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Aim Design Methods Results Conclusion Implications for Patient Care Impact Reporting Method Patient or Public Contribution To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk‐stratified intervention bundle.Single‐centre, cross‐sectional, observational, prospective.The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation.Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient‐/carer‐focused interventions was particularly poor, with evidence indicating they had been implemented for 3%–10% of patients. Also, nutritional screening‐related interventions were implemented poorly. Clinically indicated implementation of heel‐elevation devices and bariatric equipment was low for at‐risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such.While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them.Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation.The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals.The study adheres to STROBE guidelines.None. [ABSTRACT FROM AUTHOR]

Background: A skin tear is a traumatic wound that occurs in up to one in five hospitalized patients. Nursing care includes application of a dressing to create a moist wound healing environment. Aim: To compare the effectiveness of two standard dressings (adhesive silicone foam vs. meshed silicone interface) to heal hospital‐acquired skin tear. Methods: An intention‐to‐treat pilot study was designed using a randomized, non‐inferiority trial in an Australian tertiary hospital setting. Consenting participants (n = 52) had acquired a skin tear within the previous 24 h and had agreed to a 3‐week follow‐up. Data were collected between 2014 and 2020. The primary outcome measure was wound healing at 21 days. Results: Baseline characteristics were similar in both arms. Per protocol, 86% of skin tears were fully healed at 3 weeks in the adhesive silicone foam group, compared to 59% in the meshed silicone interface group. Greater healing was observed across all skin tear categories in the adhesive silicone foam dressing group. In the intention‐to‐treat sample, healing was 69% and 42%, respectively. Conclusions: Results suggest the adhesive silicone foam dressing may be superior, as it produced clinically significant healing of skin tears at 3 weeks compared to the meshed silicone interface dressing. Accounting for potential loss to follow‐up, a sample of at least 103 participants per arm would be required to power a definitive study. Summary statement: What is already known about this topic? A skin tear is a traumatic wound that is commonly acquired during hospitalization that affects older adults in particular. In hospital settings, it may occur in up to one in five patients.A variety of skin tear dressings have been used in previous studies, with healing rates ranging from 34% to 97% at 21 days; however, evidence for the most effective dressing type is inconclusive.If treated inappropriately, or left untreated, minor skin tears can become chronic or complicated wounds, yet prevalence and treatment of hospital‐acquired injuries are under‐reported. What this paper adds? Based on our per‐protocol results, an adhesive silicone foam dressing may be superior, as it produced clinically significant healing of 86% of skin tears at 3 weeks compared to 59% with the meshed silicone interface dressing.Based on the methods and results from this pilot study, a future definitive trial would be feasible but would need to account for a relatively large loss to follow‐up rate. The implications of this paper: Using our intention‐to‐treat results, a future study would need a sample size of 103 per arm to be sufficiently powered, which may be impractical to achieve within a single hospital setting; thus, a multi‐site study would be advisable. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Reporting Method Patient/Public Contribution Implications for the profession and/or patient care To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement.Interrater agreement study.Data were collected from November 2019 to December 2022. Paired nurse‐assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence‐adjusted and bias‐adjusted kappa.Ninety‐four nurse assessors participated. Absolute agreement of not‐at‐risk versus at‐risk‐any‐level was substantial, but absolute agreement of risk‐level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower‐risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher‐risk patients.There were clear differences in pressure injury risk‐level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation.The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool.This study adhered to the GRRAS reporting guideline.No patient or public involvement in this study.Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention. [ABSTRACT FROM AUTHOR]

Purpose: To examine the status of critical care nursing internationally, assess the impact of the COVID‐19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide. Design A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess international critical care nursing needs and provide evidence to inform critical care nursing policy, practice and research priorities globally. Methods: The sixth World Federation of Critical Care Nurses survey of CCNOs was emailed to potential participants from countries with CCNOs or known critical care nurse leaders. Data were collected online using Survey Monkey™. Responses were entered into SPSS version 28 software (IBM Corp.) and analyzed by geographical region and national wealth group. Findings Ninety‐nine national representative respondents participated in the survey (70.7% response rate). The most important issues identified were working conditions, teamwork, staffing levels, formal practice guidelines, wages, and access to quality education programs. The top five CCNO services that were of most importance were providing national conferences, local conferences, workshops and education forums, practice standards and guidelines, and professional representation. Important pandemic‐related services and activities provided by CCNOs included addressing emotional and mental well‐being of nurses, providing guidance related to nurse staffing/workforce needs, assisting to coordinate efforts to obtain personal protective equipment supplies, serving as a country liaison with the World Health Organization's COVID‐19 response activities, and assisting in the development and implementation of policies regarding standards of care. The most important contributions expected from the World Federation of Critical Care Nurses were standards for professional practice, standards for clinical practice, website resources, professional representation, and providing online education and training materials. The top five research priority areas were: stress levels (inclusive of burnout, emotional exhaustion and compassion fatigue); critical care nursing shortage, skill mix and workforce planning; recruitment, retention, turnover, working conditions; critical care nursing education and patient outcomes; and adverse events, staffing levels, patient outcomes. Conclusions: The results highlight priority areas for critical care nursing internationally. The COVID‐19 pandemic impacted critical care nurses as direct care providers. As a result, addressing the ongoing needs of critical care nurses remains a priority area of focus. The results also highlight important policy and research priorities for critical care nursing globally. Results of this survey should be incorporated into strategic action plans at the national and international levels. Clinical Relevance: Issues of importance to critical care nurses including research and policy priorities during and following COVID‐19 are now clarified through this survey.The impact and importance that COVID‐19 has had on critical care nurses and their preferences and priorities are provided.Clear guidance to leaders and policy makers on where critical care nurses would like to see greater focus and attention to help strengthen the contribution of critical care nursing practice to the global healthcare agenda. [ABSTRACT FROM AUTHOR]

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. Design: Secondary analysis of hospital pressure injury incident and validation data. Methods: All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. Results: Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ =.567, p <.001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. Conclusions: This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to analyse prevalence of pressure injury in intensive care versus non‐intensive care patients. Background: Hospital‐acquired pressure injury is an enduring problem. Intensive care patients are more susceptible due to multiple risk factors. Several studies have indicated that intensive care patients are more likely than general patients to develop pressure injuries. Design: Secondary data analysis. Methods: Eighteen general hospitals with intensive care units were included. The sample included all consenting patients. Logistic regression modelling was used to derive prevalence and effect estimates. STROBE reporting guidelines were followed. Results: The sample comprised 15,678 patients; 611 were in intensive care. The crude prevalence estimate of hospital‐acquired pressure injury was 9.6% in intensive care and 2.1% in non‐intensive care patients. The ≥Stage II hospital‐acquired prevalence estimate in was 8.6% intensive care and 1.2% in non‐intensive care patients. Intensive care patients were at markedly increased risk of hospital‐acquired pressure injury compared with non‐intensive care patients, with risk persisting after adjusting for pressure injury risk score. Risk of ≥ Stage II hospital‐acquired pressure injury was further elevated. Intensive care patients had a higher pressure injury risk level and developed a greater proportion of severe hospital‐acquired pressure injuries than non‐intensive care patients. In intensive care, most hospital‐acquired pressure injuries were found on the sacrum/coccyx and heels. Conclusions: There were significant differences between the hospital‐acquired pressure injury prevalence of intensive care versus non‐intensive care patients, which is consistent with previous studies. Overall, the prevalence of hospital‐acquired pressure injury in intensive care is relatively high, indicating that their prevention should remain a high priority within the intensive care setting. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focus for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings. Aim: To analyse MMPI incidence and characteristics in a tertiary acute general hospital. Methods: A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed. Results: There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital‐acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital‐acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube‐related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube‐related devices were most often associated with MMPI (84.8%), whereas in non‐intensive care MMPI it was the urinary catheter (51.4%). Conclusions: While hospital‐acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non‐intensive care settings. The most common sites are the lips and mouth. Relevance to clinical practice: Mucous membrane pressure injuries represent a significant proportion of all hospital‐acquired pressure injuries. Patient or public contribution: Neither patients nor the public were directly involved in this project. [ABSTRACT FROM AUTHOR]

