STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis.

AIMS AND OBJECTIVES: To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. BACKGROUND: Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. METHODS: A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. RESULTS: Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. CONCLUSION: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. RELEVANCE TO CLINICAL PRACTICE: This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period.

An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit.

AIMS AND OBJECTIVES: To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. BACKGROUND: The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. DESIGN: Naturalistic, exploratory descriptive design using observation. METHODS: Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. RESULTS: Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. CONCLUSIONS: Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. RELEVANCE TO CLINICAL PRACTICE: Patient outcomes sensitive to the quality of interprofessional handover on patient arrival in the Post-Anaesthetic Care Unit can be used to evaluate handover quality improvement initiatives. Quality handovers can improve management of pain and clinical deterioration in Post-Anaesthetic Care Unit and reduce time wasted searching for missing information.

Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks.

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

Nurses' understanding of patient-centred care in Bhutan.

AIM: The purpose of the study was to explore nurses' perceptions and understanding of patient-centred care (PCC) in Bhutan. BACKGROUND: Nurses' perceptions and understanding of PCC in Bhutan are unknown. METHODS: A non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals--the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman's correlation coefficients were used to investigate relationships between demographic variables. RESULTS: The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. CONCLUSION: Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope.

Interprofessional communication supporting clinical handover in emergency departments: An observation study.

BACKGROUND: Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. METHODS: Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. RESULTS: Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. CONCLUSIONS: Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers.

Development of the good food planning tool: A food system approach to food security in indigenous Australian remote communities.

Few frameworks exist to assist food system planning, especially for Indigenous Australian remote communities. We developed a Good Food Planning Tool to support stakeholders to collectively plan and take action for local food system improvement. Development occurred over a four-year period through an evolving four phase participatory process that included literature review, several meetings with representatives of various organisations and communities and application of the Tool with multi-sector groups in each of four Indigenous Australian remote communities. A diverse range of 148 stakeholders, 78 of whom were Indigenous, had input to its development. Five food system domains: (i) Leadership and partnerships; (ii) Traditional food and local food production; (iii) Food businesses; (iv) Buildings, public places and transport; (v) Community and services and 28 activity areas form the framework of the Tool. The Good Food Planning Tool provides a useful framework to facilitate collective appraisal of the food system and to identify opportunities for food system improvement in Indigenous Australian remote communities, with potential for adaptation for wider application.

Patient participation in a cardiac rehabilitation program.

PURPOSE: Cardiac rehabilitation programs (CRPs) aim to help patients with cardiovascular disease achieve lifestyle changes. However, attendance and completion of programs are poor worldwide. The rationale for this study was to explore patterns of attendance and completion of a CRP located in a private hospital in metropolitan Melbourne, Victoria, Australia. METHODS: This exploratory descriptive study involved linking 2 databases to analyze demographic and cardiac characteristics of patients who did or did not attend the CRP. RESULTS: Only 11.9% of patients likely to benefit attended the CRP. Predictors of attendance included marital status, gender, age, and proximity of the program to home. The crucial area identified in need of improvement is the referral process to increase the rate of participation. CONCLUSION: The major finding is the need for improvement in referral and recruitment structures to increase awareness of the program and the participation rate. Practices such as automatic referral and followup of patients are recommended. The study outcomes will benefit future research on referral processes to the CRP at the hospital.

Climate change adaptation at the intersection of food and health.

Nutritious, safe, affordable, and enjoyable food is a fundamental prerequisite for health. As a nation, Australia is currently classified as food secure with the domestic production exceeding domestic consumption of most major food groups. The domestic system is almost self-sufficient in terms of nutritious plant foods, although these foods have seen steady higher price increases relative to other foods, with nutrition equity implications. However, the viability of Australia's food security sits counter to the continued presence of a stable and supportive climate. This article reviews the current state of science concerning the interface between climate change, food systems, and human health to reveal the key issues that must be addressed if Australia is to advance human health and sustainable food systems under a changing climate.

Health-promoting education needs of middle-aged persons in a rural community in Taiwan.

The purpose of this study was to identify the health-promoting education needs of middle-aged people in a rural community of Taiwan. A randomized sample of 1100 potential respondents was mailed a survey questionnaire with a response rate of 29.7%. The questionnaire was a unique 'needs analysis' tool developed by the researchers. Data were analysed using descriptive and inferential statistics. The results indicated that many respondents were already experiencing at least one chronic disease with physical and mental health moderate in status overall, though varying between men and women. The five highest ranked education needs from an extensive list were: healthy diet, family communication, relating to adult children, fitness and exercise, and cancer prevention. The findings, supplemented by the results from other needs analysis methods that also applied, have provided important insights for the design of a relevant health-promoting education programme for middle-aged people in that community.

Photolysis of atrazine and ametryne herbicides in Barbados sugar cane plantation soils and water.

The photodegradation kinetics of atrazine (2-chloro-6-(ethylamino)-4-isopropylamino-1,3,5-triazine) and ametryne (2-methylthio-4-ethylamino-6-isopropylamino-s-triazine), in fresh and coastal salt water from Barbados, were measured under irradiation with artificial solar and UV254-radiation. The first-order rate constants were greater for ametryne than for atrazine, and the rates were reduced in seawater relative to fresh water, and in soil slurries relative to fresh water. However, rates were accelerated in the presence of iron(III) at pH 3 due to photo-Fenton type processes. This rate enhancement was reduced at ambient pH values (pH 7-7.5) representative of surface water in Barbados. These results have important implications for the relative persistence of these contaminants in aquatic environments in tropical areas.