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Biomedical subjects

Ruth Endacott

Publications and source records attributed to Ruth Endacott.

At least 19 recordsLinked to original sources
PubMed2007

Guideline implementation fails to improve thrombolytic administration.

BACKGROUND: International randomised controlled trials conducted over the last two decades have consistently demonstrated improved mortality and morbidity resulting from thrombolytic therapy for patients with acute myocardial infarction (AMI). Subsequently, evidence-based guidelines have been designed and implemented to optimize thrombolytic delivery. The effect of evidence-based clinical guidelines on clinical practice is heavily influenced by strategies used to develop, disseminate and implement those guidelines. AIMS: This study evaluated the impact of a collaborative, multifaceted implementation strategy for AMI management guidelines on thrombolytic usage in the Loddon Mallee Region, Victoria, Australia. INTERVENTION: The multi-faceted implementation strategy included an inter-disciplinary team representing all treating venues contributing to the content of the "Guidelines for the Early Management of Acute Myocardial Infarction" followed by education sessions that coincided with the dissemination of the guidelines. METHODS: A retrospective medical records audit 12 weeks before and 12 weeks after the intervention was used to evaluate the impact on proportion of those patients eligible and receiving a thrombolytic and door-to-needle time. Variables of treating venue, age, gender, type of AMI, and type of transport to hospital were also measured to determine their impact on results. RESULTS AND CONCLUSIONS: A retrospective audit of 170 medical records found that the intervention appeared to have had no impact on the proportion of patients eligible and receiving a thrombolytic (74.2% vs. 62.5%: p=0.275), and door-to-needle time (67.7 min vs. 60.5 min: p=0.759). Venue specific influences produced a variety of patterns in thrombolytic delivery that require further exploration. This suggests that a single solution approach across multiple venues will have limited impact.

Adult↗
PubMed2006

Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana.

This descriptive exploratory study investigated the reported practices and perceptions of emergency nurses related to infection control in the context of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana. Quantitative and qualitative data were collected using a self-administered questionnaire. Forty questionnaires were distributed to nurses with emergency department experience in Botswana, with a response rate of 55% (n = 22). Quantitative data were analysed using descriptive statistics while qualitative data were subjected to thematic and content analysis. The majority of respondents reported compliance with universal precautions at the hospital emergency department. However, qualitative data highlighted resource constraints that may hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage of equipment and materials, inadequate staffing and absence of sustainable in-service education programs. Further, the reported compliance with Universal Precautions had not removed the fear of exposure to HIV/AIDS and perceived risk of transmission to family. The authors recommend in-service education and practice initiatives to promote sustainable compliance with universal precautions and realistic risk perception among nurses. Further research is required to evaluate nurses' compliance with universal precautions in developing countries using observational methods or in-depth interviews. This would enable exploration of nurses' actions regarding compliance with universal precautions.

Blood-Borne Pathogens↗
PubMed2006

Characteristics of patients who did not wait for treatment in the emergency department: a follow up survey.

A significant number of patients leave the emergency department (ED) before being treated or after treatment has been initiated but not completed. This paper reports the findings of a study examining the demographics and characteristics of those who did not wait for treatment in an ED in Melbourne. A telephone survey was undertaken to examine the reasons they did not wait. Data were collected in four one-month periods across the year and patients were telephoned within 72 h of their departure from the ED. The majority of those who did not wait were Australian Triage Scale category 4 or 5, male, and with a mean age of 37 years. Sixty per cent of those who did not wait presented between the hours of 6 pm and 6 am and waited an average of 130 min before leaving. Over fifty per cent (127) of those surveyed (n=243) sought treatment elsewhere and over a third (72) thought their problem was inappropriate for an ED. However, the need for communication with patients in the waiting room should not be under-played.

Adult↗
PubMed2006

Developing new services for eating disorders: an evaluation study.

