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Professor Doug Elliott

Biography

Doug Elliott is an experienced and active academic, with 27 years of service across a number of universities – the University of Technology Sydney, The University of Sydney, University of Western Sydney and Cumberland College of Health Sciences. His senior academic and clinical service roles have included Professor, Faculty Director of Research (Associate Dean, Research equivalent), Clinical Professor in a tertiary hospital, Head of an academic department, and a conjoint hospital appointment as Assistant Director of Nursing – Research in a tertiary hospital. Prior to this, Doug worked as a clinical nurse in Lismore, Sydney and Perth.

As a Professor for over a decade in a developing academic discipline, Doug has significant leadership experience, including strategic planning, policy development, operational management, and modeling behaviours and mentoring for staff, research students and other collaborators.

Doug’s clinical and health services research focuses on the health-related quality of life and illness and recovery experiences of individuals with critical and acute illnesses; and the use of information and communications technologies to improve patient outcomes and clinical practice. He has received $1.3 M in competitive research funding, including from the National Health and Medical Research Council, the Australian Commission on Safety and Quality in Health Care and the HCF Foundation; published over 100 peer-reviewed articles and book chapters; and was co-editor for three textbooks on critical care nursing, nursing and midwifery research and pathophysiology and nursing practice.

Professional

Doug was inducted as a Life Member of the Australian College of Critical Care Nurses (ACCCN) in 2006 for over 20 years of service to critical care, including volunteer roles as Associate Editor and Editorial Board member for the peer-reviewed Australian Critical Care journal, inaugural Chair of their Research Advisory Panel, and member of their Education Advisory Panel. He is currently on the Editorial Board for the American Journal of Critical Care, and peer-reviews for several international critical care medicine and nursing journals, and a number of competitive funding bodies. Doug contributes to NSW Health through a range of activities, including projects with the Intensive Care Coordinating and Monitoring Unit (ICCMU).

Image of Doug Elliott
Professor, Faculty of Health
Associate Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Core Member, Health Services and Practice Research Strength
BAppSc(Nurs) (Curtin), Master - Applied Science (Nursing), Doctor of Philosophy
Life Member, Australian College of Critical Care Nurses
 
Phone
+61 2 9514 4832
Room
CB10.07.222

Research Interests

Health-related quality of life
Illness experiences of critically ill individuals
Knowledge management
Clinical practice guideline development
Mixed methods

Can supervise: Yes
Registered at Level 1 Research areas Complex and Chronic Care Critical / Acute Care Randomised Control Trials

