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Brigid M Gillespie,1–3 Kyra Hamilton,4 Dianne Ball,5 Joanne Lavin,6 Therese Gardiner,6 Teresa K Withers,7 Andrea P Marshall1–3 1School of Nursing & Midwifery, Griffith University, Gold Coast, 2Gold Coast University Hospital and Health Service, Southport, 3Nursing & Midwifery Education & Research Unit (NMERU), National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, 4School of Applied Psychology, Griffith University, Mt Gravatt, 5Communio Pty Ltd, Sydney, 6Nursing & Midwifery Education & Research Unit, 7Surgical and Procedural Services, Gold Coast University Hospital and Health Service, Southport, Australia Background: Compliance with surgical safety checklists (SSCs) has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve.Objectives: The objective of this study was to undertake a process evaluation of four knowledge translation (KT) strategies used to implement the Pass the Baton (PTB) intervention which was designed to improve utilization of the SSC. Methods: As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well) in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Results: Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently implemented. Of the 220 staff working in the department, that is, nurses, anesthetists, and surgeons, 160 (72.7%) knew about the PTB strategies. Qualitative analysis revealed that implementation was generally feasible and acceptable. A barrier to feasibility was physician engagement. An impediment to acceptability was participants’ skepticism about the ability of the KT strategies to effect behavioral change.Conclusion: Overall, results of this evaluation suggest that success of implementation was moderate. Given the probable impact of contextual factors, that is, team culture and the characteristics of participants, the KT strategies may need modification prior to widespread implementation. Keywords: implementation, complex intervention, patient safety, process evaluation, research methods, logic model, surgery

Cameron J Phillips,1,2 Andrea P Marshall,3,4 Nadia J Chaves,5 Stacey K Jankelowitz,6,7 Ivan B Lin,8 Clement T Loy,9,10 Gwyneth Rees,11 Leanne Sakzewski,12 Susie Thomas,13,14 The-Phung To,15 Shelley A Wilkinson,16,17 Susan Michie18 1Division of Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia; 2School of Medicine, Flinders University, Adelaide, SA, Australia; 3Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Southport, QLD, Australia; 4Gold Coast University Hospital, Southport, QLD, Australia; 5Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia; 6Central Clinical School, Sydney Medical School, University of Sydney, 7Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia; 8Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia; 9School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 10Huntington Diseases Centre, Westmead Hospital, Westmead, NSW, Australia; 11Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 12Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD, Australia; 13Physiotherapy Department, Flinders Medical Centre, Bedford Park, SA, Australia; 14International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, SA, Australia; 15Pharmacy Department, Austin Health, Heidelberg, VIC, Australia; 16Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia; 17Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, QLD, Australia; 18University College London Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College, London, UK Background: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. Keywords: barriers and enablers, behavioral change, evidence-based practice, implementation, health care, Theoretical Domains Framework

