Pressure injury prevalence in Australian intensive care units: A secondary analysis

BACKGROUND

Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors.

METHOD

This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI.

RESULTS

Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49-12.11), impaired mobility (OR: 3.13, 95% CI: 1.08-9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00-1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01-1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14-0.91).

CONCLUSION

This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population.

Barriers and facilitators to physical activity participation in adults living with type 1 diabetes: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and map barriers to and facilitators of physical activity in adults living with type 1 diabetes.

INTRODUCTION

Physical activity is crucial to the day-to-day management of type 1 diabetes and in the prevention of diabetes-related complications. Despite these benefits, people living with type 1 diabetes have higher inactivity rates than those in the general population. Identifying barriers and facilitators to physical activity, specific to the type 1 diabetes population, may help explain this discrepancy.

INCLUSION CRITERIA

This scoping review will include articles describing adults aged 18 years or over, living with type 1 diabetes in any care setting. Included literature will focus on the key concepts under review: barriers to or facilitators of physical activity participation. Literature examining efficacy of strategies to manage blood glucose levels for physical activity will not be included.

METHODS

All sources of information will be reviewed, including peer-reviewed, published and unpublished literature. Database search limits will be applied to include articles written in English, involving human participants and published between 1996 and February 2019. Once all records are identified, duplicates will be removed. Remaining records will be subject to title and abstract screening where articles will be excluded if they clearly meet at least one exclusion criteria. All remaining full-text articles will be assessed for eligibility against inclusion and exclusion criteria. Included articles will undergo critical appraisal before being synthesized, charted and discussed.

Estimation of Body Fluid Status by Fluid Balance and Body Weight in Critically Ill Adult Patients: A Systematic Review

BACKGROUND

The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body fluid status. The determination of body fluid status plays an important role in the management of critically ill patients where aggressive fluid resuscitation is often required. This can adversely affect patient outcomes if changes in fluid distribution are not detected early in patients who are susceptible to fluid overload.

AIM

To synthesize the best available evidence on the accuracy of daily fluid balance charting compared with the measurement of body weight for the estimation of body fluid status in critically ill adult patients.

METHODS

The review considered studies that investigated the accuracy of charting daily fluid balances or changes in body weight measurements or used both noninvasive methods in the estimation of body fluid status. The search sought to identify published, English language studies from 1980 until February 2018. Databases searched included MEDLINE, CINAHL, EMBASE, TRIP, Scopus, TROVE, ProQuest Dissertations, Australian and New Zealand Trials Registry, and Cochrane Central Register of Clinical Trials. Three reviewers independently assessed retrieved studies that matched inclusion criteria using standardized critical appraisal instruments.

RESULTS

The review included 13 cohort studies. Effectiveness of daily fluid balance charting was affected by inaccuracies observed in seven studies. Inability to obtain consecutive daily body weight measurements reduced the accuracy of monitoring changes in five studies. Seven studies found measurement of daily fluid balance inconsistent with changes in body weight.

LINKING EVIDENCE TO ACTION

The accuracy of charting fluid balance is suspect. Measurement of body weight is hard to accomplish. A combination of the two commonly used methods is more likely to be effective in estimating body fluid status than reliance on one single approach.

Models for predicting skin tears: A comparison

A recently published model that predicted the risk of skin tears in older adults was compared with seven additional published models. Four models were excluded because of limitations in research design. Four models were compared for their relative predictive performance and accuracy using sensitivity, specificity, and the area under the curve (AUC), which involved using receiver-operating characteristic analysis. The predictive ability of the skin tear models differed with the AUC ranging between 0.673 and 0.854. Based on the predictive ability, the selection of models could lead to different clinical decisions and health outcomes. The model, which had been adjusted for potential confounders consisted of five variables (male gender, history of skin tears, history of falls, clinical skin manifestations of elastosis, and purpura), was found to be the most parsimonious for predicting skin tears in older adults (AUC 0.854; 81.7% sensitivity; 81.4% specificity). Effective models serve as important clinical tools for identifying older individuals at risk of skin tears and can better direct more timely and targeted prevention strategies that improve health outcomes and reduce health care expenditure.

Nurses' perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study

Background: Quality improvement projects have been widely adopted to prevent complications in the ICU. Objective: This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. Design: A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. Results: The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Discussion: Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU.

Using 'draw, write and tell' to understand children's health-related experiences

BACKGROUND

In recognising the capability and rights of children to express their experiences, 'draw, write and tell' (DWT) has emerged as a participatory qualitative research method. DWT enables children to communicate their experiences by drawing, writing words and telling the story of their pictures in response to interview questions.

AIM

To discuss the challenges and benefits of using DWT to explore children's experiences of pain.

DISCUSSION

Aspects that affect the quality of data in DWT include the materials used and the influences of the primary caregiver. Experience suggests that if trust between the child and researcher has been established, the duration of the interview is unimportant.

CONCLUSION

While many methods of analysis can be used with data gathered using DWT, it is important to ensure children's perspectives are represented accurately. Furthermore, children's capacity as active participants in research should be reflected.

IMPLICATIONS FOR PRACTICE

Future studies could examine the potential of using drawings to share information in adult and paediatric clinical settings.

Defining age-related skin tears: a review

Skin tears are reported to be the most common wound found amongst elderly individuals, yet there is a lack of evidence and consensus on a definition for these age-related traumatic injuries. A consensus on definition is essential for benchmarking prevalence and incidence and informing clinical diagnosis, management and reporting. This paper examines the extent of similarity and heterogeneity between the published definitions of skin tears and the underpinning evidence for the same. Five criteria were used to evaluate and compare the published skin tear definitions – reference to skin pathology; cause of injury; effect of injury; site of injury; and reference to the population group being studied. As a result of the review and recent research findings, which explicitly demonstrate age-related changes to the structural and mechanical properties of skin and associated increased risk of skin tears, the authors present a new skin tear definition based on these findings. Skin tears are defined as trauma-induced partial or full thickness wounds which primarily occur on the extremities of older persons with age-related changes to the skin’s structural and mechanical support properties, and are commonly associated with elastosis and/or ecchymosis.

Compression bandaging: Identification of factors contributing to non-concordance

Aims To elucidate reasons for non-concordance with compression bandaging, subject the identified reasons to thematic analysis and use the resultant themes as the basis for the development of a screening tool to identify those patients at risk of non-concordance with compression bandaging. Method A literature search was undertaken using the terms ‘concordance’, ‘compression bandaging’ and ‘venous leg ulcer’. Articles were included if they discussed reasons for non-concordance with compression bandaging. Forty-one articles were identified which met inclusion criteria. The full texts were read and the reasons for non-concordance tabulated. These were then subjected to thematic analysis. Results Six themes emerged. These were termed knowledge deficit; resource deficit; psychosocial issues; pain/discomfort; physical limitations; and wound management. These themes were used to develop a screening tool to identify patients who exhibit barriers to concordance with compression bandaging. Discussion Compression bandaging is the recommended treatment for venous leg ulceration1-3. However, the degree of concordance with compression bandaging therapy remains at sub-optimal levels4,5. Consequently patients experience protracted ulceration. The development of a risk screening tool for non-concordance will permit targeted intervention to address barriers to concordance before the patient has a poor experience of compression therapy.

A risk model for the prediction of skin tears in aged care residents: A prospective cohort study

The objective of this study was to construct a predictive model to identify aged care residents at risk of future skin tears. Extensive data about individual characteristics, skin characteristics, and skin properties were gathered from 173 participants at baseline and at 6 months. A predictive model, developed using multivariable logistic regression, identified five variables that significantly predicted the risk of skin tear at 6 months. These included: a history of skin tears in the previous 12 months (OR 3.82 [1.64-8.90], P = 0.002), purpura ≤20 mm in size (OR 3.64 [1.42-9.35], P = 0.007), a history of falls in the previous 3 months (OR 3.37 [1.54-7.41], P = 0.002), clinical manifestations of elastosis (OR 3.19 [1.38-7.38], P = 0.007), and male gender (OR 3.08 [1.22-7.77], P = 0.017). The predictive model yielded an area under the receiver operating characteristic curve of 0.854 with an 81.7% sensitivity and an 81.4% specificity. This predictive model could inform a simple but promising bedside tool for identifying older individuals at risk of skin tears.

