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Kathryn Zeitz

Publications and source records attributed to Kathryn Zeitz.

9 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

Australian issues in the provision of after-hours primary medical care services in rural communities.

OBJECTIVE: In 2003 the Rural Doctors Workforce Agency in South Australia (SA) facilitated the 'SA Rural Hospital After Hours Triage Education and Training Program'. It was designed to improve communication between rural general practitioners (GPs) and nurses undertaking after-hours triage, provide training in triage for rural nurses and develop local collaborative after-hours primary medical care models that can be applied in other settings. DESIGN: The program consisted of a series of three workshops. The first workshop provided an opportunity for GPs and nurses to discuss local issues relating to after-hours primary medical care service delivery. This was followed by a one-day workshop on triage for nurses. A follow-up refresher workshop was conducted approximately six months later. SETTING: Twenty-three rural communities in SA. PARTICIPANTS: Rural GPs and nurses working in rural communities. RESULTS: This paper reports on the issues highlighted by clinicians in providing after-hours primary medical care in rural and remote communities. These included community expectations, systems of care, scope of practice, private practice/public hospital interface, and medico legal issues. CONCLUSION: The issues facing after-hours health services in rural communities are not new. There are many opportunities for improvement of systems. A formal program including workshops and training has provided a useful forum to commence service improvements.

After-Hours Care↗
PubMed2005

Nursing observations during the first 24 hours after a surgical procedure: what do we do?

AIMS AND OBJECTIVES: The purpose of the study was to describe what constitutes postoperative nursing monitoring during the initial 24 hours on the ward including the components of observation, frequency and time spent with patients. BACKGROUND: The literature provides little guidance as to the best practice of postoperative surveillance. To understand the practice of monitoring patients after returning to the ward from a surgical procedure it is important to describe the current practice. DESIGN: The study involved a non-participant observation of nursing practice. METHOD: Data were generated via observation of postoperative patients in the first 24 hours after returning to the ward. This occurred in the general surgical units of two different South Australian hospitals over an 8-week period. RESULTS: A total of 81 patients were observed for 282 patient hours. Vital sign collection generally reflected a traditional pattern of hourly for the first four hours, reducing to four hourly across the 12- to 24-hour period. The frequency and duration of patient-nurse interactions, observations recorded and the collection of other clinical data such as pain, oxygen saturations and nausea are also discussed. RELEVANCE TO CLINICAL PRACTICE: The findings presented here depict the current nursing practice of postoperative monitoring in two different settings, providing insight into what constitutes contemporary postoperative surveillance. CONCLUSION: Before inroads can be made to identify the best practice of postoperative patient surveillance a clear cognisance of practice needs to be identified.

Data Collection↗
PubMed2004

Seeking an explanation for the poor uptake of in-hospital AED programs.

The automated external defibrillator (AED) has been adopted by emergency service personnel as a first-line intervention in the management of out-of-hospital cardiac arrest (OHCA). AED leads to more successful Advanced Cardiac Life Support; consequently, national resuscitation organisations worldwide have recommended that nurses and doctors also integrate AEDs as a component of their basic life-support response to cardiac arrest. Despite these recommendations, the implementation of AED programs within hospitals has been generally sporadic and isolated. A continuation of this situation will most likely disturb and perplex nurses and patients, as they are key stakeholders with respect to upholding recommended BLS practices. In the absence of any explanation from change agents within hospitals, this paper seeks, by way of a pilot study and a review of the literature, to identify the extent of the problem and identify factors contributing to the relatively slow uptake of this device. We argue that nurses and other first responders to in-hospital cardiac arrest (CA) have much to gain, in the context of Occupational Health Safety and Welfare (OHS and W), from ready access to AEDs. Cost factors are also considered, with initial cost of AED purchase likely to be a major concern for managers of hospital budgets. The issues we discuss in this paper clearly support the need for further research to (a) explain the nature of public hospital resistance to AEDs and (b) to consider whether AEDs will provide practical advantages to public hospitals from an occupational, social and economic perspective.

Australia↗
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↗
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↗
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↗