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Vast improvements in drugs and techniques for obstetric general anaesthesia over the last 50 years have seen the incidence of anaesthesia-related aspiration all but eradicated. However, oral intake restrictions for labouring women, instituted following Mendelson's (1946) study, continue despite these improvements. A survey of 30 obstetric anaesthetists explored their aspiration prevention strategies for caesarean section and recommendations for the oral intake of labouring women with an epidural in situ. The findings showed that a majority of these anaesthetists continued to request the fasting of all labouring women in case general anaesthesia was required and there was little consensus regarding gastric content preparation or for the oral intake of epiduralised labouring women. There is no research to support the use of oral intake restrictions in preventing aspiration. There is also no consistency among anaesthetists or supporting research for any dietary regime prescribed for labouring women with an epidural.

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.

Purpose To investigate the utility of salivary cortisol as an objective measure of stress in sick infants. Participants One hundred and forty four infants nursed in two neonatal intensive care units in two children's hospitals in Australia. Design A prospective observational cohort study. Methods Infants' saliva was collected using a 3mL syringe attached to a shortened size 8 FG feeding tube. Salivary cortisol levels were measured using ELISA and examined for associations with potential environmental stressors in the NICU. Main outcome measures 1.collection of saliva in sufficient volumes for analysis, 2.relationship between salivary cortisol levels and environmental factors associated with stress. Results Sufficient salivary cortisol samples were obtained from 49 infants (35% of participants). In the samples obtained, there was no significant correlation between salivary cortisol levels and any environmental stress factors. However, mean cortisol levels were significantly higher (a two-fold increase) in those infants who had been fed compared to those who were not fed (0.61±0.41μg/dL (SD) and 1.13±0.97μg/dL (SD), respectively). Conclusion Using the method of collection, sufficient volumes of saliva for analysis were difficult to obtain in the majority of infants. Additional technical limitations included possible milk contamination of the collected samples. Associations between environmental stressors and infant cortisol levels were unable to be determined.

The authors investigated the experiences of parents with children/adult children in metropolitan Sydney, Australia who were living with, or had recovered from, an eating disorder. During regular team meetings, the research assistant who conducted the interviews had described her reactions which led the research team to investigate her experience in more depth. The aim of the present paper was to explore the impact on the research assistant who conducted 22 in-depth interviews with the parents. One of the members of the research team interviewed the research assistant to elicit her reactions. The interview was content analyzed and the following themes were identified: (i). appreciation of an egalitarian model of research; (ii). the emotions expressed by the research assistant; (iii). making sense of the inexplicable and (iv). reflections and comparison to her own life role. The research team would like to advance the theory that the adoption of a formal debriefing mechanism be integrated into the qualitative research process.

The experiences of parents with a child with anorexia nervosa and/or bulimia nervosa were explored and this article aims to present one component of that study: parents' interactions with health professionals. The research was initiated after anecdotal stories from parents led the authors to undertake a literature review, which revealed a paucity of published research on this topic. Twenty-two interviews were conducted with volunteer parents from New South Wales, Australia. A descriptive qualitative design was used and themes were identified through in-depth analysis. Six themes were identified: finding help, feeling shut out, engagement, images portrayed, being resourceful and parents not prepared to give up. The implications for health professionals include that they acknowledge parental involvement in recovery. We urge the nursing profession, particularly mental health nurses, to work towards establishing collaborative partnerships between families & health professionals in order to achieve a better health outcome for all.

Clinical nurses use an increasing number of technological devices when providing care. While the clinical devices themselves must undergo rigorous multidimensional assessment, it is the proficiency of the user that ultimately determines the devices’ efficacy. Thus, the knowledge, skills and attitudes that nurses bring to their decision-making and use of technology are crucial elements in the technology assessment process. Technological proficiency is imperative in the current climate of rapid patient throughput in complex technological environments. This paper reports some of the findings of an Australian study, using two national Delphi panels, whose primary objective was to determine the knowledge, skills and attitudes required of expert clinicians for practice m cardiac care. Panels of 28 educators and 42 cardiac nurse clinicians completed a questionnaire indicating the importance of 107 characteristics of expert cardiac practice for both the ‘real’ and ‘ideal’ worlds of practice. Comparative results will be reported for 29 items within the thematic groups Effective use of technology, Informed decisions regarding equipment and Critical approach to the use of technology. Both panels accepted all 29 items in these three thematic groups but indicated differences in the level of agreement on the importance of items between the ‘real’ and ‘ideal’ worlds of practice. Discussion centres around those areas where improvement is needed.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

