Use of medical orders in acute care oxygen therapy

The life of every living organism is sustained by the presence of oxygen and the acute deprivation of oxygen will, therefore, result in hypoxia and ultimately death. Although oxygen is normally present in the air, higher concentrations are required to treat many disease processes. Oxygen is therefore considered to be a drug requiring a medical prescription and is subject to any law that covers its use and prescription. Administration is typically authorized by a physician following legal written instructions to a qualified nurse. This standard procedure helps prevent incidence of misuse or oxygen deprivation which could worsen the patients hypoxia and ultimate outcome. Delaying the administration of oxygen until a written medical prescription is obtained could also have the same effect. Clearly, defined protocols should exist to allow for the legal administration of oxygen by nurses without a physicians order because any delay in administering oxygen to patients can very well lead to their death.

An examination of the 'gold standard' diagnosis of major depression in aged-care settings

Objectives: Individual clinical interviews are typically viewed as the “gold standard” when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample.

Design: The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument.

Setting: Low-level aged-care residential facilities in Melbourne (equivalent to “residential homes,” “homes for the elderly,” or “assisted living facilities” in other countries).

Participants: One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning.

Measurements: Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15).

Results: The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure.

Conclusion: Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.

Use of restraint in residential care settings for children and young people

An international movement promoting the reduced use of physical restraint and other coercive practices has brought into focus the ways in which those who are responsible for the care of children and young people respond to problematic behaviour. The topic generates emotive discussion, with proponents advancing the argument that the use of coercive measures enhances the quality of care and protects young people from harm, and civil libertarians who argue that restraint is never an appropriate way of managing behaviour. Despite such debates there is an absence of good research and scholarly activity on restraint practices, leading to uncertainty about the immediate and long-term effects of particular practices on both staff and young people. Consequently, it has been difficult for agencies to develop clear, consistent, and definitive policies. Drawing on international perspectives, the aim of this article is to discuss issues relevant to the practice of restraint in residential care facilities for children and young people in Australia, highlighting a number of issues that require resolution prior to the development of practice guidelines.

Care needs and functional status of older acute care patients

A growing number of older adults are admitted to hospitals, and information is needed on how age-related functional decline affects nursing care needs of this population. This study compared the functional status at admission and total nursing care needs of three age groups of older inpatients. A 12-month retrospective audit was performed on the records of 225 patients in a private metropolitan hospital. The three groups of patients were matched on diagnosis. Findings revealed that older patients were significantly more dependent, had greater total nursing care needs, and were less likely to be discharged to home, indicating that in addition to medical diagnoses, age-related differences of older patients’ functional status at admission and inpatient nursing care needs should be factored into staff workloads and funding of nursing care. The finding that significantly fewer of the older patients returned home must be considered when reviewing health care policy and services.

It's here! Are we ready? Five case studies of health promotion practices that address climate change from within Victorian health care settings

Issue addressed: Climate changes and environmental degradation caused by anthropogenic activities are having an irrefutable impact on human health. The critical role played by health promotion in addressing environmental challenges has a history in seminal charters − such as the Ottawa Charter for Health Promotion − that explicitly link human well-being with the natural environment. The lack of documented practice in this field prompted an investigation of health promotion practice that addresses climate change issues within health care settings.

Methods: This qualitative study involved five case studies of Victorian health care agencies that explicitly identified climate change as a priority. Individual and group interviews with ten health promotion funded practitioners as well as document analysis techniques were used to explore diverse practices across these rural, regional and urban health care agencies.

Results: Health promotion practice in these agencies was oriented toward: active and sustainable transport; healthy and sustainable food supply; mental health and community resilience; engaging vulnerable population groups such as women; and organisational development.

Conclusion: Despite differences in approach, target population and context, the core finding was that health promotion strategies, competencies and frameworks were transferable to action on climate change in these health care settings.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.