Purpose: To examine the activities, concerns, and expectations of critical care nurses and professional critical care nursing organizations worldwide. Design: A descriptive survey methodology was used. This study is the fifth worldwide quadrennial review of its type to monitor variations in critical care nursing needs and provide robust evidence to inform policy related to critical care nursing practice. Methods: The fifth World Federation of Critical Care Nurses international survey of critical care nursing organizations was emailed to potential participants from countries with critical care nursing organizations or known critical care nurse leaders. Data were collected online. Responses were entered into SPSS version 23 software (IBM Corp., Armonk, NY, USA) and analyzed by geographical region and national wealth group. Findings: Eighty‐two national representative respondents participated in the survey, of whom two thirds (n = 56, 68%) had an established critical care nursing organization in their country. The five most important issues identified were working conditions, teamwork, staffing levels, the need for formal practice guidelines and competencies, and wages. The top five critical care nursing organization services that were considered to be of most importance were professional representation, as well as provision of workshops and education forums, national conferences, practice standards and guidelines, and local conferences. The most important contributions expected from the World Federation of Critical Care Nurses were standards for clinical practice and professional practice, international conferences, professional representation, and study and education grants. Conclusions: The results highlight priority areas for critical care nursing and reinforce the need to address factors that can inform critical care nursing policy and practice. Results of this survey should be incorporated into strategic action plans at the national and international levels. Clinical Relevance: Nursing leaders, policymakers, and other interested stakeholders should consider these findings when planning critical care workforce requirements. Interested parties should work collaboratively to inform recommendations for further policy and action. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the experiences of high‐risk respiratory patients undergoing bronchoscopy with conscious sedation. Background: Due to possible complications, high‐risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as “conscious sedation,” this facilitates depression of the patient's consciousness without causing respiratory compromise. Previously, studies have investigated patient experience using quantitative methods. This is the first study that has explored the patient experience during bronchoscopy from a qualitative perspective. Design: Qualitative, phenomenological approach as described by Van Manen. Methods: The setting was an endoscopy unit within an Australian tertiary hospital. Unstructured interviews were conducted with 13 patients with chronic obstructive pulmonary disease who underwent day‐case bronchoscopy. All participants received conscious sedation. They were interviewed twice, within a week, postprocedure. Interviews were transcribed verbatim and analysed using Van Manen's interpretive approach. Findings: Participants had varying experiences. Five themes emerged from the analysis: Frustration and fear; Comfort and safety; Choking and coughing; Being aware; and Consequences. Whilst not all participants experienced procedural awareness or remembered it, for those who did it was a significant event. Overall, experiences were found to be negative; however, participants accepted and tolerated them, perceiving them as necessary to obtain a diagnostic result. Conclusion: The findings demonstrate that often patients are aware during the procedure and their experience may be uncomfortable and distressing. Relevance to clinical practice: These findings have implications for patient preparation pre‐ and post‐bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware, healthcare professionals should provide patient‐focused explanations of what is happening during the procedure, as well as providing ongoing reassurance that everything is going as planned. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the patient's perspective of falling in hospital. Background: A fall in hospital can affect a patient physically and psychologically, increasing their hospital length of stay and potentially putting them at risk of further complications. Despite a wealth of literature on falls that focuses on risk assessment, preventive interventions and cost, very little research has focused on the experience of the patient that has fallen, particularly within the acute hospital setting. Design: A qualitative phenomenological design was used to investigate the experience of falling in hospital. Methods: Twelve hospital inpatients that had recently fallen were interviewed while in hospital using unstructured interviews. The methodology was guided by Van Manen's approach to data collection and analysis. Findings: Three key themes emerged from the analysis: Feeling safe, Realising the risk and Recovering independence and identity. These themes describe a continuum whereby falling was not initially a concern to participants, who trusted staff to keep them safe, and tended to not seek assistance. As participants began to appreciate the reality of their falls risk, they felt disempowered by their loss of independence but were more receptive to receiving assistance. Finally, as participants recovered, their desire to regain independence increased. They wanted others to perceive them as physically competent, rather than as a frail older person, meaning they were more willing to take risks with mobility. Conclusion: The participants’ perspective of falling describes a continuum of responses with participants positioned at different psychosocial standpoints: from initial denial of their risk of falling to realisation of the importance of their fall and acceptance of its repercussions. Relevance to clinical practice: By understanding the patient's perspective of falling, nurses and other health professionals conducting risk assessment can tailor their discussions and interventions to the patient's perceptions and needs. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore Indigenous people's experiences of hospitalisation for acute cardiac care. Background Indigenous Australians suffer a higher burden of cardiovascular ill health and hospitalisation rates in comparison with other Australians, but there is little research that explores their perspectives of hospitalisation. Design Narrative inquiry. Methods Interviews were undertaken using storytelling to facilitate participants' descriptions of their hospital experience. Data were collected during 2014-2015. A purposive sample of Indigenous cardiac patients that were admitted to hospital and their relatives participated. Findings The narrative revealed three linked themes that characterised Indigenous people's hospitalisation experiences: The impact of the past; The reality of the present; and Anticipating the future. Hospitalisation was challenging for participants due to their sense of dislocation and disorientation, a lack of cultural and spiritual aspects to care practices, and the poor interpersonal relationships they experienced. Conclusions Findings revealed that there were many unmet needs during hospitalisation for Indigenous people. Past experiences and future expectations were connected in a way that impacted on participants' current hospitalisation experience. Understanding this context, with incorporation of cultural and spiritual aspects of care may help nurses and other healthcare professionals to provide more positive interactions that in turn may contribute to improved cardiac care experiences of Indigenous people during hospitalisation. Healthcare professionals need to be aware and focused on person-specific and contextualised aspects of Indigenous people's experience of hospitalisation for cardiac care in order to impact outcomes. Relevance to clinical practice Healthcare professionals need to understand Indigenous people's perspectives that contribute to improved health outcomes. Stories of participants' experiences may assist in the identification of aspects which might further the development of culturally appropriate continuity models that could effectively provide support throughout Indigenous people's hospital journeys, and beyond the hospital, and help improve associated health outcomes. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care. Methods Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. Data sources The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. Review methods A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. Findings A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land ; Encountering dysfunctional interactions ; and Suffering stereotyping and assumptions . These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. Conclusion The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure injury risk assessment, prevention and treatment exists, but limited research exploring the patient and carer experience of living with pressure injury. Aims: The aim of this meta‐synthesis was to describe the patient and carer experience of living with a pressure injury. Design: Meta‐synthesis. Methods: A prospective review protocol was registered, and systematic search conducted across five electronic databases. The PRISMA 2020 checklist for reporting systematic reviews was used. Two reviewers independently undertook screening and review of articles, using the CASP checklist for evaluating qualitative research. A meta‐synthesis using thematic content analysis was undertaken. Results: Twelve studies met the inclusion criteria. Meta‐synthesis led to the construction of three primary themes: loss of autonomy and independence, psychological effects, and adjustment. Within these primary themes, sub‐themes of dependence, social isolation and social avoidance behaviours, feelings and emotions, loss, managing, physical consequences, service provision, and functional challenges, were identified. Conclusion: The psychology and mindset of those involved, and support to navigate the challenges that arise are two unique and clinically relevant categorisations to guide provision of pressure injury care. Adaptation to a pressure injury is multi‐faceted and contextual, challenges to adaptation create additional psychological burden. Interventions encompassing all facets of the experience are necessary. Current research into experiences is limited, and further research to support interventions is necessary. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to validate a modified version of the Paddington Alcohol Test for use in the Australian emergency department (ED) setting. Methods: A cross sectional survey was used to screen patients attending an Australian tertiary hospital ED. Datawere collected over a three-month period at randomly allocated time periods and days. Consenting participants were screened using the Alcohol Use Disorders Identification Test (AUDIT) and a modified-for-Australia version of the Paddington Alcohol Test (AusPAT). The association between the two tools was investigated, as well as the sensitivity and specificity of AusPAT at various AUDIT cut-off scores and by gender and age group. Results: The sample comprised 637 ED attendees. Their mean age was 49.9 (SD 20.0) years with a mean AUDIT score of 5.21 (SD 6.58). Most (73.2%) consumed alcohol, and a quarter was AusPATpositive (n = 153, 24.0%). AusPAT demonstrated a moderate fit with AUDIT at a cut-off score of 8 (Kappa = 0.63, P < 0.001). At this cut-off 23.4% (n = 149) were identified by AUDIT as problematic drinkers. AusPAT sensitivity was 72.5% (95% CI 65.3–79.7) with a specificity of 90.8% (95% CI 88.3–93.4). Conclusion: Our results indicate that AusPAT was moderately well associated with AUDIT. When used universally in the ED setting, its sensitivity and specificity were moderate. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 Mary’s 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 Mary’s 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. [ABSTRACT FROM AUTHOR]

