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1.
Int Emerg Nurs ; : 100867, 2020 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-32238322

RESUMO

AIM: To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice. BACKGROUND: Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined. DESIGN: Systematic literature review. DATABASES AND DATA TREATMENT: A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review. RESULTS: Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied. CONCLUSION: Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.

2.
J Clin Nurs ; 29(13-14): 2352-2362, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32221999

RESUMO

AIM: The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. BACKGROUND: Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate-to-severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management. DESIGN: This cross-sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses. METHODS: Australian emergency nurses were invited to complete an online survey comprising 91 items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study. RESULTS: Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses' intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients. CONCLUSIONS: Emergency nurses recognise the importance of pain relief. The ability to nurse-initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor. RELEVANCE TO CLINICAL PRACTICE: While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse-initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.

3.
J Clin Nurs ; 29(7-8): 1381-1397, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31856353

RESUMO

AIMS AND OBJECTIVES: To explore the nature of knowledge exchange on a multi-disciplinary Australasian intensive care virtual community of practice, "ICUConnect." BACKGROUND: Current organisational structures and cultures constrain the social networks of healthcare professionals, limiting access to contemporary best practice knowledge. While virtual communities can facilitate knowledge and clinical expertise exchange in professional networks, their effectiveness has not been established. DESIGN: A sequential mixed-methods design with a quantitative core and qualitative supplementary component was used to explore the content of discussions from an intensive care virtual community. SRQR has been used to report this study. METHODS: Email archives of an intensive care listserv (2003-2013) were mined using a two-stage sampling technique to identify discussion threads (with >2 posts) concerning ventilator or airway practices (cluster) and two sets of 20 threads (stratified across years). Summative content analysis was used to examine both manifest and latent content. RESULTS: Forty threads containing 326 emails posted by 133 individuals from 80 organisations were analysed. Nurses contributed 68% (55% were in clinical leadership roles) and physicians 27%. Three subject areas were identified: clinical practices (71%); equipment (23%); and clinical governance (6%). "Knowledge-requested" and "knowledge-supplied" posts were categorised as follows: experiential and explicit (33% and 16%, respectively); experiential (27% and 35%); or explicit (40% and 17%). Knowledge supplied was also categorised as "know-how" (20%); "know-why" (5%) or "no knowledge" exchanged (6%). The central construct of virtual community work was identified with six elements that facilitated participation and knowledge exchange including: (a) the discussion thread; (b) sharing of artefacts; (c) community; (d) cordiality; (e) maven work; and (f) promotion of the VC. Members asked questions to benchmark their practice, while those who answered were focused on ensuring that best practices were delivered. CONCLUSIONS: ICUConnect reflected characteristics of a virtual community of practice, enabling key benefits for members and the broader Australasian intensive care community, especially access to best practice knowledge from clinical experts. RELEVANCE TO CLINICAL PRACTICE: This study demonstrated that a practice-based VC can function effectively as a VCoP to establish an effective professional network where members have access to up-to-date best practice knowledge. Healthcare organisations could leverage VCs to support the professional development of HCPs and ensure that local clinical practices are based on contemporaneous knowledge. Participation by nurses in these communities facilitates individual professional development and access to important clinical knowledge and expertise, and ultimately reinforcing the unique position of nursing in delivering effective, consistent high-quality patient care.

4.
J Med Internet Res ; 21(11): e14068, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31687936

RESUMO

BACKGROUND: Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow. OBJECTIVE: This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community. METHODS: A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years-between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained. RESULTS: There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: "Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge." The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date. CONCLUSIONS: This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

5.
Nurse Res ; 27(2): 21-25, 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31468884

RESUMO

BACKGROUND: The experiences of nurses participating in ethnographic fieldwork have been well documented, but often feature short-term, intermittent periods in the field of less than a day. AIM: To provide an overview of methodological issues related to collecting data while undertaking a focused ethnography of nurses volunteering with a humanitarian organisation providing surgical care in a remote setting. DISCUSSION: Particular challenges during the fieldwork included limited space and privacy influencing data collection and secure storage; sporadic and unreliable communications limiting contact with other members of the research team; the challenges of withdrawing from the intensity of the setting; and navigating blurred boundaries between the roles of clinician and researcher. CONCLUSION: Social research in practice, despite the best of intentions and significant planning, may not always travel the expected path of rational enquiry. IMPLICATIONS FOR PRACTICE: Awareness of the challenges involved before embarking on longer term entry into remote environments may help prepare future nurse ethnographers.