Aims. This study was designed to examine the decision making processes that nurses use when assessing and managing sedation for a critically ill patient, specifically the attributes and concepts used to determine sedation needs and the influence of a sedation guideline on the decision making processes. Background. Sedation management forms an integral component of the care of critical care patients. Despite this, there is little understanding of how nurses make decisions regarding assessment and management of intensive care patients' sedation requirements. Appropriate nursing assessment and management of sedation therapy is essential to quality patient care. Design. Observational study. Methods. Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during two separate occasions for two hours of care. Follow-up interviews were conducted to collect data from five expert critical care nurses pre- and postimplementation of a sedation guideline. Data from all sources were integrated, with data analysis identifying the type and number of attributes and concepts used to form decisions. Results. Attributes and concepts most frequently used related to sedation and sedatives, anxiety and agitation, pain and comfort and neurological status. On average each participant raised 48 attributes related to sedation assessment and management in the preintervention phase and 57 attributes postintervention. These attributes related to assessment (pre, 58%; post, 65%), physiology (pre, 10%; post, 9%) and treatment (pre, 31%; post, 26%) aspects of care. Conclusions. Decision making in this setting is highly complex, incorporating a wide range of attributes that concentrate primarily on assessment aspects of care. Relevance to clinical practice. Clinical guidelines should provide support for strategies known to positively influence practice. Further, the education of nurses to use such guidelines optimally must take into account the highly complex iterative process and wide range of data sources used to make decisions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine the construct validity of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale. Background. The validity of instruments is critical in ensuring that data collected are sound and that the data measures what it purports to measure. When a new instrument is used in a different population or when it has been modified, it is useful to re-examine the construct validity of the instrument. Method. A survey design was used in September 2004 with a sample of 615 undergraduate nursing students to test the factor structure of The Nursing Students' Attitudes and Awareness of Research and Development within Nursing Scale and to estimate its similarity to the factor structure reported for the original scale developed and tested in a group of Registered Nurses. Results. Using Maximum Likelihood Factor Analysis and then Principal Axis Factoring, we were unable to obtain a similar factor structure to that originally identified for the scale. Our data resulted in a two-factor structure. One factor consisted of 16 items that reflected a positive attitude to nursing research and the other consisted of 14 items that reflected a negative attitude to nursing research. Conclusion. The substantially different factor structure identified suggests that this scale requires further refinement and testing. This case study highlights the importance of a systematic and comprehensive approach to determining construct validity of scales, thus enabling researchers to determine their suitability as data collection instruments. [ABSTRACT FROM AUTHOR]

Objective:To determine the construct validity of the Australian College of Critical Care Nurses (ACCCN) competency standards as a tool for assessing the clinical practice of specialist level critical care nurses in Australia.Design:A comparative descriptive design was used to examine the relationship between the domains, competencies and elements of the ACCCN competency standards. Participants were sent a questionnaire and asked to describe on a 7-point Likert scale how closely each competency statement and related elements reflected their level of critical care nursing practice.Subjects:A systematic sampling method was used to randomly select 1000 critical care nurses from a prelisting of members of ACCCN. A total of 532 completed questionnaires were returned.Main outcome measure:The purpose of this study was to determine the construct validity of the ACCCN competency standards by examining two structural models. The first examined how well the descriptive elements fit with their respective competency standard. The second model examined how well the competency standards group together under specific domains.Results:Statistically there was no support for the current structure for the ACCCN competencies because the elements did not fit uniquely to a single competency, but were multidimensional and loaded across several competencies. Competency statements also loaded across several domains. Modification of the current model resulted in the identification of a four-factor competency model, which demonstrated reasonable model fit.Conclusion:Several issues are highlighted, resulting in concerns regarding the validity of the ACCCN Competency Elements and Standards as a tool with which to assess the practice of critical care nurses. [ABSTRACT FROM AUTHOR]

The principles and physiological underpinnings of gastric tonometry are reviewed. Tonometric variables, including the PtCO2, pHi and CO2 gap, are described and critiqued as measurements of gastrointestinal perfusion. Increases in gastrointestinal CO2 unrelated to gastrointestinal hypoperfusion are discussed within different clinical contexts. The technical limitations of gastric tonometry, including procedural errors and PtCO2 measurement are discussed in relation to the accuracy of tonometric measurements. Tonometric measurement using semi-continuous air tonometry is introduced as a strategy to minimize technical limitations. [ABSTRACT FROM AUTHOR]