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 nonfallers (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. [ABSTRACT FROM AUTHOR]

Background: Care bundles cluster together several evidence-based practices and, in the intensive care setting, the ventilator care bundle (VCB) has been applied widely. Aim: To determine the effect of monthly feedback on VCB compliance. Design: Before and after study: primary outcome measure VCB compliance. Methods: Data were collected for 1 year from two metropolitan general intensive care units (ICU) on one randomly allocated day per week. Baseline data from adult ventilated patients were collected during the first 6 months (phase 1). During the second 6 months (phase 2), monthly compliance data were provided to each ICU regarding both ICUs' performance. Results: Both 'all or nothing' compliance (when all four VCB elements were complied with) and overall compliance (the average compliance of the four elements) increased between the two phases. These increases were mostly small and statistically insignificant. Although both measures increased in ICU B, both fell in ICU A. ICU B's overall compliance increase was statistically significant ( p = 0·005), but its 'all or nothing' compliance increase (19%), whilst arguably clinically significant, did not reach statistical significance. ICU B achieved increased compliance with all four VCB elements in phase 2, whereas ICU A achieved increases in two elements (deep vein thrombosis and gastric ulcer prophylaxis). Both ICUs achieved 100% compliance with gastric ulcer prophylaxis for all of phase 2. Head of bed elevation was the least complied with element in phase 1, and increased in ICU B only in phase 2. Conclusions: Although the compliance rates with individual elements are encouraging, the results regarding the effect of feedback on VCB compliance were variable. The finding of relatively poor compliance with head of bed elevation is consistent with previous research. Recommendations: Further research is needed to determine the effects of audit and feedback, and which strategies are most effective. [ABSTRACT FROM AUTHOR]

Abstract: Background: The application of knowledge to the care of critically ill patients is a hallmark of professional nursing practice. However, the educational preparation of intensive care nurses varies from country to country, and there has been little research that has investigated knowledge levels of European critical care nurses. Objective: The aim of this study was to examine the knowledge levels of European intensive care nurses. Design: The study was an international cross-sectional survey, with data collected from 20 European countries. Setting and participants: 318 European intensive care units participated, and data were collected from 1142 intensive care nurses. Methods: Data were collected between May and December 2009 using a 100-item multiple choice online questionnaire to assess intensive care nursing knowledge. The questionnaire was available in 16 languages, and data were collected in 11 knowledge areas. Results: A response rate of 60% was achieved; the majority of participants was female (77%). The largest groups of nurses had more than five years’ experience and were under 30 years of age. The overall mean knowledge score was 66% (SD 12). The main factor that contributed to variance in scores was nurses’ length of intensive care experience; in ten categories knowledge scores were progressively higher according to experience. If 50% is considered to be a pass mark, 90% of participants would have passed. However, in only six countries did all participants achieve a ‘pass’ score, and in five countries more than 10% of participants failed to meet this ‘pass’ criterion. The knowledge category which scored lowest was respiration and ventilation (mean score 56%, SD 15). Conclusions: Although knowledge levels differed among countries, there were no major differences. However, the relatively low scores achieved in the respiration/ventilation category are a cause of concern, and suggest that this is an education area that should be prioritised. The results should be considered within the context of each country''s healthcare and professional education systems, and strategies should be developed to improve knowledge in several key areas. [ABSTRACT FROM AUTHOR]

Abstract: Background: The application of knowledge to the care of critically ill patients is a hallmark of professional nursing practice. However, the educational preparation of intensive care nurses varies from country to country, and there has been little research that has investigated knowledge levels of European critical care nurses. Objective: The aim of this study was to examine the knowledge levels of European intensive care nurses. Design: The study was an international cross-sectional survey, with data collected from 20 European countries. Setting and participants: 318 European intensive care units participated, and data were collected from 1142 intensive care nurses. Methods: Data were collected between May and December 2009 using a 100-item multiple choice online questionnaire to assess intensive care nursing knowledge. The questionnaire was available in 16 languages, and data were collected in 11 knowledge areas. Results: A response rate of 60% was achieved; the majority of participants was female (77%). The largest groups of nurses had more than five years’ experience and were under 30 years of age. The overall mean knowledge score was 66% (SD 12). The main factor that contributed to variance in scores was nurses’ length of intensive care experience; in ten categories knowledge scores were progressively higher according to experience. If 50% is considered to be a pass mark, 90% of participants would have passed. However, in only six countries did all participants achieve a ‘pass’ score, and in five countries more than 10% of participants failed to meet this ‘pass’ criterion. The knowledge category which scored lowest was respiration and ventilation (mean score 56%, SD 15). Conclusions: Although knowledge levels differed among countries, there were no major differences. However, the relatively low scores achieved in the respiration/ventilation category are a cause of concern, and suggest that this is an education area that should be prioritised. The results should be considered within the context of each country''s healthcare and professional education systems, and strategies should be developed to improve knowledge in several key areas. [Copyright &y& Elsevier]

