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1. Registered Nurses' experiences of reading and using research for work and education: a qualitative research study

Author: Sonia Hines, Joanne Ramsbotham, and Fiona Coyer
Subjects: Nursing, Research, Research literacy, Focus groups, Qualitative research, Mathematics anxiety, RT1-120
Abstract: Abstract Background Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice. Aims This study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education. Design A qualitative descriptive study using online and in-person focus groups. Methods Focus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis. Results Three distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles. Conclusion This study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.
Published: 2022
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2. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial

Author: India Pearse, Amanda Corley, Emily N. Larsen, Claire M. Rickard, Robert S. Ware, Jill Campbell, Fiona Coyer, Evan Alexandrou, Catherine O’Brien, and Nicole Marsh
Subjects: Central venous access device, Dressing failure, Intensive care unit, Medicine (General), R5-920
Abstract: Abstract Background Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. Methods This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) ‘standard’ (in accordance with local hospital policy) CVAD dressings (control) or (2) ‘standard’ dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is ‘dressing failure’ defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). Discussion This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021
Published: 2022
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3. Optimising reflective capacity of nursing students after high fidelity simulation: A practical approach

Author: Naomi Tutticci, Fiona Coyer, and Mary Ryan
Subjects: Law in general. Comparative and uniform law. Jurisprudence, K1-7720, Education, Medicine (General), R5-920
Abstract: Navigating simulation as a nursing student is challenging. It requires critical thinking, high levels of reflection and emotional investment. Reflection fatigue can result from knowing that reflection is important but feeling reluctant to expose oneself to critique. This practical discussion explores how nurse educators can optimise nursing students’ reflective thinking within simulation and develop debrief strategies that optimise critical reflection. Debrief is a teaching and learning episode within simulation that aims to challenge students to develop their thinking and practice, without compromising instruction. Much debrief practice tends towards instruction at the expense of student self-exploration, and preparation for assessment at the cost of critical reflection. The practical approach to debrief discussed here is a timely reminder to step back and re-assess the practice of debrief. This discussion will assist nurse educators to implement a debrief that supports reflection at the highest level. Four familiar strategies of teaching and learning, when combined within debrief, can optimise the reflective capacity of nursing students: role modelling and vicarious observation, scaffolding of reflective thinking, emotional processing, and student-centred reflection. The practical strategies presented are relevant to both Australian and international nursing higher education contexts.
Published: 2021

4. Health literacy in Indigenous people with chronic disease living in remote Australia

Author: Haunnah Rheault, Fiona Coyer, Lee Jones, and Ann Bonner
Subjects: Health literacy, Health literacy questionnaire, HLQ, ATSI health, Chronic disease, Rural and remote health, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics. Methods Using a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy. Results Participants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy. Conclusion Improved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients’ needs and health capabilities to better support people to engage in effective self-management for chronic diseases.
Published: 2019
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5. The effectiveness of interventions to reduce peripheral blood culture contamination in acute care: a systematic review protocol

Author: J. A. Hughes, C. J. Cabilan, Julian Williams, Mercedes Ray, and Fiona Coyer
Subjects: Systematic review, Blood culture, Contamination, Microbial contamination, Acute care, Peripheral blood collection, Medicine
Abstract: Abstract Background Blood cultures are an integral part of the diagnosis of bacteremia in unwell patients. The treatment of bacteremia involves the rapid and accurate identification of the causative agent grown from the blood cultures collected. Contamination of blood cultures with non-pathogenic microbes such as skin commensals causes false positive results and subsequent unnecessary and potentially harmful interventions. While guidelines for blood culture quality recommend no more than 2–3% contamination rate, rates up to 12% are reported in the literature. There have been a number of methods proposed to reduce the contamination of blood cultures, including educational interventions, changing of skin cleansing preparations and introduction of blood culture collection packs in acute care settings. This protocol outlines methods to identify and evaluate interventions to reduce blood culture contamination in the acute care setting. Methods The reviewers will conduct a systematic search of literature in CINHAL, PubMed, EMBASE and the Cochrane Central register of controlled trials. Unpublished works will be identified in ProQuest Dissertations and Theses. Articles will be assessed for relevance based on their title and abstract. Remaining relevant citations will have their full text retrieved and assessed against eligibility criteria. All studies that meet the eligibility criteria will have their methodological quality appraised. Assessments for relevance and methodological quality will be conducted independently by two reviewers. If appropriate, data will be analysed using the Mantel-Haenszel method under a random effects model. Heterogeneity of the studies will be assessed using the I 2 and chi-squared statistic. Meta-analysis will be attempted if the data is suitable. Discussion This review will identify and summarise the interventions previously described in the literature aimed at reducing peripherally collected blood culture contamination rates in acute care. These findings have the potential to lead to multifaceted interventions based on previous evidence to reduce blood culture contamination in the acute setting. Reductions in the proportion of contaminated blood cultures have the potential to save money, unrequired treatment (particularly antimicrobials) and hospital bed days. Systematic review registration In accordance with guidelines outlined in the PRISMA-P methodology, this protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on December 8, 2017, and last updated on January 4, 2018 (registration number CRD42017081650).
Published: 2018
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6. Using a knowledge translation framework to identify barriers and supports to effective nursing handover: A focus group study

Author: Adriana Hada, Leanne Jack, and Fiona Coyer
Subjects: Barriers and facilitators, Clinical handover, Focus group, Knowledge translation, Nursing, Qualitative research, Science (General), Q1-390, Social sciences (General), H1-99
Abstract: The aims of this study were to systematically assess the barriers and facilitators to evidence-based nursing handover in a clinical environment, and to identify potential adopters and attributes of evidence-based nursing handover for translation into practice. The study was conducted in the medical wards of a major tertiary referral hospital in Brisbane, Australia. Participants comprised registered and enrolled nurses permanently employed in the participating wards for at least three months prior to the commencement of study. Using a qualitative focus group design, a context specific assessment of the barriers and enablers to knowledge translation was performed through five semi-structured focus groups. Focus groups discussions were recorded by a registered court reporter using a stenotype machine for voice to text transcription, transcribed verbatim and de-identified for analysis. Focus group data were analysed using thematic analysis.Three themes emerged from the focus group discussions: 1) Content (information transferred); 2) Process (steps used to transfer accountability and responsibility for care); and 3) Environment (factors impacting on safe handover). Participants identified barriers to effective nursing handover including variability of handover content and process, uncertainty around sharing sensitive information, inconsistency around clarifying gaps through questioning during the handover, superficial patient involvement, time constraints and environmental challenges. Key facilitators discussed during the focus groups were the use of integrated electronic medical records, support and clear expectations from the nursing leadership and targeted handover education.During the focus group discussions, participants identified several barriers and facilitators to effective handover. These findings will guide the development of research translation strategies to support the implementation of best practice, standardised clinical handover.
Published: 2019
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7. Correction to: Health literacy in indigenous people with chronic disease living in remote Australia

Author: Haunnah Rheault, Fiona Coyer, Lee Jones, and Ann Bonner
Subjects: Public aspects of medicine, RA1-1270
Abstract: In the original publication of this article [1], some values are missing in Table 3. Table 3 is revised in the updated figure below:
Published: 2019
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8. The viability and acceptability of a Virtual Wound Care Command Centre in Australia

Author: Michelle Barakat‐Johnson, Badia Kita, Aaron Jones, Mitchell Burger, David Airey, John Stephenson, Thomas Leong, Jana Pinkova, Georgina Frank, Natalie Ko, Andrea Kirk, Astrid Frotjold, Kate White, and Fiona Coyer
Subjects: Wound Healing, Trauma Centers, Australia, Humans, Surgery, Dermatology, Referral and Consultation
Abstract: The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7 months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5 hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.
Published: 2022

9. State‐wide prevalence of pressure injury in intensive care versus acute general patients: A five‐year analysis

Author: Paul Fulbrook, Josephine Lovegrove, Fiona Coyer, and Karen Hay
Subjects: critical care, prevalence, hospital-acquired, benchmarking, General Medicine, acute care, pressure injury, General Nursing, intensive care
Abstract: Aim The aim of this study was to analyse prevalence of pressure injury in intensive care versus non-intensive care patients. Background Hospital-acquired pressure injury is an enduring problem. Intensive care patients are more susceptible due to multiple risk factors. Several studies have indicated that intensive care patients are more likely than general patients to develop pressure injuries. Design Secondary data analysis. Methods Eighteen general hospitals with intensive care units were included. The sample included all consenting patients. Logistic regression modelling was used to derive prevalence and effect estimates. STROBE reporting guidelines were followed. Results The sample comprised 15,678 patients; 611 were in intensive care. The crude prevalence estimate of hospital-acquired pressure injury was 9.6% in intensive care and 2.1% in non-intensive care patients. The ≥Stage II hospital-acquired prevalence estimate in was 8.6% intensive care and 1.2% in non-intensive care patients. Intensive care patients were at markedly increased risk of hospital-acquired pressure injury compared with non-intensive care patients, with risk persisting after adjusting for pressure injury risk score. Risk of ≥ Stage II hospital-acquired pressure injury was further elevated. Intensive care patients had a higher pressure injury risk level and developed a greater proportion of severe hospital-acquired pressure injuries than non-intensive care patients. In intensive care, most hospital-acquired pressure injuries were found on the sacrum/coccyx and heels. Conclusions There were significant differences between the hospital-acquired pressure injury prevalence of intensive care versus non-intensive care patients, which is consistent with previous studies. Overall, the prevalence of hospital-acquired pressure injury in intensive care is relatively high, indicating that their prevention should remain a high priority within the intensive care setting. Relevance to Clinical Practice These results may be used for benchmarking and provide a focus for future education and practice improvement efforts. Patient or Public Contribution Neither patients nor the public were directly involved in the project.
Published: 2023

10. The illness severity of ward remaining patients reviewed by the medical emergency team: A retrospective cohort study

Author: Anthony Batterbury, Clint Douglas, and Fiona Coyer
Subjects: General Medicine, General Nursing
Published: 2023

11. End‐user perceptions of sub‐epidermal moisture scanning ( <scp>SEMS</scp> ) acceptability: A descriptive qualitative study

Author: Georgia Tobiano, Jill Campbell, Gary Allen, Fiona Coyer, Brigid M. Gillespie, Zena Moore, Tracy Nowicki, Rachel M. Walker, and Wendy Chaboyer
Subjects: General Nursing
Published: 2023

12. Preventing pressure injuries among patients in the intensive care unit: insights gained

Author: Stijn Blot, Sonia Labeau, and Fiona Coyer
Subjects: Pressure Ulcer, Intensive Care Units, Critical Care, Humans, Critical Care and Intensive Care Medicine
Published: 2022

13. Device-related pressure ulcers: SECURE prevention. Second edition

Author: Amit Gefen, Paulo Alves, Guido Ciprandi, Fiona Coyer, Catherine T Milne, Karen Ousey, Norihiko Ohura, Nicola Waters, Peter Worsley, Joyce Black, Michelle Barakat-Johnson, Dimitri Beeckman, Jacqui Fletcher, Holly Kirkland-Kyhn, Nils A. Lahmann, Zena Moore, Yohan Payan, and Anna-Barbara Schlüer
Subjects: Pressure Ulcer, Nursing (miscellaneous), Humans, Fundamentals and skills, Nursing
Abstract: Although great strides have been made to tackle hospital-acquired pressure ulcers (HAPUs), there is a need for greater recognition of device-related pressure ulcers (DRPUs), including their causes, management and prevention. This consensus statement, an updated second edition, aims to continue raising awareness of these largely preventable injuries and, crucially, to stimulate action. DRPUs are relatively common and account for a growing proportion of HAPUs. Updated information on the incidence of DRPUs is described in chapter 1. Although it is recognised that DRPUs increase the financial burden of healthcare, there is little formal analysis of their economic impact. This needs to be addressed; robust evidence on the burden of DRPUs and the value that can be released by adopting prevention strategies is needed to help drive action. Our understanding of the pathophysiology of DRPUs has improved significantly over the past few years; this is described in chapter 2. One crucial difference between PUs and DRPUs is that body-weight forces are less significant in DRPUs, with the force being exerted from a device that is typically strapped or taped onto the body. Devices and their securement may generate high stress concentrations in tissues, leading to cell and tissue-damage pathways associated with sustained deformation. As more evidence is published on DRPUs, recurring themes are emerging, as outlined in chapter 3: The most vulnerable patients are bearing the brunt of DRPUs; paediatric and neonatal patients, and all those needing critical care are particularly susceptible. During the COVID-19 pandemic, a new high-risk population (people with severe COVID-19 infection) emerged. They are at increased risk of DRPUs because of their need for prolonged ventilatory support, especially when 'proning' Devices associated with DRPUs are often used to perform essential, life-saving functions. They include continuous positive airway pressure (CPAP) masks or endotracheal tubes. Minimising their use is clearly not an option, so practice innovation is needed Although the most common locations for DRPUs are the face, ears, lower legs and heels, any location where a device comes into close contact with the skin can be at risk. In the same vein, any device, whether needed for a medical purpose or not, has the capacity to cause injury if its use is not properly managed. Vigilance is needed for all patients. What can be done? The importance of routine risk assessment is covered in chapter 4. Although use of a validated risk assessment tool is the vital first step, this will not be enough on its own. Several steps can be taken to ensure the safe use of devices. These are described in chapter 5 and include device repositioning, cushioning with prophylactic dressings and moisture control (only where possible and clinically appropriate). Of key importance is the development of an institutional protocol and champions to ensure all necessary steps are adopted. For any of these changes to be put into practice, awareness of DRPUs needs to increase. A number of proposals are outlined in chapter 6. A change of focus among health professionals and policy makers, along with more investment in education and training, are needed. All patients being managed with a medical device must be considered as at high risk. The pandemic introduced the world to the problem of DRPUs in health professionals caused by the extended wear of personal protective equipment. Health professionals also have a right to expect institutional protocols and provision of devices that protect them from DRPUs. Cutting-edge ideas and technologies that may be available in the future are described in chapter 7. When designing new products, manufacturers of medical devices have a duty of care to investigate the risks of DRPUs associated with their products and mitigate them, wherever possible. Our developing understanding of how the design, structure and materials used in medical devices contribute to DRPUs will help us develop new solutions for tomorrow. The first step is for everyone involved to ask themselves, 'what can I do to help?' There is work to be done-your journey to reduce DRPUs starts here!.
Published: 2022

