Search

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

The role of the wound care nurse has developed to meet the need for expert wound care advice. Internationally, the role has developed with a variety of different titles. Although all positions have some common tasks and obligations, there remain gaps in knowledge around the role of the wound care nurse. This article aims to determine the state of knowledge in relation to the context of practice, scope of practice and impact of the wound care nurse. An integrative review design was used to allow a broad search strategy and to gather papers from a variety of sources. A multi-method search strategy of the literature published between 1980-2011 was undertaken. This included 5 electronic databases, a thesis search and manual search. It was found that the characteristics of the patients wound care nurses care for reflect an ageing population and disease processes, including diabetes and obesity. Internationally, there is little consensus on the level of competence, educational requirements and qualifications required to practise as a wound care nurse. There was some evidence that the wound care nurse improved healing times and decreased pressure injury prevalence. [ABSTRACT FROM AUTHOR]

COVID-19 symptoms range from severe respiratory failure to mild anorexia, cough and smell and taste alterations, adversely impacting nutritional intake. The aim of this paper was to establish malnutrition risk, Nutrition Impact Symptoms (NIS) and associations with reduced oral intake. A retrospective observational cohort of all people testing positive for COVID-19 was conducted. Malnutrition risk, nutritional status, weight, reduced oral intake and NIS on and during admission were collected. Dietetic consultation frequency and mode were captured. Some 80% (48/60) of participants reported at least one NIS, and 58% (25/60) reported two or more. Most frequent reported symptoms were cough (60%), sore throat (35%) and reduced appetite (28%). Significant associations existed between ≥2 NIS (p=0.006), reduced appetite (p=0.000) and reduced oral intake, with 20% requiring ongoing nutrition support and consultation. High NIS prevalence confirms systematised nutrition support pathways are indicated through incorporation into standard care across the healthcare continuum, including community care. [ABSTRACT FROM AUTHOR]

Research identifies unique challenges for younger women diagnosed with breast cancer at or before 45 years of age. This paper explores the experiences of younger women from diverse cultural backgrounds with breast cancer to see if there are differing healthcare provision needs across cultures. Sandelowski and Barroso's framework for undertaking a meta-synthesis is used in this paper. Initial searches in academic databases returned 42 papers of interest. Re-reading the papers in the context of the research question identified 12 studies which met the inclusion criteria. Five key themes were identified in these 12 studies. The overarching finding is that, irrespective of cultural background, the confrontation with breast cancer transforms the younger woman's life. It seems that healthcare provision needs do not differ substantially across cultures. Health professionals should address the unique psychosocial effects of cancer in the context of the lifestage of the woman. [ABSTRACT FROM AUTHOR]

Over several decades, national competency standards have been developed In Australia to define competence for midwives. Furthermore, national standards for the accreditation of the three year, Bachelor of Midwifery programme have been developed. Each standard has associated evaluative criteria such as minimum clinical requirements to determine if the standard has been met. Concerns have been raised regarding competency based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. Philosophically there has been a move by many of the registering bodies In Australia from competency based standards to a more prescriptive approach. For example, midwifery graduates seeking to register as a midwife are now required to demonstrate substantial birthing experience as a pre-requisite for registration. However, the current number of births required for registration purposes Is unsupported by evidence and appears to be based on custom and tradition. It is essential that any midwifery practice requirements are based on evidence based research in order for the profession to be guided by evidence based outcomes. It is the purpose of this paper to present a systematic review of the evidence for incorporating minimum clinical requirements as an appropriate assessment criterion for registration. [ABSTRACT FROM AUTHOR]

Maintaining competence and keeping skills and knowledge in children's orthopaedic nursing alive are problematic in both the UK and Australia. The dearth of dedicated postgraduate courses for this specialty has resulted in an array of unregulated in-house training, nurses' individual educational needs not being met and potential for children with an orthopaedic problem being put at risk of not receiving optimal care. This paper reports on a travel scholarship used to compare and contrast the UK with Australia, which supported an international scoping exercise to identify nurses' beliefs regarding expertise in children's orthopaedic nursing and explore provision for maintaining pertinent knowledge and skills. Potential ways to improve support for nurses in maintaining expertise in this field of practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. Aims: To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. Methods: The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Results: Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. Conclusions: There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role. [ABSTRACT FROM AUTHOR]