Aims and objectives: The aim of this review was to critically analyse recent research that has investigated ventilator care bundle (VCB) use, with the objective of analysing its impact on ventilator-associated pneumonia (VAP) outcomes. Background: The VCB is a group of four evidence-based procedures, which when clustered together and implemented as an 'all or nothing' strategy, may result in substantial clinical outcome improvement. VAP is a nosocomial lung infection associated with endotracheal tube use in ventilated patients. Since the VCB was introduced there have been several studies that have reported significant VAP rate reductions. Search strategy: A comprehensive search for research, published between 2004 and 2009, was conducted using Medline and PubMed. Key words were used to identify English language studies reporting VCB implementation within adult intensive care units (ICU) and associated clinical outcomes. Studies that implemented bundle variations that did not include all four elements were excluded. Conclusions: Because of the limitations of the observational designs used in the studies retrieved, a definitive causal relationship between VCB use and VAP reduction cannot be stated. However, the evidence to date is strongly indicative of a positive association. Several studies reported the use of additional VCB elements. In these cases it is difficult to establish which elements are related to the measured outcomes. Further research is recommended to establish baseline outcome measures using the four-element VCB, before adding further processes singly, as well as research investigating the effect of audit and feedback on VCB compliance and its effect on clinical outcomes. Relevance to clinical practice: A reduction in VAP is associated with VCB use. The evidence to date, whilst not at the highest experimental level, is at the highest ethically permissible level. In the absence of contradictory research, the current evidence suggests that use of the VCB represents best practice for all eligible adult ventilated patients in ICU. [ABSTRACT FROM AUTHOR]

Background: Available literature suggests that critical care nurses have varied experiences in relation to end-of-life (EOL) care. Few studies have examined the involvement of European intensive care nurses’ involvement in EOL care decisions and the extent to which their nursing practice is based on shared beliefs, experiences and attitudes. Aim: To investigate experiences and attitudes of European intensive care nurses regarding EOL care. Methods: Using a survey method, delegates ( n = 419) attending an international critical care nursing conference were invited to complete a self-administered questionnaire about their involvement with EOL care practices. The questionnaire composed of 45 items and was available in three European languages. Results: A total of 164 questionnaires were completed, yielding a response rate of 39%. The majority of respondents (91·8%) indicated direct involvement in EOL patient care, while 73·4% reported active involvement in decision-making process. 78·6% of respondents expressed commitment to family involvement in EOL decisions, however only 59·3% of the participants said that this was routinely undertaken ( p < 0·0005, Z = −4·778). In decisions to withdraw or withhold therapy, 65% would decrease the flow of inspired oxygen, 98·8% provide continuous pain relief and 91·3% endorse open visiting. The majority (78%) disagreed that dying patients should be transferred to a single room. A division of views was observed in relation to 44% agreeing that patients should be kept deeply sedated and equal numbers contesting the continuation of nutritional support (41·6% versus 42·3%). Conclusions: The involvement of European intensive care nurses in EOL care discussions and decisions is reasonably consistent with many engaged in initiating dialogue with coworkers. In general, views and experiences of EOL care were similar, with the exception of the provision of nutrition and use of sedation. Relevance to practice: Use of formal guidelines and education may increase nurses’ involvement and confidence with EOL decisions. [ABSTRACT FROM AUTHOR]

Hospital-acquired pressure injuries cause significant harm to afflicted individuals, and financially burden hospitals. Most pressure injuries are avoidable with the use of preventative interventions. However, within acute hospital settings the effectiveness of pressure injury preventative interventions, as demonstrated by high-level evidence, requires examination. Analyse the effectiveness of interventions to prevent pressure injury in adults admitted to acute hospital settings. Systematic review and meta-analysis of randomised controlled trials. CINAHL, MEDLINE, Scopus, Web of Science and Embase were searched in May/June 2019. In April 2020, searches were updated to the end of 2019. Randomised controlled trials which investigated the effectiveness of pressure injury preventative interventions on pressure injury incidence, within adults admitted to acute hospital settings, were included. Trials limited to pressure injury treatment or specialty areas, and non-English reports, were excluded. Screening, extraction and risk-of-bias assessment were undertaken independently by two reviewers, with a third as arbitrator. Included studies were grouped by intervention type. Studies were synthesised narratively, and meta-analysis was undertaken where study interventions were similar. Using a random-effects model, primary meta-analyses were undertaken using intention-to-treat data. Of 2000 records, 45 studies were included in the systematic review which investigated nine different intervention types: continence management, heel protection devices, medication, nutrition, positioning, prophylactic dressings, support surfaces, topical preparations and bundled interventions. All studies were judged to be at unclear or high risk-of-bias. Several meta-analyses were undertaken, pooled by intervention type. Most pooled samples were heterogeneous. Based on intention-to-treat data, only one intervention demonstrated a statistically significant effect: Australian medical sheepskin surfaces compared to other standard care surfaces (risk ratio 0.42, p = 0.006, I2 = 36%), but included studies were limited by bias and age. Following per protocol meta-analyses, only two intervention types demonstrated a significant effect: support surfaces (active versus other comparison [risk ratio = 0.54, p = 0.005, I2 = 43%] and standard surfaces [risk ratio = 0.31, p < 0.001, I2 = 0%]; and reactive versus other comparison surfaces [risk ratio = 0.53, p = 0.03, I2 = 64%]) and heel protection devices versus standard care (risk ratio = 0.38, p < 0.001, I2 = 36%). Only one intervention was supported by intention-to-treat meta-analysis. Significantly, all trials were at unclear or high risk-of-bias; and there were several limitations regarding heterogeneity across trials and trial outcomes. Further large-scale, high-quality trials testing pressure injury preventative interventions are required to establish effectiveness within acute hospital settings. Attention should be paid to true intention-to-treat analysis, and acute and intensive care settings should be reported separately. PROSPERO registration number : CRD42019129556. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]

