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Aims and Objectives: To explore parental management of childhood complaints with respect to factors associated with the purchase of over-the-counter medicines and sources of information accessed by parents., Background: The use of over-the-counter medicines is extensive, but this practice is not without risks. To ensure safe use, nurses and other healthcare providers need to understand parental reasons for purchase and sources of information they access regarding management practices., Design: A cross-sectional survey., Method: Three-hundred and twenty-five parents of children (aged birth to 24 months) were recruited between September 2006-June 2007 from three recruitment sites across Melbourne, Australia. These included the following: outpatient clinics at a major paediatric hospital, maternal and child health centres and a childcare service of a tertiary education institution. Data were collected using a self-administered questionnaire., Result: Most parents (82%) purchased over-the-counter medicines if suggested by the doctor and if it had been effective in the past. Doctors were the most frequently cited source of advice for management of complaints such as an ear ache (95%), wheeziness (90%) and rash (77%). Advice from maternal and child health nurses was frequently sought for sleep difficulties (60%), while family or friends were sought for advice on irritability or crankiness (47%) and teething pain (44%)., Conclusions: The findings revealed the impact of healthcare provider recommendations on parental purchase of over-the-counter medicines. Parents mainly sought information and advice from doctors, followed by maternal and child health nurses and family or friends, which appeared to be dependent on the type of childhood complaint., Relevance to Clinical Practice: The use of over-the-counter medicines for symptom management is likely to increase with enhanced focus on self-care. It is important for all healthcare providers to proactively provide accurate, consistent and evidence-based information to parents regarding appropriate management of symptomatic and behavioural complaints., (© 2010 Blackwell Publishing Ltd.)

Aim: To describe over-the-counter (OTC) medicine use by Australian parents for children aged birth to 24 months; types of medicines used and indications for use., Methods: A cross-sectional survey of parents was conducted using a self-administered over-the-counter medicine use questionnaire. A total of 640 questionnaires were distributed to parents of children who attended a hospital outpatient clinic, maternal and child health centre, or a childcare service in Melbourne, Australia., Results: A total of 325 questionnaires were completed (50.1%). Of these, 98.2% of parents had reportedly purchased at least one OTC medicine for their child in the previous 12 months. The most commonly purchased medicines were: paracetamol (acetaminophen) (95.9%), choline salicylate (47.3%), ibuprofen (36.4%), and cough and cold products (46.7%). Paracetamol was commonly used for a high temperature (82.4%) and non-specific pain (62.3%). Over 40% of parents had used cough and cold products to treat cold and flu symptoms. Nineteen (6.1%) parents had used OTC medicines to induce sleep or settle their child., Conclusions: Most parents had used at least one OTC medicine to manage childhood symptoms. Of concern is that over 40% of parents had used cough and cold products for their young child, despite a lack of evidence surrounding their efficacy. In order to minimise risks associated with OTC medicine use, particularly cough and cold products, health-care providers need to continue the provision of current evidence-based information to parents regarding safe and appropriate use of medicines for their child.

Objectives: To retrospectively establish the nature and frequency of Axis I psychiatric disorders pre- and post-TBI., Participants: One hundred participants who were 0.5 to 5.5 years post mild to severe TBI and 87 informants, each evaluated at a single time point., Main Measure: The Structured Clinical Interview for DSM-IV Disorders (SCID-I)., Results: Preinjury, 52% received a psychiatric diagnosis, most commonly substance use disorder (41%), followed by major depressive disorder (17%) and anxiety (13%). Postinjury, 65% received a diagnosis, of which major depression became the most common (45%), followed by anxiety (38%) and substance use disorder (21%). Frequency of depression, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and phobias rose from preinjury to postinjury. More than two-thirds of postinjury depression and anxiety cases were novel and showed poor resolution rates. Few novel cases of substance use disorder were noted. Psychotic disorders, somatoform disorders, and eating disorders occurred at frequencies similar to those in the general population., Conclusions: A high frequency of postinjury psychiatric disorders was evident up to 5.5 years postinjury, with many novel cases of depression and anxiety. Individuals with TBI should be screened for psychiatric disorders at various time points post-injury without reliance on history of psychiatric problems to predict who is at risk, so that appropriate intervention can be offered.