Background/Aims: Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women. Methods: In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed. Results: A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women. Conclusions: To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome. [ABSTRACT FROM AUTHOR]

Preceptorship is a vital role in the development of both undergraduate and postgraduate midwifery students who require input and guidance from more experienced midwives. The preceptor acts as a professional role model to the student: teaching and supporting; providing a learning environment that enables confidence to develop through supervised safe practice; and assisting them to develop knowledge and skills, and adapt to new contexts and new roles within an ever-changing midwifery environment. Using reflection and critical analysis within clinical scenarios is a useful way to provide effective teaching and learning for students. This can also assist the preceptor to develop alternative teaching strategies and develop confidence to try new teaching approaches with students in future encounters. As the role of preceptor comes with great responsibility, the need for flexibility in teaching approaches, according to varied student learning styles, promotes new teaching approaches and confidence in the preceptor. This paper analyses a clinical teaching and learning scenario within a midwifery context and critiques the various teaching strategies utilised to recommend alternative approaches for the registered midwife preceptor. [ABSTRACT FROM AUTHOR]

Three-year undergraduate Bachelor of Midwifery programmes were introduced into Australian universities in 2002 in response to the midwifery profession's changing political, economic and workforce needs and expectations of the midwife's role (Glover, 1999; Cutts et al, 2002; Leap, 2002). There was an identified need to broaden the entry pathways and structure of midwifery courses to make them accessible to those who did not hold a nursing qualification or experience. Expectations of the midwife's role and scope of midwifery practice in Australia were shifting 'from the biomedical, hospital-centric focus of pregnancy to one emphasising a "new midwifery" based on a midwife-woman partnership and evidence-based practice' (Seibold, 2005:10) and this was reflected in the new midwifery curriculum. This paper presents findings from a grounded theory study exploring the experiences of early Australian Bachelor of Midwifery students, graduating in 2005-2008, from a university in Victoria, Australia. The study was timely, as the first graduates from these courses had entered the profession in 2004 and these students' experiences had not been explored. The findings demonstrate how these students underwent a process of 'assimilation' to achieve competency for beginning practice. Assimilation involved three sub-processes: 'realisation', 'adaptation' and 'consolidation'. [ABSTRACT FROM AUTHOR]

This paper describes the development of a tool for palliative care nurses to initiate and facilitate advance care planning (ACP) conversations in community palliative care practice. Seven community palliative care services located across Australia participated in a multi-site action research project. Data included participant observation, individual and focus group interviews with palliative care health professionals, and medical record audit. A directed content analysis used a pre-established palliative care practice framework of referral, admission, ongoing management, and terminal/discharge care. From this framework a Conversation Starter Tool for ACP was developed.The Tool was then used in orientation and continuing nurse education programmes. It provided palliative care nurses the opportunity to introduce and progress ACP conversations. [ABSTRACT FROM AUTHOR]

Opinion and government policy regarding homebirth remain polarised and contentious in many resource rich countries today and this controversy continues despite mounting evidence regarding the safety of homebirth for low risk women attended by competent midwives who are well integrated into responsive maternity care systems. In this environment midwives who provide care to women giving birth at home increasingly need to walk a fine line between their commitment to woman-centred care, increasing health service bureaucracy and regulatory responsibilities. This paper provides personal insights from the perspective of an academic and privately practicing midwife in Australia as to how midwives can provide homebirth services in a way that is both safe and sustainable so this important place of birth remains an option for childbearing women. [ABSTRACT FROM AUTHOR]

Australia's population is culturally and linguistically diverse, with approximately one quarter of the population born overseas (Australian Bureau of Statistics, 2005). Health-care research must be culturally sensitive and due consideration given to the unique ethical, cultural, and other issues that may arise. Issues in palliative care research have become more complex as the options of care at the end of life develop in respect to the requirements of different cultures. This paper highlights the issues that arose when conducting a qualitative study of the needs and experiences of Indian families with a relative requiring palliative care, and also proposes strategies to address the ethical and methodological problems that may arise when researching this vulnerable population. [ABSTRACT FROM AUTHOR]

