Gene expression, evolution, and the genetics of electrosensing in the smalltooth sawfish, Pristis pectinata

Sawfishes (Pristidae) are large, highly threatened rays named for their tooth-studded rostrum, which is used for prey sensing and capture. Of all five species, the smalltooth sawfish, Pristis pectinata, has experienced the greatest decline in range, currently found in only ~20% of its historic range. To better understand the genetic underpinnings of these taxonomically and morphologically unique animals, we collected transcriptomic data from several tissue types, mapped them to the recently completed reference genome, and contrasted the patterns observed with comparable data from other elasmobranchs. Evidence of positive selection was detected in 79 genes in P. pectinata, several of which are involved in growth factor/receptor tyrosine kinase signaling and body symmetry and may be related to the unique morphology of sawfishes. Changes in these genes may impact cellular responses to environmental conditions such as temperature, dissolved oxygen, and salinity. Data acquired also allow for examination of the molecular components of P. pectinata electrosensory systems, which are highly developed in sawfishes and have likely been influential in their evolutionary success.

Using machine learning models to predict falls in hospitalised adults

BACKGROUND

Identifying patients at high risk of falling is crucial in implementing effective fall prevention programs. While the integration of information systems is becoming more widespread in the healthcare industry, it poses a significant challenge in analysing vast amounts of data to identify factors that could enhance patient safety.

OBJECTIVE

To determine fall-associated factors and develop high-performance prediction tools for at-risk patients in acute and sub-acute care services in Australia.

METHODS

A retrospective study of 672,400 patients admitted to acute and sub-acute care services within a large metropolitan tertiary health service in Victoria, Australia, between January 1, 2019, and December 31, 2021. Data were obtained from four sources: the Department of Health Victorian Admitted Episodes Dataset, RiskManTM, electronic health records, and the health workforce dataset. Machine learning techniques, including Random Forest and Deep Neural Network models, were used to analyse the data, predict patient falls, and identify the most important risk factors for falls in this population. Model performance was evaluated using accuracy, F1-score, precision, recall, specificity, Matthew's correlation coefficient, and the area under the receiver operating characteristic curve (AUC).

RESULTS

The deep neural network and random forest models were highly accurate in predicting hospital patient falls. The deep neural network model achieved an accuracy of 0.988 and a specificity of 0.999, while the RF achieved an accuracy of 0.989 and a specificity of 1.000. The top 20 variables impacting falls were compared across both models, and 12 common factors were identified. These factors can be broadly classified into three categories: patient-related factors, staffing-related factors, and admission-related factors. Although not all factors are modifiable, they must be considered when planning fall prevention interventions.

CONCLUSION

The study demonstrated machine learning's potential to predict falls and identify key risk factors. Further validation across diverse populations and settings is essential for broader applicability.

Factors Influencing Nursing Student Learning During Clinical Placements: A Modified Delphi Study

BACKGROUND

Factors identified as important to nursing student clinical learning include the environment, the clinical facilitator, and student human factors.

METHOD

A modified Delphi study generated clinical nurse educators' expert consensus of the importance of factors that influence student learning during clinical placements. Short-answer questions exploring facilitation of learning were also provided.

RESULTS

Thirty-four nurse educators participated in the first round, and 17 nurse educators participated in the second round. Final consensus of at least 80% agreement was reached for all factors. Enablers of student learning included a positive workplace culture, student attitude, and clear communication between facilitator and student. Barriers to student learning included lack of time for teaching, short placement duration, and poor student and facilitator attitude.

CONCLUSION

Further investigation is needed on how these factors are addressed during placements including a review of the quality of resources provided to students and clinical facilitators for student learning. [J Nurs Educ. 2023;62(6):333-341.].

From rivers to ocean basins: The role of ocean barriers and philopatry in the genetic structuring of a cosmopolitan coastal predator