Objectives: To pilot test a co-designed intervention that enhances patient participation in hospital discharge medication communication., Design: Pilot randomised controlled trial., Setting: One tertiary hospital., Participants: Patients who were ≥45 years of age; ≥1 chronic illness and ≥1 regularly prescribed medication that they manage at home were recruited between October 2022 and May 2023. Healthcare professionals on participating units completed surveys., Intervention: The co-designed intervention included three websites: a medication search engine, a medication question builder and tools to facilitate medication management at home. Inpatient posters contained QR codes to provide access to these websites., Primary and Secondary Outcome Measures: The primary outcomes were the feasibility of study processes and intervention acceptability. Feasibility of study processes was measured in terms of recruitment, fidelity, retention, missing data and contamination. Patients in the intervention group and healthcare professionals on the wards self-reported intervention acceptability. Secondary outcomes were medication understanding, use, self-efficacy and healthcare utilisation., Results: 60 patients were recruited and randomised; half in each study group. The intervention was largely delivered as intended, and 99.7% of data collected was complete. In total, 16/59 (27.1%) patients were lost to follow-up 28 days after hospital discharge, and 3 patients in the usual care group reported that they saw the intervention poster prior to hospital discharge. 21 of 24 intervention group patients (87.5%) deemed the intervention acceptable, while half of the healthcare professionals (n=5, 50%) thought it was acceptable., Conclusions: We demonstrated that in a future definitive trial, intervention fidelity would be high with little missing data, and patients would likely find the intervention acceptable. Thus, a larger trial may be warranted, as the intervention is implementable and approved by patients. However, additional strategies to increase recruitment and retention of eligible participants are needed. Healthcare professionals may require more preparation for the intervention to enhance their perceptions of intervention acceptability., Trial Registration Number: ACTRN12622001028796., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To identify the prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention among six public hospitals in one Australian State., Methods and Results: A retrospective observational research design was used. A total of 4387 cases were obtained from the State Cardiac Outcomes Registry and National Hospital Cost Data Collection. The two datasets were linked using identifiable data items. Patients were those who had elective percutaneous coronary intervention between December 2012 and December 2019 either discharged the same day of the procedure or the next day. Data were analysed using descriptive and inferential statistics. The overall same-day discharge prevalence was 6.5%, with a trend increasing from 0.2% in 2013 to 9.0% in 2019. The prevalence varied at the individual hospital level. Two hospitals did not perform same-day discharge during the study period. The remaining hospitals demonstrated variability in same-day discharge prevalence, with the highest from one hospital being 28.2% in 2019. Almost all same-day discharge patients experienced no complications during or following percutaneous coronary intervention within 24 hours. Compared to next-day discharge, same-day discharge reduced the length of stay by 18 hours and conferred an average of $3695 cost-savings per patient., Conclusions: There was limited implementation of same-day discharge in the six public hospitals contributing data to this study. Improvement in the same-day discharge rate could result in better hospital resource utilisation and reduce low-value care. Hence, strategies to implement and promote same-day discharge are warranted., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objective: The aim of this review is to identify, evaluate, and graphically display gaps in the literature related to scarce health resource allocation in humanitarian aid settings., Methods: A systematic search strategy was utilized in MEDLINE (via Ovid), Scopus, EMBASE, CINAHL Complete, and ProQuest Central. Articles were reviewed by 2 reviewers with a third reviewer remedying any screening conflicts. Articles meeting inclusion criteria underwent data extraction to facilitate evaluation of the scope, nature, and quality of experience-based evidence for health resource allocation in humanitarian settings. Finally, articles were mapped on a matrix to display evidence graphically., Results: The search strategy identified 6093 individual sources, leaving 4000 for screening after removal of duplicates. Following full-text screening, 12 sources were included. Mapping extracted data according to surge capacity domains demonstrated that all 4 domains were reflected most of all the staff domain. Much of the identified data was presented without adhering to a clear structure or nomenclature. Finally, the mapping suggested potential incompleteness of surge capacity constructs in humanitarian response settings., Conclusions: Through this review, we identified a gap in evidence available to address challenges associated with scarce resource allocation in humanitarian settings. In addition to presenting the distribution of existing literature, the review demonstrated the relevance of surge capacity and resource allocation principles underpinning the developed framework.

