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Tousignant-Laflamme Y.,Universite de Sherbrooke | Gelinas C.,McGill University | Gelinas C.,Center for Nursing Research | Marchand S.,Universite de Sherbrooke
Journal of Pain | Year: 2010

The Critical-Care Pain Observation Tool (CPOT) is a behavioral scale recommended by experts for pain assessment in critically ill patients unable to verbally communicate. The main goal of this study was to determine the relationship between self-reports of pain intensity and the CPOT score, and establish the sensibility and the specificity of the CPOT to different levels of pain intensity in healthy subjects. A total of 18 healthy subjects participated in the study (mean age = 37.8 years). All subjects underwent a 2 minutes noxious cold pressor test (CPT) at 7°C. Verbal pain ratings were obtained with a visual analog scale (0-100) while pain behaviors were videotaped. Afterwards, 2 independent evaluators quantified pain behaviors using the CPOT. Interrater reliability was supported with an ICC of 0.963 (95%CI [0.904-0.986]). A moderate positive correlation between the CPOT scores and self-reports of pain intensity during the CPT was found (r = 0.52, p = 0.028). Such result indicates that subjects reporting high level of pain showed a higher number or more intense pain behaviors. A cut-off score >2.5/8 on the CPOT led to a sensibility of 64% and a specificity of 86%. Results from this pilot study support that an increase of CPOT score is correlated with moderate to high levels of pain intensity and further support the clinical use of the CPOT. Perspective: This article presents the psychometric properties of a behavioral pain scale called the CPOT which was developed to assess pain in critically ill adults unable to self-report. Our results in healthy subjects showed that the CPOT behavioral score is significantly correlated with the self-report of pain intensity and supports its clinical use. © 2010 by the American Pain Society. Source

Stajduhar K.I.,University of Victoria | Funk L.,University of Victoria | Funk L.,Canadian Institutes of Health Research | Toye C.,Curtin University Australia | And 3 more authors.
Palliative Medicine | Year: 2010

The changing context of palliative care over the last decade highlights the importance of recent research on home-based family caregiving at the end of life. This article reports on a comprehensive review of quantitative research (1998-2008) in this area, utilizing a systematic approach targeting studies on family caregivers, home settings, and an identified palliative phase of care (n = 129). Methodological challenges were identified, including: small, non-random, convenience samples; reliance on descriptive and bivariate analyses; and a dearth of longitudinal research. Robust evidence regarding causal relationships between predictor variables and carer outcomes is lacking. Findings suggest the need for knowledge regarding: family caregiving for patients with non-malignant terminal conditions; whether needs and outcomes differ between family caregivers at the end of life and comparison groups; and caregiver outcomes in bereavement. Clear definitions of family caregiving, end of life, and needs are required as well as greater application and testing of theoretical and conceptual explanations. © 2010 The Author(s). Source

Teng T.-H.K.,University of Western Australia | Hung J.,University of Western Australia | Finn J.,University of Western Australia | Finn J.,Center for Nursing Research
Medical Journal of Australia | Year: 2010

Objectives: To examine trends and predictors of prescription medications on discharge after first (index) hospitalisation for heart failure (HF), and the effect on all-cause mortality of evidence-based therapy. Design: A retrospective multicentre cohort study, with medical record review. Setting: Three tertiary-care hospitals in Perth, Western Australia. Patients: WA Hospital Morbidity Data were used to identify a random sample of 1006 patients with an index admission to hospital for HF between 1996 and 2006. Main outcome measures: Proportion of patients prescribed evidence-based therapy for HF on discharge from hospital; and 1-year all-cause mortality. Results: Among 944 patients surviving to hospital discharge, the prescription rate of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (74.3%) and loop diuretics (85.5%) remained high over the study period, whereas that of β-blockers and spironolactone increased (10.5% to 51.3% and 1.4% to 23.3%, respectively), and digoxin prescription decreased (38.1% to 20.7%). The temporal trends in use of β-blockers, spironolactone and digoxin were in line with clinical trial evidence. Age ≥75 years was a significant, negative predictor of β-blocker and spironolactone prescription. In-hospital echocardiography, performed in 53% of patients, was associated with a significantly greater likelihood of treatment with ACE inhibitors/ARBs, β-blockers and spironolactone. Both ACE inhibitors/ARBs and β-blockers prescribed on discharge were associated with a lower adjusted hazard ratio (HR) for mortality at 1-year (HR, 0.71; P = 0.003; and HR, 0.68; P = 0.002, respectively). Conclusion: ACE inhibitors/ARBs and β-blockers, prescribed during initial hospitalisation for HF, are associated with improved long-term survival. Therapy became more evidence based over the study period, but echocardiography, an important predictor of evidence-based therapy, was underutilised. Source

