(Mis)Using Pulse Oximetry : A Review of Pulse Oximetry use in Acute Care Medical Wards

Background: Nurses routinely use pulse oximetry (SpO2) monitoring equipment in acute care. Interpretation of the reading involves physical assessment and awareness of parameters including temperature, haemoglobin, and peripheral perfusion. However, there is little information on whether these clinical signs are routinely measured or used in pulse oximetry interpretation by nurses. Aim: The aim of this study was to review current practice of SpO2 measurement and the associated documentation of the physiological data that is required for accurate interpretation of the readings. The study reviewed the documentation practices relevant to SpO2 in five medical wards of a tertiary level metropolitan hospital. Method: A prospective casenote audit was conducted on random days over a three-month period. The audit tool had been validated in a previous study. Results: One hundred and seventy seven episodes of oxygen saturation monitoring were reviewed. Our study revealed a lack of parameters to validate the SpO2 readings. Only 10% of the casenotes reviewed had sufficient physiological data to meaningfully interpret the SpO2 reading and only 38% had an arterial blood gas as a comparator. Nursing notes rarely documented clinical interpretation of the results. Conclusion: The audits suggest that medical and nursing staff are not interpreting the pulse oximetry results in context and that the majority of the results were normal with no clinical indication for performing this observation. This reduces the usefulness of such readings and questions the appropriateness of performing “routine” SpO2 in this context.

The role of mindfulness in an extended TPB framework to understand drivers’ speeding intentions in school zones.

Many researchers have demonstrated the applicability of the Theory of Planned Behaviour (TPB) in predicting both intention to speed and actual speeding behaviour. However, there remain shortcomings in the explanatory power of the TPB, with research suggesting that even when drivers had reported an intention to not speed approximately 25% of drivers report behaviour that does not align with their intentions (i.e., they engaged in speeding, Elliott & Armitage, 2006). This research explores the role of a novel and promising construct, mindfulness, in enhancing the explanatory utility of the TPB for the understanding of drivers’ speeding behaviour in school zones. Mindfulness is a concept which has been widely used in studies of consciousness, but has recently been applied to the understanding of behaviour in other areas, including clinical psychology, physical activity, education and business. It has been suggested that mindfulness can also be applied to road safety, though its application within this context currently remains limited. This study was based on an e-survey of the general driving public (N=240). Overall, the results identified mindfulness as a construct which may aid understanding of the relationship between drivers’ intentions and behaviour. Theoretically, the findings may have implications in terms of identifying mindfulness as an additional explanatory construct within a TPB framework. In road safety practice, the findings suggest that efficacious countermeasures around school zones may be those that function to heighten drivers’ mindfulness, such as flashing lights and physical speed reduction measures.

Dying in hospital: medical failure or natural outcomes?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

Emerging work practice with a telehealth stethoscope

We investigated the collaboration of ten doctor-nurse pairs with a prototype digital telehealth stethoscope. Doctors could see and hear the patient but could not touch them or the stethoscope. The nurse in each pair controlled the stethoscope. For ethical reasons, an experimenter stood in for a patient. Each of the ten interactions was video recorded and analysed to understand the interaction and collaboration between the doctor and nurse. The video recordings were coded and transformed into maps of interaction that were analysed for patterns of activity. The analysis showed that as doctors and nurses became more experienced at using the telehealth stethoscope their collaboration was more effective. The main measure of effectiveness was the number of corrections in stethoscope placement required by the doctor. In early collaborations, the doctors gave many corrections. After several trials, each doctor and nurse had reduced corrections and all pairs reduced their corrections. The significance of this research is the identification of the qualities of effective collaboration in the use of the telehealth stethoscope and telehealth systems more generally.

Application of the self-efficacy model in nursing practice [自我效能模式於護理臨床應用之剖析]

Self-efficacy has two cognitive components, efficacy expectations and outcome expectations, and their influence on behavior change is synergistic. Efficacy expectation is effected by four main sources of information provided by direct and indirect experiences. The four sources of information are performance accomplishments, vicarious experience, verbal persuasion and self-appraisal. How to measure and develop interventions is an important issue at present. This article clearly analyzes the relationship between variables of the self-efficacy model and explains the implementation of self-efficacy enhancing interventions and instruments in order to test the model. Through the process of the use of theory and feasibility in clinical practice, it is expected that professional medical care personnel should firstly familiarize themselves with the self-efficiency model and concept, and then flexibly promote it in professional fields clinical practice, chronic disease care and health promotion.

Consumer acceptance of an SMS-assisted smoking cessation intervention : a multicountry study

This study assesses smokers' perceptions, motivations, and intentions towards using an SMS-assisted smoking cessation intervention in Australia, France, and Mexico through an extended technology acceptance model with mediating variables. Data was collected through online surveys. Results show that perceived usefulness and vicarious innovativeness predict use intentions for all three countries. Perceived ease of use is significant only for Mexico. Subjective norms are significant only for Mexico and Australia. Perceived monetary value and perceived annoyance are significant mediating variables for all three countries, whereas perceived enjoyment is significant only for Mexico and Australia. These results contribute to theory and practice.

What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction?

