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Biomedical subjects

Helen McCutcheon

Publications and source records attributed to Helen McCutcheon.

15 recordsLinked to original sources
PubMed2006

Observations and vital signs: ritual or vital for the monitoring of postoperative patients?

Patient surveillance during the postoperative period has traditionally consisted of the collection of routine and regulated vital signs, supported by observations of other aspects of a patient's recovery. The purpose of this research was to determine if the frequent collection of postoperative vital signs assisted in detecting postoperative complications in the first 24 hours after a patient has returned to the ward setting. The study involved: (1) a survey of policy documents; (2) observations of postoperative nursing care; and (3) an audit of medical records. Major findings revealed that vital signs are collected based on tradition and are collected routinely, and there may not be a relationship between vital-signs collection and the occurrence or detection of complications.

Adult↗
PubMed2006

Mealtimes in hospital--who does what?

AIM: This paper describes the findings of a descriptive study about what nurses do at mealtimes in relation to monitoring/assisting the eating practices of older patients in an acute care facility. BACKGROUND: The prevalence of under nutrition is known to be high in hospitalized older patients and insufficient dietary intake is regarded as a major cause. However, most of the research tends to concentrate on the nursing home setting. Little is known about the situation in acute care facilities. METHODS: Two medical wards participated in the study. Ward 1 had introduced a change of nurses' meal break time and ward 2 continued with normal practice. Convenience sampling was used. Fifty nurses and 48 patients were observed at different mealtimes during two weeks. Four nurses and four patients who were observed were also interviewed. Data were analysed using descriptive statistics and thematic analysis. RESULTS: Kitchen staff delivered all meals and collected the majority of the meal trays. Older patients did not receive enough assistance during mealtimes. Interruptions happened frequently and social interaction was neglected. About one-third of patients observed left more than two-third of their meals. CONCLUSION: Nutrition issues appeared to receive less priority in the ward than other nursing care activities and nurses' assistance was generally insufficient and not provided in a timely manner. Relevance to clinical practice. Findings highlight the deficiency in practice that should suggest to nurses that they examine their practice and put into place strategies to ensure older patients are properly/adequately hydrated and receive sufficient nutrient intake.

Activities of Daily Living↗
PubMed2006

The history of nursing services and education in Sri Lanka and the effects on developing professionalism.

Understanding the evolution of nursing in a country provides perspective on the origins of current successes and dilemmas and enables the development of strategies and plans for future trends in the profession. This article explores the evolution of nursing services and education in Sri Lanka and the effects on developing professionalism in nursing. Internet database searches, personal communication, and published and unpublished literature and reports were reviewed to obtain historical information on nursing services and education in Sri Lanka. The Sri Lankan health system is reviewed, and the establishment of Western medicine in Sri Lanka and its effects on developing institutionalized nursing education is presented, with a focus on the evolution of nursing education. Major challenges for the nursing profession in Sri Lanka are discussed, and some recommendations are shared.

Delivery of Health Care↗
PubMed2004

Detecting pain in people with an intellectual disability.

The assessment of pain in a person with an intellectual disability (ID) is often a difficult undertaking complicated by idiosyncratic reactions or vague descriptions. The person with an ID may also be unable to verbally communicate their discomfort. For the carer who knows the individual with an ID, knowing how they respond to painful stimuli assists the carer to detect new instances of pain. The emergency nurse is unlikely to have met the person with an ID and therefore detecting pain by observing behaviour or using self-report measures is unlikely to succeed. There have been some attempts to categorize behavioural responses to pain by people with an ID, however, they have not been developed into a useful assessment tool. Emergency nurses must therefore rely on the person who knows the person with an ID.

Communication Barriers↗
PubMed2004

Postnatal depression: a review of current literature.

The print and other forms of media offer significant amounts of information to women about pregnancy, parenthood and the birth process, but much less information exists about postnatal depression and how to cope with the frequently painful realities involved in childbirth and parenting--especially when debilitated by postnatal depression (PND). Even less information exists about such women's reactions to interventions by health professionals, which is the subject of my Ph.D study in progress. This article reviews current literature about the clinical presentation of postnatal depression, the three major types of mood disorders following childbirth, the risk factors for postnatal depression, detection and treatment of postnatal depression and the need for further research on treatment outcomes for women with PND.

Adult↗
PubMed2004

Postoperative complications in the first 24 hours: a general surgery audit.

