Barriers to information transfer for multi-trauma patients upon discharge from the Emergency Department in a tertiary level hospital

Purpose: Communication is integral to effective trauma care provision. This presentation will report on barriers to meaningful information transfer for multi-trauma patients upon discharge from the Emergency Department (ED) to the care areas of Intensive Care Unit, High Dependency Unit, and Perioperative Services. This is an ongoing study at one tertiary level hospital in Queensland. Method: This is a multi-phase, mixed method study. In Phase 1 data were collected about information transfer. This Phase was initially informed by a comprehensive literature review, then via focus groups, chart audit, staff survey and review of national and international trauma forms. Results: The barriers identified related to nursing handover, documented information, time inefficiency, patient complexity and stability and time of transfer. Specifically this included differences in staff expectations and variation in the nursing handover processes, no agreed minimum dataset of information handed over, missing, illegible or difficult to find information in documentation (both medical and nursing), low compliance with some forms used for documentation. Handover of these patients is complex with information coming from many sources, dealing with issues is more difficult for these patients when transferred out of hours. Conclusions and further directions: This study investigated the current communication processes and standards of information transfer to identify barriers and issues. The barriers identified were the structure used for documentation, processes used (e.g. handover), patient acuity and time. This information is informing the development, implementation and evaluation of strategies to ameliorate the issues identified.

(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.

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.

Communication predicaments of older health care consumers : what can 'we' do about it?

Focuses on the importance of communication to the well-being of older people in Australia. Role of communication for the design, delivery and evaluation of health services for the elderly; Impact of aging on communication; Importance of communication between health care providers and nursing home residents.

Perceptions of over-accommodation used by nurses in communication with the elderly

The aim of the study was to determine how aspects of communication between nurses and the elderly were perceived by elderly people, future nurses, and uninvolved observers. Respondents (elderly women and nursing and psychology students) rated videotapes of interactions between a nurse and an elderly woman on three dimensions: patronizing, status, and solidarity. Three communication strategies and their combinations were represented in the vignettes. Because the strategies presented were perceived as patronizing by all three groups, no group effect was found for the patronizing dimension. The results show clear group differences particularly between the nursing students and the elderly, with the elderly rating many of the strategies more positively than did the nursing students. The results are discussed in relation to previous evaluations of overaccommodation, and implications of the different perceptions are considered.

Building shared situational awareness in surgery through distributed dialogue

Background Failure to convey time-critical information to team members during surgery diminishes members’ perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness. Methods Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semi structured interviews were performed with 24 participants from anaesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used. Results: The domain “coordinating decisions in surgery” was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, i.e., synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority. Conclusion Strategies used to convey decisions that enhanced shared situational awareness included the use of “self-talk”, closed-loop communications, and “overhearing” conversations that occurred at the operating table. Behaviours’ that compromised a team’s shared situational awareness included tunnelling and fixating on one aspect of the situation.

Developing examplars for sustained integration of palliative care principles into allied health curricula

The PCC4U (Palliative Care Curriculum for Undergraduates) project aims to support the inclusion of the principles and practice of palliative care in all health professional training. While uptake rates of the project resources and curriculum initiatives is strong in medicine and nursing (86% of courses actively engaged with the project in 2012) integration of palliative care content in allied health disciplines has been less consistent. This report explores the process adopted to address this issue. In 2012 six allied health courses – representing social work, pharmacy, psychology, occupational therapy, dietetics and physiotherapy – commenced a range of tailored curriculum initiatives with the aim of informing the development of exemplars of integration of palliative care in specific disciplines. The PCC4U project provided palliative care learning materials, curriculum resources and expertise, and financial support as part of this curriculum development process. Review of the outcomes of each initiative indicates that tailored support has provided an opportunity for courses to develop palliative care curriculum content that reflects both discipline and local contexts. It has contributed six discipline specific exemplars of the integration of palliative care in allied health professional curricula and provided insights into allied health educational approaches in palliative care, particularly the use of evidence based resources. As a result project curriculum materials and activities have been expanded. These will be implemented with allied health courses through workshops, site visits and curriculum mapping initiatives in 2013 to better sustain the integration of palliative care in health professional curricula.

Engaging paramedic students in research: A case report

The use of volunteer undergraduate students to support simulated training for peers is common in Paramedic Science. However, there are limited examples of engaging paramedic student-volunteers in research as compared to that reported in cognate disciplines such as Medicine and Nursing. This case report shares our experience with engaging a penultimate year paramedic student in evaluation research. This information we hope will start the dialogue on the epistemology and pedagogies for effective engagement of undergraduate paramedic students as future researchers.

Emotional intelligence development in student radiation therapists: A longitudinal pilot study

Emotional intelligence (EI) is defined as “the ability to recognise, understand and manage emotions in ourselves and others” [1]. Initially identified as a concept applied to leadership and management, EI is now recognised as an important skill in a number of areas, including healthcare [2]. Empathy (the ability to see the world through someone else’s eyes) is known to play an important role in the therapeutic relationship with patients [3]. As EI has been shown to improve empathy [4], it is clear that developing the EI of student health professionals should benefit patients in the long term. It is not surprising, then, that a number of studies have investigated the role of EI in medical, dental and nursing students, however there is little reported evidence relating to EI development in pre-registration radiation therapy (RT) students.

