Malcolm Elliott is a PhD candidate in the St Vincent's Centre for Nursing Research (Melbourne, Aust). His research is examining adverse events in patients recently discharged from ICU.
Abstract: Nurses have traditionally relied on five vital signs to assess their patients – temperature, pulse, blood pressure, respiratory rate and oxygen saturation. But as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to identify patients who are clinically deteriorating. This paper describes clinical issues to consider when measuring vital signs as well as proposing additional assessments to perform as part of routine patient assessment – pain, level of consciousness and urine output.
Abstract: Providing quality care to patients in intensive care units (ICU) is vital, as these units are expensive and in limited supply. Preventable deaths in ICU patients represent not only a human cost but also a waste of valuable resources. As such the outcomes of patients admitted to ICU are often closely examined to ensure these expensive resources have been utilized appropriately.
ICU readmission rates are often used as a marker of care quality but doing so creates significant problems. Readmission rates for example, may only reflect care delivered after ICU discharge and not before. Furthermore readmission rates may highlight that resources aimed at improving patient outcomes, such as critical care outreach teams, are actually working. This paper describes the limitations with using ICU readmission rates as a marker of care quality.
Abstract: Objective: The purpose of this study was to identify and describe the experiences
and perceptions of nurses regarding the factors that contribute to the
readmission of patients to intensive care.
Methods: Twenty-one nurses participated in the study. Unstructured interviews
were conducted to ascertain participants’ perceptions and experiences. Interview
transcripts were analyzed using a constant comparison method to identify
major conceptual categories.
Results: Five main themes were identified that contributed to the readmission
of patients to intensive care: premature discharge from intensive care, delayed
medical care at the ward level, heavy nursing workloads, lack of adequately
qualified staff, and clinically “challenging” patients who demanded a different
skill set from the nurses.
Conclusion: Discharging patients early from the intensive care unit when they
are clinically unstable creates issues around workload and significantly challenges
ward staff. It also increases the likelihood of patients being readmitted to
the intensive care unit. Hospital managers need to look at ways of increasing the
knowledge and skills of ward staff or identify more appropriate environments
for managing these acutely ill patients.
Abstract: Nurses are responsible for ensuring safety and quality of patient care at all times. Many nursing tasks involve a degree of risk, and medication administration arguably carries the greatest risk. Unfortunately, patients are frequently harmed or injured by medication errors. Some suffer permanent disability and for others the errors are fatal. Nurses have traditionally followed the five rights of medication administration (patient, drug, route, time, dose) to help prevent errors, and more recently, the seven rights (including documentation and reason). This article identifies nine rights of medication administration.
Abstract: The life of every living organism is sustained by the presence of oxygen and the acute deprivation of oxygen will, therefore, result in hypoxia and ultimately
death. Although oxygen is normally present in the air, higher concentrations are required to treat many disease processes. Oxygen is therefore considered to be a drug requiring a medical prescription and is subject to any law that covers its use and prescription. Administration is typically authorized by a physician following legal written instructions to a qualified nurse. This standard procedure helps prevent incidence of misuse or oxygen deprivation which could worsen the patient’s hypoxia and ultimate outcome. Delaying the administration of oxygen until a written medical prescription is obtained could also have the same effect. Clearly, defined protocols should exist to allow for the legal administration of oxygen by nurses without a physician’s order because any delay in administering oxygen to patients can very well lead to their death.
Abstract: The education of nurses has traditionally been conducted in the hospital based setting. This changed over the last few decades, with nursing education now being a tertiary based course in many countries. There were numerous reasons for this move, the main goal being to improve the educational experience of students and thus the competence of graduates.
Nurse academics whose role is to educate students are faced with the challenge of ensuring their teaching reflects the contemporary nursing environment. One way of doing this is by actively engaging in clinical practice. However there are arguments for and against (as well as barriers to) them doing so and little empirical evidence to support either argument. Individually, nurse academics must make a decision about whether engaging in clinical practice is beneficial to their career and the students they teach.
