Melanie Jessup

“All at Sea”: The Experience of Living With Cystic Fibrosis

In this qualitative study the researchers explored living with cystic fibrosis (CF)—a chronic, life-threatening, life-limiting disease that demands a relentless regime of daily treatment. The unique challenges and issue for care that CF presents were considered. Utilizing a phenomenological perspective, data drawn from unstructured interviews included narratives and drawings contributed by children, adolescents, young adults, and parents—eight families representing nine young people with CF. In line with van Manen’s approach, four existentials were used to consider a lifeworld in which notions of time, body, space, and relationship are indelibly altered. From original fright, through ongoing dynamics of fear, fight, flight, form, familiarity, and philosophy, people with CF pursue a future that is threatened and continually redefined. As a result of enhanced understanding, care can be delivered from an empathetic bearing toward those for whom it is not so much a bothersome routine, but a life-and-death imperative.

Enhancing Self-Efficacy for Self-Management in People with Cystic Fibrosis

This paper reports on a research trial designed to evaluate the benefits of a health mentoring programme supported with a web and mobile phone based self-monitoring application for enhancing self-efficacy for self-management skills and quality of life for people with CF. This randomised, single-blind controlled trial evaluated two strategies designed to improve self-management behaviour and quality of life. Task-specific self-efficacy was fostered through mentorship and self-monitoring via a mobile phone application. Trial participants were randomised into one of three groups: Control, Mentor-only and Mentor plus mobile phone. Analysis and discussion focus on the experiences of participants through a methodology utilising descriptive statistics and semi-structured interviews. The results highlight the challenges of stimulating self-management behaviours particularly in adolescents and in the evaluation of the role of mobile applications in supporting them.

Regression forecasting of patient admission data

Forecasting is an important aid in many areas of hospital management, including elective surgery scheduling, bed management, and staff resourcing. This paper describes our work in analyzing patient admission data and forecasting this data using regression techniques. Five years of Emergency Department admissions data were obtained from two hospitals with different demographic techniques. Forecasts made from regression models were compared with observed admission data over a 6-month horizon. The best method was linear regression using 11 dummy variables to model monthly variation (MAPE=1.79%). Similar performance was achieved with a 2-year average, supporting further investigation at finer time scales.

Paediatric pain assessment and management in the emergency setting: The impact of a paediatric pain bundle

OBJECTIVES To evaluate the impact of a paediatric pain bundle on pain assessment and management of children with fractured forearms who presented to an Emergency Department (ED). METHODS A descriptive, comparative pilot study was conducted at a large regional hospital ED to describe differences in pain assessment, management and documentation in the 4months before and after the implementation of a paediatric pain bundle. RESULTS A total of 242 children with fractured forearms visited the ED over two separate 4-month periods during 2009. Compared to the pre time period, children in the post time period did not differ significantly regarding pain assessment score documentation (13.5% vs. 20.7%, p=0.14), administration rate of analgesia (58.7% vs. 65.5%, p=0.28) or time to analgesia (28min vs. 35min, p=0.22). CONCLUSIONS In this pilot study, findings indicated clinical significance but not statistical significance. The assessment and management of pain in the ED paediatric population is challenging due to difficulties interpreting responsiveness and to organisational and system imperatives that delay time critical aspects such as time to analgesia. Further focus on documentation, assessment and management practices is required in larger populations across a number of sites.

Parental Experience of Information and Education Processes Following Diagnosis of Their Infant With Cystic Fibrosis Via Newborn Screening

UNLABELLED Following diagnosis with cystic fibrosis (CF), initial education powerfully influences parental adjustment and engagement with care teams. This study explored the education needs of ten parents following their infants diagnosis with CF via newborn screening. DESIGN AND METHODS Phenomenological study using van Manens approach, with ten participant parents of children 1-8 years with CF. RESULTS Parents recounted varying degrees of coping with information they acknowledged as overwhelming and difficult. For some it was too much too soon, while others sought such clarity to put CF into context. CONCLUSIONS Participants delivered insight into their engagement with their education about CF. Their recommendations for appropriate context, content, format and timing of delivery enable development of education that is accurate and relevant.

Mirror, mirror on the wall: who is the true nurse after all?

Abstract This somewhat colloquial reflection on personal experience reveals some commonly perceived images and metaphors pertaining to nursing that have been birthed in history, perpetuated by the media, and entrenched in the minds of both onlookers and, unfortunately, of those not quite so detached. The reader might identify with some, and be amazed at others, or be provoked on a similar journey of reminiscence and reconsideration of the images that have shaped and informed their practice. The literature presents the not always positive portrayal of nursing, and the resultant adverse effect this exerts not only upon the profession, but upon its practitioners as well. Thus is set forth the challenge of how to respond.

The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

Study Objectives: To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. Methods: Setting: The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). Design: A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. Results: Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). Conclusions: The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

Cementing pathways home: Enhancing quality of life for people with chronic obstructive pulmonary disease

While in past years there have been multiple attempts to address the issues surrounding the community/acute care interface, current outcomes suggest that few in Tasmania have achieved their goals for older people with chronic diseases, who continue to be high users of acute facilities. This presentation details the Pathways Home Chronic Respiratory Partnerships Project—a controlled study of a transferable, community-based program of self-management, supported by phone mentoring and patient symptom monitoring. A multidisciplinary collaboration between the University of Tasmanias Schools of Medicine, Nursing & Midwifery, and Information Systems, the project focuses on those with respiratory conditions due to their high level of hospital presentations. The evaluative process ensures transferability to other chronic conditions.

Family-centred care in cystic fibrosis: a pilot study in North Queensland, Australia

The aims were to: (i) examine perceptions of family‐centred care of parents of children with cystic fibrosis and healthcare professionals who care for them; (ii) test design and tools in a regional population.

Users’ experiences of an emergency department patient admission predictive tool: A qualitative evaluation

Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool’s accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making. Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally.