School of Nursing & Midwifery, University of Western Sydney Building 7, Campbelltown Campus Locked Bag 1797 Penrith South DC 1797 Ph: 4620 3344 Fax: 4620 3161
Liz Halcomb was appointed as a Senior Lecturer in the School of Nursing and Midwifery in 2007. Prior to this she was employed within the Nursing Research Units within the Sydney West and Sydney South West Area Health Services and as Trauma Data Manager at Liverpool Hospital. Liz has worked in a range of medical and surgical clinical areas as well as the Intensive Care Unit of a major metropolitan hospital. Liz was awarded a PhD in 2006, and since that time her teaching and research interests have focused on general practice nursing, chronic disease management, cardiovascular disease, ageing, mixed methods research and evidence based practice. Liz was appointed Course Coordinator Grad Dip/Master of Nursing in 2008.
Abstract: Casualisation of the academic workforce has resulted in an increase in the employment of sessional teachers in Bachelor of Nursing (BN) programs. Many of these teachers are drawn from specialty clinical areas and continue to work clinically while teaching part-time. The aim of this study was to explore the perceptions of sessional teachers about their perceived contribution to an undergraduate Bachelor of Nursing program in a single Australian university. Twelve sessional teachers participated in semi-structured interviews as part of a larger mixed method study exploring the issues related to sessional teaching in the Bachelor of Nursing program. Three themes emerged from the data; (1) "Bringing 'reality' to the classroom", (2) "Privileging experiential knowledge", and (3) "Establishing boundaries with students". Underpinning the narratives was a strong subtext related to the theory-practice gap. Proactive strategies to facilitate the potential of sessional staff are articulated in the paper.
Abstract: The aim of this study was to examine the psychometric properties, including predictive validity, of the newly-developed nursing self-efficacy for mathematics (NSE-Math). The NSE-Math is a 12 item scale that comprises items related to mathematic and arithmetic concepts underpinning medication calculations. The NSE-Math instrument was administered to second year Bachelor of Nursing students enrolled in a nursing practice subject. Students' academic results for a compulsory medication calculation examination for this subject were collected. One-hundred and twelve students (73%) completed both the NSE-Math instrument and the drug calculation assessment task. The NSE-Math demonstrated two factors 'Confidence in application of mathematic concepts to nursing practice' and 'Confidence in arithmetic concepts' with 63.5% of variance explained. Cronbach alpha for the scale was 0.90. The NSE-Math demonstrated predictive validity with the medication calculation examination results (p=0.009). Psychometric testing suggests the NSE-Math is a valid measure of mathematics self-efficacy of second year nursing students.
Abstract: AIMS: The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. BACKGROUND: Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. DESIGN: National postal survey embedded in a sequential mixed method design. METHODS: 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. RESULTS: Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. CONCLUSION: Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.
Abstract: Verbatim transcription of interview data has become a common data management strategy in nursing research and is widely considered to be integral to the analysis and interpretation of verbal data. As the benefits of verbal data are becoming more widely embraced in health care research, interviews are being increasingly used to collect information for a wide range of purposes. In addition to purely qualitative investigations, there has been a significant increase in the conduct of mixed-method inquiries. This article examines the issues surrounding the conduct of interviews in mixed-method research, with particular emphasis on the transcription and data analysis phases of data management. It also debates on the necessity to transcribe all audiorecorded interview data verbatim, particularly in relation to mixed-method investigations. Finally, it provides an alternative method to verbatim transcription of managing audiorecorded interview data.
Abstract: Background: xD;Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. xD;Aim: xD;This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. xD;Methods: xD;Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. xD;Results: xD;This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. xD;Conclusion: xD;Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential.