Midwifery education in Australia has embraced competency-based learning models where assessment of clinical competency is fundamental to educational programmes. Both clinical and theoretical components of the programme need to be fulfilled and passed in order to register as a midwife. Concerns have been raised regarding competency-based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. It is the purpose of this paper to present the findings from a delphi study which aimed to gain consensus from experts regarding the appropriateness of using minimum requirements of birth and follow-through experiences for registration purposes in Australia. The delphi is stage two of a research project. Stage one involved a systematic review of literature to establish the evidence for measuring competency in midwifery practice using minimal requirements of stated clinical experience for registration purposes. The findings from this review concluded that no specific evidence exists for measuring competency in midwifery practice using minimum requirements of stated clinical experience for registration purposes. The results of the delphi indicate that there is consensus that prescriptive criteria should be incorporated to measure competence in midwifery students for registration purposes. Nevertheless, a number of significant issues were raised with regards to achieving minimum requirements in practice. [ABSTRACT FROM AUTHOR]

Background: A Massive Open Online Course (MOOC) on death and dying was conducted to open the dialogue around death and dying. In one activity, participants were asked to engage with language and to think of alternative words (or euphemisms) that are used to describe death. Aim: To reflect from a nursing perspective how language enables and sometimes disguises important messages and conversations. Methods: Four hundred and seventy one participants provided 3053 euphemisms. Findings: Euphemisms were varied, with many providing commentary on their purpose and use. Discussion: As a society we have become quite creative in the use of euphemisms, but need to be mindful of misunderstandings and misinterpretations which can cause embarrassment and distress in clinical situations. Conclusion: This paper describes some of the euphemisms that were provided, examining why they are used and how their use can be easily misconstrued in daily life and in clinical practice. [ABSTRACT FROM AUTHOR]

Neonatal death is one of the most challenging elements of nursing and midwifery practice and health professionals supporting parents following such a loss often develop their skills in bereavement care through experience and modelling from experienced peers. For student nurses and midwives who have limited exposure to neonatal death during their clinical experiences, developing the skills to support bereaved parents is a priority during their undergraduate education. Clinical simulations can aid student learning in this complex area of clinical practice and assist them to engage effectively in support for bereaved parents. This paper reports on a qualitative study where the use of neonatal resuscitation simulation is used to prepare a group of undergraduate (double degree) nurse midwives to support bereaved parents surrounding neonatal death. The findings indicate that this simulation can assist students to develop and reflect upon their bereavement support skills in the context of unexpected neonatal death. They also point to the need for equipping students with self care strategies to manage their personal responses to the highly emotive context of neonatal death and supporting the bereaved mother. [ABSTRACT FROM AUTHOR]

The use of negative pressure wound therapy (NPWT) for the treatment of wounds is not uncommon in modern health-care systems. However, use of NPWT as a wound prevention strategy, or 'well-wound therapy', is not so common. To date, papers that do discuss the use of NPWT in this way have focused mainly on orthopaedic and sternotomy wounds. This case study will present the use of NPWT with the goal of preventing laparotomy breakdown, utilising an innovative splinting technique. [ABSTRACT FROM AUTHOR]

Background: Integrated peripheral intravenous catheters (PIVCs) demonstrate clinical efficacy, however, device complexity and design differences may be a potential barrier to implementation. Aims: To assess nurse acceptability of integrated PIVC systems. Methods: A cross-sectional survey was nested within a multicentre randomised controlled trial. One hundred nurses caring for patients with integrated and non-integrated PIVCs completed a 17-item survey about key differences between devices (eg function and appearance, perceived patient comfort and skin injuries). Findings: Most nurses reported the integrated PIVC wings prevented device movement (80%), achieved patient comfort in areas of flexion (78%), and no patients developed skin injuries (100%). Nurses rated the ease of accessing and overall confidence using the integrated PIVC as significantly higher than the non-integrated design (P<0.001).Conclusion: The integrated PIVC received positive feedback from nurses and had few barriers to implementation. [ABSTRACT FROM AUTHOR]

This paper considers the recent controversies around the regulation of cosmetic surgery procedures. The author suggests that any review considering reform of the law in this area should not only look at issues concerning the safety of the procedures and competence of the practitioners, but should also address the question of which procedures should be allowed. In particular, the author advocates that there should be a review as to the whether cosmetic procedures should be made available to those under the age of 18 years. The paper also discusses analogous legislation in Queensland, Australia and explores whether this could be a useful model for legislative reform. [ABSTRACT FROM AUTHOR]

