The role of critical care nurses in organ and tissue donation: A position statement of the Australian College of Critical Care Nurses.

INTRODUCTION: Australian organ and tissue donation rates are low compared to other countries. Acknowledging that donation practices vary across Australia, the Australian College of Critical Care Nurses supported the development of a position statement to explicate critical care nurses' role in supporting organ and tissue donation. Several Australian peak professional organisations provide guidance to inform and support organ and tissue donation. AIM: The aim of this study was to develop a position statement using contemporary Australian research evidence to build upon and complement existing guidance, focussing on the role of critical care nurses in organ and tissue donation in Australian critical care. METHOD: An approach similar to a rapid review was used, providing a streamlined approach to synthesising evidence. A comprehensive search using Medical Subject Headings, keywords, and synonyms was undertaken using Medline and CINAHL Complete via EBSCOhost to identify peer-reviewed Australian research evidence about critical care nurses' role, obligations, expectations, and scope of practice during organ and tissue donation. Narrative synthesis was used to synthesise the research evidence. FINDINGS: The importance of separating death from organ donation in discussions with family, the timing and the approach to organ donation conversations, and working in collaboration with the DonateLife Donation Specialist Nurses were identified. The importance of understanding family perspectives, caring for families, and collegial support for critical care clinicians were also identified. With the guidance of peak professional organisations, the research evidence was then used to develop practice recommendations for critical care units, leaders, and critical care nurses. DISCUSSION AND CONCLUSION: The recommendations explicate the important contribution critical care nurses can make to ensuring timely, sensitive communication, providing high-quality end-of-life care, supporting families irrespective of the donation decision and supporting colleagues from the wider critical care team, thereby optimising the processes related to organ and tissue donation in Australian critical care settings.

A retrospective descriptive study of medical record documentation of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds.

INTRODUCTION: Communication between clinicians and family members of patients about treatment limitation practices is essential to care-planning and decision-making. For patients and family members from culturally diverse backgrounds, there are additional considerations when communicating about treatment limitations. OBJECTIVE: The objective of this study was to explore how treatment limitations are communicated with family members of patients from culturally diverse backgrounds in intensive care. METHODS: A descriptive study using a retrospective medical record audit was undertaken. Medical record data were collected from patients who died in 2018 in four intensive care units in Melbourne, Australia. Data are presented using descriptive and inferential statistics and progress note entries. RESULTS: From 430 adult deceased patients, 49.3% (n = 212) of patients were born overseas, 56.9% (n = 245) identified with a religion, and 14.9% (n = 64) spoke a language other than English as their preferred language. Professional interpreters were used in 4.9% (n = 21) of family meetings. Documentation about the level of treatment limitation decisions were present in 82.1% (n = 353) of patient records. Nurses were documented as present for treatment limitation discussions for 49.3% (n = 174) of patients. Where nurses were present, nurses supported family members, including reassurance that end-of-life wishes would be respected. There was evidence of nurses coordinating healthcare activities and attempting to address and resolve difficulties experienced by family members. CONCLUSIONS: This is the first known Australian study to explore documented evidence of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds. Many patients have documented treatment limitations, yet there are a proportion of patients who die before treatment limitations can be discussed with family, which may influence the timing and quality of end-of-life care. Where language barriers exist, interpreters should be used to better ensure effective communication between clinicians and family. Greater provision for nurses to engage in treatment limitation discussions is required.

How do intensive care clinicians ensure culturally sensitive care for family members at the end of life? A retrospective descriptive study.

INTRODUCTION: Patients and their family members have diverse needs at the end of life, influenced by culture. OBJECTIVE: To examine whether clinicians (doctors and nurses), provided culturally sensitive care for family members of patients from culturally diverse backgrounds who died in an intensive care unit. METHODS: A retrospective medical record audit was undertaken in four metropolitan intensive care units in Melbourne, Australia. Quantitative data are reported using descriptive statistics. Qualitative progress note entries are presented using themes. RESULTS: In all, 430 patients died in 2018 and were included in the audit. Almost half of patients (47.9%, n = 206) were born in Australia, with the remaining 52.1% (n = 224) representing 41 other countries of birth. Languages other than English were spoken by 14.9% (n = 64) of patients. Christian religions were most common (50.2%, n = 216), followed by Buddhism 3.0% (n = 13), and Hindu and Islam respectively (1.9%, n = 8). A cultural assessment was undertaken in 10.5% (n = 45) of cases, mostly by social workers, to ascertain family members' wishes and preferences for the dying patient's end-of-life care. Religious leaders (eg. priests) (25.1%, n = 108) and interpreters (4.9%, n = 21) contributed to ensuring family members could participate as desired, in accordance with cultural wishes and preferences. CONCLUSIONS: Despite the culturally-diverse patient population, findings show that details about culturally sensitive end-of-life care are rarely documented. Comprehensive documentation is required of how clinicians assess patient and family member cultural wishes and preferences, in conjunction with how clinicians attempt to address these cultural needs.

