Yenna Salamonson

A Review of the Six-Minute Walk Test: Its Implication as a Self-Administered Assessment Tool:

Background: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. Aim: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. Method: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. Conclusions: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.

Hate the course or hate to go: Semester differences in first year nursing attrition

Most of the attrition from nursing courses occurs in the first year of study. Devising university strategies to reduce attrition requires an understanding of why students leave. The aim of this study was to explore whether students who leave a nursing course in the first semester leave for the same or different reasons than students who leave in the second semester of study. Seventeen students who had left the course were interviewed by telephone: seven in the first semester and ten in the second. In the first semester, students who leave consider themselves unprepared for university, have competing roles outside university and develop a strong dislike of the nursing course. They decide quickly that the course is unsuitable and leave. Those who leave in second semester would prefer to stay but events in their life create a crisis where they can no longer cope with university studies. These students hope to return to nursing whereas students who leave in the first semester are unlikely to consider returning. Attempts to retain students in the first semester may be futile as these students may be unsuited or uncommitted whereas there is greater scope to retain those who leave in the second semester.

Academic engagement and disengagement as predictors of performance in pathophysiology among nursing students

Abstract Connecting students with learning activities to promote academic engagement has been a focus of higher education over the past decade, partly driven by an increasing rate of student participation in part-time employment, and a growing concern about the quality of the student experience. Using a prospective survey design, this study selected three elements of academic engagement (homework completion, lecture attendance, and study hours) and academic disengagement (part-time work), to identify predictors of academic performance in a pathophysiology subject in 126 second year nursing students. Homework completion emerged as the strongest positive predictor of academic performance, followed by lecture attendance; however, time spent studying was not a significant predictor of academic performance. Of concern was the finding that the amount of part-time work had a significant and negative impact on academic performance. Combining all elements of academic engagement and disengagement, and controlling for age and ethnicity, the multiple regression model accounted for 34% of the variance in the academic performance of second year nursing students studying pathophysiology. Results from these findings indicate the importance of active learning engagement in influencing academic success, and provide some direction for nursing academics to design effective learning approaches to promote academic engagement of nursing students.

The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers

OBJECTIVE To determine whether the introduction of the Medical Emergency Team (MET) system designed to provide immediate help for seriously ill patients: (i) changed the pattern of ICU patient transfers from the wards; and (ii) improved hospital survival rates. METHODS Prospective information on MET calls and unanticipated ICU transfers was collected for 3 years in a suburban metropolitan hospital. RESULTS A 3-year review of MET showed the number of MET calls doubled in the second and third year and the team was activated for more than just the most extremely ill patients. Whilst the frequency of calls for cardiopulmonary arrest remained constant (n = 16), increased use of the MET resulted in the proportion of calls for cardiopulmonary arrest dropping from 30% in year 1 to 13% in year 3. A slight decrease in the percentage of in-hospital deaths (0.74% in year 1 to 0.65% in year 3) was also demonstrated. The incidence of cardiopulmonary arrest per hospital admission also decreased slightly (0.08-0.07%). Although the overall number of ICU transfers remained constant, more seriously ill patients were transferred to ICU via the MET system. This was accompanied by a significant fall in unanticipated ICU transfers. Whilst the reduction in hospital deaths was encouraging, this study could not demonstrate whether the slight improvement in hospital survival rate over the 3 years was due to the MET system. CONCLUSION More information is needed to demonstrate that the MET system improves patient survival. The study also highlights the importance of taking proactive measures, which should include providing in-service education on the benefits of early identification and treatment of patients who are at risk of acute deterioration, raising awareness and changing attitudes in hospitals when introducing system such as the MET.

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

BACKGROUND Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise. OBJECTIVES To assess the psychometric properties of Banduras exercise self-efficacy (ESE) scale in an Australian CR setting. DESIGN Validation study. SETTING Cardiac rehabilitation. PARTICIPANTS One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years). METHODS Participants completed a six-minute walk test (6MWT) and Banduras exercise self-efficacy scale at enrollment and on completion of a 6-week CR program. RESULTS Banduras ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p=0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r=0.28, p=0.035) was seen. CONCLUSIONS The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patients efficacy for regular physical activity.

