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Biomedical subjects

K Daffurn

Publications and source records attributed to K Daffurn.

11 recordsLinked to original sources
PubMed1995

How consistently do RNs perform the procedure of collecting specimens for measurement of gastric pHi and CO2?

Gastric Tonometry is an important tool being used more frequently in the Intensive Care Unit (ICU). Tonometry is used to collect normal saline which has equilibrated with the stomach contents and is used in combination with a sample of arterial blood to calculate intragastric PaCO2 and intramucosal pH (pHi). These values are indicative of gastric perfusion. Correct performance of each of the 5 procedural steps to instill and then collect the normal saline is paramount for accuracy of the CO2 and pHi results. The aim of this study was to examine how consistently nurses perform the procedure. Study participants comprised two groups of 15 registered nurses (RNs) chosen at random from the nurses employed in the ICU at Liverpool Hospital (NSW, Australia). The first group of RNs were asked to answer a questionnaire before and after performing the tonometry procedure under simulated conditions. The second group were asked to perform the tonometry procedure only. Each participant was observed by one of the researchers whilst performing all of the procedural steps. Regardless of critical care experience of participants or the number of years since registration a s a nurse, error rates in performing the specimen collection/procedure were as high as 34%. This study is designed to examine the previously unaddressed area of how accurately nursing staff follow systematic instructions to collect the mucosal sample.

Bias↗
PubMed1995

A CQI approach to the investigation of noise levels within the intensive care unit environment.

In February 1991, the Intensive Care Unit (ICU) at Liverpool Hospital was extended and relocated to a larger area. It soon became apparent that noise levels within the newly renovated unit were particularly worrying to patients, staff and relatives. A Continuous Quality Improvement (CQI) group was formed to investigate, and develop measures to reduce these noise levels. Through the implementation of various CQI tools a study plan was developed to investigate the noise problem. The study plan included: a patient, relative and staff questionnaire; a literature search; identification of levels of noise using a sound level meter; contracting a noise consultant to visit and review the ICU environment. The results of the CQI investigations revealed that there was an inappropriately high level of noise in the ICU. Several key contributing factors were also identified. These findings provided the basis for several positive measures to be undertaken including: the installation of sound absorbing ceilings; removal of rubbish bin lids; revision of the telephone ringing system; revision of the mobile x-ray machine; prioritisation of audible machine alarms; education of staff in noise level awareness; The application of the Continuous Quality Improvement (CQI) process to the noise problem facilitated the exploration of the source of noise, the effects on staff and patients, and ways to reduce noise levels in the intensive care environment.

Health Facility Environment↗
PubMed1995

The Medical Emergency Team.

The concept of a Medical Emergency Team was developed in order to rapidly identify and manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions. The aim of this study was to describe the utilization and outcome of Medical Emergency Team interventions over a one-year period at a teaching hospital in South Western Sydney. Data was collected prospectively using a standardized form. Cardiopulmonary resuscitation occurred in 148/522 (28%) calls. Alerting the team using the specific condition criteria occurred in 253/522 (48%) calls and on physiological/pathological abnormality criteria in 121/522 (23%) calls. Survival rate to hospital discharge following cardiopulmonary arrest was low (29%), compared with other medical emergencies (76%).

APACHE↗
PubMed1994

Do nurses know when to summon emergency assistance?

At Liverpool Hospital in 1989, mortality from cardiopulmonary arrest was 71% in the general wards, and 64% in the Emergency department. In an attempt to identify and treat seriously ill patients before they progressed to cardiac arrest, a medical emergency team (MET) was established. The MET replaced the existing cardiac arrest team and comprised a nurse from the intensive care unit (ICU), a resuscitation registrar (an anaesthetics trainee), a medical registrar and a senior registrar from the ICU. The resuscitation registrar was the team leader. The calling criteria for the MET were based on predetermined physiological variables, abnormal laboratory results, and specific conditions or if nursing or medical staff were concerned by the patient's condition. A study was conducted 2 years following implementation of the MET system, to determine registered nurses' (RNs) opinions, knowledge and use of the system. A questionnaire distributed to 141 nurses rostered on the chosen study date revealed a positive attitude the MET, although there was a low awareness regarding the availability of the MET information booklet. 53% of nurses had called the MET in the last 3 months; all would call the team again in the same circumstances. The correct response in three of four hypothetical situations presented was to call the MET. The number of correct responses varied between scenarios from 17-73%. Hypotension did not appear to alert nurses to summon emergency assistance. Some nurses, despite the presence of severe deterioration and patient distress, called the resident rather than the MET.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Problems following discharge after intensive care.