The impact of design elements on undergraduate nursing students' educational outcomes in simulation education: protocol for a systematic review.

BACKGROUND: Although simulation-based education (SBE) has become increasingly popular as a mode of teaching in undergraduate nursing courses, its effect on associated student learning outcomes remains ambiguous. Educational outcomes are influenced by SBE quality that is governed by technology, training, resources and SBE design elements. This paper reports the protocol for a systematic review to identify, appraise and synthesise the best available evidence regarding the impact of SBE on undergraduate nurses' learning outcomes. METHODS: Databases to be searched from 1 January 1990 include the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), American Psychological Association (APA) PsycInfo and the Education Resources Information Centre (ERIC) via the EBSCO host platform. The Excerpta Medica database (EMBASE) will be searched via the OVID platform. We will review the reference lists of relevant articles for additional citations. A combination of search terms including 'nursing students', 'simulation training, 'patient simulation' and 'immersive simulation' with common Boolean operators will be used. Specific search terms will be combined with either MeSH or Emtree terms and appropriate permutations for each database. Search findings will be imported into the reference management software (Endnote© Version.X9) then uploaded into Covidence where two reviewers will independently screen the titles, abstracts and retrieved full text. A third reviewer will be available to resolve conflicts and moderate consensus discussions. Quantitative primary research studies evaluating the effect of SBE on undergraduate nursing students' educational outcomes will be included. The Mixed Methods Appraisal Tool (MMAT) will be used for the quality assessment of the core criteria, in addition to the Cochrane RoB 2 and ROBINS-I to assess the risk of bias for randomised and non-randomised studies, respectively. Primary outcomes are any measure of knowledge, skills or attitude. DISCUSSION: SBE has been widely adopted by healthcare disciplines in tertiary teaching settings. This systematic review will reveal (i) the effect of SBE on learning outcomes, (ii) SBE element variability and (iii) interplay between SBE elements and learning outcome. Findings will specify SBE design elements to inform the design and implementation of future strategies for simulation-based undergraduate nursing education. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021244530.

Supporting Muslim families before and after a death in neonatal and paediatric intensive care units.

BACKGROUND: The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences. AIMS: The aim of this study was to explore the perceived impact and influence of cultural diversity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children. DESIGN: A qualitative descriptive approach was used in this study, conducted in Saudi Arabia. METHODS: Semi-structured interviews were used to gather data from a convenience sample of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis. RESULTS: Thirteen registered nurses participated; all were born overseas, identified with various faiths and spoke English in the workplace. A respect for diversity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally diverse nature of the nursing workforce. CONCLUSIONS: Significant challenges exist for a culturally diverse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural diversity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural diversity.

Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review.

OBJECTIVES: The objectives of this systematic review were the following: (i) to describe whether culturally sensitive communication is used by clinicians (nurses and physicians) when communicating with patients and families at the end-of-life in the intensive care unit and (ii) to evaluate the impact of culturally sensitive communication at the end-of-life. The systematic review question was how is culturally sensitive communication used by clinicians when communicating with patients and families at the end-of-life in the intensive care unit? DATA SOURCES: A search of CINAHL, MEDLINE, Embase, and PsycINFO databases identified all peer-reviewed research evidence published in English between January 1994 and November 2017. Two authors independently assessed articles for inclusion. From the 124 articles resulting from the search, nine were included in this systematic review. REVIEW METHODS: Articles were independently assessed for quality by two authors using Caldwell et al.'s framework to critique health research. The data available in this systematic review were heterogeneous, with varied study designs and outcome measures, making the data unsuitable for meta-analysis. The most appropriate method for data synthesis for this systematic review was narrative synthesis. RESULTS: From the narrative synthesis, two major themes emerged: communication barriers and cultural and personal influences on culturally sensitive communication. Communication barriers were identified in eight studies, influencing the timing and quality of culturally sensitive communication at the end-of-life. Cultural and personal influences on communication at the end-of-life was present in eight studies. CONCLUSIONS: The findings of this systematic review show that clinicians lack the knowledge to enable effective interaction with culturally diverse patients and families at the end-of-life.

Broadband trailing edge noise from a sharp-edged strut.

