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Biomedical subjects

Jeanette Robertson

Publications and source records attributed to Jeanette Robertson.

10 recordsLinked to original sources
PubMed2005

Use and development of clinical pathways by registered nurses in an acute paediatric setting.

Clinical pathways are widely regarded as providing valuable knowledge about specific types of patients and their care, as well as providing direct guidance in clinical practice. In Australia, the use of care pathways has occurred with seemingly minimal professional nursing debate as to their benefits in practice. Comments supporting the introduction of pathways into clinical practice have focused on assistance to decision making, facilitation of clinical judgements about care, assistance in improving practice and utility as educational tools, particularly for new staff, new graduates and casual employees. A survey of 259 nurses working in an acute paediatric setting sought to gain their views about pathways of care with regard to satisfaction with use, content of pathway, ability to use in practice, effect on practice and commitment to use. While the most positive findings to emerge from the research indicated that nurses liked clinical pathways because they saved time and reduced documentation requirements, issues were also raised about the need for a broader, more inclusive development process for pathways, and an improved education program for staff use. The implications to arise from these findings are important for senior staff and educators who are responsible for staff orientation programs and ongoing staff development as well as for those responsible for the development and implementation of clinical pathways into practice.

Attitude of Health Personnel↗
PubMed2005

From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice.

BACKGROUND: This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery. AIMS: Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP). METHODS: A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants. FINDINGS: The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

Diffusion of Innovation↗
PubMed2003

Nursing management of fever in children: a systematic review.

OBJECTIVES: The aim of the present review was to determine whether the best available evidence supports the types and timing of the various nursing interventions that are commonly used to reduce fever in non-critically-ill children, and to what extent the outcomes are influenced by these nursing actions. METHODS: Studies included were randomised or quasi-randomised controlled trials that involved non-critically-ill children with a fever aged between 3 months and 16 years. The search strategy sought to identify both published and unpublished research reports in the English language and covered all major databases up to 1998. The methodological quality of each study was assessed by two independent reviewers using a piloted critical appraisal checklist. Despite all studies being randomised, heterogeneity precluded conduction of a meta-analysis; therefore, evidence was synthesised using narrative summaries. RESULTS: Ten studies were assessed as being of sufficient quality to be included in the review. These studies addressed two of the intervention categories identified in the protocol: (i) administration of antipyretics (paracetamol); and (ii) direct cooling measures on the outcome measure (reduction of or prevention of increase in fever). The review found little benefit from sponging in temperate climates and usually at the expense of the child's comfort. There may be situations in high environmental temperatures and high humidity, or where there is a need for immediate temperature reduction, in which sponging may be warranted. Risks were identified when paracetamol was administered on a sustained basis over even a short period of time and above a relatively low total daily dosage. There was a lack of evidence to support the administration of antipyretics to reduce the incidence of febrile convulsions. There is a need for parental education that focuses on knowledge of the body's protective physiological responses and how to support these responses. CONCLUSION: The primary purpose for intervening when a child has a fever is to increase the child's comfort. This consideration should be weighed against any harm that might result from intervening. There was a lack of evidence to support the routine use of sponging. The administration of paracetamol should be used selectively and with caution. In summary, care needs to be individualised, based on current knowledge of the effectiveness and risks of interventions.

Acetaminophen↗
PubMed2002

Management of the child with fever.

The primary purpose of any intervention is to increase the child's comfort (or decrease their discomfort). The decision to treat fever therefore needs to be: individualised, based on knowledge of effectiveness, balanced against any risk of harm that might result from intervening. Interventions that assist the body's physiological responses to infection (eg encouraging fluids and removing excess clothing or wrappings) are particularly recommended.

Acetaminophen↗