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Background Being able to visit a critically ill relative provides comfort to family members and has recognised benefits to the patient. Limited research has been conducted on demographic characteristics and visiting behaviours of family members with a relative in the intensive care unit (ICU). Objectives The objective was to provide an overview of local ICU visitor behaviours and practices across four metropolitan units in Australia. Methods A convenience sample of 440 participants from four ICUs across a metropolitan city in eastern Australia was required for the study. A descriptive 22-item self-report survey was used. Data were collected from four ICUs in a metropolitan city in eastern Australia. Sample characteristics and other variables were analysed using descriptive statistics. Results Data collection was undertaken from April 2018 to May 2019. Four hundred sixty-two (n = 462) ICU visitors responded. There were no significant differences between visitor characteristics across the four hospitals. The mean age of the respondents was 49 years, the youngest participant being 18 years and the oldest being 93 years, with most visitors being women (n = 312, 68%). The participants were more likely to be close relatives such as spouses (n = 117, 25%), parents (n = 113, 24%), or children (n = 79, 17%). Visitors reported different methods by which they received information about visiting policies across units and indicated that they would have visited more frequently if able. Although most respondents rated their ICU visiting experience favourably, some reported being frequently asked to leave the patient's bedside impacted their experience. Conclusions This study has highlighted that families want to remain in close proximity when they have a relative in the ICU. Despite visiting hours being flexible, most families visit midmorning so that they can talk with staff. Data captured in this study can be used toward improving the ICU visiting experience for family members.

Objective The objective of this scoping review is to investigate use of patient reported experience measures and patient reported outcome measures within the acute health care context. Introduction Data from patient reported outcome measures and patient reported experience measures provide important information for health professionals and organizations in order to improve patient-centered care. These two measures have potential to narrow the gap between the clinician's and patient's views and help tailor treatment plans to meet the patient's preferences and needs. Inclusion criteria This scoping review will consider studies that include patients of any age and any condition who have obtained care from any acute health care facility. The concepts of this review are: the types of research studies that have been done using patient reported experience measures and patient reported outcome measures data in acute hospital settings, the geographical contexts of these two measures' studies, the barriers and facilitators that have been identified in studies that use data from the measures, the characteristics of patient reported experience measures and patient reported outcome measures data and the ways in which these types of data have been applied to clinical practice in acute care settings. This review will consider studies that are set in any acute health care setting including inpatient and outpatient areas, emergency departments, and critical care units. Methods This scoping review, utilizing JBI methods, will include an extensive search of the databases for published and unpublished literature. The review will consider any type of quantitative, qualitative, or mixed methods research evidence as well as systematic reviews to understand how hospitals use patient reported experience measures and patient reported outcome measures data in health care. Each included study will be assessed by two independent reviewers and data will be extracted from included papers using a standardized data extraction tool.

The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature.A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs.This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included.Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs.The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision.The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.

Aim To ensure that gynae-oncology surgical patients receive relevant written information, in their preferred format, and at a time that suits them, according to the best available evidence. Methods This project utilized an audit and feedback design and was conducted over a 9-month period from August 2015 to May 2016. Twenty-nine patients were audited prior to two strategies being implemented. The first strategy was a standardized e-mail letter to all patients (containing links to surgical information, cancer support websites and a short video introducing hospital staff, and the second was a discharge information sheet detailing wound care, signs of complications, actions to take and follow-up instructions. Thirty patients were audited post-implementation to evaluate the success of these strategies. Results There were significant increases in the number of patients who said they received written information on their diagnosis, surgery and potential complications at initial consultation and a significant increase in the number of patients who said they were provided with written follow-up information on discharge. Pre-audit, 83% of patients stated they would like to receive a list of reliable websites to access and post-audit, 89% of patients stated they found the websites provided were useful. Discussion Although gynae-oncology surgical patients did previously receive relevant verbal information, little or no written information was provided. The pre-implementation audit provided insight into the information these patients required. The e-mail was generally well received by patients; however; there was a minority who did not have internet access and therefore a paper version was provided. Conclusion This project identified deficits in the provision of written information for surgical gynae-oncology patients. Two strategies were implemented to address this deficit with positive results in the number of patients receiving written information; however, further investigation is needed to establish patient satisfaction with this information.

The objective is to evaluate the effectiveness of nurse-initiated interventions (NIIs) on patient outcomes in the emergency department (ED).More specifically, the objectives are to identify the effectiveness of NIIs, including but not limited to, nurse-initiated medications, nurse-initiated intravenous fluid therapy and nurse-initiated pathology on patient waiting time, time to treatment, length of stay, pain levels, symptom relief, patient satisfaction, leave without being seen rates and mortality rates in ED settings.

REVIEW QUESTION/OBJECTIVE The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.