Research Question: What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction? Background: Important characteristics of current nursing practice include nurses having the ability to develop and continue therapeutic relationships with patients, nurses having autonomy and control over the practice environment and nurses having more involvement in decision making. In addition, employee satisfaction is enhanced when organisations offer access to authority. Despite this, nurses continue to complain of feeling powerless in their ability to make decisions. Sample: The study population and criteria for selection included Registered Nurses in Australia who were at the time members of an Australian professional and industrial organisation. Methods: A cross-sectional survey was undertaken. Data analysis was conducted using descriptive and bivariate statistics, and structural equation modeling. Results: The model fit the data well (χ² = 2.3594, χ²/df = 2.3594 and CFI = 0.9987). Twenty four percent of variation in caring efficacy (CE) can be accounted for by general self-efficacy (GSE); work locus of control (WLC) and practice environment (PE) and 62% of the variation in job satisfaction (JS) can be accounted for by GSE, WLC and PE. All pathways were found to be significant except PE to CE. GSE positively explained CE (β = 0.38). WLC was negatively related to CE i.e., as CE scores increased WLC scores decreased (β = -0.23). Further testing of the model found CE was positively related to GSE (βZ = 0.38, p < 0.001) and negatively related to WLC (βZ = - 0.23, p = 0.001). PE was not significantly associated with CE (βZ = - 0.01, p = 0.85). JS was explained by PE, which was positively related (βZ = 0.69, p = < 0.001); GSE which was negatively related (βZ - 0 .09, p < 0.001) and WLC, which was also negatively related (βZ = - 0.20, p < 0.001). Implications for Practice Nursing and organisational leaders should ensure the development of strategies for professional development and orientation programmes which may enhance nurses’ ability to develop caring relationships and express caring behaviours to their patients and as a result improve organisational and patient outcomes. Nursing shortages and turnover rates are associated with job satisfaction and the nursing practice environment. Improving the nursing environment can produce benefits to the health system such as better job satisfaction, improved workforce retention and better patient outcomes.

Rock, paper, scissors : reflective practice for design process in the novice landscape architect

We describe a pedagogical approach that addresses challenges in design education for novices. These include an inability to frame new problems and limited-to-no design capability or domain knowledge. Such challenges can reduce student engagement with design practice, cause derivative design solutions as well as the inappropriate simplification of design assignments and assessment criteria by educators. We argue that a curriculum that develops the student’s design process will enable them to deal with the uncertain and dynamic situations that characterise design. We describe how this may be achieved and explain our pedagogical approach in terms of methods from Reflective Practice and theories of abstraction and creativity. We present a landscape architecture unit, recently taught, as an example. It constitutes design exercises that require little domain or design expertise to support the development of conceptual thinking and a design rationale. We show how this approach (a) leveraged the novice’s existing spatial and thinking skills while (b) retaining contextually-rich design situations. Examples of the design exercises taught are described along with samples of student work. The assessment rationale is also presented and explained. Finally, we conclude by reflecting on how this approach relates to innovation, sustainability and other disciplines.

Evaluation in health outcomes research : linking theories, methodologies and practice in health promotion.

Health outcomes research has developed as a means of evaluating the effectiveness of health care interventions and as an approach to informing resource allocation. The use of a health outcomes approach in health promotion has made increasing demands on evaluation methodologies to demonstrate program effectiveness. However, criticism of the contribution of health promotion to outcomes research has made several assumptions about the use of qualitative methodologies and the content of program objectives largely derived from a biomedical approach. In contrast to the measurement of biomedical interventions in clinical health care, health promotion practice involves social phenomena, wide-reaching cultural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisation of the health outcomes approach with the differentiation of three types of outcomes: health development outcomes; social health outcomes; and biomedical health outcomes. It is concluded that this differentiation moves away from dualist concepts that advocate the replacement of goals and targets with regional and locally based approaches. Rather, the future direction for health promotion evaluation needs to employ a framework that elaborates multiple methodologies and approaches necessary for establishing what relationships exist between morbidity, mortality, health advancement and equity.

Advice to consult a general medical practitioner in Western Australia : Could it be cancer?

Background: Many people will consult a medical practitioner about lower bowel symptoms, and the demand for access to general practitioners (GPs) is growing. We do not know if people recognise the symptoms of lower bowel cancer when advising others about the need to consult a doctor. A structured vignette survey was conducted in Western Australia. Method: Participants were recruited from the waiting rooms at five general practices. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of 64 based on six clinical variables. Twenty-seven vignettes described high-risk bowel cancer scenarios. Respondents were asked if they would recommend a medical consultation for the case described and whether they believed the scenario was a cancer presentation. Logistic regression was used to estimate the independent effects of each variable on the respondent's judgement. Two-hundred and sixty-eight completed responses were collected over eight weeks. Results: The majority (61%) of respondents were female, aged 40 years and older. A history of rectal bleeding, six weeks of symptoms, and weight loss independently increased the odds of recommending a consultation with a medical practitioner by a factor of 7.64, 4.11 and 1.86, respectively. Most cases that were identified as cancer (75.2%) would not be classified as such on current research evidence. Factors that predict recognition of cancer presentations include rectal bleeding, weight loss and diarrhoea.

General practice patients in the emergency department

One of the mysteries of public policy is that at times the public discourse settles on a perspective that is based on flimsy or even contradictory evidence. One such discussion relates to the factors that contribute to the congestion of hospital emergency departments (EDs) in Australia.