Background: Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed. Aim: To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia. Method: This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital. Results: The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences. Conclusion: Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that single rooms for patients improve patient dignity and privacy and reduce infection transmission, but they can be socially isolating. It is not well understood how single rooms affect long-stay patients. Aims: To understand the experience of being an inpatient in a ward with singleroom design. Methods: A qualitative, phenomenological study was conducted using semi-structured interviews with patients (n=10) in a newly built cancer hospital with a 100% single-room haematology ward. Interviews were analysed using Colaizzi’s (1978) seven-step analysis. Findings: Patients described their experiences of their acute stay using the concepts of privacy, isolation and independence, as well as enabling sleep. Privacy enabled patients to have their own toilet, was perceived to aid infection control and provided silence. Privacy came at a cost of isolation, but patients re-framed this as expected and necessary for self-preservation. Furthermore, they were unsure as to whether other patients would reciprocate social contact and instead relied on the healthcare team. Patients sought independence during their acute stay as it enabled them to control the environment and create a space for healing. The ability to sleep and be rested was also a critical feature of patients’ stay. Conclusion: The research highlighted that haematology patients prefer single rooms. However, because they experienced isolation, it also highlighted the importance of facilitating and enabling peer support within the haematology setting. [ABSTRACT FROM AUTHOR]

Women have a strong need to be involved in their own maternity care. Pregnancy hand-held records encourage women's participation in their maternity care; gives them an increased sense of control and improves communication among care providers. They have been successfully used in the UK and New Zealand for almost 20 years. Despite evidence that supports the use of hand-held records, widespread introduction has not occurred in Australia. The need for an electronic version of pregnancy hand-held records has become apparent, especially after the introduction of the Electronic Medical Record in Australia. A personal digital assistant (PDA) was developed as an interactive antenatal electronic maternity record that health-care providers could use in any setting and women could access using the internet. This article will describe the testing of the antenatal electronic maternity record. [ABSTRACT FROM AUTHOR]

Views on the global perspective of Maternity Coalition, a consumer childbirth movement based in Australia. Agitation for reform of maternity services; Influence and driven by service users working in alliance with sympathetic maternity care professionals and often midwives; Aim to humanize provision and address spiraling rates of childbirth interventions.

The Guidelines for a Palliative Approach in Residential Aged Care (Australian Government Department of Health and Ageing, 2004) are the result of the synthesis of evidence from three disciplines: geriatrics, gerontology and palliative care. Each paradigm challenges and informs the others, together developing a balanced and enriched understanding of palliative aged care. The guidelines address the challenges of the clinical and service delivery contexts of palliative care in residential aged care facilities, including the impact of complex, co-morbid illnesses with unpredictable trajectories; shorter, more dependent inpatient stays; and an evolving accreditation process. [ABSTRACT FROM AUTHOR]

Aim: this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. Background: most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. Design: a cohort study with control design. Method: sixty participants were purposively sampled and allocated to an intervention or a control group. Results: moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. Conclusion: the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping. [ABSTRACT FROM AUTHOR]

Medication errors can have deleterious effects on patient safety and care. Interruptions, patient acuity and time pressures have all been cited as contributing factors in the incidence of medication errors. Yet, despite the number of different strategies that can be taken to reduce the incidence of medication errors, they still occur. The strategies often focus on refining systems and processes, depending on the root cause of the error. However, less recognised as contributory elements are human factors such as anger, hunger or tiredness. The aim of this quality improvement initiative was to reduce medication errors by 25% on a medical ward, through the introduction of the hunger, angry, lonely, tired (HALT) model to address the human factors associated with medication errors. Post-implementation, the HALT model appeared to have resulted in a total reduction in medication errors over a 2-month period by 31%. Mistakes related to human error were reduced by 25%, and those linked to communication and documentation errors by 22%. While this was a small-scale study, this is a significant reduction in medication errors. However, caution should be used when addressing other contributing factors associated with medication errors as using HALT alone will not address these. [ABSTRACT FROM AUTHOR]

