Family presence during resuscitation (FPDR): Perceived benefits, barriers and enablers to implementation and practice.

INTRODUCTION: There are a number of perceived benefits and barriers to family presence during resuscitation (FPDR) in the emergency department, and debate continues among health professionals regarding the practice of family presence. AIM: This review of the literature aims to develop an understanding of the perceived benefits, barriers and enablers to implementing and practicing FPDR in the emergency department. RESULTS: The perceived benefits include; helping with the grieving process; everything possible was done, facilitates closure and healing and provides guidance and family understanding and allows relatives to recognise efforts. The perceived barriers included; increased stress and anxiety, distracted by relatives, fear of litigation, traumatic experience and family interference. There were four sub themes that emerged from the literature around the enablers of FPDR, these included; the need for a designated support person, the importance of training and education for staff and the development of a formal policy within the emergency department to inform practice. CONCLUSION: In order to ensure that practice of FPDR becomes consistent, emergency personnel need to understand the need for advanced FPDR training and education, the importance of a designated support person role and the evidence of FPDR policy as enablers to implementation.

Attitudes, implementation and practice of family presence during resuscitation (FPDR): a quantitative literature review.

AIM: To undertake a review of the quantitative research literature, to determine emergency staff and public attitudes, to support the implementation and practice of family presence during resuscitation in the emergency department. BACKGROUND: FPDR although endorsed by numerous resuscitation councils, cardiac, trauma and emergency associations, continues to be topical, the extent to which it is implemented and practiced remains unclear. REVIEW METHODS: A review of the quantitative studies published between 1992 and October 2011 was undertaken using the following databases: CINAHL, Ovid Medline, PSYCHINFO, Pro-Quest, Theses Database, Cochrane, and Google Scholar search engine. The primary search terms were 'family presence', and 'resuscitation'. The final studies included in this paper were appraised using the Critical Appraisal Skills Programme criteria. RESULTS: Fourteen studies were included in this literature review. These included quantitative descriptive designs, pre and post-test designs and one randomized controlled trial (RCT). The studies were divided into three main research areas; investigation of emergency staff attitudes and opinions, family and general public attitudes, and four papers evaluating family presence programs in the emergency department. Studies published prior to 2000 were included in the background. CONCLUSION: FPDR in the emergency department is well recognised and documented among policy makers, the extent in which it is implemented and practiced remains unclear. Further research is needed to assess how emergency staff are educated and trained in order to facilitate family presence during resuscitation attempts.

The influence of adult behaviors on child coping during venipuncture: a sequential analysis.

The aim of this exploratory study was to investigate the influences of adult behaviors on child coping behaviors during venipunctures (VPs) in an emergency department. Observations of children and adults from 66 VPs were coded using a modified version of the Child-Adult Medical Procedure Interaction Scale and analyzed using sequential analysis. Results showed adult reassurance behavior promoted child distress behaviors, such as crying, as well as nondistress behaviors, such as information seeking; adult distraction behaviors promoted children's distraction, control, and coping behaviors; and children frequently ignored adult behaviors. Findings suggest further exploration of children's internal strategies for coping, such as appraisal, and clarifying the role of adult reassurance in child coping behaviors.

Development of an undergraduate nursing Clinical Evaluation Form (CEF).

A clinical placement evaluation form for undergraduate nursing students was developed to address the need for evaluating success in clinical teaching support and provide a feedback loop to the University, clinical educators and clinical venues. A 21-item, with five domains, (orientation, clinical educator/teacher, ward staff and environment, clinical hurdles, and university) Clinical Evaluation Form (CEF) was developed. The form was live tested with 178 year 1 and 2 undergraduate nursing students. The CEF scale was reliable (alpha=0.90) and has good face and content validity approved by an expert panel. Further research is recommended to validate the CEF for use multi-professionally and across all year levels.

Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM).

AIM: To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. BACKGROUND: Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. METHODS: (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated 'real time' events. RESULTS: Following expert review, selected items were found to have a high total content validity index of 0.96. A single 'teamwork' construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p<0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were 'fair', with positive feasibility ratings following 'real time' testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. CONCLUSION: In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians' tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.

A multicultural perspective on conducting palliative care research in an Indian population in Australia.

Australia's population is culturally and linguistically diverse, with approximately one quarter of the population born overseas (Australian Bureau of Statistics, 2005). Health-care research must be culturally sensitive and due consideration given to the unique ethical, cultural, and other issues that may arise. Issues in palliative care research have become more complex as the options of care at the end of life develop in respect to the requirements of different cultures. This paper highlights the issues that arose when conducting a qualitative study of the needs and experiences of Indian families with a relative requiring palliative care, and also proposes strategies to address the ethical and methodological problems that may arise when researching this vulnerable population.

Automated versus manual blood pressure measurement: a randomized crossover trial.

This study evaluated the accuracy and reliability of the Dinamap 8100 automated blood pressure machine against three internationally recognized criteria. Systolic and diastolic blood pressures were taken concurrently by two nurses using the automated machine and a manual sphygmomanometer. Results demonstrated agreement between automated and manual readings on one set of criteria for both systolic and diastolic pressures, and support for systolic readings only on one other criterion. Comparison of mean differences between automated and manual measures showed the automated machine consistently under-read both systolic and diastolic blood pressures. The conclusion from this study was that the Dinamap 8100 machine can be used with some degree of confidence to assess systolic blood pressures in a general population of adult hospital inpatients, but with caution when taking diastolic readings.

Treatment content in child and adolescent mental health services: development of the treatment recording sheet.

This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.

Using overseas registered nurses to fill employment gaps in rural health services: quick fix or sustainable strategy?