14. A theory-based research literacy intervention for nurses: A pilot study

Author: Sonia Hines, Joanne Ramsbotham, and Fiona Coyer
Subjects: Adult, Literacy, Evidence-Based Practice, Humans, Learning, Nurses, Pilot Projects, General Nursing
Abstract: Difficulties with understanding research literature can lead to nurses having low engagement with evidence-based practice (EBP). This study aimed to test the feasibility of an education intervention using an academic literacies approach to improve nurses' research literacy.An interactive workshop was devised utilizing genre analysis and tested in a pre/post pilot study. EBP self-efficacy was measured at baseline and posttest using the Self-Efficacy in Evidence-Based Practice instrument (26 items on an 11-point scale for total scores from 0 to 260). Research comprehension was measured with a 10-question quiz (range 0-10).When analyzed with a paired t-test, EBP self-efficacy increased significantly (MD: 56.9, SD: 39.9, t = 4.5, df = 9, p .001). Research comprehension also improved (MD: 1.1; SD: 1.1, t = 2.9, df 9, p .01). The workshop evaluations (n = 9) were overwhelmingly positive.This novel approach to research pedagogy aligns well with adult learning theory and social learning theory and is suitable for small group learning in continuing education. There is considerable potential for further work in this area. Genre analysis shows promise as a strategy for teaching nurses to understand research literature.
Published: 2022

15. Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study

Author: Glenn Gardner, Helen Gosby, Fiona Coyer, Anne Gardner, and Christopher Helms
Subjects: mixed‐method design, clinical learning and teaching, Specialty, Delphi method, nurse practitioners, Likert scale, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Delphi technique, Content validity, Humans, 030212 general & internal medicine, Nurse education, General Nursing, computer.programming_language, Medical education, 030504 nursing, capability, practice-based learning, Original Research: Empirical Research–Mixed Methods, Professional development, Australia, practice‐based learning, mixed-method design, Research Papers, nurse education, Respondent, Medicine, 0305 other medical science, Psychology, computer, Delphi, metaspecialty
Abstract: To achieve profession-wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties).Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three-round Delphi study (Survey Phase).Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in-depth interviews of purposeful sample of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web-based Delphi surveys), with draft standards reviewed profession-wide. Responses comprised scoring using Likert scales to calculate content validity indexes for individual standards with qualitative responses supporting decision-making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of individual and group feedback. The study was conducted 2014-2017.Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy-three standards were validated, with final content validity indices of 92-100%. Scale-level indices were 98%, strongly validating metaspecialty taxonomy.A research-derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education.The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.目的: 就六大澳大利亚执业护士专业领域的临床实践标准达成专业共识 (称为元专业) 。设计: 序贯混合法和初步解释研究 (解释阶段) , 随后是修正的三轮德尔菲研究 (调查阶段) 方法: 招募了来自澳大利亚所有司法管辖区的参与者。主要的资格标准是目前认可的具有12个月或以上经验的执业护士。解释阶段包括对有目的的执业护士进行深度访谈, 以确定临床护理活动和实践过程。制定了六套与先前确定的六个元专业相关的临床实践标准草案。调查阶段的第一轮结果将被告知 (六项基于网络的德尔福调查) , 并在整个专业范围内审查标准草案。回答包括使用李克特量表进行评分, 以计算单个标准的内容有效性指数, 以及提供支持决策的定性回答。在第二轮和第三轮, 参与者在考虑个人和小组反馈后, 对原始标准或修订标准的相关性进行评级。该研究于2014年‐2017年进行。结果: 解释阶段: 对16名执业护士的访谈数据进行分析, 得出了75项标准草案。调查阶段: 221名执业护士完成第一轮 (20%合格的澳大利亚执业护士) 。加权受访者保留率为92%。共验证了73项标准, 最终的内容效度指数为92‐100%。规模级指数为98%, 对元专业分类法具有很强的验证性。结论: 制定了一套由研究衍生并经专业认可的执业护士临床实践标准。这提供了一个广泛的临床学习结构与元专业指导执业护士学生临床教育。影响: 临床实践标准和元专业分类加强了国内外护士临床教育和专业发展。这些新颖的研究方法和发现适用于其他保健专业的高级专业角色。.
Published: 2020

16. Nurse-led randomised controlled trials in the perioperative setting: A scoping review

Author: Judy Munday, Niall Higgins, Saira Mathew, Lizanne Dalgleish, Anthony S Batterbury, Luke Burgess, Jill Campbell, Lori J Delaney, Bronwyn R Griffin, James A Hughes, Jessica Ingleman, Samantha Keogh, and Fiona Coyer
Subjects: Advanced and Specialized Nursing, Medical–Surgical Nursing
Published: 2022

17. Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review

Author: Niall Higgins, Judy Munday, Saira Mathew, James A. Hughes, Fiona Coyer, Bronwyn Griffin, Jill Campbell, Lori Delaney, Lizanne Dalgleish, Jessica Ingleman, Samantha Keogh, Anthony S Batterbury, and Luke Burgess
Subjects: medicine.medical_specialty, education.field_of_study, Randomization, business.industry, 030503 health policy & services, Population, General Medicine, Perioperative, law.invention, Clinical trial, 03 medical and health sciences, Critical appraisal, 0302 clinical medicine, Systematic review, Randomized controlled trial, Data extraction, law, medicine, 030212 general & internal medicine, 0305 other medical science, Intensive care medicine, education, business, General Nursing
Abstract: Purpose : Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. Methods : This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014– 19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. Results : From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. Conclusion : Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
Published: 2020

18. Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study

Author: Anna Doubrovsky, Fiona Coyer, Harn‐Rong N. Wang, Jill Campbell, Johnathon Collins, and Veeranjit Singh
Subjects: Adult, Male, medicine.medical_specialty, Longitudinal study, Critical Illness, Dermatology, law.invention, Neck Injuries, Immobilization, Young Adult, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, law, Intensive care, medicine, Chi-square test, Humans, Longitudinal Studies, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Pressure Ulcer, business.industry, Incidence, Protective Devices, Incidence (epidemiology), Australia, Original Articles, Odds ratio, Middle Aged, Intensive care unit, Confidence interval, Intensive Care Units, Emergency medicine, Cervical Vertebrae, Female, Surgery, Cervical collar, business
Abstract: Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C‐collar) device in situ and are subsequently exposed to device‐related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C‐collar‐related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C‐collar were retrieved over a 9‐year period. Chi square and t‐tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine‐year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C‐collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024‐1.723, P = .033). Time in the C‐collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P
Published: 2020

19. Identifying nurse sensitive indicators specific to haemodialysis nursing: A Delphi approach

Author: Ann Bonner, Fiona Coyer, and David McIntyre
Subjects: Nursing practice, 030504 nursing, Haemodialysis nurse, business.industry, media_common.quotation_subject, Delphi method, Context (language use), 03 medical and health sciences, Nursing care, Qualitative feedback, 0302 clinical medicine, Nursing, Medicine, Quality (business), 030212 general & internal medicine, 0305 other medical science, business, computer, General Nursing, Delphi, computer.programming_language, media_common
Abstract: Background Nurse sensitive indicators measure the quality of care that is specific to the practice of nurses. There are currently few indicators suitable to measure haemodialysis nursing practice. Aim To identify haemodialysis nurse sensitive indicators. Methods The Delphi technique, an iterative process, was used to attain consensus from a national expert panel of haemodialysis registered nurses. The panel rated their level of agreement, importance and frequency of nurse sensitive indicators using online surveys that included qualitative feedback. Results of each round shaped subsequent rounds. Consensus was set at greater than 70.0%. Findings The 38-member expert panel had a median haemodialysis experience of 17 years (IQR 8.5–22) and 89% had attained a specialist post-registration renal qualification. Round 1 assessed the suitability of 38 nurse sensitive indicators. Those indicators failing to achieve consensus were retested and removed after round 2 (n = 12). Round 3 assessed a modified list of 26 nurse sensitive indicators with all achieving consensus. The fourth and final round was used to both provide feedback to the expert panel and to elicit further qualitative feedback. Discussion A comprehensive set of quality indicators to measure nursing-sensitive activities in the specialised context of haemodialysis have been developed. Conclusion These 26 haemodialysis nurse sensitive indicators capture the structures, processes and outcomes which could measure the quality of nursing care provided to people receiving haemodialysis.
Published: 2020

20. Device-related pressure ulcers

Author: Peter Worsley, Fiona Coyer, Catherine T Milne, Paulo Alves, Karen Ousey, G. Ciprandi, Nicola Waters, Norihiko Ohura, Amit Gefen, and Veritati - Repositório Institucional da Universidade Católica Portuguesa
Subjects: Pressure Ulcer, medicine.medical_specialty, Nursing (miscellaneous), business.industry, MEDLINE, Text mining, Clinical Protocols, Equipment and Supplies, Practice Guidelines as Topic, Medicine, Humans, Fundamentals and skills, business, Intensive care medicine, Consensus development, Adverse effect
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Published: 2020

21. Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review

Author: Lizanne Dalgleish, Jill Campbell, Fiona Coyer, and Kathleen Finlayson
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, Critical Care, business.industry, Critical Illness, MEDLINE, 030208 emergency & critical care medicine, Dermatology, Cochrane Library, Skin Diseases, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Respiratory failure, Data extraction, Intensive care, Cohort, medicine, Etiology, Humans, Intensive care medicine, business, Medical literature
Abstract: To present a systematic review of the literature conducted to define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in adult intensive care patients.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant should be better able to:1. Outline the background information helpful for understanding the authors' systematic review of ASF in adult intensive care patients.2. Summarize the results of the authors' review of the risk factors, causes, and antecedent conditions of ASF in adult intensive care patients.To define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in the adult intensive care patient cohort.The Cochrane Library, Joanna Briggs Institute Evidence-Based Practice Database, PubMed, Medical Literature Analysis and Retrieval System, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar.Studies were selected if they were qualitative or quantitative research that reported ASF in adult human patients in an ICU setting. The preliminary search yielded 991 records and 22 full texts were assessed for eligibility. A total of three records were included. Studies were appraised using the Mixed Methods Appraisal Tool.Data from the included studies were extracted by one reviewer and summarized in data collection tables that were checked and verified by a second reviewer.Study authors identified five independent predictors of ASF: peripheral vascular disease, mechanical ventilation longer than 72 hours, respiratory failure, liver failure, and sepsis. However, the term ASF was applied to retrospective cohorts of patients who developed severe pressure injuries. This, combined with the absence of evidence surrounding the assessment, clinical criteria, and diagnosis of ASF, could impact these variables' predictability relative to the condition.These results highlight a substantial evidence gap regarding the etiology, diagnostic biomarkers, and predictors of ASF. Further research focused on these gaps may contribute to an accurate and agreed-upon definition for ASF, as well as improved skin integrity outcomes.
Published: 2020

22. Prevalence of pressure injury in adults presenting to the emergency department by ambulance

Author: Fiona Coyer, Sandra Miles, and Paul Fulbrook
Subjects: Adult, Male, pressure injury prevention, medicine.medical_specialty, emergency department, emergency care, Ambulances, Psychological intervention, pressure injury, Emergency Nursing, Critical Care Nursing, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Prevalence, medicine, Humans, 030212 general & internal medicine, Aged, Pressure Ulcer, Pressure injury, business.industry, Australia, 030208 emergency & critical care medicine, Emergency department, Middle Aged, Cross-Sectional Studies, Hospital admission, Emergency medicine, Female, Observational study, Presentation (obstetrics), Ambulance transport, Emergency Service, Hospital, Risk assessment, business
Abstract: Introduction: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED). Methods: An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation. Results: Pressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk. Conclusions: The results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended.
Published: 2019

23. Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID-19 pandemic

Author: Michelle Barakat‐Johnson, Aaron Jones, Mitch Burger, Thomas Leong, Astrid Frotjold, Sue Randall, Bora Kim, Judith Fethney, and Fiona Coyer
Subjects: Coronavirus, integumentary system, Artificial Intelligence, Australia, COVID-19, Humans, Surgery, Dermatology, Health Services, Mobile Applications, Pandemics
Abstract: Wound documentation is integral to effective wound care, health data coding and facilitating continuity of care. This study evaluated the usability and effectiveness of an artificial intelligence application for wound assessment and management from a clinician-and-patient user perspective. A quasi-experimental design was conducted in four settings in an Australian health service. Data were collected from patients in the standard group (n = 166, 243 wounds) and intervention group (n = 124, 184 wounds), at baseline and post-intervention. Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively, and bivariate statistics were used to determine between-group differences. Thematic analysis of interviews was conducted. Compared with the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% vs 70%, P .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99%). Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. The use of the application facilitated remote patient monitoring and reduced patient travel time while maintaining optimal wound care.
Published: 2021

24. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial

Author: India Pearse, Amanda Corley, Emily N. Larsen, Claire M. Rickard, Robert S. Ware, Jill Campbell, Fiona Coyer, Evan Alexandrou, Catherine O’Brien, and Nicole Marsh
Subjects: Adult, Intensive Care Units, Adhesives, Australia, Medicine (miscellaneous), Central Venous Catheters, Humans, Pharmacology (medical), Jugular Veins, Bandages
Abstract: Background Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. Methods This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) ‘standard’ (in accordance with local hospital policy) CVAD dressings (control) or (2) ‘standard’ dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is ‘dressing failure’ defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). Discussion This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621001012864. Registered on 2 August 2021
Published: 2021

25. Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study)

Author: Kim LeBlanc, Fiona Coyer, Amit Gefen, Maarit Ahtiala, Yolanda Walsh, Steven Smet, Joyce Black, Kathleen M. Vollman, Heidi Hevia, Anika Fourie, and Dimitri Beeckman
Subjects: Respiratory distress syndrome, Critical Care, Critical Illness, education, Dermatology, Scientific literature, Gap analysis, Pressure ulcer, Article, Patient Positioning, Pathology and Forensic Medicine, Wound care, Prone position, Intensive care, Health care, Medicine, Humans, Protocol (science), Respiratory Distress Syndrome, business.industry, COVID-19, Guideline, medicine.disease, Respiration, Artificial, Clinical trial, Critical care, Intensive Care Units, Medical emergency, business, Respiratory Insufficiency, Skin damage
Abstract: Background Ventilating critically ill patients with acute respiratory distress syndrome in the prone position is a life-saving strategy, but it is associated with adverse consequences such as skin damage. Aim To identify, review and evaluate international proning and skin care guidelines and make an inventory of commonly used equipment and training resources. Design A gap analysis methodology was applied. Methods 1) Comprehensive search and evaluation of proning and skin care guidelines, 2) extensive search and listing equipment and educational resources, and 3) international consultation with 11 experts (8 countries). Data sources A variety of sources researched through July 2021 were used to identify relevant literature: (1) scientific literature databases and clinical trials registries, (2) intensive care and wound care associations, (3) healthcare organisations, (4) guideline development organisations, and (5) the Google search engine. Eleven international experts reviewed the literature and provided insights in two, 2-h online sessions. Findings The search yielded 24 guidelines. One clinical practice guideline had high methodological quality. Twenty-five devices/equipment and sixteen teaching materials were identified and discussed with the expert panel. The gap analysis identified a lack of concise, accessible, evidence-based guidelines and educational materials of short duration. Conclusion This analysis forms the basis for designing a competency-based education and training intervention for an interdisciplinary team caring for the skin of critically ill patients in the prone position. Impact The results can assist the multidisciplinary team to review their current protocol for prone positioning. This is a first step in developing a training package for clinicians.
Published: 2021

26. Research priorities for acute wounds in adults in Australia: a scoping review protocol

Author: Carolina Weller, Kathleen Finlayson, Fiona Coyer, Fiona M. Wood, Ut Thi Bui, and Kylie Sandy-Hodgetts
Subjects: Protocol (science), medicine.medical_specialty, integumentary system, business.industry, MEDLINE, CINAHL, Cochrane Library, Panacea (medicine), Wound care, Quality of life (healthcare), Medicine, Professional association, business, Intensive care medicine
Abstract: Background. Preservation and restoration of skin integrity following surgery is paramount for optimal patient wound healing outcomes. Acute wounds such as incisional wounds, skin tears, trauma or burn injury cause pain, reduce quality of life and are a considerable economic burden to the Australian healthcare system. Despite considerable advances in surgical technique and even with a panacea of innovative novel wound dressings, our scientific and clinical understanding of wound healing prevention and management of acute wound complications continue to present a considerable challenge to clinicians and policy makers. Understanding the gaps in knowledge and identifying clinical practice deficits are key for prevention and management of acute wounds. Aims. This scoping review aims to (i) map current research evidence and outcomes in acute wounds management, (ii) map current research evidence and outcomes in acute wounds prevention and (iii) determine research gaps in acute wound research relevant to Australia. Methods. The framework for this scoping review will utilise the PRISMA-ScR framework developed by Tricco et al.1. We will search the following databases – Medline, CINAHL, Embase, Joanna Briggs Institute (JBI), Cochrane Library and PubMed from January 2010 to March 2021. Trial registries (e.g. ISRCTN, ANZCTR and clinicaltrials.gov) and websites and publications of professional associations for wound care will also be searched. Two reviewers will independently screen all titles, abstracts and full text for articles to include. Conflicts will be solved by a third reviewer. This scoping review will include both qualitative and quantitative studies on acute wounds conducted in Australia. We will extract data from eligible articles and results will be grouped according to area of research and synthesised in a narrative review. Ethics and dissemination. As we will use data (i.e., journal articles) from publicly available platforms this scoping review does not require ethical approval. Findings will be disseminated through a peer-reviewed journal and conference presentation and social media platforms.
Published: 2021

27. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, Gonzalo, Pagella, Matías, Baini, Pierina Arias Campos, Ignacio, Sabbag, Armando, Schmukler, Imelda Perdomo Fonseca, Gonzalo Martín Alvarez, Mario, Ramirez, Fernando, Tapia, Carlos Alejandro Bascary, Graciela Del Valle Gimenez, Fernando Pablo Bertoletti, Esteban, Milioto, Pablo Julio Maldonaldo Bonsignore, Maria Alejandra Fernandez, Julie, Smith, Tim, Chimunda, Lorraine, Thompson, Teena, Maguire, Wendy, Chaboyer, Stacey, Watts, Marion, Mitchell, Madeleine, Powell, India, Lye, Leanne, Parsons, Nerilee, Baker, Claire, Reynolds, Amy, Thompson, Kristy, Masters, Kellie, Sosnowski, Lynette, Morrison, Gavin, D Leslie, Ramanathan, Lakshmanan, Alexis, Tabah, Wendy, Brown, Sharon, McDowell-Skaines, Andrea, Mclucas, Chris, Smith, Mandy, Tallot, Sarah, Jones, Michelle, Barakat-Johnson, Thomas, Leong, Rand, Butcher, Kerrie, Martin, Philipp, Douschan, Dirk von Lewinski, René, Schmutz, Uta, Kolussi, Fatema, Salman, Zainab, Ateya, Koen De Decker, Niels Van Regenmortel, Anita, Jans, Patricia, Wijnands, Stefano, Coremans, Patrick, M Honore, David De Bels, Tanja, Depuydt, Caroline, Paillet, Luc-Marie, Jacquet, Walter, Swinnen, Francis, Hannes, Matthia, Mergeay, Stijn Van de Velde, Silvie, Allaert, Pieter, Hoste, Christophe, Borin, Sandrine, Balon, Vincent, Fraipont, Patrick, Biston, Nicolas De Schryver, Thierry, Dugernier, Ilse Van Cotthem, Angelica Olivetto de Almeida, Silvia Angelica Jorge, Delmiro, Becker, Raysa Cristina Schmidt, Evellyn, Oliveira, Aline, Ramalho, Eliane, Mazocoli, Audrey, Fioretti, Elaine, Barros, Leticia, Serpa, Suzana, Bianchini, Ticiane, Campanili, Taís, Pantaleao, Paulo Carlos Garcia, Ana Lucia Vitti Ronchini, Rayanne, Santos, Nurulhuda Binti, A Manap, Sean, Bagshaw, Dominic, Carney, Jon, Davidow, Ella, Rokosh, Andréa Maria Laizner, Samantha, Smith, Megan, Mcquirter, Betty Star Kampayana, René, Favre, Martin, Sills, Julie, Dallaire, Cathy, Becker, Sherissa, Microys, Bonnie, Bowes, Jennifer, Lajeunesse, Rishi, Ghosh, Jacqueline, Baptiste-Savoie, Rose, Raizman, Gabriel, Suen, Noushin, Taghavi, Orla, Smith, Clare, Fielding, Julieta, Canales, Pia, Molina, Javiera, Chaparro, Maria Idalia Sepulveda, Matias Jesús Flamm Zamorano, Pamela, Rocha, Ximena, Villanueva, Paola, Araya, Meneses, Dayan, Fernando, Avalos, Xiaohan, Li, Liu, Yu, Xinxia, Li, Xiaoyan, Chen, Zhixia, Jiang, Jing, Yang, Jingfang, Chen, Lei, Yang, Kefang, Wang, Jie, Gao, Xiuhua, Fang, Ronghua, Zhao, Xinhua, Xia, Hongmei, Liu, Jing, Li, Haiyan, Wang, Gen, Meng, Yanhong, Di, Damei, Wang, Rong Hua Zhao, Li Ping Hu, Peipei, Xu, Qing Feng Jiao, Hai Yun Wang, Chun Jie Xia, Yan, Liu, Mei, Ye, Yan, Wan, Wenmei, Wang, Yajun, Ding, Aiua, Ren, Yan, Gao, Qi, Li, Guifang, Du, Yanling, Shen, Yanming, Ding, Ning, Li, Cui, Yuan, Lei, Tan, Qiang, Lin, Hailing, Guo, Howe, Yan, Xiao, Xu, Wei, Zhang, Jinxian, Liang, Libing, Zhang, Eryun, Tian, Qian, Zhao, Lin, Insu, Jingwen, Dong, Yanmei, Gu, Ying, Liu, Lina, Zhao, Wei, Wang, Hongmei, Qiao, Lili, Tuo, Mengmeng, Lv, Jin Yu Zhu, Jifen, Zhu, Ying, Wei, Man, Liu, Yin, He, Jiyin, Cheng, Jin, Liu, Jia, Na, Dongfang, Wei, Qing, Li, Xiaoying, Wu, Huan, Duan, Dongliang, Lin, Qiong, Liang, Xiaofang, Luo, Yunfeng, Xiong, Rong Fen Huang, Jing, Fu, Tao, Zan, Man, Ye, Zeya, Shi, Yanfei, Long, Yang, Lei, Xiaodi, Liu, Chen, Yumei, Lingling, Wang, Yali, Zhang, Yan, Xu, Cheng, Wang, Zhijuan, Chengxia, Sun, Jinhui, Song, Yingli, Wang, Xiumei, Liu, Yupeng, Liu, Yuxia, Yuan, Qingping, Huang, Fengling, Yang, Yun, Wu, Xianping, Luo, Xiaowu, Bai, Hong, Zheng, Min, Song, Yue, Sun, Zhangshuangzi, Li, Feifei, Luo, Miao, Liu, Li Chuntang Li, Xinjian, Li, Guiping, Zhang, Lina, Xiao, Tingting, Yu, Guangyuan, Gao, Wei, Wei, Fanglan, Wang, Ting, Han, Tingting, Li, Zeng, Qi, Jing Mei Zeng, Yan, Long, Fuqun, Pan, Jing, Wang, Guoxue, He, Haiyan, Chen, Feifei, Zhang, Chao, Yu, Gao, Chunhua, Xiuying, Yao, Dongmei, Bai, Liu, Lu, Xuelian, Xu, Yan, Wang, Xuejuan, Liang, Zhang, Na, Aizhi, Zhang, Xiaochun, Hu, Hui, Zhang, Ruixia, Wang, Poon Shing Tak, Sung Wai Ho, Qun Xia Jiang, Xinran, Ding, Liu, Hong, Limei, Miao, Zhaoxia, Feng, Liping, Huang, Juan, Wu, Yuping, Wang, Jiye, Guo, Baoke, Zhang, Chaoqun, Ma, Han, Yu, Congcong, Liu, Min, Ding, Linlin, Luan, Jing, Zheng, Shanshan, Lv, Shumin, Jiang, Wenzhen, Cao, Xiujuan, Xue, Guangyan, Liu, Xiyan, Wei, Youru, Jiang, Zhiru, Yao, Gao, Li, Jinhua, Li, Wenwen, Zhao, Mei, Jiang, Junping, Hao, Jing, Zhang, Caiju, Song, Feifei, Chen, Shuhui, Wang, Lili, Hu, Deyan, Cao, Jianhong, Wan, Xiaomin, Wang, Hongyan, Shao, Zhenxia, Zhang, Xia, Cui, Jingyu, Liu, Lijuan, Zhao, Xingguo, Li, Limei, Fan, Ling, Zhang, Min, Yu, Biyan, Li, Chunxia, Li, Ling, Liu, Xuelian, Liu, Wenmin, Chen, Yan, Li, Zhang, Zhigang, Yuchen, Wu, Chenghau, Mu, Guoyan, Zhu, Fan, Yang, Qi, Bo, Ling, Li, Meili, Chen, Jing Hua Jiang, Hai, Yin, Xuelian, Pang, Yue Ying Gong, Shunzhu, Yang, Xiaoli, Yan, Xianhong, Zheng, Dehong, Lei, Lei, Lei, Yinhua, Guo, Lihong, Liu, Jing, Yu, Wei, Sun, Aiping, Bi, Weiwei, Li, Yang, Wu, Ji, Li, Dongshu, Ni, Zijing, Wu, Bing, Song, Qin, Fei, Yang, Xiaoyan, Qiong, Ran, Xixi, Li, Xueping, Jiao, Hua, Ji, Sun, Zhiping, Hong, Ma, Jianhong, Mu, Yanhua, Hao, Yin, Li, Ying, Wang, Caihong, Hui, Wenjie, Ju, Yuxia, Huo, Yuxia, Wang, Lei, Chen, Yan, Yan, Qingli, Zhao, Hongjuan, Chen, Guijun, Bao, Ying, Cao, Hong, Li, Hong, Zhang, Ying, Zhang, Lina, Xu, Jia, Guixiang, Ying, Li, Hui Min Zhao, Xia, Huang, Zhaoxing, Dai, Yanman, Jian, Hongsu, Zhang, Zhixia, Tian, Zu Qing Cao, Miao, Li, Yang, Liu, Fei, Ouyang, Fuying, Ma, Wangyan, Jin, Liuyan, Ge, Shifen, Wu, Weilian, Yuan, Tianfei, Chen, Guanxiu, Shi, Zhihong, Chen, Kewei, Liu, Xue, Lin, Yuemen, Ly, Sun, Lijuan, Xiao Fang Tian, Shuo, Wang, Zhangxia, Feng, Xiaozhe, Liu, Yunchun, Dong, Jundi, Zhang, Nie, Bocui, Guoxian, Wang, Yingjuan, Zhao, Xiaojun, Wu, Qiao, Yang, Rongjun Ling Hu, Xue Qin Li, Zhu Jun Yu, Yanlan, Yao, Xiaoqiong, Deng, Yan, Xiao, Yan, Xie, Yanping, Yang, Huai, Yang, Yuming, Zhou, Zhuqing, Li, Min, Xiao, Yongxia, Yang, Yani, Tian, Luz Marina Silva Gama, Juan Sebastian Hernandez, Nestor, Caicedo, Jorge, Marin, Maria-Elena, Ochoa, Monica, Gomez, José, Rojas-Suarez, Jeniffer, Gonzalez, Amylkar José Garay Reyes, Edwin, Chapeta, Estefania, Orozco, Ina, Filipović-Grčić, Anita, Vuković, Suzana, Pečenković, Aleksandar, Šuput, Gordana, Zivanovic-Posilovic, Armanda, Bozena, Nikolina, Udiljak, Morena, Milic, Renata Curic Radivojevic, Slobodan, Mihaljevic, Marijana, Matas, Dinko, Tonkovic, Hemena, Čuljak, Ivana, Herceg, Gordana, Pavlisa, Milena, Dobric, Tatjana, Beker, Višnja Nesek Adam, Tanja, Goranovic, Chrysanthos, Markoulias, Mina, Mathaios, Maria, Mylordou, Eleni, Achilleos, Pavlina, Kleanthous, Veronika, Kotanidi, Maria, Foka, Iwy, Charalabous, Anna, Alexandrou, Marios, Georgiou, Artemis, Patsalos, Sofia, Zepoy, Constantina, Constantinou, Petr, Piza, Tomas, Vymazal, Elisabeth, Wiborg, Louise, Bruhn, Karin, Kaasby, Karin Rehnholt Pedersen, Sanne, Mikkelsen, Marie, Collet, Anne, Langvad, Hanne, Andresen, Susanne, Fischer, Inger Ebbesen 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Alkhumsi, Abdualhamid, I Alshrif, Ahmed Ali Aboufray, Aya, Alabuzidi, Ahmed Ramadan Triki, Mala, Elgammudi, Hajer Ben Zahra, Enas, Soula, Maram Milud Said Al-Alawi, Hazem, Ahmed, Mohamed Abdurazzag Ali Ghula, Saulius, Vosylius, Lucie, Mouton, Touraj, Rastegar, Claude, Sertznig, Gilles, Martin, Christian, Theisen, Christian, Ferretti, Fränk, Gils, Marc, Gallion, Asmah, Zainudin, Laila Kamaliah Kamalul Bahrin, Shanti Rudra Deva, Azmin Huda Abdul Rahim, Sherliza, Wahab, W Nazaruddin, W Hassan, Wan Nasrudin Wan Ismail, Mohd Nazri Ali, Tien Meng Khoo, Noryani Mohd Samat, Jenny May Geok Tong, Nik Azman Nik Adib, Mohd Basri Mat Nor, Shanthi, Ratnam, Nahla, Ismail, Siti Rohayah Sulaiman, Kit Weng Foong, Anita, Alias, Ngu Pei Hua, Jorge Macias Zermeno, Daniel, Blanco, Karely, Duran, Claudia Lizbeth Lopez Nava, San Juan Roman Nandyelly, Luis Alejandro Sanchez-Hurtado, Brigitte, Tejeda-Huezo, Mario Del Moral Armengol, Luis Pedro Ambriz Nava, Jorge Guerra Herrera, Gilberto Felipe Vazquez de Anda, 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Fethi, Gül, İsmail, Cinel, Iskender, Kara, Hasan Nabi Undar, Yesim Serife Bayraktar, Jale Bengi Çelik, Murat Emre Tokur, Demet Tok Aydin, İsmail, Yildiz, Beysim, Özcan, Başar, Erdivanli, Ahmet, Eroglu, Devrim, Akdağ, Nurdan, Ünlü, Adonis, Dungca, Ashwaq, Ali, Bindu, Thankamma, Paul Eric Reyes, Sini, John, Ajitha, Rajendran, Fatima Kasem El Ahmad, Kathleen Ann Smiley, Susanna, Hojden, Mia Thorning Miller, Vishnu Das Sasidharan Nair, Maria Gracia San Antonio, Khaled Al Qawasmeh, Sabah Abu Shawish, Hilary, Twiggs, Ines, Rosado, Volodymyr, Babych, Faye, Morren, Charlotte, Young, Nicola, Vaughan-Jones, Stephanie, Harris, Karen, Burns, Carmel, Georgiev, Rosina, Shayamano, Ian, Kerslake, Peter, Creber, Ana, Vochin, Catherine, O'Brien, Paul, Caddell, Samantha, Hagan, Mandy, Hughes, Tomasz, Torlinski, James, Sherwin, Santhana, Kannan, Amber, Markham, Richard, Lebon, Jason, Cupitt, Julius, Cranshaw, Nigel, White, Victoria, Marriott, Wendy, Milner, Casiano Barrera Groba, Joao, Azoia, Petra, Polgarova, Shaly, George, Ritoo, Kapoor, Ceri, Lynch, Nathalie, Fox, Karen, Cranmer, Natalie, Fox, Thomas, Llewellym, Kelly, Matthews, Louise, Maltby, Jowena, Ibao, Karen, Boulton, Rachel, Jarman, Karen, Baxter, Ashok Sundai Raj, Arif, Moghal, Joanne, White, Suzanne, Barrowcliffe, Mark, Pulletz, Vaarisan, Ganeshalingam, Rosaleen, Baruah, Carole, Boulanger, Helen, Baker, Justin, Woods, Poe Poe Ei, Vongayi, Ogbeide, Paul, Hayden, Jennifer, Hughes, Madhu, Balasubramanian, Armorel, Salberg, Rajnish, Saha, Dagmar, Holmquist, Claire, Derbyshire, Neil, Smith, Elizabeth, Stones, Jane, Ademokun, Monica, Popescu, Maria Schofield Legorburo, Samantha, North, Carole, Brett, Helen, Jaundoo, Jayne, Craig, Simon, Whiteley, Clare, Howcroft, Liz, Wilby, Peter, Delve, David, Shaw, Karen, Williams, Ingeborg, D Welters, Jane, Mcmullen, Stephen, Brett, Leah, Flores, Treiza, Trueman-Dawkins, Mae, Templeton, John, Adams, Catherine, Smith, John, Prowle, Heather, Byers, Andrea, Mcdonnell, Bernd Oliver Rose, Rosie, Reece-Anthony, Luis, Mendes, Marcela, Vizcaychipi, Rhian, Bull, Grace, Lacaden, Eleanor, Santiago, Carlos Castro Delgado, Sarah, Farnell-Ward, Elaine, Thorpe, Justine, Somerville, Anne, Williams, Donna, Cummings, Helen, Derrick, Sarah, Brumwell, Claire, Randell, Nicola, Mccann, Emma, Aves, Gillian, Berry, Tamas, Szakmany, Una, Gunter, Paul, Pulak, Nikki, Sarkar, Kerry, Wright, Vitor, Gomes, Jones, Jo, Ruth, Palfrey, Julie, Camsooksai, Abby, Lewis, Antony, Eneas, Ascanio, Tridente, Louise, Barr, Beverley, Thomas, Emma, Parkin, Daniel, Horner, Christian, Frey, Suzanne, Bench, Rachel, Baumber, Phil, Broadhurst, Matthew, Jackson, Lynne, Williams, Michele, Clark, Jonathan, Paddle, Sarah, Bean, Sarah, Buckley, Christopher, Palfreeman, Sophie, Liu, Nicola, Allison, Ben, Attwood, Penny, Parsons, Victoria, Houghton, Sarah Jane Turner, David, Higgins, Egidija, Bielskute, Nicola, Horrigan, Reni, Jacob, Karen, Habgood, Ahmed, Zaki, Amy, Collins, Jenny, Lord, Charalice, Ramiro, Agnieszka, Kubisz-Pudelko, Michelle, Kotze, Helen, Williams, Ihor, Iovenko, Alexander, Tsarev, Arturo, Briva, Gabriela, Mendez, Lena, Napolitano, Magnus, Teig, Jarone, Lee, Gabriel Enrique Rodriguez, Talia, Ben-Jacob, Christopher, Potestio, Timothy, Eng, Dea, Mahanes, Ashish, Khanna, Abhijit, Duggal, Masakatsu, Nananmori, Manuel, Lois, Anna, Diaz, Kunal, Karamchandani, Cheryl, Bealer, Cindy, Barefield, Dorothy, Terry, Pauline, Fivecoat, Olakunle, Idowu, Juan, Cata, Tara, Clesi, Jessica, Peterson, Kevin, Hatton, Jasdeep, Dhaliwal, Dorothee, Mueller, Jing, Tao, Ashley Szabo Eltorai, Stephen, M Pastores, Natalie, Remor, Janel, Salazar, Diane, Barkas, Aaron, Joffe, Christopher, Barnes, Carrie, Sona, Marilyn, Schallom, Jack, Short, Javier, Lorenzo, Ingrid Von Der Osten, Marta, Borkowska, Mireia, Llaurado-Serra, Liesbet, Demarré, Vincianne, Pleitinckx, Cynthia, Xing, Anne-Sophie, Debue, Stefan, Goller, Elsa, Afonso, Gusarov, V, Eugeniya, Larina, Llaurado-Serra, M, Yalim, Dikmen, DecubICUs Study Team, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, Muzha, D., Ribas, A.M., Lipovesty, F., Loudet, C., Coyer, F., Eller, P., Mostafa, N., Honoré, P.M., Telleria, V.M., Smajic, J., Nogueira, P.C., Nafees, KMK, Hentchoya, R., Rose, L., Soledad, J., Lin, F., Cardenas, Y., Reyes, A.G., Sustic, A., Mpouzika, M., Vymazal, T., Jensen, H.I., Aguirre-Bermeo, H., Maddison, L., Valta, M., Calvino-Gunther, S., Bloos, F., Adipa, F.E., Koulouras, V., Enamorado, J., Ágoston, Z., Birgisdóttir, H., Gupta, A., Gurjar, M., Kilapong, B., Hashemian, S.M., Martin-Loeches, I., Benbenishty, J., Cortegiani, A., Fletcher, K., Hayashi, Y., Waweru-Siika, W., Abidi, K., Lee, S.M., Hadri, B., Dolgusevs, M., Abillama, F.F., Jovaisa, T., Thix, C., Elhadi, M., Nor, B.M., Ratnam, S., Mazlan, M.Z., Maiyalagan, S., Sánchez-Hurtado, L., Belii, A., Naranpurev, M., Gautam, P., De Lange, D., Parke, R., Ilesanmi, R.E., Shosholcheva, M., Petosic, A., Lind, R., Ffarcsi, M.H., Bogarin, J., Hernandez, A.M., Mikaszewska-Sokolewicz, M., Sousa, B., Tomescu, D., Sandesc, D., Twagirumugabe, T., Gusarov, V., Ebaid, M., Jankovic, R., Slobodianiuk, G., Martonova, A., Knafelj, R., Mer, M., Maseda, E., Panka, B., Schefold, J.C., Joelsson-Alm, E., Trongtrakul, K., Merritt-Charles, L., Besbes, L.O., Dikmen, Y., Zgrzheblovska, L., Fielding, M., Rubulotta, F., Khanna, A.K., Saager, L., von der Osten, I., Greca, A., Cani, A., Xhindi, N., Hyska, G., Pinto, S., Alves, P., Esposito, R., Valgolio, E., Minope, JTS, Abdala, A., Ayala, M., Bravo, S., Bantar, A., Delgado, P., Badariotti, G., Lipovestky, F., Diaz, A., Saul, P., Setten, M., Aucapina, A., Acosta, Y., Gonzalez, V., Camputaro, L., Baccaro, F., Villa, R., Mastantuono, M., Dean, E., Rostello, O.F., Brizuela, P., Bartoli, J.R., Guereschi, M., Quiroga, C., Putruele, S., Villegas, P., Curilen, V., Fernandez, R., Nocheretti, M.G., Escalante, R.G., Loudet, C.I., Fernandez, S., Gonzalez, A.L., Alvarez, G.A., Iglesias, F., Chaparro, S., Zakalik, G., Pagella, G., Baini, M., Campos, P.A., Sabbag, I., Schmukler, A., Fonseca, I.P., Alvarez, G.M., Ramirez, M., Tapia, F., Bascary, C.A., Del Valle Gimenez, G., Bertoletti, F.P., Milioto, E., Bonsignore, PJM, Fernandez, M.A., Smith, J., Chimunda, T., Thompson, L., Maguire, T., Chaboyer, W., Watts, S., Mitchell, M., Powell, M., Lye, I., Parsons, L., Baker, N., Reynolds, C., Thompson, A., Masters, K., Sosnowski, K., Morrison, L., Leslie, G.D., Lakshmanan, R., Tabah, A., Brown, W., McDowell-Skaines, S., McLucas, A., Smith, C., Tallot, M., Jones, S., Barakat-Johnson, M., Leong, T., Butcher, R., Martin, K., Douschan, P., von Lewinski, D., Schmutz, R., Kolussi, U., Salman, F., Ateya, Z., De Decker, K., Van Regenmortel, N., Jans, A., Wijnands, P., Coremans, S., Honore, P.M., De Bels, D., Depuydt, T., Paillet, C., Jacquet, L.M., Swinnen, W., Hannes, F., Mergeay, M., Van de Velde, S., Allaert, S., Hoste, P., Borin, C., Balon, S., Fraipont, V., Biston, P., De Schryver, N., Dugernier, T., Van 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Yuan, C., Tan, L., Lin, Q., Guo, H., Yan, H., Xu, X., Zhang, W., Liang, J., Zhang, L., Tian, E., Zhao, Q., InSu, L., Dong, J., Gu, Y., Zhao, L., Qiao, H., Tuo, L., Lv, M., Zhu, J.Y., Zhu, J., Wei, Y., Liu, M., He, Y., Cheng, J., Liu, J., Jia, N., Wei, D., Wu, X., Duan, H., Lin, D., Liang, Q., Luo, X., Xiong, Y., Huang, R.F., Fu, J., Zan, T., Shi, Z., Long, Y., Lei, Y., Liu, X., Yumei, C., Wang, L., Zhang, Y., Xu, Y., Cheng, X., Zhijuan, W., Sun, C., Song, J., Wang, Y., Yuan, Y., Huang, Q., Yang, F., Wu, Y., Bai, X., Zheng, H., Song, M., Sun, Y., Li, Z., Luo, F., Li, L.C., Zhang, G., Xiao, L., Yu, T., Gao, G., Wei, W., Wang, F., Han, T., Li, T., Zeng, Q., Zeng, J.M., Pan, F., Wang, J., He, G., Chen, H., Zhang, F., Chao, Y., Chunhua, G., Yao, X., Bai, D., Liu, L., Liang, X., Zhang, N., Zhang, A., Hu, X., Zhang, H., Wang, R., Tak, P.S., Ho, S.W., Jiang, Q.X., Ding, X., Hong, L., Miao, L., Feng, Z., Huang, L., Wu, J., Guo, J., Zhang, B., Ma, C., Han, Y., Liu, C., Ding, M., Luan, L., Zheng, J., Lv, S., Jiang, S., Cao, W., Xue, X., Liu, G., Wei, X., Jiang, Y., Yao, Z., Gao, L., Zhao, W., Jiang, M., Hao, J., Zhang, J., Song, C., Chen, F., Wang, S., Hu, L., Cao, D., Wan, J., Wang, X., Shao, H., Zhang, Z., Cui, X., Fan, L., Yu, M., Li, B., Li, C., Chen, W., Li, Y., Zhigang, Z., Yuchen, W., Mu, C., Zhu, G., Bo, Q., Li, L., Chen, M., Jiang, J.H., Yin, H., Pang, X., Gong, Y.Y., Yang, S., Yan, X., Zheng, X., Lei, D., Lei, L., Guo, Y., Yu, J., Sun, W., Bi, A., Li, W., Ni, D., Wu, Z., Song, B., Fei, Q., Xiaoyan, Y., Ran, Q., Xixi, L., Jiao, X., Ji, H., Zhiping, S., Hong, M., Jianhong, M., Hao, Y., Yin, L., Hui, C., Ju, W., Huo, Y., Chen, L., Yan, Y., Bao, G., Cao, Y., Xu, L., Guixiang, J., Zhao, H.M., Huang, X., Dai, Z., Jian, Y., Tian, Z., Cao, Z.Q., Li, M., Ouyang, F., Ma, F., Jin, W., Ge, L., Wu, S., Yuan, W., Chen, T., Shi, G., Chen, Z., Liu, K., Lin, X., Yuemen, L., Lijuan, S., Tian, X.F., Dong, Y., Bocui, N., Wang, G., Zhao, Y., Yang, Q., Hu, R.L., Li, X.Q., Yu, Z.J., Yao, Y., Deng, X., Xiao, Y., Xie, Y., Yang, Y., Yang, H., Zhou, Y., Xiao, M., Tian, Y., Gama, LMS, Hernandez, J.S., Caicedo, N., Marin, J., Ochoa, M.E., Gomez, M., Rojas-Suarez, J., Gonzalez, J., Reyes, AJG, Chapeta, E., Orozco, E., Filipović-Grčić, I., Vuković, A., Pečenković, S., Šuput, A., Zivanovic-Posilovic, G., Bozena, A., Udiljak, N., Milic, M., Radivojevic, R.C., Mihaljevic, S., Matas, M., Tonkovic, D., Čuljak, H., Herceg, I., Pavlisa, G., Dobric, M., Beker, T., Adam, V.N., Goranovic, T., Markoulias, C., Mathaios, M., Mylordou, M., Achilleos, E., Kleanthous, P., Kotanidi, V., Foka, M., Charalabous, I., Alexandrou, A., Georgiou, M., Patsalos, A., Zepoy, S., Constantinou, C., Piza, P., Wiborg, E., Bruhn, L., Kaasby, K., Pedersen, K.R., Mikkelsen, S., Collet, M., Langvad, A., Andresen, H., Fischer, S., Kjærgård, I.E., Jepsen, B., Husted, B., Bestle, M., Kodal, A.M., Hansen, TCB, Pedersen, ASB, Thomsen, T.D., Hoegenhaven, A., From, M., Frandsen, T.M., Henning, G., Hansen, A., Bliksted, I.A., Tamayo, L.M., Mogrovejo, P., Palaez, C., Tutillo, DRM, Hurtado, C.V., García, M.F., Alvarez, D., Guerrero, F., Vasquez, A., Kütimets, M., Tamme, K., Anvelt, E., Dlamini-Sserumaga, L., Löfqvist, C., Lusenius, V., Kauppi, O., Sakki, J.K., Tervo-Heikkinen, T., Kesti, U., Merilainen, M., Karjula, E., Peltomaa, M., Palmu, A., Ahtiala, M., Valta, M.A., Mentec, H., Plantefève, G., Besch, G., Pili-Floury, S., Ledochowski, S., Déserts, MDD, Giacardi, C., Daubin, C., Massard, A., Le Guen, Y., Blanc, A., Mandaroux, S., Günther, S.C., Avogadro, P., Radavidson, A., Turc, J., Jochmans, S., Quintard, H., Boyer, L., Bruel, C., Philippart, F., Montravers, P., Atchade, E., Flessel, N., Chinardet, B., Soulisse, L., Pillard, C., Ngo, D., Bongiorno, B., Heitzler, N., Souppart, V., Gautheret, N., Timsit, J.F., Essardy, F., Fartoukh, M., Mehay, D., Etourneau, F., Farkas, J.C., Beuret, P., Preda, G., De Montmollin, E., Castelain, V., Jaschinski, U., Rothenfusser, M., Kindgen-Milles, D., Dimski, T., Fiedler, C., Heinicke, T., Meybohm, P., Schulze, T., Bota, M., Pelz, S., Odenthal, T., Christ, M., Bösl, K., Chovas, A., Stehr, S., Simon, P., Grotheer, S., Schüppel, S., Schaller, S., Albrecht, L., Stübner, A., Graeser, S., Kolbe, N., Lausch, M., Diers, A., Guenther, U., Riessen, R., Roller, M., Osei, I.P., Kusi-Appiah, A.C., Yakubu, Y.H., Guadi-Gosh, B., Dragoumanis, C., Christofis, C., Kazakos, N., Bastani, S., Martinos, C., Bekos, V., Papanikolaou, M., Papavasilopoulou, T., Efthymiou, A., Chantziara, V., Kyriakoudi, A., Kakaras, N., Diakaki, C., Flevari, A., Nikolaou, C., Katerina, K., Avramopoulou, L., Tsikritsaki, K., Gkiokas, G., Pantiora, E., Katsenos, C., Patsiou, E.C., Alexandropoulou, P., Koutsodimitropoulos, I., Farmakis, E., Nestora, K., Chatzis, M., Kondili, E., Soundoulounaki, S., Mousafiri, O., Lepida, D., Liarmakopoulou, A., Papathanakos, G., Oikonomou, M., Ioannides, P., Papadopoulos, D., Staikos, I., Stafylaraki, M., Raitsiou, B., Mandis, K., Ravani, I., Kourelea, 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McPherson, S., Corcoran, A., Gordon, P., Rooney, G., Levy, D., Azencot, M., Gurevich, V., Lavy, A., Bendelari, V., Marconi, R., Barone, A., Gatti, C., Giampaoletti, A., Borgognoni, C., Ghioldi, D.M., Raimondo, A., Castiglione, G., Bruno, A.V., Rubulotta, G., Mo, A., Corso, A., Girianni, S., Bruni, A., Garofalo, E., Maggiore, S.M., Di Risio, A., Calamai, I., Spina, R., Spadaro, S., Volta, C.A., Cotoia, A., Mirabella, L., Maulicino, L., Abregal, G., Donvito, M., D'Ambrosio, P., Binda, F., Adamina, I., Galazzi, A., Negro, A., Vaschetto, R., Capuzzi, F., Boschetto, M., Stivanello, L., Bonaccorso, L., Megna, C., Iozzo, P., Rizzo, A., Scire, G., Taibi, M.R., Tranello, F.P., Manzo, A., Traina, L., Pastore, B., Quaini, A., Giusti, G.D., Montaldi, G., Piergentili, F., Mancini, F., Casaioli, S., Uccelli, F., Guarracino, F., Onelli, A., Di Gravio, V., Cossu, M., Matrona, O., Rocco, M., Alampi, D., Dellafiore, F., Ranalli, F., Bossolasco, M., Brizio, E., Migliorino, P., Cortellazi, P., Rosati, M., D'Ambrosio, F., Quagliotto, C., Roman-Pognuz, E., Peratoner, A., De Rosa, S., Martin, M.A., De Sanctis, F., Ciorba, P., Toppin, P., Harding-Goldson, H., Taito, S., Shime, N., Yamamoto, R., Kanda, F., Hirao, A., Egi, M., Noguchi, A., Hashimoto, S., Aya, U., Sakuramoto, H., Ohuchi, A., Kataoka, J., Maruyama, K., Nakayama, I., Nishime, Y., Fujimoto, K., Takahashi, K., Tsujimoto, M., Shimizu, M., Tole, E., Correia, M.C., Kim, J.H., Park, S., Kim, K.C., Baek, J., Bae, J.M., Park, S.Y., Park, T.S., Lee, H.B., Park, J., Yeon-Joo, L., Young-Jae, C., Jeon, K., Kim, S.C., Lee, J., Chee, H.K., Huh, J.W., Sim, Y.S., Kim, J., Chang, Y., Ahn, J.J., Kang, B.J., Lee, W.Y., Lee, S.J., Baftiu, N., Krastins, I., Stiban, S., Feghaly, M.E., Gharios, E., Merheb, M., Benlamin, M., Khaled, A., Belkhair, W.A., Tabib, M., Ashour, F., Elhadi, A., Tababa, OWE, Khaled, T., Alkhumsi, SIR, Alshrif, A.I., Aboufray, A.A., Alabuzidi, A., Triki, A.R., Elgammudi, M., Zahra, H.B., Soula, E., Al-Alawi, MMS, Ahmed, H., 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. 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C., Bekos V., Papanikolaou M., Papavasilopoulou T., Efthymiou A., Chantziara V., Kyriakoudi A., Kakaras N., Diakaki C., Flevari A., Nikolaou C., Katerina K., Avramopoulou L., Tsikritsaki K., Gkiokas G., Pantiora E., Katsenos C., Patsiou E.-C., Alexandropoulou P., Koutsodimitropoulos I., Farmakis E., Nestora K., Chatzis M., Kondili E., Soundoulounaki S., Mousafiri O., Lepida D., Liarmakopoulou A., Papathanakos G., Oikonomou M., Ioannides P., Papadopoulos D., Staikos I., Stafylaraki M., Raitsiou B., Mandis K., Ravani I., Kourelea S., Efthimiou A., Thoma G., Bakas A., Psarulis K., Anisoglou S., Papageorgiou E., Michailidou E., Tholioti T., Lavrentieva A., Sourla E., Spyropoulou A., Pantelas N., Stalika K.M.M., Georgakas I., Karathanou A., Tsikriki S., Dimoula A., Kanakaki S., Vakalos A., Pagioulas K., Enamorado J.E., Nardai G., Hawchar F., Blondal A., Rygvadottir B., Jonasdottir R.J., Shah B., Kaushik S., Tripathy S., Singh M., Agarwal S., Gupta M., Ahmad M., Mangal K., Bhargava V., 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C., Jibrin D., Sankey B.J., Adekola O., Olanipekun S., Shosolcheva M., Gievski V., Kartalov A., Naumovski F., Kuzmanovska B., Trposak A., Bogoevska-Miteva Z., Rosalia R., Olsen B.F., Sjobo B., Jensen K.D., Sykehus D., Johansen B.F., Straede E., Johansen E., Finnstrom I.J., Toellefsen A., Ostenjo H., Bjorgen H., Bratsberg B., Kristoffersen E., Skorstad E.M., Hansen S., Vullum S., Lunde G.A., Arntsen W., Lund M., Akselsen G.R., Monstad K.R., Stenset A., Haugom H., Monsen B., Hogvall L., Trudvang S., Galaaen B., Malmin S.K., Andersen M.H., Hargott R.F., Andersen Y., Steffenak E., Nyhus M., Meland B., Hashmi M., Rivas N., Maidana E., de Jesus Ortiz A., Cabral D.M.B., Simi M., Aponte C., Rivas J.C., Gill S., Garcia A., Alvarenga G., Cespedes L., Perez H., Moreira M.L., Canete F., Gonzalez R., Monges N., Coman M., Pederzani M., Franco N., Aganon F., Martinez R., Noblezada-Uy D., Ellazar C.G., Cerezo F.D., Palo J.E., Aperocho C.A.J., Isanan M., Tubacka M., Jasiewicz P., Czuczwar M., Borys M., 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N.N., Jansson E.B., Malvemyr A.-S., Johansson L., Sandberg U., Tingsvik C., Mattsson G., Lof G., Spangfors M., Ringdal M., Geijer S., Orvelius L., Hylen M., Lagerhall C., Akerman E., Hellkvist V.H., Mickelsson U., Wahlbom E., Larsson I.-M., Wallin E., Boroli F., Ory S., Jong M.L., Dullenkopf A., Lang M., Fleury Y., Maus M., Ben-Hamouda N., Fishman A., Hsu M.Y., Chang S.C., Trongtratul K., Sawawiboon C., Morakul S., Khwannimit B., Singh K., Ventour D., Figaro-Barclay D., Sankar-Maharaj S., Mebazaa M.S., Kamoun S., Elatrous S., Besbes L., Abroug F., Naija W., Elhechmi Y.Z., Sellami W., Hajjej Z., Merhabene T., Talik I., Kuscu O.O., Dilek O., Zerman A., Dal H.C., Turan S., Aydemir S., Yilmaz H., Calili D.K., Izdes S., Cengiz M., Gumus A., Tasdemir B., Kagnici A., Ay M., Ay S.A., Caliskan G., Akbas T., Balbay A.O., Efe S., Inal V., Elay G., Karabacak P., Ozserezli B., Senturk E., Demirkiran O., Bozbay S., Erdogan E., Akker M., Peker N., Ozgultekin A., Serin S.O., Turan C., Karaoren G., Goksu S., Karakurt S., Arikan H., Gul F., Cinel I., Kara I., Undar H.N., Bayraktar Y.S., Celik J.B., Tokur M.E., Aydin D.T., Yildiz I., Ozcan B., Erdivanli B., Eroglu A., Akdag D., Unlu N., Dungca A., Ali A., Thankamma B., Reyes P.E., John S., Rajendran A., Ahmad F.K.E., Smiley K.A., Hojden S., Miller M.T., Das Sasidharan Nair V., Antonio M.G.S., Qawasmeh K.A., Shawish S.A., Twiggs H., Rosado I., Babych V., Morren F., Young C., Vaughan-Jones N., Harris S., Burns K., Georgiev C., Shayamano R., Kerslake I., Creber P., Vochin A., O'Brien C., Caddell P., Hagan S., Hughes M., Torlinski T., Sherwin J., Kannan S., Markham A., Lebon R., Cupitt J., Cranshaw J., White N., Marriott V., Milner W., Groba C.B., Azoia J., Polgarova P., George S., Kapoor R., Lynch C., Fox N., Cranmer K., Llewellym T., Matthews K., Maltby L., Ibao J., Boulton K., Jarman R., Baxter K., Raj A.S., Moghal A., White J., Barrowcliffe S., Pulletz M., Ganeshalingam V., Baruah R., Baker H., Woods J., Ei P.P., Ogbeide V., Hayden 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P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.
Subjects: Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021
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28. Optimising reflective capacity of nursing students after high fidelity simulation: A practical approach