Severity of illness and risk of readmission to intensive care: A meta-analysis

BACKGROUND Almost one in every 10 patients who survive intensive care will be readmitted to the intensive care unit (ICU) during the same hospitalisation. The association between increasing severity of illness (widely calculated in ICU patients) with risk of readmission to ICU has not been systematically summarized. OBJECTIVE The meta-analysis was designed to combine information from published studies to assess the relationship between severity of illness in ICU patients and the risk of readmission to ICU during the same hospitalisation. DATA SOURCES Studies were identified by searching MEDLINE (1966 to August 2008), EMBASE (1980-2008), and CINAHL (1982 to August 2008). REVIEW METHODS Studies included only adult populations, readmissions to ICU during the same hospitalisation and reports of valid severity of illness index. RESULTS Eleven studies (totaling 220000 patients) were included in the meta-analysis. Severity of illness (APACHE II, APACHE III, SAPS and SAPS II) measured at the time of ICU admission or discharge, was higher in patients readmitted to the ICU during the same hospitalisation compared to patients not-readmitted (both p-values<0.001). The risk of readmission to ICU increased by 43% with each standard deviation increase in severity of illness score (regardless if measured on admission to, or discharge from the ICU) (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.3-1.6). CONCLUSIONS A relationship between increasing intensive care severity of illness and risk of readmission to ICU was found. The effect was the same regardless of the time of measurement of severity of illness (at admission to ICU or the time of discharge from ICU). However, further research is required to develop more comprehensive tools to identify patients at risk of readmission to ICU to allow the targeted interventions, such as ICU-outreach to follow-up these patients to minimize adverse events.

Unplanned admission to intensive care after emergency hospitalisation: Risk factors and development of a nomogram for individualising risk

BACKGROUND AND AIMS Unplanned admission to an intensive care unit (ICU) is associated with high mortality, having the highest incidence among patients who are emergency admissions to the hospital. This study was designed to identify factors associated with unplanned ICU admission in emergency admissions to hospital and develop an absolute risk tool to individualise the risk of an event during a hospital stay. METHODS Emergency department (ED) and in-patient hospital data from a large teaching hospital of consecutive admissions from 1 January 1997 to 31 December 2007 aged over 14 years was included in this study. Patient data extracted from 126826 emergency presentations admitted as in-patients consisted of demographic and clinical variables. RESULTS During an 11-year period 1582 incident unplanned ICU admissions occurred. Predictors of unplanned ICU admission included older age, being male, having a higher acuity triage category and a history of co-morbid conditions. Emergency department diagnostic groups associated with higher incidence of unplanned ICU admission included: sepsis, acute renal failure, lymphatic-hematopoietic tissue neoplasms, pneumonia, chronic-airways disease and bowel obstruction. The final model used to develop the nomogram had an ROC curve AUC of 0.7. CONCLUSION This study identified factors associated with unplanned ICU admission and developed a nomogram to individualise risk prior to a patient being transferred from the ED. This nomogram provides clinicians the opportunity prior to transfer from the ED, to either (1) review the appropriateness of the ward level of planned transfer or (2) flag patients for follow-up on the general ward to assess for deterioration.

Trial and retribution: a qualitative study of whistleblowing and workplace relationships in nursing

Abstract This paper reports a study aiming to present and describe the effects of whistleblowing episodes on nurses’ workplace relationships. Eighteen participants with direct experience of whistleblowing were recruited into the study, which was informed by a qualitative narrative inquiry design. Findings were clustered into four main themes, namely: Leaving and returning to work—The staff don’t like you; Spoiled collegial relationships—Barriers between me and my colleagues; Bullying and excluding—They’ve just closed ranks; and, Damaged inter-professional relationships’I did lose trust in doctors after that. Findings suggest a need to facilitate a climate in which it is safe for nurses (and others) to raise concerns about patient care or organisational wrongdoing, and to eliminate the existing belief that whistleblowing is a negative act fuelled by revenge or sedition.

Learning preference as a predictor of academic performance in first year accelerated graduate entry nursing students : a prospective follow-up study

The growth of accelerated graduate entry nursing programs has challenged traditional approaches to teaching and learning. To date, limited research has been undertaken in the role of learning preferences, language proficiency and academic performance in accelerated programs. Sixty-two first year accelerated graduate entry nursing students, in a single cohort at a university in the western region of Sydney, Australia, were surveyed to assess their learning preference using the Visual, Aural, Read/write and Kinaesthetic (VARK) learning preference questionnaire, together with sociodemographic data, English language acculturation and perceived academic control. Six months following course commencement, the participants grade point average (GPA) was studied as a measurement of academic performance. A 93% response rate was achieved. The majority of students (62%) reported preference for multiple approaches to learning with the kinaesthetic sensory mode a significant (p=0.009) predictor of academic performance. Students who spoke only English at home had higher mean scores across two of the four categories of VARK sensory modalities, visual and kinaesthetic compared to those who spoke non-English. Further research is warranted to investigate the reasons why the kinaesthetic sensory mode is a predictor of academic performance and to what extent the VARK mean scores of the four learning preference(s) change with improved English language proficiency.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

BackgroundNursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time.MethodsIn the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time.ResultsTwo hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time.ConclusionsThis study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.