Anne Gardner - Academia.edu (original) (raw)
Papers by Anne Gardner
Background Multi-centre studies generally cost more than single-centre studies because of larger ... more Background
Multi-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals.
Methods
We collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget.
Results
The total costs of gaining approval were 38 % of the budget for a study of 50 centres (mean cost AUD 6960persite)and26960 per site) and 2 % for a study of 11 centres (mean cost AUD 6960persite)and22300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety.
Conclusions
Improvements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked.
Aims: To explore correlations between peak pressure and pressure gradient at 1.5 cm and 2.5 cm, a... more Aims: To explore correlations between peak pressure and pressure gradient at 1.5 cm and 2.5 cm, and selected risk factors for pressure injury including Waterlow risk assessment score and body mass index.
Background: Accurately predicting pressure injury formation remains elusive. Exploring pressure gradients through pressure mapping systems may increase understanding of suspected deep pressure injury development.
Methods: A nested prospective correlational exploratory study recruited 120 medical and surgical patients with convenience sampling. Patients were positioned supine with a 30-degree head elevation, on a computer linked pressure sensor mapping mat. Mean peak interface pressure and pressure gradients were calculated.
Results: Large correlation coefficients were identified between peak interface pressure and pressure gradients at distances of 1.5 cm and 2.5 cm, indicating that the area at the base of the ‘cone-like’ pressure damaged area remained essentially constant, rather than increasing with peak interface pressure.
Conclusions: Pressure is experienced in a ‘V’ shape rather than a ‘U’ shape. Additionally, the area subjected to the highest pressure gradient is restricted in size and the impact of pressure reduces with distance from the point of peak interface pressure. The results suggest that with increasing peak interface pressure, the surrounding area becomes subject to higher gradients and shearing forces.
Relevance to clinical practice: Increased use of pressure mapping systems in the clinical setting shows educational promise through visualisation of factors affecting deep tissue injury.
Background: Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised ... more Background: Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised patients. Around the world, the incidence and severity of CDI appears to be increasing, particularly in the northern hemisphere. The purpose of this integrative review was to investigate and describe mortality in hospitalised patients with CDI.
Methods: A search of the literature between 1 January 2005 and 30 April 2011 focusing on mortality and CDI in hospitalised patients was conducted using electronic databases. Papers were reviewed and analysed individually and themes were combined using integrative methods.
Results: All cause mortality at 30 days varied from 9% to 38%. Three studies report attributable mortality at 30 days, varying from 5.7% to 6.9%. In hospital mortality ranged from 8% to 37.2%.
Conclusion: All cause 30 day mortality appeared to be high, with 15 studies indicating a mortality of 15% or greater. Findings support the notion that CDI is a serious infection and measures to prevent and control CDI are needed. Future studies investigating the mortality of CDI in settings outside of Europe and North America are needed. Similarly, future studies should include data on patient co-morbidities.
Background/Aims: Many patients undergoing life-preserving haemodialysis are exposed to additional... more Background/Aims: Many patients undergoing life-preserving haemodialysis are exposed to additional risks because access is via a central venous catheter (CVC). Despite a paucity of evidence, guidelines and policies dictated the use of transparent exit site wound dressings, which was contrary to local nurses’ practice of using an opaque wound dressing. This study aimed to explore nurses’ experiences with three types of CVC exit site dressings in the context of a randomised controlled trial (RCT).
Methods: A descriptive exploratory design was used. Transcripts from seven focus groups held with haemodialysis nurses were analysed thematically.
Results: Fifteen nurses, with varying haemodialysis experience, provided comments on the ease of applying and removing the dressings, problems encountered with the dressings, which dressing types they thought best or worst, and the value of having a specific work practice instruction developed for the RCT. It was clear that, although no dressing type was perfect, the opaque dressing was the best given the properties of the dressings, the patients’ preferences, and the humid climate.