OBJECTIVE: This paper aims to evaluate the structures and processes of eating disorders services in two regional cities in Australia. METHOD: Stakeholder evaluation undertaken between 2002 and 2005 uses interviews, questionnaires and service delivery data to examine: structure and patient profile of the two services, barriers and success factors and local factors influencing development of the services. RESULTS: The Bendigo service provided secondary consultation and specialist management with upskilling of primary care workers as a key goal. Patients were referred to the service via mental health triage. The Geelong service initially offered assessment only, with direct access for the general public. Treatment was offered from early 2004. The Bendigo service assessed 41 patients, 63% were diagnosed with anorexia nervosa or bulimia nervosa. Most patients had a moderate or severe eating disorder. The Geelong service assessed 186 patients, 55% were diagnosed with anorexia nervosa or bulimia nervosa and 80% of this subset had not previously been treated for an eating disorder. General practitioners identified barriers to development of the services as: problems with capacity building and unrealistic expectations. The success factors were providing a locally based service with credible clinicians and effective communication. CONCLUSIONS: Activity analysis demonstrates that the goals for both services were met. There is a need to measure both short- and long-term patient outcomes in order to fully assess effectiveness and applicability to other settings. Local factors, such as availability of specialist providers, would need to be taken into account.

Anorexia Nervosa↗
PubMed2006

Managing patients at risk of deterioration in rural hospitals: a qualitative study.

OBJECTIVE: This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia. DESIGN: A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift. SETTING: Smaller rural hospitals in Victoria. PARTICIPANTS: Registered Nurses (Division 1). MAIN OUTCOME MEASURE: Observed and reported strategies used to manage deteriorating patients. RESULTS: Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service. CONCLUSIONS: We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery.

Adaptation, Psychological↗
PubMed2006

Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients.

Recording a patient's vital signs is a basic requirement that in part informs clinical decision-making. Practice suggests that recording a trauma patient's temperature is occasionally overlooked in the emergency department. A staff survey was undertaken to gain an appreciation of knowledge and understanding of the issues that surround accidental or exposure hypothermia in trauma patients. Results demonstrate that nurses and doctors are unsure of how to define hypothermia and are not conversant with simple ways to prevent heat loss or rewarm patients. Complications from hypothermia such as coagulopathy and metabolic acidosis were seldom identified. Issues that limit staff recording temperature include patient access and acuity, lack of knowledge and confidence and access to temperature-measuring devices. These results emphasize the need for regular education. Implications for clinical practice were considered; an algorithm to guide staff on ways to improve the monitoring and management of temperature in trauma patients was developed. Opportunities for ongoing and further research were identified.

Education, Continuing↗
PubMed2005

Clinical research 5: quantitative data collection and analysis.

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process. A couple of points: 1. It is artificial to describe research as qualitative or quantitative. Studies often include both dimensions. However, for the purposes of this paper/series, this distinction is drawn for clarity of writing. 2. It is common practice for quantitative studies to refer to study 'subjects' and qualitative studies to refer to study 'participants'. For ease of reading, the latter term will be used throughout this series

Clinical Nursing Research↗
PubMed2005

Clinical Research 6: Writing and research.

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process.

Clinical Nursing Research↗
PubMed2004

Clinical research 4: qualitative data collection and analysis.

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process. A couple of points: 1. It is artificial to describe research as qualitative or quantitative. Studies often include both dimensions (for example, Evangelista LS, Doering L, Dracup K. Meaning and life purpose: the perspectives of post-transplant women. Heart Lung 2003;32(4):250-7; Fitzsimmons D, Parahoo K, Richardson SG, Stringer M. Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis. Heart Lung 2003;32(1):23-31). However, for the purposes of this paper/series, this distinction is drawn for clarity of writing. 2. It is common practice for quantitative studies to refer to study 'subjects' and qualitative studies to refer to study 'participants'. For ease of reading, the latter term will be used throughout this series.

Anthropology, Cultural↗
PubMed2004

Making portfolios work in practice.

BACKGROUND: A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self-directed learning and provides a collection of detailed evidence of a person's competence. AIMS: This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England. METHODS: This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used. FINDINGS: Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers' expectations was essential to allay feelings of insecurity. CONCLUSIONS: To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students' stage of professional and academic development. Over-complex approaches to practice assessment, particularly in the early stages of students' careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.

Clinical Competence↗
PubMed2004

An ethnographic study of three mental health triage programs.

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services.

Anthropology, Cultural↗
PubMed2003

Evaluating portfolio assessment systems: what are the appropriate criteria?

PURPOSE: The purpose of this paper is to discuss how portfolio assessment processes should be evaluated. BACKGROUND: Articles in the nursing literature discuss the use of validity and reliability as criteria for evaluating portfolio assessment processes, and recommendations include tighter specification of grading criteria, a standardized national approach to assessing clinical competence in nursing students, and inter-rater reliability checks. On the other hand, some general practitioner educators suggest that these may not be the appropriate criteria because the nature of the evidence in portfolios is descriptive and judgement-based rather than quantifiable. METHOD: Drawing on multi-method case study data from a recent study evaluating the use of portfolios in the assessment of learning and competence in nursing education in England, we suggest that criteria developed to evaluate qualitative research may be more appropriate for evaluating portfolio assessment processes. DISCUSSION: Multiple sources of evidence from the varied perspectives of students, teachers, practice assessors and external examiners are tapped as part of the portfolio assessment process. Tripartite meetings between students, teachers and clinical assessors to review placements are crucial in verifying both the written evidence and students' ability to communicate and critically analyse their performance. The variety of evidence collected would potentially allow monitoring, using qualitative research evaluation criteria, both of the portfolios themselves and the systems by which they are monitored and evaluated. However, not all this information is collected consistently and systematically, as called for in curriculum documents. CONCLUSIONS: Use of qualitative research evaluation criteria offers a potentially productive way forward in evaluating portfolio assessment processes but some aspects of current practice need to be tightened, particularly double marking, internal moderation and external examining.

Clinical Competence↗
PubMed2003

Portfolios and assessment of competence: a review of the literature.

BACKGROUND: The literature review presented here was conducted as part of an English National Board for Nursing, Midwifery and Health Visiting funded project to evaluate the use of portfolios in the assessment of learning and competence. Initial consideration of the topic revealed the need to clarify the terminology and approaches used to assess competence using portfolios, and therefore the literature review was conducted to inform the study. AIMS: To clarify definitions, theoretical bases and approaches to competence and the use of portfolios in the assessment of learning and competence in nursing education. METHODS: A comprehensive literature review was conducted using the CINAHL and MEDLINE databases and the keywords competenc*, portfolios and nursing. Articles published in the period 1989-2001 in English were obtained and their reference lists scrutinized to identify additional references. Twenty articles were found using a combination of the keywords competenc* and portfolios, and 52 using the combination portfolios and nurse education. Articles were included in the review if they focused on the use of portfolios in nursing, and those concerned with professional or transitional portfolios were excluded. This article will analyse definitions of and approaches to competence and its measurement and to portfolios and their use as discussed in the articles identified. RESULTS: Three approaches to competence were identified, each with its appropriate forms of assessment. With regard to portfolios, a number of definitions were again found, but there was a consensus that the theoretical basis of their use is theories of adult learning. A number of reasons for and advantages and disadvantages of their use were found, as well as varying ideas about what a portfolios should consist of and how it should be assessed. CONCLUSION: A holistic approach to competence seems to be compatible with the use of portfolios to assess competence in nursing students, but the concept and its implementation is still evolving. A variety of assessment methods are needed for assessment and portfolios appear to have the potential to integrate these. Reflection is an essential component of a portfolio, as are the student-teacher relationship and explicit guidelines for constructing the portfolio. Issues of rigour in assessment of portfolios need to be addressed, but the assessor's professional judgement will inevitably enter into this assessment.

Clinical Competence↗
PubMed2003

The reality of clinical learning in critical care settings: a practitioner:student gap?

* This article reports on the clinical phase of a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting to evaluate the effectiveness of educational preparation for critical care nursing [Scholes & Endacott (2002) Evaluation of the Effectiveness of Educational Preparation for Critical Care Nursing. ENB, London]. The authors draw on observation and interview data from clinical settings (general and paediatric intensive care units; operating theatre departments; accident and emergency departments and coronary care units), focusing specifically on the way in which curricular intentions were made a reality in clinical practice. The reality of learning in practice is examined, with evidence from the data to illustrate the real world of clinical practice. * Different models of support and supervision are identified, alongside strategies used to create different learning opportunities. The majority of students remained in their own workplace when undertaking the English National Board for Nursing, Midwifery and Health Visiting clinical course. This raised a number of issues for the students and their colleagues which we have labelled the practitioner:student gap. The authors discuss the impact this has on supernumerary status, perceptions of learning and opportunities to undertake placements.

Clinical Competence↗
PubMed2002

Through the eyes of the expert witness.

Nurses are increasingly asked to provide expert advice to a court of law, for example through a formal contract as an expert witness or through providing the trust solicitor with a response to a complaint from a patient or relatives. The purpose of this brief paper is to share experiences of undertaking the role of 'expert witness' in the UK and to highlight some of the pitfalls and the wider context in which such a role is undertaken.

Expert Testimony↗