Marion Mitchell

The objective structured clinical examination (OSCE): optimising its value in the undergraduate nursing curriculum.

This article explores the use of the objective structured clinical examination (OSCE) in undergraduate nursing education. The advantages and limitations of this assessment approach are discussed and various applications of the OSCE are described. Attention is given to the complexities of evaluating some psychosocial competency components. The issues are considered in an endeavour to delineate the competency components, or skill sets, that best lend themselves to assessment by the OSCE. We conclude that OSCEs can be used most effectively in nurse undergraduate curricula to assess safe practice in terms of performance of psychomotor skills, as well as the declarative and schematic knowledge associated with their application. OSCEs should be integrated within a curriculum in conjunction with other relevant student evaluation methods.

Nurse-Led Telephone Interventions for People with Cardiac Disease: A Review of the Research Literature

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Dealing with death: an audit of family bereavement programs in Australian intensive care units.

Patient death in Intensive Care Units (ICU) can be sudden and unexpected, leading to emotionally charged situations and life changing circumstances for family members. Supporting families during and after this critical period is particularly challenging for ICU nurses who often feel dissatisfied with the way they deal with the situation. Bereavement programs in various areas of nursing have been reported to be beneficial in promoting normal grief patterns. There is, however, a lack of research in the area of evaluation of bereavement programs in adult ICUs. This paper presents the results of an Australia-wide audit on current practices in the area of bereavement programs within adult ICUs. Surveys were sent to 117 adult Australian ICUs; 99 surveys were returned completed (84.6% response rate). It was identified that most surveyed units offer minimal components of bereavement programs, such as viewing of the deceased and communicating with family members. Less than one third (n=26) provide additional follow-up services in the form of telephone calls and sympathy cards or referral to additional services. Ten units employ some form of program evaluation. Verbal feedback from staff and families is the primary assessment method. Over half of responding ICUs indicated they are considering or interested in providing a bereavement program in their unit. This study highlights the need for research-based data to support the introduction or deletion of strategies for bereavement programs using family-centred outcome measures. ICU nurses are interested in this area of clinical practice and require considerable support. It is recommended that this support can come via postgraduate and on-going education, hospital policies and procedures.

Enriching learning using Web and computer technologies: how not to throw caution to the wind

Proponents of computer or web-based learning enthusiastically discuss its democratising potential in education whilst critics argue that the medium has many difficulties. Whilst acknowledging the need for caution in embracing this innovative technology, an Australian School of Nursing recently set about transforming an on-campus conventionally delivered nursing degree program into one which is web enhanced. This paper aims to describe the project as well as the teaching and learning approaches taken. Wh ilst our experience may not be universal, many of the ideas and lessons learned may be relevant to nursing educators interested in enhancing the quality and richness of their curriculum processes with computer and web-based activities.

Innovation in learning – An inter-professional approach to improving communication

Inter-professional education (IPE) is recognised as a major way of introducing students in the health professions to the importance of teamwork and communication in the delivery of excellent healthcare. This pilot project evaluated mixed versus single discipline group tutorials of nursing and medical students as a way to promote IPE and understanding of communication. Four tutorial sessions were video-recorded and analysed using a video analysis coding grid. Additional data were drawn from student evaluations and assessment of group participation and were subjected to quantitative and qualitative analysis. The case study as portrayed in the DVD was thought to provide an effective learning tool by both sets of students. Medical students rated the need for mixed group tutorials significantly lower than the nursing students who thought the tutorial activity helped with an appreciation of the importance of communication to effective teamwork. However, medical students in the single discipline group did not understand the nursing role. The resources fostered reflection on students own professional role as well as others; however, the importance of communication within the nursing role needs to be recognised by nursing students and curriculum designers.

An implementation framework for using OSCEs in nursing curricula

The implementation framework outlined in this paper has been developed from feedback of a trial across three different nursing and midwifery programmes and is designed to assist educators to incorporate OSCEs within their curricula. There is value in flagging the pedagogical principles embodied in the framework and alerting educators to their importance for more meaningful student learning. For each step practical advice is provided contributing to the utility of this approach. Considerations are systematic ensuring that the use of OSCEs in health care curricula assures judicious use of resources to achieve desired student outcomes.

Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities

Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but ‘highly-visible’ populations.

Sedation protocols to reduce duration of mechanical ventilation in the ICU: a Cochrane Systematic Review

AIMS Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. BACKGROUND Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. DESIGN Cochrane systematic review of randomized controlled trials. DATA SOURCES Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. REVIEW METHODS Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. RESULTS Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. CONCLUSIONS There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.

Adherence to therapeutic hypothermia guidelines for out-of-hospital cardiac arrest.

BACKGROUND Out of hospital cardiac arrest is associated with a high rate of mortality, and poor neurological outcomes. Favourable neuro-protective effects are associated with induced hypothermia and international recommendations exist for therapeutic hypothermia. OBJECTIVE This study reviews practice for therapeutic hypothermia for out of hospital cardiac arrest patients within one ICU. It aims to describe the level of adherence to the guideline, identify barriers to implementation and to improve adherence. SETTING This project was conducted in an adult ICU which admits 2000 patients yearly. METHODS A retrospective chart audit was used to document practice for a 12 month period. RESULTS 33 patients were admitted to the ICU with a diagnosis of out of hospital cardiac arrest and met study inclusion criteria. From this sample of 33 patients, four patients (12%) were at the goal temperature of 32.5-33.5 °C, in the target time of 2h. Nearly half (n = 17) were not cooled at all. The length of time the patient was in the ICU prior to active cooling commencing varied from <1 h (n = 15, 45%) to >3 h (n = 5, 15%). Twenty-four percent (n = 9) were cooled for the recommended length of time. There were medical orders stating a target temperature in nearly half of the cases (n = 18), however, only 27% (n = 9) were consistent with the ICU guidelines. A number of strategies have been initiated. They aim to improve communication and ready access to the required materials. CONCLUSIONS The audit indicated that less than a third of the patients experienced therapeutic induced hypothermia and only 12% were at goal temperature within the required 2 h. Strategies initiated to improve guideline implementation included; regular education sessions with ICU staff; placing a cooling blanket on the bed prior to admitting a patient post OOHCA; improving ready access to cooling agents and the addition of a care path for the induction and maintenance of therapeutic hypothermia to support and prompt clinicians when using the computerised patient record system.

Testing differences in proportions

This paper is the sixth in a series of statistics articles recently published by Australian Critical Care. In this paper we explore the most commonly used statistical tests to compare groups of data at the nominal level of measurement. The chosen statistical tests are the chi-square test, chi-square test for goodness of fit, chi-square test for independence, Fishers exact test, McNemars test and the use of confidence intervals for proportions. Examples of how to use and interpret the tests are provided.