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To analyse the psychometric properties of the Braden scale to assess pressure injury risk in adults in intensive care. A systematic review was conducted, with literature searches undertaken in five electronic databases. No date limits were applied. Selection, data extraction and risk of bias assessment were completed by two reviewers independently. A customised data extraction template was used, with risk of bias conducted using the COSMIN Risk of Bias checklist. Data were analysed using narrative synthesis. Thirty-four studies met inclusion criteria. Two studies reported internal consistency with Cronbach's alpha ranging from poor (0.43) to good (0.85). For interrater reliability, only four studies reported intraclass correlation, ranging from 0.66 to 0.96 for Braden sum score. Three studies reported convergent validity, with strong associations found between the COMHON Index (r = 0.70), Cubbin-Jackson scale (r = 0.80), and Norton scale (r = 0.77), but contrasting associations with the Waterlow score (r = 0.22 to 0.72). A large majority of studies reported predictive validity (n = 29), with wide variability. Several studies investigated optimal cut-off scores, with the majority indicating this was in the range of 12–14. This review demonstrates inconsistency in the psychometric properties of the Braden scale in ICU settings. Further research is needed to determine suitability of the Braden scale for ICU before it can be recommended as standard for clinical practice, including comparison with other ICU-specific risk assessment tools. When used in ICU, the reliability, validity and reported cut-off scores of the Braden scale are variable. As a predictive tool, the scale should be used cautiously. In ICU, the value of the Braden scale resides in its ability to identify patients that are most at risk of developing a pressure injury and to implement preventative measures to mitigate identified risk factors. [ABSTRACT FROM AUTHOR]

To assess the interrater reliability of the COMHON (level of CO nciousness, M obility, H aemodynamics, O xygenation, N utrition) Index pressure injury risk assessment tool. Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated. Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey. Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (r s) for ordinal variables. All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 – 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score. The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted. Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to provide a rich description of the lived experiences of parents whose child had received care in a new paediatric emergency department. A descriptive phenomenological design was used. Semistructured interviews were conducted with 18 parents. Participants were asked to describe their experience of having a sick or injured child treated at the paediatric emergency department, recounting the story of their journey from when their child was first sick or injured, through to their experience within the emergency department, until discharge home. Data were analysed using Colaizzi's phenomenological approach. Following analysis, six themes emerged: I can't imagine my life without her; Keeping me up to date with what was happening; They treated my child in a way that was toddler friendly; They had our child's best interest at heart; We were working as a team; and There are games and books in the waiting room. The findings demonstrated that parents' experience of having an ill or injured child treated by the paediatric emergency department was a positive experience and highlighted factors that contributed to this experience. These included open communication, competent and skilled staff, being seen in a timely manner and being cared for in a thorough, family inclusive and child-friendly way. [ABSTRACT FROM AUTHOR]

• Falls are a major cause of ED presentation, particularly for older people. • Admission to hospital carries an increased risk of further falls. • Screening is required to help prevent unnecessary falls-based admissions. • Use of a short multi-factor screening tool was found to be time-efficient. • Further research is required on completing ED referrals based on screening results. The purpose of this study was to evaluate use of a short multi-factor falls-risk screening tool for older people within the emergency department, to enable rapid identification of falls-risk and triggers for multidisciplinary referral for further falls-specific assessment. Older people, aged ≥70 years, presenting to the emergency department with a fall-related injury or disease (n = 137) were recruited by a research nurse following randomisation. A short multi-factor screening tool was completed, comprised of 14 falls-risk-related assessment components. Only one participant did not generate any referrals. Participants generated most referrals for medications (85.4%), social and housing (84.6%), vision (67.2%), podiatry (66.9%), or function and mobility (54.7%). Based on our results, the screening tool could be reduced to eleven components. The median time-to-screen was 11 min (IQR 9–15), with 736 triggers generated for referral and further assessment of falls-risk. Falls are a major cause of ED presentation for older people. A short multi-factor screening tool with eleven components could be adapted to local familiar falls-risk tools and be completed in less than 10 min. Further research to trial the feasibility of completing ED referrals based on screening results is required to confirm the usefulness of such screening and referral within the ED. [ABSTRACT FROM AUTHOR]

