Introduction: VVECMO is a support option for severe respiratory failure with a potentially revers... more Introduction: VVECMO is a support option for severe respiratory failure with a potentially reversible pathophysiology that is refractory to conventional treatments. Although not universally accepted, it is sometimes used as a bridge to lung transplant in endstage respiratory failure in selected patients. We describe a case of a young man who received prolonged ECMO support in this context and discuss some salient learning points. Case description: BF was admitted to ICU with respiratory failure due to acute interstitial pneumonitis and was placed on VV-ECMO due to extreme difficulty with oxygenation and ventilation. He was transferred to an ECMO/transplant centre the next day where a bicaval ECMO catheter was inserted. This was in order to attempt awake/ambulatory ECMO since he appeared otherwise fit with single organ failure. Issues with delirium, hypertension, tachycardia and de-saturation meant that extubation was not achievable. BF was urgently listed for lung transplantation which he received after 24 days of EMCO. He progressed well following transplantation and was extubated on day 52. He spent 61 days in ICU and was discharged from hospital following an 80 day stay.
Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adve... more Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-hour duration to assess agreement between the two methods; total sleep time and wake time. Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and speci city (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (speci city 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371 p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients.
Purpose: Nurses provide care at each phase of the complex perioperative pathway and are well plac... more Purpose: Nurses provide care at each phase of the complex perioperative pathway and are well placed to identify areas of care requiring investigation in randomised controlled trials. Yet, currently, the scope of nurse-led randomised controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomised controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation.
AIM The aim of this scoping review was to identify empirical literature on simulation used to dev... more AIM The aim of this scoping review was to identify empirical literature on simulation used to develop undergraduate nursing student's clinical assessment skills to recognise and respond to patient deterioration. BACKGROUND Early recognition and response to clinical deterioration is necessary to ensure the best outcome for the patient. Undergraduate nursing students have limited exposure to deteriorating patient situations, therefore simulation is widely implemented in nursing courses to address this educational need. It is imperative to identify the simulation modalities and features that best optimise student learning. DESIGN Scoping review using the Joanna Briggs Institute scoping reviews methodology and the Arksey and O'Malley framework. REVIEW METHODS Seven health databases were searched electronically for relevant literature and complemented with hand searching for additional relevant sources. A total of 344 potential articles were identified from the seven databases: Cumulative Index to Nursing and Allied Health Literature (n = 234); PubMed (n = 16); Medline (n = 51); Scopus (n = 21); Embase (n = 3); American Psychological Association PsychInfo (n = 13); and JBI (n = 6). After applying inclusion and exclusion criteria, 15 research articles were included in the review. RESULTS Most research on clinical deterioration simulation was quantitative (n = 12), two were qualitative and one used a mixed method approach. Findings included a lack of situational awareness, distractors causing incomplete patient assessment and failure to recognise deterioration. Repeated simulation showed positive results. CONCLUSIONS Findings of this review suggest students lack situational awareness, perform incomplete assessment and fixate on single cues rather than an entire clinical picture. The use of a variety of simulation modalities was effective in improving student performance. Repeated practice within a single simulated learning experience, was shown to improve performance and situational awareness. This approach to simulation is under-researched in nursing and needs further exploration.
BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of ... more BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care. OBJECTIVE The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients. METHODS An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire. RESULTS The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05). CONCLUSIONS Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.
Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim o... more Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs. An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location. Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026). This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.
Critical Care Nursing Clinics of North America, 2021
Sleep in intensive care is hampered due to many factors; the clinical environment itself exacerba... more Sleep in intensive care is hampered due to many factors; the clinical environment itself exacerbates sleep disturbance. Research suggests that interventions aimed at improving sleep quality have produced positive effects in reducing incidences and duration of delirium. Sleep disturbance is well documented among intensive care patients; however, its prognostic impact is not fully understood. Delirium, disproportionally prevalent among intensive care patients, has significant prognostic factors related to patient outcomes, in which sleep disturbance often is present. The relationship between sleep disturbance and delirium is complex, sharing commonalities in relation to neurobiological and neurohormonal alterations, which may contribute to a bidirectional relationship.
Sleep is a fundamental physiological phenomenon essential to human survival and supports optimal ... more Sleep is a fundamental physiological phenomenon essential to human survival and supports optimal functionality both physiologically and psychologically. Despite the general acknowledgement of its importance, patients' ability to sleep within the hospital setting is widely reported as grossly impaired. Clinical studies have consistently reported patients' poor sleep quality, characterised by decreased total sleep time and frequent disruptions which inhibit the ability to acquire consolidated sleep (Elliott et al. 2013).
Patient centred care and holistic approaches are considered essential to providing quality health... more Patient centred care and holistic approaches are considered essential to providing quality healthcare. Although, benefits are derived from collaborative approach these concepts are often not adhered to in a nocturnal clinical setting, whereby sleep quality is commonly compromise. In order to achieve a patient centred approach to care there is a need to acknowledge sleep as an important component to supporting recovery.
Clinical placement is an essential component to undergraduate nursing students' development a... more Clinical placement is an essential component to undergraduate nursing students' development and provides an invaluable opportunity to develop skills, tacit knowledge, demonstrate conceptual understanding, and professional competency.