Background: Women's sexual function can be dramatically affected during and after pregnancy. Aims: To explore Australian women's personal experience of changes in their sexual function during pregnancy and childbirth. Methods: This was an online qualitative survey in which women across Australia who had given birth in the previous 12 months were invited to take part. A total of 273 responses were included. Findings: The five main themes that emerged were: mental health changes; obstetric violence (including lack of support from caregivers, violation of privacy, instrumental delivery and episiotomy); relationship issues (including lack of support from partner, lack of intimacy and domestic violence); physical changes (including birth trauma and negative body image); and role conflict (including role incompatibility, breastfeeding and lack of sleep). Mental health changes were reported to have both positive and negative impacts on women's sexual function. Conclusions: Women experience many changes in their sexual function during and after pregnancy. Health professionals should take an integrated approach to improve women's sexual function and overall wellness. [ABSTRACT FROM AUTHOR]

Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the gluteus maximus and gluteus medius muscles, respectively. However, little research has confirmed the reliability of these sites for the presence and thickness of the target and other muscles, and subcutaneous fat. This study characterised and compared these at the V-method and G-method ventrogluteal sites and dorsogluteal site (n=60). Gluteus maximus, medius and minimus were identified at each site, plus tensor fascia latae at ventrogluteal sites. Gluteus maximus and subcutaneous fat were significantly thicker and gluteus minimus significantly thinner at the dorsogluteal site than both ventrogluteal sites. Gluteus medius was the thickest muscle at each injection site, and thicker at the G-method than the V-method ventrogluteal site. Therefore, the dorsogluteal site reliably targets gluteus maximus, and the G-method ventrogluteal site was more reliable than the V-method ventrogluteal site to target gluteus medius in terms of presence and thickness. [ABSTRACT FROM AUTHOR]

Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure; however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients’ experiences of PVC insertion. Some 10 participants were purposively sampled for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter; technique of device insertion; competence of the inserter; and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences; siting the PVC in locations other than the antecubital fossa and hand; ensuring experienced and confident inserters are available to insert PVCs. [ABSTRACT FROM AUTHOR]

Background Postnatal depression symptoms are the most common mental health problem following childbirth. Aims This study aimed to investigate the association between sexual dysfunction, relationship dissatisfaction and symptoms of postnatal depression among Australian women during the first year after giving birth. Methods Australian women who had given birth during the past 12 months were invited to participate in a cross-sectional online study. A multi-section questionnaire was designed to collected data. Findings Almost a quarter of respondents (24%) reported symptoms of postnatal depression. The symptoms of postnatal depression were significantly associated with low educational level, exclusive breastfeeding, clinically diagnosed depression, sexual dysfunction, not being the initiator of sex during partnered sexual activity, and relationship dissatisfaction. The risk of depression symptoms was 2.2 times greater in women who had a low level of education, 2.5 times greater in women with sexual dysfunction and 3.7 times greater in women with relationship dissatisfaction. Conclusions Symptoms of depression are prevalent among postnatal women during the first year after childbirth and are significantly associated with sexual dysfunction and relationship dissatisfaction. [ABSTRACT FROM AUTHOR]

Some university schools of nursing in Australia and the UK have developed collaborative links with Malaysia to deliver part-time Transnational Higher Education (TNHE) post-registration top-up nursing degree courses. It enables nurses trained to diploma level to upgrade to a degree qualification. The views of 18 Malaysian nurses who had studied with one Australian and two UK TNHE universities were explored using a hermeneutic phenomenological approach. Participants recruited via convenience and snowball sampling methods were interviewed in English and Bahasa Malaysia (Malaysian language). Thematic analysis were used to analyse data. Findings indicated nurses’ frustration with technology-enhanced teaching and learning and a lack of support throughout the programme. Although nurses developed confidence in using computer technology, they remained disappointed with the level of academic support. The data and some useful strategies outlined provide important insights for TNHE providers, the Malaysian Nursing Board and private hospital employers to consider for enhancing nurses learning and experiences. [ABSTRACT FROM AUTHOR]

