Biomedical subjects

Sandra Dunn

Publications and source records attributed to Sandra Dunn.

15 recordsLinked to original sources

PubMed2006

A framework for description and evaluation of the nurse specialist role in South Australia.

Professionalising forces in nursing, burgeoning costs and increasing crises in medical care in rural and remote areas have led to the development of specialty nursing. However, description and evaluation of the role of the Nurse Specialist in the Australian context has not been well documented. This interpretive study was designed to explore the major components of Nurse Specialist roles in South Australia and to develop a framework for description and evaluation of these roles. A total of 30 Nurse Specialists from two major metropolitan teaching hospitals participated in focus groups to explore their roles. Role components were used to develop tools and a framework for describing and evaluating these roles. Participants identified clinical, educational, professional development, management and research as key components of the Nurse Specialist role. The results highlighted the diversity within the role for each Nurse Specialist and the need for a comprehensive range of evaluation tools. Recommendations arising from the research suggest that evaluation strategies need to be accompanied by appropriate staff education and be sensitive to the social, political and economic context of practice.

Attitude of Health Personnel↗

PubMed2006

The highly conserved family of Tetrahymena thermophila chromosome breakage elements contains an invariant 10-base-pair core.

As a typical ciliate, Tetrahymena thermophila is a unicellular eukaryote that exhibits nuclear dimorphism: each cell contains a diploid, germ line micronucleus (MICN) and a polyploid, somatic macronucleus (MACN). During conjugation, when a new MACN differentiates from a mitotic descendant of the diploid fertilization nucleus, the five MICN chromosomes are site-specifically fragmented into 250 to 300 MACN chromosomes. The classic chromosome breakage sequence (CBS) is a 15-bp element (TAAACCAACCTCTTT) reported to be necessary and sufficient for chromosome breakage. To determine whether a CBS is present at every site of chromosome fragmentation and to assess the range of sequence variation tolerated, 31 CBSs were isolated without preconception as to the sequence of the chromosome breakage element. Additional CBS-related sequences were identified in the whole-genome sequence by their similarities to the classic CBS. Forty CBS elements behaved as authentic chromosome breakage sites. The CBS nucleotide sequence is more diverse than previously thought: nearly half of the CBS elements identified by unbiased methods have a variant of the classic CBS. Only an internal 10-bp core is completely conserved, but the entire 15-bp chromosome breakage sequence shows significant sequence conservation. Our results suggest that any one member of the CBS family provides a necessary and sufficient cis element for chromosome breakage. No chromosome breakage element totally unrelated to the classic CBS element was found; such elements, if they exist at all, must be rare.

Animals↗

PubMed2005

Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research.

BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Attitude of Health Personnel↗

PubMed2005

Perceptions of working as a nurse in an acute care setting.

This paper focuses on the changing nature of nurses' perceptions of their work. It examines the major sources of satisfaction and dissatisfaction experienced by nurses working at a major teaching hospital in May 2000. Coding categories reflected four components of nurses' work experiences: organizational, interpersonal, structural and professional. Organizational aspects of work were over-represented as sources of satisfaction and dissatisfaction and related to perceived changes in management philosophy (increasing productivity with limited resources). Study findings provide some clear goals for responsive, sensitive management.

Adult↗

PubMed2004

Using nursing information systems to enhance quality service across multiple service providers.

This study explored the key requirements identified by stakeholders for the integration of Nursing Information Systems (NIS) in three public hospitals in the southern suburbs of Adelaide. The study used a qualitative approach of semi-structured interviews, focus groups, site visits to the hospitals and review of relevant literature to ascertain what participants saw as the necessary ingredients to create regional NIS. Study findings showed that the current NIS are not sustainable in terms of staffing levels, physical resources or the capacity of the two currently-used computer products to interface with newer generation products. A critical issue for adopting a regional model is the willingness of local sites to revise their current internal structures and functions. This restructuring towards a regionalised NIS would improve overall communication, education, security efficiency and sustainability.