Abstract: Pulse oximetry has become one of the most commonly used tools it: H:e 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 oximetry were reviewed. These studies revealed significant knowledge deficits about pulse oximetry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximetry 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 oximetry 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 oximetry is maintained in order to ensure that patient outcomes are not compromised.
Notes: Winner of the Australian College of Critical Care Nurses' best review paper 2006. citations 17
Abstract: Acutely ill patients are commonly found on general hospital wards; some of these are patients who have been recently discharged from an intensive care unit (ICU). These patients may require a higher level of care than other ward patients and, due to the acuity of their illness, are at risk of readmission to ICU. Research has indicated that patients readmitted to ICU have mortality rates up to six times higher than those not readmitted and are eleven times more likely to die in hospital. Numerous studies have retrospectively examined these readmissions but, despite this, there is still no clear indication of why ICU readmissions occur or what the common characteristics of readmitted patients are.
This literature review examines the published studies on patients who have been readmitted to ICU. Further research is needed to explore why readmissions to ICU occur and the type of patient who is at greatest risk for readmission.
Abstract: The ability to calculate drug dosages correctly is an essential skill for registered nurses to possess. Performing drug calculations accurately is not a skill
that new graduates have the luxury of developing over time. Drug errors are in many instances directly related to either the administration of an incorrect dose or incorrect infusion rate (Gladstone, 1995) caused by calculation errors.
A strategy for implementing drug calculation skills into our new under graduate nursing curriculum was initiated to assist students in developing proficiency in drug calculations. The aim of this program is to promote the development of calculation skills in undergraduate nursing students, rather than simply assessing their skills.
Abstract: This study attempts to address the content of nursing handover when compared with formal documentation sources.
Background: The nursing handover has attracted criticism in the literature in relation to its continuing role in modern nursing. Criticisms include those related to time expenditure, content, accuracy and the derogatory terms in which patients are
sometimes being discussed.
Method: Twenty-three handovers, covering all shifts, from one general medical ward were audio-taped. Their content was analysed and classified according to where, within a ward’s documentation systems, the information conveyed could be located.
Findings: Results showed that almost 84.6% of information discussed could be located within existing ward documentation structures and 9.5% of information discussed was not relevant to ongoing patient care. Only 5.9% of handover content involved discussions related to ongoing care or ward management issues that could not be recorded in an existing documentation source.
Conclusion: Streamlining the nursing handover may improve the quality of the information presented and reduce the amount of time spent in handover.
Abstract: Clinical nurses encounter critical incidents every day. While these may be a source of frustration, they also have the potential to be turned into research projects so that problems can be examined and others can learn from them. This paper describes the reflective process used to generate a research project fron a critical incident encountered in the clinical area.
Abstract: Nasogastric tubes are a commonly used medical device. There are numerous complications associated with their use, one of the most significant is when they are inadvertently inserted into the cranium. Clinicians need to be aware of this complication and the type of patient who is most susceptible.
Abstract: Nasogastric tubes are a medical device that can be used for a number of purposes. The process of inserting them however can be complicated. Nurses must therefore use an evidencebased approach to confirm the correct position of nasogastric tubes and there are three main techniques described in the literature to do so. To date, one group of authors has published the majority of the studies on these techniques. This paper reviews their work.
Abstract: The clinical area is an important learning environment for undergraduate nursing students. Unfortunately, it can also be a source of significant
stress and anxiety for students and there are a number of reasons for this. Much can be done to help alleviate this stress and create a positive learning environment for students.
This paper explores the literature to ascertain the common sources of stress for undergraduate students in the clinical area. It also reviews strategies for improving the quality of the learning experience.
Abstract: Clinical education is an essential part of every undergraduate nursing curriculum. The main benifits are that it allows students to put theory into practice and experience the realities cif the practice-based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students' assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.