The Bull Shark (Carcharhinus leucas) faces varying levels of exploitation around the world due to its coastal distribution. Information regarding population connectivity is crucial to evaluate its conservation status and local fishing impacts. In this study, we sampled 922 putative Bull Sharks from 19 locations in the first global assessment of population structure of this cosmopolitan species. Using a recently developed DNA-capture approach (DArTcap), samples were genotyped for 3400 nuclear markers. Additionally, full mitochondrial genomes of 384 Indo-Pacific samples were sequenced. Reproductive isolation was found between and across ocean basins (eastern Pacific, western Atlantic, eastern Atlantic, Indo-West Pacific) with distinct island populations in Japan and Fiji. Bull Sharks appear to maintain gene flow using shallow coastal waters as dispersal corridors, whereas large oceanic distances and historical land-bridges act as barriers. Females tend to return to the same area for reproduction, making them more susceptible to local threats and an important focus for management actions. Given these behaviors, the exploitation of Bull Sharks from insular populations, such as Japan and Fiji, may instigate local decline that cannot readily be replenished by immigration, which can in turn affect ecosystem dynamics and functions. These data also supported the development of a genetic panel to ascertain the population of origin, which will be useful in monitoring the trade of fisheries products and assessing population-level impacts of this harvest.

An investigation into nursing students' application of infection prevention and control precautions

BACKGROUND

Undergraduate education of Health Care Workers is pivotal to ensuring that frontline clinicians have appropriate knowledge and skills in Infection Prevention and Control (IPC).

OBJECTIVES

The aim of this study was to describe undergraduate nursing students' self-reported compliance with Standard Precautions and to explore the psychosocial factors that influence adherence in clinical practice.

DESIGN

A cross-sectional survey design was used.

SETTING

The study was conducted in the School of Nursing and Midwifery at an Australian University.

PARTICIPANTS

All undergraduate nursing students were invited to participate in an online survey; 321 participated, mean age 25.7 years (SD = 8.4). The majority, 196 (61%), had no healthcare work experience, 54 (17%) were patient-care assistants, 40 (13%) enrolled nurses, and 31 (9%) were nurses registered overseas.

METHODS

Two validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) and the Factors Influencing Adherence to Standard Precautions Scale- Student version (FIASPS-SV). Linear regression was used to measure the impact of psychosocial factors on self-reported compliance.

RESULTS

Overall self-reported compliance with prevention of cross-infection was 83%, use of Personal Protective Equipment (81%), correct disposal of sharps (83%) and general waste (75%), and equipment decontamination (69%). The predominant factors endorsed on the FIASPS-SV were 'Leadership' (M = 15.21 SD = 5.28) and 'Contextual cues' (M = 19.09 SD = 6.37). Multivariate linear regression demonstrated that after adjusting for age, gender and years of nursing study, the Leadership factor predicted participants' self-reported compliance on the 'prevention of cross-infection' (p < .001), 'use of PPE' (p < .001), 'waste disposal' (p = .021), and 'decontamination of equipment' (p < .001) sub-domains of the CSPS.

CONCLUSIONS

These findings highlight that strong clinical leadership and role modelling are essential to ensure all healthcare students prioritise rigorous adherence with infection prevention and control guidelines.

Nursing students' awareness and perceptions of nurses' role in antimicrobial stewardship

Antimicrobial resistance is a major threat to public health worldwide. Antimicrobial stewardship programs and interventions aiming to optimise the use of antibiotics, are increasingly used to ensure judicious use of antibiotics and limit the emergence of antimicrobial resistance. Nurses are pivotal in antimicrobial stewardship however nursing students' awareness of such programs has not been investigated. This study aimed to elicit nursing students' perspectives and perceptions of the nurse's role in antimicrobial stewardship. A cross-sectional design was utilised to survey pre-registration nursing students. A total of 321 nursing students enrolled in an Australian university participated. The survey comprised questions on knowledge and opinions regarding the nurse's role in AMS and on a range of topics relating to antimicrobial stewardship and antimicrobial resistance, through closed and open-ended questions. While 44.5% of participants indicated they were familiar with the term Antimicrobial Stewardship, 70.7% believed they had very little or no knowledge of the principles. Completion of subjects with a focus on quality and safety in nursing practice and quality use of medications was associated with greater awareness. Findings underscore the need to engage nursing students in discussions exploring the problem of antimicrobial resistance and the important role nurses play in Antimicrobial Stewardship programs.

Genetic evidence supports a range extension for the Brazilian cownose ray Rhinoptera brasiliensis in the western North Atlantic

We report 24 new records of the Brazilian cownose ray Rhinoptera brasiliensis outside its accepted geographic range. Sequencing of a 442-base pair portion of the mitochondrial NADH dehydrogenase subunit 2 gene for 282 Rhinoptera samples revealed eight records off the east coast of the USA and 16 from the eastern Gulf of Mexico. Both sexes of all life stages were documented in all seasons over multiple years in the Indian River and Lake Worth lagoons, Florida, indicating that their range extends further in the western North Atlantic than previously described.

