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Aim: To describe for areas of improvement in the management of COPD and reduction in emergency department presentations in Queensland. Background: If current trends in the management of COPD do not change, the predicted 4.5 million Australians diagnosed with COPD by 2050 will place significant burdens on already over-utilised frontline ED services. Separately COPD is more costly per case than cardiovascular disease and is a more common presentation to Emergency Departments in any year than most types of cancer, road traffic accidents and heart disease. Study Design and Methods: This study used a qualitative thematic analysis methodology in which field convergent interviews were employed to generate data. Sixteen staff and nine patients across three major Southern Queensland Health acute care facilities participated in the study. The authors analysed interview data using qualitative thematic analysis. Results: This research has revealed several noteworthy concepts worthy of further exploration. Thematic analysis from both staff and patient interviews identified the following issues: 1. Nurse case management, 2. Integrated communication of patient assessment and history data, 3. Failure in COPD management, and 4. Knowledge utilisation among ED clinicians. Inherent among these key concepts is a primary goal of coordinated congruent COPD management that optimise a patient's functional status and quality of life, improving symptoms management, and avoiding recurrent exacerbations. Discussion: These insights into the experience of patients and hospital staff into the management of COPD provides valuable insight into current and desired practices that can help to minimise presentations to Emergency Departments. The findings of the research provide insights and future direction for improvements by addressing the inconsistency in disease management. The need for more accessible and consistent patient management and a more congruent centralised patient support framework was also identified. Conclusion: There is indication of support stemming from the voices of patients and hospital staff around the need for COPD case management to become the dominant method of care. Future research should consider the cost benefit and patient outcomes of the implementation of such a role and the avoidance of ED presentations. Implications for research, policy, and practice: The findings of this research imply a need to streamline the patient support and disease management discharged planning process by ensuring one health professional maintains ongoing education, support, and assessment to the patient. Future research needs to better ascertain the positive economic benefits to healthcare organisations by employing Case Managers for patients with COPD. What is already known about the topic? * Case management roles can be effective in reducing ED usage for adults with chronic illnesses. * The World Health Organization (WHO) has called for planned ongoing assessment, care and support coordinated by a proactive investment in real time solutions that address the increasing burden of this disease on the healthcare sector. * The WHO has endorsed targeted patient support strategies that coordinate care over time, addressing the physical and mental health needs of people with chronic illness. What this paper adds: * Findings from this research show that discharged planning support practices with Southern Queensland Healthcare Organisations require review and ongoing evaluation. * This may include, streamlining the patient support and disease management discharged planning; or designated case management or integration of systems to prevent ED presentations. * This research adds to the voices of patients and staff that confirm published research recommendations. [ABSTRACT FROM AUTHOR]

Background: Intensive care nurses look after the most critically ill patient population with the highest mortality rate on a daily basis. Whilst research to date has highlighted and provided some insights into the current provision of end of life care, further research is much needed to improve the efficacy of nurses existing practice. Objective: To investigate the specific barriers and contextual characteristics that nurses experience within the Intensive Care Unit environment. Study Methods: The National Questionnaire of Critical Care Nurses Regarding End of Life Care was used to collect quantitative and qualitative data to answer the research questions. This study was conducted in a major intensive care unit located in a tertiary public hospital in metropolitan Western Australia. Results: The respondent rate was 67.31%. Obstacles with the highest perceived intensity score (PIS) reported by participants involved issues around the communication and practice of end of life care including family interaction. The ranges of mean scores for supportive behaviours were much higher than the ranges for obstacles. These supportive behaviours included allowing family members to have adequate time alone with the patient after death, and families being taught how to engage with the dying patient. Conclusion: The findings reflect that the most intense and frequently occurring obstacles are consistent with past research. A perceived negative end of life care experience by the nurse was found to negatively impact the nurse's psychological and physiological health. The research demonstrates the need for a stronger multidisciplinary patient centred approach. It is envisaged that the findings will support the review and development of appropriate guidelines to support nurses caring for intensive care patients in the initial and progressive phases of end of life care. What is already known about this topic? * ICU patients have the highest incidence of mortality in the acute care setting with one in four patients dying in an ICU, accounting for 15% of all hospital deaths annually. * This patient population presents nurses with a set of unique, yet significant challenges related to increased rate of mortality. * There is a significant amount of existing literature that has explored moral distress amongst nurses, particularly in relation to end of life care. What this paper adds: * This research suggests that there continues to be obstacles that impede critical care nurse's ability to facilitate EOLC in the ICU setting. * The participants of this study highlighted the need for stronger emphasis being placed on decision making processes, communication, and standardised practice. * The most supportive behaviours reported were associated with practice that could be initiated by the nurse such as, allowing family members adequate time with their loved one pre and post death, and teaching family members how to act and engage with their loved ones during this time. [ABSTRACT FROM AUTHOR]