This paper presents experimental data concerning the flow and noise generated by a sharp-edged flat plate at low-to-moderate Reynolds number (Reynolds number based on chord of 2.0 × 10(5) to 5.0 × 10(5)). The data are used to evaluate a variety of semi-empirical trailing edge noise prediction methods. All were found to under-predict noise at lower frequencies. Examination of the velocity spectra in the near wake reveals that there are energetic velocity fluctuations at low frequency about the trailing edge. A semi-empirical model of the surface pressure spectrum is derived for predicting the trailing edge noise at low-to-moderate Reynolds number.

On the aeroacoustic tonal noise generation mechanism of a sharp-edged plate.

This letter presents an experimental study on the tonal noise generated by a sharp-edged flat plate at low-to-moderate Reynolds number. Flow and far-field noise data reveal that, in this particular case, the tonal noise appears to be governed by vortex shedding processes. Also related to the existence of the tonal noise is a region of separated flow slightly upstream of the trailing edge. Hydrodynamic fluctuations at selected vortex shedding frequencies are strongly amplified by the inflectional mean velocity profile in the separated shear layer. The amplified hydrodynamic fluctuations are diffracted by the trailing edge, producing strong tonal noise.

Green's function approximation from cross-correlation of active sources in the ocean.

Green's function approximation via ocean noise cross-correlation, referred to here as ocean acoustic interferometry, has been demonstrated experimentally for passive noise sources. Active sources offer the advantages of higher frequencies, controllability, and continuous monitoring. Experimental ocean acoustic interferometry is described here for two active source configurations: a source lowered vertically and one towed horizontally. Results are compared and contrasted with cross-correlations of passive noise. The results, in particular, differences between the empirical Green's function estimates and simulated Green's functions, are explained with reference to theory and simulations. Approximation of direct paths is shown to be consistently good for each source configuration. Secondary (surface reflection) paths are shown to be more accurate for hydrophones with a greater horizontal separation.

Green's function approximation from cross-correlations of 20-100 Hz noise during a tropical storm.

Approximation of Green's functions through cross-correlation of acoustic signals in the ocean, a method referred to as ocean acoustic interferometry, is potentially useful for estimating parameters in the ocean environment. Travel times of the main propagation paths between hydrophone pairs were estimated from interferometry of ocean noise data that were collected on three L-shaped arrays off the New Jersey coast while Tropical Storm Ernesto passed nearby. Examination of the individual noise spectra and their mutual coherence reveals that the coherently propagating noise is dominated by signals of less than 100 Hz. Several time and frequency noise normalization techniques were applied to the low frequency data in order to determine the effectiveness of each technique for ocean acoustic applications. Travel times corresponding to the envelope peaks of the noise cross-correlation time derivatives of data were extracted from all three arrays, and are shown to be in agreement with the expected direct, surface-reflected, and surface-bottom-reflected interarray hydrophone travel times. The extracted Green's function depends on the propagating noise. The Green's function paths that propagate horizontally are extracted from long distance shipping noise, and during the storm the more vertical paths are extracted from breaking waves.

Shallow-water seismoacoustic noise generated by tropical storms Ernesto and Florence.

Land-based seismic observations of double frequency (DF) microseisms generated during tropical storms Ernesto and Florence are dominated by signals in the 0.15-0.5 Hz band. In contrast, data from sea floor hydrophones in shallow water (70 m depth, 130 km off the New Jersey coast) show dominant signals in the ocean gravity-wave frequency band, 0.02-0.18 Hz, and low amplitudes from 0.18 to 0.3 Hz, suggesting significant opposing wave components necessary for DF microseism generation were negligible at the site. Florence produced large waves over deep water while Ernesto only generated waves in coastal regions, yet both storms produced similar spectra. This suggests near-coastal shallow water as the dominant region for observed microseism generation.

Multichannel array diagnosis using noise cross-correlation.

A practical application of noise cross-correlation for the diagnosis of a multichannel ocean hydrophone array is derived. Acoustic data were recorded on a horizontal line array on the New Jersey Shelf while Tropical Storm Ernesto passed through. Results obtained from active source measurements reveal that signals from several hydrophones, which were recorded on certain channels before the storm, are recorded on different channels after the storm. Noise cross-correlation of data recorded during the storm show when, and in what manner, these changes took place.

Ocean acoustic interferometry.

Ocean acoustic interferometry refers to an approach whereby signals recorded from a line of sources are used to infer the Green's function between two receivers. An approximation of the time domain Green's function is obtained by summing, over all source positions (stacking), the cross-correlations between the receivers. Within this paper a stationary phase argument is used to describe the relationship between the stacked cross-correlations from a line of vertical sources, located in the same vertical plane as two receivers, and the Green's function between the receivers. Theory and simulations demonstrate the approach and are in agreement with those of a modal based approach presented by others. Results indicate that the stacked cross-correlations can be directly related to the shaded Green's function, so long as the modal continuum of any sediment layers is negligible.