Objective: Providing education to patients requiring anticoagulant therapy may be associated with improved outcomes. This study investigated the knowledge outcomes of a validated educational intervention., Methods: Parents of children with congenital heart disease requiring warfarin therapy took part in an educational intervention. Warfarin knowledge was assessed prior to commencing the program, immediately following its completion and 6 months following completion., Results: Parents demonstrated a statistically significant improvement in their warfarin knowledge immediately following completion of the program (p < 0.0001), with this improvement being sustained over time., Conclusion: Current approaches to educating parents of children requiring warfarin therapy are likely suboptimal. Using a validated model of education may be associated with improved knowledge outcomes for patients., Practice Implications: Consideration to the processes used in delivering patient education may result in improved patient knowledge outcomes.

Aim: This paper reports on the development and evaluation of a multidisciplinary critical appraisal and research utilization-training programme at one organization with the aim of demonstrating a potential approach to the challenge of ensuring practice is evidence based., Background: Considerable time and attention is devoted to developing and evaluating new clinical innovations. Nevertheless, it is estimated that a quarter of patients continue to receive treatments that are unnecessary or potentially harmful., Design: A cross-sectional qualitative evaluation survey of nurses and allied health staff participating in the training programme., Methods: After running the programme twice at this organization we sought to evaluate the impact of the programme. Participants were asked to write answers to open-ended questions to examine personal and professional outcomes of participation., Results: All respondents found the programme to be worthwhile and beneficial to their everyday practice. Importantly, participants reported feeling more confident when discussing clinical issues within the multidisciplinary team. The majority have presented their work via oral presentations or in publications and many have gone on to enroll in higher degrees., Conclusions: A critical appraisal and research utilization programme, as described here, has benefits for clinicians in terms of building confidence, knowledge and skill acquisition and also for the organization in terms of provision of evidence-based care and quality and safety. It successfully addresses commonly reported barriers to research utilization., Relevance to Clinical Practice: A programme such as the Clinical Research Fellowship increases clinicians' ability and confidence to generate research questions that are meaningful to practice and then investigate the issue in a rigorous and timely manner.

Background: Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration., Objective: To characterize the role of Australian critical care nurses in the management of mechanical ventilation., Methods: A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined., Results: Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients., Conclusions: In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

Background: The importance of interdisciplinary collaboration has been attested to by a number of authors. Some have suggested that Nurse Practitioners (NPs) may be able to improve collaboration between doctors and nurses, but this assertion does not appear to have been researched., Aims and Objectives: To investigate doctors' and nurses' perceptions of interdisciplinary collaboration in two neonatal intensive care units, and to assess the impact of a Neonatal Nurse Practitioner (NNP) practice model on these perceptions. The study was conducted as part of a larger project to develop a NNP model of practice., Design: Survey, pre- and post-intervention., Methods: Medical and nursing staff in both units were surveyed before and after introduction of the NP model of practice. The instrument consisted of 25 statements relating to nurse-doctor interactions, with which respondents indicated their level of agreement on a five-point Likert scale. The Mann-Whitney U-test was used to compare scores for individual items and for overall collaboration between various groups of staff, and between the first and second surveys., Results: Significant differences between the responses of nurses and doctors were found on both surveys. Areas of disagreement chiefly concerned doctors' behaviour and their attitudes towards nurses, rather than nurses' behaviour or environmental factors. Doctors consistently reported a higher degree of collaboration than did nurses. Few differences were found between first and second surveys., Conclusions: Results suggest that problems in nurse-physician interactions exist in both units. No impact of the NNP role, as established in this project, on interdisciplinary collaboration could be demonstrated. Further research in this area is warranted.

The lack of research utilization within nursing practice has been extensively discussed in the literature. The Clinical Research Fellowship (CRF) program was developed to assist nurses to change practice on the basis of high-quality research evidence. This paper presents the results of a qualitative study examining the experiences of four CRF participants and three of their unit managers in completing the program and implementing changes within the clinical setting. The major themes to emerge from the data were: experience of the program, outcomes, implementation, assistance from the Centre for Psychiatric Nursing Research and Practice, Victoria, Australia, benefits and drawbacks to the program and whether it would be recommended to others. The findings indicate a positive view of the program itself although problems with the implementation stage were clearly evident. Further support following completion of the program is required to achieve maximum benefit from the program.