Conclusion: The perspectives voiced by the focus group participants support the need to modify the local health service’s policy, in line with revised state and national guidelines for this type of patient cohort, to allow for individual, contextual and climatic considerations.
Aim: This study explored the visual anatomical characteristics of the buttock region through use ... more Aim: This study explored the visual anatomical characteristics of the buttock region through use of an interface pressure mapping system to determine the correlation of shape with selected risk factors.
Background: Pressure injuries are a major challenge for health care systems worldwide. Risk assessment tools are limited in predicting pressure injury. Interface pressure mapping systems can potentially map body shape data related to pressure injury risk.
Methods: This work was nested within a larger exploratory study which utilised a randomised controlled design. One hundred and twenty-six patients were recruited at any time during their admission to a public tertiary referral hospital or a community hospital. Equipment including the designated standard hospital mattress and bed, and the Tekscan ClinseatTM pressure mapping system was used to explore the visual anatomical characteristics of patients’ buttock region and the correlation of shape with selected risk factors. Demographic and Waterlow Risk Assessment Tool data were collected.
Results: Five buttock shapes were observed using the interface pressure mapping surface, then categorised into ‘round/square’ and ‘other’ groups. Round and square shapes were significantly associated with higher body mass index and Waterlow Risk Assessment scores.
Conclusions: Visually assessing buttock shape demonstrates potential for identifying pressure injury risk in this region.
Background: Catheter associated urinary tract infections (CAUTI) are one of the most frequent hea... more Background: Catheter associated urinary tract infections (CAUTI) are one of the most frequent healthcare associated infections. Antiseptic cleaning of the meatal area before and during catheter use may have the potential to reduce CAUTI risk.
Aim: To systematically review the literature and meta-analyse studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTI.
Methods: Electronic databases were searched to identify randomised controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated and compared across intervention and control groups using DerSimonian-Laird random effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic.
Findings: We identified 2665 potential papers, of which 14 studies were eligible for inclusion. There was no difference in CAUTI incidence when comparing an antiseptic and non-antiseptic agent (pooled OR=0.90, 95% CI=0.73-1.10; P=0.31) and for different agents compared: povidone-iodine versus routine care; povidone-iodine versus soap and water; chlorhexidine versus water; povidone-iodine versus saline; povidone-iodine versus water; and green soap and water versus routine care (P>0.05 for all). Comparison of an antibacterial with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in CAUTI incidence regarding country, setting, risk of bias, sex and frequency of administration.
Conclusions: There were no differences in CAUTI rates although methodological issues hamper generalisability of this finding. Antibacterials might be significant in a well conducted study. Results provide good evidence to inform infection control guidelines in catheter management.
Aim: To explore the role of the Australian breast care nurse in the provision of information and ... more Aim: To explore the role of the Australian breast care nurse in the provision of information and support to women with breast cancer, with a focus on the differences experienced depending on geographic work context.
Design: A cross-sectional study.
Methods: This study conducted in 2013, involved surveying BCNs currently working in Australia, using a newly developed self-report online survey.
Results: Fifty breast care nurses completed the survey, 40% from major cities, 42% from inner regional Australia and 18% from outer regional, remote and very remote Australia. Patterns of service indicated higher caseloads in urban areas, with fewer kilometres served. Breast care nurses in outer regional, remote and very remote areas were less likely to work in multidisciplinary teams and more likely to spend longer consulting with patients. Breast care nurses reported they undertook roles matching the competency standards related to the provision of education, information and support; however, there were barriers to fulfilling competencies including knowledge based limitations, time constraints and servicing large geographical areas.
Conclusions: This was the first Australian study to describe the role of the breast care nurse nationally and the first study to investigate breast care nurses perceived ability to meet a selection of the Australian Specialist Breast Nurse Competency Standards. Important differences were found according to the geographical location of breast care nurses.
Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infecti... more Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs.
Setting: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013.
Participants: A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded.
Outcome measures: The primary outcome measures were the HAUTI and CAUTI point prevalence.
