of the nurse as either a person or professional. CONCLUSION Personal, interpersonal, and contextual factors affect delivery of care and impact of the death of the child on the critical care nurse. Reviewing individual and institutional practices could improve provision of care, interprofessional collaboration, and support provided to staff involved.
Collapse
Affiliation(s)
- Mitchell Grimston
- Education and Training Service, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Nepean Emergency Department, Penrith, NSW, Australia
| | - Ashleigh E Butler
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, UCL/Great, London, UK
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| |
Collapse
|
26
|
Butler AE, Hall H, Copnell B. Becoming a Team: The Nature of the Parent-Healthcare Provider Relationship when a Child is Dying in the Pediatric Intensive Care Unit. J Pediatr Nurs 2018; 40:e26-e32. [PMID: 29454506 DOI: 10.1016/j.pedn.2018.02.002] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore bereaved parents' perspectives of parent and staff roles in the pediatric intensive care unit when their child was dying, and their relationships with healthcare staff during this time. DESIGN AND METHODS Constructivist grounded theory was used to undertake this study. Semi-structured interviewers were conducted with 26 bereaved parents recruited from four Australian pediatric intensive care units. The constant comparative method, coupled with open, focused, and theoretical coding were used for data analysis. RESULTS Becoming a team explores the changes that occurred to the parent-healthcare provider relationship when parents realized their child was dying and attempted to become part of their child's care team. When the focus of care changed from 'life-saving' to 'end-of-life', parents' perspectives and desires of their and the healthcare providers' roles changed. Parents' attempted to reconstruct their roles to match their changing perspectives, which may or may not have been successful, depending on their ability to successfully negotiate these roles with healthcare providers. CONCLUSIONS Findings offer insights into parental understandings of both the parental and healthcare provider roles for parents of dying children in intensive care, and the ways in which the parent-healthcare provider relationships can influence and be influenced by changes to these roles. PRACTICE IMPLICATIONS Successful parent-healthcare provider relationships require an understanding of the parental and healthcare provider role from the parents' perspective. The meanings of the parental and healthcare provider roles should be explored with parents of dying children, and supported as much as possible to enable the development of a collaborative relationship.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Victoria 3800, Australia; Adult and Pediatric Intensive Care Unit, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Victoria 3800, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Victoria 3800, Australia
| |
Collapse
|
27
|
Butler AE, Hall H, Copnell B. Bereaved parents' experiences of the police in the paediatric intensive care unit. Aust Crit Care 2018; 32:40-45. [PMID: 29571596 DOI: 10.1016/j.aucc.2018.02.004] [Citation(s) in RCA: 2] [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] [Received: 11/07/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A child's death in the intensive care unit is often sudden and unexpected, requiring the involvement of the state coroner to investigate both the cause and the circumstances surrounding the death. This process often involves the police, who arrive in intensive care to identify the body and collect statements from the parents. At present, very little is known about parents' experiences of this process. OBJECTIVES To explore bereaved parents' experiences of police presence in intensive care, as part of routine coronial investigations. The findings arose from a larger study on bereaved parents' experiences of the death of a child in the intensive care unit. METHODS Secondary analysis of incidental data from a larger grounded theory study. Nine bereaved parents from two paediatric intensive care units (PICUs) mentioned police presence in the PICU during their original audio-recorded, semistructured interviews. These data were extracted, and thematic analysis techniques were used to identify key themes. RESULTS Three main concepts were identified with the parents' experiences: (i) timing of police interviews; (ii) the impacts of police presence; and (iii) the demeanour of the officers. Overall, the parents' experiences of police presence were negative. They felt that police arrived too soon after their child's death and took too long taking their statements, hindering their ability to say goodbye. The presence of police officers also made parents feel as though they were being accused of involvement in their child's death. Finally, several participants also experienced inappropriate or unsympathetic attitudes from the police officers attending their child's death. CONCLUSIONS Findings from our study indicate that parents' experiences of police presence in the PICU as part of a coronial investigation may be negative, leaving lasting impressions on their experiences of their child's death. These findings provide areas for improvements in care delivery and the treatment of newly bereaved parents during the early phases of a coronial investigation.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia; Adult and Paediatric Intensive Care Unit, Monash Health, Victoria, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
