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Biomedical subjects

W Chaboyer

Publications and source records attributed to W Chaboyer.

At least 19 recordsLinked to original sources

The impact of an ICU liaison nurse on discharge delay in patients after prolonged ICU stay.

The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention--the ICU liaison nurse role--in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICUpatients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. The liaison nurse was involved in assessment of patients for transfer to the ward, with a major focus on coordinating patient transfer including liaison with ward staff prior to and following ICU discharge. Logistic regression was used to quantify the risk of discharge delay associated with the liaison nurse intervention with adjustment for potential confounding variables. While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjustingforpotential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer

Adult↗

The utility of cognitive behavioural therapy on chronic haemodialysis patients' fluid intake: a preliminary examination.

The aim of this study was to assess the influence of cognitive behavioural therapy (CBT) on chronic haemodialysis (HD) patients' ability to achieve fluid intake related behavioural objectives. This one group before and after quasi-experiment consisted of a four-week base-line phase, a six-week intervention phase and a four-week follow-up phase. Interventions included self-contract, reinforcement and self-monitoring. Participants were 10 Japanese HD outpatients. The average achievement of the fluid intake objective in the intervention phase was 65%. Fifty percent of participants achieved their objectives at least 3/4 of the time without individualised reinforcement. CBT was effective in helping patients change their fluid intake behaviours.

Cognitive Behavioral Therapy↗

Effect of central venous catheter type on infections: a prospective clinical trial.

This study reports on a block clinical trial of two types of central venous catheters (CVCS): antiseptic-impregnated catheters (AIC) and non-impregnated catheters (non-AIC), on catheter tip colonization and bacteraemia. In total, 500 catheters were inserted in 390 patients over the 18 month study period, 260 (52.0%) AIC and 240 (48.0%) non-AIC. Of these, 460 (92.0%) tips (237 AIC and 223 non-AIC) were collected. While significantly fewer AIC, 14 (5.9%), than non-AIC, 30 (13.5%), catheters were colonized (P<0.01), there was no difference in the rates of bacteraemias in the two groups (0.8% vs. 2.7%, respectively, P=0.16). There were 6.87 (95% CI 3.38-14.26) and 16.92 (95% CI 10.61-27.12) colonized AIC and non-AIC catheters, respectively, per 1000 catheter days, a difference that was significant (P<0.01). However, no difference emerged between bacteraemias in AIC and non-AIC catheters per 1000 catheter days measured at 0.98 (95% CI 0.24-5.54) and 3.38 (95% CI 1.29-9.34), respectively (P=0.10). Of the 444 CVCs that were sited in the subclavian or jugular veins and had tips collected, significantly more catheters were colonized in the jugular group, 19 (20%), compared with the subclavian group, 24 (6.9%; P< or =0.01). Overall, the low rates of colonization and bacteraemia may be explained by the population studied, the policies used and the employment of a clinical nurse dedicated to CVC management.

Anti-Infective Agents, Local↗

Factors influencing job valuation: a comparative study of critical care and non-critical care nurses.

This study sought to identify the relationship between three predictor variables, perceived collaboration with medical staff, autonomy and independent actions and an outcome, the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical care nurses perceived themselves to have a more collaborative relationship with the medical staff, described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more, however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work.

Adult↗

Cohesion among nurses: a comparison of bedside vs. charge nurses' perceptions in Australian hospitals.

AIM: This study examines the extent to which hospital nurses view their working environment in a positive sense, working as a cohesive group. BACKGROUND: Despite the fact that nursing in Australia is now considered a profession, it has been claimed that nurses are an oppressed group who use horizontal violence, bullying and aggression in their interactions with one and other. METHODS: After ethical approval, a random sample of 666 nurses working directly with patients and all 333 critical care nurses employed in three large tertiary Australian hospitals were invited to participate in the study in the late 1990s. A mailed survey examined the perceptions of interaction nurses had with each other. The hypothesis, that level of employment (either Level I bedside nurses or Level II/III clinical leaders) and area of work (either critical care or noncritical care) would influence perceptions of cohesion, as measured by the cohesion amongst nurses scale (CANS) was tested. RESULTS: In total 555 (56%) surveys were returned. Of these, 413 were returned by Level I and 142 by Level II/III nurses. Of this sample, 189 were critical care and 355 noncritical care nurses. There was no difference between Level I and II/III nurses in mean CANS scores. It is interesting to note that the item rated most positively was "nurses on the units worked well together", however, the item rated least positive was "staff can be really bitchy towards each other" for both Level I and II/III nurses. There was no difference in CANS scores between critical care and noncritical care nurses. CONCLUSIONS: Nurses working in Australian hospitals perceived themselves to be moderately cohesive but, as would be expected in other work settings, some negative perceptions existed.