Results: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter 26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition.
Conclusions: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.
Journal of Advanced Nursing, 2004
Background. The process and content of nurse practitioner educational preparation has received s... more Background.
The process and content of nurse practitioner educational preparation has received scant research attention, despite increasing interest in and investigations into nurse practitioner services in Australia and internationally.
Aims.
The aim of this paper is to report a study investigating the educational process and content required for nurse practitioner preparation.
Methods.
A trial of practice was conducted with four nurse practitioner candidates over a 12 month period. The candidates practised in different specialities, giving rise to four models of the nurse practitioner role. The trial had multiple aims related to the role and scope of practice of the nurse practitioner. An action learning model was used, in which participating nurse practitioner candidates 'worked-into-the-role' of extended practice and learned from experience through clinical mentoring, reflection and action. Data collection methods centred on transcripts from group work activities related to a collaborative engagement with and reflections on clinical practice. This resulted in the collaborative production of data to inform a research-based nurse practitioner curriculum structure.
Findings.
The findings relate to the content and learning process required for nurse practitioner education and are described in terms of three broad areas of study: clinical practice, clinical sciences and nursing studies.
Conclusions.
A curriculum structure that describes content and process for nurse practitioner education was developed from the findings. A further outcome of this trial was confirmation of importance of the clinical environment for nurse practitioner education. Inherent in this aspect of clinical learning is the role of a committed clinical mentor who can facilitate purposeful learning.
Journal of clinical nursing, Jan 17, 2016
Study Objective To facilitate staff transition from an open plan to a two cot Neonatal Intensive ... more Study Objective
To facilitate staff transition from an open plan to a two cot Neonatal Intensive Care Unit (NICU) design.
Background
In 2012, an Australian regional NICU transitioned from an open plan to a two cot NICU design. Research has reported single and small room NICU design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such NICUs. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice.
Design
A Participatory Action Research (PAR) approach.
Methods
A participatory action group titled the Change and Networking (CAN) Group collaborated with staff over a four year period (2009-2013) to facilitate the transition. The CAN Group utilised a collaborative, cyclical process of planning, gathering data, taking action, and reviewing the results in order to plan the next action. Data Sources included: meeting and workshop minutes, newsletters, feedback boards, sub group reports and a staff satisfaction survey.
Results
The study findings include a description of 1) how the PAR cycles were utilised by the CAN Group: providing examples of projects and strategies undertaken; and 2) evaluations of PAR methodology and Group by NICU staff and CAN members.
Conclusion
This study has described the benefits of using PAR to facilitate staff transition from an open plan to a two cot NICU design. PAR methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long term effect of NICU design on staff workload, maintaining and supporting a skilled workforce as well as the impact of the a new NICU design on the NICU culture.
PloS one, 2016
This study describes the antimicrobial resistance temporal trends and seasonal variation of Esche... more This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI.
A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community-acquired.
Five-year hospital and community resistance rates were highest for ampicillin
(41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006).
An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.
BMC family practice, Jan 29, 2016
Background: In 2010 policy changes were introduced to the Australian healthcare system that grant... more Background: In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models.
Methods: A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics.
Results: Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners’ and medical practitioners’ adjustment to new routines and facilitating the collaborative work relied on the willingness and personal commitment of individuals.
Conclusions: Findings of this study suggest that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, strategic support from healthcare reform decision-makers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice models in primary healthcare.
Journal of advanced nursing, Jan 18, 2016
AIM: The aim of this study was to achieve profession-wide consensus on an Australian nurse practi... more AIM: The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework.
BACKGROUND: Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties.
DESIGN: This study employed an online three-round modified Delphi method.
METHOD: Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience (n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties.
RESULTS: One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation.
CONCLUSION: A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.
International journal of nursing studies, Jan 12, 2016
Although nurses generally constitute the largest component of the health workforce there is no sy... more Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population. This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions. A cross-sectional survey design was used. The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services. All full-time, part-time and casual nurses and midwives employed within the health service were invited t...
