Heather James

A descriptive study of peripheral intravenous catheters in patients admitted to a pediatric unit in one Australian hospital.

Over a 5-month period, 496 peripheral intravenous catheters (PIVs) inserted into neonates, infants, and children were prospectively studied. Data were collected on demographic patient characteristics, PIV indications for use, dwell time, and reasons for removal, together with nursing actions. The results showed that most PIVs were removed within 72 hours. In 6.6% of cases, some degree of phlebitis was present at PIV removal. The risk of phlebitis increased when the PIV remained in place longer, the child was younger, or medication was administered. The greatest risk was age, with neonates being 5½ times more likely to have some degree of phlebitis than non-neonates.

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

Abstract This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using communitybased services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community-focussed, multidisciplinary, generalist in nature.

Health service provision for community-dwelling people suffering urinary incontinence: A case study of neglect

Access to health services for common health problems is a fundamental principle of primary health care. Although there have been few Australian prevalence studies, it is estimated that about 900,000 adult Australians suffer from incontinence (National Health and Medical Research Council, 1994). The purpose of this study was to investigate urinary continence services for community-dwelling people in the Gold Coast region of Australia, prior to implementing new services. A case study design was used, including: a survey of general medical practitioners, specialist medical practitioners, physiotherapists, hospitals, and home visiting agencies in the region; a focus group with key stakeholders; and a critical review of the literature in relation to prevalence, treatment-seeking behaviour and service provision. Health practitioners were asked about services provided, policies, clinical pathways, referrals, and their views on what services they would like to see offered in the region. Results showed that while there were some existing continence-specific services in the region, they were inadequate to provide for the numbers of people in need. Many generalist health practitioners demonstrated a lack of interest in and knowledge of the plight of those suffering from incontinence. Links between services were found to be ad hoc, with inconsistent referral patterns between health professionals. These findings are consistent with international studies. It was concluded that, in general, community-dwelling people suffering incontinence were poorly served by health professionals due an inability of available services to meet demand, and a lack of knowledge and/or interest by many generalist health practitioners.