BACKGROUND: Traditionally, the purpose of routine postoperative surveillance has been to detect postoperative complications. The literature reports well-documented, procedure-specific postoperative complication rates. However, there are no reports detailing the prevalence of postoperative complications in general surgical ward settings, where nurses care for patients following a variety of surgical procedures. AIMS: This paper reports an audit of the frequency and type of postoperative complications in a general surgical population occurring in the first 24 hours postoperatively. METHOD: A patient record audit was undertaken for all postoperative patients who returned to two general surgical wards. This was conducted sequentially, involving a 4 week data collection phase in each participating ward during 2001. RESULTS: The audit sample comprised 144 patient records with an average patient age of 54 years. Statistically significant results included the rate of postoperative nausea and vomiting of 37.5% (n = 54), and 17% (n = 25) of patients experiencing another 'clinical event'. LIMITATIONS: The findings reflect only those complications recorded/documented in postoperative patients' records, and cannot be generalized beyond the sample and setting. CONCLUSIONS: Postoperative patients cared for on general surgical wards experienced a high level of nausea and vomiting, while the occurrence of life-threatening complications was small.

Adolescent↗
PubMed2003

Evidence-based practice: to be or not to be, this is the question!

Evidence-based nursing is the current fashion. It is being touted as the mechanism to achieve best practice in the clinical setting. But while evidence-based practice (EBP) is being presented in the literature, discussed at nursing practice forums, and evidence-based centres of excellence have developed, there seems to be very little impact in the practice that nurses deliver on a daily basis. The case in point is the collection of vital signs. While not historically a nursing skill, over the last 60 years it has become an integral component of practice in the postoperative general surgical setting. The evidence to support these practices is scant. Policies and text purport traditional routine-regulated practice without substantive evidence to support their claims. These policies are being used to control rather than support EBP. In conjunction with the traditional practice of vital sign collection and the culture of the clinical settings, the policies are limiting opportunities for clinicians to make individual decisions about care delivery based on the unique needs of each patient. Rather than focusing on EBP as the solution to the development of best practice, is it not time to change the focus to real strategies that will assist in achieving best practice? These include the creation of rigorous relevant evidence, the valuing of clinical expertise and the changing of the cultures in which nurses develop and practice.

Benchmarking↗
PubMed2003

No time for dying: a study of the care of dying patients in two acute care Australian hospitals.

OBJECTIVES: Research was conducted in two teaching hospitals in Australia to collect data on the care of patients dying in the acute care setting. METHODOLOGY: Non-participant observation of the care of dying patients in medical wards was the primary method of data collection and selected staff were interviewed. Observers collected data on the type of care, who gave the care, and the time given to care. Thematic analysis was applied to both the observational and interview data. PARTICIPANTS: Patients selected were over the age of 18 years, with a terminal diagnosis and an estimated six days to live. RESULTS: Three major factors emerged from the data to form the context in which patients were cared for and died: 1) the organizational factor, 2) the environmental factor, and 3) the human factor. The presence or absence of family members influenced the amount of care given. If family members were not present, dying could be an isolating experience, with minimal care focused on routine hospital activities. CONCLUSION: This research indicated that the principles of palliative care are yet to be incorporated in the acute care hospital setting.

Adult↗
PubMed2002

Policies that drive the nursing practice of postoperative observations.

Postoperative nursing care traditionally has involved the utilisation of regulated, routine patient observation to monitor patient progress. This study was designed to review the policy/procedure documentation that drives this practice and to determine who contributes to policy development. In all, 75 surgical hospitals were surveyed, producing 47 procedures for content analysis. Findings suggest that there is a great diversity in procedures between organisations. The most common pattern of postoperative vital sign collection is hourly for 4 h and then 4 hourly in 27% of the regimes. On average a patient receives 10 sets of observation in the first 24 h, with neurovascular, wound and drain checks the most frequent observations collected in addition to vital signs.

Clinical Protocols↗
PubMed2002

Is there an association between maternal hypotension and poor pregnancy outcome?: a review of contemporary literature.

This literature review highlights that research about the effect of maternal hypotension in pregnancy has either concentrated on an acute hypotensive episode, or looked at the influence of persistent maternal hypotension on fetal growth and/or premature birth. Whilst there is some German literature no published English study has specifically examined the possible significance of chronic maternal hypotension on the risk of stillbirth. There is, therefore, a significant gap in the research in this area.