Background: Early mobilisation is beneficial to support recovery among critically ill patients. The literature highlights the benefits of family engagement in early mobilisation, yet this practice remains underutilised. Effective implementation depends on understanding the key antecedents that influence family engagement in early mobilisation, specifically families' knowledge, contemplation, confidence and readiness. However, no measurement tools currently exist to assess these. Therefore, developing a psychometrically supported instrument is essential to understanding and enhancing families' factors influencing their engagement in early mobilisation., Aim: To develop and evaluate the psychometric properties of an instrument to assess families' knowledge, contemplation, confidence and readiness to engage in early mobilisation., Design: A multi-site cross-sectional survey design., Methods: Based on established psychological theory (Social Cognitive Theories and Behaviour Change Theories), an item pool was developed to assess families' knowledge, contemplation, confidence and readiness to participate in early mobilisation. To psychometrically evaluate the new tool, a multi-site cross-sectional survey was undertaken from May 2020 to June 2022 across five intensive care units in Australia. Data from 370 families of critically ill patients were used to evaluate the structural, convergent and discriminant validity as well as the reliability of the new instrument., Results: Confirmatory factor analysis indicated good model fit, supporting the proposed structure. All items displayed high standardised factor loadings except one, which improved upon freeing an error covariance. Positive inter-factor correlations were moderate to strong and were substantially lower than the square root of the average variance extracted, supporting both convergent and discriminant validity, respectively. Additionally, all subscales demonstrated well to excellent reliability., Conclusion: The findings provide preliminary support for the multiple types of validity evidence and the reliability of the instrument. This new instrument is suitable for use in clinical and research applications to assess families' knowledge, contemplation, confidence and readiness for their engagement in early mobilisation., Impact: Family engagement in early mobilisation activities may have multiple benefits but it is not commonly implemented in the ICU. Factors influencing family engagement in early mobilisation are poorly understood. Influential psychological theories highlight the likely importance of knowledge, contemplation, confidence and readiness. A readily available instrument designed to assess these constructs among family members is needed to deepen research understanding and guide clinical practice. The proposed instrument is designed to measure factors influencing family engagement in early mobilisation, which may support healthcare professionals and health services to identify and tailor strategies to support family engagement in early mobilisation., Reporting Method: Recommendations for reporting the results of studies of instrument and scale development and testing was followed to report this study., Patient or Public Contribution: Family members of adult critically ill patients participated in this study, and they provided the data through the survey., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions., Objectives: The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients., Methods: A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines., Results: Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted., Conclusions: Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate ED and intensive care unit healthcare professionals' perspectives and knowledge of the law that underpins end-of-life decision-making in Queensland, Australia., Methods: An online survey with questions about perspectives, perceived, and actual, knowledge of the law was distributed by the professional organisations of medical practitioners, nurses and social workers who work in Queensland EDs and intensive care units., Results: The survey responses of 126 healthcare professionals were included in the final analysis. Most respondents agreed that the law was relevant to end-of-life decision-making, but that clinician and family consensus mattered more than following the law. Generally, doctors' legal knowledge was higher than nurses'; however, there were significant gaps in the knowledge of all respondents about the operation of advance health directives in Queensland., Conclusions: The legal framework that supports end-of-life decision-making for adults who lack decision-making capacity has been in place for more than two decades. Despite frequently being involved in making or enacting these decisions, gaps in the legal knowledge of healthcare professionals who work in EDs and intensive care units in Queensland are evident. Further research to better understand how to improve knowledge and application of the law is warranted., (© 2024 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background: Increased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ)., Methods: Informed by Donabedian's 'Evaluating the Quality of Medical Care' model and the Institute of Medicine's Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre., Results: Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up., Conclusion: Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations., (© 2024. The Author(s).)

Background: Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families., Aim: In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature., Study Design: In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting., Results: Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies., Conclusions: There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions., Relevance to Clinical Practice: Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation., (© 2023 British Association of Critical Care Nurses.)

Background: Data on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting., Objectives: The objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices., Methods: A multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received., Results: A total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m 2 ), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%)., Conclusion: Critically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common., Competing Interests: Conflict of interest Four authors (Chapple, Ridley, Marshall, and Udy) hold leadership positions with Australian Critical Care. Chapple and Ridley are Editors, Marshall is the Editor-in-Chief, and Udy is a member of the Editorial Board. Consistent with ACC policies, the authors are excluded from any decision-making processes in relation to this submission. The manuscript was managed from submission through to final decision by Assoc Prof Tom Buckley, Editor., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.

