Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery

AIM(S)

To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery.

DESIGN

This scoping review was conducted according to the JBI scoping review framework.

METHODS

Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria.

DATA SOURCES

Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023.

RESULTS

A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%).

CONCLUSIONS

This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement in this scoping review.

Randomized controlled trials of mental health nurse-delivered interventions: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base.

ABSTRACT

INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare.

AIM

To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020.

METHOD

A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias.

RESULTS

Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias.

DISCUSSION

Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery.

IMPLICATIONS FOR PRACTICE

Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery.

The community nurse in Australia. Who are they? A rapid systematic review

AIM

This study aimed to profile the community nurse in Australia.

BACKGROUND

The need for nurses in the community health care sector is increasing in response to shorter hospital stays, an aging population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector.

EVALUATION

MEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010 and 2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, 2 databases and 2 reports) were included in the review. Abstracted data followed the principles of workforce planning and included demographics, qualifications and roles.

KEY ISSUES

Inconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work.

CONCLUSION

A lack of concrete data has overshadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan.

IMPLICATIONS FOR NURSING MANAGEMENT

There is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce.

A systematic review of activities undertaken by the unregulated Nursing Assistant

AIM

To identify activities performed by Nursing Assistants in acute and primary healthcare.

DESIGN

Systematic review.

DATA SOURCES

The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants.

REVIEW METHODS

From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories.

RESULTS

Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision.

CONCLUSION

Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training.

IMPACT

Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.

Intrahospital transfers and the impact on nursing workload

AIMS AND OBJECTIVES

To determine the rate of patient moves and the impact on nurses' time.

BACKGROUND

Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previously been measured.

DESIGN

A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study.

METHODS

Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n = 34,715) was undertaken followed by an observational-timing study of nurses' activities associated with patient transfers (n = 75).

RESULTS

Over 10,000 patients were moved 34,715 times in 1 year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42 min and bed transfers took 11 min of nurses' time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month.

CONCLUSION

Transferring patients is workload intensive on nurses' time and should be included in nursing workload measurement systems.

RELEVANCE TO CLINICAL PRACTICE

Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.

Nurse-Performed Endoscopy: Implications for the Nursing Profession in Australia

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country's health system model.

Sexual harassment among young tourists visiting Mediterranean resorts

Despite the known increase in substance use and risky sexual behaviors among young people during holiday periods, issues of sexual harassment (SH) and having sex against one's will (SAW) have not received adequate attention. We implemented a cross-sectional airport-based study to identify experience of SH and SAW in 6,502 British and German holidaymakers aged 16-35 years visiting tourist resorts in Southern Europe (Crete, Cyprus, Italy, Portugal, and Spain) in summer 2009. Across all participants, 8.6 % reported SH during their holiday and 1.5 % reported SAW. Women reported higher levels of SH than heterosexual males. However, gay and bisexual males reported SH levels similar to females and the highest levels of SAW. Of 19 predictor variables tested, ten were independently associated with SH. SH was increased in those who were visitors to Mallorca or Crete, British, younger, female, gay or bisexual, frequently drunk on holiday, cocaine users, and attracted to bars where people get drunk, or where there are opportunities for sex. Among 13 predictor variables tested for SAW, four were significant. SAW reduced in those visiting Cyprus, and was strongly associated with being a gay or bisexual male, using cannabis on holiday and being attracted to bars where there were opportunities for sex. Holiday resorts represent a key location for SH and SAW, especially for holidaymakers who get drunk and use drugs. Preventive programs can raise awareness of the risks of unwanted sexual encounters on holiday and work with the tourist industry and tourist authorities to develop environments where sexual aggression is not tolerated.