When children are ill enough to require admission to paediatric intensive care, parents may become distressed about their child's medical condition and this distress may be compounded by the unfamiliar nature of the highly technological environment. Parents of children who are sick enough to warrant intubation are particularly likely to be exposed to a frightening array of technological equipment. Seventy-one parents of intubated and non-intubated children completed the Parental Stressor Scale: Paediatric Intensive Care Unit (PSS:PICU). Overall the findings suggest that parents were most distressed (a) by the painful procedures to which their children were subjected, (b) by the sights and sounds of the intensive care unit and (c) by their children's reactions to intensive care. The behaviour of staff towards parents and the way that staff communicated with them caused the least distress. When the levels of stress reported by parents of intubated children were compared with those reported by parents of non-intubated children, different patterns of stress were found. Painful procedures were a source of greater stress to parents of intubated children whereas the behaviour of staff and the children's reactions to the intensive care experience caused greater stress to the parents of the non-intubated children. In general the findings suggest that the needs of parents of non-intubated children are being overlooked, with staff focusing more of their attention on the parents of intubated children.

Palliative care staff were compared with staff from burn and neonatal units, and with mature age general nursing trainees at the end of their training. Hypotheses, based on a personal construct model of their quality of life, sources of anxiety, and types of social interactions were tested. These tests were conducted by applying content analysis scales to their responses to an open-ended request in their interview schedule. The palliative care staff did express better quality of life, in terms of significantly less anxiety and depression, as well as more good feelings than the other staff groups. They showed, as predicted, significantly more anxiety about death, but less shame and diffuse anxiety. They also reported more helping and loving interactions but fewer influencing or vaguely defined, but shared interactions. The implications of these findings for the model and for the support of palliative care staff are considered.

Methodological challenges associated with sensitive research, such as research with vulnerable families, have been well described, but there are few examples of how such challenges have been addressed in specific projects. To help address this gap, we describe how we designed and conducted a qualitative study of 91 members of 29 families caring for children or young people with life-limiting conditions. Although some issues associated with researching sensitive topics were anticipated, others were encountered that were not expected. We discuss insights gained from this study in relation to factors that influence effectiveness of recruitment, the quality of data collection, and the safety of participants and researchers.

This study compared the adjustment of mothers and fathers who have a child with cystic fibrosis On most scales mothers, but not fathers, were found to have significantly poorer mental health than the general population Both mothers and fathers' perceptions of the stresses associated with rearing children with cystic fibrosos were related to their mental health Fathers mental health was also related to their wives' concerns about rearing children with cystic fibrosis The support of fathers appeared to protect mothers from the stress associated with cystic fibrosis, especially when fathers placed a high value on child-rearing activities.

Objective: The aim of this study was to validate a clinician-friendly pain assessment tool for all groups of critically ill infants cared for in the specific neonatal intensive care units (NICUs) studied. Design: A prospective study was undertaken to test the Pain Assessment Tool (PAT). Interrater reliability of the PAT score was assessed by two nurses who simultaneously determined an infant's PAT score. The PAT was validated against the CRIES score—crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness—and the mother's assessment of her infant's discomfort using the Visual Analogue Scale (VAS). Setting: The NICUs at two children's hospitals. Patients: Participants were 144 preterm and term infants. Infants on a ventilator and those who had undergone surgery were included. Results: The interrater reliability of the PAT was .85 with a mean difference of 0.17 (standard deviation: 1.73). There was a strong correlation between the PAT and CRIES scores (r = 0.76) and a moderate correlation (.38) between the PAT score and the VAS scores of the infant's mother. The correlation coefficient between the PAT score and CRIES score was significant for all groups (p .01). Conclusions: The PAT score was shown in this study to be a valid, reliable, and clinician-friendly pain assessment measurement tool for all infants nursed in the NICU.

Objective:To determine the optimal time interval for the routine replacement of intravenous administration sets when crystalloids or parenteral nutrition are administered via a central or peripheral catheter in an acute care setting.Design:Systematic review of all randomized or systematically allocated controlled trials addressing the frequency of replacing intravenous administration sets.Methods:The Cochrane Controlled Trials Register (June 2001) and the Ovid databases (Medline, CINAHL, and CancerLit-July 2001) were searched. Bibliographies, relevant conference proceedings, and any product information were also checked for references.Results:Eighteen studies were selected for review. The 12 included studies were separated into 3 intravenous administration set change comparisons; 24 hours versus 48 hours or more; 48 hours versus 72 hours or more; and 72 hours versus 96 hours or more. There was good evidence that changing intravenous administration sets every 72 hours or more does not increase the risk of infusate-related bloodstream infection (BSI) in patients with central or peripheral catheters and a fair level of evidence that it does not increase the risk of catheter-related BSI. There were insufficient data regarding the incidence of BSI among patients receiving parenteral nutrition, particularly lipid-containing parenteral nutrition.Conclusions:It appears that intravenous administration sets containing crystalloids can be changed in patients with central or peripheral catheters every 72 hours or more without increasing the risk of BSI. However, it is not possible to conclude that intravenous administration sets containing parenteral nutrition, particularly lipid-containing parenteral nutrition, can be changed at this interval.