Swimming against the flow-Environmental DNA can detect bull sharks (Carcharhinus leucas) across a dynamic deltaic interface

Human activities in coastal areas are accelerating ecosystem changes at an unprecedented pace, resulting in habitat loss, hydrological modifications, and predatory species declines. Understanding how these changes potentially cascade across marine and freshwater ecosystems requires knowing how mobile euryhaline species link these seemingly disparate systems. As upper trophic level predators, bull sharks (Carcharhinus leucas) play a crucial role in marine and freshwater ecosystem health. Telemetry studies in Mobile Bay, Alabama, suggest that bull sharks extensively use the northern portions of the bay, an estuarine-freshwater interface known as the Mobile-Tensaw Delta. To assess whether bull sharks use freshwater habitats in this region, environmental DNA surveys were conducted during the dry summer and wet winter seasons in 2018. In each season, 5 × 1 L water samples were collected at each of 21 sites: five sites in Mobile Bay, six sites in the Mobile-Tensaw Delta, and ten sites throughout the Mobile-Tombigbee and Tensaw-Alabama Rivers. Water samples were vacuum-filtered, DNA extractions were performed on the particulate, and DNA extracts were analyzed with Droplet Digital™ Polymerase Chain Reaction using species-specific primers and an internal probe to amplify a 237-base pair fragment of the mitochondrial NADH dehydrogenase subunit 2 gene in bull sharks. One water sample collected during the summer in the Alabama River met the criteria for a positive detection, thereby confirming the presence of bull shark DNA. While preliminary, this finding suggests that bull sharks use less-urbanized, riverine habitats up to 120 km upriver during Alabama's dry summer season.

Patients' expectations and experiences of stem cell therapy for the treatment of knee osteoarthritis

BACKGROUND

Stem cell therapy is a novel treatment option for people living with osteoarthritis. Research investigating stem cell therapy for this debilitating condition has predominantly involved the pathogenesis of the cells and efficacy of the treatment. There is little understanding of patients' expectations and experiences of stem cell therapy treatment.

OBJECTIVE

To explore the expectations and experiences of people undergoing stem cell therapy for the treatment of knee osteoarthritis.

DESIGN

An exploratory, descriptive, qualitative study using semi-structured interviews was conducted.

SETTING AND PARTICIPANTS

Participants were recruited into two groups: (a) Expectations Group (n = 15); the expectations of stem cell treatment were explored with participants that were yet to commence stem cell therapy. (b) Experiences Group (n = 15); the experiences of stem cell therapy were explored with participants 12 months after their initial stem cell treatment. Transcripts were analysed using thematic analysis to identify themes in both groups.

RESULTS

Themes for the Expectations Group were active involvement in the treatment; treatment will improve symptoms; and benefits of treatment outweigh the risks. Themes for the Experiences Group were symptoms of treatment; satisfaction with treatment; and anticipation of further improvement.

DISCUSSION AND CONCLUSIONS

The findings are the first qualitative study to represent patients' perspective on expectations and experiences of stem cell therapy for knee osteoarthritis. They provide insight into the potential areas for improvement within this field to aid patients' preparation and approach to the treatment, promoting patient-centred care.

Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia

OBJECTIVES

This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes.

METHODS

A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT).

RESULTS

Nursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT.

CONCLUSION

This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.

Review of Current Conservation Genetic Analyses of Northeast Pacific Sharks

Conservation genetics is an applied science that utilizes molecular tools to help solve problems in species conservation and management. It is an interdisciplinary specialty in which scientists apply the study of genetics in conjunction with traditional ecological fieldwork and other techniques to explore molecular variation, population boundaries, and evolutionary relationships with the goal of enabling resource managers to better protect biodiversity and identify unique populations. Several shark species in the northeast Pacific (NEP) have been studied using conservation genetics techniques, which are discussed here. The primary methods employed to study population genetics of sharks have historically been nuclear microsatellites and mitochondrial (mt) DNA. These markers have been used to assess genetic diversity, mating systems, parentage, relatedness, and genetically distinct populations to inform management decisions. Novel approaches in conservation genetics, including next-generation DNA and RNA sequencing, environmental DNA (eDNA), and epigenetics are just beginning to be applied to elasmobranch evolution, physiology, and ecology. Here, we review the methods and results of past studies, explore future directions for shark conservation genetics, and discuss the implications of molecular research and techniques for the long-term management of shark populations in the NEP.

