Judy Currey - Academia.edu (original) (raw)

Papers by Judy Currey

Worldviews on Evidence-Based Nursing, 2015

Single checking medications has been increasingly adopted over the past decade by nurses in Austr... more Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model. In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.

Australasian emergency nursing journal : AENJ, 2014

Team-based learning (TBL) is a highly structured educational strategy that improves student engag... more Team-based learning (TBL) is a highly structured educational strategy that improves student engagement, promotes deeper learning and builds professional skills but has had limited use in nursing education. To examine participant experiences of TBL using one-off teams in a hospital setting. A prospective exploratory design was used in an urban district hospital in Melbourne, Australia. The sample was 49 registered nurses. The intervention was a TBL-based education program focused on assessment and management of adult patients with isolated distal limb injuries. Data were collected using two instruments that evaluated participant experiences of the narrated slide presentation and participant experiences of learning of using TBL. Quantitative data were analysed using descriptive statistics and thematic analysis was used to analyse the qualitative data. The results revealed two key themes: "quality of learning" and "positive team experience". The presentation was acc...

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 2014

Several studies have shown that the acuity and complexity of patients admitted to coronary care u... more Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown. To describe the workforce and workplace resources of adult CCUs in Victoria, Australia. This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010. A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met t...

Medical Science Educator, 2014

Medical schools around the world often use peer physical examination (PPE), which involves studen... more Medical schools around the world often use peer physical examination (PPE), which involves students examining each other, as part of their clinical skills training. However, no Australian medical school has a policy and accompanying procedure in place to address unexpected circumstances such as the discovery of an abnormality, inappropriate behaviour, breaches in confidentiality and students not wishing to examine fellow students. This paper suggests ideas for what a PPE policy and procedure may look like to address these concerns.

Australian Critical Care, 2015

Interventional cardiology practices have advanced immensely in the last two decades, but the educ... more Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.

Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 2015

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes ... more The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. University postgraduate critical care nursing programme. Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. Postgraduate critical care nursi...

Worldviews on Evidence-Based Nursing, 2011

The aim of this review was to determine if ventilation-weaning protocols developed and implemente... more The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care. A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review. Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation. Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.

The Journal of Thoracic and Cardiovascular Surgery, 2010

Objective. Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 ho... more Objective. Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.

The Journal of Heart and Lung Transplantation, 2007

graft survival but this was not significant [53 of 58 (91%) vs. 320 of 334 (96%), respectively; p... more graft survival but this was not significant [53 of 58 (91%) vs. 320 of 334 (96%), respectively; pϭ0.15]. However, post-LAS recipients had a significantly lower 180-day graft survival than pre-LAS recipients [36 of 44 (82%) vs. 315 of 334 (94%), respectively; pϭ0.002].

Journal of Clinical Nursing, 2006

Cardiac surgical patients are distinguished by their potential for instability in the early posto... more Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses' perceptions of assuming responsibility for such patients. An understanding of nurses' perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports. The aim of this study was to describe critical care nurses' perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. An exploratory descriptive study based on naturalistic decision-making. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called 'Framework' were used to analyse the interview transcripts. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making. Nurses' previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.

Journal of Clinical Nursing, 2008

To examine the impact and obstacles that individual Institutional Research Ethics Committee (IREC... more To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Journal of Cardiothoracic and Vascular Anesthesia, 1997

To investigate the relationship between excessive endogenous production of nitric oxide (NO) and ... more To investigate the relationship between excessive endogenous production of nitric oxide (NO) and the low systemic vascular resistance (SVR) syndrome after cardiac surgery. Prospective, case-control. Cases defined by low SVR postoperatively (< 750 dyn/s/cm-5), and matched with controls (> 900 dyn/s/cm-5). Cardiothoracic intensive care unit (ICU) in a tertiary care hospital. Forty-four patients after cardiac surgery. Collection of plasma and urine samples after identification. Plasma and urine nitrate concentrations were measured as an index of endogenous NO production. Hemodynamic, inotropic, and outcome data were collected. Median nitrate concentrations did not differ between cases and controls (plasma, 58 mumol/L, v 62 mumol/L, p = 0.43; urine, 399 mumol/L v 404 mumol/L, p = 0.38). Times to extubation and intensive care unit (ICU) discharge were prolonged in patients with low SVR (17.8 hours v 8.7 hours, p = 0.021; 2.5 days v 1.2 days, p = 0.019, respectively). No association between "low SVR syndrome" and endogenous NO production was found. Patients with low SVR after cardiac surgery required a longer period of inotropic and ventilator support, with delay in discharge from the ICU. The risk and cost implications of this syndrome support further research.

