Developing an accurate system of measuring colour in a venous leg ulcer in order to assess healing.

OBJECTIVE: To develop a standardised method of assessing venous ulceration, based on the colour of an ulcer bed and the surrounding skin. METHOD: This pilot study involved taking three sequential digital photographs during an episode of care and measuring the colour using image analysis software. Ten episodes of care were used for data collection. RESULTS: Based on previous research, a threshold of < or =3 degrees of colour and 3% of saturation was selected to indicate the reliability of the system. The mean of the colour measurements was inside the reliability threshold when measuring an ulcer bed, but outside the threshold for measuring the surrounding skin. CONCLUSION: The results indicate that the system provides consistent visual representation of a venous leg ulcer.

Critical care education: an examination of students' perspectives.

Specialist nursing education at the tertiary level is a relatively recent occurrence in Australia. With this move to higher education a variety of issues such as course duration, award level and clinical versus theoretical outcomes provided the impetus for this study. This study examined critical care nursing students' perceptions of undertaking post-graduate education within the higher education sector. Four themes arose from analysis of eight focus group interviews with a total of 42 students from 35 courses offered in eight universities across Australia. The first theme, student burden, included subthemes of financial, heavy workload and student-work conflicts. Student benefits, the second theme, encompassed financial and other benefits. The third theme, clinical experience, incorporated clinical capability, synthesizing, support required and clinical learning. The final theme of student attitude included the subthemes of individual, technology and course. Without student evaluations, curricular improvements including assessment and clinical experience will not evolve to the best of their potential.

Psychosocial recovery following ICU: experiences and influences upon discharge to the community.

While appropriate referrals to community services upon discharge home may address the physical needs of former intensive care patients, the psychological needs may be overlooked. This pilot study describes the recovery period following discharge to home of former intensive care unit (ICU) patients and their significant others, and identifies factors influencing recovery and the role of community support in the recovery period.Semi-structured interviews were conducted with five patients and four significant others, 6 to 15 weeks following discharge from the ICU. Data were analysed using constant comparison to identify recurring categories and themes. The recovery period was characterized by the patients' focus on physical recovery with the major theme described as 'moving on', incorporating normalizing life, return to usual routines, and leaving behind the ICU experience. Factors influencing the recovery period included individual attitudes, prior experiences, the ICU experience and support of family and friends. Community support was not commonly utilized with participants describing a perceived stigma attached to asking for professional help. Attention to physical needs and care often masked the psychological support received, particularly from family members. Despite awareness of community supports, patients were generally reluctant to avail themselves of any of these services.

Preparing for coronary angioplasty: the patients' experiences.

Coronary angioplasty and stent placement procedures now represent one of the fastest growing specialties in cardiac care; patients undergo a short stay admission with limited care time with nurses. The purpose of this study was to describe participants' experiences of preparing for angioplasty in such an environment. Eight men and three women were interviewed 1 month after discharge from hospital. Verbatim transcripts were analysed for major themes using the qualitative techniques of grounded theory. Participants described working through a problem solving process in response to the perceived health threat associated with undergoing angioplasty. In step one, the problem was identified. In step two, coping responses were taken to try and solve the problem. In step three, the results of the coping responses were appraised or evaluated. The two problems identified were ongoing chest pain and anxiety related to fear of the unknown. The coping responses initiated included acquiring knowledge of the angioplasty, confidence in the skill of the doctor, support from family and gearing up psychologically. In the final appraisal of the coping responses, the participants decided to either go ahead with, or delay the angioplasty procedure. The results of this study indicate that the preparation for angioplasty represents a period of adjustment that may be anxiety provoking. Participants' experiences provide new knowledge of the concerns and challenges faced when undergoing such an invasive procedure in a short stay environment. The results clearly highlight that psychosocial aspects of nursing care are an essential component of nursing practice for angioplasty patients.

Developing specialty knowledge: the case of Australian critical care nursing.

