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Biomedical subjects

B Copnell

Publications and source records attributed to B Copnell.

7 recordsLinked to original sources
PubMed2001

Evidence based practice: are critical care nurses ready for it?

In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.

Adult↗
PubMed1998

Synthesis in nursing knowledge: an analysis of two approaches.

The need for synthesis in nursing knowledge development has been attested to by many authors. It is consistent with nursing's holistic focus and is the mark of a mature discipline. This paper examines two approaches to synthesis: the use of multiple paradigms and the possible emergence of a new paradigm based on chaos theory. It argues that in their current form both approaches have flaws and neither achieves synthesis as it is here defined. However, both may make significant contributions to the development of nursing knowledge.

Data Interpretation, Statistical↗
PubMed1998

Understanding change in clinical nursing practice.

The present paper employs a poststructural framework to explore the construction of change in clinical nursing practice, as portrayed in nursing literature. In it a critique of two specific bodies of literature is offered: that which deals with the 'abstract' conception of change (but which is heavily influenced by organizational discourses) and that which describes changes in the clinical setting of critical care nursing practice. It is argued that the discursive constitution of change that is revealed in this analysis disadvantages clinical nurses. Because the context in which change occurs is largely unacknowledged, clinical nursing practice, as experienced and understood by nurses, is also marginalized. Change in clinical practice is under-researched, and such inquiry should be undertaken from the perspective of nurses themselves, and requires an exploration of the discursive context of nursing work.

Humans↗
PubMed1997

Analysis of risk factors for omental herniation associated with removal of peritoneal catheters.

BACKGROUND: Peritoneal catheters may be used routinely in children undergoing cardiac surgery. Removal of the catheter is often complicated by omental herniation, which can cause intraperitoneal bleeding, peritonitis, and bowel obstruction. Instillation of saline into the catheter before removal is used in some institutions as a preventive measure, but the practice has never been investigated. OBJECTIVE: To determine the effectiveness of instilling saline into peritoneal catheters before their removal in reducing the occurrence of omental herniation and to determine risk factors for omental herniation. METHODS: A total of 404 patients with peritoneal catheters in place were randomized to either the control or the study group. The study group (n = 204) had saline (1 mL/kg; maximum, 10 mL) instilled into the catheter before the catheter was removed; the control group (n = 200) did not. Extrusion or no extrusion of omentum was recorded. Other data collected included the child's weight, the length of time the catheter was in place, whether peritoneal dialysis was performed, and whether the child was pharmacologically paralyzed when the catheter was removed. RESULTS: Extrusion of omentum occurred in 39% of the study group and in 33% of the controls. Results of logistic regression analysis suggested that omental herniation was more common in smaller children, children whose catheters remained in place longer, and children who were not pharmacologically paralyzed when the catheter was removed. CONCLUSIONS: Instillation of saline does not appear to reduce the occurrence of omental herniation. Further research into strategies to reduce this complication is recommended.

Adolescent↗
PubMed1995

Endotracheal suctioning: time-worn ritual or timely intervention?

BACKGROUND: Although many investigators have assessed the technique of endotracheal tube suctioning, the tissue of how frequently it should be performed remains controversial. No objective data is available to determine the answer. OBJECTIVE: To determine the criteria nurses use to make decisions regarding endotracheal suctioning. METHOD: Twenty-four registered nurses of varying levels of experience were asked a series of open-ended questions related to their theoretical knowledge, their ability to apply this knowledge, their suctioning practice, and how they made decisions regarding suctioning. RESULTS: All participants believed their patients required suctioning every 1 to 3 hours, with 17 performing it every 2 to 3 hours. Twenty criteria of which nine related to frequency were used in determining suctioning requirements. Eleven related to recognizing the need for immediate suctioning and were concerned with changes in the patient's condition. Common significant changes included desaturation, hemodynamic changes, loss of color, and blood gas changes. No single criterion was identified by all nurses. No differences were apparent between experienced and less experienced nurses. CONCLUSIONS: The large number of criteria identified suggests that the decision to suction is a complex one. It is a concern that many nurses rely on a deterioration in the patient's condition to indicate when suctioning is required. A policy of suctioning as necessary is provision of clear guidelines and education of all staff.

Adolescent↗
PubMedDate not supplied

Effect of reusing suction catheters on the occurrence of pneumonia in children.

OBJECTIVE: The purpose of this study was to determine whether disposable suction catheters can be reused in the same patient for a 24-hour period without affecting the incidence of pneumonia. DESIGN: The study design was a randomized controlled trial. SETTING: The study was conducted in the pediatric intensive care unit of a tertiary pediatric center. SAMPLE: Subjects included 486 children with an endotracheal tube in place. OUTCOME MEASURES: The development of pneumonia, diagnosed with radiographic and clinical evidence, was the measure. Cost analysis was also undertaken. METHOD: Subjects in the study group (n = 241) were suctioned using the same catheter for a 24-hour period. Those in the control group (n = 245) had a new catheter for each episode of suctioning. RESULTS: Pneumonia developed in 14 members (5.71%) of the control group and in 12 members (4.98%) of the study group, a difference of 0.7% (95% CI, -3.3% to 4.7%). Cost analysis indicated a saving of Aust $4.14 per patient per day. CONCLUSION: Reusing suction catheters for up to 24 hours is both safe and cost-effective.

Adolescent↗