| |
Collapse
|
28
|
Butler AE, Copnell B, Hall H. Welcoming expertise: Bereaved parents' perceptions of the parent-healthcare provider relationship when a critically ill child is admitted to the paediatric intensive care unit. Aust Crit Care 2017; 32:34-39. [PMID: 29153961 DOI: 10.1016/j.aucc.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/28/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Entering the paediatric intensive care unit with a critically ill child is a stressful experience for parents. In addition to fearing for their child's well-being, parents must navigate both a challenging environment and numerous new relationships with healthcare staff. How parents form relationships with staff and how they perceive both their own and the healthcare providers' roles in this early stage of their paediatric intensive care journey is currently unknown. PURPOSE This paper explores bereaved parents' perceptions of their role and their relationships with healthcare providers when their child is admitted to the intensive care unit, as part of a larger study exploring their experiences when their child dies in intensive care. METHODS A constructivist grounded theory approach was utilised to recruit 26 bereaved parents from 4 Australian intensive care units. Parents participated in audio-recorded, semi-structured interviews lasting 90-150min. All data were analysed using the constant comparative analysis processes, supported by theoretical memos. RESULTS Upon admission, parents viewed healthcare providers as experts, both of their child's medical care and of the hospital system. This expertise was welcomed, with the parent-healthcare provider relationship developing around the child's need for medical care. Parents engaged in 2 key behaviours in their relationships with staff: prioritising survival, and learning 'the system'. Within each of these behaviours are several subcategories, including 'Stepping back', 'Accepting restrictions' and 'Deferring to medical advice'. CONCLUSIONS The relationships between parents and staff shift and change across the child's admission and subsequent death in the paediatric intensive care unit. However, upon admission, this relationship centres around the child's potential survival and their need for medical care, and the parent's recognition of the healthcare staff as experts of both the child's care and the hospital system.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia; Adult and Paediatric Intensive Care Unit, Monash Health, Victoria, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
| |
Collapse
|
29
|
McKenna L, Copnell B, Butler AE, Lau R. Learning style preferences of Australian accelerated postgraduate pre-registration nursing students: A cross-sectional survey. Nurse Educ Pract 2017; 28:280-284. [PMID: 29066158 DOI: 10.1016/j.nepr.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/24/2017] [Revised: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Abstract
Graduate entry programs leading to registration are gaining momentum in nursing. These programs attract student cohorts with professional, cultural, gender and age diversity. As a consequence of this diversity, such accelerated programs challenge traditional pedagogical methods used in nursing and require different approaches. To date, however, there has been limited research on the learning styles of students undertaking these programs to inform academics involved in their delivery. Kolb's Experiential Learning model has been used widely in a variety of educational settings because it is based on the theory of experiential learning. More recently VARK (Visual, Aural, Read/write and Kinaesthetic) model has become popular. The aim of this study was to investigate the learning styles of two cohorts of graduate entry nursing students undertaking an accelerated masters-level program. This was a cross-sectional survey of two cohorts of Master of Nursing Practice students enrolled at a large Australian university. The students were more inclined toward converging (practical) and least toward concrete experience (experiencing) learning styles. The majority of students were more inclined toward kinaesthetic and least toward aural learning style. Findings have implications for academics engaged in teaching graduate entry nursing students.