The consequences of executive turnover

The high rate of executive turnover in the healthcare industry is a major issue for health service organisations and their staff both in Australia and internationally. In the course of planning a research project examining nurse turnover at the clinical level within three Australian States/Territories, the researchers became aware of frequent executive turnover at all levels (State Department of Health, Area Health Service, hospital). Over a period of approximately 2 years there were 41 executives occupying 18 different positions, highlighting the scope of this issue in Australia. Few studies have examined the causes and consequences of this phenomenon in depth. Factors such as age, gender, education, lack of career advancement opportunities and remuneration have all been identified in the literature as important contributors to executive turnover. High turnover rates have been found to be associated with a number of negative consequences, including organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. While the use of ‘acting’ roles may assist in filling executive positions on a temporary basis, consequences for the rest of the organisation are associated with their extended use. Steps which health services planners may take to attempt to minimise executive turnover include providing staff members with appropriate challenges and opportunities for growth and ensuring that a clear succession plan is in place to minimise the impact for the organisation and its staff.

Substance use, violence, and unintentional injury in young holidaymakers visiting Mediterranean destinations

BACKGROUND

Young people's alcohol and drug use increases during holidays. Despite strong associations between substance use and both violence and unintentional injury, little is known about this relationship in young people holidaying abroad. We examine how risks of violence and unintentional injury abroad relate to substance use and the effects of nationality and holiday destination on these relationships.

METHODS

A cross-sectional comparative survey of 6,502 British and German holidaymakers aged 16 to 35 years was undertaken in airports in Cyprus, Greece, Italy, Portugal, and Spain.

RESULTS

Overall, 3.8% of participants reported having been in a physical fight (violence) on holiday and 5.9% reported unintentional injury. Two thirds reported having been drunk on holiday and over 10% using illicit drugs. Levels of drunkenness, drug use, violence, and unintentional injury all varied with nationality and holiday destination. Violence was independently associated with being male, choosing the destination for its nightlife, staying 8 to 14 days, smoking and using drugs on holiday, frequent drunkenness, and visiting Majorca (both nationalities) or Crete (British only). Predictors of unintentional injury were being male, younger, using drugs other than just cannabis on holiday, frequent drunkenness, and visiting Crete (both nationalities).

CONCLUSIONS

Violence and unintentional injury are substantial risks for patrons of international resorts offering a hedonistic nightlife. Understanding those characteristics of resorts and their visitors most closely associated with such risks should help inform prevention initiatives that protect both the health of tourists and the economy of resorts marketed as safe and enjoyable places to visit.

[Violence in nightlife environments and its relationship with the consumption of alcohol and drugs among young Spaniards]

Violence in nightlife environments (NE) is a rarely studied phenomenon. There is growing interest in determining its prevalence and its relationship with sociodemographic variables, drunkenness and drug use. A survey to 440 youngsters, selected by the respondent-driven sampling methodology, was conducted, and the inclusion criteria were: to go out regularly, and to use alcohol and/or illegal drugs. The survey was carried out in the Balearic Islands, Galicia and Comunidad Valenciana. During the past year and while going out at night, 5.2% of the youngsters carried weapons, 11.6% were attacked or threatened with a weapon and 23% got into a fight. Logistic regression revealed that the best predictor for the behaviour of carrying a weapon is polydrug use; whereas amongst those who had been threatened, it was being frequently involved in rows or arguments related to substance use; and for those involved in fights, it was being younger (14-18) and being frequently involved in rows or arguments related to substance use. There is a high prevalence of violent behaviors in NE. Prevention should take into account particularly the younger individuals, those who engage in polydrug use and those who often have fights and discussions related to drug consumption.

Staffing, skill mix and the model of care

AIMS AND OBJECTIVES

The study aimed to explore whether nurse staffing, experience and skill mix influenced the model of nursing care in medical-surgical wards.

BACKGROUND

Methods of allocating nurses to patients are typically divided into four types: primary nursing, patient allocation, task assignment and team nursing. Research findings are varied in regard to the relationship between these models of care and outcomes such as satisfaction and quality. Skill mix has been associated with various models, with implications for collegial support, teamwork and patient outcomes.

DESIGN

Secondary analysis of data collected on 80 randomly selected medical-surgical wards in 19 public hospitals in New South Wales, Australia during 2004-2005.