The generation of new knowledge is important to the evolution of the nursing profession and its specialties and is a fundamental requirement for the development of the discipline. This study documents the growth of empirical knowledge in Australian critical care nursing by examining the research published in one critical care specialty journal and a second generalized nursing research journal between 1994 and 1998. The proportion of research published in the specialty journal increased from 25 to 69%, with almost one-half focusing on patient therapies and treatments. The proportion of research in the general journal was consistently high, approximately 80 to 90%, with one to two critical care research articles per year. Nurses were first authors on the vast majority of these research articles. Approximately half of the critical care research focused on patient care. The results support the claim that Australian critical care nurses are conducting research to promote best practice in patient care and are thus contributing to the development of the discipline of nursing.

The development of competency standards for specialist critical care nurses.

In defining the contemporary role of the specialist nurse it is necessary to challenge the concept of nursing as merely a combination of skills and knowledge. Nursing must be demonstrated and defined in the context of client care and include the broader notions of professional development and competence. This qualitative study sought to identify the competency standards for nurse specialists in critical care and to articulate the differences between entry-to-practice standards and the advanced practice of specialist nurses. Over 800 hours of specialist critical care nursing practice were observed and grouped into 'domains' or major themes of specialist practice using a constant comparison qualitative technique. These domains were further refined to describe attributes of the registered nurses which resulted in effective and/or superior performance (competency standards) and to provide examples of performance (performance criteria) which met the defined standard. Constant comparison of the emerging domains, competency standards and performance criteria to observations of specialist critical care practice, ensured the results provided a true reflection of the specialist nursing role. Data analysis resulted in 20 competency standards grouped into six domains: professional practice, reflective practice, enabling, clinical problem solving, teamwork, and leadership. Each of these domains is comprised of between two and seven competency standards. Each standard is further divided into component parts or 'elements' and the elements are illustrated with performance criteria. The competency standards are currently being used in several Australian critical care educational programmes and are the foundation for an emerging critical care credentialling process. They have been viewed with interest by a variety of non-critical care specialty groups and may form a common precursor from which further specialist nursing practice assessment will evolve.

The roles of Australian chairs in clinical nursing.

Australian chairs in clinical nursing have been established in order to achieve more effective partnerships between academia and the health care sector in education, research and quality of nursing care. The aim of this study was to describe the goals, obstacles, supports and outcomes of such appointments. The study explored the perceptions of a purposive sample of Australian professors holding clinical chairs, stratified to ensure representation of both the geographical and clinical specialty diversity of the population. Eight professors were interviewed using semi-structured telephone interviews. The interviews covered three phases: role establishment, current foci and future developments. Qualitative analysis for common themes and areas of divergence was conducted with concurrent analysis providing the opportunity to seek confirmation for emerging themes. The participants highlighted the diversity of arrangements between university and health sector partners in establishing their respective roles. Clear communication was crucial to successful partnership arrangements. All roles included components of education, research and politics but the relative contribution of each of these areas depended to a large extent on the priorities of the employing partners. The participants felt the need to secure sustainable income sources and consolidate outcomes to ensure the continued viability of their positions. Clinical professorial nursing appointments provide one means of addressing perceived gaps in the links between the university and health care sectors, academia and clinicians, thus enhancing nursing education, research and politics. Through emphasizing common purpose and mutual respect, these positions can illuminate the crucial role nursing plays in Australian health care delivery.

Students' perceptions of field experience in professional development: a comparative study.

The movement of the health care and education professions from an apprenticeship model in the early half of the century to the tertiary education sector has brought an awareness of the key role field experience or practicum plays in professional development. The literature has demonstrated that field experience during teacher education and clinical education is a valuable part of preparation for entry into the teaching and nursing professions. The purpose of this study was to compare and contrast the perceptions of final year students from three distinct undergraduate field experiences. Queensland University of Technology students from adult and workplace education, secondary education, and nursing participated in the study. Data were collected through a series of focus group interviews with groups of five to nine participants across the three discipline areas. Students described their expectations of the practical side of their learning and the learning outcomes that eventuated during the practicum.

Managing central venous catheters: a prospective randomised trial of two methods.