Author: Fiona Coyer, Mary Ryan, and Naomi Tutticci
Subjects: Higher education, business.industry, media_common.quotation_subject, Debriefing, Reflective thinking, Feeling, Nursing, Critical thinking, High fidelity simulation, ComputingMilieux_COMPUTERSANDEDUCATION, Psychology, Reflection (computer graphics), business, Critical reflection, media_common
Abstract: Navigating simulation as a nursing student is challenging. It requires critical thinking, high levels of reflection and emotional investment. Reflection fatigue can result from knowing that reflection is important but feeling reluctant to expose oneself to critique. This practical discussion explores how nurse educators can optimise nursing students’ reflective thinking within simulation and develop debrief strategies that optimise critical reflection. Debrief is a teaching and learning episode within simulation that aims to challenge students to develop their thinking and practice, without compromising instruction. Much debrief practice tends towards instruction at the expense of student self-exploration, and preparation for assessment at the cost of critical reflection. The practical approach to debrief discussed here is a timely reminder to step back and re-assess the practice of debrief. This discussion will assist nurse educators to implement a debrief that supports reflection at the highest level. Four familiar strategies of teaching and learning, when combined within debrief, can optimise the reflective capacity of nursing students: role modelling and vicarious observation, scaffolding of reflective thinking, emotional processing, and student-centred reflection. The practical strategies presented are relevant to both Australian and international nursing higher education contexts.
Published: 2021

