Beverly O'Connell

Is FAST stroke smart? Do the content and language used in awareness campaigns describe the experience of stroke symptoms?

Background Public education campaigns for stroke are used worldwide. However, there are few published evaluations of such campaigns. Aim This cross-sectional study examined patient and bystander awareness of two Australian campaigns, ‘FAST’ (face, arm, speech, time) and ‘Signs of Stroke’, and evaluated the campaigns ability to identify stroke and to describe the symptom experience. Methods Interviews were conducted with either stroke patients or a key bystander for consecutive eligible cases admitted to two metropolitan hospitals between August 2006 and April 2008. Participants were asked to describe awareness of the FAST campaign, the symptoms experienced and to evaluate the symptom descriptions of Signs of Stroke against their own experience. Results A total of 100 patients and 70 bystanders were interviewed for 170 cases (71% of eligible cases). Only 12% of those interviewed were aware of the FAST campaign, and of these few (19%) were able to recall all FAST symptoms, with only one bystander using the FAST assessments to identify stroke. At least one FAST symptom was reported by 84% and one Signs of Stroke symptom by 100%. Less than half of those experiencing ‘weakness or paralysis’ thought this description exactly described their experience. Common descriptors of symptoms were: face or mouth droop or drop; trouble using, coordinating or moving arm, hand or leg; trouble walking or standing; numbness; and slurring or loss of speech. Conclusion Awareness of the FAST and Signs of Stroke campaigns was low, with poor recall and little use of the FAST assessments. Some symptom descriptions used in the campaign were not reflective of the symptom experience. The content and language of these campaigns could be improved to portray stroke symptoms more realistically.

Recovery from gynaecological day surgery: are we underestimating the process

This paper reports a study investigating the post operative experiences of 80 women following gynaecological day surgery. Women kept a diary for the first 4 days following surgery. The diary included a recovery rating scale and a symptom management index focusing particularly on symptoms. A telephone interview conducted on post-operative day 10 further explored experiences. Results at day 4 indicated women experienced significant problems with pain, moving around and tiredness. By day 10, women were still experiencing tiredness, pain and other lingering problems. The study indicates that patients experience more problems than discharge education assumes.

Why do hospitalized older adults take risks that may lead to falls

The behaviour of hospitalized older adults can contribute to falls, a common adverse event during and after hospitalization.

Carers' perspectives of respite care in Australia: an evaluative study.

Caring for someone with dementia is burdensome and challenging. In Australia, respite services help carers to cope with these demands. In this descriptive study, 62 carers of people with dementia provided information on their use of respite care, its effectiveness and their satisfaction with services provided during the preceding 12 months. Results indicated that carers used day centre, in-home, residential, regular outings and cottage care. The main reasons for use were to assist with managing care, take a break, or attend to health problems. Although 78% of carers rated respite as beneficial to their care recipients, most suggested areas that required attention. Improvements included the need for more time and flexibility, better quality and more permanent staff, improved communication, bureaucracy, administration and affordability. Respite providers need to recognize these limitations and develop strategies to improve the delivery of diverse respite care for carers of people with dementia.

Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp

Abstract This research aimed to describe the number and type of residents admitted to emergency departments (EDs) over 2 years; and to explore nurses’ perceptions of the reasons why residential aged care facility (RACF) residents are referred to EDs. The research objective was addressed in a retrospective exploratory study using data on admissions to EDs from RACFs (N = 3,094) at the participating organisation over a 2-year period, and interview data on seven RACF and four ED nurses’ perceptions of the issues involved. Most residents presenting at EDs required urgent medical attention. Major themes identified by RACF and ED nurses included issues related to staff competency, availability of general practitioners, lack of equipment in RACFs, residents and family members requesting referrals, communication difficulties, and poor attitudes towards RACF staff. There is a need to use strategies to detect residents whose conditions are deteriorating and treat them promptly in RACFs.

Construct validity and reliability of the Handover Evaluation Scale.