Research in Health - postgraduate

Medical-Surgical Nursing - undergraduate

Chapters

Elliott, D., Aitken, L.M. & Chaboyer, W. 2012, 'Scope of Critical Care Practice' in Elliott, D., Aitken, L. & Chaboyer, W. (eds), ACCCN's Critical Care Nursing, 2nd Edition, Mosby, Sydney, pp. 3-16.
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A revised new edition of this comprehensive critical care nursing text, developed with the Australian College of Critical Care Nurses (ACCCN). This second edition of ACCCN's Critical Care Nursing has been fully revised and updated for critical care nurses and students in Australia and New Zealand. As well as featuring the most recent critical care research data, current clinical practice, policies, procedures and guidelines specific to Australia and New Zealand, this new edition offers new and expanded chapters and case studies. The ultimate guide for critical care nurses and nursing students alike, ACCCN's Critical Care Nursing 2e has been developed in conjunction with the Australian College of Critical Care Nurses (ACCCN).
Elliott, D. & Rattray, J. 2012, 'Recovery and rehabilitation' in Elliott, D., Aitken, L. & Chaboyer, W. (eds), ACCCN's Critical Care Nursing, 2nd Edition, Mosby, Sydney, pp. 57-77.
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A revised new edition of this comprehensive critical care nursing text, developed with the Australian College of Critical Care Nurses (ACCCN). This second edition of ACCCN's Critical Care Nursing has been fully revised and updated for critical care nurses and students in Australia and New Zealand. As well as featuring the most recent critical care research data, current clinical practice, policies, procedures and guidelines specific to Australia and New Zealand, this new edition offers new and expanded chapters and case studies. The ultimate guide for critical care nurses and nursing students alike, ACCCN's Critical Care Nursing 2e has been developed in conjunction with the Australian College of Critical Care Nurses (ACCCN).
Daly, J., Elliott, D. & Chang, E. 2010, 'Research in nursing: Concepts and processes' in Daly, J., Speedy, S. & Jackson, D. (eds), Contexts of nursing 3e, Churchill Livingstone, Sydney, pp. 128-144.
Daly, J., Elliott, D. & Chang, E. 2009, 'Research in nursing: Concepts and processes (Chapter 9)' in Daly, J., Speedy, S. & Jackson, D. (eds), Contexts of nursing, 3rd Ed, Churchill- Livingston, Elsevier, Sydney, pp. 129-144.
Davidson, P.M. & Elliott, D. 2008, 'Managing approaches to nursing care delivery' in Chang, E. & Daly, J. (eds), Transitions in Nursing, Elsevier/Churchill Livingstone, Sydney, Australia, pp. 126-144.
Elliott, D. 2007, 'Searching the literature' in Schneider, Z., Whitehead, D., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing & midwifery research: methods and critical appraisal for evidence-based practice, Elsevier, Sydney, pp. 33-45.
Elliott, D. 2007, 'Reviewing the literature' in Schneider, Z., Whitehead, D., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing & midwifery research: methods and critical appraisal for evidence-based practice, Elsevier, Sydney, pp. 46-61.
Methods and appraisal for evidence-based practice
Elliott, D. & Thompson, D.R. 2007, 'Common quantitative methods' in Schneider, Z., Whitehead, D., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing & midwifery research: methods and critical appraisal for evidence-based practice, Elsevier, Sydney, pp. 156-174.
Aitken, L.M., Chaboyer, W. & Elliott, D. 2007, 'The scope of Critical Care Practice' in ACCCN's Critical Care Nursing, Elsevier, Sydney, pp. 3-14.
Chaboyer, W. & Elliott, D. 2007, 'Care Across the Continuum' in ACCCN's Critical Care Nursing, Elsevier, Sydney, pp. 71-85.
Adamson, H. & Elliott, D. 2007, 'Clinical information' in Elliott, D., Aitken, L. & Chaboyer, W. (eds), ACCCN's Critical Care Nursing, Elsevier, Sydney, pp. 33-56.
Clinical information in the critical care setting is essential for clinical care, quality improvement, practice development, and research activities. A vast array of clinical data are collected on critical care patients, and are documented in a range of locations; patient medical records; paper-based or automated bedside clinical information systems; handheld devices; unit-specific or hospital-wide information systems; and disciplinary-based databases.
Thompson, D.R., Daly, J., Elliott, D. & Chang, E. 2006, 'Research in nursing: concepts and processes' in Daly, J., Speedy, S. & Jackson, D. (eds), Contexts of Nursing: an Introduction, Churchill Livingstone, Sydney, Australia, pp. 114-128.
Anders, R., Daly, J., Thompson, D., Elliott, D. & Chang, E. 2005, 'Research in nursing (Chapter 8)' in Professional nursing: Concepts, issues and challenges, Springer, New York, pp. 153-174.
Anders, R., Daly, J., Thompson, D.R., Elliott, D. & Chang, E. 2005, 'Research in Nursing (Chapter 8)' in Daly, J., Speedy, S., Jackson, D., Lambert, V. & Lambert, C. (eds), Professional nursing: Concepts, issues and challenges, Springer Publishing Company, New York, pp. 153-174.
Davidson, P.M., Elliott, D. & Daffurn, K. 2004, 'Contemporary approaches to nursing practice' in Daly, J., Speedy, S. & Jackson, D. (eds), Nursing leadership, Churchill Livingstone, Sydney, Australia, pp. 285-297.
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Davidson, P.M., Elliott, D. & Daffurn, K. 2004, 'Leading contemporary approaches to nursing practice' in Daly, J., Speedy, S. & Jackson, D. (eds), Nursing leadership, Churchill Livingstone, Sydney, pp. 285-312.
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Elliott, D. 2003, 'Quantitative data collection' in Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing Research: methods, critical appraisal and utilisation 2nd Edition, Elsevier, Sydney, pp. 276-294.
Elliott, D. 2003, 'Interventional design and methods' in Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing Research: methods, critical appraisal and utilisation 2nd Edition, Elsevier, Sydney, pp. 316-330.
Elliott, D. 2003, 'Reading review papers' in Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing Research: methods, critical appraisal and utilisation 2nd Edition, Elsevier, Sydney, pp. 73-90.
Elliott, D. 2003, 'Assessing instrument psychometrics' in Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing Research: methods, critical appraisal and utilisation 2nd Edition, Elsevier, Sydney, pp. 331-348.
Elliott, D. 2003, 'Research and professional practice' in Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. (eds), Nursing Research: methods, critical appraisal and utilisation 2nd Edition, Elsevier, Sydney, pp. 3-20.
Thompson, D., Daly, J., Elliott, D. & Chang, E. 2002, 'Research in nursing: Concepts and processes (Chapter 8)' in Daly, J., Speedy, S., Jackson, D. & Darbyshire, P. (eds), Contexts of nursing (UK/European adaptation), Blackwell Publishing, Oxford, pp. 84-100.

Conferences

Hoang, D.B., Elliott, D., McKinley, S.M., Nanda, P., Schulte, J. & Duc, N.A. 2012, 'Tele-monitoring techniques to support recovery at home for survivors of a critical illness', Signal Processing and Information Technology 2012, IEEE International Symposium on Signal Processing and Information Technology, IEEE, Ho Chi Minh City, Vietnam, pp. 1-6.
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This paper proposes and explores the design of a system that includes sensor-based procedures and techniques for remote physiological sensing and functional assessment for these individuals.
Schulte, J., Duc, N.A., Hoang, D.B., Elliott, D., McKinley, S. & Nanda, P. 2012, 'A remote sensor-based 6-minute functional walking ability test', Proceedings of IEEE Sensors.
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This paper proposes and implements an integrated remote sensor-based 6-minute walk test (6MWT) for monitoring a patient's clinical condition and correlate this data to the walking activity that the patient is performing to assess his/her functional ability and physical performance. The 6MWT is known to be one of the most effective rehabilitation tests for a clinician to assess individuals with a variety of clinical conditions including survivors of a critical illness. Our method deploys body sensors for measuring health conditions and an on-body accelerometer for detecting motion. An intelligent algorithm was developed to detect a walk step, count the number of steps, and dynamically derive the step distance based on an individual's real-time walking parameters. The path and the derived walk distance are then related to their vital signs to assess their functional ability under various walk conditions. Our remote 6MWT is being considered for a telehealth rehabilitation procedure in an integrated assistive healthcare system. © 2012 IEEE.