This Paper Was Originally Published As Mitchell B Gardner a Beckingham W Fasugba O Healthcare Associated Urinary Tract Infections a Protocol For a National Point Prevalence Study Healthcare Infection 19 26 31 Retrieved from Http Dx Doi Org 10 1071 Hi13037 Issn 1835 5617, 2013
Background: Urinary tract infections account for ~30% of healthcare-associated infections reporte... more Background: Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study.
Methods: A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived.
Discussion: Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition.
Conclusion: Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.
Australian Critical Care, May 1, 2006
The quality of sedation management in mechanically ventilated patients has been a source of conce... more The quality of sedation management in mechanically ventilated patients has been a source of concern in recent years. This paper summarises the literature on the principles of optimal sedation, discusses the consequences of over and undersedation, highlighting the importance of appropriate pain management, and presents a case study using the results of an audit of 48 mechanically ventilated adults. As a result of the review and audit, we are implementing changes to practice. The most important recommendations from the literature are the use of a sedation scale, setting of a goal sedation score, appropriate pain management and implementation of a nurse initiated sedation algorithm. Other recommendations include use of bolus rather than continuous sedative infusions and recommencing regular medications for anxiety, depression and other phychiatric disorders as soon as possible. A recommendation arising from our audit was the need to identify patients at high risk of oversedation and undersedation and adopt a proactive rather than reactive approach to management. The practice goal is to provide adequate and appropriate analgesia and anxiolysis for patients. This will improve patient comfort while reducing length of mechanical ventilation and minimising risk of complications.
BMC nursing, 2016
Background: The nurse practitioner is a growing clinical role in Australia and internationally, w... more Background: The nurse practitioner is a growing clinical role in Australia and internationally, with an expanded scope of practice including prescribing, referring and diagnosing. However, key gaps exist in nurse practitioner education regarding governance of specialty clinical learning and teaching. Specifically, there is no internationally accepted framework against which to measure the quality of clinical learning and teaching for advanced specialty practice.
Methods: A case study design will be used to investigate educational governance and capability theory in nurse practitioner education. Nurse practitioner students, their clinical mentors and university academic staff, from an Australian university that offers an accredited nurse practitioner Master’s degree, will be invited to participate in the study.
Semi-structured interviews will be conducted with students and their respective clinical mentors and university academic staff to investigate learning objectives related to educational governance and attributes of capability learning. Limited demographic data on age, gender, specialty, education level and nature of the clinical healthcare learning site will also be collected. Episodes of nurse practitioner student specialty clinical learning will be observed and documentation from the students’ healthcare learning sites will be collected.
Descriptive statistics will be used to report age groups, areas of specialty and types of facilities where clinical learning and teaching is observed. Qualitative data from interviews, observations and student documents will be coded, aggregated and explored to inform a framework of educational governance, to confirm the existing capability framework and describe any additional characteristics of capability and capability learning.
Discussion: This research has widespread significance and will contribute to ongoing development of the Australian health workforce. Stakeholders from industry and academic bodies will be involved in shaping the framework that guides the quality and governance of clinical learning and teaching in specialty nurse practitioner practice. Through developing standards for advanced clinical learning and teaching, and furthering understanding of capability theory for advanced healthcare practitioners, this research will contribute to evidence-based models of advanced specialty postgraduate education.
Faculty of Health Institute of Health and Biomedical Innovation School of Nursing, 2010
Australian Infection Control, Jun 1, 2005
Gardner, Anne, Darvill, Jon and Milbourne, Kate 2005-06, Letters to the editor : Routine replacem... more Gardner, Anne, Darvill, Jon and Milbourne, Kate 2005-06, Letters to the editor : Routine replacement of short peripheral IV catheters, Australian infection control, vol. 10, no. 2, pp. 67-69. ... Unless expressly stated otherwise, the copyright for items in Deakin Research Online is owned ...