METHODS

Nurses (n = 2278, 80.9% response rate) were surveyed using The Nursing Care Delivery System and the Nursing Work Index-Revised. Staffing and skill mix was obtained from the ward roster and other data from the patient record. Models of care were examined in relation to these practice environment and organisational variables.

RESULTS

The models of nursing care most frequently reported by nurses in medical-surgical wards in this study were patient allocation (91%) and team nursing (80%). Primary nursing and task based models were unlikely to be practised. Skill mix, nurse experience, nursing workload and factors in the ward environment significantly influenced the model of care in use. Wards with a higher ratio of degree qualified, experienced registered nurses, working on their 'usual' ward were more likely to practice patient allocation while wards with greater variability in staffing levels and skill mix were more likely to practice team nursing.

CONCLUSIONS

Models of care are not prescriptive but are varied according to ward circumstances and staffing levels based on complex clinical decision making skills.

RELEVANCE TO CLINICAL PRACTICE

Variability in the models of care reported by ward nurses indicates that nurses adapt the model of nursing care on a daily or shift basis, according to patients' needs, skill mix and individual ward environments.

The influence of personal networks on the use and abuse of alcohol and drugs

Party networks of young people are very important for socialization, but can also influence their involvement in risk behaviours or they can be protective. The influence of nightlife network of friends in using alcohol/ drugs is investigated through a survey. We explore the individual-centred networks (7.360 friends) of 1.363 recreational nightlife users in 9 European cities in 2006, through 22 friend characteristics. Statistical analysis utilised factorial analysis with varimax rotation and analysis of variance. The 69% of the sample had been drunk during the last month and more than half of them had used illicit drugs. Most of the respondents use to have a stable group of friends with whom to go out. Networks main characteristics were being more or less deviant and/or prosocial. Having not network or a less prosocial network is related to be low consumers. Having a non deviant, but prosocial network is related to being a person who gets drunk without using illegal drugs. Users of illegal drugs have a deviant and prosocial network. Finally ex users have less deviant networks, but at the same time a helper and prosocial network. Males drug use patterns appear to be less affected by the characteristics of their networks. Some preventive consequences coming from these results are already known as the importance of having less deviant friends. But some other issues are less known: to enhance certain prosocial skills may have counter preventive effects among recreational users and to influence the network for preventative purposes may be more effective among females.

Which young people accept a lift from a drunk or drugged driver?

INTRODUCTION

Riding with a drunk and/or a drugged driver (RDD) is a risk behaviour that has received very little attention in spite of its potential dangers. Young people involved in the recreational nightlife context are especially at risk.

METHOD

1363 regular users of recreational nightlife from nine European countries (mean age: 21.75; 51.5% women) filled out a self-administered and anonymous questionnaire (in 2006).

RESULTS

37.2% had practised RDD during the previous month. RDD is related to drunkenness and use of drugs, personality factors such as impulsivity, preferring to use a private car to get to nightlife venues, living in a southern European country and being unemployed. No significant influence was found for age, gender, educational level or socioeconomic status.

DISCUSSION

It is important to raise awareness about the high prevalence of RDD. This lack of awareness can be related to its social acceptance among young people. The use of private cars for going to nightlife venues should be discouraged.

Traffic risk behaviors at nightlife: drinking, taking drugs, driving, and use of public transport by young people

Road traffic crashes associated with nightlife alcohol and recreational drug use are a major health problem for young people.

OBJECTIVES

This study explores use of different forms of transport to and from nightlife environments and the relationships between traffic risk behaviors, drunkenness, and drug consumption.

METHODS

1363 regular nightlife users from nine European cities in 2006 completed a self-administered and anonymous questionnaire. Sampling utilized a variation of respondent-driven sampling.

RESULTS

Private car was the most frequent form of transport used when going out, especially by males and older individuals. Drug use was related to crashes and traffic risk behaviors, including having a lift from someone drunk or driving drunk or driving having taken drugs; drunkenness was related to risk behaviors but not to crashes (possibly because drunk people tend to use the private car less). Males showed higher levels of drunkenness and drug consumption, traffic risk behaviors, and traffic crashes. Age is not related to the traffic risk behaviors, but older individuals had less crashes.