Computer User Training↗

PubMed2002

Patients' interpretation of the symptoms of myocardial infarction: implications for cardiac rehabilitation.

Research has shown that patients' models of illness are likely to be different from those of health professionals and that these beliefs may be more important than medical factors in directing the recovery process. Beliefs about myocardial infarction may influence coping with the illness, expectations for recovery, patients' reactions to subsequent cardiac events, morbidity and compliance rates and attendance at rehabilitation courses. This qualitative study explores patients' interpretation of the symptoms of myocardial infarction and their personal theories about the illness. Data collection was undertaken in a coronary care unit, using semi-structured interviews with 50 patients. Ethnographic content analysis was used to develop an insightful description of commonalties in the data. Major categories from the data included: providing a historical context, the metaphor of a heart attack, labelling of symptoms and making sense of the illness experience. Interventions to increase participation in rehabilitation programmes need to take into consideration patients' theories about their illness.

Adult↗

PubMed2002

Systematic review of the effectiveness of urinary continence products.

Urinary incontinence is common, and considerable advances have been made in treatments and therapies for this distressing and socially unacceptable condition. Most people with incontinence use continence products to conceal their loss in the short term or long term. A huge range of products is available, including absorbent products, collection devices, catheters, and accessories. However, little guidance is available to aid consumers and health professionals in product selection. Therefore, a systematic review of research literature from 1982 to 2000 concerning the effectiveness of continence products was conducted. More than 350 articles were retrieved, of which 75 met the selection criteria for this review. It is apparent that there is a lack of high-quality research into the effectiveness of continence products. A recurrent theme in the literature is the importance of individual assessment to find products to suit the particular needs of each consumer. This review indicates that the absence of research information about the effectiveness of continence aids and appliances makes selection difficult.

Equipment Design↗

PubMed2002

Perceptions of the researcher: in-depth interviewing in the home.

In this paper we explore the home as a setting to collect qualitative data. The text is drawn from a collaborative research initiative that sought to interview people with cardiac disease. The literature pays little attention to the home as a venue for in-depth data gathering and yet from our experience it is very different to other settings. We argue the need for extra consideration to aspects such as trust, self-disclosure and safety, and draw these conclusion from the data gathered in the field.

House Calls↗

PubMedDate not supplied

Aerobic exercise and the post myocardial infarction patient: a review of the literature.

Meta analyses of randomized controlled tests of cardiac rehabilitation after myocardial infarction demonstrate that regular exercise reduces the risk of overall mortality and cardiovascular mortality. In patients with established coronary artery disease, exercise is associated with improved activity tolerance, modification of risk factors, and improvement in quality of life. Randomized controlled tests demonstrate that whereas older patients after coronary events are substantially less fit than younger patients, they obtain a similar relative improvement of aerobic capacity with a graded conditioning program. However, older adults are enrolled in such programs at a lower rate than other age groups. Despite similar clinical profiles to men, women are less likely to participate in exercise rehabilitation. In this article we discuss the principles of program development, guidelines for monitoring of patients, and facilitation of exercise programs in the Australian context.

Coronary Artery Disease↗

PubMedDate not supplied

Development and evaluation of an innovative community-based PEG support service.

The Percutaneous Endoscopic Gastrostomy Care and Support Service was launched in March 1999 as a joint project of the Endoscopy Suite and Hospital at Home at Flinders Medical Centre South Australia. The Support Service was developed to provide, through integration of services, a link between the acute care setting and the community to ensure optimal management of patients with percutaneous endoscopic gastrostomy tubes. A percutaneous endoscopic gastrostomy coordinator was employed to undertake further development of the service. Integration of data from questionnaires and the percutaneous endoscopic gastrostomy data base was used to evaluate the service. Data indicated there was a need for a support service, not only for patients living with percutaneous endoscopic gastrostomy tubes, but also for the caregivers of those patients who require specialized knowledge to manage percutaneous endoscopic gastrostomy related problems. As a result of this project, percutaneous endoscopic gastrostomy management can now be provided in the patient's home setting, thereby improving patient and caregiver satisfaction and reducing hospital admissions.