Questioning skills of clinical facilitators supporting undergraduate nursing students

AIMS AND OBJECTIVES

To report on a study investigating questioning skills of clinical facilitators who support the learning of undergraduate nursing students.

BACKGROUND

The ability to think critically is integral to decision-making and the provision of safe and quality patient care. Developing students' critical thinking skills is expected of those who supervise and facilitate student learning in the clinical setting. Models used to facilitate student learning in the clinical setting have changed over the years with clinicians having dual responsibility for patient care and facilitating student learning. Many of these nurses have no preparation for the educative role. This study adapted a comparative study conducted over fifteen years ago.

DESIGN

Descriptive online survey including three acute care patient scenarios involving an undergraduate nursing student. Participants were required to identify the questions they would ask the student in relation to the scenario.

METHODS

A total of 133 clinical facilitators including clinical teachers, clinical educators and preceptors from five large partner healthcare organisations of one Australian university participated.

RESULTS

The majority of questions asked were knowledge questions, the lowest category in the cognitive domain requiring only simple recall of information. Facilitators who had undertaken an education-related course/workshop or formal qualification asked significantly more questions from the higher cognitive level.

CONCLUSION

The study provides some evidence that nursing facilitators in the clinical setting ask students predominantly low-level questions. Further research is needed to identify strategies that develop the capacity of facilitators to ask higher level cognitive questions.

RELEVANCE TO CLINICAL PRACTICE

Clinical facilitators should undertake targeted education that focuses on how to frame questions for students that demand application, analysis, synthesis and evaluation.

Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study

AIMS AND OBJECTIVES

To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission.

BACKGROUND

Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium.

DESIGN

Retrospective case-control study with two controls per case.

METHODS

An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation.

RESULTS

Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission.

CONCLUSIONS

Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and prevention of delirium can contribute to improved patients safety and reduction in harm.

Use of videos to support teaching and learning of clinical skills in nursing education: A review

Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.

An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration

AIM

The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions.

BACKGROUND

Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted.

DESIGN

A descriptive exploratory design.

METHODS

Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed.

RESULTS

Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions.

CONCLUSIONS

Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

INTRODUCTION

While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs.

METHODS AND ANALYSIS

A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs.

CONCLUSIONS

This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs.

Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study

BACKGROUND

Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills.

OBJECTIVES

This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.

DESIGN

Mixed-method multi-centre study.

SETTING

High fidelity simulated acute clinical environment in three Australian universities.

PARTICIPANTS

A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.

METHOD

In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.

RESULTS

Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.

CONCLUSIONS

Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

Nursing administration of medication via enteral tubes in adults: a systematic review

Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Selection criteria  Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Data collection and analysis  Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. Results  There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

A systematic review of the effectiveness of current interventions to assist adults with heart failure to comply with therapy and enhance self-care behaviours

BACKGROUND

Heart failure is a common chronic disease that is one of the leading causes of hospitalisations in many countries around the world. Poor compliance with recommended self-care behaviours, for example managing medication and diet regimes, rather than the deterioration of the cardiac condition, have contributed to a significant proportion of heart failure exacerbations. Patients with heart failure can benefit from interventions that aim to increase their knowledge of the disease and support them in managing their care. There is a need, however, to determine which interventions, if any, are more effective in achieving the aims of self-care.

OBJECTIVE

This review examined the evidence to answer the question: What are the most effective interventions for helping adults with heart failure comply with therapy and enhance self care behaviours?

INCLUSION CRITERIA

This review focused on adults (aged 18 years and over) diagnosed with heart failure.The review considered studies that evaluated interventions aimed to help people with heart failure to improve self-care behaviours.Randomised control trials, quasi-randomised designs and pre-test post-test studies were included in the review.The primary outcome measure was improvement in actual self-care behaviours, including adherence to medications, maintaining a healthy diet, daily weighing, reducing salt intake, recognising symptoms and contacting health professionals when assistance may be required.

SEARCH STRATEGY

The search sought to identify published and unpublished, English language studies from 1990 until 2010. Databases searched included Medline, EMBASE, CINAHL, PsycInfo, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews & JBI COnNECT, PubMed, Informit - Health Collection, MEDNAR, Dissertations & Theses, and Google Scholar METHODOLOGICAL QUALITY: Two independent reviewers independently used the standard critical appraisal tool, from the Joanna Briggs Institute, to assess the methodological quality of studies that matched with inclusion criteria.