CONCLUSIONS

There are serious health problems related to transport and recreational nightlife activities. It is necessary to improve later public transport services, complemented by actions that deter the use of private cars. The relationships of both drunkenness and cannabis/cocaine use with traffic risk behaviors should be addressed and programs implemented to change risk perceptions on the effects of illegal drugs on driving.

Alcohol, drugs, sex and violence: health risks and consequences in young British holidaymakers to the Balearics

BACKGROUND

Substance use, risky sexual behaviour and violence are among the key youth health issues today. Whilst they are the focus of much prevention work in the UK, relatively little information is available to inform prevention in international holiday resorts, where young people can take the greatest risks with their health.

METHODS

We conducted a cross-sectional survey of 1033 British holidaymakers aged 16-35 in Ibiza and Majorca airports (Spain). Surveys covered frequency of alcohol and drug use at home and abroad, and drunkenness, sexual activity and experience of a range of negative experiences on holiday.

RESULTS

Illicit drug use was more common in Ibiza. Over half (53.9%) of visitors to Ibiza reported using at least one drug on holiday (compared with 13.9% in Majorca) and over a third reported using more than one drug. However visitors to Majorca reported more frequent drunkenness and more negative outcomes (arguments, fighting, unintentional injury, illness and requiring medical attention). In both locations, frequency of substance use increased on holiday. A quarter of those travelling without a partner reported having had sex during their holiday, and of these a third did not consistently use condoms. Frequent drunkenness was associated with fighting, unintentional injury and sex with a new partner. Illicit drug use, particularly polydrug use, was associated with fighting and unprotected sex.

CONCLUSIONS

Young holidaymakers face significant health risks on holiday. Understanding which resorts are associated with which types of health risk behaviour is critical in targeting health promotion and harm reduction measures appropriately.

Enrolled nurse skill extension: metropolitan myth or rural reality?

OBJECTIVE

The objective of this study was to examine whether the position of 'after hours clinical support enrolled nurse' is embracing clinical skill extension in the acute surgical area.

DESIGN

Experienced enrolled nurses employed in a supernumerary capacity documented all activities with which they were engaged over a six-month period.

SETTING

Six surgical wards within a tertiary referral hospital, Sydney, Australia.

SUBJECTS

Enrolled nurses working after hours in an extended support role in a supernumerary capacity.

RESULTS

Data demonstrated that, in this study, the 'after hours clinical support enrolled nurse' was primarily performing routine nursing activities. Although the number of extended skills (n=13) performed could be considered diverse for an enrolled nurse, many were seldom performed. The most frequently performed extended skills were patient escorts and undertaking bladder ultrasounds with a mobile scanner. Medication administration was rarely performed.

CONCLUSION

The role primarily incorporates basic nursing care with minimal scope for extended skills. The paper recommends that basic nursing practices be delegated to assistants in nursing to enable the 'after hours clinical support enrolled nurse' to effectively support registered nurses and extend their own practice.

Source and content of health information for patients undergoing laparoscopic cholecystectomy

This study, a component of a larger research project examining the effect of pre-admission education on patients' ability and confidence in domiciliary self-care following laparoscopic cholecystectomy, identified the source(s) of specific health- and hospital-related information for patients undergoing this operative procedure. One-hundred laparoscopic cholecystectomy patients were surveyed at pre-admission, following assessment by the pre-admission nurse, anaesthetist and registered medical officer to determine what information had been provided by the pre-admission nurse and/or alternative sources of information provision. The findings showed that laparoscopic cholecystectomy patients received information from multiple sources. Pre-admission clinic nurses were more likely to provide information related to the surgical procedure and hospital length of stay than about postoperative expectations and self-care. Overall, patients perceived that medical practitioners imparted the most information. Printed literature and informal channels of information provision featured strongly, indicating patients' resourcefulness in obtaining information related to their surgery. Informal communication showed the importance of social networks and personal experience in aiding patients' comprehension of the hospital and recovery experience.

