Intensive care nurses' perceptions of brain death

Research during the last 2 decades has revealed significant confusion or lack of acceptance and inconsistent application of the brain death concept within the medical and nursing professions. The aim of this naturalistic and descriptive study was to investigate the extent to which a sample of 40 Australian intensive care nurses regarded brain death as a meaningful conception of death. In contrast with the majority of the literature pertaining to health care professionals' perceptions of brain death which has focused upon clinical knowledge, the study elicited the expression of personal beliefs. The study utilised a structured interview method with nurses from seven metropolitan intensive care units (ICUs). Transcript analysis revealed five categories of perception constituting a spectrum ranging from complete acceptance to complete rejection, with almost half (48%, n=19) the sample regarding the brain dead patient as less than completely meaningfully dead.

Rather than supporting the literature's suggestion that non-acceptance of the medico-legally recognised brain death notion is, necessarily, evidence of professional ignorance, the findings suggest the participants holding these perceptions were generally well-informed about brain stem function and brain death diagnosis. The study affirms the importance of supportive workplace environments which facilitate the expression of dissonant perceptions and proposes that educators and managers must acknowledge these dissonances.

Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Beyond the silo effect : the challenges of collaboration

Women entering the maternity arena in Australia and other Western regimes have suffered incidentally from what is known as the' silo effect'. This refers to a clash between the training regimes of the 'old' professionalism and the 'new' professionalism. Under the 'old' professionalism, hierarchies were erected between medicine and the so-called semi-professions such as nursing and social work (Tully and Mortlock 2004) resulting in what Degeling et al (1998; 2000) have documented as oppositional modes of decision-making, styles of working, roles and accountabilities. Within the last decade, a 'new professionalism' has emerged in many Western regimes, including Canada, NZ, the UK and The Netherlands. (Romanow Report 2002; Street, Gannon and Holt 1991; Victorian Department of Human Services, Australia 2004) depicted by a flatter more egalitarian structure of multidisciplinarity .. An example in Australia is the Future Directions in Maternity Care document released in mid 2004 by the Bracks Victorian Labor government. In Australia, the move towards the 'new professionalism' can be attributed to a confluence of macro economic factors including the swing away from hospital-based training and towards university-based training for nurses and midwives, the ripple effects of three decades of feminism, the professionalisation of midwifery, the attrition of midwives from the workforce, the rise of health consumerism from the late 1980s and the crippling costs of professional indemnity health insurance for obstetricians leading to a crisis in recruitment.

Long-term risk factor control after a cardiac rehabilitation programme

This study examined the hypothesis that Phase II cardiac rehabilitation participants (CRP) had better long-term risk factor control, self-rated perception of health and return to work rates than non-participants (NP) between 18 and 36 months post myocardial infarction (MI). It was a comparative study in a 550 bed hospital.

Approximately half of both groups did not achieve a total cholesterol (TC) of 5.5mmol/L or less. Compared with NP, CRP were significantly more likely to have a TC<=6.5mmol/L (7% vs. 28%) (p=0.006). NP with TC>6.5mmol/L were significantly less likely to be on treatment (p=0.002). CRP were more likely to regularly exercise than NP (79% vs. 61%) (p=0.038). The success rate for blood pressure targets, return to work rates and self-rated perception of health were similar in both groups.

In conclusion, CRP had better long-term control of some risk factors than NP. The study provides comparative longer term patient outcomes after an Australian cardiac rehabilitation (CR) programme and forms the basis for further outcome measurement.

Staff perceptions on the use of a sedation protocol in the intensive care setting

Sedation protocols are increasingly being investigated as a method of achieving improved patient outcomes whilst guiding the decision making of both nursing and medical practitioners. However, only a limited number of studies have investigated the perceptions of staff towards a sedation protocol during its implementation. This study was designed to survey the perceptions of staff regarding the implementation of a sedation protocol in an Australian intensive care unit (ICU). Questionnaires were distributed to all multidisciplinary team members who had used the sedation protocol. The response rate was 50% (n=70). The questionnaire combined the use of visual analogue scales plus a comments section to obtain qualitative data.

The results revealed that staff perceived sedation management to be enhanced with the use of a protocol and therefore should be incorporated into routine clinical practice. Staff perceived that providing clear guidelines that facilitated decision making and assisted beginner practitioners enhanced sedation management. In addition, there was a perceived improvement in the patient outcomes, including a decrease in the frequency of over-sedation resulting in a reduced ICU stay.

Positive perceptions may assist in the introduction of other interventional protocols. Other protocols may target areas where variability in clinical decision making exists, despite research evidence that supports specific therapeutic interventions. Further studies addressing protocol implementation for clinical interventions are warranted in other ICU settings.

Real estate employability : differing perceptions of graduates from undergraduate and postgraduate courses

Purpose – Employability is likely to be at the forefront of any degree applicant's mind in England and Wales due to an impending large increase in the cost of tuition. The purpose of this paper is to report the findings of a Centre for Education in the Built Environment-funded project which has investigated real estate graduate competencies and employability. The paper concentrates on significant differences in emphasis by graduates from undergraduate (UG) and postgraduate (PG) courses.

Design/methodology/approach – Following an extensive literature review, 72 competencies have been identified and the Confederation of British Industry classification of knowledge, skills and attributes has been adopted. An online survey of 639 graduates (half UG and half PG) asked respondents to complete five-point Likert attitude scales to rate how their course enabled development of the 72 competencies. Themes developed from the results of the questionnaire study have been explored in greater detail with five real estate education providers and the human resource managers of four large London employers.

Findings – Rather surprisingly, UGs rated their gaining of the vast majority of the competencies more highly than PGs. This finding seems to be at odds with the impression given by the educators and employers, both of whom perceive a preference for the greater maturity and commercial awareness of graduates from PG courses.

Originality/value – Real estate course providers can use the results of this study to ensure that their programmes of study adequately address what is likely to become the crucial factor in the choice of any future programme of study – employability.