Community Health Nursing↗

PubMedDate not supplied

Pediatric atopic eczema: the impact of an educational intervention.

Patient education has been regarded as having a key role in the self-management of atopic eczema. However, the relationship between the educational interventions and clinical outcomes including severity of eczema, quality of life, and family impact has not been rigorously examined. The purpose of this longitudinal randomized controlled study was to evaluate the impact of an intensive education program with a focus on dermatology and immunology designed for parents and children diagnosed with atopic eczema. The intention of this study was not to change treatment regimes prescribed by the patient's physician. The Scoring Atopic Dermatitis rating system was used for assessment of disease impact, and the impact on quality of life was quantified by using the Children's Dermatology Life Quality Index, Infants' Dermatology Quality of Life Index, and Dermatitis Family Impact. A total of 61 pediatric patients (0-16 years) diagnosed with atopic eczema from the metropolitan area of Adelaide were randomized to either the control or intervention group. Results of the study showed that the intervention group had a significant improvement in the scoring atopic dermatitis measure when compared to the control group at week 4 and week 12. Quality of life measures did not significantly improve with decreased severity of eczema except in the group of children aged 5-16 years which, despite small numbers, showed a significant improvement in quality of life scores. These findings suggest that education provides an important role in decreasing the severity of eczema.

Adolescent↗

PubMedDate not supplied

Against all odds: breastfeeding a baby with harlequin ichthyosis.

Harlequin ichthyosis, a congenital skin condition, poses challenges to nursing care, which include preventing infection, feeding, and enhancing attachment. Although breastfeeding is recognized as the best form of nutrition for infants, it may not be considered as part of a treatment plan for infants with complex needs. This article explores the experiences of one mother and her newborn with harlequin ichthyosis, and how they taught us to remember that there are unlimited possibilities for care.

Adaptation, Psychological↗

PubMedDate not supplied

Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations.

This article describes a framework for evaluating and adapting existing practice guidelines for local use by health care organizations and groups. The framework presents the major issues related to guideline adaptation and breaks them down into manageable steps. Many steps of the framework are illustrated using the process used by the Registered Nurses Association of Ontario to develop best practice guidelines for breastfeeding.

Benchmarking↗

PubMedDate not supplied

The relationship between vulnerability factors and breastfeeding outcome.

OBJECTIVE: To determine whether vulnerability factors (confidence with breastfeeding, postpartum depression, supplementation, and perceived adequacy of support) are associated with breastfeeding outcome at 6 weeks postpartum after controlling for age and education. DESIGN: Secondary analysis of a cross-sectional telephone survey at 6 weeks postpartum. SETTING: Ottawa-Carleton, Ontario, Canada. PARTICIPANTS: A proportionate, consecutive sample of breastfeeding women from each of four hospitals in the region (526/554, 95% response rate). METHODS: Stratified bivariate analyses were used to examine the relationship between each factor and breastfeeding outcome. Multivariate logistic regression analyses examined relationships between all factors and breastfeeding outcome. RESULTS: In the logistic regression analyses, confidence with breastfeeding (odds ratio: 1.85, 95% confidence interval: 1.50-2.27, p < .001) and postpartum depression (odds ratio: 0.28, 95% confidence interval: 0.11-0.71, p= .007) were related to breastfeeding after controlling for age and education. CONCLUSIONS: Support for breastfeeding should include assessment of maternal confidence with breastfeeding and postpartum depression. Evaluation of intervention strategies to address these vulnerability factors is a priority.

Adult↗

PubMedDate not supplied

Competency and capability: imperative for nurse practitioner education.

OBJECTIVE: The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. SETTING: The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand. SUBJECTS: The research was informed by multiple data sources including nurse practitioner program curricula documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners. PRIMARY ARGUMENT: Findings from this research include support for master's level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability. CONCLUSIONS: There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand.

Attitude of Health Personnel↗