Assuntos
Antropologia Cultural/métodos , Enfermeiras e Enfermeiros , Pesquisa , Comunicação , Coleta de Dados , Humanos , Armazenamento e Recuperação da Informação , Missões Médicas , Socorro em Desastres , Pesquisadores , Fatores de Tempo
6.
J Clin Nurs ; 28(11-12): 2124-2134, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30786101

RESUMO

AIMS AND OBJECTIVES: To explore the experiences of mothers of extremely premature babies during their Neonatal Intensive Care Unit stay and transition home. BACKGROUND: Mothers of extremely preterm infants (28 weeks' gestation or less) experience a continuum of regular and repeated stressful and traumatic events, during the perinatal period, during the Neonatal Intensive Care Unit stay, and during transition home. METHOD: An interpretive description method guided this study. Ten mothers of extremely premature infants who had been at home for less than six months were recruited via a Facebook invitation to participate in semi-structured telephone interviews exploring their experiences in the Neonatal Intensive Care Unit and the transition home. The data were examined using a six-phase thematic analysis approach. The COREQ checklist has been used. RESULTS: Two main themes emerged: (a) things got a bit dire; and (b) feeling a failure as a mother. Participants had a heightened risk of developing a mental disorder from exposure to multiple risk factors prior to and during birth, as well as during the postnatal period in the Neonatal Intensive Care Unit and their infant's transition to home. Mothers highlighted the minimal support for their mental health from healthcare professionals, despite their regular and repeated experience of traumatic events. CONCLUSION: The mothers were at high risk of developing post-traumatic stress symptoms and/or other mental health issues. Of note, study participants relived the trauma of witnessing their infant in the Neonatal Intensive Care Unit, demonstrated hypervigilance behaviour and identified lack of relevant support needed when their infant was at home. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for nurses to include a focus on the mothers' psychosocial needs. Supporting maternal mental health both improves maternal well-being and enables mothers to be emotionally available and responsive to their extremely preterm infant.


Assuntos
Lactente Extremamente Prematuro , Mães/psicologia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Enfermagem Neonatal/métodos , Gravidez , Pesquisa Qualitativa , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia
7.
Aust Crit Care ; 32(2): 131-138, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29754983

RESUMO

BACKGROUND: Despite improvements in survival after critical illness and intensive care unit (ICU) treatment, some recovering patients still face ongoing challenges. There are few investigations exploring the incidence, risk factors, and trajectory for cognitive impairment (CI) in former ICU patients in Australia. OBJECTIVES: To test the feasibility of a study protocol designed to ascertain the incidence and impact of CI during recovery from a critical illness. METHODS: We conducted a mixed-methods longitudinal single-centre pilot study. Participants were adult patients mechanically ventilated for ≥48 h. Cognitive function was assessed during hospitalisation and at 1 week, 2 months, and 6 months after hospital discharge, using the Montreal Cognitive Assessment instrument. Factors potentially affecting cognitive function were also collected, including demographic and clinical variables and fatigue, frailty, and muscle strength. Semistructured interviews were conducted to further explore participants' experiences during recovery. RESULTS: We screened 2068 patients (10% met the inclusion criteria). Participants (n = 20) were mostly male with a mean age 61.9 years and a median of 4 days of mechanical ventilation. Data collection was complete for 14 and 11 participants at 2 months and 6 months, respectively. Pre-illness patients were not cognitively impaired; one patient had delirium in ICU. The proportion of patients with CI ranged from 80% (17/18) while in hospital to 35% (5/14) at 6 months. Participants were challenged by fatigue and sleep disruption during recovery but were not particularly concerned about CI. CONCLUSIONS: Recruitment in ICU was challenging as few patients received prolonged mechanical ventilation. The protocol was feasible, but some attrition was noted. A significant proportion of patients had mild CI, largely confined to recall, and language cognitive domains; quantitative findings were supported by interview findings. Further investigations are required to ascertain the most appropriate inclusion criteria to enable identification of those at highest risk of CI.

8.
Int Emerg Nurs ; 43: 67-73, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30381142

RESUMO

BACKGROUND: In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM: To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS: Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS: Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS: The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.


Assuntos
Papel do Profissional de Enfermagem/psicologia , Percepção , Atitude do Pessoal de Saúde , Austrália , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Projetos Piloto , Inquéritos e Questionários , Listas de Espera
9.
BMC Res Notes ; 11(1): 769, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373649

RESUMO

OBJECTIVE: To examine anti-microbial prescribing practices associated with ventilator-associated pneumonia from data gathered during an audit of practice and outcomes in intensive care units (ICUs) in a previously published study. RESULTS: The patient sample of 169 was 65% male with an average age of 59.7 years, a mean APACHE II score of 20.6, and a median ICU stay of 11 days. While ventilator-associated pneumonia was identified using a specific 4-item checklist in 29 patients, agreement between the checklist and independent physician diagnosis was only 17%. Sputum microbe culture reporting was sparse. Approximately 75% of the sample was administered an antimicrobial (main indications: lung infection [54%] and prophylaxis [11%]). No clinical justification was documented for 20% of prescriptions. Piperacillin/tazobactam was most frequently prescribed (1/3rd of all antimicrobial prescriptions) with about half of those for prophylaxis. Variations in prescribing practices were identified, including apparent gaps in antimicrobial stewardship; particularly in relation to prescribing for prophylaxis and therapy de-escalation. Sputum microbe culture reports for VAP did not appear to contribute to prescribing decisions but physician suspicion of lung infection and empiric therapy rather than ventilator-associated pneumonia criteria and guideline concordance.


Assuntos
Antibacterianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Auditoria Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
10.
Int Emerg Nurs ; 40: 46-53, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29885907

RESUMO

AIM: This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED). BACKGROUND: Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain. DESIGN: Systematic review. DATABASES AND DATA TREATMENT: Four databases - CINAHL, EMBASE, Medline, ProQuest - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to December 2017; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published valid criteria. RESULTS: Twelve articles met inclusion, comprising a wide range of analgesics and administration routes to manage mild to severe pain. Overall study quality was high; 7 studies included a form of comparison group. Patient outcome measures included time to analgesia (n = 12; 100%), change in pain score (n = 6; 50.0%); adverse events (n = 6; 50.0%); patient satisfaction (n = 5; 41.7%) and documenting pain assessment (n = 2; 16.7%). CONCLUSION: Nurse-initiated analgesia was associated with safe, timely and effective pain relief.


Assuntos
Analgesia/normas , Papel do Profissional de Enfermagem , Analgesia/enfermagem , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Dor/tratamento farmacológico , Manejo da Dor/enfermagem , Satisfação do Paciente , Fatores de Tempo , Tempo para o Tratamento/normas
11.
J Clin Nurs ; 27(7-8): e1402-e1411, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29266573