A randomised, prospective study was conducted to evaluate the impact on central venous catheter (CVC) infection when fluids and lines connected to a CVC were changed using a 'sterile' compared to an 'aseptic, non-touch' technique. The study sought to determine whether there were any differences in CVC tip colonisation (CTC) or CVC-related bacteraemia (CRB) as a result of the technique used for fluid and line changes. In the sterile technique (control) group, fluids and tubing were changed using full sterile technique. In the aseptic, non-touch (experimental) group, fluids and tubing attached to the CVC were changed using only a small sterile drape and a 2-minute clinical hand wash. When the CVC was removed, the tip was sampled and cultured using the semi-quantitative method. Blood cultures were also collected. In all, 111 samples from 79 patients were included in the trial: 61 in the sterile technique group and 50 in the non-touch, aseptic technique group. Results showed a CTC rate of 31 per cent in the control group and 14 per cent in the experimental group, while the CRB rate was 8.2 per cent and 6 per cent respectively. The most common organisms cultured were Staphylococcus aureus and S. epidermis respectively. This study indicates that it is safe to change fluids and lines attached to CVCs using the aseptic, non-touch technique, which has resulted in significant financial savings through less use of equipment and less nursing time required to perform fluid and line changes.

Patient satisfaction with an outpatient endoscopic service.

The competitive health care market, increasing demand for patient involvement in establishing directions for health care and implementation of hospital accreditation have all driven hospitals toward evaluation of patient satisfaction with the service they receive from the health care venue. Although the concept of patient involvement in health care evaluation and quality assurance is not new, relatively little literature exists on patient satisfaction with outpatient endoscopic services. This study was designed to explore patient satisfaction with endoscopic services and factors influencing their perceptions. The sample (N = 151) included patients undergoing outpatient endoscopic examination over a 1-month period. The 14-item questionnaire included demographics and patients' perceptions of their experiences pre, interim, and postprocedure. Patients' age, referral source, procedure characteristics, perception of the quality of preprocedure information all influenced perceptions of the service provided by the endoscopic unit. Overall, service satisfaction was good. The results of this study have provided the multidisciplinary team with direction for planning improvements in care, and they may be relevant to other outpatient endoscopic services.

Undergraduate nursing students' perceptions of their clinical learning environment.

The clinical learning environment (CLE) is an interactive network of forces influencing student learning outcomes in the clinical setting. This study used mixed methods to identify factors characterizing students' perceptions of the CLE. The sample consisted of 229 undergraduate students in the second or third year of their biophysical nursing strand. The five subscales of the Clinical Learning Environment Scale, 'staff-student relationships', 'nurse manager commitment', 'patient relationships', 'student satisfaction' and 'hierarchy and ritual', were supported by qualitative data obtained from student interviews. Interpersonal relationships between the participants in the CLE were crucial to the development of a positive learning environment. Student satisfaction with the CLE was both a result of, and influential in creating, a positive learning environment. Nurse educators, clinical venues, and all others participating in the undergraduate nursing students' clinical education, must collaborate in order to create a CLE which promotes the development of well-educated registered nurses capable of providing safe, cost-effective patient care.

The development of a clinical learning environment scale.

Within nursing, there is a strong demand for high-quality, cost-effective clinical education experiences that facilitate student learning in the clinical setting. The clinical learning environment (CLE) is the interactive network of forces within the clinical setting that influence the students' clinical learning outcomes. The identification of factors that characterize CLE could lead to strategies that foster the factors most predictive of desirable student learning outcomes and ameliorate those which may have a negative impact on student outcomes. The CLE scale is a 23-item instrument with five subscales: staff-student relationships, nurse manager commitment, patient relationships, interpersonal relationships, and student satisfaction. These factors have strong substantive face validity and construct validity, as determined by confirmatory factor analysis. Reliability coefficients range from high (0.85) to marginal (0.63). The CLE scale provides the educator with a valid and reliable instrument to evaluate affectively relevant factors in the CLE, direct resources to areas where improvement may be required, and nurture those areas functioning well. It will assist in the application of resources in a cost-effective, efficient, productive manner, and will ensure that the clinical learning experience offers the nursing student the best possible learning outcomes.