Collapse
Affiliation(s)
- Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing & Midwifery, Monash University, Clayton Campus, Wellington Rd, Clayton, Victoria 3800, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing & Midwifery, Monash University, Clayton Campus, Wellington Rd, Clayton, Victoria 3800, Australia.
| | - Ashleigh E Butler
- School of Nursing & Midwifery, Monash University, Clayton Campus, Wellington Rd, Clayton, Victoria 3800, Australia.
| | - Rosalind Lau
- School of Nursing & Midwifery, Monash University, Clayton Campus, Wellington Rd, Clayton, Victoria 3800, Australia.
| |
Collapse
|
30
|
Butler AE, Hall H, Copnell B. The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit. J Adv Nurs 2017; 74:89-99. [DOI: 10.1111/jan.13401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ashleigh E. Butler
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| | - Helen Hall
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| | - Beverley Copnell
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| |
Collapse
|
31
|
Butler AE, Hall H, Copnell B. Ethical and Practical Realities of Using Letters for Recruitment in Bereavement Research. Res Nurs Health 2017; 40:372-377. [PMID: 28543552 DOI: 10.1002/nur.21800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/11/2022]
Abstract
Recruitment of participants into bereavement research may present many challenges for the research team. At present, there is little consensus for researchers and ethics committees on the most appropriate method of recruitment. There is some evidence that participants prefer to be contacted about research studies via letters. However, recruitment involving the use of a letter can occur in a number of ways, each with ethical and practical benefits and limitations. In a study of the experiences of bereaved parents, we used letters in three ways: direct mailing from the research team with an opt-out option; permission to mail letters obtained by social workers from a hospital-based follow-up program during routine contact; and letters mailed from the hospital's PICU research nurse at the hospital with instruction on how to opt in. In this paper, the practical and ethical realities of each method are highlighted, using examples from our own experiences. Nineteen parents also provided reflections in follow-up phone calls. While direct researcher contact is perhaps the most feasible for researchers, ethical concerns may render it unacceptable. While contact via a known member of a follow-up program is more ethically appropriate for participants, it also presents significant practical issues. We suggest that contact via a representative of the healthcare institution provides the best balance of ethical and practical acceptability for both participants and the research team, but responsiveness to the ethical and practical requirements of the study is crucial in ensuring it can be successfully undertaken. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia.,Adult and Paediatric Intensive Care Unit, Monash Health, Victoria, Australia, PO Box 2742 Rowville, VIC, Australia, 3178
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia
| |
Collapse
|
32
|
Abstract
Conducting qualitative research, especially in areas considered 'sensitive', presents many challenges. The processes involved in such research often expose both participants and the research team to a vast array of risks, which may cause damage to their personal, professional, social and cultural worlds. Historically, these risks have been considered independent of each other, with most studies exploring only the risks to participants or only risks to researchers. Additionally, most researchers only consider risks during data collection, frequently overlooking risks that might be present during other phases of the research project. We aim, therefore, to bring together this fractured literature to enable an integrated exploration of the current academic discourse relating to risks to participants with the literature exploring risks to researchers across all phases of the research process. This article draws on personal experiences to highlight ethical issues and risks encountered by both participants and researchers throughout all phases of a research project. Beginning in recruitment, we discuss the risk of secondary distress in participants arising from researcher contact and then explore the concept of informed consent during grief and bereavement research. We then focus on risks present during data collection, examining risks for participants, such as emotional distress, and potential safety risks for the research team. Finally, we consider the risks which arise in data analysis, including both confidentiality and the possibility of researcher burnout. Previous recommendations are summarised, with new management strategies suggested based on lessons learned along the way.
