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Biomedical subjects

P Fulbrook

Publications and source records attributed to P Fulbrook.

17 recordsLinked to original sources
PubMed2001

Worldwide overview of critical care nursing organizations and their activities.

While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.

Critical Care↗
PubMed2000

Fit for practice: Project 2000 student nurses' views on how well the curriculum prepares them for clinical practice.

This paper presents the findings from a small study, which compared student nurses' views on how well they felt the Project 2000 curriculum had prepared them for their first clinical placements. The views of two student nurse cohorts were obtained using a questionnaire developed for the purpose. The curriculum for the 'old' cohort allowed very little clinical time during the first 18 months and focused on academic classroom-based learning. The curriculum was subsequently restructured so that students on the 'new' curriculum experienced greater emphasis on practice and theory to practice links, and undertook their first clinical placement much earlier on in their course. Although statistical analysis of difference between the two cohorts suggests that students from the 'new' cohort felt they were better prepared, the actual differences in scores was small. The findings of this study provide only modest evidence of improvement in 'new' student nurses' views of how well they felt they had been prepared for their first placement.

Attitude of Health Personnel↗
PubMed1999

Exploring the expanded role of nurses in critical care.

This paper reports on a small research study that explored the perceptions of staff in an intensive/coronary/high-dependency care unit on the expanded role of nurses in critical care. The research was undertaken in two phases. In the first phase, focus groups and interviews of nursing and medical staff were used as methods to explore their perceptions. Data were analysed by thematic content analysis and generated four categories: specialized skills; maintaining competence; how far nurses can go; and training and education. Using verbatim examples from the participants, these categories are described. In summary, it was found that both doctors and nurses were in favour of nursing role developments, and for the nurses this was driven by their desire to meet the patients' needs. In a smaller second phase, a questionnaire was developed based on information gained in the first phase. It was utilized to seek the views of all the nursing staff on specific role-expansion activities. Findings revealed substantial support for developing the role of critical care nurses in a number of activities: cannulation; venepuncture; ordering blood tests and X-rays; performing physiotherapy; inserting arterial lines; performing elective cardioversion; thrombolysis treatment and intubation. This research study has yielded important information. However, it is recognized that, whilst these roles may be new to this particular critical care unit, there are many other units where they may already be common practice. Whenever new roles are developed, it is important to evaluate their effectiveness in measurable terms and regular audit is advisable. Further research is therefore recommended on both the development and evaluation of new roles in critical care.

Attitude of Health Personnel↗
PubMed1999

Measuring the outcome of paediatric intensive care.

This paper describes the background to the publication of the paediatric intensive care framework (NHS Executive 1997a) and sets out the case for outcome assessment of paediatric intensive care. Issues relating to mortality and morbidity assessment are discussed and several assessment tools are outlined. It is proposed that functional and psychological outcome assessments are important indicators of the quality of health care provision.

Child Development↗
PubMed1999

The role of the nurse in the paediatric out-patient department.

The aim of the study was to describe the role and function of the paediatric nurse in a POPD. The work of the three RSCNs and one HCSW employed in the department, was examined. 60% of the work undertaken in the department could be described as 'non-nursing'. The implications of this study are discussed in relation the department involved in the study, and generally in terms of potential development for POPDs.

Ambulatory Care↗
PubMed1997

Core body temperature measurement: a comparison of axilla, tympanic membrane and pulmonary artery blood temperature.

This research study was undertaken to examine the relationship between pulmonary artery blood temperature (regarded as the 'gold standard' measurement for core body temperature), axilla temperature using the Tempa.DOT Ax chemical thermometer and tympanic membrane temperature using the Diatek 9000 InstaTemp thermometer. Sixty adult intensive care patients had their temperatures monitored. A single set of five simultaneous temperatures, i.e. left and right axilla, left and right tympanic membrane (TM), and pulmonary artery (PA) blood were recorded. The mean difference between left and right TM temperatures was 0.58 degree C, and although both were moderately well correlated with PA temperature (r = 0.63 and 0.78, respectively) the mean differences between the two sites were clinically significant (0.85 degree C and 0.94 degree C, respectively). The range of differences between the sites was significant. Plotting limits of agreement showed that both left and right TM temperatures may be up to 1.2 degrees C above or 1.3 degrees C below PA blood temperature: a clinically unacceptable range. In particular, large temperature differences were recorded when patients were lying with one side of their head to a pillow. Fan therapy directed to the head was not found to affect these differences significantly. The mean difference between left and right axilla temperatures was 0.36 degree C, and although both were modestly correlated with PA temperature (r = 0.48 and 0.53, respectively) the mean differences between the two sites were clinically significant (0.47 degree C and 0.50 degree C, respectively). The range of differences between the sites was particularly significant. Plotting limits of agreement showed that both left and right axilla temperatures may be up to 1.2 degrees C above or 1.6 degrees C below PA blood temperature: a clinically unacceptable range. Because the range of temperature differences found between PA blood and the other sites was so great, it is concluded that neither the chemical axilla thermometer nor the tympanic membrane thermometer used in this study are clinically reliable tools for adult intensive care patients.