Patients can experience medication-related harm and hospital readmission because they do not understand or adhere to post-hospital medication instructions. Increasing patient medication literacy and, in turn, participation in medication conversations could be a solution. The purposes of this study were to co-design and test an intervention to enhance patient participation in hospital discharge medication communication. In terms of methods, co-design, a collaborative approach where stakeholders design solutions to problems, was used to develop a prototype medication communication intervention. First, our consumer and healthcare professional stakeholders generated intervention ideas. Next, inpatients, opinion leaders, and academic researchers collaborated to determine the most pertinent and feasible intervention ideas. Finally, the prototype intervention was shown to six intended end-users (i.e. hospital patients) who underwent usability interviews and completed the Theoretical Framework of Acceptability questionnaire. The final intervention comprised of a suite of three websites: (i) a medication search engine; (ii) resources to help patients manage their medications once home; and (iii) a question builder tool. The intervention has been tested with intended end-users and results of the Theoretical Framework of Acceptability questionnaire have shown that the intervention is acceptable. Identified usability issues have been addressed. In conclusion, this co-designed intervention provides patients with trustworthy resources that can help them to understand medication information and ask medication-related questions, thus promoting medication literacy and patient participation. In turn, this intervention could enhance patients' medication self-efficacy and healthcare utilization. Using a co-design approach ensured authentic consumer and other stakeholder engagement, while allowing opinion leaders and researchers to ensure that a feasible intervention was developed., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)

Background: The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data., Methods: This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts., Results: Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast)., Conclusions: Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context., (© 2024 The Authors. Asia-Pacific Psychiatry published by John Wiley & Sons Australia, Ltd.)

Introduction: Research evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence-based central venous access device care., Aim: The aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting., Method: This exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis., Results: Three overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members' behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation., Conclusion: To bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians' work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care., Implications for Clinical Practice: When developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions. Methods A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis. Results Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts - 'healthcare professionals choreograph the end of life' and 'patients and families are carried on an unplanned journey'. Conclusions There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.

