The intensive care unit visiting study: A multisite survey of visitors.

BACKGROUND: Being able to visit a critically ill relative provides comfort to family members and has recognised benefits to the patient. Limited research has been conducted on demographic characteristics and visiting behaviours of family members with a relative in the intensive care unit (ICU). OBJECTIVES: The objective was to provide an overview of local ICU visitor behaviours and practices across four metropolitan units in Australia. METHODS: A convenience sample of 440 participants from four ICUs across a metropolitan city in eastern Australia was required for the study. A descriptive 22-item self-report survey was used. Data were collected from four ICUs in a metropolitan city in eastern Australia. Sample characteristics and other variables were analysed using descriptive statistics. RESULTS: Data collection was undertaken from April 2018 to May 2019. Four hundred sixty-two (n = 462) ICU visitors responded. There were no significant differences between visitor characteristics across the four hospitals. The mean age of the respondents was 49 years, the youngest participant being 18 years and the oldest being 93 years, with most visitors being women (n = 312, 68%). The participants were more likely to be close relatives such as spouses (n = 117, 25%), parents (n = 113, 24%), or children (n = 79, 17%). Visitors reported different methods by which they received information about visiting policies across units and indicated that they would have visited more frequently if able. Although most respondents rated their ICU visiting experience favourably, some reported being frequently asked to leave the patient's bedside impacted their experience. CONCLUSIONS: This study has highlighted that families want to remain in close proximity when they have a relative in the ICU. Despite visiting hours being flexible, most families visit midmorning so that they can talk with staff. Data captured in this study can be used toward improving the ICU visiting experience for family members.

PREMS and PROMS data within the acute health care context: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to investigate use of patient reported experience measures and patient reported outcome measures within the acute health care context. INTRODUCTION: Data from patient reported outcome measures and patient reported experience measures provide important information for health professionals and organizations in order to improve patient-centered care. These two measures have potential to narrow the gap between the clinician's and patient's views and help tailor treatment plans to meet the patient's preferences and needs. INCLUSION CRITERIA: This scoping review will consider studies that include patients of any age and any condition who have obtained care from any acute health care facility. The concepts of this review are: the types of research studies that have been done using patient reported experience measures and patient reported outcome measures data in acute hospital settings, the geographical contexts of these two measures' studies, the barriers and facilitators that have been identified in studies that use data from the measures, the characteristics of patient reported experience measures and patient reported outcome measures data and the ways in which these types of data have been applied to clinical practice in acute care settings. This review will consider studies that are set in any acute health care setting including inpatient and outpatient areas, emergency departments, and critical care units. METHODS: This scoping review, utilizing JBI methods, will include an extensive search of the databases for published and unpublished literature. The review will consider any type of quantitative, qualitative, or mixed methods research evidence as well as systematic reviews to understand how hospitals use patient reported experience measures and patient reported outcome measures data in health care. Each included study will be assessed by two independent reviewers and data will be extracted from included papers using a standardized data extraction tool.

Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review.

OBJECTIVE: The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature. INTRODUCTION: A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs. INCLUSION CRITERIA: This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included. METHODS: Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs. RESULTS: The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision. CONCLUSIONS: The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.

Implementing patient information for gynae-oncology patients at a tertiary referral health service.

AIM: To ensure that gynae-oncology surgical patients receive relevant written information, in their preferred format, and at a time that suits them, according to the best available evidence. METHODS: This project utilized an audit and feedback design and was conducted over a 9-month period from August 2015 to May 2016. Twenty-nine patients were audited prior to two strategies being implemented. The first strategy was a standardized e-mail letter to all patients (containing links to surgical information, cancer support websites and a short video introducing hospital staff, and the second was a discharge information sheet detailing wound care, signs of complications, actions to take and follow-up instructions. Thirty patients were audited post-implementation to evaluate the success of these strategies. RESULTS: There were significant increases in the number of patients who said they received written information on their diagnosis, surgery and potential complications at initial consultation and a significant increase in the number of patients who said they were provided with written follow-up information on discharge. Pre-audit, 83% of patients stated they would like to receive a list of reliable websites to access and post-audit, 89% of patients stated they found the websites provided were useful. DISCUSSION: Although gynae-oncology surgical patients did previously receive relevant verbal information, little or no written information was provided. The pre-implementation audit provided insight into the information these patients required. The e-mail was generally well received by patients; however; there was a minority who did not have internet access and therefore a paper version was provided. CONCLUSION: This project identified deficits in the provision of written information for surgical gynae-oncology patients. Two strategies were implemented to address this deficit with positive results in the number of patients receiving written information; however, further investigation is needed to establish patient satisfaction with this information.

Effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis: a systematic review.

BACKGROUND: Incontinence-associated dermatitis (IAD) is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes pain, redness, swelling and excoriation, and may lead to complications such as fungal skin infections and pressure injuries. It is important to prevent and treat IAD to avoid complications and improve patient outcomes. A number of products are available for protecting skin, but evidence on their effectiveness is limited. OBJECTIVES: The current review aimed to establish the effectiveness of topical skin products in reducing the occurrence and/or severity of IAD. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adult patients over the age of 18 years with incontinence and/or diarrhea. TYPES OF INTERVENTION: Topical skin products as individual interventions or part of a skin care regimen. TYPES OF STUDIES: Both published and unpublished study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after, prospective and retrospective cohort, case-control, analytical cross-sectional, descriptive study designs including case series, individual case reports and descriptive cross-sectional studies across all care settings for inclusion. OUTCOMES: The primary outcome of interest was the absence or non-development, reduction or resolution, new development or increase in the occurrence of IAD or the increase in severity of IAD. The secondary outcome was any adverse effect caused by the skin care products used. SEARCH STRATEGY: A three-step search strategy to find both published and unpublished papers was utilized in this review. Studies were limited to those published in English from 1980 to 2016. METHODOLOGICAL QUALITY: Papers selected were assessed by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted using the standardized data extraction tool in JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes. DATA SYNTHESIS: Studies were assessed for methodological quality and statistical significance to determine validity and generalizability of study results. It was not possible to pool studies to conduct meta-analysis or test for heterogeneity. RESULTS: There were a limited number of clinical trials that compared products for efficacy in preventing and treating IAD. Assessment tools and severity scores used to measure skin damage outcomes were dissimilar and prone to subjectivity. It was difficult to ascertain superiority of any individual product. CONCLUSION: Information on barrier protective efficacy, side effects and cost can be valuable to both clinicians and care providers. More randomized controlled trials on product effectiveness for prevention and treatment of IAD are highly recommended.

Effectiveness of nurse-initiated interventions on patient outcomes in the emergency department: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective is to evaluate the effectiveness of nurse-initiated interventions (NIIs) on patient outcomes in the emergency department (ED).More specifically, the objectives are to identify the effectiveness of NIIs, including but not limited to, nurse-initiated medications, nurse-initiated intravenous fluid therapy and nurse-initiated pathology on patient waiting time, time to treatment, length of stay, pain levels, symptom relief, patient satisfaction, leave without being seen rates and mortality rates in ED settings.

Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.

Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings.More specifically the review questions are.

The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update.