Advanced practice: A survey of current perspectives of Australian pharmacists

Background An Advanced Pharmacy Practice Framework for Australia (the ‘APPF’) was published in October 2012. Further to the release of the APPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model for Australian pharmacists. Aim To gauge the perspectives of the pharmacy profession relating to advanced practice, via an online survey, in order to inform the design of the model. Method A survey was developed and administered to Australian pharmacists through SurveyMonkey . The survey content was based on findings from a review of national and international initiatives for recognition of advanced practice in pharmacy and other health disciplines, including medicine and nursing. Results The results of the survey showed that a high proportion of respondents considered they were already working at, or working towards achieving, an advanced level of practice. The responses relating to the assessment methods showed a clear preference for ‘submission of a professional portfolio’. A ‘written examination’ had a low level of support and in relation to an ‘oral examination by a panel’ there was a marked preference for a panel of multidisciplinary health professionals over a panel of pharmacists. Conclusion The survey outcomes will inform the development of an advanced pharmacy practice recognition model for Australian pharmacists, particularly in relation to the assessment methods. Survey outcomes also demonstrated that there is scope to further enhance the application of the APPF in the development and recognition of advanced practitioners, and to build greater awareness of the breadth of competencies encompassed by ‘advanced practice’.

Emotional intelligence development in student radiation therapists: A longitudinal pilot study

Emotional intelligence (EI) is defined as “the ability to recognise, understand and manage emotions in ourselves and others”. Initially identified as a concept applied to leadership and management, EI is now recognised as an important skill in a number of areas, including healthcare [2]. Empathy (the ability to see the world through someone else’s eyes) is known to play an important role in the therapeutic relationship with patients [3]. As EI has been shown to improve empathy [4], it is clear that developing the EI of student health professionals should benefit patients in the long term. It is not surprising, then, that a number of studies have investigated the role of EI in medical, dental and nursing students, however there is little reported evidence relating to EI development in pre-registration radiation therapy (RT) students.

El arte de registrar. La importancia de los registros de enfermería

[ES]La literatura especializada coincide en señalar serios problemas en los registros de enfermería. Se registra mal por muchos motivos: por desconocimiento, por inexperiencia, por la idea de que es una tarea burocrática y ajena, y sobre todo por una idea distorsionada del rol de la enfermería. Un registro adecuado contribuye no sólo a la calidad de los cuidados, sino que hace visible el trabajo que enfermería realiza y puede contribuir a desarrollar la disciplina enfermera y reforzar su rol independiente. En este trabajo se analiza, a partir de la literatura especializada, el problema de los registros de enfermería: los problemas más frecuentes y sus causas, la perspectiva de las enfermeras sobre los registros, los problemas éticos y legales que implican y las posibles soluciones para una nueva manera de registrar.

Características pessoais e institucionais e comportamentos de autocuidado de docentes de enfermagem segundo os modos adaptativos de Roy: estudo em Instituições Públicas do Estado do Rio de Janeiro

Este trabalho enfoca a promoção da vida através de comportamentos saudáveis, tendo como objetivos: delinear o perfil sociodemográfico e institucional/profissional dos docentes de enfermagem e analisar seus hábitos de vida, segundo os modos adaptativos de Roy. Foi utilizada a Teoria de Sister Callista Roy, destacando-se os modos de adaptação: fisiológico, autoconceito e interdependência. Implementou-se o método descritivo, quantitativo, transversal através da técnica de autorelato em amostra de 101 docentes. Para investigar esses aspectos, utilizou-se dois questionários, um deles com a escala de Likert, adaptado para a pesquisa. A produção de dados transcorreu de janeiro a março de 2009, após aprovação do Comitê de Ética em Pesquisa, Protocolo 2187, e concordância das quatro instituições públicas de ensino universitário, do Estado do Rio de Janeiro-Brasil, selecionadas. Os dados obtidos foram submetidos á estatística, aplicando-se medidas de tendência central. Quanto ao perfil docente: predomina a faixa etária de 40 a 59 anos, com 69,3%, de união estável. Relacionando cor e crença religiosa, constatou-se 37,6% de católicos brancos. Dos 50 docentes, 5% têm residência própria, na zona norte. Possuem renda individual acima de 8 salários mínimos, 67,32%, a maioria com vínculo trabalhista. No tempo de serviço, 22,94% situam-se entre 11 a 15 anos, com carga horária de 20 a 40 horas. Quanto à titulação, 42,56% são doutores e 80,2% possuem um tipo de regime estatutário. Concernente aos Modos Adaptativos de Roy foi atribuído, predominantemente, o conceito A- hábitos de vida saudável, aos modos Fisiológicos e de Autoconceito, seguindo-se o de Interdependência, que apresentou quatro conceitos B- em busca de hábitos de vida saudável, sendo o mais homogêneo dos três modos. Identificou-se que o Modo Fisiológico foi heterogêneo, pois os valores das medidas de tendência central se distanciam entre si. Concluindo-se que o pressuposto formulado atendeu parcialmente às expectativas dos docentes por utilizarem, em benefício próprio, seus saberes sobre o cuidar promovendo o bem-estar com qualidade. Considerou-se que a interdependência pode ser conquistada pelos sujeitos, visto que o enfrentamento das suas atividades profissionais, paralelamente ao viver pessoal, pode ser motivo de satisfação com o trabalho docente, remuneração recebida, ambiente institucional, relações de poder/saber no trabalho, além da possibilidade de atender sua necessidade gregária promovendo o convívio com a família e amigos. Lembra-se que lidar com pessoas cujas subjetividades devem ser objetivadas, visando sua compreensão para o atendimento de saúde, exige equilíbrio e progresso das dimensões corporais física, mental e espiritual do profissional.