Background: Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological impairment, largely from stroke. Dysphagia is not generally considered a major cause of mortality; however, the complications that result from this medical condition, namely, aspiration pneumonia and malnutrition, are among the most common causes of death in the older adults. Methods : This is an update of an existing systematic review. The standard systematic review methods of the Joanna Briggs Institute were used. Methods were specified in advance in a published protocol. Awide range of databases were searched for quantitative research articles examining the effectiveness of nursing interventions to identify and manage dysphagia in adult patients with acute neurological dysfunction, published between 2008 and 2013. Results : Four new studies were added in this update, for a total of 15 included studies. Strong evidence was found to show that nurse-initiated dysphagia screening is effective for reducing chest infections in patients with dysphagia (odds ratio [OR] = 0.45, 95% CI [0.33, 0.62], p > .00001). Nurse-initiated dysphagia screening by trained nurses may be effective for detection of dysphagia, and training nurses in dysphagia screening improves the number and accuracy of screens conducted. The presence of formal dysphagia guidelines in a health facility is likely to reduce inpatient deaths (OR = 0.60, 95% CI [0.43, 0.84], p = .003) and chest infections (OR = 0.68, 95% CI [0.51, 0.90], p = .008); however, it does not appear that formal guidelines have an effect on length of stay. Conclusions : Nurse-initiated dysphagia screening for patients with acute neurological dysfunction is effective for a range of important patient outcomes. The presence of formal guidelines for the identification and management of dysphagia may have a significant effect on serious adverse outcomes such as chest infections and death. Training nurses to conduct dysphagia screening will improve patient outcomes.

Background Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate care for both the patient and the family. An initial search of the Cochrane and Joanna Briggs Institute Libraries did not reveal any published systematic reviews recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care unit.Objectives This systematic review aims to establish best practice in addressing the needs of family members with a relative admitted to an adult critical care unit.Search strategy An extensive search of the major databases was conducted. Databases searched included: MEDLINE, CINAHL, psycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as Pubmed. The search included published and unpublished studies and papers in English from 1980-2010.Selection criteria This review considered any randomised controlled trials that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult intensive care unit. In the absence of randomised controlled trials, other research designs such as quasi-experimental as well as before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients.Assessment of quality Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute.Data collection and analysis Data was extracted from the papers included in this review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form.Results Fourteen studies and one dissertation met the inclusion criteria and were included in the review. There were 12 quasi-experimental studies identified including 8 two or three group, pre-test/post-test studies; 1 one-way between subjects design; 1 interrupted time series and 1 two-group comparative design study. The dissertation was a quasi-experimental three group pre-test/post-test design. There were 3 prospective randomised trials included. The evidence identified includes: the use of support groups for family members of patients admitted to an intensive care unit, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs and open or more flexible visiting hours.Conclusion/Recommendations This review makes several recommendations for clinical practice to address family needs of patients admitted to a critical care unit, however this review highlights the need for significant further research in this area. Future intervention studies focusing on family needs could include: the use of technology such as DVD's and SMS for informing families and interventions specifically designed to improve family comfort.

Aims and objectives. The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Background. Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. Design. This study used a descriptive qualitative design. Methods. Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. Results. The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. Conclusion. The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Relevance to clinical practice. Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.

Background: Violence in healthcare has been widely reported and healthcare workers, particularly nurses in the acute care setting, are ill-equipped to manage patients who exhibit aggressive traits. An initial search of the Cochrane Library and the Joanna Briggs Institute did not reveal any published systematic reviews recommending strategies to manage aggressive and/or violent behaviours in patients admitted to an acute hospital setting.----- Objectives: This systematic review aims to establish best practice in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting.----- Search strategy: A three-step search strategy was utilised during this review. Major databases searched included: MEDLINE, CINAHL, PsycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as PubMed. The search included published and unpublished studies and papers in English from 1990-2007.----- Selection criteria: This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. In the absence of RCT's, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for preventing and managing patient aggression in acute care areas.----- Assessment of quality: Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute. Data collection and analysis: Data was extracted from the papers included in this review using the standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics: Assessment and Review Instrument (JBI-MAStARI)package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form.----- Results: Twelve studies and one dissertation met the inclusion criteria and were included in the review. The evidence identified includes: the benefit of education and training of acute care nurses in aggression management techniques; the use of “as required” medications to minimise harm to patients and staff; and that specific interventions such as music therapy and physical restraint may play a role in managing aggressive and/or violent behaviours from patients in the acute care setting.----- Conclusion: This review makes several recommendations for clinical practice to prevent and manage aggressive behaviours in acute hospital patients. However due to the lack of high quality intervention studies conducted in the acute care setting there is huge scope for future research in this area.

Background: Violence in health care has been widely reported and health care workers, particularly nurses in acute care settings, are ill-equipped to manage patients who exhibit aggressive traits. Aim: The aim of this systematic review was to establish best practice in the prevention and management of aggressive behaviours in patients admitted to acute hospital settings. Data Sources: An extensive search of the major databases was conducted from 1990 to 2007. The search included published and unpublished studies and papers in English. Review Methods: This review considered any quantitative research study design that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. Each included study was quality assessed by two independent reviewers and data were extracted using the relevant tools developed by the Joanna Briggs Institute. Results: Ten studies met the inclusion criteria and were included in the review. The evidence identified from the studies includes: the benefit of education and training of acute care nurses in aggression management techniques; use of “as required” medications is effective in minimising harm to patients and staff; and that specific interventions such as physical restraint may play a role in managing aggressive behaviours from patients in the acute care setting. Conclusions: This review makes several recommendations for the prevention and management of aggressive behaviours in acute hospital patients. However, due to the lack of high-quality studies conducted in the acute care setting there is huge scope for future research in this area.

The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients.Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group.This study used a descriptive qualitative design.Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes.The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills.The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients.Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.