Journal articles

Aitken, L.M., Burmeister, E., McKinley, S.M., Alison, J.A., King, M.T., Leslie, G. & Elliott, D. 2015, 'The effect of home based rehabilitation and other predictors on physical recovery in ICU survivors: a cohort analysis', American Journal of Critical Care.
Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S. & Roche, M. 2015, 'Clinical user experiences of observation and response charts: Focus group findings of using a new format chart incorporating a track and trigger system', BMJ Quality and Safety, vol. 24, no. 1, pp. 65-75.
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Background: Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards. Methods: Across eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2-6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach. Findings: In this exploration of initial user experiences, key emergent themes were: tensions between vital sign 'ranges versus precision' to support decision making; using a standardised 'generalist chart in a range of specialist practice' areas; issues of 'clinical credibility', 'professional autonomy' and 'influences of doctors' when communicating abnormal signs; and 'permission and autonomy' when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of 'increased activity/uncertain benefit' was uncovered. Conclusions: Findings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design chara...
Varndell, W., Elliott, D. & Fry, M. 2015, 'Assessing, monitoring and managing continuous intravenous sedation for critically ill adult patients and implications for emergency nursing practice: A systematic literature review', Australasian Emergency Nursing Journal, vol. 18, no. 2, pp. 59-67.
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Background: Critically ill mechanically ventilated patients in ED have complex needs; chief among these is adequate sedation in addition to effective pain-relief. Emergency nurses are increasingly responsible sedation and analgesia for this complex cohort of patients. The aim of this review was to examine (1) the evidence around assessing, monitoring and managing continuous intravenous sedation for critically ill adult patients, and (2) the implications for emergency nursing practice. Study design: Systematic review. Method: The review of literature extended from 1946 to 2013 and examined peer review journal articles, policy and guidelines to provide a more complex understanding of a phenomenon of concern. A total of 98 articles were incorporated and comprehensively examined. Results: Analysis of the literature identified several implications for emergency nursing practice and the management of continuous intravenous sedation: workload, education, monitoring and assessing sedation and policy. Conclusion: Limited literature was found that directly addressed Australasian emergency nursing practices' in managing on-going intravenous sedation and analgesia for patients. Balancing patient sedation and analgesia requires highly complex knowledge, skills and expertise; the degree of education and training required is above that obtained during pre-registration nurse training. No state or national models of education or training were identified to support ED nurses' practices in managing sedation. Little research has addressed the safety of continuous sedation use in ED.
Allen, E., Jackson, D. & Elliott, D. 2015, 'Exploring interprofessional practices in rapid response systems: a case study protocol', Nurse researcher, vol. 22, no. 3, pp. 20-27.
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AIM: To describe the development of a proposed case study protocol investigating interprofessional relationships in a rapid response system (RRS) in a socioculturally complex clinical environment.
Knowles, S., Lam, L.T., McInnes, E., Elliott, D., Hardy, J. & Middleton, S. 2015, 'Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: Effects of a targeted protocol implementation for nursing and medical staff', BMC Nursing, vol. 14, no. 1.
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Background: Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. Methods: A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Results: Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. Conclusion: This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management pr...
Innes, K., Jackson, D., Plummer, V. & Elliott, D. 2015, 'Care of patients in emergency department waiting rooms - an integrative review.', J Adv Nurs.
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AIM: To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. BACKGROUND: Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. DESIGN: Integrative review. DATA SOURCES: Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. REVIEW METHODS: Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. RESULTS: Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. CONCLUSION: Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives.
Knowles, S., McInnes, E., Elliott, D., Hardy, J. & Middleton, S. 2014, 'Evaluation of the implementation of a bowel management protocol in intensive care: effect on clinician practices and patient outcomes.', J Clin Nurs, vol. 23, no. 5-6, pp. 716-730.
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AIMS AND OBJECTIVES: To evaluate the effect of a multifaceted implementation of a bowel management protocol on outcomes for intensive care patients, in particular the incidence of constipation and diarrhoea, and on clinicians' bowel management practices. BACKGROUND: Complications associated with poor bowel management for critically ill patients result in adverse outcomes. Implementation of protocols requires strategies proven to change clinician behaviour. DESIGN: Before and after study. METHODS: Our bowel management protocol was implemented using three evidence-based elements: education sessions, printed educational materials in the form of a fact sheet and reminders. We retrospectively collected data from patients' medical records admitted at two time points within three Sydney metropolitan intensive care units (preimplementation, n = 101; postimplementation, n = 107). RESULTS: No significant difference was found in the incidence of constipation and diarrhoea pre and postimplementation of the protocol. Seventy-two per cent (n = 73) of patients preimplementation and 70% (n = 75) of patients postimplementation experienced one or more episodes of constipation (bowels not open for 72 hours or greater), and 16% (n = 16) of patients preimplementation and 20% (n = 21) of patients postimplementation experienced one or more episodes of diarrhoea. There was a slight nonsignificant increase in bowel assessment on admission by medical officers postimplementation (pre, 47%, n = 48; post, 60%, n = 64). CONCLUSION: Targeted multifaceted implementation of a bowel management protocol did not have an impact on the incidence of constipation or diarrhoea for intensive care patients or on clinician practices. The lack of impact on patient outcomes may be due to clinicians' nonadherence to our bowel management protocol. Reasons clinicians' practices did not change may include the influences of clinical decision-making on behaviour. RELEVANCE TO CLINICAL PRACTICE: This study highligh...