Background: The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients., Objective: The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase., Methods: This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}])., Results: A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2-8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05-1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5-75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03-1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV., Conclusions: During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Aims and Objectives: The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision-making and to evaluate intervention and study feasibility., Background: Family partnerships can improve outcomes for critically ill patients and family members. Interventions that support families to engage with health professionals require evaluation., Design: A multi-centre, randomised, parallel group superiority Phase II randomised controlled trial., Methods: In nine intensive care units (ICUs) across three countries, critically ill patients ≥60 years, or those 55-59 years with advanced chronic diseases and expected ICU length of stay >72 h and their family member were enrolled between 9 May 2017 and 31 March 2020. Participants were randomised (1:1:1) to either a decision support or nutrition optimisation family-centred intervention, or usual care. Primary outcomes included protein and energy intake during ICU and hospital stay (nutrition intervention) and family satisfaction (decision support). Study feasibility was assessed as a composite of consent rate, intervention adherence, contamination and physician awareness of intervention assignment., Results: We randomised 135 patients/family members (consent rate 51.7%). The average rate of randomisation was 0.5 (0.13-1.53) per month. Unavailability (staff/family) was the major contributor to families not being approached for consent. Declined consent was attributed to families feeling overwhelmed (58/126, 46%). Pandemic visitor restrictions contributed to early study cessation. Intervention adherence for the decision support intervention was 76.9%-100.0% and for the nutrition intervention was 44.8%-100.0%. Nutritional adequacy, decisional conflict, satisfaction with decision-making and overall family satisfaction with ICU were similar for all groups., Conclusions: Active partnerships between family members and health professionals are important but can be challenging to achieve in critical care contexts. We were unable to demonstrate the efficacy of either intervention. Feasibility outcomes suggest further refinement of interventions and study protocol may be warranted., Relevance to Clinical Practice: Interventions to promote family partnerships in critical illness are needed but require a greater understanding of the extent to which families want and are able to engage and the activities in which they have most impact., Reporting Method: This study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) and the Template for Intervention Description and Replication (TIDieR) guidelines., Patient or Public Contribution: Patients and caregivers were engaged in and contributed to the development and subsequent iterations of the two family-centred interventions use in this study., Clinical Trial Registration Number: Trial registration., Clinicaltrials: gov, ID: NCT02920086. Registered on 30 September 2016. First patient enrolled on 9 May 2017 https://clinicaltrials.gov/ct2/results?cond=&term=NCT02920086&cntry=&state=&city=&dist=., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients., Background: Early mobilisation is beneficial to minimise intensive care unit acquired-weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation., Design: A descriptive qualitative study., Methods: Face-to-face, individual, semi-structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study., Results: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation., Conclusion: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice., Relevance to Clinical Practice: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Laws that regulate healthcare practice at the end of life reflect the values of the society where they apply. Traditionally, healthcare professionals rely on their clinical knowledge to inform treatment decisions, but the extent to which the law also informs health professionals' decision-making at the end of life is uncertain., Objective: The objective of this study was to describe what healthcare professionals working in emergency departments and intensive care units know about the law that relates to end-of-life decision-making for hospitalised adults and what affects its application., Review Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews., Data Sources: Data were sourced by searching the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL [via EBSCOhost]), Nursing and Allied Health and Health and Medical Collection (via ProQuest Central), Excerpta Medica dataBASE (Embase), PubMed, PsycINFO, and HeinOnline., Results: Systematic screening of the search results and application of inclusion criteria resulted in the identification of 18 quantitative and three qualitative articles that were reviewed, summarised, and reported. Ten of the quantitative studies assessed knowledge and attitudes to law or end-of-life decision-making using hypothetical scenarios or vignettes. Qualitative studies focussed on how the law was applied when end-of-life decisions were made. End-of-life decision-making is mostly based on the clinical needs of the patient, with the law having a secondary role., Conclusion: Around the world, there are significant gaps in healthcare professionals' legal knowledge. Clinical factors are considered more important to end-of-life decision-making than legal factors. End-of-life decision-making is perceived to carry legal risk, and this results in the provision of nonbeneficial end-of-life care. Further qualitative research is needed to ascertain the clinician-related factors that affect the integration of law with end-of-life decision-making., (Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Up to 40% of patients with traumatic injury experience critical bleeding, many requiring transfusion of blood products. International transfusion guidelines recommend the use of viscoelastic testing to guide blood product replacement. We implemented a Point of Care ROTEM® blood test for trauma patients who present and initiate a trauma activation., Objectives: The aim of this study was to undertake an evaluation of the implementation data to identify factors which helped and hindered this new practice., Methods: A sequential mixed-methods design was conducted to evaluate intervention implementation. The intervention was designed with interprofessional collaboration and incorporated education and skills training supplemented with a decision aide. Patients aged ≥ 18 years who met the trauma activation criteria were included. Data collection occurred throughout the 21-month implementation period inclusive of initial roll out, maintenance and sustainability and include the number of ROTEM® blood tests taken and clinical characteristics of patients. Individual interviews were conducted with health professionals with experience of the intervention after the implementation period was complete., Results: A total of 1570 eligible patients were included. The number of patients who had a ROTEM® blood test taken increased over time to 63%. The proportion of patients having a ROTEM® blood test obtained was higher for major trauma patients (n=162, 66.9%) who were admitted to the Intensive Care Unit. Regression analysis found trauma service presence on arrival and the sustainability phase of implementation increased the likelihood of having a ROTEM® taken. Qualitative data suggest that a more tailored approach to intervention implementation would assist with adoption., Conclusion: Implementation of new practice requires careful planning and should be undertaken with input from end-users. Continuous evaluation is necessary to support ongoing implementation and sustainability. To ensure effective implementation occurs, complex interventions need to be made workable and integrated in everyday health care practice., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)