BACKGROUND: Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate holistic care for both the patient and the family. Family interaction can significantly impact on the experience of critical illness, notwithstanding the challenge of meeting families' needs for many clinicians in the intensive care unit (ICU). Family needs have been extensively researched; however, a previous Joanna Briggs Institute (JBI) systematic review was the first published systematic review recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care setting. Since its publication in 2011, additional research findings have been published and it was deemed appropriate to update the original systematic review. OBJECTIVES: This systematic review aims to establish recent best practice in addressing the needs of family members with a relative or loved one admitted to an adult critical care unit. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Studies that included family members (including children) of adult patients in an ICU were considered for inclusion in this review. Patients with any clinical condition, length of stay or outcome were included. TYPES OF INTERVENTION(S): This review considered interventions that addressed the five previously identified categories of family needs: support - support groups, training in coping strategies and journal or diary writing; assurance - face-to-face meetings and participation in ward rounds; proximity - changes to visitation policies; information - staff and/or family education, handouts and brochures and the use of technology (e.g. SMS messages); and comfort - changes to the ICU physical environment. TYPES OF STUDIES: This review considered any randomized controlled trials (RCTs) that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult ICU. In the absence of RCTs, other research designs such as quasi-experimental, as well as pre- and post-studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients. TYPES OF OUTCOMES: This review considered studies that evaluated outcomes with a validated tool that measured information comprehension, coping mechanisms, anxiety, depression, stress and satisfaction. SEARCH STRATEGY: An extensive search of the major databases was conducted. Databases searched included PubMed, CINAHL, psycINFO, Health source, Web of Science, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects. The original search of this review included published and unpublished studies and articles in English from 1980 to 2010. The updated search identified articles for inclusion from 2010 to 2014. METHODOLOGICAL QUALITY: Quantitative articles selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. DATA EXTRACTION: Data was extracted from the articles included in this review using standardized data extraction tools from the JBI Meta Analysis of Statistics Assessment and Review Instrument package. DATA SYNTHESIS: The studies included in this review were not suitable for meta-analysis and therefore the results are presented as a narrative summary. RESULTS: Originally, 14 studies and one dissertation met the inclusion criteria and were included in the review. Of these, 12 were quasi-experimental studies and three were prospective randomized trials. In this current update, 14 new articles were identified for inclusion - one RCT, 10 quasi-experimental studies and three observational studies. The settings were in ICUs in Sweden, USA, United Kingdom, the Netherlands, France, Hong Kong, Saudi Arabia and Iran. The evidence identified from all studies in the review includes the use of support groups for family members of patients admitted to an ICU, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs, use of a diary, changes in the physical environment and open or more flexible visiting hours. CONCLUSIONS: This current update of the original review makes several reiterative and new recommendations for clinical practice to address family needs of patients admitted to a critical care unit; however, the need for significant further research in this area is again highlighted. Future intervention studies focusing on family needs could include the use of technology such as DVDs (Digital Versatile Discs) and SMS (Short Message Service) for informing families and interventions specifically designed to improve family comfort. IMPLICATIONS FOR PRACTICE: Communication interventions help promote family involvement in their loved one's care and facilitate their decision-making capacity, as well as improving clinician and family interaction, family comprehension of their loved one's condition and also reduce the development of post-traumatic stress-related symptoms (Grade A). Family satisfaction may be increased with the provision of comfortable physical environments with noise reduction measures (Grade B). IMPLICATIONS FOR RESEARCH: More rigorous high-quality studies investigating interventions to meet the needs of family with a relative in ICU are needed. The majority of included studies in this updated review focused on family satisfaction wherein more robust data on family needs would better inform health professionals in their practice.

Nursing Interventions for Identifying and Managing Acute Dysphagia are Effective for Improving Patient Outcomes: A Systematic Review Update.

BACKGROUND: Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological impairment, largely from stroke. Dysphagia is not generally considered a major cause of mortality; however, the complications that result from this medical condition, namely, aspiration pneumonia and malnutrition, are among the most common causes of death in the older adults. METHODS: This is an update of an existing systematic review. The standard systematic review methods of the Joanna Briggs Institute were used. Methods were specified in advance in a published protocol. A wide range of databases were searched for quantitative research articles examining the effectiveness of nursing interventions to identify and manage dysphagia in adult patients with acute neurological dysfunction, published between 2008 and 2013. RESULTS: Four new studies were added in this update, for a total of 15 included studies. Strong evidence was found to show that nurse-initiated dysphagia screening is effective for reducing chest infections in patients with dysphagia (odds ratio [OR] = 0.45, 95% CI [0.33, 0.62], p < .00001). Nurse-initiated dysphagia screening by trained nurses may be effective for detection of dysphagia, and training nurses in dysphagia screening improves the number and accuracy of screens conducted. The presence of formal dysphagia guidelines in a health facility is likely to reduce inpatient deaths (OR = 0.60, 95% CI [0.43, 0.84], p = .003) and chest infections (OR = 0.68, 95% CI [0.51, 0.90], p = .008); however, it does not appear that formal guidelines have an effect on length of stay. CONCLUSIONS: Nurse-initiated dysphagia screening for patients with acute neurological dysfunction is effective for a range of important patient outcomes. The presence of formal guidelines for the identification and management of dysphagia may have a significant effect on serious adverse outcomes such as chest infections and death. Training nurses to conduct dysphagia screening will improve patient outcomes.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update.