Davidson, P.M., Newton, P.J., Ferguson, C., Daly, J., Elliott, D., Homer, C., Duffield, C. & Jackson, D. 2014, 'Rating and ranking the role of bibliometrics and webometrics in nursing and midwifery', The Scientific World Journal, vol. 2014.
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Background. Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implications for metric of evaluation, and specify the implications for nursing and midwifery and implications of social networking for bibliometrics and measures of individual performance. Method. A review of electronic databases CINAHL, Medline, and Scopus was undertaken using search terms such as bibliometrics, nursing, and midwifery. The reference lists of retrieved articles and Internet sources and social media platforms were also examined. Results. A number of well-established, formal ways of assessment have been identified, including h- and c-indices. Changes in publication practices and the use of the Internet have challenged traditional metrics of influence. Moreover, measuring impact beyond citation metrics is an increasing focus, with social media representing newer ways of establishing performance and impact. Conclusions. Even though a number of measures exist, no single bibliometric measure is perfect. Therefore, multiple approaches to evaluation are recommended. However, bibliometric approaches should not be the only measures upon which academic and scholarly performance are evaluated. © 2014 Patricia M. Davidson et al.
Varndell, W., Elliott, D. & Fry, M. 2014, 'The validity, reliability, responsiveness and applicability of observation sedation-scoring instruments for use with adult patients in the emergency department: A systematic literature review', Australasian Emergency Nursing Journal.
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Aim: This paper reports a systematic literature review examining the range of published observational sedation-scoring instruments available in the assessment, monitoring and titration of continuous intravenous sedation to critically ill adult patients in the Emergency Department, and the extent to which validity, reliability, responsiveness and applicability of the instruments has been addressed. Background: Emergency nurses are increasingly responsible for the ongoing assessment, monitoring and titration of continuous intravenous sedation, in addition to analgesia for the critically ill adult patient. One method to optimise patient sedation is to use a validated observational sedation-scoring tool. It is not clear however what the optimal instrument available is for use in this clinical context. Methods: A systematic literature review methodology was employed. A range of electronic databases were searched for the period 1946-2013. Search terms incorporated "sedation scale", "sedation scoring system", "measuring sedation", and "sedation tool" and were used to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. Articles were assessed using the Critical Appraisal Skills Program (CASP) making sense of evidence tools. Results: A total of 27 observational sedation-scoring instruments were identified. Sedation-scoring instruments can be categorised as linear or composite, the former being the most common. A wide variety of patient behaviours are used within the instruments to measure depth and quality of patient sedation. Typically sedation-scoring instruments incorporated three patient behaviours, which were then rated to generate a numerical score. The majority of the instruments have been subjected to validity and reliability testing, however few have been examined for responsiveness or applicability. Conclusions: None of the 27 observational sedation-scoring instruments were designed or ...
Abbenbroek, B., Duffield, C.M. & Elliott, D. 2014, 'The intensive care unit volume-mortality relationship, is bigger better? An integrative literature review', Australian Critical Care, vol. 27, no. 4, pp. 157-164.
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Objective: To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality. Background: Large multi-speciality ICUs are emerging in response to increasing demand for critical care. Consolidation of resources through regionalisation of services aims to contain costs and optimise demand management and operational synergies. Higher patient volumes in ICU have been associated with improved outcomes. Limited evidence exists, however, to suggest an optimal volume of patients in terms of risk-adjusted mortality. Review method: Retrospective integrative literature review. Data sources: EMBASE, PubMed and Cumulative Index to Nursing and Allied Health Literature electronic databases. Inclusion criteria: Primary studies of risk adjusted mortality in adult ICU patients published between 1995 and 2012. Exclusion criteria: Studies of admissions following elective procedures. Results: Twenty quantitative observational studies were included in this review. Studies were primarily retrospective with three conducted prospectively. Nine studied mechanically ventilated patients, six included all admissions to ICU, three reported on patients with sepsis and one study each on patients post cardiac arrest and those receiving renal replacement therapy. A significant association was evident in sixteen studies suggesting a lower risk of adjusted mortality in higher-volume units. The association was not consistent across all diagnosis. A non-linear relationship observed in two studies noted no mortality benefit occurring above a volume threshold of 450 cases annually per diagnostic category and above 711 cases not specific to a diagnostic group. Conclusion: Patient mortality may be improved in large capacity ICUs. However, the association is not consistent across all diagnostic groups. Risk adjusted mortality is increased in low volume ICUs. There appears to be a high volume threshold at which point the risk adjusted mortality benefit is also los...
Elliott, D., McKinley, S., Perry, L., Duffield, C., Iedema, R., Gallagher, R., Fry, M., Roche, M. & Allen, E. 2014, 'Clinical utility of an observation and response chart with human factors design characteristics and a track and trigger system: Study protocol for a two-phase multisite multiple-methods design', Journal of Medical Internet Research, vol. 16, no. 8, pp. e40-e40.
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Background: Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs. Objective: To describe the study protocol for the clinical testing of these observation and response charts (ORCs). Methods: We propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site's existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources. Results: Site selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress. Conclusions: This detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.