Admission control and overload management techniques are central to the design and implementation of real-time database systems. We motivate the need for these mechanisms and present protocols for adding such capabilities to real-time databases. In particular, we present a novel admission control paradigm, we describe a number of admission control strategies and contrast (through simulations) their relative performance.

The use of admission control and overload management techniques in real-time systems has been shown to result in improved system performance-in terms of maximizing the value-added to the system by those transactions committing on time-in comparison to systems which do not employ such techniques. Continuing with our research in hard deadline Real-Time DataBase (RTDB) systems, we investigate the challenges associated with soft deadline transactions and describe a number of admission control and overload management techniques as well as scheduling algorithms appropriate for such systems.

In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs. © 2002 Elsevier Science Ltd. All rights reserved.

The aim of this study was to identify the conditions that Australian nurses believe support or hinder the development of evidence-based nursing. A survey instrument was developed from the results of content analysis of the UK and the USA research and of interviews with 12 Australian nurses. Eight hundred and sixteen nurses working in three large hospitals responded representing a response rate of 65%. Principal axis factor analysis of the survey results revealed six conditions that the participants believed were necessary for evidence-based nursing to take place. The results of this study may be used to develop models for the improvement of evidence-based nursing in Australia.

Evidence from Australia, the UK and the USA suggests that while research output has increased, clinical nurses make limited use of the findings to improve patient care (Funk et al., 1991; Stetler and DiMaggio, 1991; Capra et al., 1992; Nagy et al., 1992; Webb and Mackenzie, 1993; Pearcey, 1995).

The infliction of pain on patients is part of the daily routine for many nurses, particularly those who work in burns units, but there has been little help available for nurses to develop useful ways of coping with such circumstances. Few researchers have considered how the ways that nurses manage their feelings about pain may provide insights into the reasons why available pain control methods have not been fully practiced. The aim of this study was to identify the range of coping strategies used by nurses when conducting painful procedures. Nurses working in five burns units were interviewed about their feelings when it was necessary for them to inflict pain on patients in the course of giving patient care. Content analysis was used to identify the kinds of coping strategies used by nurses to manage their feelings about such situations. Fourteen kinds of strategy were identified and were then grouped into four categories: (i) distancing oneself from the patient's pain; (ii) engaging with the patient's pain; (iii) seeking social support and (iv) reconstructing the nurse's core role. The use of each of these categories of coping have implications for both the management of patient's pain and the nurse's emotional well-being. While distancing oneself from the patient's pain was the most prevalent way for nurses to cope with their feelings about causing pain to patients, all types of coping strategies had their advantages. It is possible that combinations of various strategies may be the most effective way for nurses to deal with their patients' pain.

Nurses are more likely than other health professionals to be exposed to individuals who suffer severe pain for extended periods of time. Such exposure is likely to arouse emotional distress which not only has implications for their occupational health but may interfere with their ability to manage pain effectively. This study compared the emotional reactions to their patients' pain, of nurses who were exposed to patients with severe and obvious pain (nurses working in burns units) and nurses whose patients' pain is uncertain because they are unable to communicate (nurses working in neonatal intensive care units). The results showed that pain generated greater anxiety in nurses caring for patients with severe burns, but that they also demonstrated a greater sense of personal competence and control over the management of their patients' pain. The findings also showed that when dealing with patients' pain the morale of nurses was linked to: (a) perceived challenges to their images of themselves as alleviators of pain; (b) the extent to which their sense of personal vulnerability was aroused by contact with patients experiencing severe pain; (c) their beliefs about their ability to assess patients' pain; and (d) the quality of their professional relationships with the medical staff who controlled the most powerful forms of pain relief.

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.

Admission control and overload management techniques are central to the design and implementation of Real-Time Database Systems. In this chapter, we motivate the need for these mechanisms and we present previous and current research work aimed at adding such capabilities to Real-Time Databases.

Parents (n = 200) were asked to find and then count their infant's pulse using 4 methods: listening to the apex, palpating the apex beat, and palpating the carotid and brachial pulses. Listening to the apex method was the fastest and most accurate method of heartbeat detection.