OBJECTIVE: This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria. DESIGN: An exploratory descriptive design. SETTING: Small rural hospitals in Gippsland, Victoria. PARTICIPANTS: Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia). RESULTS AND CONCLUSION: Recruitment of married overseas trained nurses is more sustainable than that of single registered nurses, however, the process of recruitment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommodation and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospitals. Overall both the registered nurses and the employees believe the experience to be beneficial rather than detrimental.

Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial.

BACKGROUND: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial. METHODS/DESIGN: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate. Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method. DISCUSSION: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRNO12607000324415.

The attitudes and practices of neonatal nurses in the use of kangaroo care.

OBJECTIVES: To survey the attitudes and practices of Australian neonatal nurses in the use of kangaroo care (KC) and identify possible concerns with promoting KC in the neonatal intensive care unit (NICU). DESIGN: A two-phase research approach was used that included a descriptive survey followed by in-depth interviews with a subset of survey respondents. SAMPLE: Thirty four nurses working in the NICU of a large public hospital in Melbourne completed a survey questionnaire. Four respondents were subsequently selected for follow-up interview to explore in greater depth issues associated with promoting KC in the NICU. OUTCOME MEASURES: Quantitative data were analysed to describe the attitudes, practices and role of the neonatal nurse in promoting KC. Analysis of qualitative responses to survey questions and interviews were coded and major themes identified. RESULTS: All neonatal nurses surveyed assisted and encouraged parents to provide KC and the majority agreed on the benefits of KC for both infant and parents. There was a general acceptance that KC can be practiced with low birth weight infants requiring intubation and all but two nurses found facilitating KC professionally satisfying. Results also identified practical concerns with the practice of KC and some uncertainty that KC promotes breastfeeding. Notable constraints to promoting KC in the NICU were heavy staff workloads, insufficient education, lack of organisational support and the absence of clear protocols, especially for low birth weight infants. CONCLUSIONS: This study confirms neonatal nurses strongly support the use of KC in the NICU. Although the majority of nurses reported positive attitudes and practices, they did identify a number of educational and practical concerns that need to be addressed to ensure KC with low birth weight infants is safe and effective.

Quality of life of cancer patients receiving inpatient and home-based palliative care.

AIMS: This paper reports a comparative study of the symptom experience, physical and psychological health, perceived control of the effects of cancer and quality of life of terminally ill cancer patients receiving inpatient and home-based palliative care, and the factors that predict quality of life. BACKGROUND: Quality of life is a major goal in the care of patients with terminal cancer. In addition to symptom management, psychological care and provision of support, being cared for at home is considered an important determinant of patient well-being. A more comprehensive understanding of the impact of cancer on patients and their families will inform the delivery of palliative care services. METHODS: Fifty-eight patients with terminal cancer (32 inpatients, 26 home-based) were recruited from major palliative care centres in Australia in 1999. A structured questionnaire designed to obtain sociodemographic information, medical details and standard measures of symptoms, physical and psychological health, personal control and quality of life was administered by personal interview. RESULTS: The two groups were similar on most demographic measures, although more home-care patients were married, of Australian descent and had private health insurance cover. The most prevalent symptoms reported were weakness, fatigue, sleeping during the day and pain. Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores, and better physical health and quality of life than those receiving inpatient care. Home-care patients also reported statistically significantly more control over the effects of their illness, medical care and treatment received, and the course of the disease. Multiple regression analyses showed that better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher quality of life. CONCLUSIONS: The main issues arising from the findings for nurses are the early detection and management of both physical and psychological symptoms, particularly fatigue, pain, anxiety and depression, and the need to use strategies that will empower patients to have a greater sense of control over their illness and treatment. Research is needed to identify other factors that may impact on quality of life, and to establish the extent to which inpatient and home-based care meets the needs of both the patient with terminal cancer and their family.

Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer.

This study aims to describe symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal tract (GIT) cancer, and to identify the extent to which demographic, physical, and psychosocial factors predict their quality of life. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from 3 major hospitals in Shanghai completed a self-report questionnaire. The questionnaire was designed to obtain demographic and medical data and measures of symptoms, psychological distress, social support, health-related quality of life (HRQoL), and global quality of life (GQoL). Measures developed in English were translated into Chinese using the procedure advocated by WHO. The results showed that the most common signs and symptoms reported were fatigue, pain, and weight loss; 28% of the patients were depressed; and overall, patients had a moderate quality of life. Comparative analyses found some difference on measures for demographic and diagnostic subgroups. Depression, symptom distress, and social support accounted for 44% of the total variance for HRQoL, while perceived financial difficulty and symptom distress accounted for 20% of the total variance for GQoL. Findings from this research give insights into the importance of quality of life assessment, symptom management, and intervention to improve the quality of life of Chinese cancer patients. It also raises questions about measures of quality of life that are culturally relevant.

Quality of life of Chinese patients newly diagnosed with gastrointestinal cancer: a longitudinal study.

Cancer of the gastrointestinal (GIT) tract is a major health problem in China. The aims of the study were to investigate quality of life of Chinese patients newly diagnosed with gastrointestinal (GIT) cancer, identify factors predicting quality of life, and to examine the pattern of stability and change in symptoms, psychosocial measures and quality of life over a 6 months period. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from three major hospitals in Shanghai completed a self-report questionnaire initially and 6 months later. Results indicated that Chinese patients newly diagnosed with GIT cancer experience a range of symptoms associated with cancer and its treatment that resulted in varying degrees of symptom distress, anxiety and depression, and decreased quality of life. Findings from this research give insights into the importance of ongoing quality of life assessment, symptom management, and intervention to improve quality of life of Chinese cancer patients. It also raised questions about measures of quality of life that are culturally relevant.