Journal of Advanced Nursing, 2011

Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing ... more Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.

Heart & Lung: The Journal of Acute and Critical Care, 2003

The purpose of this study was to explore the extent and sources of variability of critical care n... more The purpose of this study was to explore the extent and sources of variability of critical care nurses' hemodynamic decision making as a function of contextual factors in the immediate 2-hour period after cardiac surgery. A qualitative exploratory design with observation and interview was used. Eight critical care nurses were observed on different occasions in clinical practice for a 2-hour period. A brief interview immediately followed each observation to clarify observation data. Analysis of the data revealed that patient management decisions were made both by individual nurses and by a team of nurses and health professionals. Team decision making (TDM) is described in this study as integrated or non-integrated and refers to an intra-professional nursing team. During displays of integrated TDM, the primary nurse, who was assigned to care for the patient, made most hemodynamic decisions and nurses who assisted the primary nurse deferred decisions. During displays of non-integrated TDM, nurses assisting the primary nurse assumed responsibilities for most patient-related decisions. Non-integrated TDM occurred more frequently when inexperienced cardiac surgical intensive care nurses were in the role of primary nurse, whereas integrated TDM was more common among experienced cardiac surgical intensive care nurses. This observed variability can occur in multiple ways and in hemodynamic decision making has implications for patient outcomes as behaviors of non-integrated TDM led to nurses sensing a loss of control of patient management.

Collegian, 2013

Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical ou... more Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical outcomes in response to the high burden of disease from chronic heart failure (CHF). Programmes vary in model, duration, complexity of interventions and incorporation of evidence-based guidelines for programme delivery. Few studies have explored patient outcomes at 12 months from enrolment in a CHF. The aim of the current study was to explore the characteristics and clinical outcomes of patients enrolled in four high complexity CHF-MPs at 12 months after initial enrolment. A secondary aim was to explore the adoption of key evidence-based CHF management strategies in these programmes. After ethics approval, a multisite mixed methods design was implemented incorporating survey and chart audit. Programme characteristics and interventions used in four CHF-MPs were surveyed in Stage 1. Stage 2 involved a chart audit of patients enrolled in the programmes (N = 135) on or after the 1/1/07. Primary endpoints were all-cause hospitalisation and/or mortality at 12 months. Data were analysed using descriptive and inferential statistics. All programmes implemented a high complexity of evidence-based interventions consistent with national guidelines. However, documentation of New York Heart Association functional class was rare; limiting quantifiable evaluation of response to therapy throughout programme enrolment. The majority of patients (73%) had severe systolic heart failure with high co-morbidities reflected in a mean Charlson's total co-morbidity score of 3 (± 2.1). The high rate of baseline evidence-based, pharmacothe- rapy (beta-blocker: 86%, n = 112 and ACE inhibitor: 76%, n = 103) was maintained at 12 months (71% and 84% respectively). At 12 months all cause hospitalisation and/or mortality was 57% (n = 77). The CHF-MPs in this study implemented complex evidence-based interventions resulting in high rates of key medication prescription. However, despite the implementation of several evidence-based interventions, over a period of 12 months, more than half of the patients were rehospitalised or died.

Australian Critical Care, 2004

Pain during chest tube removal can be moderately to severely intense and distressful to patients.... more Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain. To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients. Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time. Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered. If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.

Australian Critical Care, 2010

Australian Critical Care, 2007

To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessa... more To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessary to gain insight in the experiences and potential needs of these partners. Thirteen partners of HF patients participated in semistructured interviews specifically focused on their experiences as a partner. Patients had had HF for at least 18 months, and their partners were interviewed at home without the patient being present. Content analysis was used to organize the data and to identify categories and themes. Partners of HF patients experience several changes in life as reflected in the main themes: changes in life, changes in relationship, coping, and support. Partners support patients in their daily activities; they often change their own daily schedule and have to adjust joint activities. Regaining a new balance together is one of the challenges that couples face when confronted with HF. Anxiety is an important theme especially in the acute phase that can interfere with adequate coping strategies. Changes in relationship are related to difficulties in communication and sexuality. Although most partners seem to cope relatively well, the impact of HF on their lives is profound. Partners are vulnerable especially at the onset of the illness, and therefore, it is important to involve partners actively in the early process of rehabilitation and recognize their importance to the patient and their potential problems.

Australian Critical Care, 1999

The Australian College of Critical Care Nurses Limited (ACCCN) (formerly the Confederation of Aus... more The Australian College of Critical Care Nurses Limited (ACCCN) (formerly the Confederation of Australian Critical Care Nurses (CACCN)) considers appropriate preparation of specialist critical care nurses a vital component for the provision of quality care to patients and their ...

