Patricia Davidson - Academia.edu (original) (raw)

Papers by Patricia Davidson

BioMed Research International, 2015

Journal of Clinical Nursing, 2015

The purpose of this review was to explore what is known about interruptions and distractions on m... more The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. Systematic, critical literature review. Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.

Archives of Gerontology and Geriatrics, 2015

A major challenge facing our health care systems internationally is managing the needs of increas... more A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings. Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts. Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care. The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute care settings.

Nurse Education Today, 2015

Approaches to clinical education are highly diverse and becoming increasingly complex to sustain ... more Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu OBJECTIVE: To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) legacies from the past and the inherent features of nurse education and (2) challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent.

Nurse Education Today, 2015

Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preven... more Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4weeks to extend the reflective learning process and review the impact of the experience from the student perspective. Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and improve deductive reasoning and analysis. The heightened awareness of interruptions and their impacts on the medication administration process, along with techniques to manage interruptions more effectively serves to better prepare nurses for practice.

Journal of Clinical Nursing

To review community programmes promoting self-care or self-management for older people with chron... more To review community programmes promoting self-care or self-management for older people with chronic disease in Thailand. Identifying successful elements of culturally appropriate and effective community-based interventions to promote self-care with chronic illness is increasingly important. Integrative review. CINAHL, Medline, Health Source Nursing Academic databases. Integrative review of peer-reviewed articles written between 1946-2012. Articles were included if they described self-care, self-management, chronic disease and community care interventions targeting older people in Thailand. Of the 58 articles retrieved, only 13 articles met the eligibility criteria. Elements of effective interventions included: (1) providing culturally sensitive information, (2) including approaches of shared decision-making and mutual goal setting and (3) flexibility within the intervention to adapt to participant needs. Shared decision-making and mutual goal setting between interventionists and pat...

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 26, 2015

This study investigated the effectiveness of a structured telephone intervention for caregivers o... more This study investigated the effectiveness of a structured telephone intervention for caregivers of people diagnosed with poor prognosis gastrointestinal cancer to improve psychosocial outcomes for both caregivers and patients. Caregivers of patients starting treatment for upper gastrointestinal or Dukes D colorectal cancer were randomly assigned (1:1) to the Family Connect telephone intervention or usual care. Caregivers in the intervention group received four standardized telephone calls in the 10 weeks following patient hospital discharge. Caregivers' quality of life (QOL), caregiver burden, unmet supportive care needs and distress were assessed at 3 and 6 months. Patients' QOL, unmet supportive care needs, distress and health service utilization were also assessed at these time points. Caregivers (128) were randomized to intervention or usual care groups. At 3 months, caregiver QOL scores and other caregiver-reported outcomes were similar in both groups. Intervention grou...

Heart, Lung and Circulation, 2015

Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an abso... more Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF. An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed. Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age; living alone (HR 1.09, 95% CI 0.74-1.59); those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to individuals with one documented co-morbidity). The C-statistic of the final model was 0.80. We have developed a practical model for individualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.

Food & Nutrition Research, 2015

Journal of Immigrant and Minority Health, 2015

This study examined the relationships among the constructs of acculturative stress, depression, E... more This study examined the relationships among the constructs of acculturative stress, depression, English language use, health literacy, and social support and the influence of these factors on health-seeking behaviors of Filipino Australians. Using a self-administered questionnaire, 552 respondents were recruited from November 2010 to June 2011. Structural equation modelling was used to examine relationships. A direct and negative relationship between health-seeking behaviors and depression, and an indirect relationship with acculturative stress, was observed mediated through depression. Social support had an important moderating influence on these effects. Although there was an inverse relationship between age and English language usage and depression, age was positively related to health-seeking behavior. Despite their long duration of stay, Filipino Australian migrants continue to experience acculturative stress and depression leading to lower health-seeking behaviors. This study highlights the importance of screening for acculturative stress and depression in migrants and fostering social support.

Circulation. Cardiovascular quality and outcomes, 2015

Heart Failure Reviews, 2015

Journal of clinical nursing, 2015

ESC Heart Failure, 2015

ABSTRACT AimsThe primary aim of this study is to provide data to inform the design of a randomize... more ABSTRACT AimsThe primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes.Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed.Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.

Asia-Pacific journal of clinical oncology, Jan 14, 2015

To develop clinical practice guidelines for screening, assessing and managing cancer pain in Aust... more To develop clinical practice guidelines for screening, assessing and managing cancer pain in Australian adults. This three-phase project utilized the ADAPTE approach to adapt international cancer pain guidelines for the Australian setting. A Working Party was established to define scope, screen guidelines for adaptation and develop recommendations to support better cancer pain control through screening, assessment, pharmacological and non-pharmacological management, and patient education. Recommendations with limited evidence were referred to Expert Panels for advice before the draft guidelines were opened for public consultation via the Cancer Council Australia Cancer Guidelines Wiki platform in late 2012. All comments were reviewed by the Working Party and the guidelines were revised accordingly. Screening resulted in six international guidelines being included for adaptation - those developed by the Scottish Intercollegiate Guidelines Network (2008), National Health Service Quali...

