Paul Fulbrook

The Presence of Family Members During Cardiopulmonary Resuscitation: European Federation of Critical Care Nursing Associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement

This paper presents the European federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement on The Presence of Family Members During Cardiopulmonary Resuscitation. Copyright of this position statement is jointly owned by the European Federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, the Council on Cardiovascular Nursing and Applied Professions, and Connect Healthcare Publishing Ltd.

Revisiting qualitative inquiry: Interviewing in nursing and midwifery research:

Qualitative research is now often favoured in nursing and midwifery because it emphasises a person-centred and holistic approach. In this paper it is proposed that this type of inquiry is not only a valid way of carrying out research but also a very useful means of eliciting the perspectives of patients and colleagues. It is acknowledged that qualitative approaches are not unproblematic. In particular, there are issues of validity and reliability which should be addressed by researchers, hence a discussion of these is included. Interviewing is the most common method of collecting data within this approach and is examined here, together with its advantages, common pitfalls and problems.

Sleep assessment of hospitalised patients : A literature review

BACKGROUND Sleep is a dynamic and essential part of human life and health. In healthcare settings, nurses are strategically placed to promote sleep and sleep health. In this regard, nursing actions should be based upon effective methods of assessment of patient sleep. Standardised sleep assessment does not currently occur in the care of acute hospitalised patients. Use of an appropriate measurement tool would help evaluate inpatient sleep. An effective, efficient sleep assessment tool is needed to aid clinicians. Such assessment would enable specific nursing intervention to be tailored to individual patients. OBJECTIVE The objective of this paper was to examine the literature on sleep measurement to identify subjective sleep assessment tools that may be suitable for routine use with hospitalised patients, and to evaluate their reliability and validity. METHOD A review of existing literature was undertaken to identify and evaluate subjective sleep measurement tools. RESULTS The initial literature searches identified 402 articles, of which ten met the criteria for review. These reported on three subjective sleep measurement scales: the Richards-Campbell Sleep Questionnaire; the St Marys Hospital Sleep Questionnaire; and the Verran Snyder-Halpern Sleep Scale. The Richards-Campbell Sleep Questionnaire is brief and easy to use. In specific samples, its items correlate with domains reflecting sleep quality and has shown excellent internal consistency. Equivocal results and scoring challenges were found with the St Marys Hospital Sleep Questionnaire. The Verran Snyder-Halpern Sleep Scale captured sleep disturbance and total sleep time, but time-to-complete is more burdensome than the Richards-Campbell Sleep Questionnaire. CONCLUSIONS The current use of sleep assessment instruments in the acute hospital setting is restricted mainly to research activities. Of the three tools identified that could be used clinically to measure inpatient sleep, and although it was developed for use in the intensive care setting, the Richards-Campbell Sleep Questionnaire held greatest potential due to its ease and rapidity of use. However, it has yet to be validated for use with general hospital inpatients, and further research is required in this area.

Fear of falling: association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay

Rationale, aims and objectives Falls in hospital are costly and may impact psychologically on fallers causing them to avoid mobilization, thereby affecting recovery rate and hospital length of stay. The study aim was to investigate the relationships between fear of falling, falls risk, in-hospital falls and hospital length of stay. Method A convenience sample (n = 141) of patients from a large tertiary hospital was recruited. Data were collected over 6 months using the Modified Falls Efficacy Scale (MFES) on ward admission, prior to discharge, and in the event of a fall. Results A third of the sample (n = 44) was admitted to hospital following a fall. The majority (65%) was categorized as medium falls risk. Twenty-five participants sustained a total of 30 falls during their hospital admission of which 13 sustained a total of 15 falls on the study wards. The mean admission MFES score was 5.5, which increased to 6.1 on hospital discharge. Fallers scored significantly lower admission MFES scores than non-fallers (P = 0.003). Receiver-operating curve analysis indicated that admission MFES score was a ‘fair’ predictor of sustaining a fall (area under curve = 0.71, P = 0.013). With a cut-off score of 5, admission MFES sensitivity was 77% and specificity was 55%. Study ward fallers had significantly longer hospital length of stay (49 days) than non-fallers (27 days; P = 0.037). Furthermore, regardless of whether the participant was a faller or not, significantly longer hospital stay was associated with an admission MFES score of less than 5. Conclusions An admission MFES score of less than 5 is an effective predictor of patient falls and is associated with a significantly longer hospital length of stay.