Ask me: Children's experiences of pain explored using the draw, write, and tell method

PURPOSE

Pain management within emergency departments (ED) remains challenging. Given that unrelieved pain in children is linked to a number of negative physiological and psychological consequences, optimal management of children's pain is paramount. Many studies exploring children's pain have adopted quantitative methods or sought the perspectives of adults. Compared to adults, studies examining children's views on pain and pain management are limited. This study aimed to explore children's pain experiences, their perception of pain management and expectations of the role of the nurse.

DESIGN

This was a qualitative descriptive study using an inductive approach.

METHODS

Fifteen children, aged 4-8 years who presented to the ED of an Australian tertiary pediatric hospital in acute pain participated. Data were collected using draw, write, and tell (DWT) technique and analyzed using thematic analysis.

RESULTS

Three themes emerged (1) "Security," (2) "My pain" with subthemes: "The pain feelings" and "My sad/happy feelings," (3) "Comfort and relief" with subthemes: "Taking my mind off it," "Resting" and "Hospital things." When in pain children needed to feel secure. Parents and nurses were important in fostering a secure environment for children. Children were capable of describing their pain and identified nonpharmacological strategies to help their pain.

PRACTICE IMPLICATIONS

Children as young as 4 years old can provide detailed accounts of their pain, which extends beyond physical dimensions to include visual, auditory, and sensory features. Nurses need to listen, be honest, and develop trust with children to be helpful. Nonpharmacological pain-relieving strategies can be implemented by parents and nurses in collaboration with the child. Fostering a secure environment is essential.

Extraordinary water adsorption characteristics of graphene oxide

The laminated structure of graphene oxide (GO) confers unique interactions with water molecules which may be utilised in a range of applications that require materials with tuneable hygroscopic properties. The precise role of the expandable interlayer spacing and functional groups in GO laminates has not completely been understood to date. Herein, we report the experimental and theoretical investigations on the adsorption and desorption behaviour of water in GO laminates as a function of relative pressure. We observed that GO imparts high water uptake capacity of up to 0.58 gram of water per gram of GO (g g-1), which is significantly higher than silica gel as a conventional desiccant material. More interestingly, the adsorption and desorption kinetics of GO is five times higher than silica gel. The observed extraordinary adsorption/desorption rate can be attributed to the high capillary pressure in GO laminates as well as micro meter sized tunnel-like wrinkles located at the surface.

'We didn't have to dance around it': opt-out HIV testing among homeless and marginalised patients

This study explored opt-out HIV testing in an Australian general practice. The aims were to: (1) determine the effect of the opt-out approach on the number of HIV tests performed; and (2) explore the acceptability of opt-out HIV testing from the healthcare providers' perspective. A prospective mixed-methods study of opt-out HIV testing over a 2-year period (March 2014-March 2016) was conducted. Implementation was based on a theoretical framework that was developed specifically for this study. The setting was Homeless Healthcare, a health service in Perth, Western Australia. The number of HIV tests conducted during the control year (usual practice) was compared with the intervention year (opt-out testing). After the intervention, the healthcare providers (n=8) were interviewed about their experiences with opt-out HIV testing. Directed content analysis was used to explore the qualitative data. HIV testing rates were low during both the control year and the intervention year (315 HIV tests (12% of the patient cohort) and 344 HIV tests (10%) respectively). Opt-out HIV testing was feasible and acceptable to the participating healthcare providers. Other health services could consider opt-out HIV testing for their patients to identify people with undiagnosed infections and sustain Australia's low HIV prevalence.

Experiences of acute pain in children who present to a healthcare facility for treatment: a systematic review of qualitative evidence

BACKGROUND

Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review.

OBJECTIVES

To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Children aged four to 18 years (inclusive) attending a healthcare facility who experienced acute pain associated with any injury, medical condition or treatment.