Collapse
|
33
|
Alabdulaziz H, Moss C, Copnell B. Paediatric nurses’ perceptions and practices of family-centred care in Saudi hospitals: A mixed methods study. Int J Nurs Stud 2017; 69:66-77. [DOI: 10.1016/j.ijnurstu.2017.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
|
34
|
Malini H, Copnell B, Moss C. Considerations in adopting a culturally relevant diabetes health education programme: An Indonesian example. Collegian 2017. [DOI: 10.1016/j.colegn.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Suryanto, Plummer V, Copnell B. Collaboration between nurses and physicians in an Indonesian Emergency Department. ACTA ACUST UNITED AC 2016; 19:82-9. [DOI: 10.1016/j.aenj.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
|
36
|
Butler A, Hall H, Copnell B. A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care. Worldviews Evid Based Nurs 2016; 13:241-9. [PMID: 26790142 DOI: 10.1111/wvn.12134] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [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: 06/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews. AIMS To guide researchers through the process of developing a qualitative systematic review protocol, using an example review question. METHODOLOGY The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction techniques; and data synthesis. The paper highlights important considerations during the protocol development process, and uses a previously developed review question as a working example. IMPLICATIONS FOR RESEARCH This paper will assist novice researchers in developing a qualitative systematic review protocol. By providing a worked example of a protocol, the paper encourages the development of review protocols, enhancing the trustworthiness and value of the completed qualitative systematic review findings. LINKING EVIDENCE TO ACTION Qualitative systematic reviews should be based on well planned, peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in clinical practice. Protocols should outline, in detail, the processes which will be used to undertake the review, including key search terms, inclusion and exclusion criteria, and the methods used for critical appraisal, data extraction and data analysis to facilitate transparency of the review process. Additionally, journals should encourage and support the publication of review protocols, and should require reference to a protocol prior to publication of the review results.
Collapse
Affiliation(s)
- Ashleigh Butler
- PhD candidate, School of Nursing and Midwifey, Monash University, and Clinical Nurse Specialist, Adult and Pediatric Intensive Care Unit, Monash Health, Melbourne, Victoria, Australia
| | - Helen Hall
- Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Beverley Copnell
- Senior Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
37
|
Bloomer MJ, Endacott R, Copnell B, O'Connor M. 'Something normal in a very, very abnormal environment'--Nursing work to honour the life of dying infants and children in neonatal and paediatric intensive care in Australia. Intensive Crit Care Nurs 2015; 33:5-11. [PMID: 26687773 DOI: 10.1016/j.iccn.2015.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 02/18/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/24/2022]
Abstract
The majority of deaths of children and infants occur in paediatric and neonatal intensive care settings. For nurses, managing an infant/child's deterioration and death can be very challenging. Nurses play a vital role in how the death occurs, how families are supported leading up to and after the infant/child's death. This paper describes the nurses' endeavours to create normality amidst the sadness and grief of the death of a child in paediatric and neonatal ICU. Focus groups and individual interviews with registered nurses from NICU and PICU settings gathered data on how neonatal and paediatric intensive care nurses care for families when a child dies and how they perceived their ability and preparedness to provide family care. Four themes emerged from thematic analysis: (1) respecting the child as a person; (2) creating opportunities for family involvement/connection; (3) collecting mementos; and (4) planning for death. Many of the activities described in this study empowered parents to participate in the care of their child as death approached. Further work is required to ensure these principles are translated into practice.
Collapse
Affiliation(s)
- Melissa J Bloomer
- Monash University, School of Nursing and Midwifery, Building E, PO Box 527, Frankston, VIC 3199, Australia.
| | - Ruth Endacott
- Monash University, School of Nursing and Midwifery, 10 Chancellors Walk, Clayton Campus, Clayton, VIC 3800, Australia.
| | - Beverley Copnell
- Monash University, School of Nursing and Midwifery, 10 Chancellors Walk, Clayton Campus, Clayton, VIC 3800, Australia.
| | - Margaret O'Connor
- Monash University, School of Nursing and Midwifery, Building E, PO Box 527, Frankston, VIC 3199, Australia.
| |
Collapse
|
38
|
Abstract
BACKGROUND AND OBJECTIVES The PICU is the most common site for inpatient pediatric deaths worldwide. The impact of this clinical context on family experiences of their child's death is unclear. The objective of the study was to review and synthesize the best available evidence exploring the family experience of the death of their child in the PICU. METHODS Studies were retrieved from CINAHL Plus, OVID Medline, Scopus, PsycINFO, and Embase. Gray literature was retrieved from greylit.com, opengrey.edu, Trove, Worldcat, and Google scholar. Study selection was undertaken by 4 reviewers by using a multistep screening process, based on a previously developed protocol (International Prospective Register of Systematic Reviews 2015:CRD42015017463). Data was extracted as first-order constructs (direct quotes) or second-order constructs (author interpretations) onto a predeveloped extraction tool. Data were analyzed by thematic synthesis. RESULTS One main theme and 3 subthemes emerged. "Reclaiming parenthood" encompasses the ways in which the parental role is threatened when a child is dying in the PICU, with the subthemes "Being a parent in the PICU," "Being supported," and "Parenting after death" elucidating the ways parents work to reclaim this role. The review is limited by a language bias, and by the limitations of the primary studies. CONCLUSIONS When a child dies in a PICU, many aspects of the technology, environment, and staff actions present a threat to the parental role both during and after the child's death. Reclaiming this role requires support from health care providers and the wider community.
Collapse
Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and Adult and Paediatric ICU, Monash Health, Melbourne, Australia
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
| | - Georgina Willetts
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
| |
Collapse
|
39
|
Abstract
Endotracheal suctioning is an essential intervention for the care of an intubated child and is one of the most commonly performed interventions in pediatric intensive care. Despite this, much of the research related to endotracheal suctioning is dated and the bulk of it conducted in preterm infants and adults. This paper will review research related to endotracheal suctioning that involves or relates to children in intensive care to provide a current review of the literature in this field. It will conclude with recommendations for practice where possible and identify areas for further research.
Collapse
Affiliation(s)
- Lyvonne N Tume
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.,The School of Health, University of Central Lancashire, Preston, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| |
Collapse
|
40
|
Al Thobaity A, Plummer V, Innes K, Copnell B. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. ACTA ACUST UNITED AC 2015; 18:156-64. [DOI: 10.1016/j.aenj.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/01/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
|
41
|
Butler A, Willetts G, Copnell B. Nurses' perceptions of working with families in the paediatric intensive care unit. Nurs Crit Care 2015; 22:195-202. [PMID: 26031857 DOI: 10.1111/nicc.12142] [Citation(s) in RCA: 12] [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: 06/11/2014] [Revised: 09/03/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research exploring nurses' experiences working with families in paediatric intensive care unit (PICU) is limited. No studies have been undertaken in a mixed adult-paediatric ICU. OBJECTIVES To explore nurses' perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit (ICU). DESIGN Descriptive qualitative design. METHODOLOGY Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was enhanced using an audit trail, member checks and peer review of all data. RESULTS Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU scrutinized the physical, cultural and institutional factors which impacted on the nurses' ability to work with families in the PICU. Finally, the overarching theme Competing values explores the interplay between the nurses' personal values and those of the PICU and the institution. CONCLUSIONS Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value placed on families and on the time nurses spent with them often competed for priority with nurses' other values and the wider culture of the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to variability in nurses' working with families. RELEVANCE TO CLINICAL PRACTICE The results highlighted a need for education for both nurses and medical staff who work with families of critically ill children. Additionally, the need for each PICU to have a written policy on family presence and participation is crucial to guide practice and maintain continuity of care.
Collapse
Affiliation(s)
- Ashleigh Butler
- Adult and Pediatric Intensive Care, Monash Medical Centre, Monash Health, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Georgina Willetts
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
42
|
Bloomer MJ, O'Connor M, Copnell B, Endacott R. Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: nurses' emotional talk and sources of discomfort. A mixed methods study. Aust Crit Care 2015; 28:87-92. [PMID: 25659197 DOI: 10.1016/j.aucc.2015.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 08/13/2014] [Revised: 11/28/2014] [Accepted: 01/08/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure. OBJECTIVES The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants. METHODS Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content. RESULTS Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses. CONCLUSION This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.