29. Registered Nurses' experiences of reading and using research for work and education: a qualitative research study

Author: Sonia Hines, Joanne Ramsbotham, and Fiona Coyer
Subjects: General Nursing
Abstract: BackgroundConsiderable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice.AimsThis study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education.DesignA qualitative descriptive study using online and in-person focus groups.MethodsFocus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis.ResultsThree distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles.ConclusionThis study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.
Published: 2021

30. An international consensus on device-related pressure ulcers

Author: Holly Kirkland-Kyhn, Nils Lahmann, Catherine T Milne, Karen Ousey, G. Ciprandi, Amit Gefen, Fiona Coyer, Nicola Waters, Joyce M. Black, Michelle Barakat-Johnson, Norihiko Ohura, Paulo Alves, Dimitri Beeckman, Jacqui Fletcher, Peter Worsley, Zena Moore, Yohan Payan, and Anna-Barbara Schlüer
Subjects: Pressure Ulcer, medicine.medical_specialty, Consensus, Equipment and Supplies, Risk Factors, business.industry, medicine, MEDLINE, Humans, Nursing, Intensive care medicine, business, General Nursing
Abstract: Catherine Milne and colleagues present the findings of their review, ccna2@juno.com
Published: 2020

31. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review

Author: Fiona Coyer, Michelle Barakat-Johnson, Michelle Lai, Kathryn White, Timothy Wand, and Mengbo Li
Subjects: Pediatrics, medicine.medical_specialty, Nursing (miscellaneous), Iatrogenic Disease, Prevalence, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Intensive care, medicine, Humans, Cumulative incidence, 030212 general & internal medicine, Data reporting, Stage (cooking), Nose, Pressure Ulcer, Adverse Outcome Pathways, business.industry, Incidence, Incidence (epidemiology), Checklist, Intensive Care Units, medicine.anatomical_structure, Equipment and Supplies, Fundamentals and skills, business
Abstract: Objective: The objective of this review was to synthesise the literature and evaluate the incidence, prevalence and severity of medical device-related pressure ulcers (MDRPU) in adult intensive care patients. Method: Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure ulcer (PU) as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using 12 statistic. Results: We included 13 studies in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas category II followed by category I were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose. Conclusion: While MDRPU are common in intensive care patients, it is an understudied area. Inconsistency in the staging of MDRPU, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.
Published: 2019

32. Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis

Author: Ignacio Martin-Loeches, Louise Rose, Elsa Afonso, Julie Benbenishty, Bronagh Blackwood, Carole Boulanger, Silvia Calvino-Gunther, Wendy Chaboyer, Fiona Coyer, Mireia Llaurado-Serra, Frances Lin, Francesca Rubulotta, Ged Williams, Mieke Deschepper, Guy Francois, Sonia O. Labeau, and Stijn I. Blot
Subjects: Adult, Critical Illness, Comorbidity, Pressure injuries, Intensive Care Units, Pulmonary Disease, Chronic Obstructive, Risk Factors, Decubitus ulcers, Intensive care, Medicine and Health Sciences, Humans, COPD, Hospital Mortality, Propensity Score, General Nursing, Retrospective Studies
Abstract: BackgroundPressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available.ObjectiveTo assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality.Study design and methodsThis is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression).ResultsOf the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58).Conclusion and implicationsCritically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
Published: 2022

33. Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

Author: Fiona Coyer, Michelle Lai, Michelle Barakat-Johnson, and Amit Gefen
Subjects: Adult, Male, medicine.medical_specialty, Critical Care, medicine.medical_treatment, Pilot Projects, Dermatology, Intervention group, Patient Positioning, law.invention, Raised intracranial pressure, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Extracorporeal membrane oxygenation, Humans, Medicine, 030212 general & internal medicine, Clinical efficacy, Aged, Aged, 80 and over, Pressure Ulcer, business.industry, Australia, Outcome measures, Occiput, Original Articles, Equipment Design, Middle Aged, Intensive care unit, medicine.anatomical_structure, Physical therapy, Female, Surgery, Occipital Lobe, Stress, Mechanical, business, Head
Abstract: This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post-test design with a historical control group was used in a 54-bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty-four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger-scale study.
Published: 2018

34. Identifying contributing factors to tracheostomy stoma breakdown: a retrospective audit in a single adult intensive care unit

Author: Kathy Hocking, Nanette Nanette, Stacey Llewellyn, Karyn Heineger, Fiona Coyer, and Anita Pelecanos
Subjects: medicine.medical_specialty, Referral, business.industry, Incidence (epidemiology), Audit, Tracheostomy stoma, Intensive care unit, law.invention, Adult intensive care unit, Health facility, law, Acute care, Emergency medicine, medicine, business
Abstract: Introduction Tracheostomies are a common adjunct to therapy for critically ill patients in the intensive care unit (ICU). This study sought to identify the incidence of, and demographic, clinical and care process factors related to, tracheostomy-related skin injuries (TRSI) in ICU patients. Methods Conducted in a 36-bed ICU of an Australian metropolitan tertiary referral acute care health facility, this study employed a retrospective review of patient records between February 2015 and December 2016 for patients who had a tracheostomy inserted during an ICU admission. Records were reviewed for the patient’s admission or a 20-day observation period, whichever was shorter. Results Of the 102 patients included, 66 were male (64.7%) and their mean age was 50 years (SD=18.3). Of these patients, 23 (22.5%) developed a TRSI. No association was found between patient characteristics, tracheostomy insertion method and the development of a TRSI; however, the use of non-adjustable flange tubes was associated with the development of TRSI (p=0.023). Omissions in nursing documentation of care processes for tracheostomies were observed. Conclusion This study addressed a specific medical device, the tracheostomy tube, providing evidence of TRSI occurrence in the ICU setting. Although no common demographic, clinical nor care process factors were associated with TRSI development, findings from this study highlight a deficiency in nursing documentation.
Published: 2021

35. Developing a postgraduate professional education framework for emergency nursing: a co-design approach

Author: Fiona Coyer, Robyn Fox, Alexandra L. McCarthy, Amanda Henderson, Karen Theobald, and Bernadette Thomson
Subjects: Postgraduate nursing education, Higher education, education, 03 medical and health sciences, 0302 clinical medicine, Nursing, ComputingMilieux_COMPUTERSANDEDUCATION, Co-design, Curriculum development, Medicine, 030212 general & internal medicine, Nursing management, Curriculum, General Nursing, lcsh:RT1-120, lcsh:Nursing, 030504 nursing, business.industry, Nursing research, Professional development, Industry-academic, Emergency nursing, Coursework, Partnership, 0305 other medical science, business, Research Article
Abstract: Background Hospital and university service providers invest significant but separate resources into preparing registered nurses to work in the emergency department setting. This results in the duplication of both curricula and resource investment in the health and higher education sectors. This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. Methods The study was informed by evidence-based co-design, using emergency nursing as an exemplar. Eighteen hours of co-design workshops were completed with 21 key clinical-academic stakeholders from hospital and university settings. Results Outcomes were matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework; mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education; a new University-Industry Academic Integration Framework; five agreed guiding principles of postgraduate curriculum development for university-industry curriculum co-design; and a Graduate Certificate of Emergency Nursing curriculum exemplar. Conclusion Industry-academic service provider co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability. The study developed strategies and exemplars for future use in any mutually determined academic-industry education partnership.
Published: 2021

36. Silicone adhesive multilayered foam dressings for pressure ulcer prevention

Author: Fiona Coyer
Subjects: Pressure Ulcer, business.industry, Silicones, Dentistry, Dermatology, Original Articles, Skin Care, Bandages, Clinical Trial, Silicone adhesive, Adhesives, Medicine, Pressure Ulcer Prevention, Humans, Clinical Trials, business
Abstract: Summary Background Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital‐acquired pressure ulcers (PUs). Objectives To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. Methods This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At‐risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) – pooled as the treatment group – and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. Results In the intention‐to‐treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41–0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35–0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34–1·68, P = 0·49). Conclusions Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at‐risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas., What is already known about this topic? The incidence of hospital‐acquired pressure ulcers (PUs) remains high despite the implementation of best‐practice recommendations.The concept of using silicone foam dressings as an additional prophylactic strategy in PU prevention has been investigated in previous studies but with some limitations.Most RCTs were monocentric studies, restricted to either critically ill or acute care patients and did not observe more than two anatomical at‐risk skin sites, which limited the generalizability of the findings. What does this study add? This large pragmatic RCT suggests that it is beneficial to use silicone adhesive multilayer foam dressings on the sacrum, in addition to standard of care, to help prevent hospital‐acquired PUs.Clinical decision making for heel dressings should be based on the clinical effectiveness of the intervention weighed against the potential risk of falling. Linked Comment: F. Coyer. Br J Dermatol 2021; 185:4–5.
Published: 2021

37. Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Fiona Coyer, Farid Zand, Hernan Aguirre-Bermeo, Ahmet Eroglu, Bram Kilapong, Rocco Monica, Francesca Rubulotta, SeoK Chan Kim, Miguel Angel Gimenez Lajara, DANIELA ALAMPI, Bodin Khwannimit, Mª Luisa Blasco, Małgorzata Mikaszewska-Sokolewicz, Özlem Özkan Kuşcu, Gian Domenico Giusti, Louise Rose, Alexis Tabah, Paulo Alves, Frances Fengzhi Lin, Martin Spångfors, Mohd Basri Mat Nor, Dana Tomescu, Wendy Chaboyer, Lamia Besbes, Serdar Efe, Mohd Zulfakar Mazlan, Joerg C. Schefold, Yalim Dikmen, Mieke Deschepper, Arto A. Palmu, Francois Philippart, Volkan Inal, MIREIA LLAURADO-SERRA, João Vieira, Dylan De Lange, Erik Roman-Pognuz, Sonia Labeau, CAROLE BOULANGER, Luis Alejandro Sánchez-Hurtado, David Perez-Torres, Morten Bestle, Tomasz Torlinski, Daniel Edward Horner, Marc Bota, Jose Trenado Álvarez, Marina Zhedaeva, Alessandro Di Risio, Nika Zorko Garbajs, Philip Broadhurst, Ascanio Tridente, Marcela Vizcaychipi, Hilaryano Ferreira, Walter Swinnen, Hayriye Cankar dal, Julie Benbenishty, Ioana Grigoras, Luis Antonio Gorordo-Delsol, Labeau, Sonia O [0000-0003-3863-612X], Afonso, Elsa [0000-0003-0873-0852], Benbenishty, Julie [0000-0002-8488-9649], Blackwood, Bronagh [0000-0002-4583-5381], Boulanger, Carole [0000-0002-1392-6633], Brett, Stephen J [0000-0003-4545-8413], Calvino-Gunther, Silvia [0000-0003-3586-7205], Chaboyer, Wendy [0000-0001-9528-7814], Coyer, Fiona [0000-0002-8467-0081], Deschepper, Mieke [0000-0001-6797-3147], Honore, Patrick M [0000-0002-6697-4890], Jankovic, Radmilo [0000-0003-0742-8686], Khanna, Ashish K [0000-0002-9083-891X], Llaurado-Serra, Mireia [0000-0002-5123-0581], Lin, Frances [0000-0001-8735-5469], Rose, Louise [0000-0003-1700-3972], Rubulotta, Francesca [0000-0001-8644-1728], Saager, Leif [0000-0003-3416-4727], Williams, Ged [0000-0002-7481-2445], Blot, Stijn I [0000-0003-2145-0345], and Apollo - University of Cambridge Repository
Subjects: Adult, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Mistake, morbidity, pressure injury, Critical Care and Intensive Care Medicine, DecubICUs Study Team, decubitus epidemiology, icu, mortality, outcome, pressure ulcer, risk factors, Anesthesiology, Prevalence, medicine, Humans, Hospital Mortality, Aged, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, business.industry, Correction, Respiration, Artificial, Patient Discharge, Intensive Care Units, Adult intensive care unit, Emergency medicine, business
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021

38. Developing a postgraduate professional education framework for emergency nursing: A co-design approach between healthcare industry and academic partners

Author: Amanda Henderson, Alexandra L. McCarthy, Robyn Fox, Bernadette Thomson, Fiona Coyer, and Karen Theobald
Subjects: Co-design, Medical education, Professional development, ComputingMilieux_COMPUTERSANDEDUCATION, Healthcare industry, Business, Emergency nursing
Abstract: Background: Hospital and university service providers invest significant but separate resources into preparing registered nurses to work in the emergency department setting. This results in the duplication of both curricula and resource investment in the health and higher education sectors. This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. Methods: The study was informed by evidence-based co-design, using emergency nursing as an exemplar. Eighteen hours of co-design workshops were completed with 21 key clinical-academic stakeholders from hospital and university settings. Results: Outcomes were matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework; mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education; a new University-Industry Academic Integration Framework; five agreed guiding principles of postgraduate curriculum development for university-industry curriculum co-design; and a Graduate Certificate of Emergency Nursing curriculum exemplar. Conclusion: Industry-academic service provider co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability. The study developed strategies and exemplars for future use in any mutually determined academic-industry education partnership.
Published: 2020

39. Moisture-associated skin damage: A timely report of an oft forgotten clinical problem

Author: Fiona Coyer
Subjects: Skin care, medicine.medical_specialty, Cross-Sectional Studies, Critical Care, business.industry, MEDLINE, Medicine, Humans, Critical Care Nursing, business, Intensive care medicine, Skin Care, Skin damage
Published: 2020

40. Securement to prevent device‐related pressure injuries in the intensive care unit: A randomised controlled feasibility study

Author: Fiona Coyer, Anna Doubrovsky, Jane-Louise Cook, Amanda Vann, and Wendy J. Brown
Subjects: medicine.medical_specialty, Nursing staff, Dermatology, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, law, Skin surface, medicine, Intubation, Intratracheal, Pressure, Humans, 030212 general & internal medicine, Intubation, Gastrointestinal, Endotracheal tube, Skin protection, Pressure Ulcer, business.industry, Incidence (epidemiology), Outcome measures, Original Articles, Process of care, Intensive care unit, Intensive Care Units, Emergency medicine, Feasibility Studies, Surgery, business
Abstract: Medical device-related pressure injuries are the most common cause of pressure injuries within the intensive care unit, in particular those caused by nasogastric tubes and endotracheal tubes. There are several known methods, which can alleviate the pressure of these devices on the skin surface to reduce the rate of these injuries. To determine the feasibility of conducting a larger, adequately powered trial testing, several clinically effective interventions to reduce the incidence of medical device-related pressure injuries caused by these devices. Patients were recruited into both study arms and received one of three different methods of skin protection for both arms. Outcome measures included fidelity to the processes of care protocol, recruitment potential, and the number of medical device-related pressure injuries. Recruitment (n = 87) was slower than expected with less than 10% of screened potential patients available for enrolment. Fidelity to the process of care for each subgroup was variable with better adherence in the nasogastric tube arm compared to the endotracheal tube arm. This feasibility study has revealed concerns about the intervention designs and effectiveness as well as challenges for the adherence of the nursing staff to the protocol.
Published: 2020

41. Implementing best available evidence into practice for incontinence-associated dermatitis in Australia: A multisite multimethod study protocol