Intensive care units (ICUs) are now present in most acute care hospitals. While long-term studies on patients admitted to these units have been performed to identify mortality, functional outcome and quality of life, there is little information on the recovery period in the weeks immediately following discharge. The aim of this study was to identify and describe the sequelae found in patients at 3 months after leaving the ICU. The study was conducted over a 6-month period during 1991, in a university teaching hospital in Sydney, Australia. 54 patients with a length stay (LOS) of greater than 48 hours in the ICU were included. Each patient was interviewed in an outpatient clinic attached to the ICU. Information collected included pre-admission details, reason for admission, treatments provided and complications encountered. General health state, social and employment details, functional status, referral patterns since discharge and recollection of ICU stay were studied. The major findings indicated that many of the patients interviewed were returning towards near normal general health, but were suffering mild to moderate physical and psychosocial sequelae. In the majority of cases the problems were not incapacitating. The predominant complaints were minor to severe pain, sleeping difficulties, tiredness and breathlessness. Financial problems were reported by a small number of patients. Depression, irritability or a feeling of loneliness were present in over one-third of the group. More than half the patients required referral for further assessment. 34% of patients had no recollection of their ICU stay. 16 patients (29.6%) reported unpleasant memories including nightmares and hallucinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1994

The basic knowledge assessment tool: is it useful?

Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT). Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p = 0.02) and those possessing ICU qualifications (p = 0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.

Adult↗
PubMed1993

The role of the intensive care nurse--their choice.

An inability to attract and retain sufficient numbers of Registered Nurses (RN's), and Resident Medical Officer shortages in 1990 lead to a concern about who would provide services and whether RN's should "extend" their roles. This survey was developed to allow clinical nurses to identify what their role should be and to quantify the degree of role extension already occurring in the Intensive Care Units (ICU's) of New South Wales' hospitals. Surveys (823) were sent to 33 ICU's across New South Wales. Major Teaching (MTH), Suburban (SH) and Country (CH) hospitals were included in equal numbers. Nurse Unit Managers were contacted and agreed to the distribution of the questionnaire to all RN's working in these units. General demographic information was sought regarding experience in ICU, with the remainder of the questions related to whether nurses should take on extra tasks and what nursing duties could be relinquished. Overall return rate was 51.8% with variations in the type of hospital, MTH (35%), SH (57%), CH (68%). Nurses (72%) want to extend or already do have an extended role. However, they are very definite about what tasks they wish to perform and consistently throughout New South Wales do not wish to perform clerical tasks, some invasive procedures such as endotracheal intubation or arterial cannulation or prescribe medications. The majority of RN's want to relinquish non nursing duties such as cleaning, ordering supplies and clerical tasks. The study demonstrated that, a great many nurses working in ICU would like to and/or perceive the need for some role extension. Clearly nurses must be included in all discussions and decisions affecting their future.

Choice Behavior↗
PubMed1992

Active management of the dying patient.

OBJECTIVE: To document the process of managing the dying patient in the intensive care unit (ICU) and thus to broaden community debate about an issue that is usually only discussed at a theoretical or philosophical level. SETTING: A six-bed ICU in Liverpool Hospital, a 419-bed teaching institution in the southwestern area of Sydney. PATIENTS: Twenty-seven patients, seen over a nine-month period, who had curative treatment withdrawn or withheld. The mean age of the patients was 68 years and the severity of illness, by the APACHE II scoring system, ranged from 12 to 45. INTERVENTIONS: Twenty-three of the 27 patients were mechanically ventilated and 11 were receiving inotropic support. Medical staff usually initiated discussions and sought staff consensus that the patient should be allowed to die (on 23 of 27 occasions). Most relatives (25 of 27) accepted this decision. Support therapies and routine care were stopped according to policy guidelines. Sedatives and narcotics were used in some patients (18 of 27). Twenty-one patients died in the ICU and six in the general ward areas. CONCLUSION: Introduction of a policy to guide management of dying patients in intensive care has been accepted by staff. Most dying patients are now managed in accordance with these guidelines. Further discussion and debate of this important issue, by health professionals and society as a whole, is required.

Adult↗
PubMed1990

Cost awareness study.

A cost awareness study was performed to elicit how aware Intensive Care Unit staff were of the cost of commonly used items. All staff attached to the Unit were given a questionnaire and asked to estimate the price of a list of drugs, fluids, equipment and disposables. Response rate was 100%, with 97% validity. The range, mean and stand deviation of the estimated costs were computed and then compared with the actual price of each item. This paper reviews the results and briefly discusses three questions. What had the study achieved? Should we consider costs? How much does it cost to run our department?

Attitude of Health Personnel↗
PubMedDate not supplied

Fluid balance charts: do they measure up?

Many current nursing activities are performed without regular reviews of their usefulness. The recording of fluid gains and losses on a fluid balance chart is one such activity. This article explores the practice of fluid monitoring on the wards of a university teaching hospital.

Health Knowledge, Attitudes, Practice↗