William McGuiness

Acute (adult clinical inpatient) care nurses' attitudes towards and knowledge of nationally endorsed 5As smoking cessation guidelines.

Nurses are expected to be involved in health promotion, including smoking cessation. This study aimed to assess nurses’ knowledge, sense of responsibility and willingness to provide smoking cessation interventions as described in the national 5As guideline. Data were collected by a survey distributed to a convenience sample of nursing staff (n = 162) from thirteen different adult acute care wards at a major metropolitan Melbourne hospital. Nearly all respondents (87%) agreed that they had a responsibility to counsel patients, and 22% were already doing so, but only 22% (n = 36) of respondents demonstrated an adequate level of knowledge of smoking cessation. Nurses were more likely to counsel patients on health conditions related to their area of practice than those that were not. The findings indicate that greater emphasis is needed in undergraduate courses and in-service programs to increase nurses’ awareness, and implementation of the 5As guideline for smoking cessation.

Approaches to the application and removal of compression therapy: A literature review

Compression therapy is used in the treatment of venous disorders, lymphoedema and burns. Adherence to compression therapy is reported to be poor, due to a number of factors, including difficulty in applying and removing the compression garments. A literature review was conducted to identify aids, equipment and other approaches to ease the application and removal of compression therapy garments. Some 12 studies were identified. Most studies focused on chronic venous insufficiency and venous ulcers. Four methods of easing compression garment application and removal were identified: (1) devices to assist in application and removal; (2) altered compression stocking design; (3) adjustable compression wrap devices; and (4) education. Patients prescribed compression therapy should be educated on how to apply and remove the compression garments, and have application devices made available to them.

eHealth in Wound Care: from conception to implementation

Executive summary Purpose This document aims to provide wound care clinicians with a rapid and structured overview of the key issues related to use of eHealth applications (telemedicine and telehealth) within wound care. This includes: An overview of terminology and available literature Guidance on the methodology for evaluation of eHealth solutions An introduction to and discussion of the potential benefits of eHealth technologies in wound care, and the possible barriers to their implementation Recommendations for ensuring a good implementation process and supporting involvement of wound care professionals in safeguarding that eHealth solutions meet the needs of the patients. Methodology The document sections lean on the structure and focus areas of the Model for ASsessment of Telemedicine (MAST) which defines crucial items to evaluate an eHealth application. The content of the document is developed on the basis of a literature review, identifying available documentation for use of eHealth solutions in wound care. Furthermore, it draws on various key documents recently published on the general development, evaluation and implementation of eHealth solutions. These include valuable up-to-date information relevant for any group of clinicians wishing to follow and influence the way eHealth solutions are integrated into clinical practice. Findings and conclusions The literature review revealed that the amount and level of evidence for use of eHealth applications in wound care is still limited. Some MAST domains are not examined in any of the available studies. Thus, more research is required to identify the potential benefits and harms to patients, and the possible challenges related to implementation of eHealth solutions in wound care. Potential barriers and facilitators for the implementation of eHealth applications into wound care practice are identified in the document, and these may all either enhance or impede the process. However, the available research does demonstrate patient satisfaction, improved access to health services for all client cohorts, and increased job satisfaction for clinicians. The document recommends that wound management clinicians, considering the use of eHealth applications in their clinical practice, consult widely and conduct regular evaluation of the outcomes to ensure efficient implementation of these services. To support this approach, steps to ensure a good implementation process within a given organisation have been proposed. These are synthesised into a three circle model.

Chapter 3: The model for assessment of telemedicine (MAST) – evaluation of telemedical solutions

In 2009, a group of researchers were asked to develop a specific model for assessing telemedicine (MethoTelemed) and this led to the development of a multidisciplinary, systematic, unbiased and robust system named MAST.16 This document describes the three steps in evaluating procedures, focusing on mature eHealth technologies to be introduced in the health-care services, targeting individuals with a variety of diseases. These steps include:

Profiling wound management in the emergency department: A descriptive analysis

BACKGROUND The service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes. The aim of this study was to describe the discharge and referral status of adult patients presenting to one Australian emergency department with a wound, skin or ulcer condition. METHODS A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014. RESULTS A total of 4231 wound, skin and ulcer conditions were managed, accounting for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer. CONCLUSIONS Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.

Chapter 5: Barriers and facilitators for eHealth

When practitioners and service providers look to introduce eHealth technologies they are often confronted by a confusing array of advice; the complexities of the devices, the infrastructure requirements and the best approach to user education. A rapid expansion of technological options and the need to ‘future proof’ any investment can result in health-care providers taking a conservative approach. This section explores the barriers and facilitators to the use of eHealth in an effort to help provide a framework for judicious decisions for effective implementation. The discussion draws from MAST and focuses on the patients, health practitioners, and services.