Collapse
Affiliation(s)
- Melissa J Bloomer
- Monash University, School of Nursing and Midwifery, Building E, PO Box 527, Frankston, VIC 3199, Australia.
| | - Margaret O'Connor
- Emeritus Professor of Nursing, Monash University, School of Nursing and Midwifery, Building E, PO Box 527, Frankston, VIC, 3199, Australia
| | - Beverley Copnell
- Monash University, School of Nursing and Midwifery, Wellington Road, Clayton, VIC 3800, Australia
| | - Ruth Endacott
- Monash University, School of Nursing and Midwifery, Wellington Road, Clayton, VIC 3800, Australia; Plymouth University, Faculty of Health and Human Sciences, 8 Portland Villas, Drake Circus, Plymouth PL4 8AA, UK
| |
Collapse
|
43
|
Butler A, Hall H, Willetts G, Copnell B. Parents' experiences of healthcare provider actions when their child dies: an integrative review of the literature. J SPEC PEDIATR NURS 2015; 20:5-20. [PMID: 25443391 DOI: 10.1111/jspn.12097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 08/16/2014] [Revised: 10/21/2014] [Accepted: 10/26/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To review, critique and synthesise current research studies that examine parental perceptions of healthcare provider actions during and after the death of a child. CONCLUSIONS Five main themes were synthesised from the literature: staff attitudes and affect; follow-up care and ongoing contact; communication; attending to the parents; and continuity of care. PRACTICE IMPLICATIONS This review helps to identify important aspects of paediatric end-of-life care as recognised by parents, with the intention of placing the family at the centre of any future end-of-life care education or policy/protocol development.
Collapse
Affiliation(s)
- Ashleigh Butler
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia; Adult and Paediatric Intensive Care Unit, Monash Health, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Beverley Copnell
- Beverley Copnell is a senior lecturer at the School of Nursing and Midwifery, Monash University, in Melbourne, Australia
| |
Collapse
|
45
|
Butler A, Copnell B, Willetts G. Family-centred care in the paediatric intensive care unit: an integrative review of the literature. J Clin Nurs 2013; 23:2086-99. [PMID: 24372988 DOI: 10.1111/jocn.12498] [Citation(s) in RCA: 37] [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: 09/03/2013] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To review extant research on family-centred care in a paediatric intensive care environment and identify gaps in the literature. BACKGROUND Family-centred care is currently a core concept in paediatric nursing, focusing on the premise that families are central to a child's well-being, and as such, should be included as equal members of the child's healthcare team. Due to the nature of critical care, family-centred care may be challenging to implement and maintain. DESIGN An integrative literature review. METHODS The review was conducted using the Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar databases, from 1990 to present. The search focused on the following terms: 'p(a)ediatric critical care', 'paediatric intensive care unit', 'family cent(e)red care', 'parental needs', 'family presence' and 'family/nurse roles'. Additionally, the search was limited to studies conducted in a developed country and published in English. RESULTS Eighteen studies were included in the review. The results demonstrated that implementing family-centred care into a paediatric intensive care environment posed several challenges. The discrepancy between nurses' and parents' perception of their roles, the reluctance of medical staff to share potentially negative or rapidly changing information, restrictive family presence and poor understanding of family needs emerged as the key difficulties. No studies evaluated strategies to improve family-centred care practice. CONCLUSIONS Family-centred care presents many challenges in a paediatric intensive care environment; however, nurses are uniquely positioned to foster relationships with families, encourage accurate and honest information sharing and advocate for families to be present when they choose. RELEVANCE TO CLINICAL PRACTICE This review outlines the extant research to enhance awareness of the unique state of family-centred care in paediatric intensive care and makes recommendations for future research.
Collapse
Affiliation(s)
- Ashleigh Butler
- ICU, Monash Medical Centre, Clayton, Vic., Australia; School of Nursing and Midwifery, Monash University, Clayton, Vic., Australia
| | | | | |
Collapse
|
46
|
Dargaville PA, Copnell B, Mills JF, Haron I, Lee JKF, Tingay DG, Rohana J, Mildenhall LF, Jeng MJ, Narayanan A, Battin MR, Kuschel CA, Sadowsky JL, Patel H, Kilburn CJ, Carlin JB, Morley CJ. Fluid recovery during lung lavage in meconium aspiration syndrome. Acta Paediatr 2013. [PMID: 23194445 DOI: 10.1111/apa.12070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Lung lavage using two aliquots of 15 mL/kg of dilute surfactant was performed in 30 ventilated infants with severe meconium aspiration syndrome (MAS). Mean recovery of instilled lavage fluid was 46%, with greater fluid return associated with lower mean airway pressure at 24 h and a shorter duration of respiratory support. CONCLUSION Recovery of instilled lavage fluid is paramount in effective lung lavage in MAS and must be afforded priority in the lavage technique.