Worldviews on Evidence-Based Nursing, 2015

Single checking medications has been increasingly adopted over the past decade by nurses in Austr... more Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model. In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.

Australasian emergency nursing journal : AENJ, 2014

Team-based learning (TBL) is a highly structured educational strategy that improves student engag... more Team-based learning (TBL) is a highly structured educational strategy that improves student engagement, promotes deeper learning and builds professional skills but has had limited use in nursing education. To examine participant experiences of TBL using one-off teams in a hospital setting. A prospective exploratory design was used in an urban district hospital in Melbourne, Australia. The sample was 49 registered nurses. The intervention was a TBL-based education program focused on assessment and management of adult patients with isolated distal limb injuries. Data were collected using two instruments that evaluated participant experiences of the narrated slide presentation and participant experiences of learning of using TBL. Quantitative data were analysed using descriptive statistics and thematic analysis was used to analyse the qualitative data. The results revealed two key themes: "quality of learning" and "positive team experience". The presentation was acc...

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 2014

Several studies have shown that the acuity and complexity of patients admitted to coronary care u... more Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown. To describe the workforce and workplace resources of adult CCUs in Victoria, Australia. This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010. A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met t...

Medical Science Educator, 2014

Medical schools around the world often use peer physical examination (PPE), which involves studen... more Medical schools around the world often use peer physical examination (PPE), which involves students examining each other, as part of their clinical skills training. However, no Australian medical school has a policy and accompanying procedure in place to address unexpected circumstances such as the discovery of an abnormality, inappropriate behaviour, breaches in confidentiality and students not wishing to examine fellow students. This paper suggests ideas for what a PPE policy and procedure may look like to address these concerns.

Australian Critical Care, 2015

Interventional cardiology practices have advanced immensely in the last two decades, but the educ... more Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.

Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 2015

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes ... more The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. University postgraduate critical care nursing programme. Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. Postgraduate critical care nursi...

Worldviews on Evidence-Based Nursing, 2011

The aim of this review was to determine if ventilation-weaning protocols developed and implemente... more The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care. A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review. Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation. Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.

The Journal of Thoracic and Cardiovascular Surgery, 2010

Objective. Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 ho... more Objective. Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.

The Journal of Heart and Lung Transplantation, 2007

graft survival but this was not significant [53 of 58 (91%) vs. 320 of 334 (96%), respectively; p... more graft survival but this was not significant [53 of 58 (91%) vs. 320 of 334 (96%), respectively; pϭ0.15]. However, post-LAS recipients had a significantly lower 180-day graft survival than pre-LAS recipients [36 of 44 (82%) vs. 315 of 334 (94%), respectively; pϭ0.002].

Journal of Clinical Nursing, 2006

Cardiac surgical patients are distinguished by their potential for instability in the early posto... more Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses' perceptions of assuming responsibility for such patients. An understanding of nurses' perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports. The aim of this study was to describe critical care nurses' perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. An exploratory descriptive study based on naturalistic decision-making. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called 'Framework' were used to analyse the interview transcripts. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making. Nurses' previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.

Journal of Clinical Nursing, 2008

To examine the impact and obstacles that individual Institutional Research Ethics Committee (IREC... more To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Journal of Cardiothoracic and Vascular Anesthesia, 1997

To investigate the relationship between excessive endogenous production of nitric oxide (NO) and ... more To investigate the relationship between excessive endogenous production of nitric oxide (NO) and the low systemic vascular resistance (SVR) syndrome after cardiac surgery. Prospective, case-control. Cases defined by low SVR postoperatively (< 750 dyn/s/cm-5), and matched with controls (> 900 dyn/s/cm-5). Cardiothoracic intensive care unit (ICU) in a tertiary care hospital. Forty-four patients after cardiac surgery. Collection of plasma and urine samples after identification. Plasma and urine nitrate concentrations were measured as an index of endogenous NO production. Hemodynamic, inotropic, and outcome data were collected. Median nitrate concentrations did not differ between cases and controls (plasma, 58 mumol/L, v 62 mumol/L, p = 0.43; urine, 399 mumol/L v 404 mumol/L, p = 0.38). Times to extubation and intensive care unit (ICU) discharge were prolonged in patients with low SVR (17.8 hours v 8.7 hours, p = 0.021; 2.5 days v 1.2 days, p = 0.019, respectively). No association between "low SVR syndrome" and endogenous NO production was found. Patients with low SVR after cardiac surgery required a longer period of inotropic and ventilator support, with delay in discharge from the ICU. The risk and cost implications of this syndrome support further research.

Journal of Advanced Nursing, 2011

Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing ... more Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.

