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Biomedical subjects

Glenn Gardner

Publications and source records attributed to Glenn Gardner.

10 recordsLinked to original sources
PubMed2006

Using a monitored test to assess risk of aspiration in postoperative patients.

Pulmonary aspiration is associated with high morbidity and mortality rates. Older adult patients have been shown to be particularly at risk for aspiration. A randomized controlled trial was conducted to investigate the efficacy of a simple, noninvasive screening test-the monitored sip test-in identifying patients at risk for aspiration, including "silent aspirators." Based on clinical judgment using the study's outcome measures, incidence of aspiration-related lung injury was high (ie, 37.5%); however, no identification of patients at risk for aspiration occurred after either the use of the monitored sip test or routine cautious introduction of fluids during the data collection phase of the study.

Aged↗
PubMed2005

Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research.

BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Attitude of Health Personnel↗
PubMed2005

Surgeons' perspectives on surgical wound infection rate data in Queensland, Australia.

BACKGROUND: The results of the Study on the Efficacy of Nosocomial Infection Control (SENIC) project demonstrated that hospitals with active infection control programs had lower rates of nosocomial infection than those without such programs. A key component of these programs was the inclusion of a systematic method for monitoring nosocomial infection and reporting these infections to clinicians. OBJECTIVES: To identify the perspectives of surgeons in Queensland, Australia, regarding infection rate data in terms of its accuracy and usefulness as well as their perceptions regarding acceptable infection rates for surgical procedures classified as "clean" or "contaminated." METHODS: A postal survey was conducted, with a convenience sample of 510 surgeons. RESULTS: More than 40% (n = 88) of respondents believed that the acceptable infection rate associated with clean surgical procedures should be less than 1%, a rate much lower than the threshold of 1.4% to 4.1% set by the Australian Council on Healthcare Standards (ACHS). Almost 30% (n = 55) of respondents reported that they would accept infection rates of 10% or higher for contaminated surgical procedures, which is higher than the ACHS threshold of 1.4% to 7.9%. Respondents identified failure to include postdischarge infections in the data and difficulties standardizing criteria for diagnosis of infection as the major impediments to the accuracy and usefulness of data provided. CONCLUSION: The results of this study have significant implications in relation to the preparation of surgical site infection reports, especially in relation to the inclusion of postdischarge surveillance data and information regarding pathogens, antibiotic sensitivities, and comorbidities of patients developing surgical site infection. Surgeons also identified the need to include information regarding the use of standardized definitions in the diagnosis of wound infection and parameters that allow comparison of infection rates to improve their perceptions regarding data accuracy and usefulness.

Attitude of Health Personnel↗
PubMed2005

A trial of nurse practitioner scope of practice.

AIMS: The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice. BACKGROUND: Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues. METHODS: This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period. FINDINGS: The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models. CONCLUSIONS: This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.

Adolescent↗
PubMed2004

Nurse practitioner education: a research-based curriculum structure.

BACKGROUND: The process and content of nurse practitioner educational preparation has received scant research attention, despite increasing interest in and investigations into nurse practitioner services in Australia and internationally. AIMS: The aim of this paper is to report a study investigating the educational process and content required for nurse practitioner preparation. METHODS: A trial of practice was conducted with four nurse practitioner candidates over a 12-month period. The candidates practised in different specialities, giving rise to four models of the nurse practitioner role. The trial had multiple aims related to the role and scope of practice of the nurse practitioner. An action learning model was used, in which participating nurse practitioner candidates 'worked-into-the-role' of extended practice and learned from experience through clinical mentoring, reflection and action. Data collection methods centred on transcripts from group work activities related to a collaborative engagement with and reflections on clinical practice. This resulted in the collaborative production of data to inform a research-based nurse practitioner curriculum structure. FINDINGS: The findings relate to the content and learning process required for nurse practitioner education and are described in terms of three broad areas of study: clinical practice, clinical sciences and nursing studies. CONCLUSIONS: A curriculum structure that describes content and process for nurse practitioner education was developed from the findings. A further outcome of this trial was confirmation of importance of the clinical environment for nurse practitioner education. Inherent in this aspect of clinical learning is the role of a committed clinical mentor who can facilitate purposeful learning.

Adult↗
PubMed2004

Telling accounts of wound infections: avoidance, anomaly and ambiguity.

Drawing from an interpretive study this article reports on an investigation into the way that patients receive information about having a surgical wound infection. The study findings indicated that patients often struggle to gain this information and health professionals use a range of strategies to avoid rather than engage the patient in discussions about their infection. A sociological analysis of this avoidance draws upon the literature pertaining to issues of power/knowledge, shame and reluctance to engage in potentially distressing interactions. The findings also indicate that considerations of the success of surgery can relate more to the technical aspects of the operation rather than the patient health outcomes. This study demonstrates the clinical relevance of interpretive research and shows how this approach can produce knowledge to inform health service and patient care practices.

Anger↗
PubMed2003

Reconceptualising the objectives of a pilot study for clinical research.

This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.

Biomedical Research↗
PubMedDate not supplied

Managing intravenous medications in the non-hospital setting: an ethnographic investigation.

Little published information exists about the issues involved in conducting complex intravenous medication therapy in patients' homes. An ethnographic study of a local hospital-in-the-home program in the Australian Capital Territory explored this phenomenon to identify those factors that had an impact on the use of medicine in the home environment. This article focuses on one of the three themes identified in the study-Clinical Practice. Within this theme, topics related to the organization and management of intravenous medications, geography and diversity of patient caseload, and communication in the practice setting are discussed. These findings have important implications for policy development and establishment of a research agenda for hospital-in-the-home services.

Adaptation, Psychological↗