Collapse
Affiliation(s)
| | | | | | - Ismail Haron
- Department of Paediatrics; Selayang Hospital; Selangor; Malaysia
| | - Jimmy KF Lee
- Department of Paediatrics; Hospital Sultanah Nur Zahirah; Kuala Terengganu; Malaysia
| | | | - Jaafar Rohana
- Department of Paediatrics; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur; Malaysia
| | | | - Mei-Jy Jeng
- Department of Paediatrics; Taipei Veteran's General Hospital; Taipei; Taiwan; China
| | - Anushree Narayanan
- Department of Neonatology; KK Women's and Children's Hospital; Singapore; Singapore
| | | | | | | | - Harshad Patel
- Neonatal Unit; Wellington Hospital; Wellington; New Zealand
| | - Charles J Kilburn
- Department of Paediatrics; Royal Darwin Hospital; Darwin; NT; Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute; and University of Melbourne; Melbourne; Vic.; Australia
| | | | | |
Collapse
|
47
|
Hepponstall JM, Tingay DG, Bhatia R, Loughnan PM, Copnell B. Effect of closed endotracheal tube suction method, catheter size, and post-suction recruitment during high-frequency jet ventilation in an animal model. Pediatr Pulmonol 2012; 47:749-56. [PMID: 22290736 DOI: 10.1002/ppul.21607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/03/2011] [Indexed: 11/10/2022]
Abstract
RATIONALE High-frequency jet ventilation (HFJV) is often used to treat infants with pathologies associated with gas trapping and abnormal lung mechanics, who are sensitive to the adverse effects of suction. OBJECTIVE This study aimed to investigate the effect of closed suction (CS), catheter size, and the use of active post-suction sighs on tracheal pressure (P(trach)), and global and regional end-expiratory lung volume (EELV) during HFJV. METHODS Six anaesthetized and muscle-relaxed adult rabbits were stabilized on HFJV. CS was performed using all permutations of three CS methods (Continual negative pressure, negative pressure applied during Withdrawal, and HFJV in Standby) and 6 French gauge (6 FG) and 8 French gauge (8 FG) catheter, randomly assigned. The sequence was repeated using post-suction sighs. P(trach), absolute (respiratory inductive plethysmography) and regional (electrical impedance tomography; expressed as percentage of vital capacity for the defined region of interest, %Z(VCroi) ) EELV were measured before, during and 60 sec post-suction. RESULTS CS methods exerted no difference on ΔP(trach), ΔEELV(RIP), or Δ%Z(VCroi) . 8FG catheter resulted in a mean (95%CI) 20.0 (17.9,22.2) cm H(2)O greater loss of P(trach) during suction compared to 6FG (Bonferroni post-test). Mean (± SD) ΔEELV(RIP) was -6(±3) and -2(±1) ml/kg with the 8 and 6 FG catheters (P < 0.0001; Bonferroni post-test). ΔEELV was 31.7 (21.1,42.4) %Z(VCroi) and 24.8 (10.9,38.7) %Z(VCroi) greater in the ventral and dorsal hemithoraces using the 8 FG. Only after 8 FG CS was post-suction recruitment required to restore EELV. CONCLUSIONS In this animal model receiving HFJV, ΔP(trach), ΔEELV, and need for post-suction recruitment during CS were most influenced by catheter size. Volume changes within the lung were uniform.