PHENOMENA OF INTEREST

Children's experiences and perceptions of their acute pain, pain management and expectations of others in managing their pain. Studies on children's experiences of pain in the postoperative context were excluded as a systematic review exploring this phenomenon had previously been published. Studies reporting on children's experiences of chronic pain were also excluded.

CONTEXT

Any healthcare facility including general practitioners' surgeries, hospitals, emergency departments and outpatient clinics.

TYPES OF STUDIES

Qualitative studies including phenomenology, grounded theory, ethnography, action research and feminist research designs.

SEARCH STRATEGY

Using a three-step search strategy, databases were searched in December 2015 to identify both published and unpublished articles from 2000 to 2015. Studies published in languages other than English were excluded.

METHODOLOGICAL QUALITY

All studies that met the inclusion criteria were assessed by at least two independent reviewers for methodological quality using a standardized critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Data were extracted from the papers included in the review using standardized data extraction tool from JBI-QARI.

DATA SYNTHESIS

Findings were pooled using JBI-QARI. Findings were rated according to their level of credibility and categorized based on similarity in meaning and then were subjected to a meta-synthesis.

RESULTS

Four studies were included in this review. Two meta-syntheses were generated from five categories based on 21 findings: first, children can express their pain experiences in terms of cause, location, meaning and quality. Children's pain experiences include both physical and psychological dimensions. Children's pain experiences are influenced by their previous pain experiences, pain expectations and sociocultural factors. Second, children use a range of cognitive/behavioral and sensory/physical self-soothing strategies not only to help manage their pain, but also rely on the actions and presence of others as helpers when they are in pain.

CONCLUSION

Children's pain is a multi-dimensional complex phenomenon relying upon a multi-modal approach to management. Children as young as four years are capable of articulating their pain in terms of location, intensity and depth. The way children perceive, express and respond to pain is shaped by sociocultural factors, previous pain experiences and their expectations of pain. Children, parents and healthcare professionals play an important role in managing children's pain experiences.

A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing

Opt-out HIV testing (in which patients are offered HIV testing as a default) is a potentially powerful strategy for increasing the number of people who know their HIV status and thus limiting viral transmission. Like any change in clinical practice, implementation of opt-out HIV testing in a health service requires a change management strategy, which should have theoretical support. This paper considers the application of three theories to the implementation and evaluation of an opt-out HIV testing programme: Behavioural Economics, the Health Belief Model and Normalisation Process Theory. An awareness, understanding and integration of these theories may motivate health care providers to order HIV tests that they may not routinely order, influence their beliefs about who should be tested for HIV and inform the operational aspects of opt-out HIV testing. Ongoing process evaluation of opt-out HIV testing programmes (based on these theories) will help to achieve individual health care provider self-efficacy and group collective action, thereby improving testing rates and health outcomes.

Coping and caring: support resources integral to perioperative nurses during the process of organ procurement surgery

AIMS AND OBJECTIVES

To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being.

BACKGROUND

Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace.

DESIGN

A qualitative grounded theory method.

METHODS

The study was informed by perioperative nurses (n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method.

RESULTS

Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support.

CONCLUSION

These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally.

RELEVANCE TO CLINICAL PRACTICE

Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment.

Maternity high-dependency care and the Australian midwife: A review of the literature

BACKGROUND

Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.

INTRODUCTION

Rising levels of maternal morbidity from non-obstetric causes have led midwives to work with women who require highly complex care, beyond the standard customary midwifery role. Whilst the nursing profession has developed and refined its expertise as a specialty in the field of high-dependency care, the midwifery profession has been less likely to pursue this as a specific area of practice.

DISCUSSION

This paper explores the literature surrounding maternity high-dependency care. From the articles reviewed, four key themes emerge which include; the need for maternity high-dependency care, maternal morbidity and maternity high-dependency care, the role of the midwife and maternity high-dependency care and midwifery education and preparation for practice. It highlights the challenges that health services are faced with in order to provide maternity high-dependency care to women. Some of these challenges include resourcing and budgeting limitations, availability of educators with the expertise to train staff, and the availability of suitably trained staff to care for the women when required.