AIMS AND OBJECTIVES To examine the psychometric properties of the Handover Evaluation Scale using exploratory and confirmatory factor analysis. BACKGROUND Handover is a fundamental component of clinical practice and is essential to ensure safe patient care. Research indicates a number of problems with this process, with high variability in the type of information provided. Despite the reported deficits with handover practices internationally, guidelines and standardised tools for its conduct and evaluation are scarce. Further work is required to develop an instrument that measures the effectiveness of handover in a valid and reliable way. DESIGN Secondary analysis of data collected between 2006-2008 from nurses working on 24 wards across a large Australian healthcare service. METHODS A sample of 299 nurses completed the survey that included 20 self-report items which evaluated the effectiveness of handover. Data were analysed using exploratory factor analysis and confirmatory factor analysis supported by structural equation modelling. RESULTS Analyses resulted in a 14-item Handover Evaluation Scale with three subscales: (1) quality of information (six items), (2) interaction and support (five items) and (3) efficiency (three items). A fourth subscale, patient involvement (three items), was removed from the scale as it was not a good measure of handover. CONCLUSIONS The scale is a self-report, valid and reliable measure of the handover process. It provides a useful tool for monitoring and evaluating handover processes in health organisations, and it is recommended for use and further development. RELEVANCE TO CLINICAL PRACTICE Monitoring handover is an important quality assurance process that is required to meet healthcare standards. This reliable and valid scale can be used in practice to monitor the quality of handover and provide information that can form the basis of education and training packages and guidelines to improve handover policies and processes.

Residents’ perceptions and experiences of social interaction and participation in leisure activities in residential aged care

Abstract Social interaction and participation in leisure activities are positively related to the health and well-being of elderly people. The main focus of this exploratory study was to investigate elderly peoples’ perceptions and experiences of social interaction and leisure activities living in a residential aged care (RAC) facility. Six residents were interviewed. Themes emerging from discussions about their social interactions included: importance of family, fostering friendships with fellow residents, placement at dining room tables, multiple communication methods, and minimal social isolation and boredom. Excursions away from the RAC facility were favourite activities. Participants commonly were involved in leisure activities to be socially connected. Poor health, family, the RAC facility, staffing, transportation, and geography influenced their social interaction and participation in leisure activities. The use of new technologies and creative problem solving with staff are ways in which residents could enhance their social lives and remain engaged in leisure activities.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

AIM This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility. APPROACH The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted. IMPLICATIONS Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Point prevalence of patients fulfilling MET criteria in ten MET equipped hospitals. The methodology of the RESCUE study

OBJECTIVE The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. DESIGN AND SETTING A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. PATIENTS All inpatients were eligible except intensive care and psychiatric patients. MEASUREMENT AND MAIN RESULTS On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. CONCLUSION In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.

Tri‐focal Model of Care Implementation: Perspectives of Residents and Family

Abstract Purpose To explore residents’ and family members’ perceptions of partnership‐centered long‐term care (LTC) associated with implementation of the Tri‐focal Model of Care. The Model promotes partnership‐centered care, evidence‐based practice, and a positive environment. Its implementation is supported by a specifically designed education program. Methods The Model was implemented over approximately 12 months in seven LTC facilities in Victoria, Australia. A qualitative exploratory‐descriptive approach was used. Data were collected using individual and focus group interviews with residents and family members prior to and following implementation of the Model. Data were analyzed thematically. Findings Prior to implementation of the Model, residents described experiencing a sense of disempowerment, and emphasized the importance of communication, engagement, and being a partner in the staff–resident care relationship. Following implementation, residents reported experiencing improved partnership approaches to care, although there were factors that impacted on having a good experience. Family members described a desire to remain involved in the residents life by establishing good communication and rapport with staff. They acknowledged this was important for partnership‐centered care. Following implementation, they described experiencing a partnership with staff, giving them confidence to assist staff and be included in decisions about the resident. Conclusions The Tri‐focal Model of Care can enable residents, family members, and staff to be partners in resident care in LTC settings. Clinical Relevance With an ageing population, an increasing demand for complex, individualized LTC exists. Delivery of high‐quality LTC requires a strategy to implement a partnership‐centered approach, involving residents, family members, and staff.