Background Multi-centre studies generally cost more than single-centre studies because of larger ... more Background
Multi-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals.
Methods
We collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget.
Results
The total costs of gaining approval were 38 % of the budget for a study of 50 centres (mean cost AUD 6960persite)and26960 per site) and 2 % for a study of 11 centres (mean cost AUD 6960persite)and22300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety.
Conclusions
Improvements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked.
Aims: To explore correlations between peak pressure and pressure gradient at 1.5 cm and 2.5 cm, a... more Aims: To explore correlations between peak pressure and pressure gradient at 1.5 cm and 2.5 cm, and selected risk factors for pressure injury including Waterlow risk assessment score and body mass index.
Background: Accurately predicting pressure injury formation remains elusive. Exploring pressure gradients through pressure mapping systems may increase understanding of suspected deep pressure injury development.
Methods: A nested prospective correlational exploratory study recruited 120 medical and surgical patients with convenience sampling. Patients were positioned supine with a 30-degree head elevation, on a computer linked pressure sensor mapping mat. Mean peak interface pressure and pressure gradients were calculated.
Results: Large correlation coefficients were identified between peak interface pressure and pressure gradients at distances of 1.5 cm and 2.5 cm, indicating that the area at the base of the ‘cone-like’ pressure damaged area remained essentially constant, rather than increasing with peak interface pressure.
Conclusions: Pressure is experienced in a ‘V’ shape rather than a ‘U’ shape. Additionally, the area subjected to the highest pressure gradient is restricted in size and the impact of pressure reduces with distance from the point of peak interface pressure. The results suggest that with increasing peak interface pressure, the surrounding area becomes subject to higher gradients and shearing forces.
Relevance to clinical practice: Increased use of pressure mapping systems in the clinical setting shows educational promise through visualisation of factors affecting deep tissue injury.
Background: Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised ... more Background: Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised patients. Around the world, the incidence and severity of CDI appears to be increasing, particularly in the northern hemisphere. The purpose of this integrative review was to investigate and describe mortality in hospitalised patients with CDI.
Methods: A search of the literature between 1 January 2005 and 30 April 2011 focusing on mortality and CDI in hospitalised patients was conducted using electronic databases. Papers were reviewed and analysed individually and themes were combined using integrative methods.
Results: All cause mortality at 30 days varied from 9% to 38%. Three studies report attributable mortality at 30 days, varying from 5.7% to 6.9%. In hospital mortality ranged from 8% to 37.2%.
Conclusion: All cause 30 day mortality appeared to be high, with 15 studies indicating a mortality of 15% or greater. Findings support the notion that CDI is a serious infection and measures to prevent and control CDI are needed. Future studies investigating the mortality of CDI in settings outside of Europe and North America are needed. Similarly, future studies should include data on patient co-morbidities.
Background/Aims: Many patients undergoing life-preserving haemodialysis are exposed to additional... more Background/Aims: Many patients undergoing life-preserving haemodialysis are exposed to additional risks because access is via a central venous catheter (CVC). Despite a paucity of evidence, guidelines and policies dictated the use of transparent exit site wound dressings, which was contrary to local nurses’ practice of using an opaque wound dressing. This study aimed to explore nurses’ experiences with three types of CVC exit site dressings in the context of a randomised controlled trial (RCT).
Methods: A descriptive exploratory design was used. Transcripts from seven focus groups held with haemodialysis nurses were analysed thematically.
Results: Fifteen nurses, with varying haemodialysis experience, provided comments on the ease of applying and removing the dressings, problems encountered with the dressings, which dressing types they thought best or worst, and the value of having a specific work practice instruction developed for the RCT. It was clear that, although no dressing type was perfect, the opaque dressing was the best given the properties of the dressings, the patients’ preferences, and the humid climate.
Conclusion: The perspectives voiced by the focus group participants support the need to modify the local health service’s policy, in line with revised state and national guidelines for this type of patient cohort, to allow for individual, contextual and climatic considerations.