Aragon Penoyer D.,Center for Nursing Research
Critical Care Medicine | Year: 2010

Background: Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Most of those studies were generated from general acute care units. Critically ill patients demand increased nurse staffing resources and nurses who have specialized knowledge and skills. Appropriate nurse staffing in critical care units may improve the quality of care of critically ill patients. Objectives: To review the literature evaluating the association of nurse staffing with patient outcomes in critical care units and populations. Methods: An annotated review of major nursing and medical literature from 1998 to 2008 was performed to find research studies conducted in intensive care units or critical care populations where nurse staffing and patient outcomes were addressed. RESULTS: Twenty-six studies met inclusion for this review. Most were observational studies in which outcomes were retrieved from existing large databases. There was variation in the measurement of nurse staffing and outcomes. Outcomes most frequently studied were infections, mortality, postoperative complications, and unplanned extubation. Most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care unit patients. Conclusions: Findings from this review demonstrate an association of nurse staffing in the intensive care unit with patient outcomes and are consistent with findings in studies of the general acute care population. A better understanding of nurse staffing needs for intensive care unit patients is important to key stakeholders when making decisions about provision of nurse resources. Additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source

Hegney D.,Curtin University Australia | Hegney D.,Center for Nursing Research | Eley R.,University of Queensland | Eley R.,University of Southern Queensland | Francis K.,Charles Sturt University
Nurse Education Today | Year: 2013

Introduction: In Australia, unlike other countries, programmes which lead to registration as a registered or enrolled nurse (called "entry to practice" programmes) are carried out solely in the tertiary sector. In Australian nursing and the wider community, there continues to be a debate over the place of preparation and the "work readiness" of graduates. Background: Despite several opinion papers on the preparation of registered nurses, there is a dearth of published research on the perceptions of the clinical nursing workforce on the suitability of the current preparation for practice models. Methods: Data were collected from approximately 3000 nurses in Queensland, Australia in 2007 and 2010. The aim of these studies was to ascertain issues around nursing work. This paper reports on qualitative data that were collected as part of that larger survey. Specifically this paper provides the thematic analysis of one open-ended question: "what are the five key issues and strategies that you see could improve nursing and nursing work?" as it was apparent when we undertook thematic analysis of this question that there was a major theme around the preparation of nurses for the nursing workforce. We therefore carried out a more detailed thematic analysis around this major theme. Results: The major sub-themes that we identified from comments on the preparation of the nursing workforce were: perceptions of lack of clinical exposure and the need to increase the amount of clinical hours; the design of the curriculum, the place of preparation (solely within industry or a great focus on industry), financial consideration (students to be paid for their work); and in 2007 only, the need for students to have better time management. Discussion: The findings suggest that a majority of respondents believed there should be changes to the entry to practice preparation for nurses. The major focus of these comments was the perception of insufficient clinical experience and inappropriate curriculum content. Thus, graduates are not "work ready" Conclusion: The attitude of clinical nurses, who work closely with student nurses, influences the workplace experience of student nurses. It is apparent from the statements of respondents in this study, that there is a need for stronger industry/academic partnerships, particularly around the design and implementation of the entry-to-practice curriculum. © 2012 Elsevier Ltd. Source

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