Objective: Chronic wound assessment requires a systematic approach in order to guide management and improve prognostication. Following a pilot study using the original TIME-H scoring system in chronic wound management, modifications were suggested leading to the development of the Modified TIME-H scoring system. This study investigates the feasibility and reliability of chronic wound prognostication applying the Modified TIME-H score. Method: Patients referred to the hospital's outpatient wound clinic over a 9-month period were categorised into one of three predicted outcome categories based on their Modified TIME-H score. Results: This study shows a higher proportion of patients in the certain healing category achieved healed wounds, with a higher rate of reduction in wound size, when compared with the other categories. The three categories defined in this study are certain healing, uncertain healing and difficult healing. Conclusion: The Modified TIME-H score could be a useful tool for assessment, patient-centred management and prognostication of chronic wounds in clinical practice and requires further validation from other institutions. Declaration of interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Aim: The aim of this case study was to explore the environmental challenges nurses experience with infection control practice, and the strategies they use to overcome those challenges. Method: An exploratory case study was conducted in four home visiting nursing organisations in southeast Queensland, Australia, using data triangulation (document review, individual interviews, and focus groups). Data were analysed using a framework approach to identify themes. Results: Three major infection prevention and control challenges were experienced in the community context. The first challenge is the nature of the work environment, including: poor cleanliness in clients' home environments, pets or vermin, inadequate hand-washing facilities, and a lack of appropriate storage space for clinical materials. The second challenge occurs when nurses lack access to appropriate infection control equipment, including wound-management materials and sharps containers. The third challenge is dealing with clients' poor personal hygiene and health status. Participants addressed these issues by offering assistance, using clean surfaces at clients' homes, applying an alcohol-based hand rub, providing client education, and reducing the cost of purchasing equipment for clients. Conclusion: It is imperative that policy is developed to support nurses' decision making and practices as they address infection control challenges in the community environment. Ensuring staff are well-supported with resources, education, policy, and guidelines to address these challenges is important for the delivery of safe and high-quality care in community settings. [ABSTRACT FROM AUTHOR]

International guidelines indicate that management of asthma during pregnancy should be multidisciplinary; however, the role of midwives has not been researched. Method: A qualitative descriptive study exploring Australian midwives’ current knowledge about asthma in pregnancy and their perceived role in antenatal asthma management was conducted, involving individual semi-structured in-depth interviews with 13 midwives in a tertiary referral hospital. Data were analysed using Morse and Field’s four-stage process. Findings: Midwives identified barriers preventing them from providing antenatal asthma management, including: lack of knowledge about asthma in pregnancy; time constraints; women’s knowledge about asthma in pregnancy; lack of a clear referral pathway; and lack of accessible asthma management equipment. Barriers were influenced by the institutional context in which the midwives worked. Conclusion: While participants identified barriers preventing them from providing recommended antenatal asthma management, they also suggested that improving their knowledge about asthma in pregnancy and developing a clear referral pathway may be beneficial. [ABSTRACT FROM AUTHOR]

Objective: To estimate the potential cost saving to the Australian health-care system of introducing the use of prophylactic dressings to prevent hospital-acquired pressure ulcers (PUs) for patients with a high-risk developing a PU. Method: We estimated the costs of pressure ulceration based on conservative estimates of an incidence rate of 13% within 10% of the total admitted Australian patient population. Results from a recent large randomised control trial of prophylactic dressing used to prevent PUs in high-risk patients were then extrapolated to this population to derive a potential national cost/benefit calculation. Results: Our estimate revealed that within the high-risk population of acute hospitals, more than 71,000 patients could be expected to develop a PU annually costing AU$77,800,000 (£43,000,000). Whereas by implementing a national PU prevention initiative based on the use of prophylactic multilayer silicone foam dressings for high-risk patients, an annual saving of AU$34,800,000 (£19,700,000) could be achieved, which represents a cost benefit of 55% to the Australian health-care system. Conclusion: Our estimate of the potential cost benefit of implementing the use of prophylactic dressings to prevent hospital acquired PUs in high-risk patients uses conservative estimates of both the incidence rates of ulceration and of treatment costs. However, this is also based on one of the largest reported randomised control trials of this technique to prevent PUs. We believe that our modelling is robust yet requires replication in other countries with different health-care systems and costing structures. [ABSTRACT FROM AUTHOR]

Researchers in Australia at the University of Adelaide have developed a process for turning waste plastic bags into a high-tech nano-material. This nanotechnology uses non-biodegradable plastic grocery bags to make carbon nanotube membranes that have a variety of applications, including filtration, sensing and energy storage. [Copyright &y& Elsevier]