Aim: This study explored the visual anatomical characteristics of the buttock region through use ... more Aim: This study explored the visual anatomical characteristics of the buttock region through use of an interface pressure mapping system to determine the correlation of shape with selected risk factors.
Background: Pressure injuries are a major challenge for health care systems worldwide. Risk assessment tools are limited in predicting pressure injury. Interface pressure mapping systems can potentially map body shape data related to pressure injury risk.
Methods: This work was nested within a larger exploratory study which utilised a randomised controlled design. One hundred and twenty-six patients were recruited at any time during their admission to a public tertiary referral hospital or a community hospital. Equipment including the designated standard hospital mattress and bed, and the Tekscan ClinseatTM pressure mapping system was used to explore the visual anatomical characteristics of patients’ buttock region and the correlation of shape with selected risk factors. Demographic and Waterlow Risk Assessment Tool data were collected.
Results: Five buttock shapes were observed using the interface pressure mapping surface, then categorised into ‘round/square’ and ‘other’ groups. Round and square shapes were significantly associated with higher body mass index and Waterlow Risk Assessment scores.
Conclusions: Visually assessing buttock shape demonstrates potential for identifying pressure injury risk in this region.
Background: Catheter associated urinary tract infections (CAUTI) are one of the most frequent hea... more Background: Catheter associated urinary tract infections (CAUTI) are one of the most frequent healthcare associated infections. Antiseptic cleaning of the meatal area before and during catheter use may have the potential to reduce CAUTI risk.
Aim: To systematically review the literature and meta-analyse studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTI.
Methods: Electronic databases were searched to identify randomised controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated and compared across intervention and control groups using DerSimonian-Laird random effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic.
Findings: We identified 2665 potential papers, of which 14 studies were eligible for inclusion. There was no difference in CAUTI incidence when comparing an antiseptic and non-antiseptic agent (pooled OR=0.90, 95% CI=0.73-1.10; P=0.31) and for different agents compared: povidone-iodine versus routine care; povidone-iodine versus soap and water; chlorhexidine versus water; povidone-iodine versus saline; povidone-iodine versus water; and green soap and water versus routine care (P>0.05 for all). Comparison of an antibacterial with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in CAUTI incidence regarding country, setting, risk of bias, sex and frequency of administration.
Conclusions: There were no differences in CAUTI rates although methodological issues hamper generalisability of this finding. Antibacterials might be significant in a well conducted study. Results provide good evidence to inform infection control guidelines in catheter management.
Aim: To explore the role of the Australian breast care nurse in the provision of information and ... more Aim: To explore the role of the Australian breast care nurse in the provision of information and support to women with breast cancer, with a focus on the differences experienced depending on geographic work context.
Design: A cross-sectional study.
Methods: This study conducted in 2013, involved surveying BCNs currently working in Australia, using a newly developed self-report online survey.
Results: Fifty breast care nurses completed the survey, 40% from major cities, 42% from inner regional Australia and 18% from outer regional, remote and very remote Australia. Patterns of service indicated higher caseloads in urban areas, with fewer kilometres served. Breast care nurses in outer regional, remote and very remote areas were less likely to work in multidisciplinary teams and more likely to spend longer consulting with patients. Breast care nurses reported they undertook roles matching the competency standards related to the provision of education, information and support; however, there were barriers to fulfilling competencies including knowledge based limitations, time constraints and servicing large geographical areas.
Conclusions: This was the first Australian study to describe the role of the breast care nurse nationally and the first study to investigate breast care nurses perceived ability to meet a selection of the Australian Specialist Breast Nurse Competency Standards. Important differences were found according to the geographical location of breast care nurses.
Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infecti... more Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs.
Setting: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013.
Participants: A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded.
Outcome measures: The primary outcome measures were the HAUTI and CAUTI point prevalence.
Results: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter 26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition.