Abnormal affective modulation of somatosensory brain processing among patients with fibromyalgia

OBJECTIVE

It is well established that subjective pain perception can be modulated by negative mood states and that patients with chronic pain are characterized by high levels of depression and anxiety. Nevertheless, very little is known about the effects of negative mood induction on brain processing of somatosensory information in fibromyalgia. The objective of the present study was to examine the influence of two emotional states (pleasant and unpleasant) on brain activity of patients with fibromyalgia (FM; n = 27) and with musculoskeletal (MSK) pain resulting from identifiable somatic lesions (n = 16).

METHODS

For this purpose, somatosensory-evoked potentials (SEPs) elicited by nonpainful pneumatic stimuli, delivered to the right and left hand following an oddball paradigm, were recorded when patients were viewing affective slides.

RESULTS

As compared with patients with MSK pain, patients with FM displayed overall larger P50 amplitude to tactile stimuli. In addition, significantly larger P50 and smaller N80 amplitudes were found within patients with FM when they were viewing the unpleasant rather than the pleasant slides.

CONCLUSION

Our data suggest an abnormal processing of nonpainful somatosensory information in FM, especially when somatic signals are arising from the body within an aversive stimulus context. These findings provide further support for the use of biopsychosocial models for understanding FM and other chronic pain states.

The effect of pre-admission education on domiciliary recovery following laparoscopic cholecystectomy

OBJECTIVES

The objectives of this randomised controlled study were to determine if pre-admission patient education affects post-operative pain levels, domiciliary self-care capacity and patient recall following a laparoscopic cholecystectomy (LC). Participants were randomised to receive the standard preadmission program (SP) or an individualised, education intervention (El).

DESIGN

A pre-operative questionnaire was administered in the pre-admission clinic to determine participants' knowledge of LC and post-operative management. Telephone follow-up and post-operative questionnaire were conducted approximately 14 days post discharge.

SETTING

Preadmission clinic of a Sydney, Australia, tertiary referral hospital.

SAMPLE

Ninety-three elective LC patients.

RESULTS

EI participants experienced lower pain levels and had significantly greater recall of provided information. However, no significant differences were found between the control and intervention groups for domiciliary self-care.

CONCLUSION

Pre-admission education intervention helps reduce post-operative pain levels following LC and significantly increases patients' knowledge of self-care and complication management.

The provision and utilisation of casemix and demographic data by nursing managers in seven hospitals

The role of the nursing manager has evolved from clinician and bed manager to one with greater accountability for evidence based practice, benchmarking and more recently, budget liability. Casemix data are widely believed to be a means of providing essential information for effective decision making and financial management but have not been widely utilised by nursing managers (Diers & Bozzo, 1999). This paper will report the results of a survey of nursing managers in seven hospitals within a metropolitan area health service. The hospitals include tertiary referral hospitals, specialist public hospitals and an affiliated public hospital for aged care and rehabilitation services. The survey sought to establish what casemix and related data were provided to nurse managers, who provided these data and how supplied data were utilised by the nurse managers. Results demonstrated that the majority of nursing managers surveyed received minimal (if any) casemix and/or demographic data on a routine basis. Some were provided with data in response to specific requests. The information that was provided varied both within and across hospitals, and no consistent methods of data distribution were available. Few nursing managers believed that the information provided aided their decision-making processes partly due to the minimalist nature of provided data while some nursing managers demonstrated a lack of understanding of the potential benefit of casemix data as a resource to support management decision making.

A retrospective comparative study of patients with chest pain and intra-ward transfers

This retrospective, comparative survey examined patients who had a discharge diagnosis of chest pain and were admitted to The St. George Hospital between July 1999 to June 2000. The aim was to identify the clinical wards/units to which patients were admitted and the number of intra-ward transfers' patients experienced during their hospitalisation. Patients admitted to the cardiology ward/units and outlying wards were compared to determine the number of intra-ward transfers and length of hospital stay. The study found that older patients were more likely to be transferred and that the number of intra-ward transfers impacted upon length of hospital stay.

Research into the workload and roles of oncology nurses within an outpatient oncology unit

This project evaluated the roles and workload of Registered Nurses (RNs) within an outpatient Cancer Care Centre (CCC) of a tertiary referral hospital in Sydney, Australia. The research incorporated the two distinct areas of radiation oncology and haematology oncology. Patient throughput (incorporating clinic attendance and treatments) was known to have increased substantially since the centre opened in 1994. The nursing Full Time Equivalents (FTEs) for the CCC were determined when the centre opened with minimal change to the nursing establishment since then. Nursing staff perceived that their workload had increased substantially and that their roles had become more complex. Work sampling was conducted over a 3-month period and identified the range of nursing activities performed by the oncology outpatient nurse. The nurses were found to have a large administrative role while their nursing activities ranged from basic nursing tasks to more specialist activities including patient counseling and complex chemotherapy regimes.

Critical care dependency tool: monitoring the changes

The critical care patient dependency system (CCPD) is a factorial patient acuity system developed in 1993 by Ferguson and Harris-Ingall' for use in adult critical care areas. It was developed specifically to help determine Australian nursing cost weights and was utilised to collect data from nine Sydney critical care units from October 1992 until May 1993. The St. George Hospital (SGH) general intensive care unit, one of the nine participating hospitals, continues to use and collect data with the CCPD. This paper describes the instrument and compares data on Australian national diagnosis related groups (ANDRGs), collected during the original study, to ANDRG information on the critical care population 3 and 6 years later. In addition, the paper examines and compares the demographics of the SGH critical care patient population, patient acuity (based upon CCPD patient scores) and intensive care nursing clinical practices collected over a 3 month period in 1996 and again in 1999. Demographic and patient acuity data for SGH in 1993 are unavailable and so comparisons were unable to be made. The findings demonstrate changes in the management of critically ill patients, especially in relation to ventilation management, wound care and invasive monitoring practices; this resulted in shifts to the nursing workload. For this reason, the instrument is useful in providing nurse managers with information about patient dependencies and nursing work.

The integration movement in California's workers' compensation market

Over the past two decades the California workers' compensation industry has been responding to rapidly rising medical costs. The first response was to attempt to adopt principles of managed care; the second, to increase efficiency by integrating activities, first within companies, then between companies and providers, and finally across companies providing both group health and workers' compensation. This article chronicles the integration movement, analyzes the forces driving it, and discusses how contradictory government incentives have both propelled and hindered integration.

[Good practices of publication of clinical cases of pharmacovigilance: comments, Groupe de Travail sur les Bonnes Pratiques de Publication de Cliniques en Pharmacovigilance: commentary]

This paper introduces some comments on the complete text of Good Pharmacovigilance Publishing Practices, which forms appendix number 2 of the Good Pharmacovigilance Practices now published by the French Drug Agency, as was Good Clinical Practices. Each good practice is printed in italic and presented in a frame; the following comments are designed to facilitate its application. The technical terms that are used in this text are presented according to the glossary in Good Pharmacovigilance Practices.

[Fever caused by fipexide. Evaluation of the national pharmacovigilance survey]

Fourteen cases of drug fever due to fipexide were reported by a retrospective survey of a National Network of French Pharmacovigilance. 8 women, 6 men (mean age, 52 years), presented a sudden fever with a mean onset delay of 7 days after the first cure (range 2-12 days). In five cases, drug fever was the only manifestation; in other cases, it was associated with systemic or cutaneous signs. Eosinophilia was frequent (8 cases) and once, a chest picture showed an interstitial pneumonitis. Fever disappeared promptly after discontinuation of the drug and for ten patients, the rechallenge was positive within a short time. The clinical picture and laboratory tests are discussed and suggest an hypersensitivity reaction.