Wendy Smyth

A survey-based study of knowledge of Alzheimer’s disease among health care staff

BackgroundContinued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district.MethodsKnowledge levels were investigated via the validated 30-item Alzheimer’s Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated.ResultsA diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer’s disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as ‘risk factors’ and ‘course of the disease.’ Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops.ConclusionsSpecific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.

Children's Postoperative 'Pro Re Nata' (PRN) Analgesia: Nurses' Administration Practices

Abstract Aims and objectives: This paper reports a study aimed at exploring the nursing practices associated with the administration of pro re nata (PRN) postoperative analgesia to children, and at gaining a preliminary understanding of the decisions that nurses make about this important intervention. Background: Nurses are responsible for assessing and administering the appropriate medication at the appropriate time to the child in pain. There was scant published research about the administration of postoperative PRN analgesia to children, or about the decision-making processes inherent in this aspect of clinical nursing care. Design: A sequential mixed methods explanatory study with two data collection phases – quantitative followed by qualitative – was conducted. Results: Nurses used multiple strategies to ascertain children’s need for postoperative PRN analgesia, including reference to pain assessment tools, focussing on the behavioural cues of children, involving parents and children, and drawing upon personal and professional backgrounds and experience. Evaluation of the effectiveness of PRN postoperative analgesia was poorly communicated. Conclusions: Decision-making associated with the selection and administration of appropriate analgesia to children is complex. In-service education should be developed and offered to nurses working with children postoperatively to ensure the appropriate use of PRN pain relief. Relevance to clinical practice: Documentation surrounding this task is poor and needs to be addressed as a matter of urgency to ensure quality patient outcomes.

Using Carspecken's critical ethnography in nursing research

Abstract Critical ethnography is an increasingly popular methodology for nursing research, but little advice is available as to what forms it may take, their applicability and their relative strengths and weaknesses. This paper introduces and assesses the method developed and described by Phil Carspecken for use in educational research, presented in his book Critical Ethnography in Educational Research (1996). It outlines some of the philosophical and social theories which drive the methodology, and describes the steps in the research method with reference to nursing situations. Strengths and weaknesses are noted, and it is concluded that Carspeckens approach is useful for researching issues of interest to nurses who locate themselves in the critical theoretical tradition.

OUTCOMES OF BUTTONHOLE AND ROPE‐LADDER CANNULATION TECHNIQUES IN A TROPICAL RENAL SERVICE

BACKGROUND Buttonhole cannulation was introduced into this Queensland Renal Service in 2005. Contrary to published literature, a local review of cannulation outcomes found no greater likelihood of infections with the buttonhole technique. OBJECTIVES To compare the outcomes of buttonhole and rope-ladder cannulation techniques. DESIGN Prospective cohort. PARTICIPANTS Consenting patients attending for haemodialysis via an existing arteriovenous fistula (n = 104). MEASUREMENTS Cannulation sites were assessed at every dialysis session for 12 weeks; fear and pain were scored by participants weekly. RESULTS No statistically significant differences in infection, haematoma formation, pain or fear between the techniques. Occurrence of aneurysm was higher (p < 0.05) in the rope-ladder group. More patients in buttonhole group required multiple cannulation attempts (p < 0.05). More of the rope-ladder group failed to attend their scheduled dialysis sessions (p < 0.05). CONCLUSIONS AND APPLICATIONS TO PRACTICE This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation. Specifically, buttonhole cannulation appears to be a safe alternative means of fistula access to the gold-standard cannulation technique. The Service is examining strategies to improve attendance.

Effectiveness and Acceptability of a Moisturizing Cream and a Barrier Cream During Radiation Therapy for Breast Cancer in the Tropics: A Randomized Controlled Trial.

Background: Inconsistent evidence about product effectiveness to prevent moist desquamation during radiation treatment and minimal research about the acceptability to patients of recommended products prompted this study. Objective: This randomized controlled trial compared the effectiveness of 2 creams at minimizing the incidence of moist desquamation in a tropical setting and explored which product was most acceptable to patients receiving radiation treatment. Methods: Participants (n = 255) were stratified according to breast or chest wall radiation treatment and randomly allocated to use a moisturizing or barrier cream. Nurses assessed radiation skin reactions weekly with a standardized grading system, and patients were telephoned 1 month after completing treatment for a final skin assessment. Participants completed an Acceptability Survey at similar times. Results: At treatment completion, 15% of participants had moist desquamation. An additional 26% self-reported this at follow-up. Risk factors for moist desquamation included increased breast cup size and body mass index. The barrier cream significantly reduced the incidence of moist desquamation during treatment in patients receiving radiation to the chest wall (&khgr;2 = 3.93, P = .047). Participants preferred the barrier cream over the moisturizer (&khgr;2 = 5.81, P = .02) during treatment. Conclusions: This study identified a relatively high incidence of moist desquamation in patients receiving radiation therapy for breast cancer. Future patients will have information about product effectiveness in minimizing moist desquamation when choosing skin care products. Implications for Practice: Structured discharge planning and patient education need to include information about factors that contribute to the likelihood of developing moist desquamation.