Abstract: This paper seeks to highlight the utility of the Corbin and Strauss Chronic Illness Trajectory Framework in describing recovery from traumatic injury and encourages consideration of its implementation into contemporary trauma nursing (Corbin and Strauss, 1991; 1992). To date, few such frameworks have been proposed to sensitize health professionals to the path of recovery following traumatic injury. Although this framework was initially conceived for use in the domain of chronic illness, the lasting effects of severe traumatic injury have significant parallels to chronic conditions such as stroke (Burton, 2000) and multiple sclerosis (Miller, 1993) to which the framework has previously been applied. This paper demonstrates the Trajectory Framework as a useful structure to potentially enhance the development of post-discharge interventions for trauma survivors and encourages consideration of its implementation into the nursing management of this complex patient group.
Abstract: Background: Critical reflection upon nursing practice is pivotal in achieving optimal patient outcomes. Implicit in this statement is knowledge about and an understanding of the implementation of evidence-based practice (EBP). Aim: This study sought to evaluate baseline knowledge in order to assess and inform a multifaceted intervention to promote EBP in a multi-site facility in Western Sydney, Australia. Method: On two consecutive days in February 2003, a convenience sample of 229 nurses were surveyed using a five-item, investigator developed, written survey tool. Data were analysed using descriptive statistics. Results: Although the majority of respondents (n= 143: 62%) stated that they were aware of EBP, a considerable number (n= 86: 38%) stated they had not previously heard of the term. Of concern, 43% (n=99) of respondents were unable to identify a source of information and resources about EBP. Conclusions: The results of this observational, descriptive survey underscore the importance of ongoing strategic interventions to improve knowledge, access and implementation of EBP amongst clinical nurses. This study also provides baseline data upon which to evaluate local interventions to promote knowledge of EBP amongst clinicians.
Abstract: The complex nature of phenomena investigated by nurses demands the use of a multifaceted approach to develop nursing knowledge. Triangulation offers a rigorous methodological framework by which to achieve this aim. The authors describe the historical and philosophical underpinnings of triangulation and outline considerations in relation to applying it in contemporary nursing research.
Abstract: It is only recently that recognition of the serious and debilitating sequelae of trauma has prompted exploration of outcomes beyond survival, such as disability, health status and quality of life. This paper aims to review the literature describing outcomes following severe traumatic injury to provide clinicians with a greater understanding of the recovery trajectory following severe trauma and highlight the issues faced by those recovering from such injury. Electronic databases, published reference lists and the Internet were searched to identify relevant literature. The heterogeneous nature of published literature in this area prohibited a systematic approach to inclusion of papers in this review. xD;Trauma survivors report significant sequelae that influence functional status, psychological wellbeing, quality of life and return to productivity following severe injury. Key themes that emerge from the review include: current trauma systems which provide inadequate support along the recovery trajectory; rehabilitation referral which is affected by geographical location and provider preferences; a long-term loss of productivity in both society and the workplace; a high incidence of psychological sequelae; a link between poor recovery and increased drug and alcohol consumption; and valued social support which can augment recovery. xD;Future research to evaluate interventions which target the recovery needs of the severely injured patients is recommended. Particular emphasis is required to develop systematic, sustainable and cost-effective follow-up to augment the successes of existing acute trauma services in providing high quality acute resuscitation and definitive trauma management.
Abstract: BACKGROUND: This study investigated the validity of similar Injury Severity Scores (ISS) generated by different Abbreviated Injury Scale triplets. METHODS: A cohort of trauma patients admitted to a single major trauma service between 1995 and 2002 was studied retrospectively. Mortality rates were compared for groups with identical ISS scores but different triplets. RESULTS: For 2,223 of the 5,946 trauma patients studied, 12 ISS scores were generated by two different Abbreviated Injury Scale triplets. Six of these ISS totals showed significant differences in mortality depending on the triplet source. One of the most striking was ISS 25 (triplet 5,0,0), with a mortality of 20.6%, as compared with 0% for triplet 4,3,0 (p = 0.005). The other statistically significant mortality differences for ISS totals were ISS 27-28.6% (5,1,1) versus 7.4% (3,3,3) (p = 0.05); ISS 29-30.3% (5,2,0) versus 4.6% (4,3,2) (p = 0.002); ISS 33-50% (4,4,1) versus 6.7% (5,2,2) (p = 0.034); ISS 34-45.2% (5,3,0) versus 4.3% (4,3,3) (p = 0.0009); and ISS 41-60% (5,4,0) versus 11.1% (4,4,3) (p = 0.05). CONCLUSIONS: The mortality rates are significantly different between pairs of triplets that generate the same ISS total. Caution must be used in the interpretation of outcomes from ISS values generated by different triplets.