Conclusions: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.
Journal of Advanced Nursing, 2004
Background. The process and content of nurse practitioner educational preparation has received s... more Background.
The process and content of nurse practitioner educational preparation has received scant research attention, despite increasing interest in and investigations into nurse practitioner services in Australia and internationally.
Aims.
The aim of this paper is to report a study investigating the educational process and content required for nurse practitioner preparation.
Methods.
A trial of practice was conducted with four nurse practitioner candidates over a 12 month period. The candidates practised in different specialities, giving rise to four models of the nurse practitioner role. The trial had multiple aims related to the role and scope of practice of the nurse practitioner. An action learning model was used, in which participating nurse practitioner candidates 'worked-into-the-role' of extended practice and learned from experience through clinical mentoring, reflection and action. Data collection methods centred on transcripts from group work activities related to a collaborative engagement with and reflections on clinical practice. This resulted in the collaborative production of data to inform a research-based nurse practitioner curriculum structure.
Findings.
The findings relate to the content and learning process required for nurse practitioner education and are described in terms of three broad areas of study: clinical practice, clinical sciences and nursing studies.
Conclusions.
A curriculum structure that describes content and process for nurse practitioner education was developed from the findings. A further outcome of this trial was confirmation of importance of the clinical environment for nurse practitioner education. Inherent in this aspect of clinical learning is the role of a committed clinical mentor who can facilitate purposeful learning.
Journal of clinical nursing, Jan 17, 2016
Study Objective To facilitate staff transition from an open plan to a two cot Neonatal Intensive ... more Study Objective
To facilitate staff transition from an open plan to a two cot Neonatal Intensive Care Unit (NICU) design.
Background
In 2012, an Australian regional NICU transitioned from an open plan to a two cot NICU design. Research has reported single and small room NICU design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such NICUs. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice.
Design
A Participatory Action Research (PAR) approach.
Methods
A participatory action group titled the Change and Networking (CAN) Group collaborated with staff over a four year period (2009-2013) to facilitate the transition. The CAN Group utilised a collaborative, cyclical process of planning, gathering data, taking action, and reviewing the results in order to plan the next action. Data Sources included: meeting and workshop minutes, newsletters, feedback boards, sub group reports and a staff satisfaction survey.
Results
The study findings include a description of 1) how the PAR cycles were utilised by the CAN Group: providing examples of projects and strategies undertaken; and 2) evaluations of PAR methodology and Group by NICU staff and CAN members.
Conclusion
This study has described the benefits of using PAR to facilitate staff transition from an open plan to a two cot NICU design. PAR methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long term effect of NICU design on staff workload, maintaining and supporting a skilled workforce as well as the impact of the a new NICU design on the NICU culture.
PloS one, 2016
This study describes the antimicrobial resistance temporal trends and seasonal variation of Esche... more This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI.
A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community-acquired.
Five-year hospital and community resistance rates were highest for ampicillin
(41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006).
An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.
BMC family practice, Jan 29, 2016
Background: In 2010 policy changes were introduced to the Australian healthcare system that grant... more Background: In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models.
Methods: A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics.
Results: Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners’ and medical practitioners’ adjustment to new routines and facilitating the collaborative work relied on the willingness and personal commitment of individuals.
Conclusions: Findings of this study suggest that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, strategic support from healthcare reform decision-makers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice models in primary healthcare.
Journal of advanced nursing, Jan 18, 2016
AIM: The aim of this study was to achieve profession-wide consensus on an Australian nurse practi... more AIM: The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework.
BACKGROUND: Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties.
DESIGN: This study employed an online three-round modified Delphi method.
METHOD: Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience (n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties.
RESULTS: One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation.
CONCLUSION: A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.
International journal of nursing studies, Jan 12, 2016
Although nurses generally constitute the largest component of the health workforce there is no sy... more Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population. This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions. A cross-sectional survey design was used. The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services. All full-time, part-time and casual nurses and midwives employed within the health service were invited t...