Aims. The aim of this survey was to gain an overview of enteral nutrition practices and procedures of European adult intensive care units and to describe current trends. Background. Currently, little is known about nutritional practices in European intensive care units and whether they match existing guidelines. Design. Survey. Methods. A 51-item questionnaire about nutritional assessment and enteral feeding was distributed to 383 intensive care units in 20 countries. Results. A total of 380 (99·2%) questionnaires were returned. Most intensive care units (86·5%, n = 320/370) did not use a nutritional risk score and 35·8% ( n = 133/371) conducted daily assessments of nutritional status; body weight and serum albumin were the commonest measures. Checking the position of the feeding tube using auscultation of injected air was widespread (72·6%, n = 275/373). Most units used a clinical protocol and under half were supported by a nutritional support team. Conclusion. There are some variations in enteral nutrition practices across European intensive care units. Involvement of nurses in performing nutritional assessments or developing clinical protocols was minimal. The use of outdated procedures for checking feeding tube placement is a concern. There is scope for further development of nutrition guidelines in European units. Relevance to clinical practice. This study is relevant to all nurses working in critical care areas. The findings suggest that when an intensive care unit is supported by a nutritional support team it is more likely that a nutritional score will be used and nutritional assessments will be made daily. Many intensive care practices do not conform to international guidelines for enteral feeding. Nutritional assessment and the use of nutritional risk scores are areas that would benefit from further application in intensive care. This study may provide an impetus for intensive care units to review their nutrition assessment practices and to advance evidence-based guidelines, developed by multi-professional teams, which ensure the safe and effective management of patients receiving enteral nutrition. [ABSTRACT FROM AUTHOR]

This article describes the development of a new multi-professional Master's degree programme, which is aimed at supporting the education of practitioners in meeting the needs of Level 1 critically ill patients. The main drivers that influenced its development were Comprehensive Critical Care ( ) and the National Health Service Modernisation Agency for Critical Care. The programme was aimed primarily at junior doctors, senior ward nurses, senior physiotherapists and members of Outreach teams. The programme was designed to maximize work-based learning and is framed around two clinically focused units. The programme is informed by principles of quality improvement and aims to prepare practitioners to meet the needs of Level 1 patients ‘at the point of need’. [ABSTRACT FROM AUTHOR]

• The care bundle is a new concept in critical care, which is currently being promoted by the National Health Service Modernisation Agency for Critical Care • Care bundles originated in North America and are described best as groups of evidence-based practice interventions • The theory behind care bundles is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcome • Care bundles are relatively easy to develop, implement and audit, and provide practitioners with a practical method for implementing evidence-based practice • This article describes the care bundle and offers practical suggestions about how to develop, implement and audit them in practice [ABSTRACT FROM AUTHOR]

Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care. Systematic review and meta-analysis of incidence and prevalence Articles published in English between 2009 and 2018, reporting pressure injury as a primary outcome were selected based on inclusion criteria. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted. Sub-group meta-analyses were conducted to investigate potential causes of heterogeneity. Fifteen studies met the criteria for inclusion in the systematic review, of which 14 were incidence studies. Heterogeneity was significant and there was large observed variance between studies. The 95% confidence interval of cumulative incidence across all 14 studies, with an overall sample size of 6371, was 9.8–25.6%. In 11 studies that included all-stage pressure injury the 95% confidence interval was 8.3–28.3%. In seven studies in which Stage 1 pressure injury was excluded, the 95% confidence interval was 5.8–22.7%. In the single prevalence study included, which excluded Stage 1 pressure injury, prevalence was 8.8%. The incidence of pressure injury in cardiac intensive care patients was similar to that found in general intensive care patients. However, our results suggest that the incidence may be significantly higher in cardiac surgical patients admitted to intensive care. There were significant differences across the various studies in the ways in which data were collected and reported. Further well-designed studies are required to better understand incidence in this population, using standardised methods of data collection and reporting. [ABSTRACT FROM AUTHOR]

Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and healthcare costs. Within the hospital setting, it is considered to be largely preventable and regarded as an adverse event. In this context, prophylactic use of a protective sacral dressing to prevent pressure injury has been investigated by various researchers. Analyse the effectiveness of prophylactic sacral protective dressings to prevent pressure injury. Systematic review and meta-analysis of randomised controlled trials. Electronic database searches were undertaken in 2018 and 2019. Initial searches identified 557 articles. Following duplicate removal and screening, 49 full text articles were reviewed. Most were excluded, leaving six studies that met the criteria for full review. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted using sample sizes based on intention-to-treat analysis. Sub-group meta-analyses were conducted of three studies in the intensive care setting and four studies that used the same dressing. Overall, the six randomised controlled trials were judged to be of moderate quality. Due to visibility of the intervention, blinding was rare. Five studies were described as intention-to-treat; however two of these presented per-protocol analyses. All studies compared the intervention plus standard care to standard care. Five studies demonstrated statistically significant reduced pressure injury incidence in the intervention group. All studies were included in the meta-analysis (total n = 1872) and demonstrated homogeneity (I 2 = 10%). Meta-analysis revealed an overall effect in favour of the intervention [risk ratio (RR) = 0.30, 95% CI 0.17–0.51] with a 95% prediction interval of 0.11–0.80. Sub-group analyses of intensive care studies and those using the same dressing demonstrated positive effects (RR = 0.17, 95% CI 0.06–0.49, I 2 = 0%, and RR = 0.32, 95% CI 0.13–0.764, I 2 = 31%; respectively). The meta-analysis provides moderate evidence of the effectiveness of a prophylactic sacral dressing to prevent pressure injury, with an overall relative risk indicating that the intervention decreases pressure injury risk by 70%. Sub-group analysis of intensive care studies demonstrated a large relative risk reduction of 83% suggesting the dressing may be more effective in this high-risk group. The lower relative risk reduction of 68% found in four studies using the same dressing, in which there was moderate heterogeneity, indicates that further research is needed to clarify dressing choice. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians carry a greater burden of cardiovascular disease than other Australians. A variety of programs has been implemented with the broad aim of improving Indigenous cardiovascular health, however, relatively few have been evaluated rigorously. In terms of effectiveness, understanding how to best manage cardiovascular disease among this population is an important priority. The review aimed to examine the evidence relating to the effectiveness of cardiovascular programs for Indigenous Australians. Methods: PubMed, CINAHL, PsycINFO, Scopus and Web of Science databases were systematically searched for relevant studies, limited to those published in English between 2008 and 2017. All studies that used experimental designs and reported interventions or programs explicitly aimed at improving Indigenous cardiovascular health were considered for inclusion. Methodological quality of included studies was appraised using design-specific Joanna Briggs Institute critical appraisal checklists. Data were extracted using the Joanna Briggs Institute data extraction form and synthesised narratively. Results: Eight studies met the inclusion criteria and were assessed to be of varying methodological quality. Common features of effectiveness of programs were integration of programs within existing services, provision of culturally appropriate delivery models with a central role for Indigenous health workers, and provision of support processes for communities such as transportation. It was noted however, that the programs modelled the interventions based on mainstream views and lacked strategies that integrated traditional knowledge and delivery of health care. Conclusions: Very few cardiovascular healthcare programs designed specifically for Indigenous Australians, which had undergone rigorous study, were identified. Whilst the majority of included articles were assessed to be of satisfactory methodological quality, the nature of interventions was diverse, and they were implemented in a variety of healthcare settings. The limited evidence available demonstrated that interventions targeted at Indigenous cardiovascular health and related risk factors can be effective. The results indicate that there are opportunities to improve cardiovascular health of Indigenous people at all stages of the disease continuum. There is a need for further research into evidence-based interventions that are sensitive to Indigenous culture and needs. Trial registration: Registered with PROSPERO International: CRD2016046688. [ABSTRACT FROM AUTHOR]

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions. Prospective, interrupted time-series study. Seven adult inpatient wards in three Australian hospitals. 825 adults with 867 peripheral intravenous catheters. Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD − 4.4%, 95% CI − 8.5, − 0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD − 5.2%, 95% CI − 9.7, − 0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD − 5.2%, 95% CI − 10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the need to change the writing practice about critical care nursing. Attempt to challenge the traditional approach to academic writing; Acceptance of writing in the first person; Narrative writing as a creative writing that focuses on "I".

Aims and objectives: To explore the experiences of men and women with cystic fibrosis in becoming parents. Background: As lifespan for people with cystic fibrosis increases, and reproductive technology advances, having a child of their own becomes a possibility. Design: This study used a phenomenological framework. Methods: Seven Australian adults with cystic fibrosis were invited to describe their experiences of becoming parents in the context of a semi‐structured interview. Analysis of the data involved highlighting recurrent phrases and isolating emergent themes. Results: Two overarching themes characterised the participants’ experience: Counting the cost, as they recalled Concentric communication and Pathways to pregnancy; and Living the dream, as they cast a retrospective view over this, their major achievement, in the light of their Reaction: a dream comes true, Coping: a question of balance, Conjecture: the future redefined and Confidence: recalibrating. Conclusions: While advances in cystic fibrosis care and reproductive technology have increased the possibility of individuals with cystic fibrosis becoming parents, the passage to becoming a parent is a complex process. Relevance to clinical practice: These findings can inform health professionals to support the adaptive work necessary for families that include members with cystic fibrosis. A contemporary understanding of this phenomenon is necessary for facilitating clinically relevant communication. [ABSTRACT FROM AUTHOR]

