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Biomedical subjects

J Wilson-Barnett

Publications and source records attributed to J Wilson-Barnett.

At least 19 recordsLinked to original sources
PubMed2006

An evaluation of protocolised weaning on the duration of mechanical ventilation.

Using a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non-protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re-intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. In the intervention unit, outcomes were longer in Phase II compared with Phase I (all p < 0.005). When adjusted for admission APACHE II score and diagnostic category, only intensive care stay remained significantly longer (p = 0.002). There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re-intubation or intensive care unit mortality.

Aged↗
PubMed2005

Effect of recommended positioning on stroke outcome at six months: a randomized controlled trial.

OBJECTIVE: To evaluate the effect on patient outcome of a teaching package for nurses designed to improve the positioning of stroke patients. DESIGN: Cluster randomized controlled trial with six-month follow-up. SETTING: Ten stroke rehabilitation hospital units located within one UK inner city region. These were randomized to control or intervention group. SUBJECTS: A sample of 120 patients admitted within four weeks of a first stroke and with a hemiplegia. No eligible patient refused to participate. Eighty-three (69%) completed the study. INTERVENTION: All nursing staff on the intervention units received a group teaching package to improve their clinical practice in patient positioning. MAIN OUTCOME MEASURE: Rivermead Mobility Index (RMI) at six months post stroke. Patient's position was recorded using an established observational tool. RESULTS: After the teaching there was some evidence of better positioning in the intervention than the control group (difference in percentage of correct positions per patient 4.9%, 95% confidence interval (Cl -0.1% to 9.9%, p = 0.055). There was no evidence of differences between the two groups in any of the outcome measures at six months although there was a trend towards increased elbow flexor tone in the control group. CONCLUSIONS: A teaching intervention to improve patient positioning made no significant impact on outcome at six months post stroke. However, following the teaching there was only a slightly higher incidence of recommended patient positioning within the intervention group. Thus, a teaching package may not be powerful enough to enable any effect on patient outcome to be measured.

Aged↗
PubMed2001

Economic evaluation of a nursing-led intermediate care unit.

OBJECTIVES: The aim of this paper is to examine the costs of introducing a nursing-led ward program together with examining the impact this may have on patients' outcomes. METHODS: The study had a sample size of 177 patients with a mean age of 77, and randomized to either a treatment group (care on a nursing-led ward, n = 97) or a control group (standard care usually on a consultant-led acute ward, n = 80). Resource use data including length of stay, tests and investigations performed, and multidisciplinary involvement in care were collected. RESULTS: There were no significant differences in outcome between the two groups. The inpatient costs for the treatment group were significantly higher, due to the longer length of stay in this group. However, the postdischarge costs were significantly lower for the treatment group. CONCLUSIONS: The provision of nursing-led intermediate care units has been proposed as a solution to inappropriate use of acute medical wards by patients who require additional nursing rather than medical care. Whether the treatment group is ultimately cost-additive is dependent on how long reductions in postdischarge resource use are maintained.

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PubMed2001

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units.

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Clinical Competence↗
PubMed2001

The UKCC's Scope of Professional Practice--some implications for health care delivery.

AIMS: The research reported here is part of a larger study commissioned by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) to analyse and understand the impact of the Scope of Professional Practice (Scope) on the practice of nursing, midwifery and health visiting. The data in this paper relate to attitudes about, and perceptions of Scope among a variety of stakeholders. BACKGROUND: This research provided a valuable opportunity to explore the essence of Scope and the ways in which it can enable nurses, midwives and health visitors to adapt to growing or changing health care needs. The findings contribute to this debate, by drawing on the knowledge and experience of the key groups involved in the change process. METHOD: The study utilized several approaches, tailored to meet the requirements of each phase. In this (the final) phase a structured questionnaire was sent to different groups of stakeholders. FINDINGS AND CONCLUSIONS: The stakeholders displayed considerable interest in the development of innovative systems for delivering nursing and midwifery care, provided that the necessary safeguards and support were in place. Scope was seen as a valuable way of optimizing the skills and contribution of nurses, midwives and health visitors.

Attitude of Health Personnel↗
PubMed2001

Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care.

OBJECTIVES: To evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. DESIGN: Randomized controlled trial comparing outcomes of care on a nursing-led inpatient unit with the system of consultant-managed care on a range of acute hospital wards. SETTING: hospital wards in an acute inner-London National Health Service trust. SUBJECTS: 175 patients assessed to be medically stable but requiring further inpatient care, referred to the unit from acute wards. INTERVENTION: 89 patients were randomly allocated to care on the unit (nursing-led care with no routine medical intervention) and 86 to usual hospital care. MAIN OUTCOME MEASURES: Length of hospital stay, discharge destination, functional dependence (Barthel index) and direct healthcare costs. RESULTS: Care in the unit had no significant impact on discharge destination or dependence. Length of inpatient stay was significantly increased for the treatment group (P=0.036; 95% confidence interval 1.1-20.7 days). The daily cost of care was lower on the unit, but the mean total cost was pound sterlings 1044 higher-although the difference from the control was not significant (P=0.150; 95% confidence interval - pound sterlings 382 to pound sterlings 2471). CONCLUSIONS: The nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.