The Fitzpatrick skin type scale: a reliability and validity study in women undergoing radiation therapy for breast cancer.

OBJECTIVE This study aimed to evaluate the internal consistency reliability and construct validity of the Fitzpatrick Skin Type Scale during radiation therapy in a cohort of women receiving treatment for breast cancer. METHOD The assessment of the scale was performed as a nested study within a randomised controlled trial of two creams used for radiation therapy skin care for breast cancer patients. The sample consisted of 244 female patients undergoing radiation therapy for breast cancer. Participants completed a modified version of the Fitzpatrick Skin Type Scale. RESULTS Internal consistency as measured by Cronbachs alpha was 0.505, 0.829 and 0.339 for the Genetic Disposition, Sun Exposure and Tanning Habits subscales respectively. Only the Sun Exposure subscale surpassed the 0.70 cut-off, indicating good internal consistency. Maximum likelihood factor analysis with promax rotation method confirmed the a priori factor structure for the Sun Exposure subscale as well as providing evidence of construct validity for this subscale. Analysis for the other two subscales highlighted issues with internal reliability and construct validity suggesting that not all items on each subscale truly measure the intended trait. CONCLUSION The study findings support reliability and validity of the Sun Exposure subscale of the Fitzpatrick Skin Type Scale in a convenience sample of women receiving radiation therapy for cancer. Despite limitations with two of the three subscales, this tool continues to be used in clinical practice.

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.

Self-reported long-term conditions of nurses and midwives across a northern Australian health service: A survey

BACKGROUND Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population. OBJECTIVES This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions. DESIGN A cross-sectional survey design was used. SETTINGS The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services. PARTICIPANTS All full-time, part-time and casual nurses and midwives employed within the health service were invited to participate; 665 (30.9%) completed surveys were returned. METHODS A paper-based questionnaire, comprising six sections, was individually addressed to all potential participants, together with reply-paid envelopes for returning completed questionnaires. The anonymous questionnaire took approximately 15 to 25min to complete, less time if the nurse reported no long-term conditions. RESULTS Three-fifths of respondents had at least one long-term condition. Respondents older than 50 years were statistically more likely to report having at least one long-term condition (χ(2)=5.64, p=0.018). Back pain, migraine and asthma were the most frequently reported individual conditions; more than one-quarter of respondents reported a condition relating to mental health and wellbeing. Respondents who reported more than one long-term condition compared to a single long-term condition were statistically more likely to have had more years of nursing experience (t=02.2, p=0.03). Nurses used a combination of varied personal and workplace strategies for many conditions; however personal strategies were most frequently used for all conditions. CONCLUSIONS This survey elicited information about reported long-term conditions, and strategies that nurses used to manage the condition they considered most important to them. We recommend that further investigation into how the full range of workplace strategies could be implemented to assist nurses to manage long-term conditions.

Carspecken's Critical Methodology - A Theoretical Assessment

Abstract This paper builds on the authors’ earlier introduction to Carspecken’s highly theorized ‘critical qualitative research’ methodology, also referred to as ‘critical ethnography’, and reviews its diverse theoretical origins. In particular, it briefly reviews the contribution of philosophical pragmatism, critical social theory, phenomenology, and the expressivism of J. G. Herder. It goes on to describe and assess the extent to which Carspecken successfully integrates these in order to create a coherent theoretical foundation for research, and outlines the virtues and weaknesses that characterise his methodology. Through an appeal to pragmatic philosophy, Carspecken sets aside the host of theoretical problems raised by his eclecticism, and for researchers similarly unmoved by theoretical anomalies and contradictions, his methodology offers a potentially productive, flexible approach to critical ethnographic research.

Peripherally inserted central catheter complications highlight the need for ongoing support: results of a chart audit

Abstract Introduction Since the 1940s, peripherally inserted central catheters have proved beneficial to patients and organisations, in acute and community settings. Background Nurses within the Medical Imaging Department of an Australian regional hospital commenced insertion of peripherally inserted central catheters under ultrasound guidance in 2002. This initiative increased the number of successful insertion attempts and reduced sequelae of poorly-inserted catheters. However, medical imaging nurses raised concerns regarding the number of patients returning to the department for catheter replacements. Process Aretrospective audit of charts of patients who had a peripherally inserted central catheter over a 13-month period was undertaken. Data were collected to ascertain: the number of peripherally inserted central catheters replaced within 8 weeks of insertion; the reasons for replacement; and number of days before complications arose. Findings Over 10% of the 575 patients who had a peripherally inserted central catheter within the time period had their catheters replaced ( n = 59). Three main complications contributed to the need for line replacement: suspected infection (44%); occluded lines (23%); and securement issues such as dislodgement or accidental removal (15%). Laboratory-confirmed infections included both Gram-positive and Gram-negative organisms. The median dwell time until complication was 13 days. Outcomes This review has identified that introducing a new service does not negate the need for ongoing support and resourcing in order to sustain low complication rates.