RESUMO

AIMS AND OBJECTIVES: To identify the activities and behaviours of waiting room nurses in emergency department settings. BACKGROUND: Emergency care has expanded into waiting rooms in some emergency departments. Often viewed as an adjunct to triage, the aim of waiting room nurses is to commence care early, reassess patients and improve communication between patients, families and staff. There is however a paucity of literature relating to waiting room nurses, especially in relation to their current activities and behaviours. DESIGN AND METHODS: Part of a larger exploratory sequential mixed methods designed study. This phase used a nonparticipant observer role to observe waiting room nurses in their natural setting undertaking normal care and responsibilities. One observer, using a tool and reflective journal, collected data on participant interactions, processes and practices on eight waiting room nurses over 13 episodes of observation (total 65 hr:50 min) in two emergency departments. Data analysis used descriptive statistics and thematic analysis. RESULTS: Participants were observed to anticipate and prioritise to deliver holistic, patient-centred care in emergency department waiting rooms. Waiting room nurses had a varied and unpredictable workload, including facilitating the flow of patients from the waiting room. They contributed to patient safety in the waiting room, primarily by reassessing and detecting clinical deterioration. CONCLUSION: Further research into this role is required, including linking efficacy with experience of nurses, impact the role has on patient safety, and patient and family perceptions of the role. RELEVANCE TO CLINICAL PRACTICE: Therapeutic engagement allowed waiting room nurses to reassure and calm patients and families, and deliver holistic, patient-centred care. Waiting room nurses contributed to patient safety in the waiting room, by promptly commencing episodes of care in the waiting room and through close monitoring and assessment to detect patient deterioration.


Assuntos
Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Adulto , Feminino , Humanos , Segurança do Paciente , Assistência Centrada no Paciente/métodos , Pesquisa Qualitativa , Triagem/organização & administração
12.
Scand J Trauma Resusc Emerg Med ; 25(1): 75, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28764789

RESUMO

BACKGROUND: Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department. METHODS: In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described. DISCUSSION: Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.


Assuntos
Dor Aguda/diagnóstico , Dor Aguda/enfermagem , Estado Terminal/enfermagem , Serviço Hospitalar de Emergência , Manejo da Dor/métodos , Dor Aguda/etiologia , Adulto , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , New South Wales , Medição da Dor
13.
J Clin Nurs ; 26(23-24): 3990-4012, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28382678

RESUMO

AIMS AND OBJECTIVES: To identify, appraise and synthesise current evidence regarding organisation-wide interprofessional practice issues that facilitate or inhibit effective recognition and response to clinical deterioration, using a theoretical rapid response system model. BACKGROUND: Recognition and response to clinical deterioration, in adult general medical-surgical ward patients, is embedded as routine interprofessional practice in acute healthcare organisations worldwide. The process of care escalation is complex and sometimes involves multiple health professionals from different disciplines with varying levels of expertise. While a theoretical rapid response system model offers a formalised structured approach to escalate patient care, it is unclear how the implementation of this model, or similar, influences rapid response system-wide interprofessional practices to effectively recognise and respond to clinical deterioration. DESIGN: An integrative review. METHODS: This review was conducted using key words to systematically search four electronic bibliographic databases (PubMed, CINAHL, ProQuest Central, Cochrane Library). Twenty-nine eligible full-text papers were identified. Quality appraisal of methods was performed using recommended guidelines. Study findings were narratively coded, themed and conceptualised in the context of an organisation-wide rapid response system using an interprofessional collaborative practice framework. RESULTS: Five main themes aligned with the four interprofessional collaborative practice competency domains and a learning continuum of professional development: Organisational culture, Role perceptions and professional accountability, Communication of clinical needs, Team-based practices, and Interprofessional learning opportunities in recognising and responding to clinical deterioration. Within these themes, three notable interprofessional practice issues were highlighted: professional reporting hierarchies (inhibiting), critical care outreach services (facilitating) and interprofessional relationships (facilitating). CONCLUSIONS: A unique approach for exploring organisation-wide interprofessional practice issues has been presented using an interprofessional collaborative practice framework. Further interpretive organisation-wide research is necessary to develop a more in-depth and meaningful understanding of interprofessional collaborative practice issues that facilitate or inhibit effective recognition and response to clinical deterioration. RELEVANCE TO CLINICAL PRACTICE: This review presents a unique system-wide approach for exploring how health professionals interprofessionally collaborate in practice to effectively recognise and respond to clinical deterioration.