Collapse
Affiliation(s)
- J Michele Hepponstall
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia.
| | | | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND The presence of family in the patient care area during resuscitation events is a matter of current debate among health care professionals in many communities. Family presence is highly recommended by many health organizations worldwide for several reasons including patient and family rights. There are no policies or guidelines in Saudi Arabia to guide health professionals in their practice regarding the option of family being present during resuscitations. The purpose of this study was to identify the attitudes of nurses towards family presence during resuscitation in the Muslim community of Saudi Arabia. DESIGN This is a descriptive survey using data from a convenience sample of 132 nurses using a self-administered questionnaire. The study took place in two major trauma centres in the eastern region of Saudi Arabia. RESULTS The analysis of the data revealed that nurses (n = 132) had negative attitudes towards family presence during resuscitation. A high percentage (77·2%) agreed that witnessing resuscitation is a traumatic experience for the family members. Almost all participants (92·3%) disagreed with the statement that the practice of allowing family members to be present during the resuscitation of a loved one would benefit the patient and 78% disagreed with the statement that it would benefit families. The majority of the participants (65%) revealed that the presence of family would negatively affect the performance of the resuscitation team. However, almost half of the sample (43·8%) would prefer a written policy allowing the option of family presence during resuscitation in Saudi Arabia. CONCLUSION The findings of the study strongly suggest the need for the development of written policies offering families the option to remain with patients during resuscitation in Saudi Arabia. The study further recommends the development of education programs for staff and public for the safe implementation of the practice.
Collapse
Affiliation(s)
- Abbas S Al-Mutair
- Ministry of Health & Ministry of Higher Education, Riyadh, Saudi Arabia.
| | | | | |
Collapse
|
49
|
Dargaville PA, Copnell B, Mills JF, Haron I, Lee JKF, Tingay DG, Rohana J, Mildenhall LF, Jeng MJ, Narayanan A, Battin MR, Kuschel CA, Sadowsky JL, Patel H, Kilburn CJ, Carlin JB, Morley CJ. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. J Pediatr 2011; 158:383-389.e2. [PMID: 20947097 DOI: 10.1016/j.jpeds.2010.08.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/13/2010] [Accepted: 08/25/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS). STUDY DESIGN We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO). RESULTS Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization. CONCLUSION Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
Collapse
Affiliation(s)
- Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kiraly NJ, Tingay DG, Mills JF, Dargaville PA, Copnell B. Volume not guaranteed: closed endotracheal suction compromises ventilation in volume-targeted mode. Neonatology 2011; 99:78-82. [PMID: 20733330 DOI: 10.1159/000316854] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Closed endotracheal suction interferes with mechanical ventilation received by infants, but the change to ventilation may be different when ventilator modes that target expired tidal volume (VT(e)) are used. OBJECTIVE To measure airway pressure and tidal volume distal to the endotracheal tube (ETT) during and after closed suction in a volume-targeted ventilation mode with the Dräger Babylog 8000+, and to determine the time until VT(e) returns to the baseline level. METHODS In this benchtop study, closed suction was performed on 2.5- to 4.0-mm ETTs connected to a test lung. 5-8 French suction catheters were used at suction pressures of 80-200 mm Hg during tidal-volume-targeted ventilation. RESULTS During catheter insertion and suction, circuit inflating pressure increased and tidal volume was maintained, except when a large catheter relative to the ETT was used, in which case tidal volume decreased. End-expiratory pressure distal to the ETT was reduced during suction by up to 75 cm H(2)O while circuit end-expiratory pressure was unchanged. Reduction in end-expiratory pressure distal to the ETT was greatest with large catheters and high suction pressures. Following suction, circuit and tracheal inflating pressures increased and tidal volume increased before returning to baseline in 8-12 s. CONCLUSIONS Closed endotracheal suction interferes with ventilator function in volume-targeted mode, with substantially negative intratracheal pressure during suction, and the potential for high airway pressures and tidal volumes following the procedure. These effects should be considered and pressure limits set appropriately whenever using volume-targeted ventilation.
Collapse
Affiliation(s)
- Nicholas J Kiraly
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Vic, Australia. nicholas.kiraly @ mcri.edu.au
| | | | | | | | | |
Collapse
|