What is the evidence for the use of high flow nasal cannula oxygen in adult patients admitted to critical care units? A systematic review.

BACKGROUND: Humidified high flow nasal cannula oxygen therapy is increasingly available in Australian adult intensive care units. Its use in paediatric populations has been extensively studied and has shown positive effects however its clinical effectiveness in adults has not been established. PURPOSE: A systematic review of the literature was conducted to critique current evidence, inform nursing practice and make recommendations for nursing research. METHODS: An extensive search strategy identified clinical studies comparing standard oxygen therapy with high flow therapy in critical care units. Two reviewers independently assessed articles for eligibility, methodological quality and inclusion. Outcomes of interest included oxygenation, ventilation, work of breathing, positive airway pressure, patient comfort and long term effect. A narrative synthesis was conducted to describe the emerging evidence. FINDINGS: Eight studies were included for review. All were abstracts or poster presentations from scientific meetings therefore the quality of data available for analysis was poor. Findings indicated there was preliminary evidence to support the use of high flow therapy to optimise oxygenation in adults. This therapy may reduce the effort of breathing and provide augmented airway pressures. Patients described the therapy as comfortable. No definitive evidence supported the claim that ventilation is improved or conclusively demonstrated a long-term effect. CONCLUSION: Humidified high flow nasal cannula may be used as an intermediate therapy to improve oxygenation in adult critical care patients. Further research is required to determine the duration of effect of the therapy, identify the patient population for whom it is most beneficial and evaluate long-term outcomes; to enable definitive recommendations for practice to be made.

Publish or perish: ensuring longevity in nurse education-evaluation of a strategy to engage academics, students, and clinicians in publication activity.

The expectation that academics publish and disseminate research findings, information, and knowledge is increasingly becoming a component of nursing and academic practice. This can be seen as an overwhelming responsibility in the absence of a supportive framework and arbitrary expectations to "publish or perish" within academic and professional life. The pressure to publish has been associated with detrimental effects on creativity, morale, and output. An initiative by a school of nursing to develop a supportive framework to assist staff and multidisciplinary colleagues to publish, by promoting a cultural change through focusing on the benefits of publishing, was successful in increasing confidence, knowledge, and motivation to publish. Through the implementation of a strategic plan acknowledging 4 incremental stages, "promote, prepare, polish and proliferate," the enormity of the task of publishing was demystified, the skills required were outlined, and the incentive of incorporating these strategies into practice were highlighted.

The clinical effectiveness of nurse practitioners' management of minor injuries in an adult emergency department: a systematic review.

Background The increasing cost of healthcare in Australia demands changes in the way healthcare is delivered. Nurse practitioners have been introduced into specialty areas including emergency departments. Specific interventions are known to include the treatment and management of minor injuries, but little has been reported on their work. Objectives Examine the best available evidence to determine the clinical effectiveness of emergency department nurse practitioners in the assessment, treatment and management of minor injuries in adults. Inclusion criteria For inclusion studies had to include adult patients treated for minor injuries by nurse practitioners in emergency departments. All study designs were included. Search strategy English language articles from 1986 onwards were sought using MEDLINE, CINAHL, Embase and Science Citation Index. Methodological quality Two independent reviewers critically appraised the quality of the studies and extracted data using standardised tools. Data collection Two independent reviewers assessed the eligibility of each study for inclusion into the review and the study design used. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Data synthesis Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. For each outcome measure, results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Results Nine studies from a total of 55 participants met the inclusion criteria. Two were randomised controlled trials. Metasynthesis of research findings generated five synthesised findings derived from 16 study findings aggregated into seven categories. Evidence comparing the clinical effectiveness of nurse practitioners to mainstream management of minor injuries was fair to poor methodological quality. When comparable data were pooled, there were no significant differences (P < 0.05) between nurse practitioners and junior doctors. Conclusions The results emphasise the need for more high-quality research using appropriate outcome measures in the area of clinical effectiveness of nurse practitioners, particularly interventions that improve outcomes for presentations to emergency departments and address issues of waiting and congestion.