Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : A modified Delphi study

Aim To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Background Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist presents means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances in which nurse-administered procedural sedation and analgesia is used in the cardiac catheterisation laboratory. Methods A sequential mixed methods design was utilised. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised in accordance with responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterisation laboratory nurses. All but one of the draft recommendations met the pre-determined cut-off point for inclusion. There were a total of 59 responses to the second round. Consensus was reached on all recommendations. Implications for nursing The guidelines that were derived from the Delphi study offer twenty four recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Post-procedural patient assessment and monitoring. Conclusion These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterisation laboratory setting.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

2 Hour game jam at SLQ Garage Gamer - Live performance with crowd participation

The 2 hour game jam was performed as part of the State Library of Queensland 'Garage Gamer' series of events, summer 2013, at the SLQ exhibition. An aspect of the exhibition was the series of 'Level Up' game nights. We hosted the first of these - under the auspices of brIGDA, Game On. It was a party - but the focal point of the event was a live streamed 2 hour game jam. Game jams have become popular amongst the game development and design community in recent years, particularly with the growth of the Global Game Jam, a yearly event which brings thousands of game makers together across different sites in different countries. Other established jams take place on-line, for example the Ludum Dare challenge which as been running since 2002. Other challenges follow the same model in more intimate circumstances and it is now common to find institutions and groups holding their own small local game making jams. There are variations around the format, some jams are more competitive than others for example, but a common aspect is the creation of an intense creative crucible centred around team work and ‘accelerated game development’. Works (games) produced during these intense events often display more experimental qualities than those undertaken as commercial projects. In part this is because the typical jam is started with a conceptual design brief, perhaps a single word, or in the case of the specific game jam described in this paper, three words. Teams have to envision the challenge key word/s as a game design using whatever skills and technologies they can and produce a finished working game in the time given. Game jams thus provide design researchers with extraordinary fodder and recent years have also seen a number of projects which seek to illuminate the design process as seen in these events. For example, Gaydos, Harris and Martinez discuss the opportunity of the jam to expose students to principles of design process and design spaces (2011). Rouse muses on the game jam ‘as radical practice’ and a ‘corrective to game creation as it is normally practiced’. His observations about his own experience in a jam emphasise the same artistic endeavour forefronted earlier, where the experience is about creation that is divorced from the instrumental motivations of commercial game design (Rouse 2011) and where the focus is on process over product. Other participants remark on the social milieu of the event as a critical factor and the collaborative opportunity as a rich site to engage participants in design processes (Shin et al, 2012). Shin et al are particularly interested in the notion of the site of the process and the ramifications of participants being in the same location. They applaud the more localized event where there is an emphasis on local participation and collaboration. For other commentators, it is specifically the social experience in the place of the jam is the most important aspect (See Keogh 2011), not the material site but rather the physical embodied experience of ‘being there’ and being part of the event. Participants talk about game jams they have attended in a similar manner to those observations made by Dourish where the experience is layered on top of the physical space of the event (Dourish 2006). It is as if the event has taken on qualities of place where we find echoes of Tuan’s description of a particular site having an aura of history that makes it a very different place, redolent and evocative (Tuan 1977). The 2 hour game jam held during the SLQ Garage Gamer program was all about social experience.

Chemotherapy-induced nausea and vomiting : a review to inform clinical practice

Chemotherapy-induced nausea and vomiting (CINV) is a common sideeffect of cytotoxic treatment and despite the widespread use of anti-emetic medication, it continues to affect a significant proportion of patients with up to 23% and 73% of chemotherapy patients still experiencing vomiting and nausea symptoms, respectively. This is of particular concern in oncology patients as nausea and vomiting may result in malnutrition, decreased quality of life and in extreme cases, treatment stoppage. Therefore, the primary aim of this paper was to inform clinicians on the current literature regarding CINV including its effect on the patient, its pathophysiology, and current treatment options. In addition, this review will also discuss the usage of dietetic interventions as well as less utilised, novel interventions such as oral ginger extracts in the treatment of CINV. In order to address these issues, a systematic literature search was conducted using Pubmed, CINAHL, MEDLINE, Embase, and Health Source (Nursing/Academic Edition). A key finding of this review was that common dietary strategies (e.g. eating slowly, avoiding fatty foods) seem to be solely based on professional opinion as no clinical trials investigating these strategies were identified. In contrast, ginger extracts were found to possess several viable mechanisms that interact with CINV progression including 5-HT3, Substance P and acetylcholine receptor antagonism; anti-inflammatory and antioxidant properties; and gastrointestinal motility and gastric emptying modulation. In conclusion, research investigating dietetic interventions in the management of CINV is sparse and requires further investigation while novel intervention such as ginger, possess multiple mechanisms that may benefit CINV management. This review will discuss the prevalence and significance of CINV, dietetic and novel treatment options, and provide implications for clinical practise and future research.

Characteristics of chemotherapy practice in rural and remote area health facilities in Queensland

Objective The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland. Design A questionnaire survey that elicited descriptive quantitative and qualitative data. Setting Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy. Subjects Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs. Main outcome measures: Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues. Results The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes. Conclusions It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.

Why nurses are attracted to rural and remote practice

This is the second paper of a larger study that examined the factors influencing the decisions of rural and remote area nurses, formerly employed by Queensland Health, to leave or to remain in this area of nursing. The study was a cross-sectional survey that gathered data from nurses who had resigned from permanent positions in Queensland Health during the period February 1999 to May 2000. This paper reports only those factors that influenced their decision to remain in rural and remote area practice, which can be categorised into personal, professional and rural influences. The results of this study are congruent with previous national and international research findings into these issues for nurses in rural and remote areas. The paper makes recommendations to attract nurses to the rural and remote work force.

Evidence-based practice and rural nursing : A literature review

This literature review is an exploration of issues related to evidence-based practice and rural nursing. Given the contribution that nursing research can make to improved client care in rural areas, it is important that nurses’ awareness and understanding of evidence-based practice be enhanced, and that strategies for fostering the development of clinically relevant programs of nursing research be identified for rural health services. The review highlights the deficiencies in the current metropolitan-based approaches to evidence-based practice that may disadvantage rural clients and nursing practitioners, because they do not accommodate the inherent differences in rural and metropolitan healthcare cultures. It emphasises the need to seek approaches to research-based practice that arise from the specific needs of the rural setting.

Effects of size of health service on scope of rural nursing practice

This paper presents the findings of an analysis of the activities of rural nurses from a national audit of the role and function of the rural nurse (Hegney, Pearson and McCarthy 1997). The results suggest that the size of the health service (defined by the number of acute beds) influences the activities of rural nurses. Further, the study reports on the differences of the context of practice between different size rural health services and the impact this has on the scope of rural nursing practice. The paper will conclude that the size of the health service is an outcome of rurality (small population densities, distance from larger health facilities, lack of on-site medical and allied health staff). It also notes that the size of the health service is a major contextual determinant of patient acuity and staff skill-mix in small rural hospitals, and therefore the scope of rural nursing practice.

Conference Keynote: Information literacy research and practice: An experiential perspective

In this paper I will explore some experience-based perspectives on information literacy research and practice. The research based understanding of what information literacy looks like to those experiencing it, is very different from the standard interpretations of information literacy as involving largely text based information searching, interpretation, evaluation and use. It also involves particular understandings of the interrelation between information and learning experiences. In following this thread of the history of information literacy I will reflect on aspects of the past, present and future of information literacy research. In each of these areas I explore experiential, especially phenomenographic approaches to information literacy and information literacy education, to reveal the unfolding understanding of people’s experience of information literacy stemming from this orientation. In addressing the past I will look in particular at the contribution of the seven faces of information literacy and some lessons learned from attending to variation in experience. I will explore important directions and insights that this history may help us to retain; including the value of understanding peoples’ information literacy experience. In addressing the present, I will introduce more recent work that adopts the key ideas of informed learning by attending to both information and learning experiences in specific contexts. I will look at some contemporary directions and key issues, including the reinvention of the phenomenographic, or relational approach to information literacy as informed learning or using information to learn. I will also provide some examples of the contribution of experiential approaches to information literacy research and practice. The evolution and development of the phenomenographic approach to information literacy, and the growing attention to a dual focus on information and learning experiences in this approach will be highlighted. Finally, in addressing the future I will return to advocacy, the recognition and pursuit of the transforming and empowering heart of information literacy; and suggest that for information literacy research, including the experiential, a turn towards the emancipatory has much to offer.

Review: "Context : A framework for its Influence on Evaluation Practice (New Directions for Evaluation No. 135)" edited by Rog, D. J.; Fitzpatrick, J. L. and Conner, R. F.

This book offers a framework for the influence of context on evaluation practice and is applied to three case studies: environmental context; indigenous context and political context; and finishes with a process for implementation.

Peer review of teaching practice and resources : exploring new spaces to embrace cultural change

The implementation of systematic peer review as a professional development activity, and as a support for educational design activities is under-utilised in many Australian higher education institutions. This case study reports on the first stages of planning and implementation of an institution-wide project to enhance teaching and learning quality at a remote and regional university, where one of the major strategies for improvement is peer review. Through a systematic process of staff engagement in peer review, within and from outside the organisation, a substantial change in flexible learning is envisaged. A mix of new and different learning spaces are to be used in the project, including blended learning spaces for academic development. This paper describes the research framework that will guide the peer review process and examines the early findings of the design-based research. Leadership, awareness raising and development of a supportive community of inquiry are seen as key components for successful implementation of peer review. In addition, unique contextual elements add to the complexity of designing for transformative change within such a relatively new organization.