Adult↗
PubMed1994

Assessing mental competence of patients and relatives.

This paper presents a discussion on the assessment of mental competence of patients and relatives in the health care setting. Their decision-making ability is explored with particular reference to the giving of consent for nursing intervention and medical treatment. It is suggested that, in addition to obvious psychological or neurological disorders, decision-making ability will be influenced by psychological stress and the ability to communicate effectively. It highlights the ambiguity of mental competence assessment and concludes that such assessments will, to a greater or lesser extent, be subject to value-laden judgement.

Decision Making↗
PubMed1993

Core temperature measurement: a comparison of rectal, axillary and pulmonary artery blood temperature.

This research study was undertaken to determine the relationship between pulmonary artery (PA) blood temperature, rectal temperature and axillary temperature for adult patients admitted to an intensive care unit (ICU). 31 adults had their temperatures monitored. Simultaneous recordings of PA blood temperature, rectal temperature and axillary temperature were taken every 4h for up to 7 days. The mean difference between rectal and axillary temperature for all 31 patients was 0.32 degree C. Of the 16 patients who had their PA blood temperature monitored mean rectal temperature was 0.1 degree C above PA blood temperature and mean axillary temperature was 0.19 degree C below PA blood temperature. Very high statistical correlations were obtained which demonstrate the strength of the relationships between the three sites (rectal-axillary temperature difference R = 0.97; PA blood-rectal temperature difference R = 0.99; PA blood-axilla temperature difference R = 0.97). The linear relationship between the three sites studied was not found to be affected by age, gender, number of temperature samples taken, post/non-operative admission or peripheral temperature.

Adult↗
PubMed1993

Core temperature measurement in adults: a literature review.

This paper provides a comprehensive review of the literature related to the clinical assessment of core body temperature in adults. It does not attempt to address temperature measurement in children. It considers temperature-taking instruments used in current practice, and predominantly investigates the use of the three main sites of rectum, mouth and axilla.

Adult↗
PubMedDate not supplied

On the receiving end: experiences of being a relative in critical care. Part 1.

This is the first of a series of three papers, presenting in her own words the experiences of Jane, an intensive care staff nurse, when her husband was admitted to her own intensive care unit. In part one, Jane describes her husband's admission to the accident and emergency department, the intensive care unit and subsequent transfer to a regional neurological unit. Jane gives a powerful and often very moving account of her experiences as a relative on the receiving end of critical care. There are many aspects of her husband's nursing and medical care, with which Jane remains dissatisfied. Some of these issues are discussed through professional commentaries, which are offered in the latter part of the paper.

Adult↗
PubMedDate not supplied

Health care support workers in the critical care setting.

The 1999/2000 winter demands on the NHS have once again highlighted deficits in UK critical care provision (Daily Telegraph, 2000; London Evening Standard, 2000) Recent years have seen the development of the role of health care support workers in the NHS; some critical care units now employ health care support workers This research examined the views of critical care unit staff on the introduction of health care support workers into the critical care unit It is concluded that the role is viable within the setting of this study A framework is outlined that could form the basis for a critical care health care support worker training programme

Attitude of Health Personnel↗
PubMedDate not supplied

The care of critically ill children in adult ICUs: the way forward.

It is unlikely that in the short or medium term the PIC service can be restructured to such an extent that no children would need to be admitted to an adult ICU. Until this is the case the contribution of adult ICUs to the provision of PIC should be acknowledged and formally recognised as part of the service. Furthermore, there should be active support for these units from major/regional centres. There are clearly only a few adult ICUs which admit significant numbers of children. However, a more detailed analysis of adult ICUs is required to identify units which have available the full range of facilities, support services and appropriate staff to care for critically ill children. It is likely that only a few adult ICUs could meet the recommendations above, and it is in these units where efforts need to be concentrated. It is imperative that any nationally agreed standards or guidelines for PIC must apply equally to both adult ICU and paediatric ICU.

Adult↗
PubMedDate not supplied

Advanced practice: do we know what it is?

The UKCC has proposed the development of an advanced practitioner role. The role is equated with master's and doctorate level of preparation. The development of the advanced practitioner role is outlined. The assumption that the nursing profession understands the term advanced practice is challenged. It is not possible to make explicit the role of the advanced practitioner unless nursing knowledge is used as its foundation. Two basic questions have yet to be answered: What is advanced practice? What is an advanced practitioner?

Education, Nursing, Graduate↗