CONCLUSION

In order to provide maternity high-dependency care, midwives need to be suitably equipped with the knowledge and skills required to do so.

Living beyond the Unanticipated Sudden Death of a Partner: A Phenomenological Study

This research project explored grief and its impact upon men and women who have experienced the sudden and unanticipated death of his or her partner.

It included what grief meant to them, how it was manifested in his or her everyday lives and how his or her partner's death had impacted upon his or her relationship with themselves, with others and the world. A Husserlian phenomenological approach was used to explore the experiences of the ten women and five men whose partner had died up to five years prior to being interviewed. The need for the surviving partner to continue to participate in everyday life placed great strain upon the internal resources of the surviving partner. The surviving partner needed to reinvent him or herself, in an attempt to become independent and regain functionality, whilst dealing with the sadness and loss that they had experienced. The surviving partner discovered that a new life order emerged that included hope, optimism, planning for the future and perhaps the prospect of a new relationship. The death of a partner left the surviving partner with a loss that would always be a part of them, with the memories of his or her relationship being maintained within them that will never be replaced by somebody else. The results of this research project reinforce the need for ongoing education of the community in grief and bereavement issues in order to increase the awareness of the support needs of the bereaved person. The length of time and amount of energy required to incorporate the experience into the survivor's life, is greatly underestimated by the community, and perhaps by some of the health and caring professionals. Colonial and hospital based bereavement support services need to be established and be proactive using outreach programs, actively offering the suddenly bereaved partner and family support and information.

Measurement of morphological and physiological skin properties in aged care residents: a test-retest reliability pilot study

This test-retest pilot study investigated the intra-rater reliability and reproducibility of non-invasive technologies to objectively quantify morphological (colour, thickness and elasticity) and physiological (transepidermal water loss (TEWL), hydration, sebum and pH) skin properties in an aged care population. Three consecutive measurements were taken from five anatomical skin sites, with the mean of each measurement calculated. The intra-class correlation coefficient (ICC) and the standard error of measurement (SEM) were used to examine the intra-rater reliability and reproducibility of measurements. Non-invasive technologies in this study showed almost perfect reliability for ultrasound measurements of the subepidermal low echogenicity band (SLEB) (ρ = 0·95-0·99) and skin thickness (ρ = 0·95-0·99) across all sites. The ICC was substantial to almost perfect for pH (ρ = 0·76-0·88) and viscoelasticity (ρ = 0·67-0·91) across all sites. Hydration (ρ = 0·53-0·85) and skin retraction (ρ = 0·57-0·99) measurements ranged from moderate to almost perfect across all sites. TEWL and elasticity were substantial to almost perfect across four sites. Casual sebum levels and most colour parameters showed poor ICC. The use of non-invasive technologies in this study provided an objective and reliable means for quantifying ageing skin and may offer future studies a valuable option for assessing skin tear risk.

Experiential learning not enough for organ procurement surgery: implications for perioperative nursing education

CONTEXT

Perioperative nurses play a vital role in assisting in surgical procedures for multiorgan procurement, receiving little education apart from on-the-job experiential learning when they are asked to participate in these procedures.

OBJECTIVES

Within an Australian context and as part of a larger study, this article describes issues that hindered perioperative nurses' participatory experiences as a result of lacking education, previous exposure, and preparation for assisting in surgical procedures for organ procurement.

DESIGN

The grounded theory method was used to develop a substantive theory of perioperative nurses' experiences of participating in surgical procedures for multiorgan procurement.

PARTICIPANTS

Thirty-five perioperative nurses who had experience in surgical procedures for organ procurement from regional, rural, and metropolitan hospitals of 2 Australian states, New South Wales and Western Australia, participated in the research.

RESULTS

Levels of knowledge and experience emerged from the data as an influencing condition and was reported to affect the perioperative nurses' participatory experiences when assisting in procurement surgical procedures. Six components of levels of knowledge and experience were identified and are described.

