Revising the critical care family needs inventory for the emergency department

Background: The Critical Care Family Needs Inventory (CCFNI) has been used widely over the last two decades for analysing the needs of family members in the intensive care unit. However, it has significant limitations as a needs assessment tool for use with families in the Emergency Department (ED). This paper discusses the methodological challenges encountered during the process of reviewing and adapting this tool for use in the ED. Aims: The purpose of this study was to revise and adapt the CCFNI for use with a population of family members of critically ill patients in an Australian Emergency Department. Instrument: The process of tool revision, adaptation and reconstruction included: critique of the CCFNI; concept definition; item review; content and structure revision; scale revision; and testing with a sample of the target population. Methods: Data collection methods were aimed at accessing a vulnerable population, while enhancing response rate and data quality. A sample of 84 relatives of critically ill patients from one Melbourne Metropolitan Emergency Department was used, 73% of whom returned questionnaires. Results: Pilot data were examined with the specific purpose of identifying elements of the tool that required refinement or modification. Methods used for establishing reliability and validity of the revised tool provided satisfactory results. Limitations: Limitations of this study include inadequate sample size for exploratory factor analysis, and an incomplete response set for some items, which influenced item analysis. Conclusion: The process used for addressing the identified methodological issues in reviewing and adapting the CCFNI for use in the ED provides a framework for adapting an established tool for a specific purpose.

Accompanying critically ill relatives in emergency departments

Background. Family members are a crucial part of the holistic approach to care in emergency departments. In particular, they are a group who are vulnerable, yet have been overlooked when considering care options.

Aim. The primary aim of this systematic review was to appraise research relevant to identifying and meeting the needs of family members who accompany a critically ill person into the Emergency Department (ED). The information was intended to inform future research into the care of these people.

Method. A quality assessment strategy was specifically developed to evaluate the various research designs used. The outcomes of the highest quality studies were used to develop evidence-based clinical practice guidelines to inform clinicians caring for family members who accompany a critically ill person into the ED.

Results. Recommendations for family care drawn from this review provide the foundation for more rigorous methodologies in future research into this topic. Key findings concern family needs for communication, proximity, support, comfort, assurance and to locate meaning in the event.

Conclusion. The review has revealed current knowledge about the care of family members who accompany a critically ill person into the ED that provides guidelines for practice. Despite significant limitations, the knowledge can lead to recommendation to guide and inform future intervention research.

Families needs in emergency departments: instument development

Background. Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined.

Aim. The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs.

Method. Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires.

Results. The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate.

Conclusions. This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.

Family member presence during resuscitation in the emergency department: an Australian perspective

Objective: The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice.

Methods: A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations.

Results: The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements.

Conclusion: Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.

Examining communication and team performance during clinical handover in a complex environment : the private sector post-anaesthetic care unit

* Threats to patient safety during clinical handover have been identified as an ongoing problem in health care delivery.

* In complex handover situations, organisational, cultural, behavioural and environmental factors associated with team performance can affect patient safety by undermining the stability of team functioning and the effectiveness of interprofessional communication.

* We present a practical framework for promoting systematic, comprehensive measurement of the factors involved in clinical handover.

* The framework can be used to develop viable solutions to the problems of clinical handover.

* The framework was devised and used in a recent project examining interprofessional communication and team performance during clinical handover in post-anaesthetic care units.

* The framework combines five key concepts: clinical governance, clinician engagement, ecological validity, safety culture and team climate, and sustainability.

* We believe that use of this framework will help overcome the limitations of previous research that has not taken into account the complex and multifaceted influences on clinical handover and interprofessional communication.

Evaluating New Zealand sports stars as celebrity endorsers : intriguing results

Celebrity athlete endorsement of products and services has become prominent in the promotional mixes of New Zealand companies and organisations. For years advertisers and researchers have pondered how successful celebrity athlete endorsement really works. Most suggest some form of transfer of positive images takes place between celebrity and the product or service they are endorsing and source-credibility models have become the preferred research design. The overall objective of this research was to assist sport marketing managers and their advertising agencies in matching celebrities with products and services. An ancillary objective was to compare results obtained from multiple-item and single-item scales. An exploratory study with tertiary students was conducted, using both Ohanian’s (1990) 15 item source-credibility scale and two single-item measures to examine potential “endorsement fit” for four New Zealand sporting heroes. They were Bernice Mene (recently retired national netball team captain), Dean Barker (America’s Cup yachting defender’s helmsman), Mandy Smith (recently retired national women’s hockey team star) and Justin Marshall (All Black rugby’s most capped halfback), all of whom were adjudged by students as physically attractive sports stars. The product reported here against which these athletes were scored was an isotonic sports drink. Results were mixed; the Ohanian source-credibility scale yielded selection of different celebrity athletes to the single-item measures. The research results show that matching celebrities to products for potential endorsement opportunities is a complex issue, leaving scope for judgement and intuition alongside quantification. Still unresolved is the question of multiple-item measures versus single-item measures in advertising and service research.

Psychosocial care of family of critically-ill patients in emergency departments

Responding to families with a critically ill relative is difficult for emergency department clinicians. This innovative research program used best evidence, integrated with perspectives from families and clinicians, to develop context specific guidelines and sensitive tools to assist emergency department clinicians provide quality psychosocial care to meet multidimensional family needs.

Human saccadic eye movements and tracking by active foveation in log polar space

One of the possible models of the human visual system (HVS) in the computer vision literature has a high resolution fovea and exponentially decreasing resolution periphery. The high resolution fovea is used to extract necessary information in order to solve a vision task and the periphery may be used to detect motion. To obtain the desired information, the fovea is guided by the contents of the scene and other knowledge to position the fovea over areas of interest. These eye movements are called saccades and corrective saccades. A two stage process has been implemented as a mechanism for changing foveation in log polar space. Initially, the open loop stage roughly foveates on the best interest feature and then the closed loop stage is invoked to accurately iteratively converge onto the foveation point. The open loop stage developed for the foveation algorithm is applied to saccadic eye movements and a tracking system. Log polar space is preferred over Cartesian space as: (1) it simultaneously provides high resolution and a wide viewing angle; and (2) feature invariance occurs in the fovea which simplifies the foveation process.

Reported medication errors after introducing an electronic medication management system

Aims and objectives
To explore the effects of introducing an electronic medication management system on reported medication errors.
Background
Computerised medication management systems have been found to improve medication safety; however, introducing medication management system into healthcare environments can create unanticipated or new problems and opportunities for medication error.
Design
Descriptive analysis of medication error reports.
Methods
This was a retrospective analysis of 359 incident reports drawn from the period of 1 May 2005–30 April 2006 across two hospital sites of a single not-for-profit private health service located in metropolitan Melbourne. Site A used a conventional pen and paper system for medication management, and Site B had introduced a computerised medication management system.
Results
Most medication errors occurred at the nurse administration (71·5%) and prescribing (16·4%) stages of delivery. The most common medication error type reported at Site A was omission (33%), and at Site B was wrong documentation (24·2%). A higher proportion of errors at the prescribing phase, and less nurse administration errors, were detected at Site B where the medication management system was in use. The incidence of other, less frequent errors was similar across the two hospital sites.
Conclusions
This examination of medication error reports suggests there are differences in the types of medication errors that are reported in association with the introduction of electronic medication management system compared to pen and paper system systems. The findings provide a new insight into the effects of introducing an electronic medication management system on the types of medication errors reported.
Relevance to clinical practice
The findings provide a new insight into the types of medication errors that are reported during implementation of an electronic medication management system. Extra support for physicians prescribing practices should be considered.