DATA COLLECTION

The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute Meta analysis of Statistic Assessment and Review Instrument.

DATA SYNTHESIS

Appropriate data were pooled for meta-analysis. The remaining studies were grouped according to outcome measures and type of intervention and presented descriptively.

RESULTS

The review included thirteen studies; eight were randomised controlled trials and five were pre-test post-test studies.

CONCLUSIONS

The review confirmed that education alone is less effective than a combination of education and the use of personal diaries to promote daily weighing. There is some evidence to suggest that motivational interviewing has potential for use in the heart failure population and may be more beneficial than standard education. Furthermore education should be tailored to individual learning needs.Clinicians should ideally work with patients to encourage the use of tools to reinforce the importance of self-care behaviours. Tailoring interventions to suit the individual is also beneficial.Interventions that promote efficacy in self-care behaviours through empowerment should be investigated in future studies. Further research needs to also consider the impact of an intervention/s over an extended timeframe (e.g. more than 12 months) as the majority of the research focuses on short time periods (e.g. 3 months).

Post-anaesthetic discharge scoring criteria: A systematic review

EXECUTIVE SUMMARY

Aim This systematic review investigates the essential components of an effective and feasible scoring system to assess patients following anaesthesia and surgery, thereby enhancing patient safety through timely and appropriate discharge from the Post-Anaesthetic Care Unit. The findings of the evidence synthesis will be used to inform the development of a Post-Anaesthetic Care Unit discharge tool.Methods A systematic review of quantitative research conducted in adult populations on post-anaesthetic discharge assessment strategies utilised in post-anaesthetic care units following any type of surgical procedure. An extensive literature search was constructed to identify all relevant studies published between 1970 and 2010. Studies were appraised and data was extracted by two reviewers using the standardised critical appraisal and data extraction tools from the Joanna Briggs Institute.Results A total of eight studies were included in the review. One randomised controlled trial and four observational studies provided evidence on the effectiveness and feasibility of discharge assessment tools. All studies identified pain, conscious state, and nausea and vomiting as important variables to consider in assessing a patient's readiness for discharge from the post-anaesthetic care unit. Two additional observational studies and a retrospective records analysis investigated the recovery of patients in the post-anaesthetic care unit, providing data on psychomotor and cognitive recovery following anaesthetic.Conclusion There was general agreement amongst the studies that post-anaesthetic care unit discharge assessment should consider levels of pain, conscious state, and nausea and vomiting. Although vital signs were included in all the discharge assessment tools, there was variation in the specific vital signs included within tools, with blood pressure being the only vital sign consistently used. The value of including urine output, oral intake or psychomotor testing in assessing readiness for post-anaesthetic care unit discharge was inconclusive and therefore requires further investigation.Implications for practice Based on the evidence from studies at moderate to high risk of bias analysed in this systematic review, the following recommendations are considered important for the assessment of the readiness of adult patients to be discharged from the post-anaesthetic care unit:• Assessment of pain, conscious state, blood pressure and nausea and vomiting should be made before discharging a patient. Assessment of other vital signs should be considered before discharging a patient from post-anaesthetic care unitImplications for research The synthesised evidence suggests there is limited consensus on criteria for post-anaesthetic care unit discharge assessment and further investigation using sound methodologies is required, especially with regard to patient outcomes. The following recommendations can be made:• Further research should investigate the validity and reliability of assessment variables on post-anaesthetic care unit discharge tools, the implementation of validated post-anaesthetic care unit discharge criteria for assessment of patient readiness for discharge, and, the relationship between post-anaesthetic care unit discharge assessment and patient safety.

A systematic review of nursing administration of medication via enteral tubes in adults

AIM

This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.

BACKGROUND

Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.

DESIGN

Systematic review.

METHODS

CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary.

RESULTS

Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.

CONCLUSION

The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication.

RELEVANCE TO CLINICAL PRACTICE

Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Nursing administration of medication via enteral tubes in adults: a systematic review

BACKGROUND

Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown.

OBJECTIVES

The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications.

SEARCH STRATEGY

The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies.

SELECTION CRITERIA

Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications.

DATA COLLECTION AND ANALYSIS

Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary.

RESULTS

There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

Nasogastric tubes: an historical context

Nurses commonly care for patients with nasogastric tubes. Many authors have addressed the management of nasogastric tubes; however, discussion rarely considers the historical perspective. The purpose of this article is to provide an historical context on nasogastric tubes.