A sudden death on clinical placement: A student's perspective of nurse grief.

Abstract This paper explores the reflections of a student nurse upon hearing of the sudden death of a patient she had cared for the previous night on clinical placement. Her journey, and those of colleagues she has observed, prompted this paper's discussion of nurse grief, the support mechanisms available and those preferred by nurses, and the potential outcomes if grief is not acknowledged, supported, and managed. Disenfranchised grief is a major factor in the development of prolonged and cumulative grief responses and negative outcomes for nurses, patients, and the collective nursing profession, however the establishment and utilisation of informal support networks has been found to encourage a discussion of feelings and lead to a healthy resolution of nurse grief.

A sudden death on clinical placement: A student's perspective of nurse grief.

Abstract This paper explores the reflections of a student nurse upon hearing of the sudden death of a patient she had cared for the previous night on clinical placement. Her journey, and those of colleagues she has observed, prompted this paper's discussion of nurse grief, the support mechanisms available and those preferred by nurses, and the potential outcomes if grief is not acknowledged, supported, and managed. Disenfranchised grief is a major factor in the development of prolonged and cumulative grief responses and negative outcomes for nurses, patients, and the collective nursing profession, however the establishment and utilisation of informal support networks has been found to encourage a discussion of feelings and lead to a healthy resolution of nurse grief.

Surveillance of adverse events following immunisation: the model of SAEFVIC, Victoria.

State-based adverse events following immunisation (AEFI) reporting systems in Australia demonstrate marked regional differences in surveillance methodologies and reporting rates. To improve AEFI services in Victoria, Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) was established in 2007. SAEFVIC comprises a central reporting enhanced passive surveillance system integrated with clinical services. AEFI may be reported by phone, fax or on-line. Immunisation nurse specialists follow up all reports, coupled with physician review as required. Supervised re-vaccination in a hospital environment, when appropriate, helps ensure clinical support for vaccinees, families and health-care providers. The Brighton Collaboration, the Australian Immunisation Handbook and in-house case definitions are used to categorise AEFI reports. In the first 3 years (2007-2010) of operation 3,265 reports were received, describing 4,293 AEFI. The number of reports received increased annually over the 3-year period. Seventy-six per cent of AEFI met one of 52 established case definitions and the remainder were recorded verbatim: 22% of reported AEFI were considered severe. Of 1,086 persons reporting an AEFI in 2009, 356 (36%) attended for a clinical consultation and 325 (83%) were revaccinated, of which 114 were day stay or overnight patients. Enhanced passive AEFI surveillance using integrated clinical services has been shown to improve adverse event reporting with reporting rates in Victoria increasing from 2.6 per 100,000 in 2003 to 13.5 per 100,000 per annum in 2009. This report describes the SAEFVIC service model and summarises outcomes and lessons learnt in the first 3 years of operation.

Prevalence of influenza vaccination in South Australian aged care homes.

OBJECTIVE: To determine the prevalence of influenza immunisation of residents within South Australian aged care homes, reasons why vaccination is not given, the policy associated with vaccination administration and the source of the vaccination. METHOD: A clustered, multistage, area sample was used to assess the provision of the influenza vaccine to 500 randomly selected residents within 50 randomly selected aged care homes in South Australia during face-to-face interviews with the director of nursing at each of the selected facilities. The response rate was 100%. RESULTS: Overall, 88.4% (95% CI 85.2-91.0) of residents had received an influenza immunisation in 2001. The reasons why a resident did not have an influenza vaccination included refusal and allergy. Consent was generally obtained on an ad hoc basis (in 94.0% of homes) with the most frequent form of consent type being verbal (66.0%). Influenza vaccine administration was part of standing drug orders in 16.0% of cases and over half of the homes (54.0%) had a specific policy of education and encouraging both residents and staff to be vaccinated against influenza. CONCLUSION: Residents of aged care homes, a population deemed to be at high risk of contracting influenza, are receiving an adequate level of influenza coverage although improvements could be made. Addressing policy and procedural issues can maintain, and further improve, vaccination levels. IMPLICATIONS: Clarification of policies for influenza vaccination administration particularly in regard to staff could further improve rates of vaccination coverage.

Local reactions after the fourth dose of acellular pertussis vaccine in South Australia.

OBJECTIVE: To assess the reported rate of local reactions after administration of acellular pertussis vaccine (DTPa) according to dose number and type of pertussis vaccine (whole-cell or acellular) used for the primary course, and to document the severity and outcome of fourth-dose local reactions. DESIGN AND SETTING: Retrospective review. Reports of adverse events after vaccination in South Australia between 1 January 1997 and 31 December 2000 were reviewed, and a questionnaire administered to all parents who reported a local reaction after the fourth dose of DTPa. MAIN OUTCOME MEASURES: The number, and rate per 100 000 administered doses, of local reactions following the primary and booster doses of DTPa, and of local reactions after the fourth-dose in cohorts of children whose primary vaccinations were with either DTPw or DTPa. Redness and/or swelling at the injection site as reported by parents. RESULTS: Of 581 reported adverse events after vaccination, 138 were local reactions after a pertussis-containing vaccine. Primary vaccinations with DTPa was a significant risk factor for a fourth-dose local reaction (relative risk, 6.7; 95% CI, 2.4-18.5). Parental questionnaires were completed for 45 of the 71 children (63%) with reported local reactions after the fourth dose of DTPa; extensive limb swelling was reported in 8 children (18%) and all except one child had recovered by the time of review. CONCLUSIONS: Parents should be informed that children receiving booster doses of DTPa vaccine, after primary doses with DTPa, are at increased risk of local reactions (which tend to resolve spontaneously) but not of systemic effects. Studies should be initiated to investigate the pathogenesis and the risk of recurrence of local reactions to further improve vaccination schedules.

Prevalence of influenza immunisation in Australia and suggestions for future targeting of campaigns.

OBJECTIVES: Reports on the results of a national survey conducted in Australia, in 2000. The objectives were to determine national estimates of influenza vaccination coverage for each state and territory of Australia, to obtain information related to attitudes towards and influences on immunisation decisions and explain the factors involved with failure to immunise. METHOD: The survey was conducted using the Computer Assisted Telephone Interview (CATI) system. The overall participation rate for the survey was 88.6% and the final number of completed interviews across Australia was n = 10,505. RESULTS: Two target groups, those aged 65 years and over and those "at risk" of influenza aged between 40 and 64 years were defined. The overall immunisation rates in these two groups were 74% and 32% resp. The rate of immunisation among females generally exceeded that of males. A multivariate model provided the best joint set of explanatory variables for not getting immunised. These include sex, income, general practitioner recommendation, and general perceptions regarding the influenza injection. CONCLUSION: This study identified important issues in the decisions of people to immunise. It also highlighted the need to target the findings in effective immunisation policies and strategies to improve health outcomes for those at risk of adverse influenza events.