Chronic Disease↗
PubMed2002

Issues of qualification assessment for nurses in a global market.

Many nurses have a desire to travel and work overseas for both long- and short-term periods. Some may continue postgraduate study, while others may simply wish to gain experience working in another country. Depending on the country where the nurse wishes to travel and work, the process of having qualifications assessed may be quite different, usually difficult and time consuming. There are several models of assessment currently used in various countries; from examinations for all to qualification comparability, the range is diverse. These models are very relevant given that the profession has experienced a global shortage of nurses that is unlikely to improve with the current work force predictions. Reasons for the shortages range from an aging nursing population to the profession's inability to attract young people. This has lead some countries to entice nurses from other countries to lessen their shortages. This paper discusses the issues in relation to the assessment of overseas qualified nurses applying to migrate or seek employment in Australia. Some of the issues highlighted are English language assessment, qualification assessment, competency assessment, timeliness, cost and equity. Assessment models from the global market and the impact these models have on attracting nurses to Australia are discussed.

Adult↗
PubMed2002

Effectiveness of mechanical compression devices in attaining hemostasis after femoral sheath removal.

BACKGROUND: Cardiac interventions are widely accepted as a practical treatment option for coronary artery disease. However, few changes have occurred in the techniques used for percutaneous arterial cannulation and for attaining hemostasis after cardiac interventions. To date, researchers have focused on techniques to achieve optimal hemostasis at the time of removal of the arterial catheter and to minimize the impact and complications of arterial puncture. OBJECTIVE: To summarize the best available evidence on the effectiveness of mechanical compression devices used to obtain hemostasis following femoral sheath removal after cardiac interventional procedures. METHOD: An attempt was made to detect both published and unpublished reports of research evaluations of mechanical compression techniques used to attain hemostasis after femoral sheath removal. Methodological quality was assessed by using predesigned criteria. Data were extracted from information on randomized controlled trials and were statistically combined in meta-analysis where possible. Evidence was also synthesized by using narrative summaries. RESULTS: Twelve studies met the inclusion criteria; however, only 3 were included in the meta-analysis. The results of meta-analysis indicated that the mechanical compression technique was the most effective for preventing formation of hematomas. The prevalence of bleeding did not differ significantly for different methods of compression. CONCLUSION: A gap exists in the literature on quality randomized controlled trials of various devices used to attain hemostasis after femoral sheath removal.

Cardiac Catheterization↗
PubMedDate not supplied

Descriptive study of nurses' compliance with postprocedural vital sign measurement in a gastrointestinal investigation unit.

There has been a tremendous growth in day surgery units to meet the demand for cost-effective healthcare. As a result of increased outpatient use of these units, procedures for administrative and clinical management have been developed. The effectiveness of the use of these protocols, however, has not been tested. This article reports on a study that examined nurses' compliance with a protocol for postprocedural vital signs measurement in a gastrointestinal day unit. The protocol's effectiveness in detecting postprocedure complications and the resource implications of the protocol were examined. The rate and type of postprocedure complications detected are also reported. Analysis of the observation data suggests staff are undertaking observations according to the protocol for most patients. Some patients appear, however, to be having their observations done outside the time frame recommended by the protocol. It is possible that staff are exercising their clinical judgement and continuing observations on some patients, though this is speculation and requires further research. Findings from the study raise questions regarding whether postprocedure monitoring is resource efficient.

Adolescent↗
PubMedDate not supplied

Tradition, rituals, and standards, in a realm of evidenced based nursing care.

Evidenced-based nursing is seen as the future of nursing but the real world in which practice occurs is limiting the possibilities for change. The practice of post-operative (PO) vital sign collection in the general ward setting is described as an example of the complexities that surround practice. Despite the ongoing work around evidenced-based practice, elements of nursing practice remain based on tradition. Routines and rituals are driving care rather than clinical judgement. The complexities of practice limit the possibilities for change. These complexities include the systems in which nurses' practice, the fear of medico-legal repercussions, and the sense of security that rituals provide. This paper discusses these themes including the barriers to change and the implications for practice. The development of evidenced-based practice is only one component of the solution to the provision of best practice. Care is required to ensure that the evidenced-based movement does not lead to recipe book care rather than patient centred practice.

Evidence-Based Medicine↗