BACKGROUND: Nurse-led preadmission clinics or services have been implemented in many health services as a strategy to facilitate the admission and assessment of booked surgical cases. In order to provide the most recent available evidence, this systematic review is an update of our previous review published in 2010. OBJECTIVES: The objective of this review was to integrate recent research with a previously published systematic review on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. TYPES OF PARTICIPANTS: The review considered studies that included adult or pediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient. TYPES OF INTERVENTIONS: The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and patient or parent satisfaction. TYPES OF STUDIES: The review update considered any randomized controlled trials published after 2009; in the absence of randomized controlled trials other research designs, such as non-randomized controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in each component of this review. METHODOLOGICAL QUALITY: Methodological validity was assessed by two reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Due to the clinical heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. RESULTS: Four new studies were identified from searches and added to the 19 studies from the previous review for a total of 23 studies. There is weak evidence to suggest nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, length of stay, adverse surgical events and morbidity. Similarly weak evidence suggests nurse-led preadmission services may improve patient preparation, recognition of postoperative needs and patient/parent satisfaction. CONCLUSIONS: While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low.

Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: a systematic review.

BACKGROUND: Violence in health care has been widely reported and health care workers, particularly nurses in acute care settings, are ill-equipped to manage patients who exhibit aggressive traits. AIM: The aim of this systematic review was to establish best practice in the prevention and management of aggressive behaviours in patients admitted to acute hospital settings. DATA SOURCES: An extensive search of the major databases was conducted from 1990 to 2007. The search included published and unpublished studies and papers in English. REVIEW METHODS: This review considered any quantitative research study design that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. Each included study was quality assessed by two independent reviewers and data were extracted using the relevant tools developed by the Joanna Briggs Institute. RESULTS: Ten studies met the inclusion criteria and were included in the review. The evidence identified from the studies includes: the benefit of education and training of acute care nurses in aggression management techniques; use of "as required" medications is effective in minimising harm to patients and staff; and that specific interventions such as physical restraint may play a role in managing aggressive behaviours from patients in the acute care setting. CONCLUSIONS: This review makes several recommendations for the prevention and management of aggressive behaviours in acute hospital patients. However, due to the lack of high-quality studies conducted in the acute care setting there is huge scope for future research in this area.

ICU nurses' experiences and perspectives of caring for obstetric patients in intensive care: a qualitative study.

AIMS AND OBJECTIVES: The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. BACKGROUND: Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. DESIGN: This study used a descriptive qualitative design. METHODS: Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. RESULTS: The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. CONCLUSION: The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. RELEVANCE TO CLINICAL PRACTICE: Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.

The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review.