The Australian Nursing and Midwifery Journal, 2017
While simulation is recognised as a safe and effective way to teach health students, the evolutio... more While simulation is recognised as a safe and effective way to teach health students, the evolution of spatial mapping technology and 3D applications has the potential to change nurse education, and enhance the understanding of both anatomy and physiology and physical assessment.
Students have a propensity to focus their learning aligned to the assessment items established wi... more Students have a propensity to focus their learning aligned to the assessment items established within the units of study, rather than acknowledging the broader need to learn and apply the content taught. This approach to education stifles students' learning and their ability to apply knowledge, and as a result, essential content can be poorly retained.
Purpose: Nurses provide care at each phase of the complex, perioperative pathway and are well pla... more Purpose: Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. Methods: This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. Results: From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. Conclusion: Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
International Journal of Nursing & Clinical Practices, 2017
Increasing health expenditure requires clinical leaders to have a functional understanding of hea... more Increasing health expenditure requires clinical leaders to have a functional understanding of health economics and its implications on the provisions of healthcare services. The subsequent health related illnesses associated with tobacco use, contribute to considerable economic burden to the health care system. Epidemiological analysis of tobacco use, suggests that it will become the leading cause of death in developed countries. The relative impact smoking has on the healthcare systems has been proffered to negate the burden of cost on health services secondary to reduced lifespans. Investing in chronic disease management programs such as pulmonary rehabilitation may reduce the impact of exacerbations of respiratory diseases on the individuals functioning, and alleviate some of the burden on acute care systems.
To describe the baseline hemodynamic variables and response time of hemodynamic changes associate... more To describe the baseline hemodynamic variables and response time of hemodynamic changes associated with the Valsalva maneuver using noninvasive continuous cardiac output monitoring (Nexfin). Hemodynamic monitoring provides an integral component of advanced clinical care and the ability to monitor response to treatment interventions. The emergence of noninvasive hemodynamic monitoring provides clinicians with an opportunity to monitor and assess patients rapidly with ease of implementation. However, the responsiveness of this method in tracking dynamic changes that occur has not been fully elucidated. A prospective observational study was conducted involving 44 healthy volunteers (age = 38 ±12 years). Participants performed a Valsalva maneuvers to illicit dynamic changes in blood pressure, cardiac output, cardiac index, systemic vascular resistance index (SVRI), and stroke volume. Changes in these hemodynamic parameters were monitored while performing repeated standardized Valsalva m...
Introduction: VVECMO is a support option for severe respiratory failure with a potentially revers... more Introduction: VVECMO is a support option for severe respiratory failure with a potentially reversible pathophysiology that is refractory to conventional treatments. Although not universally accepted, it is sometimes used as a bridge to lung transplant in endstage respiratory failure in selected patients. We describe a case of a young man who received prolonged ECMO support in this context and discuss some salient learning points. Case description: BF was admitted to ICU with respiratory failure due to acute interstitial pneumonitis and was placed on VV-ECMO due to extreme difficulty with oxygenation and ventilation. He was transferred to an ECMO/transplant centre the next day where a bicaval ECMO catheter was inserted. This was in order to attempt awake/ambulatory ECMO since he appeared otherwise fit with single organ failure. Issues with delirium, hypertension, tachycardia and de-saturation meant that extubation was not achievable. BF was urgently listed for lung transplantation which he received after 24 days of EMCO. He progressed well following transplantation and was extubated on day 52. He spent 61 days in ICU and was discharged from hospital following an 80 day stay.
Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adve... more Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-hour duration to assess agreement between the two methods; total sleep time and wake time. Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and speci city (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (speci city 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371 p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients.
Purpose: Nurses provide care at each phase of the complex perioperative pathway and are well plac... more Purpose: Nurses provide care at each phase of the complex perioperative pathway and are well placed to identify areas of care requiring investigation in randomised controlled trials. Yet, currently, the scope of nurse-led randomised controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomised controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation.
AIM The aim of this scoping review was to identify empirical literature on simulation used to dev... more AIM The aim of this scoping review was to identify empirical literature on simulation used to develop undergraduate nursing student's clinical assessment skills to recognise and respond to patient deterioration. BACKGROUND Early recognition and response to clinical deterioration is necessary to ensure the best outcome for the patient. Undergraduate nursing students have limited exposure to deteriorating patient situations, therefore simulation is widely implemented in nursing courses to address this educational need. It is imperative to identify the simulation modalities and features that best optimise student learning. DESIGN Scoping review using the Joanna Briggs Institute scoping reviews methodology and the Arksey and O'Malley framework. REVIEW METHODS Seven health databases were searched electronically for relevant literature and complemented with hand searching for additional relevant sources. A total of 344 potential articles were identified from the seven databases: Cumulative Index to Nursing and Allied Health Literature (n = 234); PubMed (n = 16); Medline (n = 51); Scopus (n = 21); Embase (n = 3); American Psychological Association PsychInfo (n = 13); and JBI (n = 6). After applying inclusion and exclusion criteria, 15 research articles were included in the review. RESULTS Most research on clinical deterioration simulation was quantitative (n = 12), two were qualitative and one used a mixed method approach. Findings included a lack of situational awareness, distractors causing incomplete patient assessment and failure to recognise deterioration. Repeated simulation showed positive results. CONCLUSIONS Findings of this review suggest students lack situational awareness, perform incomplete assessment and fixate on single cues rather than an entire clinical picture. The use of a variety of simulation modalities was effective in improving student performance. Repeated practice within a single simulated learning experience, was shown to improve performance and situational awareness. This approach to simulation is under-researched in nursing and needs further exploration.
BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of ... more BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care. OBJECTIVE The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients. METHODS An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire. RESULTS The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05). CONCLUSIONS Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.
Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim o... more Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs. An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location. Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026). This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.
Critical Care Nursing Clinics of North America, 2021
Sleep in intensive care is hampered due to many factors; the clinical environment itself exacerba... more Sleep in intensive care is hampered due to many factors; the clinical environment itself exacerbates sleep disturbance. Research suggests that interventions aimed at improving sleep quality have produced positive effects in reducing incidences and duration of delirium. Sleep disturbance is well documented among intensive care patients; however, its prognostic impact is not fully understood. Delirium, disproportionally prevalent among intensive care patients, has significant prognostic factors related to patient outcomes, in which sleep disturbance often is present. The relationship between sleep disturbance and delirium is complex, sharing commonalities in relation to neurobiological and neurohormonal alterations, which may contribute to a bidirectional relationship.
Sleep is a fundamental physiological phenomenon essential to human survival and supports optimal ... more Sleep is a fundamental physiological phenomenon essential to human survival and supports optimal functionality both physiologically and psychologically. Despite the general acknowledgement of its importance, patients' ability to sleep within the hospital setting is widely reported as grossly impaired. Clinical studies have consistently reported patients' poor sleep quality, characterised by decreased total sleep time and frequent disruptions which inhibit the ability to acquire consolidated sleep (Elliott et al. 2013).
Patient centred care and holistic approaches are considered essential to providing quality health... more Patient centred care and holistic approaches are considered essential to providing quality healthcare. Although, benefits are derived from collaborative approach these concepts are often not adhered to in a nocturnal clinical setting, whereby sleep quality is commonly compromise. In order to achieve a patient centred approach to care there is a need to acknowledge sleep as an important component to supporting recovery.
Clinical placement is an essential component to undergraduate nursing students' development a... more Clinical placement is an essential component to undergraduate nursing students' development and provides an invaluable opportunity to develop skills, tacit knowledge, demonstrate conceptual understanding, and professional competency.
The Australian Nursing and Midwifery Journal, 2017
While simulation is recognised as a safe and effective way to teach health students, the evolutio... more While simulation is recognised as a safe and effective way to teach health students, the evolution of spatial mapping technology and 3D applications has the potential to change nurse education, and enhance the understanding of both anatomy and physiology and physical assessment.
Students have a propensity to focus their learning aligned to the assessment items established wi... more Students have a propensity to focus their learning aligned to the assessment items established within the units of study, rather than acknowledging the broader need to learn and apply the content taught. This approach to education stifles students' learning and their ability to apply knowledge, and as a result, essential content can be poorly retained.
Purpose: Nurses provide care at each phase of the complex, perioperative pathway and are well pla... more Purpose: Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. Methods: This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. Results: From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. Conclusion: Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
International Journal of Nursing & Clinical Practices, 2017
Increasing health expenditure requires clinical leaders to have a functional understanding of hea... more Increasing health expenditure requires clinical leaders to have a functional understanding of health economics and its implications on the provisions of healthcare services. The subsequent health related illnesses associated with tobacco use, contribute to considerable economic burden to the health care system. Epidemiological analysis of tobacco use, suggests that it will become the leading cause of death in developed countries. The relative impact smoking has on the healthcare systems has been proffered to negate the burden of cost on health services secondary to reduced lifespans. Investing in chronic disease management programs such as pulmonary rehabilitation may reduce the impact of exacerbations of respiratory diseases on the individuals functioning, and alleviate some of the burden on acute care systems.
To describe the baseline hemodynamic variables and response time of hemodynamic changes associate... more To describe the baseline hemodynamic variables and response time of hemodynamic changes associated with the Valsalva maneuver using noninvasive continuous cardiac output monitoring (Nexfin). Hemodynamic monitoring provides an integral component of advanced clinical care and the ability to monitor response to treatment interventions. The emergence of noninvasive hemodynamic monitoring provides clinicians with an opportunity to monitor and assess patients rapidly with ease of implementation. However, the responsiveness of this method in tracking dynamic changes that occur has not been fully elucidated. A prospective observational study was conducted involving 44 healthy volunteers (age = 38 ±12 years). Participants performed a Valsalva maneuvers to illicit dynamic changes in blood pressure, cardiac output, cardiac index, systemic vascular resistance index (SVRI), and stroke volume. Changes in these hemodynamic parameters were monitored while performing repeated standardized Valsalva m...
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Papers by Lori Delaney