Background/aims: Knowledge brokerage is a relatively new method for promoting knowledge translation in health -care services; it promotes knowledge translation through an intermediary person known as a knowledge broker. Knowledge brokerage was introduced in response to the recognised challenges to evidence -based practice as existing methods are found to have a variable impact on practice. Method s : This study was conducted using a single workplace, phenomenological, case study design. Seven participants, who are in academic, managerial, clinical and knowledge broker positions, were asked to reflect on their experience of participating in a pilot knowledge brokerage project within a regional health service. The Gibbs Model of Reflective Practice was used as a basis for both eliciting and analysing participant s ' reflections, and the data were analysed thematically. Findings: Themes that were identified across both time points and/or by both participants and the knowledge broker are reported here. These themes were classified into four categories : doing research ; lived experience ; building, cementing and maintaining relationships ; and enacting knowledge brokerage. Conclusions: A number of positive outcomes for the health service and university were identified, and knowledge brokerage will become a sustained feature of the relationship between these two organisations. This study has expanded the current evidence base for knowledge brokerage in health-care services, and provides information that may be useful to those considering implementation of knowledge broker roles for supporting evidence -based practice. [ABSTRACT FROM AUTHOR]

The relationship between social connection and health is widely recognised. However, there is a paucity of literature regarding the impact of district nursing care on social connection for people with a chronic illness such as type 2 diabetes mellitus (T2DM). Using a mixed-method approach, an exploration of the perceptions of older people living in the community with T2DM regarding their health and social connections was carried out. Findings revealed a strong relationship between the clients and the district nurse. The district nurse is an important aspect of clients' social connection. For some clients where their social connection is limited, the district nurse is a central element. When the district nurse is the major social connection, problems can arise for the client, especially when they are being discharged or changes are made to their care. [ABSTRACT FROM AUTHOR]

Aims/background: Occupational therapy (OT) and physiotherapy (PT) curricula content and preparedness for work-related practice and occupational health and safety (OHS) are not well documented. This study aimed to identify content and other elements of entry-level curricula in 23 OT and 17 PT programmes from Australia and New Zealand, and to identify educators' perceptions of OT and PT graduates' preparedness for work-related practice and OHS topics. Method: A telephone survey collected curricula content as well as teaching and assessment methods from 19 OT and PT work-related practice educators. Educators reported perceptions of new graduate preparedness for 22 topics in the field of work-related practice identified in an earlier study. Results included descriptive statistics and thematic analyses. Findings: Educators reported a high rate of inclusion (81%) of work-related practice topics in curricula. The main teaching method was theory (99.5%) and other methods included hands-on practical work with students and fieldwork with clients. Educators reported similar assessment processes across programmes. New graduates were prepared for practice with minimal supervision in the majority of topics (81%). Conclusions: Work-related practice content was included strongly and consistently in OT and PT entry-level curricula. However, as the majority of content was embedded in other courses, topics may not have been explicit and identifiable to students. New graduates were perceived to be prepared for practice with minimal supervision. This finding will assist employers to understand new graduates' preparedness for practice and needs for further development. Preparedness for practice in this field was similar to expectations of preparedness for other practice areas. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of a pilonidal sinus wound on patients' psychological wellbeing. Method: An interpretive descriptive approach, using the Model of Living conceptual framework, guided data collection and analysis. The Model of Living was chosen to elicit information on how a pilonidal sinus wound affected activities of living. Participants were recruited from a database of a community nursing service, using purposive sampling, until data saturation was evident. Semi-structured interviews were used to collect the data. Data were examined for frequent patterns, which were organised into themes. Results: Seven males and four females with ages ranging 17-39 years were selected through purposive sampling. Five participants reported that their wound affected their psychological wellbeing. Three themes and eight subthemes were identified from the data: adaption, perception and control. Depression and stress were associated with pain, physical inactivity, body weight changes and delayed wound healing. Conclusion: A pilonidal sinus wound can affect the psychological wellbeing of patients through pain, physical inactivity, changed body weight and delayed wound healing. Pre-existing conditions could also be exacerbated by the wound. Declaration of interest: The study was part of the requirement of a Master of Nursing, and a scholarship of $2000 was granted by Regal Health Services to assist with the study. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

The article discusses an exploratory study examining oral discomfort from the perspective of terminally ill patients by conducting interviews based on the experiences and perceptions of oral discomfort and effects on regular functioning among 14 palliative care patients. Vulnerability of terminally ill patients to oral problems is discussed. Results of the study reveal that all the patient had oral issues, which negatively affected their quality of life.