EXECUTIVE SUMMARY: Background Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate care for both the patient and the family. An initial search of the Cochrane and Joanna Briggs Institute Libraries did not reveal any published systematic reviews recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care unit.Objectives This systematic review aims to establish best practice in addressing the needs of family members with a relative admitted to an adult critical care unit.Search strategy An extensive search of the major databases was conducted. Databases searched included: MEDLINE, CINAHL, psycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as Pubmed. The search included published and unpublished studies and papers in English from 1980-2010.Selection criteria This review considered any randomised controlled trials that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult intensive care unit. In the absence of randomised controlled trials, other research designs such as quasi-experimental as well as before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients.Assessment of quality Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute.Data collection and analysis Data was extracted from the papers included in this review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form.Results Fourteen studies and one dissertation met the inclusion criteria and were included in the review. There were 12 quasi-experimental studies identified including 8 two or three group, pre-test/post-test studies; 1 one-way between subjects design; 1 interrupted time series and 1 two-group comparative design study. The dissertation was a quasi-experimental three group pre-test/post-test design. There were 3 prospective randomised trials included. The evidence identified includes: the use of support groups for family members of patients admitted to an intensive care unit, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs and open or more flexible visiting hours.Conclusion/Recommendations This review makes several recommendations for clinical practice to address family needs of patients admitted to a critical care unit, however this review highlights the need for significant further research in this area. Future intervention studies focusing on family needs could include: the use of technology such as DVD's and SMS for informing families and interventions specifically designed to improve family comfort.

The effectiveness of interventions in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting: a systematic review.

BACKGROUND: Violence in healthcare has been widely reported and healthcare workers, particularly nurses in the acute care setting, are ill-equipped to manage patients who exhibit aggressive traits. An initial search of the Cochrane Library and the Joanna Briggs Institute did not reveal any published systematic reviews recommending strategies to manage aggressive and/or violent behaviours in patients admitted to an acute hospital setting. OBJECTIVES: This systematic review aims to establish best practice in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting. SEARCH STRATEGY: A three-step search strategy was utilised during this review. Major databases searched included: MEDLINE, CINAHL, PsycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as PubMed. The search included published and unpublished studies and papers in English from 1990-2007. SELECTION CRITERIA: This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. In the absence of RCT's, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for preventing and managing patient aggression in acute care areas. ASSESSMENT OF QUALITY: Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute. DATA COLLECTION AND ANALYSIS: Data was extracted from the papers included in this review using the standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics: Assessment and Review Instrument (JBI-MAStARI) package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form. RESULTS: Twelve studies and one dissertation met the inclusion criteria and were included in the review. The evidence identified includes: the benefit of education and training of acute care nurses in aggression management techniques; the use of "as required" medications to minimise harm to patients and staff; and that specific interventions such as music therapy and physical restraint may play a role in managing aggressive and/or violent behaviours from patients in the acute care setting. CONCLUSION: This review makes several recommendations for clinical practice to prevent and manage aggressive behaviours in acute hospital patients. However due to the lack of high quality intervention studies conducted in the acute care setting there is huge scope for future research in this area.

Implementation of a glucose management protocol to prevent hypo- and hyperglycaemia in critically ill patients.

Background Many healthcare providers acknowledge the importance of encouraging health professionals to base their practice on current evidence. There is a plethora of evidence supporting tight glucose control in critically ill patients to reduce mortality and morbidity and many studies have shown that hyperglycaemia in critically ill patients has been associated with an increased susceptibility to infection and impaired immune response. Methods This project aimed to improve current practice in the prevention and management of hypo- and hyperglycaemia in critically ill patients based on the best available evidence. The setting for the project was a large public hospital in Brisbane, Queensland, with an 11 bed tertiary referral intensive care unit (ICU) for critically ill adult patients. A pre-implementation audit using a set of evidence-based criteria from a systematic review on tight glucose control in critically ill patients was undertaken. The Joanna Briggs Institute on-line audit and feedback software, paces (Practical Application of Clinical Evidence System), was used to analyse the data to determine ICU's current compliance with established best practice in glucose management. These initial audit results were used to develop an action plan to improve glucose management practice within the unit. This included the development and implementation of a glucose management protocol, the identification of barriers and facilitators and education of clinical staff. Following the implementation of this protocol a post-implementation audit was conducted using the same criteria as in the initial audit. Results The post audit findings indicated improvement in most areas of glucose management practice within the ICU. Conclusion The success of this project is not only evident through improved ICU glucose management practice over 12 weeks, but also through clinicians gaining experience in the process of utilising evidence-based recommendations in all areas of practice.