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PubMed2001

Preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States of America.

The debate concerning nurses' diverse entry into practice was enlivened in 1995, when the American Nurses Association reaffirmed its contention that a baccalaureate degree was necessary for professional nursing practice. This debate may be informed by an appreciation of the educational routes taken by other countries that have changed from hospital-based to college-based nursing education. This paper describes and analyzes preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States, from the late nineteenth century to the present. Nurses in Australia and New Zealand are currently educated entirely at the baccalaureate level. In the United Kingdom, nursing education is in the process of becoming completely university-based, resulting in a diploma or degree. In the United States, the majority of nurses graduate from two-year associate degree programs. This level of education, briefer than in the other countries described, potentially limits nurses' professional contributions.

Australia↗
PubMed2000

Evaluation of the role of the Parkinson's disease nurse specialist.

A one year follow up study of 108 randomised patients with Parkinson's disease at three centres was performed to investigate differences between care provided by the hospital based Parkinson's disease nurse specialist (PDNS) compared with the Consultant Neurologist (control). Only two (out of 22) differences were found where physical functioning and general health improved more in the control group. Provision of PDNS' for patients with Parkinson's disease cannot therefore be recommended solely on cost-effectiveness grounds because of similar outcomes but increased costs associated with the PDNS providing additional care. However medical and nursing specialists valued their complimentary expertise, and patient and carers responses to consultations also reflect that PDNS's have particular contributions. Aspects of care most valued by patients and carers and consultation interactions are discussed.

Activities of Daily Living↗
PubMed2000

Recognising advancing nursing practice: evidence from two observational studies.

Debates over title, grades and relationships across the profession has tended to dominate the literature in advancing nursing practice. Fewer research projects have attempted to study the activities of nurses who are designated as undertaking advancing nursing roles. One study evaluating Masters courses for Clinical Nursing Practice and a second addressing the impact of the 'Scope of Professional Practice' (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, 1992) document by this team of authors afforded these research opportunities. In this paper empirical data from 'reflective' observation with 19 nurses (including midwives and health visitors) are presented to illustrate the range and type of functions undertaken by a small group of practitioners developing their practice. A number of characteristic features emerged. Assessment of individual and group needs, positive motivation to constantly improve practice, inter-disciplinary and cross agency working for planned change and an ability to identify and prioritize service requirements were recognised in these nurses' roles. Certain personal attributes were seen to be essential for successful role development such as confidence, commitment and problem solving powers combined with a positive working environment and supportive managers.

Education, Nursing, Graduate↗
PubMed2000

The effectiveness of intermediate care in a nursing-led in-patient unit.

In order to assess the potential for a nursing-led in-patient unit (NLIU) to substitute for a period of care in the acute hospital environment and promote recovery before discharge, a randomised controlled trial was conducted. The setting was an acute inner London hospital trust, part of the UK's national health service. Of patients referred to a NLIU from acute wards, 80 were randomly assigned to usual care (remain in normal hospital system) and 97 to the NLIU (nursing-led care with no routine medical involvement). Patients were identified as medically stable but in need of additional nursing intervention by referring medical staff prior to full nursing assessment of suitability. Outcomes compared included functional dependence (Barthel Index), discharge destination and length of hospital stay. Inputs from nursing, paramedical and medical staff were measured. There was no significant difference in functional independence at discharge (p0.05). Patients undergoing usual care stayed in hospital for less time (mean difference 18 days, p<0.01) but the same number of patients were in hospital 90 days after recruitment (23% NLIU, 24% usual care p0.05) due to re-admissions. The model of care implemented differed considerably from that described in the literature with the NLIU having significantly fewer qualified nurses (RNs). Although the anticipated benefits of the NLIU were not demonstrated, the study does not conclude that the model should be rejected. Factors driving length of stay need to be further investigated, as does the possibility of post-discharge benefits. The NLIU does offer some potential to substitute for acute care but also appears to substitute for a period of primary care.

Activities of Daily Living↗
PubMed2000

Influences on length of stay in intermediate care: lessons from the nursing-led inpatient unit studies.