Abstract: Background: The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. Aim: This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. Methods: Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. Results: Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. Conclusion: The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.
Abstract: BACKGROUND: The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. AIM: This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. METHODS: Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. RESULTS: Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. CONCLUSION: The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.
Abstract: BACKGROUND: The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235-240]. AIM: This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. METHODS: Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including 'Australia', 'practice nurse', 'office nurse', 'nurs*', 'heart failure', 'cardiac' and 'chronic illness'. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. RESULTS: There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary prevention strategies; (5) practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role. CONCLUSION: On the basis of this literature review, practice nurses represent a potentially useful adjunct to current models of service provision in HF management. Further research needs to comprehensively investigate the role of the practice nurse in the Australian context with a view to developing effective and sustainable frameworks for clinical practice. In particular, high-level evidence is required to evaluate the efficacy of the practice nurse role compared to current disease management strategies.
Abstract: The aim of the study was to critically review the best available literature that investigates the role of patient isolation in the minimisation of the nosocomial transmission of methicillin resistant Staphylococcus aureus (MRSA). A systematic review of such studies was undertaken. Eight articles were identified from electronic and hand searches as potentially meeting the inclusion criteria for this review. Two articles that did not meet the inclusion/exclusion criteria and one that did not meet the threshold quality score were excluded from the review. This paper is therefore a systematic review of five articles. xD;One study reported no difference between standard care and protective isolation, while two studies reported a decrease in MRSA isolates in patients who were cared for using Universal Precautions and modified isolation respectively. However, the results of only one of the two studies achieved a statistical significance. Poor compliance with isolation precautions was reported amongst staff compared to family and visitors in the other two studies. xD;Controlling the spread of MRSA is one of the most pressing infection control issues facing health service clinicians and administrators. This systematic review indicates that there is little conclusive evidence to validate isolation of patients with MRSA, although it is common clinical practice. No firm conclusions can be drawn from this review as the findings are based on single studies with small sample sizes. Well designed trials with large sample sizes are therefore a priority for the development of evidence based policies.
Abstract: The aim of this systematic review was to critically analyse the literature and present the best available evidence relating to the significance of environmental factors, including equipment, in the transmission of methicillin resistant Staphylococcus aureus (MRSA) to hospitalised patients. xD;Despite an extensive literature search only twenty studies that met the inclusion criteria were identified and analysed. There is evidence that the equipment and the inanimate environment are common reservoirs of MRSA, and that the rate of nosocommial transmission of the organism is influenced by occupancy rate and the design of clinical settings.
Abstract: The aim of this systematic review (SR) was to identify and critically appraise the best available research evidence regarding the infection control strategies used to manage nosocomial outbreaks and endemic methicillin resistant Staphylococcus aureus (MRSA) within the acute hospital setting. A thorough search of the literature identified 60 potential papers; however, only 33 studies met the quality criteria and were therefore considered the best evidence for inclusion in the review. xD;Various strategies such as staff, patient and environmental surveillance, patient isolation, flagging of medical records, use of protective apparel, education programmes for staff and monitoring of compliance with infection control practices, have been adopted to control transmission of infection during an epidemic. Medical staff, nurses and respiratory therapists were identified as sources of transmission during outbreaks. Researchers have demonstrated that between 1-20% of staff screened during an epidemic and up to 44% of staff working in areas where MRSA is endemic were colonised. Prospective patient surveillance indicated that a large number of patients were colonised without the symptomatic presentation of clinical illness. xD;This SR indicates that, in an attempt to curtail the spread of MRSA, various combinations of strategies have been beneficial. However, the effectiveness of the strategies used will depend on the patient demographics, acuity and size of the institution and the resources available.