Adult↗

Influence of self-efficacy and other factors on dietary behaviours in Japanese haemodialysis patients.

In Japan, haemodialysis patients are required to adhere to a fairly rigid dietary regimen. Guided by Bandura's theory of self-efficacy, this study tested a prediction model of dietary behaviour. A total of 325 individuals completed a self-administered survey containing nine scales, which were used to measure the six constructs in the model. Using multiple regression analysis, 24% of the variance on the Dietary Behaviour Scale could be accounted for by three predictor scales, Dietary Management Self-efficacy, Support from Family, and Self-Repressive Behaviour Patterns. Multiple regression analysis identified that four scales, Character Image of Dialysis Staff, Support from Family, Dialysis Acceptance, and Somatic Symptoms, contributed to 13% of the variance of the Dietary Management Self-efficacy Scale. These results might provide direction to those who are involved in the support and care of haemodialysis patients, some of whom require life-long treatment, as is common in Japan.

Aged↗

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↗

Caregivers of ICU patients discharged home: what burden do they face?

Reforms in healthcare aimed at cost-cutting have led to early hospital discharge for many patients, including those who have sustained critical illness or injury requiring admission to an intensive care unit (ICU). Many former ICU patients experience ongoing health-related problems following discharge from hospital, and need ongoing support and care from their family once discharged. However, family members who take on a caregiving role often experience an enormous burden. The literature has demonstrated the impact of economic, social, physical and psychological factors on those who care for the critically ill following discharge. It is therefore essential that all nurses involved in the ongoing management of ICU patients have an understanding of the caregiving role, and consider both the patient and his/her carer in the discharge planning process. This paper reviews the literature on caregiving, and examines research studies which describe and measure the factors involved in the caregiving role. Although only a small number of studies specifically focus on caregivers of former ICU patients, findings suggest that these caregivers experience a substantial burden which is associated with the complexity of the patient's physical and psychological impairment, and complex technology. To enable nurses to incorporate planning strategies and interventions aimed at minimizing the impact on the caregiver, further research is needed to more fully explore, examine and measure the factors involved in caring for ICU patients post-discharge. Furthermore, ongoing research and evaluation of interventions will build an evidence-base to inform future practice.

Caregivers↗

Critical care education: an examination of students' perspectives.

Specialist nursing education at the tertiary level is a relatively recent occurrence in Australia. With this move to higher education a variety of issues such as course duration, award level and clinical versus theoretical outcomes provided the impetus for this study. This study examined critical care nursing students' perceptions of undertaking post-graduate education within the higher education sector. Four themes arose from analysis of eight focus group interviews with a total of 42 students from 35 courses offered in eight universities across Australia. The first theme, student burden, included subthemes of financial, heavy workload and student-work conflicts. Student benefits, the second theme, encompassed financial and other benefits. The third theme, clinical experience, incorporated clinical capability, synthesizing, support required and clinical learning. The final theme of student attitude included the subthemes of individual, technology and course. Without student evaluations, curricular improvements including assessment and clinical experience will not evolve to the best of their potential.

Australia↗

Health-related quality of life of ICU survivors: review of the literature.

The importance of health-related quality of life (HRQL) as a relevant outcome measure for patients requiring intensive care unit (ICU) management has only recently been recognized. A better understanding of how this expensive service affects the health and well-being of its survivors will allow nurses and other health care professionals to plan for and provide appropriate follow-up care. This paper contains a review of the theoretical basis for quality-of-life measures, discussion of some of the methodological issues, and examination of the findings from recent studies of the quality of life of ICU patients. Although not conclusive, the review identified that ICU survivors generally have poorer HRQL scores after a 6-12 month period of recovery than during their pre-admission period. This cohort also have lower HRQL than the age-adjusted general population. Despite this apparent poorer state of health, participants often claimed to be satisfied with their HRQL. Methodological weaknesses were evident in the studies reviewed, Challenges in terms of recruitment and retention of subjects, instrumentation and data collection became evident from this review. Continued research in this area is recommended and should address the weaknesses identified.

Activities of Daily Living↗

Developing specialty knowledge: the case of Australian critical care nursing.

The generation of new knowledge is important to the evolution of the nursing profession and its specialties and is a fundamental requirement for the development of the discipline. This study documents the growth of empirical knowledge in Australian critical care nursing by examining the research published in one critical care specialty journal and a second generalized nursing research journal between 1994 and 1998. The proportion of research published in the specialty journal increased from 25 to 69%, with almost one-half focusing on patient therapies and treatments. The proportion of research in the general journal was consistently high, approximately 80 to 90%, with one to two critical care research articles per year. Nurses were first authors on the vast majority of these research articles. Approximately half of the critical care research focused on patient care. The results support the claim that Australian critical care nurses are conducting research to promote best practice in patient care and are thus contributing to the development of the discipline of nursing.