A recent study found that intermediate care in a nursing-led in-patient unit (NLIU) led to dramatically increased hospital stay when compared to usual care in a hospital. This is despite a large body of work across a variety of settings, including the pilot for that same study, which suggests that the NLIU is effective. This paper presents a series of exploratory analyses that aim to explore the findings further. A number of changes were identified in the functioning of the NLIU between the main and pilot study including patient population, leadership and staffing levels. Two ANCOVA analyses reveal that while performance of the NLIU declined between the two studies, that of usual care improved dramatically. Extended lengths of stay appear to be associated with the NLIU's location on a satellite site rather than the model of care per se. Reduction in the staffing levels on the NLIU and a change in patient population may well explain the findings.

Humans↗
PubMed2000

Editorial

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

Inter-rater reliability of postural observation after stroke.

OBJECTIVE: To explore the inter-observer reliability of bedside observations of stroke patients' posture using two versions of a pictorial tool. DESIGN: Three projects were conducted. The initial version of the tool was used in project 1. The modified version was used in projects 2 and 3. In each project a pair of observers (comprising the main observer and one of five co-observers with varying degrees of experience in observing posture) used the tool to make simultaneous observations of 19 aspects of the posture of a sample of stroke patients. Each patient was observed in one or more of four positions (seated, supine and lying on the affected and unaffected side). The degree of inter-observer agreement was sought by calculating kappa values and percentage agreement. SETTING: Medical wards, care of the elderly wards and a stroke unit. SUBJECTS: A convenience sample of 57 stroke patients. RESULTS: Four hundred and forty paired sets of observations were made (200 in project 1, 140 in project 2 and 100 in project 3). The main observer was in every pair. The co-observers made between 50 and 135 sets of observations each. When the results from all three projects were amassed, acceptable percentage agreement (i.e. > or =70%) was obtained for 67% (n = 78) and 73% (n = 55) of the results collected on aspects of the posture of the affected upper and lower limbs respectively. In contrast, acceptable percentage agreement for observations relating to the head, neck and trunk was obtained for only 34% (n = 50) of the results collected. Uneven distributions in the data made kappa values difficult to interpret. Inter-observer agreement was not noticeably higher for pairs in which both observers had prior experience of observing posture after stroke than for pairs in which one observer was relatively inexperienced. CONCLUSIONS: The tool has potential as a quick and simple means of collecting information at the bedside about stroke patients' posture. Refinements, additional training in using the tool for observers and further testing are suggested before its wider use is advocated.

Adult↗
PubMed1998

Patient assessment: validation of a nursing instrument.

The aim of this study is to evaluate the reliability and validity of the Byron Physical Assessment Framework (BPAF). The BPAF is a systems based checklist of physiological measurements, signs, and symptoms designed to structure and document the assessment of a patients physical condition by nursing staff. Initially the BPAF was refined using extensive literature review and expert opinion to improve the comprehensiveness and clarity for its intended purpose. As a result the content validity of the BPAF was supported. Inter-rater reliability between both expert-expert and novice-expert pairings was assessed. A total of 68 assessments were conducted by pairs of qualified nurses with patients on general medical and surgical wards and a nursing-led unit in one London Hospital. Reliability of the dichotomous data items of the BPAF was found to be generally good (kappa > 0.6) with only one item showing a poor reliability (kappa < 0.20). Reliability for continuous items such as pulse and respiratory rate was surprisingly low with evidence of large variation between raters in addition to systematic bias. With relatively little teaching, novice assessors were able to use the BPAF and achieve good inter-rater reliability with expert assessors although this was lower than the reliability of the expert diads. The utilisation of the BPAF to fulfil intended purpose was assessed by examining completed assessments and the outcome in terms of nurses' actions in light of new abnormal findings. Both were found to be fair, showing that the BPAF does affect the actions of nurses although it could be utilised more.

Confounding Factors, Epidemiologic↗
PubMed1998

The role of cognitive-behavioural therapy in the management of pain in patients with sickle cell disease.

Painful crisis is the most common manifestation of sickle cell disease and accounts for the second greatest number of admissions with an average length of stay of 7 days in central London. Despite this frequency of admissions, the management of pain is fraught with problems. This is not surprising since the psychological challenges presented by sickle cell disease are manifold, resulting in significant psychological distress for some individuals. This paper considers the literature on the psychosocial impact of sickle cell disease, and the American research evidence which suggests that pain management strategies that incorporate a psychological intervention can significantly reduce psychological distress as well as hospital admissions. Britain has been slow to incorporate psychology in the pain management strategies, and we have embarked on research to fill this gap. Although this research constitutes work in progress, an argument is put forward for utilizing the cognitive-behavioural perspective in the management of pain in sickle cell disease and we conclude by giving a brief summary of pilot work which is both the foundation and justification for the current ongoing research.

Adolescent↗