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Biomedical subjects

T Bucknall

Publications and source records attributed to T Bucknall.

8 recordsLinked to original sources
PubMed2001

Evidence based practice: are critical care nurses ready for it?

In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.

Adult↗
PubMed2001

Acute pain management: implications of scientific evidence for nursing practice in the postoperative context.

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

Acute Disease↗
PubMed1997

Nurses' reflections on problems associated with decision-making in critical care settings.

The present study investigated nurses' perceptions of the problems associated with their decision-making in critical care settings. This paper reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis "due to knowledge base', "lack of time to make decisions', "lack of time to implement decisions', and "personal values conflicts with other staff'. Nearly one-third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care: the demands of new intensive care technology upon the nurses' knowledge bases; and the need for in-service education to address this problem. The paper concludes with arguments for the use of in-depth interviews to further study these issues.

Adult↗
PubMed1996

Critical care nurse satisfaction with levels of involvement in clinical decisions.

This research reports the results of a survey of 230 Australian critical care nurses. The respondents were asked to rate how frequently they were involved in 10 common critical care decisions and their levels of satisfaction with their involvement for each decision task. It was found that level of task satisfaction was positively correlated with level of task involvement, thus supporting the hypothesis that nurse task decision autonomy is associated with nurse task satisfaction. The paper argues for the importance of differentiation between task satisfaction and work satisfaction in research of these issues.

Adult↗
PubMed1995

Clinical decision-making in critical care.

A survey of 230 practising critical care nurses was conducted to examine the frequencies with which the nurses made decisions to perform 10 critical care tasks drawn from cardiac, respiratory and gastrointestinal management. The relationship between the nurses' levels of appointment and the frequencies with which they made their decisions was also studied. Substantial intra-respondent and inter-respondent variations were found in the frequencies with which nurses reported that they made the decisions. Chi-square analysis showed that there was a positive association (p < 0.05) between nurses' appointment levels and the frequency with which decisions were made to perform five of the tasks. Notwithstanding these associations, it is of concern that the professional preparation of some nurses had not been at a level that equipped them to routinely make these decisions. The findings of the study have implications for the development of standards of practice guidelines and critical care education.

Adult↗
PubMed1993

Orgaran (Org 10172) or heparin for preventing venous thrombosis after elective surgery for malignant disease? A double-blind, randomised, multicentre comparison. ANZ-Organon Investigators' Group.

This double-blind, randomised, multicentre trial in 513 patients having elective surgery for intra-abdominal or intrathoracic malignancy compared the efficacy and safety of venous thrombosis (VT) prophylaxis using 750 anti-factor Xa units of Orgaran (a mixture of low molecular weight heparinoids) given subcutaneously (sc) twice-daily with that of twice-daily injections of 5,000 units standard heparin. The main study endpoints were the development of postoperative VT detected by 125I-fibrinogen leg scanning, and the onset of clinically significant venous thromboembolism or bleeding. "Intent to treat" analysis showed a statistically non-significant trend towards less VT during Orgaran prophylaxis (10.4%) than after heparin (14.9%) and there was no difference in bleeding complications between the two study groups. Results remained similar if only patients who completed the intended course of therapy ("compliant patients") were analysed. Other trials have shown that Orgaran prevents VT after hip surgery and stroke. We now show it is also safe and effective in patients having major surgery for cancer.

Aged↗
PubMedDate not supplied

Australian triage nurses' decision-making and scope of practice.

A survey of 172 Australian triage nurses was undertaken to describe their scope of practice, educational background and to explore the self-reported influences perceived to impact on their decision-making. The survey results reveal variability in the educational requirements for nurses to triage. Indeed, over half of the nurses who participated in the study worked in emergency departments that provided no specified unit-based triage education. Additionally, substantial inter-respondent variations in nurses' self-reported participation in a range of decisions to expedite emergency care were identified. Analysis revealed significant associations between demographic characteristics of the triage service, levels of nurse' autonomy and the nurses' self-reported participation in a number of triage decisions. The findings of this study have implications for emergency nurse education and the development and evaluation of triage practice guidelines.

Attitude of Health Personnel↗