This Paper Was Originally Published As Mitchell B Gardner a Beckingham W Fasugba O Healthcare Associated Urinary Tract Infections a Protocol For a National Point Prevalence Study Healthcare Infection 19 26 31 Retrieved from Http Dx Doi Org 10 1071 Hi13037 Issn 1835 5617, 2013
Background: Urinary tract infections account for ~30% of healthcare-associated infections reporte... more Background: Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study.
Methods: A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived.
Discussion: Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition.
Conclusion: Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.
Australian Critical Care, May 1, 2006
The quality of sedation management in mechanically ventilated patients has been a source of conce... more The quality of sedation management in mechanically ventilated patients has been a source of concern in recent years. This paper summarises the literature on the principles of optimal sedation, discusses the consequences of over and undersedation, highlighting the importance of appropriate pain management, and presents a case study using the results of an audit of 48 mechanically ventilated adults. As a result of the review and audit, we are implementing changes to practice. The most important recommendations from the literature are the use of a sedation scale, setting of a goal sedation score, appropriate pain management and implementation of a nurse initiated sedation algorithm. Other recommendations include use of bolus rather than continuous sedative infusions and recommencing regular medications for anxiety, depression and other phychiatric disorders as soon as possible. A recommendation arising from our audit was the need to identify patients at high risk of oversedation and undersedation and adopt a proactive rather than reactive approach to management. The practice goal is to provide adequate and appropriate analgesia and anxiolysis for patients. This will improve patient comfort while reducing length of mechanical ventilation and minimising risk of complications.
BMC nursing, 2016
Background: The nurse practitioner is a growing clinical role in Australia and internationally, w... more Background: The nurse practitioner is a growing clinical role in Australia and internationally, with an expanded scope of practice including prescribing, referring and diagnosing. However, key gaps exist in nurse practitioner education regarding governance of specialty clinical learning and teaching. Specifically, there is no internationally accepted framework against which to measure the quality of clinical learning and teaching for advanced specialty practice.
Methods: A case study design will be used to investigate educational governance and capability theory in nurse practitioner education. Nurse practitioner students, their clinical mentors and university academic staff, from an Australian university that offers an accredited nurse practitioner Master’s degree, will be invited to participate in the study.
Semi-structured interviews will be conducted with students and their respective clinical mentors and university academic staff to investigate learning objectives related to educational governance and attributes of capability learning. Limited demographic data on age, gender, specialty, education level and nature of the clinical healthcare learning site will also be collected. Episodes of nurse practitioner student specialty clinical learning will be observed and documentation from the students’ healthcare learning sites will be collected.
Descriptive statistics will be used to report age groups, areas of specialty and types of facilities where clinical learning and teaching is observed. Qualitative data from interviews, observations and student documents will be coded, aggregated and explored to inform a framework of educational governance, to confirm the existing capability framework and describe any additional characteristics of capability and capability learning.
Discussion: This research has widespread significance and will contribute to ongoing development of the Australian health workforce. Stakeholders from industry and academic bodies will be involved in shaping the framework that guides the quality and governance of clinical learning and teaching in specialty nurse practitioner practice. Through developing standards for advanced clinical learning and teaching, and furthering understanding of capability theory for advanced healthcare practitioners, this research will contribute to evidence-based models of advanced specialty postgraduate education.
Faculty of Health Institute of Health and Biomedical Innovation School of Nursing, 2010
Australian Infection Control, Jun 1, 2005
Gardner, Anne, Darvill, Jon and Milbourne, Kate 2005-06, Letters to the editor : Routine replacem... more Gardner, Anne, Darvill, Jon and Milbourne, Kate 2005-06, Letters to the editor : Routine replacement of short peripheral IV catheters, Australian infection control, vol. 10, no. 2, pp. 67-69. ... Unless expressly stated otherwise, the copyright for items in Deakin Research Online is owned ...