Emerging Technology for Enhanced Assessment of Skin Status

Pressure injury (PI) prevention has become a key nursing priority that requires clear identification of visual cues representative of PI risk. There is generalized agreement that erythema and skin wetness and/or maceration should be routinely examined by the clinician as part of PI risk assessment. Such an assessment is largely qualitative, deeply reliant on the perception and interpretation of the clinician. Consequently, skin parameters may be misinterpreted, underestimated, or even missed completely. Objective techniques are needed to augment accurate assessment of erythema and skin wetness and/or maceration. Biophysical skin analysis devices have been widely used in the cosmetic industry and clinical research to measure certain skin parameters for the purpose of skin health evaluation. This article describes 3 devices that enable noninvasive digital measurements of epidermal hydration, erythema, and epidermal lipids, respectively. The clinical application of biophysical skin analysis instruments in the assessment PI-related skin parameters could provide a feasible alternative to subjective assessment.

Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial

OBJECTIVE Compression therapy is a gold standard treatment to promote venous leg ulcer (VLU) healing. Concordance with compression therapy is, however, often sub-optimal. The aim of this study was to evaluate the effectiveness of electric stimulation therapy (EST) to facilitate healing of VLUs among people who do not use moderate-to-high levels of compression (>25 mmHg). METHOD A pilot multicentre, single-blinded randomised controlled trial was conducted. Participants were randomised (2:1) to the intervention group or a control group where EST or a sham device was used 4 times daily for 20 minutes per session. Participants were monitored fortnightly for eight weeks. The primary outcome measure was percentage of area (wound size) change. RESULTS In the 23 patients recruited, an average redution in wound size of 23.15% (standard deviation [SD]: 61.23) was observed for the control group compared with 32.67 % (SD: 42.54) for the intervention. A moderate effect size favouring the intervention group was detected from univariate [F(1,18)=1.588, p=0.224, partial eta squared=0.081] and multivariate repeated measures [F(1,18)=2.053, p=0.169, partial eta squared=0.102] analyses. CONCLUSION The pilot study was not powered to detect statistical significance, however, the difference in healing outcomes are encouraging. EST may be an effective adjunct treatment among patients who have experienced difficulty adhering to moderate-to-high levels of compression therapy.

Concordance and acceptability of electric stimulation therapy: a randomised controlled trial

OBJECTIVE A pilot single-blinded randomised controlled trial (RCT) was conducted to examine concordance with and acceptability of electric stimulation therapy (EST) in patients with venous leg ulcers (VLUs) who had not tolerated moderate to high compression. METHOD Participants were randomised to the intervention group (n=15) or a placebo control group (n=8) in which EST was used four times daily for 20 minutes per session. Participants were monitored for eight weeks during which time concordance with the treatment and perceptions of the treatment were assessed. RESULTS Concordance with the total recommended treatment time was 71.4% for the intervention group and 82.9% for the control group; a difference that was not statistically significant. Participants rated EST as acceptable (84.6% intervention; 83.3% control), only two participants, both from the placebo control group, would not be willing to use EST again. The majority considered EST easier to use than compression (68.4%). CONCLUSION EST was a practical and acceptable treatment among people who have been unable to tolerate moderate to high compression therapy.

Obesity and the Emergency Short Stay Unit

OBJECTIVES To evaluate the health service requirements of obese patients admitted to an Emergency Short Stay Unit (ESSU) and specifically compare length of stay (LOS), failure of ESSU management, and rates of investigations and allied health interventions among obese and non-obese patients. METHODS A prospective cohort study, using convenience sampling was conducted. The body mass index (BMI) of participants was calculated and those with a BMI of ⩾30 were allocated to the obese group, and those that had a BMI of <30 to the non-obese group. Data collected included demographics, admission diagnosis, time and date of ESSU admission and discharge, discharge disposition, radiological investigations, and referrals made to allied health personnel during ESSU admission. RESULTS There were 262 patients that were recruited sub-grouped into 127 (48.5%) obese participants and 135 (51.5%) non-obese participants with similar sex and diagnostic category distributions. The mean LOS in ESSU was similar - 11.5h (95% CI: 9.9-13.1) for obese patients and, 10.2h (95% CI: 8.8-11.6) for non-obese patients (p=0.21). Failure rates of ESSU management, defined as inpatient admission to hospital, were also similar with 29 (22.8%) obese patients admitted to hospital compared to 25 (18.5%) non-obese patients (p=0.39). Plain X-ray requests were significantly higher among obese patients (71.6 vs 53.3%; p=0.002), as was the rate of allied health interventions (p=0.001). CONCLUSION There was no significant difference in inpatient admission rates or LOS between obese and non-obese patients managed in the ESSU. Provisions for increased rate of investigations and allied health interventions for obese patients may facilitate timely assessment and disposition from ESSU.