Objectives: To examine in a sample of nurses working in acute-care wards, self-reported perceptions of the: 1) patient; family; nurse; doctor; and health system-related barriers to the provision of optimal end-of-life care to people who are dying in hospital; and 2) five barriers which, if removed, would lead to the greatest improvements in hospital-based end-of-life care. Background: Nurses play a central role in caring for dying patients and can offer a unique perspective about the factors that impact the quality of end-oflife care delivered in hospitals. Study design and methods: Two hundred and fifteen registered and enrolled nurses from three metropolitan and three rural hospitals across three health services completed a questionnaire-based, cross-sectional study between April 2016 and June 2017. Results: Nurses perceive that doctors continue to treat for too long (79% ranked as a large barrier); families have unrealistic expectations about a patient's prognosis (73%); junior doctors are unwilling to alter the decision of senior doctors (67%); doctors do not adequately explain the dying process (66%); and doctors have inadequate training in end-of-life care (66%). Nurses indicated that doctors reducing the length of active treatment and families having a more realistic expectation about life-expectancy would lead to the greatest improvement in end-oflife care in hospitals. Discussion: In this study of nurses working in a wide range of acute care settings across rural and metropolitan locations, substantial barriers to the provision of high-quality end-of-life care were perceived across all facets of healthcare provision. Important barriers included the continuation of potentially futile treatment, inadequacy of symptom control, and poor communication between doctors, patients and their families. Conclusion: Nurses perceive a range of patient; family; provider; and health system-related challenges to the provision of optimal end-of-life care in hospital. Findings highlight potential areas for improvement as part of a coordinated approach to optimising the provision of end-of-life care in hospitals. Future goals should include larger-scale, longitudinal studies across various states and territories to inform the development of interventions that can help to address the identified gaps in service provision. Implications for research, policy, and practice: This study has highlighted the need to involve all stakeholders when designing interventions to improve end-of-life care. Nurses can provide valuable insight into the factors that can make the greatest impact in improving care provision. It suggests that the provision of high-quality end-oflife care in hospitals is complex, and that there is substantial overlap between items nurses perceive to be barriers in each of the five domains of care provision. To achieve sustainable improvement in the quality of end-of-life care provided in hospitals, a multi-factorial, and collegial, approach to designing interventions will be needed. What is already known about the topic? • End-of-life care is increasingly being provided in hospital settings. • Nurses are an important source of information and support for dying patients and their families. • Few studies have explored nurses' perceptions of the barriers to the provision of high-quality end-oflife care across all domains of healthcare provision. What this paper adds: • Important barriers include continuation of potentially futile treatment, adequacy of symptom control, and poor communication between doctors, patients, and their families. • Findings can support the design of more effective intervention strategies to mitigate identified barriers and achieve improvements in the quality of end-of-life care delivered in hospital. [ABSTRACT FROM AUTHOR]

Objective In Western Australia the cancer nurse coordinator (CNC) role is unique, state wide and situated in nursing. It requires the domains of clinical expert, resource consultant, educator, change agent, researcher and advocate to facilitate seamless coordination of care for patients across metropolitan, rural and remote geographical areas of Western Australia. This study examined the role, function and impact of CNCs from the perspective of coordinators themselves. Design Prospective two-phase mixed method study. This paper reports data from the Self Report Activity Questionnaire in Phase one. Setting The state-wide Western Australian Cancer Nurse Coordinator Service. Subjects Metropolitan and rural CNCs (n=18) who had worked in the role for at least six months. Results Overall, CNCs spent 70% of time in clinical consultation and 41% of CNCs reported having an educational role. Most CNCs (71%) noted that at least half of their patients had complex psychosocial needs at referral. Key role-related activities related to direct nursing care and patient education were performed most frequently on a daily basis. Tasks related to care management planning, patient advocacy and multidisciplinary clinical care were performed weekly. Strategic, team communication and professional development activities were performed less frequently. Conclusion Diversity of the CNC role was demonstrated with findings showing that CNCs fulfilled the core components of the specialist cancer nurse. Given the clear need to provide consistent support to cancer patients in an increasingly individualised and integrated manner, we consider the CNC role a fundamental element of quality cancer care. [ABSTRACT FROM AUTHOR]