Author: Michelle Barakat-Johnson, Fiona Coyer, Catherine Leahy, Shifa Basjarahil, Samara Geering, Gary Disher, Joan Walsh, Michelle Lai, Natalie Ko, Jayne Campbell, Katherine M. White, Eve McClure, Melissa O'Grady, Michelle Cunich, and Thomas Leong
Subjects: Adult, Male, Adolescent, Translational research, Dermatology, Audit, Dermatitis, Contact, Pathology and Forensic Medicine, Translational Research, Biomedical, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Nursing, Clinical Protocols, Surveys and Questionnaires, Prevalence, Medicine, Humans, Qualitative Research, Protocol (science), Data collection, 030504 nursing, Pressure injury, business.industry, Australia, Guideline, Focus Groups, Middle Aged, Focus group, Urinary Incontinence, Quality of Life, Female, 0305 other medical science, business, Fecal Incontinence
Abstract: Aims Incontinence-associated dermatitis (IAD) is an insidious and under-reported hospital-acquired complication which substantially impacts on patients’ quality of life. A published international guideline and the Ghent Global IAD Categorisation Tool (GLOBIAD) outline the best available evidence for the optimal management of IAD. This study aims to implement theguideline and the GLOBIAD tool and evaluate the effect on IAD occurrences and sacral pressure injuries as well as patient, clinician and cost-effectiveness outcomes. Materials and methods The study will employ a multi-method design across six hospitals in five health districts in Australia, and will be conducted in three phases (pre-implementation, implementation and post-implementation) over 19 months. Data collection will involve IAD and pressure injury prevalence audits for patient hospital admissions, focus groups with, and surveys of, clinicians, patient interviews, and collection of the cost of IAD hospital care and patient-related outcomes including quality of life. Eligible participants will be hospitalised adults over 18 years of age experiencing incontinence, and clinicians working in the study wards will be invited to participate in focus groups and surveys. Conclusion The implementation of health district-wide evidence-based practices for IAD using a translational research approach that engages key stakeholders will allow the standardisation of IAD care that can potentially be applicable to a range of settings. Knowledge gained will inform future practice change in patient care and health service delivery and improve the quality of care for patients with IAD. Support at the hospital, state and national levels, coupled with a refined stakeholder-inclusive strategy, will enhance this project's success, sustainability and scalability beyond this existing project.
Published: 2020

42. Pressure injury prevention for COVID-19 patients in a prone position

Author: Fiona Coyer, Michelle Barakat-Johnson, Annabel Levido, Ruaidhri Carey, Kerrie Coleman, Kathy Hocking, Kimberley Counter, and Tom Leong
Subjects: medicine.medical_specialty, ARDS, Shoulders, business.industry, Psychological intervention, Lung injury, medicine.disease, Chin, Prone position, medicine.anatomical_structure, medicine, Forehead, Intensive care medicine, business, Pelvis
Abstract: Prone positioning is a method used to manage ventilator-associated lung injury and promote oxygenation in severe acute respiratory distress syndrome (ARDS). With the COVID-19 pandemic and ever-increasing numbers of patients presenting with clinical pictures of ARDS, critical care practice guidelines and governing bodies are recommending prone positioning for adult patients with ARDS related to severe COVID-19 infection. Complications associated with prone positioning in critical care have the potential to cause patient morbidity. Common complications with prone positioning include the development of pressure injuries (PIs) on the forehead, chest, pelvis, chin, shoulders, genitalia, iliac crest and knees. Ocular damage and musculoskeletal issues may also occur. These complications are largely avoidable by implementing appropriate interventions. This article summarises current best practice and literature on interventions to reduce skin injury and other complications associated with prone positioning of COVID-19 patients with ARDS.
Published: 2020

43. Maintaining skin health and integrity for staff wearing personal protective equipment for prolonged periods: a practical tip sheet

Author: Michelle Barakat-Johnson, Fiona Coyer, Kathy Hocking, Kerrie Coleman, Tom Leong, and Annabel Levido
Subjects: medicine.anatomical_structure, Coronavirus disease 2019 (COVID-19), business.industry, Health care, Medicine, Medical emergency, Therapeutic Devices, Eye protection, business, Self report, medicine.disease, Personal protective equipment, Nose
Abstract: Patient skin injuries associated with medical or therapeutic devices are increasingly reported in the literature. With the coronavirus (COVID-19) pandemic, healthcare staff are wearing personal protective equipment (PPE) for prolonged periods. Anecdotally, cases of healthcare workers' self report of injuries to their face, particularly the bridge of the nose, upper cheek, forehead and above the ears, as a result of extended use of eye protection and masks is increasing. Protecting the skin of frontline healthcare staff is as important as protecting patients' skin. The tip sheet presented in this paper provides staff with a guide in the form of written and visual assistance in order to reduce the risk of device-related pressure injuries (DRPIs) in healthcare staff caused by PPE.
Published: 2020

44. Co-designing an industry-academic postgraduate professional education framework for emergency nursing

Author: Karen Theobald, Fiona Coyer, Amanda Henderson, Bernadette Thomson, Alexandra L. McCarthy, and Robyn Fox
Subjects: ComputingMilieux_GENERAL, Medical education, education, Professional development, ComputingMilieux_COMPUTERSANDEDUCATION, Sociology, Emergency nursing
Abstract: Background This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. Hospitals and university providers in Australia invest significant but separate resources for postgraduate curricula, resulting in duplication of curricula and resources in the health and higher education sectors. Methods Using emergency nursing as an exemplar, we co-designed an industry-academic postgraduate education framework that integrated the needs and resources of the health and higher education sectors to streamline postgraduate students’ professional learning. Results Outcomes include matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework; mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education; a University-Industry Academic Integration Framework; five guiding principles of postgraduate curriculum development for university-industry curriculum co-design; and a Graduate Certificate of Emergency Nursing curriculum exemplar. Conclusion Industry-academic co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability.
Published: 2020

45. Simulation debriefing based on principles of transfer of learning: A pilot study

Author: Fiona Coyer, Sandra Johnston, and Robyn Nash
Subjects: Adult, Male, Transfer, Psychology, education, Pilot Projects, Education, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Intervention (counseling), ComputingMilieux_COMPUTERSANDEDUCATION, Humans, 030212 general & internal medicine, Curriculum, General Nursing, Medical education, 030504 nursing, Clinical placement, Debriefing, Education, Nursing, Baccalaureate, General Medicine, Focus Groups, Middle Aged, Focus group, Test (assessment), Patient Simulation, Female, Students, Nursing, Pilot test, Clinical Competence, 0305 other medical science, Transfer of learning, Psychology, Clinical psychology
Abstract: Upon completion of undergraduate nursing courses, new graduates are expected to transition seamlessly into practice. Education providers face challenges in the preparation of undergraduate nurses due to increasing student numbers and decreasing availability of clinical placement sites. High fidelity patient simulation is an integral component of nursing curricula as an adjunct to preparation for clinical placement. Debriefing after simulation is an area where the underlying structure of problems can consciously be explored. When central principles of problems are identified, they can then be used in situations that differ from the simulation experience. Third year undergraduate nursing students participated in a pilot study conducted to test a debriefing intervention where the intervention group (n=7) participated in a simulation, followed by a debriefing based on transfer of learning principles. The control group (n=5) participated in a simulation of the same scenario, followed by a standard debriefing. Students then attended focus group interviews. The results of this pilot test provided preliminary information that the debriefing approach based on transfer of learning principles may be a useful way for student nurses to learn from a simulated experience and consider the application of learning to future clinical encounters.
Published: 2017

46. High-Fidelity Simulation: Descriptive Analysis of Student Learning Styles

Author: Mary Ryan, Peter Lewis, Fiona Coyer, and Naomi Tutticci
Subjects: Cooperative learning, Nursing (miscellaneous), 020205 medical informatics, education, high-fidelity simulation, 02 engineering and technology, Education, Learning styles, 03 medical and health sciences, Nursing, active learning, 0202 electrical engineering, electronic engineering, information engineering, Student learning, Medical education, 030504 nursing, Descriptive statistics, satisfaction, Intervention studies, Modeling and Simulation, Active learning, High fidelity simulation, Individual learning, undergraduate nursing, learning styles, 0305 other medical science, Psychology
Abstract: Background: Nurse educators need to be responsive to and understand individual learning styles and characteristics. This responsiveness will contribute to a satisfying and effective high-fidelity simulation. Method: A descriptive post-test design was employed as part of a larger randomized controlled intervention study. Results: The majority of third-year nursing students were divergers (29.8%), and the highest mean score for learning characteristics was for active experimentation. Participants were highly satisfied and agreed effective teaching, and learning strategies were evident in and important for simulation. Conclusions: High-fidelity simulation is valued by third-year nursing students, irrespective of their learning styles and is particularly suited to millennial students. The implementation and design of simulation requires further examination to ensure that it consistently assists students in preparation for professional practice.
Published: 2016

47. Health literacy in Indigenous people with chronic disease living in remote Australia

Author: Lee W. Jones, Fiona Coyer, Haunnah Rheault, and Ann Bonner
Subjects: HLQ, Gerontology, medicine.medical_specialty, Population, Health literacy, Disease, Health informatics, Chronic disease, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health care, Rural and remote health, medicine, 030212 general & internal medicine, education, Health policy, education.field_of_study, business.industry, lcsh:Public aspects of medicine, Health literacy questionnaire, 030503 health policy & services, Health Policy, Public health, ATSI health, lcsh:RA1-1270, 0305 other medical science, business, Research Article
Abstract: Background Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics. Methods Using a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy. Results Participants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy. Conclusion Improved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients’ needs and health capabilities to better support people to engage in effective self-management for chronic diseases. Electronic supplementary material The online version of this article (10.1186/s12913-019-4335-3) contains supplementary material, which is available to authorized users.
Published: 2019

48. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

Author: Zijing Wu, Fiona Coyer, Wendy Chaboyer, Bing Song, and Frances Lin
Subjects: Adult, medicine.medical_specialty, Quality management, Critical Care, Population, Psychological intervention, CINAHL, Cochrane Library, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Intensive care, medicine, Humans, 030212 general & internal medicine, education, General Nursing, Pressure Ulcer, education.field_of_study, 030504 nursing, business.industry, Combined Modality Therapy, Quality Improvement, Family medicine, Needs assessment, Guideline Adherence, 0305 other medical science, business, Patient education
Abstract: Background : Pressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a reported pressure injury prevalence of 12–33%. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. Aim : This systematic review evaluated the effectiveness of pressure injury prevention programs in reducing pressure injury prevalence and incidence in the adult intensive care population. It also critically appraised the program components and strategies used to implement these programs. Method : We searched PubMed, EMBASE (embase.com), Ovid MEDLINE, EBSCOhost CINAHL, and Cochrane Library databases separately for papers published in English and Chinese from the year of 2000 to May 2018. After removing duplicates, two authors independently screened the title and abstracts, then full-text against the inclusion and exclusion criteria. Data was extracted by one author and checked by a second author. Quality appraisal was conducted by two authors by using the Quality Improvement Minimum Quality Criteria Set, and the Mixed Methods Appraisal Tool. Content analysis was used to categorise program components. Implementation strategies were grouped into six classifications: dissemination strategies, implementation process strategies, integration strategies, capacity building strategies, sustainability strategies, and scale up strategies. Results : Twenty-one peer reviewed papers (12 quality improvement projects, and 9 research papers from 8 studies) were included. Pressure injury prevention programs with 2–11 components were commonly implemented. Common components of the programs included: clarification of staff roles, introducing new roles, repositioning, staff and patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition needs assessment, documentation, multidisciplinary team involvement, and mobilisation. Implementation strategies commonly used were education, audit and feedback, and standardising documentation. Five of the eight research studies and one of the quality improvement projects reported significant decrease in pressure injury prevalence, and/or increase in compliance to pressure injury prevention protocols and strategies. Two quality improvement papers reported cost savings of $1 million and £2.6 million respectively after the implementation of the programs. Conclusion : Much of the work on multicomponent pressure injury prevention programs has been undertaken as quality improvement projects and before and after research studies with limited rigour. However, positive outcomes and strong theoretical rationales for the components in the programs suggest that they are beneficial. This calls for future high-quality research such as randomised controlled trials to test the effectiveness of multicomponent interventions and their implementation strategies. Tweetable abstract: Some multicomponent pressure injury prevention programs were found to be effective; however, higher level of research evidence is needed.
Published: 2019

49. Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries: Translating Knowledge Into Practice

Author: Fiona Coyer, Michelle Barakat-Johnson, Michelle Lai, Timothy Wand, and Kathryn White
Subjects: Quality management, Evidence-based practice, Iatrogenic Disease, MEDLINE, Context (language use), Translational Research, Biomedical, 03 medical and health sciences, 0302 clinical medicine, Practice change, Nursing, Health care, Medicine, Humans, 030212 general & internal medicine, General Nursing, Quality Indicators, Health Care, Pressure Ulcer, 030504 nursing, business.industry, Australia, Quality Improvement, Action (philosophy), Evidence-Based Practice, Facilitation, Guideline Adherence, 0305 other medical science, business, Delivery of Health Care
Abstract: Background Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes. Problem One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change. Approach This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs. Outcomes Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies. Conclusion Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.
Published: 2019

50. The authors reply

Author: Stijn Blot, Claudia Bull, Fiona Coyer, Emma Harbeck, Lukman Thalib, Frances Lin, Paula Cristina Nogueira, and Wendy Chaboyer
Subjects: medicine.medical_specialty, Pressure injury, Critical Care, business.industry, Incidence, Emergency medicine, Prevalence, Medicine, Humans, Critical Care and Intensive Care Medicine, business, Black spot
Published: 2019

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