CONCLUSION

The findings from this study provide a unique contribution to the existing literature by providing an in-depth understanding of the educational needs of perioperative nurses in order to assist successfully in multiorgan procurement procedures. These findings could guide further research with implications for clinical initiatives or education programs specifically targeting the perioperative nursing profession both locally and internationally.

The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears

A cluster randomised controlled trial was conducted to evaluate the effectiveness of a twice-daily moisturising regimen as compared to 'usual' skin care for reducing skin tear incidence. Aged care residents from 14 Western Australian facilities (980 beds) were invited to participate. The facilities were sorted into pairs and matched in terms of bed numbers and whether they provided high or low care. One facility from each matched pair was randomised to the intervention group. Consenting residents in an intervention facility received a twice-daily application of a commercially available, standardised pH neutral, perfume-free moisturiser on their extremities. Residents in the control facilities received ad hoc or no standardised skin-moisturising regimen. Participant numbers were sufficient to detect a 5% difference in incidence rate between the two groups with 80% power and a significance level of P = 0·05, and the inter-cluster correlation coefficient was 0·034. Data were collected over 6 months. A total of 1396 skin tears on 424 residents were recorded during the study. In the intervention group, the average monthly incidence rate was 5·76 per 1000 occupied bed days as compared to 10·57 in the control group. The application of moisturiser twice daily reduced the incidence of skin tears by almost 50% in residents living in aged care facilities.

Physical recovery in intensive care unit survivors: a cohort analysis

BACKGROUND

Some survivors of critical illness experience poor physical recovery, but which patients experience the most compromise during recovery is unknown.

OBJECTIVE

To identify factors associated with physical recovery by using the 6-minute walk test in adult survivors of critical illness 26 weeks after discharge from the hospital.

METHODS

A total of 195 adult survivors of a critical illness were enrolled in a multicenter trial of physical rehabilitation after discharge from the hospital. The 6-minute walk test, the 36-Item Short Form Health Survey, and sleep rated on a 5-point scale were completed at weeks 1 and 26. Clinical and demographic data were obtained from patient records.

RESULTS

A total of 145 patients completed the 26-week test. Of these, 94 (65%) increased the distance walked in 6 minutes by at least 75 m from the 1-week value and were therefore considered to have improved on the test. Factors associated with improvement included moderate to severe sleeping problems in week 1, moderate to vigorous exercise in week 26, and higher vitality in week 26. Conversely, respiratory problems and higher social functioning in week 1 were associated with less improvement in the distance walked.

CONCLUSION

Multiple factors are associated with physical recovery after critical illness. Interventions to target multidimensional aspects of recovery such as sleep and exercise may result in improved physical function after critical illness.

Australian perioperative nurses' experiences of assisting in multi-organ procurement surgery: a grounded theory study

INTRODUCTION/BACKGROUND

Multi-organ procurement surgical procedures through the generosity of deceased organ donors, have made an enormous impact on extending the lives of recipients. There is a dearth of in-depth knowledge relating to the experiences of perioperative nurses working closely with organ donors undergoing multi-organ procurement surgical procedures.

AIM

The aim of this study was to address this gap by describing the perioperative nurses experiences of participating in multi-organ procurement surgical procedures and interpreting these findings as a substantive theory.

DESIGN

This qualitative study used grounded theory methodology to generate a substantive theory of the experiences of perioperative nurses participating in multi-organ procurement surgery.

SETTING

Recruitment of participants took place after the study was advertised via a professional newsletter and journal. The study was conducted with participants from metropolitan, rural and regional areas of two Australian states; New South Wales and Western Australia.

PARTICIPANTS

Thirty five perioperative nurse participants with three to 39 years of professional nursing experience informed the study.

METHODS

Semi structured in-depth interviews were undertaken from July 2009 to April 2010 with a mean interview time of 60 min. Interview data was transcribed verbatim and analysed using the constant comparative method.

RESULTS

The study results draw attention to the complexities that exist for perioperative nurses when participating in multi-organ procurement surgical procedures reporting a basic social psychological problem articulated as hiding behind a mask and how they resolved this problem by the basic social psychological process of finding meaning.