The Australian Integrated Mental Health and Palliative Care Task (IMhPaCT) project aimed to improve the quality of palliative care for people with a severe and persistent mental illness and those who develop mental health issues as a response to their diagnosis of a life-limiting illness. These patients and families are generally cases of high complexity and require strong collaboration and cooperation across various service sectors. Education across both palliative care and mental health services was identified as a key objective in improving palliative care service delivery in this patient population.This article specifically addresses one aspect of the project-the education strategy. The processes of development, implementation, and evaluation of outcomes are discussed. [ABSTRACT FROM AUTHOR]

In July 2010, a major shift occurred in Australia's nursing and midwifery community, with the nationalizing of education and registration. With this shift came mandatory continuing professional development (CPD), coming into line with current practices in the UK. This has raised issues relating to finance, motivation and the potential dichotomy of interests relating to employee and employer. CPD has many benefits for both parties, but due to financial and organizational pressures it may prove difficult to please both sides. It is vital that a way forward is found that enables nurses and midwives to update their skills, in ever-changing areas of practice, whilst also satisfying the needs of the organization. Practitioners need to become more adept at identifying and utilizing educational opportunities in all their forms. [ABSTRACT FROM AUTHOR]

The article offers world news briefs related to international organisations. The focus of the Management Association (AWMA) in 2011 is to increase awareness of the discomfort and burden experienced by people with chronic wounds in Australia. Peggy Ahearn was appointed as executive director for the Canadian Association of Wound Care (CAWC). The European Pressure Ulcer Advisory Panel (EPUAP) will hold its annual meeting in Porto, Portugal on August 31 to September 2, 2011.

An exploratory qualitative study was undertaken with the aim of examining oral discomfort from the perspective of terminally ill patients. Interviews focusing on the experiences and perceptions of oral discomfort and effects on day-to-day functioning among 14 palliative care patients from a mid-size hospital in a regional city in Australia were conducted. The findings reveal that a range of oral problems significantly impact on the physical, social and psychological wellbeing of terminally ill patients to varying degrees, sometimes over extended periods of time. In particular, dry mouth (xerostomia) was experienced as a significantly troubling and ongoing symptom, and bouts of ulceration and infection were also commonly discussed. Furthermore, participants reported a lack of oral assessment and virtually no input from dental experts to assist with palliating oral problems. A better understanding of the impact of oral discomfort among terminally ill patients is a significant care issue for hospice and palliative care teams, especially nursing staff, and further research of this significant issue is required. The results of the current study provide preliminary evidence to support raising the clinical focus and priority of oral care for terminally ill patients in all settings. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to enhance the understanding of the baby boom generation's use and perception of recommended assistive technology. Methods: A mixed quantitative and qualitative research design was employed, primarily based on a phenomenological framework. Literature was reviewed to provide an overview of the factors found to influence the use of assistive technology. Twelve patients (born 1946-1965 inclusive) from a regional Australian public hospital, who were recommended assistive technology upon discharge, were administered questionnaires. Semi-structured interviews were undertaken with four participants. Findings: Eight participants followed recommendations to hire/purchase assistive technology. All of the participants who obtained recommended assistive technology stated they 'used' it. Cost was identified as influencing non-use.Conclusions: There was some variation from the literature in factors that influenced use, highlighting the importance of further examination of baby boomers and assistive technology use. The importance of choice and the diversity of opinion shown within this study group reinforces the need for a focus on patient-centred practice and acknowledgement of individual needs in the prescription of assistive technology. [ABSTRACT FROM AUTHOR]

The concept of woman-centred care is fundamental to midwifery and underpins the philosophy statements of midwifery professional organizations. It has also been used as a framework in a range of policy documents and standards related to midwifery and maternity service provision, notably in the UK and Australia. This discussion article questions the conceptual and practical implications of substituting 'women-centred care' for 'womancentred care' in terms of addressing women's individual needs and shifting the locus of control away from the institution and professionals towards the woman herself. Contested meanings of woman-centred care and empowerment are explored in relation to conceptual interpretations and the development of projects involving midwifery continuity of care. [ABSTRACT FROM AUTHOR]