Jeanette Robertson

Changing Central Venous Catheter Lines: Evaluation of a Modification to Clinical Practice

As the costs of providing quality nursing care increase, the conservation of both human and material resources becomes increasingly important. This study arose from a need to evaluate the procedure used to change central venous catheter (CVC) lines following the substitution of a time-consuming and costly traditional procedure with a simpler procedure that used less resources. Using a convenience sample of inpatients in the oncology unit who had either fully or partially implanted infusion devices in situ, rates of infection for CVC exit sites were calculated for the 12-month periods preceding and following the introduction of the revised procedure. No significance differences were found between the infection rates at CVC line exit sites; however, the cost of undertaking the procedure decreased following a change of equipment used in the line-change procedure. Data collection methods are discussed, together with results and implications for clinical practice.

Evaluation of a rural nurse‐led clinic for female sexual dysfunction

Objective The objective of this study was to explore changes in the sexual function of women who attended a rural nurse-led female sexual dysfunction clinic. Design This exploratory study was designed as a one-group pre-test/post-test design from a convenience sample of women attending the clinic. Setting The setting was a womens health centre located in regional Western Australia. Participants One hundred eleven women aged between 18 and 65 years were recruited from clinic attendees. Main outcome measure(s) The Australian version of the validated McCoy Female Sexuality Questionnaire was completed before the first appointment (T0), and 1 (T1) and 6 months (T2) after the last appointment. Results Women attending the clinic reported significant increases in sexual desire, satisfaction and orgasm quality and achievement at 1 and 6 months after their last appointment. There was also a significant increase in satisfaction with their main sexual partner at 6 months. Conclusions This study confirmed the value of an innovative approach to managing female sexual dysfunction in a rural area with workforce shortages and limited health services. It is recommended that care by a nurse-led multidisciplinary team be used in the management of sexual dysfunction. Further research is needed to see if this model of care would be effective in other settings.OBJECTIVE The objective of this study was to explore changes in the sexual function of women who attended a rural nurse-led female sexual dysfunction clinic. DESIGN This exploratory study was designed as a one-group pre-test/post-test design from a convenience sample of women attending the clinic. SETTING The setting was a womens health centre located in regional Western Australia. PARTICIPANTS One hundred eleven women aged between 18 and 65 years were recruited from clinic attendees. MAIN OUTCOME MEASURE(S) The Australian version of the validated McCoy Female Sexuality Questionnaire was completed before the first appointment (T0), and 1 (T1) and 6 months (T2) after the last appointment. RESULTS Women attending the clinic reported significant increases in sexual desire, satisfaction and orgasm quality and achievement at 1 and 6 months after their last appointment. There was also a significant increase in satisfaction with their main sexual partner at 6 months. CONCLUSIONS This study confirmed the value of an innovative approach to managing female sexual dysfunction in a rural area with workforce shortages and limited health services. It is recommended that care by a nurse-led multidisciplinary team be used in the management of sexual dysfunction. Further research is needed to see if this model of care would be effective in other settings.

Commentary on ‘Prophylactic drug management for febrile seizures in children’

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD003031. DOI: 10.1002/14651858.CD003031.pub2.

Non-pharmacological Management of Fever in Otherwise Healthy Children.