Australia↗

Intellectual work of the critical care nurse: applications from a qualitative study.

Worldwide shortages of critical care (CC) nurses have resulted in efforts targeted at understanding this unique area of nursing practice. This paper describes the findings of a qualitative study in which interviews with 17 CC nurses were conducted and provides insight into the support and continuing education required by both novice and experienced CC nurses. Analysis of the transcripts, field notes, memos and diagrams, and a comparison of the emerging categories to previous research, assisted in identifying several themes important to CC nursing practice. Within one of these themes, labelled 'intellectual work', four categories are described. 'Inquisitive mind', 'seeing the whole picture', 'ongoing vigilant assessment' and 'quick response' each provide evidence to support the need for adequate preparation and ongoing nurturing of CC nurses. Ensuring that educational opportunities for all CC nurses are focused on the development of sound clinical reasoning skills may result in a better prepared and more stable workforce, and optimal outcomes in patient care.

Adult↗

The expanded role of acute care nurses: the issue of liability.

For a variety of reasons the activities performed by health care professionals are ever increasing, however the legislative process regulating these specialised workers is not keeping up with the practice realities. While competency statements and credentialling mechanisms are developing, they are not uniformly in place for specialists. Therefore activities completed by these practitioners may be legally controversial. This study documents a variety of tasks completed independently by nurses employed in three acute care hospitals that legally require medical orders and then examines the legal implications of this role extension. Credentialling is one mechanism by which nurses and other health care professionals can ensure they possess the levels of knowledge and skill required to perform the advanced activities required of them and consequently avoid negative legal repercussions.

Australia↗

Dietary behaviors and sources of support in hemodialysis patients.

Individuals with chronic renal failure generally have strict dietary guidelines. This descriptive study was designed to identify the relationship between sources of social support and dietary management by Japanese hemodialysis patients. A self-administered questionnaire was completed by a convenience sample of 325 adults receiving dialysis. Subjects 65 years and older received more support from family members, doctors, nurses, and technicians than younger subjects. Subjects who had been on dialysis for less than 3 years received more support from nurses and doctors than those who had been on dialysis for longer periods of time. Multiple regression analysis identified that support from family members and nurses were significantly related to dietary behaviors. Nurses working with dialysis patients should remember to use their influence to positively support their patients and to bear in mind that long-term dialysis patients, especially those who are young and unmarried, may benefit from ongoing nursing support and encouragement.

Adult↗

Unlicensed assistive personnel in the critical care unit: what is their role?

Driven by an economic imperative, the use of unlicensed assistive personnel (UAP) has proliferated in the health care system, however, their use in the critical care (CC) environment remains relatively new. An analysis of the first phase of a mixed method study, in which interviews with 17 CC nurses were conducted in order to provide data upon which to devise a larger survey, provides insight into the potential uses and misuses of these UAP. An examination of the transcripts, field notes, and diagrams and a comparison of the emerging categories to the literature assisted in identifying several themes important to CC nursing practice. Three themes identified in the analysis--ongoing vigilant assessment, quick response and seeing the whole picture--provide evidence that if UAP are asked to complete tasks allocated to them in other areas, CC nurses will be robbed of vital, albeit subtle, aspects of their nursing practice. As reflective practitioners, CC nurses must be wary of giving away tacit features of their role which enable them to synthesise contextual variables with espoused theory and experience, in order to ensure optimal patient care and outcomes.

Adult↗

Critical care graduate diploma: nursing students' needs identified in evaluation.

In 1993 a Graduate Diploma in Critical Care Nursing was developed by the Faculty of Nursing and Health Sciences Griffith University--Gold Coast Campus, in collaboration with hospitals in the South Coast and Brisbane regions of Queensland and the Queensland Nurses Union of Employees. An independent evaluation of this 1-year full-time course identified several issues which should be considered when planning courses of this type. Student characteristics varied, and most gained entry into this course on the basis of prior experience. Many students lacked such 'hardware' skills as library access, computing and study ability. By the end of the course, students perceived that their prospects for career advancement were enhanced by the knowledge and skills gained from the course and that they had demonstrated professional development. Students emphasised the need for a strong focus on the clinical component of the course. Planning for specialty education should include comprehensive induction programs which provide opportunities to develop 'hardware' skills, and special attention must be paid to the clinical components.

Adult↗