Contemporary nurse, 2014

Abstract

BioMed Research International, 2015

Journal of Clinical Nursing, 2015

The purpose of this review was to explore what is known about interruptions and distractions on m... more The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. Systematic, critical literature review. Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.

Archives of Gerontology and Geriatrics, 2015

A major challenge facing our health care systems internationally is managing the needs of increas... more A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings. Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts. Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care. The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute care settings.

Nurse Education Today, 2015

Approaches to clinical education are highly diverse and becoming increasingly complex to sustain ... more Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu OBJECTIVE: To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) legacies from the past and the inherent features of nurse education and (2) challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent.

Nurse Education Today, 2015

Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preven... more Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4weeks to extend the reflective learning process and review the impact of the experience from the student perspective. Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and improve deductive reasoning and analysis. The heightened awareness of interruptions and their impacts on the medication administration process, along with techniques to manage interruptions more effectively serves to better prepare nurses for practice.

Journal of Clinical Nursing

To review community programmes promoting self-care or self-management for older people with chron... more To review community programmes promoting self-care or self-management for older people with chronic disease in Thailand. Identifying successful elements of culturally appropriate and effective community-based interventions to promote self-care with chronic illness is increasingly important. Integrative review. CINAHL, Medline, Health Source Nursing Academic databases. Integrative review of peer-reviewed articles written between 1946-2012. Articles were included if they described self-care, self-management, chronic disease and community care interventions targeting older people in Thailand. Of the 58 articles retrieved, only 13 articles met the eligibility criteria. Elements of effective interventions included: (1) providing culturally sensitive information, (2) including approaches of shared decision-making and mutual goal setting and (3) flexibility within the intervention to adapt to participant needs. Shared decision-making and mutual goal setting between interventionists and pat...

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 26, 2015

This study investigated the effectiveness of a structured telephone intervention for caregivers o... more This study investigated the effectiveness of a structured telephone intervention for caregivers of people diagnosed with poor prognosis gastrointestinal cancer to improve psychosocial outcomes for both caregivers and patients. Caregivers of patients starting treatment for upper gastrointestinal or Dukes D colorectal cancer were randomly assigned (1:1) to the Family Connect telephone intervention or usual care. Caregivers in the intervention group received four standardized telephone calls in the 10 weeks following patient hospital discharge. Caregivers' quality of life (QOL), caregiver burden, unmet supportive care needs and distress were assessed at 3 and 6 months. Patients' QOL, unmet supportive care needs, distress and health service utilization were also assessed at these time points. Caregivers (128) were randomized to intervention or usual care groups. At 3 months, caregiver QOL scores and other caregiver-reported outcomes were similar in both groups. Intervention grou...

Heart, Lung and Circulation, 2015

Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an abso... more Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF. An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed. Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age; living alone (HR 1.09, 95% CI 0.74-1.59); those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to individuals with one documented co-morbidity). The C-statistic of the final model was 0.80. We have developed a practical model for individualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.

Food & Nutrition Research, 2015

Journal of Immigrant and Minority Health, 2015

This study examined the relationships among the constructs of acculturative stress, depression, E... more This study examined the relationships among the constructs of acculturative stress, depression, English language use, health literacy, and social support and the influence of these factors on health-seeking behaviors of Filipino Australians. Using a self-administered questionnaire, 552 respondents were recruited from November 2010 to June 2011. Structural equation modelling was used to examine relationships. A direct and negative relationship between health-seeking behaviors and depression, and an indirect relationship with acculturative stress, was observed mediated through depression. Social support had an important moderating influence on these effects. Although there was an inverse relationship between age and English language usage and depression, age was positively related to health-seeking behavior. Despite their long duration of stay, Filipino Australian migrants continue to experience acculturative stress and depression leading to lower health-seeking behaviors. This study highlights the importance of screening for acculturative stress and depression in migrants and fostering social support.

Circulation. Cardiovascular quality and outcomes, 2015

Heart Failure Reviews, 2015

Journal of clinical nursing, 2015

ESC Heart Failure, 2015

ABSTRACT AimsThe primary aim of this study is to provide data to inform the design of a randomize... more ABSTRACT AimsThe primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes.Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed.Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.

Asia-Pacific journal of clinical oncology, Jan 14, 2015

To develop clinical practice guidelines for screening, assessing and managing cancer pain in Aust... more To develop clinical practice guidelines for screening, assessing and managing cancer pain in Australian adults. This three-phase project utilized the ADAPTE approach to adapt international cancer pain guidelines for the Australian setting. A Working Party was established to define scope, screen guidelines for adaptation and develop recommendations to support better cancer pain control through screening, assessment, pharmacological and non-pharmacological management, and patient education. Recommendations with limited evidence were referred to Expert Panels for advice before the draft guidelines were opened for public consultation via the Cancer Council Australia Cancer Guidelines Wiki platform in late 2012. All comments were reviewed by the Working Party and the guidelines were revised accordingly. Screening resulted in six international guidelines being included for adaptation - those developed by the Scottish Intercollegiate Guidelines Network (2008), National Health Service Quali...

Contemporary nurse, 2014

Abstract