Background Fever is a common childhood problem faced in both hospital and community settings. In many cases the fever is associated with mild to moderate self‐limiting illnesses. There has been a rapid increase in antipyretic use as the means of managing or treating this adaptive physiological response to infection. The use of alternative means of caring for a febrile child could minimise the amount of antipyretics administered to children and thereby reduce the potential risks. Objective The objective of this systematic review was to establish what non‐pharmacological practices are effective in managing fever in children, three months to 12 years of age, who are otherwise healthy. Inclusion criteria Interventions for inclusion were physiological e.g. maintenance of hydration and rest, and external cooling, either direct e.g. sponging, clothing, or environmental e.g. fans, ambient temperature. Outcomes of interest were effect on fever, increase in comfort, decrease in parental anxiety and reduction in unnecessary use of health services. Search strategy The search sought English, Spanish, Portuguese, Mandarin and Italian language studies, published 2001‐2011 in 12 major databases. Critical appraisal, data extraction and data synthesis Critical appraisal of and data extraction from eligible studies were undertaken using standardised tools developed by the Joanna Briggs Institute. As statistical pooling of data was precluded, the findings are presented in narrative form. Results Twelve randomised controlled trials were included, involving 986 children in total. Only one intervention identified in the review protocol ‐ direct external cooling measures ‐ was addressed by the studies. Eleven studies included sponging as an intervention while one also included clothing (unwrapping). No studies investigated physiological interventions, (e.g. hydration or rest), or environmental cooling measures, (e.g. fans or ambient temperature) as separate interventions. Three of these interventions (encouragement of fluid intake, rest and fans) were reported as part of the standard care provided to participants in several studies or were controlled in the study (ambient temperature). Only two of the four outcomes identified in the review protocol were examined (effect on fever (all 12 studies) and patient comfort). Although tepid sponging alone resulted in an immediate decrease in temperature, this response was of short duration, with antipyretics or antipyretics plus sponging having a more lasting effect. In addition, the observed levels of discomfort of the sponged children were higher than the other groups. For both measures, this effect was not statistically significant in every case. Conclusion The care of a febrile child needs to be individualised, based on current knowledge of the effectiveness and risks of interventions. The administration of antipyretics should be minimised, used selectively and with caution, even in otherwise healthy children. The results of this systematic review support previous findings that routine tepid sponging does not have an overall beneficial effect. However measures such as encouraging fluid intake and unwrapping the child should be encouraged. Implications for practice The two foci of care should be the child and the parents/primary caregiver. For the child, care should aim to support the bodys physiological responses i.e. maintain hydration, minimise use of antipyretics. Support the parents to reduce anxiety e.g. by involving them in care and providing appropriate education, particularly in respect to correct dosages of antipyretics. Implications for research Given the now well demonstrated discomfort engendered by tepid sponging, its use in treating febrile children is no longer advocated and does not warrant further research. However aspects of other non‐pharmacological interventions have not been so well researched e.g. parental response to advice on fluid intake and appropriate clothing.

Midwifery/Nursing management of hypoglycaemia in healthy full term neonates

Objectives The objectives of this review are to determine from the available evidence: • the maintenance of euglycaemia in healthy full term neonates, and • the management of asymptomatic hypoglycaemia in otherwise healthy full term neonates. Questions The specific questions being asked are: Does the available evidence support the types and timing of various midwifery/nursing interventions that are commonly used to: • prevent hypoglycaemia in healthy full term neonates? • manage asymptomatic hypoglycaemia in otherwise healthy full term neonates? Criteria for considering studies for this review Types of participants Studies that include healthy full term (37-42 weeks gestation) neonates in the first 72 hours following birth. Exclusions: • Preterm or SGA newborns • Full term neonates with a diagnosed medical or surgical condition, congenital or otherwise. • Babies of diabetic mothers. • Neonates with symptomatic hypoglycaemia. • LGA neonates (as significant proportion are of diabetic mothers) Types of interventions All interventions that fall within the scope of practice of a midwife/nurse will be included. The interventions of primary interest are those related to: • Type (breast or breast milk substitutes), amount and/or timing e.g. initiation of feeding, and frequency • Maintenance of body temperature • Monitoring (including screening) of both ‘not-at-risk’ and ‘at risk’ neonates, including blood or plasma glucose levels (bgl/pgl) and other forms of monitoring Types of outcome measures Outcomes that are of interest include, but are not confined to: • Successful breastfeeding • Occurrence of hypoglycaemia • Re-establishment and maintenance of bgl/pgl at or above set threshold (as defined in a particular study) • Developmental outcomes