Heart & Lung: The Journal of Acute and Critical Care, 2003

The purpose of this study was to explore the extent and sources of variability of critical care n... more The purpose of this study was to explore the extent and sources of variability of critical care nurses' hemodynamic decision making as a function of contextual factors in the immediate 2-hour period after cardiac surgery. A qualitative exploratory design with observation and interview was used. Eight critical care nurses were observed on different occasions in clinical practice for a 2-hour period. A brief interview immediately followed each observation to clarify observation data. Analysis of the data revealed that patient management decisions were made both by individual nurses and by a team of nurses and health professionals. Team decision making (TDM) is described in this study as integrated or non-integrated and refers to an intra-professional nursing team. During displays of integrated TDM, the primary nurse, who was assigned to care for the patient, made most hemodynamic decisions and nurses who assisted the primary nurse deferred decisions. During displays of non-integrated TDM, nurses assisting the primary nurse assumed responsibilities for most patient-related decisions. Non-integrated TDM occurred more frequently when inexperienced cardiac surgical intensive care nurses were in the role of primary nurse, whereas integrated TDM was more common among experienced cardiac surgical intensive care nurses. This observed variability can occur in multiple ways and in hemodynamic decision making has implications for patient outcomes as behaviors of non-integrated TDM led to nurses sensing a loss of control of patient management.

Collegian, 2013

Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical ou... more Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical outcomes in response to the high burden of disease from chronic heart failure (CHF). Programmes vary in model, duration, complexity of interventions and incorporation of evidence-based guidelines for programme delivery. Few studies have explored patient outcomes at 12 months from enrolment in a CHF. The aim of the current study was to explore the characteristics and clinical outcomes of patients enrolled in four high complexity CHF-MPs at 12 months after initial enrolment. A secondary aim was to explore the adoption of key evidence-based CHF management strategies in these programmes. After ethics approval, a multisite mixed methods design was implemented incorporating survey and chart audit. Programme characteristics and interventions used in four CHF-MPs were surveyed in Stage 1. Stage 2 involved a chart audit of patients enrolled in the programmes (N = 135) on or after the 1/1/07. Primary endpoints were all-cause hospitalisation and/or mortality at 12 months. Data were analysed using descriptive and inferential statistics. All programmes implemented a high complexity of evidence-based interventions consistent with national guidelines. However, documentation of New York Heart Association functional class was rare; limiting quantifiable evaluation of response to therapy throughout programme enrolment. The majority of patients (73%) had severe systolic heart failure with high co-morbidities reflected in a mean Charlson's total co-morbidity score of 3 (± 2.1). The high rate of baseline evidence-based, pharmacothe- rapy (beta-blocker: 86%, n = 112 and ACE inhibitor: 76%, n = 103) was maintained at 12 months (71% and 84% respectively). At 12 months all cause hospitalisation and/or mortality was 57% (n = 77). The CHF-MPs in this study implemented complex evidence-based interventions resulting in high rates of key medication prescription. However, despite the implementation of several evidence-based interventions, over a period of 12 months, more than half of the patients were rehospitalised or died.

Australian Critical Care, 2004

Pain during chest tube removal can be moderately to severely intense and distressful to patients.... more Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain. To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients. Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time. Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered. If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.

Australian Critical Care, 2010

Australian Critical Care, 2007

To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessa... more To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessary to gain insight in the experiences and potential needs of these partners. Thirteen partners of HF patients participated in semistructured interviews specifically focused on their experiences as a partner. Patients had had HF for at least 18 months, and their partners were interviewed at home without the patient being present. Content analysis was used to organize the data and to identify categories and themes. Partners of HF patients experience several changes in life as reflected in the main themes: changes in life, changes in relationship, coping, and support. Partners support patients in their daily activities; they often change their own daily schedule and have to adjust joint activities. Regaining a new balance together is one of the challenges that couples face when confronted with HF. Anxiety is an important theme especially in the acute phase that can interfere with adequate coping strategies. Changes in relationship are related to difficulties in communication and sexuality. Although most partners seem to cope relatively well, the impact of HF on their lives is profound. Partners are vulnerable especially at the onset of the illness, and therefore, it is important to involve partners actively in the early process of rehabilitation and recognize their importance to the patient and their potential problems.

Australian Critical Care, 1999

The Australian College of Critical Care Nurses Limited (ACCCN) (formerly the Confederation of Aus... more The Australian College of Critical Care Nurses Limited (ACCCN) (formerly the Confederation of Australian Critical Care Nurses (CACCN)) considers appropriate preparation of specialist critical care nurses a vital component for the provision of quality care to patients and their ...