CONCLUSION

This study provides a greater understanding of how these surgical procedures impact on perioperative nurses by providing a substantive theory of this experience. The findings have the potential to guide further research into this challenging area of nursing practice with implications for clinical initiatives, management practices and education.

Recent outbreaks of infectious syphilis, United Kingdom, January 2012 to April 2014

Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.

Nurse screening for delirium in older patients attending the emergency department

BACKGROUND

Delirium in older emergency department (ED) patients is common, associated with many adverse outcomes, and costly to manage. Delirium detection in the ED is almost universally poor.

OBJECTIVES

The authors aimed to develop a simple clinical risk screening tool that could be used by ED nurses as part of their initial assessment to identify patients at risk of delirium.

METHODS

A prospective cross-sectional study of patients 65 years and older attending a single ED.

RESULTS

Of 320 enrolled patients, 23 (7.2%) had delirium. Logistic regression analysis revealed 3 risk factors strongly associated with delirium risk: cognitive impairment, depression, and an abnormal heart rate/rhythm. Weighting these variables based on the strength of their association with delirium yielded a risk score from 0-4 inclusive. A cutoff of 2 or more in that score would have given a sensitivity of 87%, specificity of 70%, and NPV of 99%, while avoiding further diagnostic workup for delirium in approximately two-thirds of all patients, when used as an initial screen.

CONCLUSIONS

A simple risk screening tool using factors evident on initial nurse assessment can be used to identify patients at risk of delirium. Further trials are needed to test whether the tool improves patient outcomes.

Nurses' perceptions of standardised assessment and prevention of complications in an ICU

AIMS AND OBJECTIVES

To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit.

BACKGROUND

Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications.

DESIGN

A qualitative focus group study.

METHODS

Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses.

RESULTS

Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process.

CONCLUSION

Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes.

RELEVANCE TO CLINICAL PRACTICE

These findings provide valuable information for implementing clinical practice improvement interventions.

Nurse scholars' knowledge and use of electronic theses and dissertations

BACKGROUND

Electronic theses and dissertations (ETDs) are a valuable resource for nurse scholars worldwide. ETDs and digital libraries offer the potential to radically change the nature and scope of the way in which doctoral research results are presented, disseminated and used. An exploratory study was undertaken to better understand ETD usage and to address areas where there is a need and an opportunity for educational enhancement.

AIMS

The primary objective was to gain an initial understanding of the knowledge and use of ETDs and digital libraries by faculty, graduate students and alumni of graduate programs at schools of nursing.

DESIGN

A descriptive online survey design was used.

METHODS

Purposeful sampling of specific schools of nursing was used to identify institutional participants in Australia, New Zealand, the UK and the US. A total of 209 participants completed the online questionnaire.

RESULTS

Only 44% of participants reported knowing how to access ETDs in their institutions' digital libraries and only 18% reported knowing how to do so through a national or international digital library. Only 27% had cited an ETD in a publication. The underuse of ETDs was found to be attributable to specific issues rather than general reluctance to use online resources.

CONCLUSIONS

This is the first international study that has explored awareness and use of ETDs, and ETD digital libraries, with a focus on nursing and has set the stage for future research and development in this field. Results show that most nursing scholars do not use ETDs to their fullest potential.

Continuous renal replacement treatment and the 'bleeding patient'

A woman suspected of intra-abdominal bleeding with end-stage renal failure requiring maintenance haemodialysis was treated with continuous veno-venous haemodiafiltration in the intensive care unit. The use of citrate restricted to the extracorporeal circuit maintained continuity of treatment and avoided the adverse affects of systemic anticoagulation. Regional citrate anticoagulation was achieved using the 'modified' Alabama Protocol. A description of the protocol is included along with troubleshooting instructions. Violations of the protocol challenged the adequacy of workforce training and patient monitoring, which saw systemic ionised calcium level reach 0.62 mmol/litre and base deficit drop -14.7. After protocol transgressions were corrected the patient was successfully treated and satisfactory biochemical control achieved without placing the patient at increased risk of bleeding. Training and vigilance in the use of citrate is essential to maintain patient safety.