Background: Whilst performing a pressure injury risk assessment is not in itself preventive, risk status identification is critical to inform the judicious implementation of prevention strategies. Risk assessment is mostly undertaken using a structured tool informed by clinical judgement, though there is a perception that use of clinical judgement alone may be sufficient. Objectives: Within acute hospital settings, to identify differences in outcomes (risk status, preventive interventions) following nursing assessment of pressure injury risk when using a structured assessment tool compared to clinical judgement. Design: Systematic review. Data sources: EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus, Web of Science, Ovid EMBASE. Methods: Primary research relevant to the objectives was eligible for inclusion. Databases were searched in February 2021 (limits: date 2010–2020, English language, adults). Two reviewers undertook the review process, with a third as arbitrator. Appraisal was undertaken using Joanna Briggs Institute critical appraisal tools. Included studies are synthesised narratively. Reporting is in accordance with the PRISMA Statement. Results: Five moderate to high‐quality studies were included. Synthesis was limited by heterogeneity. Several risk assessment tools and methods of clinical judgement were used. Three studies reported pressure injury risk status using both assessment approaches, but in only one did nurses undertake both. Risk status, as identified by each method, varied and was sometimes contradictory. Three studies reported some elements of preventive intervention prescription and/or implementation following risk assessment, but comparison between approaches was limited. Conclusions: Some research suggests that risk status varies across different methods of pressure injury risk assessment, but it is unclear what impact this has on preventive intervention use. Risk status was not well linked to preventive interventions. Research is warranted to examine the influence that each approach to risk assessment alone and combined has on identified risk and preventive intervention prescription and implementation. Registration: A protocol was prospectively registered with PROSPERO (CRD42021224747). [ABSTRACT FROM AUTHOR]

Rationale Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery. Methods We conducted a prospective observational study on all adult patients undergoing surgery for fractured neck of femur between December 2013 and July 2014. We monitored their temperatures in different perioperative areas at multiple time points and also noted the warming methods used. Results Eighty-seven patients were included in this study. A significant drop in body temperature (0.7°C, 95% CI: 0.6-0.9, P < 0.001) occurred from their arrival at the operating theatre until their arrival at the recovery room. A significant drop of 0.2°C (95% CI: 0.1-0.4, P < 0.001) was observed at the holding bay area. One third of the patients were noted to be hypothermic when they arrived at the recovery room. Conclusion These results indicate that despite the use of active warming methods for most patients, significant hypothermia is still an issue amongst elderly patients undergoing hip fracture surgery. Further improvement is necessary to prevent hypothermia in this high-risk group of patients. [ABSTRACT FROM AUTHOR]

Nursing interventions for sepsis care start with promoting early identification and treatment of sepsis, as research continues to demonstrate increasing mortality rates with the progression of organ system failure and septic shock [[5]]. Compliance to all aforementioned quality indicatorsProportion of cases in which all elements of the sepsis bundle were implementedMeasured: (n cases in which all elements of the sepsis bundle were implemented/total n of sepsis cases) × 100 ht By instituting measures that are based on the SSC guidelines, critical care nurses can improve care for patients with sepsis and help to ensure that critically ill patients with sepsis receive expert nursing care to promote optimal outcomes worldwide. [Extracted from the article]

Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression. Method: A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect. Results: Average pain score of the 48 heart transplant recipients was 43 (SD ± 10, range 0–100, lower scores indicate worse pain), with moderate pain reported by 39% (n = 19). Major depression was associated with worse pain (R2 change = 36%, β = −16, 95% confidence interval [CI] = [−30, −4], p = .012). Pharmacological treatment for depression was associated with better pain scores (R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006). Conclusions: Heart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depression are common after heart transplantation. This study aimed to pilot test the feasibility of a clinical model of psychological care for heart transplant recipients. The model of care involved nurse-led screening for anxiety and depression followed by referral for a course of telephone-delivered cognitive behaviour therapy as well as co-ordination of communication with on-going specialist and primary care services. Methods: A pilot randomised controlled trial was conducted. Heart transplant recipients who self-reported at least mild anxiety or depressive symptoms were randomised (defined as a score higher than 5 on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 [GAD-7], or a score higher than 20 on the Kessler Psychological Distress Scale [K10]). The primary outcome was assessment of feasibility of conducting a larger trial, which included identification of recruitment and attrition rates as well as the acceptability of the intervention. Follow-up was conducted at 9 weeks and 6 months. Results: One hundred twenty-two of the 126 (97 %) heart transplant recipients assessed on their attendance at the outpatient clinic met the study eligibility criteria. Of these patients, 88 (72 %) agreed to participate. A moderate proportion of participants (n = 20; 23 %) reported at least mild symptoms of anxiety or depression. Five participants were excluded because they were currently receiving psychological counselling, two withdrew before randomisation and the remaining 13 were randomised (seven to intervention and six to usual care). The majority of the randomised participants were male (n = 9; 69 %) and aged over 60 (range 35-73). Median length of time post-transplant was 9.5 years (ranging from 1 to 19 years). On enrolment, 3 randomised participants were taking anti-depressants. One intervention group participant withdrew and a further 3 (50 %) declined the telephone-delivered CBT sessions; all because of restrictions associated with physical illnesses. Attrition was 30 % at the 6 month follow-up time-point. Conclusions: Due to the poor acceptability of telephone-delivered cognitive behavioural therapy observed in our sample, changes to intervention components are indicated and further pilot testing is required. Trial registration: ACTRN12613000740796 Date registered: 03/07/2013. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential. [ABSTRACT FROM AUTHOR]