Trends in nurse-administered procedural sedation and analgesia across cardiac catheterisation laboratories in Australia and New Zealand: Results of an electronic survey

BACKGROUND Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. OBJECTIVE To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. DESIGN A quantitative, cross-sectional, descriptive survey design was used. METHODS Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. RESULTS A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n=58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n=58). One respondent indicated that propofol was also used. 20% (n=12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n=18) indicated that comprehensive education about PSA is provided. 45% (n=26) indicated that nurses who administer PSA should undergo competency assessment. CONCLUSION By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand.

Open-access community child health clinics: the everyday experience of parents and child health nurses.

In Australia, Community Child Health Services (CCHS) is the primary health care service which seeks to strengthen and support families, prevent illness and manage risks. Several nursing models of care exist within CCHS, and limited research has investigated which is the best way to provide child health surveillance and parenting support during the early years. This study qualitatively explored the everyday lived experience of parents and child health nurses involved with an open-access (appointment-free, parent-led) group child health surveillance clinic. Findings showed that participants considered the open-access clinic provided a helpful and supportive way of delivering child health surveillance and parental support to families with infants aged 0–18months, without identified risk factors. The perspectives of multiple parents, nurses and other health workers found it effective, flexible and parent-directed, which may be in contrast to some traditional individual appointment child health surveillance methods.

Understanding the Experiences of Mothers Who Are Breastfeeding an Infant with Tongue-Tie A Phenomenological Study

Background: Tongue-tie or ankyloglossia is a congenital condition that negatively affects breastfeeding. The thickened, tightened, or shortened frenulum affects the infant’s ability to suck and frequently results in sore and painful nipples. Although several studies have investigated outcomes associated with treatment of tongue-tie, none have investigated mothers’ experiences of breastfeeding an infant with tongue-tie. Objective: This study aimed to understand the breastfeeding experiences of women whose infants have tongue-tie. Methods: A hermeneutic phenomenological design was employed. Data were collected using focused interviews and, following transcription, were analyzed in the phenomenological tradition. Ten women who presented at a breastfeeding clinic with feeding problems, and were diagnosed with tongue-tie, were interviewed on 2 occasions. Results: The analysis revealed a common story of tension between the mothers’ expectations and the breastfeeding challenges they faced. Their journey was characterized by 6 distinct phases described in the following themes: Expectations; Something is wrong; Questioning, seeking advice, no real answers; Symptoms and perseverance; Approaching the wall—it’s all too much; and finally, Relief. Conclusion: The women in this study described a somewhat harrowing journey, which was at odds with the natural experience they had anticipated. They encountered health professionals who were found to have limited knowledge of tongue-tie and its potential effect on breastfeeding and were unable to provide appropriate advice concerning their breastfeeding difficulties. However, following treatment with frenotomy, their breastfeeding experience improved dramatically. The reported incidence of tongue-tie is significant, and early identification and prompt and effective management would contribute to improved breastfeeding.

Pressure injury risk assessment in intensive care: comparison of inter‐rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales

AIM To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. BACKGROUND Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. DESIGN Instrument development. METHODS A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. RESULTS Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. CONCLUSION Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs.Aim To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. Background Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. Design Instrument development. Methods A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. Results Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. Conclusion Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs.

Clinical practice guidelines for nurse‐administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study

Aim To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory. Background Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory. Methods A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations. Implications for nursing The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring. Conclusion These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.AIM To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory. BACKGROUND Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory. METHODS A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations. IMPLICATIONS FOR NURSING The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring. CONCLUSION These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.

Children’s conceptions of their parent’s lung transplant

There has been no research that has investigated the psychosocial impact on children whose parents have undergone a lung transplant. The aim of this qualitative study was to describe children’s concerns and understandings of their parent’s transplant surgery. Artwork was used as a creative medium to enable children to portray their experiences in a safe, non-threatening environment. This was used as a visual primer for follow-up interviews. All children expressed similar and complementary views about uncertainty and anxiety, separation, disruption to family life, their desire for normality, and the importance of social support. Differences were evident in the way that some children managed well by adapting to the changing situations, whereas others tended towards avoidance. The findings provide several themes that may be used as a framework for family support and counselling by nurses, social workers, and other healthcare professionals who are caring for patients and their families during the transplant process.