Elliott, D., Davidson, J.E., Harvey, M.A., Bemis-Dougherty, A., Hopkins, R.O., Iwashyna, T.J., Wagner, J., Weinert, C., Wunsch, H., Bienvenu, O.J., Black, G., Brady, S., Brodsky, M.B., Deutschman, C., Doepp, D., Flatley, C., Fosnight, S., Gittler, M., Gomez, B.T., Hyzy, R., Louis, D., Mandel, R., Maxwell, C., Muldoon, S.R., Perme, C.S., Reilly, C., Robinson, M.R., Rubin, E., Schmidt, D.M., Schuller, J., Scruth, E., Siegal, E., Spill, G.R., Sprenger, S., Straumanis, J.P., Sutton, P., Swoboda, S.M., Twaddle, M.L. & Needham, D.M. 2014, 'Exploring the scope of post-intensive care syndrome therapy and care: Engagement of non-critical care providers and survivors in a second stakeholders meeting', Critical Care Medicine, vol. 42, no. 12, pp. 2518-2526.
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Background: Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post-intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families. Objectives: To report on engagement with non-critical care providers and survivors during the 2012 Society of Critical Care Medicine post-intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes. Participants: Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members. Design: Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences. Meeting Outcomes: Future steps were planned regarding 1) recognizing, preventing, and treating post-intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post-intensive care syndrome across the continuum of care, including explicit "functional reconciliation" (assessing gaps between a patient's pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post-intensive care syndrome research topic areas were identified across the continuum of recovery: characteriza...
Soo Hoo, S.Y., Gallagher, R. & Elliott, D. 2014, 'Systematic review of health-related quality of life in older people following percutaneous coronary intervention.', Nurs Health Sci, vol. 16, no. 4, pp. 415-427.
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People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care.
ROLLS, K.D., HANSEN, M., JACKSON, D. & ELLIOTT, D. 2014, 'Analysis of the Social Network Development of a Virtual Community for Australian Intensive Care Professionals', CIN - Computers Informatics Nursing.
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Social media platforms can create virtual communities, enabling healthcare professionals to network with a broad range of colleagues and facilitate knowledge exchange. In 2003, an Australian state health department established an intensive care mailing list to address the professional isolation experienced by senior intensive care nurses. This article describes the social network created within this virtual community by examining how the membership profile evolved from 2003 to 2009. A retrospective descriptive design was used. The data source was a deidentified member database. Since 2003, 1340 healthcare professionals subscribed to the virtual community with 78% of these (n = 1042) still members at the end of 2009. The membership profile has evolved from a single-state nurse-specific network to an Australia-wide multidisciplinary and multiorganizational intensive care network. The uptake and retention of membership by intensive care clinicians indicated that they appeared to value involvement in this virtual community. For healthcare organizations, a virtual community may be a communications option for minimizing professional and organizational barriers and promoting knowledge flow. Further research is, however, required to demonstrate a link between these broader social networks, enabling the exchange of knowledge and improved patient outcomes.
Varndell, W., Elliott, D. & Fry, M. 2014, 'Emergency nurses practices in assessing and administering continuous intravenous sedation for critically ill adult patients: A retrospective record review'', International Emergency Nursing.
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Aim: To generate an initial profile of emergency nurses' practices in and factors influencing the assessment and administration of continuous intravenous sedation and analgesia for critically ill mechanically ventilated adult patients. Background: Emergency nurses are relied upon to assess and manage critically ill patients, some of whom require continuous intravenous sedation. Balancing sedation is a highly complex activity. There is however little evidence relating to how emergency nurses manage continuous intravenous analgesia and sedation for the critically ill intubated patients. Design: Descriptive study. Method: A 12-month retrospective medical record review was undertaken from January to December 2009 of patients (>16 years) administered continuous intravenous sedation in ED. Results: Fifty-five patients received ongoing intravenous sedation within the ED during a median length of stay of 3.4 h. Assessment of patient depth/quality of sedation and pain-relief varied and were rarely documented. Adverse events were documented, majority (16%) drug administration related. Thematic analysis identified three themes: 'Maintaining sedation', 'Directionless-directions', and 'Navigating the balance'. Conclusion: Emergency nurses provide continuity of patient care and optimisation of analgesia and sedation for critically ill sedated patients. The safety and effectiveness of continuous intravenous sedation for the critically ill adult patient in ED are dependent on the expertise and decision-making abilities of the nurse.
Knowles, S., Lam, L.T.-.M., McInnes, E., Hardy, J., Elliott, D. & Middleton, S. 2014, 'Predictors of intensive care clinicians' behaviour intention for three bowel management practices', Australian Critical Care, vol. 27, no. 1, pp. 45-45.
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Hodgson, C.L., Stiller, K., Needham, D.M., Tipping, C.J., Harrold, M., Baldwin, C.E., Bradley, S., Berney, S., Caruana, L.R., Elliott, D., Green, M., Haines, K., Higgins, A.M., Kaukonen, K.-.M., Leditschke, I.A., Nickels, M.R., Paratz, J., Patman, S., Skinner, E.H., Young, P.J., Zanni, J.M., Denehy, L. & Webb, S.A. 2014, 'Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults', Critical Care, vol. 18, no. 6.
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Introduction: The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. Methods: A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. Results: Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations. Conclusion: Consensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events.
Conroy, K.M., Elliott, D. & Burrell, A.R. 2013, 'Validating a process-of-care checklist for intensive care units', ANAESTHESIA AND INTENSIVE CARE, vol. 41, no. 3, pp. 342-348.