Assuntos
Deterioração Clínica , Comunicação , Comportamento Cooperativo , Relações Interprofissionais , Adulto , Assistência à Saúde/organização & administração , Pessoal de Saúde/psicologia , Humanos , Cultura Organizacional , Equipe de Assistência ao Paciente , Pesquisa Qualitativa
14.
J Clin Nurs ; 26(23-24): 3950-3961, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28334465

RESUMO

AIMS AND OBJECTIVES: To appraise the literature related to voluntary humanitarian work provided by international nurses in low- to middle-income countries. BACKGROUND: Nurses and other health professionals are engaged with both governmental and nongovernmental organisations to provide care within international humanitarian relief and development contexts. Current literature describes accounts of charitable health professional activity within short-term health-focused humanitarian trips; however, there is minimal research describing the care that nurses provide and the professional roles and tasks they fulfil whilst participating in international volunteer healthcare service. DESIGN: Integrative review. METHODS: A search of articles published between 1995-2015 was conducted using seven bibliographic databases. Inclusion criteria incorporated nurses and allied health professionals' involvement in a volunteer short-term medical team capacity. Papers describing military and/or disaster response with a service-learning focus were excluded. Nineteen papers were selected for review, description and discussion of findings. RESULTS: Findings revealed limited data describing the care nurses provide and the professional roles and tasks they fulfil within the context of international humanitarian short-term medical trips. Issues raised included a description of demographic data regarding participants and sending agencies, motivation for volunteer participation, perceptions of effectiveness of particular programmes and sustainability issues related to cultural, ethical or moral obligations of foreign health professionals working in a low- to middle-income countries. CONCLUSION: Study findings highlighted that although nurses are recruited and participate in health-focused humanitarian activities in low- to middle-income countries, there is extremely limited documented research about the amount and type of care that nurses specifically provide in this context. Furthermore, when identified, it is most often hidden within studies outlining services provided by healthcare teams and not specific to the discipline of nursing. Further research is therefore required to enable greater understanding of nursing care in this context and to inform prospective volunteers of expected nursing practice. RELEVANCE TO CLINICAL PRACTICE: This article provides an analysis of available literature describing nursing involvement within the particular context of short-term medical teams delivering charitable health care.


Assuntos
Países em Desenvolvimento , Enfermeiras Internacionais , Socorro em Desastres , Assistência à Saúde/métodos , Humanos , Papel do Profissional de Enfermagem , Voluntários/psicologia
15.
J Adv Nurs ; 73(12): 2892-2902, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28329432

RESUMO

AIMS: To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated. BACKGROUND: Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required. DESIGN: Two-phase audit. METHODS: Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012). FINDINGS: Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%-14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart. CONCLUSIONS: User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.


Assuntos
Fidelidade a Diretrizes , Auditoria Médica , Registros Médicos , Observação , Humanos , Monitorização Fisiológica , Estudos Prospectivos , Estudos Retrospectivos
16.
Australas Emerg Nurs J ; 20(1): 6-11, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28108139

RESUMO

BACKGROUND: Emergency departments have become overcrowded with increased waiting times. Strategies to decrease waiting times include time-based key performance indicators and introduction of a waiting room nurse role. The aim of the waiting room nurse role is to expedite care by assessing and managing patients in the waiting room. There is limited literature examining this role. METHODS: This paper presents results of semi-structured interviews with five key informants to explore why and how the waiting room nurse role was implemented in Australian emergency departments. Data were thematically analysed. RESULTS: Five key informants from five emergency departments across two Australian jurisdictions (Victoria and New South Wales) reported that the role was introduced to reduce waiting times and improve quality and safety of care in the ED waiting room. Critical to introducing the role was defining and supporting the scope of practice, experience and preparation of the nurses. Role implementation required champions to overcome identified challenges, including funding. There has been limited evaluation of the role. CONCLUSIONS: The waiting room nurse role was introduced to decrease waiting times and contributed to risk mitigation. Common to all roles was standing orders, while preparation and experience varied. Further research into the role is required.


Assuntos
Enfermagem em Emergência , Serviço Hospitalar de Emergência , Papel do Profissional de Enfermagem , Austrália , Humanos , Entrevistas como Assunto , Segurança do Paciente , Listas de Espera , Recursos Humanos
17.
J Clin Nurs ; 26(1-2): 7-32, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27685422

RESUMO

AIM AND OBJECTIVE: To examine the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND: In the emergency department, assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e.g. endotracheal intubation) and/or diminished consciousness (e.g. sedation, delirium), placing them at great risk of inadequate pain management. Over half of intensive care critically ill intubated patients experience moderate-to-severe pain whilst intubated and mechanically ventilated. DESIGN: Systematic review. DATA SOURCES: The CINAHL, EMBASE, MEDLINE, ProQuest databases, and the Cochrane Library and the National Institute of Clinical Excellence were also searched from their date of inception to April 2016, with no language restrictions applied. REVIEW METHOD: Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published classification of psychometric tests for consistency of interpretation. RESULTS: Twenty-six studies evaluating five observational pain assessment instruments that had been used with critically ill intubated patients were identified. All five instruments included behavioural indicators, with two including physiologic indicators. All five instruments have undergone validity and reliability testing involving nonverbal critically ill intubated patients, three were examined for feasibility, and one instrument underwent sensitivity and specificity testing. None have been tested within the emergency department with nonverbal critically ill intubated adult patients. CONCLUSION: The use of an appropriate and valid observational pain assessment instrument is fundamental to detecting and optimising pain management in nonverbal critically ill intubated patients in the emergency department. Of the observational pain assessment instruments reviewed, the Critical-Care Pain Observation Tool was identified as most appropriate for testing in a prospective trial in an emergency department setting.


Assuntos
Estado Terminal , Serviço Hospitalar de Emergência , Medição da Dor , Dor/diagnóstico , Adulto , Humanos , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
J Med Internet Res ; 18(6): e166, 2016 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-27328967

RESUMO

BACKGROUND: Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines. OBJECTIVES: This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice. METHODS: An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used. RESULTS: Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of "planned behavior" and the "technology acceptance model" (n=3) suggests that social media use is mediated by an individual's positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions. CONCLUSIONS: There is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved.


Assuntos
Comunicação , Pessoal de Saúde , Mídias Sociais/estatística & dados numéricos , Humanos , Pesquisa Qualitativa , Inquéritos e Questionários
20.
JMIR Res Protoc ; 5(2): e99, 2016 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-27296929

RESUMO

BACKGROUND: Many current challenges of evidence-based practice are related to ineffective social networks among health care professionals. Opportunities exist for multidisciplinary virtual communities to transcend professional and organizational boundaries and facilitate important knowledge transfer. Although health care professionals have been using the Internet to form virtual communities for many years, little is known regarding "why" they join, as most research has focused on the perspective of "posters," who form a minority of members. OBJECTIVE: Our aim was to develop a comprehensive understanding of why health care professionals belong to a virtual community (VC). METHODS: A qualitative approach will be used to explore why health care professionals belong to an intensive care practice-based VC, established since 2003. Three asynchronous online focus groups will be convened using a closed secure discussion forum. Participants will be recruited directly by sending emails to the VC and a Google form used to collect consent and participant demographics. Participants will be stratified by their online posting behaviors between September 1, 2012, and August 31, 2014: (1) more than 5 posts, (2) 1-5 posts, or (3) no posts. A question guide will be used to guide participant discussion. A moderation approach based on the principles of focus group method and e-moderation has been developed. The main source of data will be discussion threads, supported by a research diary and field notes. Data analysis will be undertaken using a thematic approach and framed by the Diffusion of Innovation theory. NVivo software will be used to support analyses. RESULTS: At the time of writing, 29 participants agreed to participate (Focus Group 1: n=4; Focus Group 2: n=16; Focus Group 3: n=9) and data collection was complete. CONCLUSIONS: This study will contribute to a growing body of research on the use of social media in professional health care settings. Specifically, we hope results will demonstrate an enhancement of health care professionals' social networks and how VCs may improve knowledge distribution and patient care outcomes. Additionally, the study will contribute to research methods development in this area by detailing approaches to understand the effectiveness of online focus groups as a data collection method for qualitative research methods.

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