To identify paediatric emergency department nurses' perceptions of factors influencing parents' understanding of discharge information. Content analysis was used to analyse data from three semi-structured focus groups with nurses from a paediatric ED. Findings were interpreted within the three domains of structure , process , and outcomes from the Donabedian model. Within the structure domain, barriers to effective provision of discharge information included inexperienced emergency department staff and time policies. Enablers included availability of interpreter services. Process-related barriers included parents' health related behaviour and health literacy, while enablers included ensuring parents understood discharge information. Nurses' perceptions of ineffective outcomes involved the risk of parents receiving incomplete or inappropriate information. Nurses perceived effective outcomes in quality of care were related to their professional experience and competence in being able to provide useful information to parents. This study investigated ED nurses' perceptions of factors that influence parents' understanding of discharge information. Interpreting findings within the Donabedian model provided important directions for future improvements to structure, processes and outcomes for provision of discharge information to parents leaving a paediatric ED. Ultimately, the findings from this study could inform future research to maximise the role of ED nurses in providing a high quality of discharge care for children discharged from the ED. [ABSTRACT FROM AUTHOR]

Background Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging ‘navigator’ role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement through the emergency department. Methods A 20-week project was implemented to evaluate an emergency department nurse navigator role. A controlled trial was used. The navigator worked on a week-on-week-off basis, eight hours per day, seven days per week. Time-based and cost-associated outcomes were compared. Results Data from nearly 20,000 presentations during the trial period were analysed. All outcomes were improved during the ten weeks the Navigator was working. A slight improvement in National Emergency Access Target compliance was shown, with an average of 4.5 min per presentation saved. The labour cost associated with the time saved was estimated to be $170,000. Conclusions The results from this study indicate that for a relatively small investment, complementary nursing roles such as the navigator can impact emergency department patient flow. However, further studies are required to determine optimisation of the role. Relevance to practice This study provides rigorous evidence of the effects of a nurse navigator role on emergency department throughput. Whilst positive outcomes were demonstrated, suggesting a whole-of-system benefit, the magnitude of effect on a per-presentation basis was relatively small. Further studies are required to demonstrate the clinical relevance of such roles. [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]

Purpose: The aim of this study was to assess the validity and reliability of psychological screening tools in outpatient heart transplant recipients. Methods: Forty-eight heart transplant recipients completed the Patient Health Questionnaire 9-item scale (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Kessler Psychological Distress 10-item Scale (K-10) and Medical Outcomes Short Form 36-item Health Survey. A structured psychological interview (Mini International Neuropsychiatric Interview Version 6) was conducted after completion of the questionnaires. Internal consistency, criterion validity and construct validity of the PHQ-9, GAD-7 and K-10 were evaluated. Results: Internal consistency supported the reliability of the screening tools. The optimal cut-off on the PHQ-9 for depression was 10 (sensitivity = 0.86; specificity = 0.93). A score of 6 on the GAD-7 maximized sensitivity (0.75) and specificity (0.89) for anxiety. A score of 17 on the K-10 was the optimal cut-off for diagnosis of either anxiety or depression (sensitivity = 0.83; specificity = 0.84). Increasing scores on the screening tools were associated with lower health-related quality of life. Conclusion: Psychometric analyses support the reliability and validity of the PHQ-9, GAD-7 and K-10 as screening tools for detection of anxiety and depression in heart transplant recipients. [ABSTRACT FROM AUTHOR]

Background Provision of paediatric specific service areas within a hospital servicing both adult and paediatric populations is relatively novel. In Australia this is an emerging model for service delivery that takes into account the specific health needs of paediatric patients. To date, information related to the practice transition required by staff when adopting this model of care is lacking. Such information can contribute to informing service quality and identify staff perceived barriers and enablers during adoption of the model. The potential benefit of such knowledge is the early mitigation of issues and delineation of professional development requirements. The aim of this study was to investigate staff experiences of transitioning from an essentially adult emergency department with minimal paediatric presentations to a new co-located paediatric emergency department. Methods A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 emergency department staff (10 Nursing, 8 Medical) before and after the opening of the paediatric emergency department. Data were analysed thematically. Results Five themes emerged from the data analysis, these were: (1) I am really scared that I won’t have the skills necessary, (2) Having a good knowledge base helps, (3) Open, transparent communication is definitely the best thing, (4) Personality plays an important role and (5) Perceptions regarding need to separate the services. Conclusions The findings demonstrated the complexity of the change process and highlights various factors that staff found contributed positively to the change process. These included the need for clear and open communication at all levels, focused educational opportunities, and employment of staff with a positive attitude towards change. Relevance to practice Clear organisational communication and professional support are central components identified by staff to enable a more successful transition from one type of service to another. [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]

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]

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]

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]

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]