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Elliott, D., Aitken, L.M., Bucknall, T.K., Seppelt, I.M., Webb, S.A.R., Weisbrodt, L. & McKinley, S. 2013, 'Patient comfort in the intensive care unit: A multicentre, binational point prevalence study of analgesia, sedation and delirium management', Critical Care and Resuscitation, vol. 15, no. 3, pp. 213-219.
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Objective: To measure the prevalence of assessment and management practices for analgesia, sedation and delirium in patients in Australian and New Zealand intensive care units. Materials and methods: We developed survey items from a modified Delphi panel and included them in a binational, point prevalence study. We used a standard case report form to capture retrospective patient data on management of analgesia, sedation and delirium at the end of a 4-hour period on the study day. Other data were collected during independent assessment of patient status and medication requirements. Results: Data were collected on 569 patients in 41 ICUs. Pain assessment was documented in the 4 hours before study observation in 46% of patients. Of 319 assessable patients, 16% had moderate pain and 6% had severe pain. Routine sedation assessment using a scale was recorded in 63% of intubated and ventilated patients. When assessed, 38% were alert and calm, or drowsy and rousable, 22% were lightly to moderately sedated, 31% were deeply sedated (66% of these had a documented indication), and 9% were agitated or restless. Sedatives were titrated to a target level in 42% of patients. Routine assessment of delirium occurred in 3%, and at study assessment 9% had delirium. Wrist or arm restraints were used for 7% of patients. Conclusions: Only two-thirds of sedated patients had their sedation levels formally assessed, half had pain assessed and very few had formal assessment of delirium. Our description of current practices, and other observational data, may help in planning further research in this area.
McKinley, S. & Elliott, D. 2013, 'Twenty-five years of critical care nursing scholarship in Australia', Australian Critical Care, vol. 26, no. 1, pp. 7-11.
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Background: Australian Critical Care has been published since 1988 and has been an important medium for the development of critical care nursing scholarship in Australia over 25 years. Purpose: To review scholarship in critical care nursing in Australia since 1988 and record its progress in the context of developments in nursing education and intensive and critical care practice. Approach: Australian Critical Care issues since 1988 were reviewed, and abstracts from the Australian and New Zealand Annual Scientific Meeting on Intensive Care published in Australian Critical Care since the 1991 Meeting. Available evidence for the contribution of this body of scholarship to critical care nursing practice and patient care was considered. Results: Original research reports and review articles have steadily increased from 1988 to 2012. The peak years for research publications were 2001, 2005 and 2012, and for reviews 2010 and 2011. Approximately 760 abstracts were presented at the Annual Scientific Meeting from 1991 to 2010; overall 24% were found lead to peer-reviewed publications, with an increase to 30% in recent years. Summary: Over 25 years, the scholarship of critical care nursing in Australia has evolved into an established area of disciplinary knowledge, based firmly in practice. Our discipline has witnessed the opportunity for PhD training, the introduction of professorial positions, a knowledge base built on original research and rigorous reviews, and sustainable dissemination. The challenges are to further strengthen this development, increase publication of research that is done, to demonstrate the influence on practice and to develop sustainable research funding. © 2012 Australian College of Critical Care Nurses Ltd.
McKinley, S., Fien, M., Elliott, R. & Elliott, D. 2013, 'Sleep and psychological health during early recovery from critical illness: An observational study', Journal of Psychosomatic Research, vol. 75, no. 6, pp. 539-545.
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Introduction: Intensive care patients often report sleep disruption in ICU and during recovery from critical illness. Objectives: To assess: (i) patients' self-reported sleep quality in ICU, on the hospital ward after transfer from ICU and two and six months after hospital discharge; (ii) whether patients who report sleep disruption in ICU continue to report sleep disruption in recovery and (iii) whether prehospital insomnia, experiences in intensive care, quality of life and psychological health are associated with sleep disruption six months after hospital discharge. Methods: Patients completed self-report measures on sleep quality at five time points: prior to hospitalization, in ICU, the hospital ward, two months and six months after hospital discharge, their intensive care experiences two months after discharge and psychological health and quality of life six months after discharge. Results: Patients (n. = 222) were aged (mean. ±. SD) 57.2. ±. 17.2. years, 35% female, had mean ICU stay of 5. ±. 6. days and BMI of 26. ±. 5. Over half the participants (57%) reported poor sleep at six months; for 10% this was at all time points after ICU admission. Prehospitalization insomnia (p. = .0005), sleep quality on the ward (p. = .006), anxiety (p. = .002), and mental (p. = .0005) and physical health (p. = .0005) were independently associated with poorer sleep quality in survivors six months after ICU treatment. Conclusions: Sleep is a significant issue for more than half of survivors 6. months after ICU treatment. Some influencing factors, such as hospital sleep quality, anxiety, physical health and mental health, are potentially modifiable and should be targeted in recovery programs. © 2013 Elsevier Inc.
Needham, D.M., Davidson, J., Cohen, H., Hopkins, R.O., Weinert, C., Wunsch, H., Zawistowski, C., Bemis-Dougherty, A., Berney, S.C., Bienvenu, O.J., Brady, S.L., Brodsky, M.B., Denehy, L., Elliott, D., Flatley, C., Harabin, A.L., Jones, C., Louis, D., Meltzer, W., Muldoon, S.R., Palmer, J.B., Perme, C., Robinson, M., Schmidt, D.M., Scruth, E., Spill, G.R., Storey, C.P., Render, M., Votto, J. & Harvey, M.A. 2012, 'Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.', Crit Care Med, vol. 40, no. 2, pp. 502-509.
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BACKGROUND: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES: To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. PARTICIPANTS: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. DESIGN: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. MEASUREMENTS AND MAIN RESULTS: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. CONCLUSIONS: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and famili...
Alison, J.A., Kenny, P., King, M.T., McKinley, S., Aitken, L.M., Leslie, G.D. & Elliott, D. 2012, 'Repeatability of the six-minute walk test and relation to physical function in survivors of a critical illness.', Phys Ther, vol. 92, no. 12, pp. 1556-1563.
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BACKGROUND: The Six-Minute Walk Test (6MWT) is widely used as an outcome measure in exercise rehabilitation. However, the repeatability of the 6MWT performed at home in survivors of a critical illness has not been evaluated. OBJECTIVE: The purpose of this study was to evaluate, in survivors of a critical illness: (1) the repeatability of the 6MWT performed at home, (2) the effect on estimates of change in functional exercise capacity if only one 6MWT was performed at follow-up assessments, and (3) the relationship between the physical functioning (PF) score of the 36-Item Short-Form Health Survey questionnaire (SF-36) and the 6MWT. DESIGN: Repeated measures of the 6MWT and SF-36 were obtained. METHODS: Eligible participants had an intensive care unit (ICU) length of stay of ?48 hours and were mechanically ventilated for ?24 hours. Two 6MWTs and the SF-36 were conducted in participants' homes at weeks 1, 8, and 26 after hospital discharge. RESULTS: One hundred seventy-three participants completed the study. The participants had a mean age of 57 years (SD=16), a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission of 19 (SD=10), a mean ICU length of stay of 9 days (SD=8), and a mean mechanical ventilation time of 140 hours (SD=137). Of the 173 participants, 110 performed two 6MWTs at weeks 1, 8, and 26. There were significant mean increases in 6-minute walk distance in the second test of 15 m (P<.0001) at week 1, 13 m (P<.0001) at week 8, and 9 m (P=.04) at week 26. If only one 6MWT was performed at weeks 8 and 26, the estimate of change in 6-minute walk distance from week 1 was 19 m less (P<.001) at both weeks 8 and 26. There was a moderate to strong correlation between SF-36 PF score and 6-minute walk distance at each assessment (week 1: r=.62, P<.001; week 8: r=.55, P<.001; and week 26: r=.47, P<.001). LIMITATIONS: Some study participants were unable to perform a second 6MWT, and these participants may have differed in important ...
Connolly, B., Denehy, L., Brett, S., Elliott, D. & Hart, N. 2012, 'Exercise rehabilitation following hospital discharge in survivors of critical illness: An integrative review', Critical Care, vol. 16, no. 3.
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Although clinical trials have shown benefit from early rehabilitation within the ICU, rehabilitation of patients following critical illness is increasingly acknowledged as an area of clinical importance. However, despite recommendations from published guidelines for rehabilitation to continue following hospital discharge, there is limited evidence to underpin practice during this intermediate stage of recovery. Those patients with ICU-acquired weakness on discharge from the ICU are most likely to benefit from ongoing rehabilitation. Despite this, screening based on strength alone may fail to account for the associated level of physical functioning, which may not correlate with muscle strength, nor address non-physical complications of critical illness. The aim of this review was to consider which patients are likely to require rehabilitation following critical illness and to perform an integrative review of the available evidence of content and nature of exercise rehabilitation programmes for survivors of critical illness following hospital discharge. Literature databases and clinical trials registries were searched using appropriate terms and groups of terms. Inclusion criteria specified the reporting of rehabilitation programmes for patients following critical illness post-hospital discharge. Ten items, including data from published studies and protocols from trial registries, were included. Because of the variability in study methodology and inadequate level of detail of reported exercise prescription, at present there can be no clear recommendations for clinical practice from this review. As this area of clinical practice remains in its relative infancy, further evidence is required both to identify which patients are most likely to benefit and to determine the optimum content and format of exercise rehabilitation programmes for patients following critical illness post-hospital discharge. &copy; 2012 BioMed Central Ltd.
McKinley, S., Aitken, L.M., Alison, J.A., King, M., Leslie, G., Burmeister, E. & Elliott, D. 2012, 'Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness', Intensive Care Medicine, vol. 38, no. 4, pp. 627-633.
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Purpose: Some patients who survive intensive care unit (ICU) treatment report psychological sequelae during recovery. This study examined factors associated with psychological outcomes of former ICU patients up to 6 months after hospital discharge. Methods: Participants (n = 195) were adult survivors of ICU enrolled in a multicenter trial of physical rehabilitation after hospital discharge. The 36-Item Short-Form Health Survey (SF-36), the Impact of Events Scale (IES) and the Depression, Anxiety and Stress Scales were completed, and sleep rated on a five-point scale at weeks 1, 8 and 26; clinical and demographic data were obtained from patient records. Results: Participants were 41% females with mean &plusmn; standard deviation (SD) age of 57 &plusmn; 16 years and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 19 &plusmn; 7; median lengths of mechanical ventilation and ICU stay were 89 h and 6 days, respectively. Impaired mental health, depression, anxiety, stress and psychological distress significantly improved after week 1. Female gender, younger age and sleeping problems were associated with impaired psychological outcomes on bivariate analyses. Age; gender; week 1 anxiety, depression and stress; week 26 sleeping; and rehabilitation study group were entered into multiple linear regression analyses for week 26 IES and SF-36 Mental Component Summary (MCS) outcomes. IES scores were associated (p\0.05) with gender, week 1 stress and week 26 sleep but not study group; MCS scores were associated (p\0.05) with week 1 stress and week 26 sleep but not study group. Conclusion: Female gender, early levels of increased stress and problems sleeping are associated with worse psychological recovery for survivors of critical illness.&copy; Copyright jointly held by Springer and ESICM 2012.
Stewart, A.M., Baker, J.D. & Elliott, D. 2012, 'The psychological wellbeing of patients following excision of a pilonidal sinus', JOURNAL OF WOUND CARE, vol. 21, no. 12, pp. 595-600.
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Denehy, L. & Elliott, D. 2012, 'Strategies for post ICU rehabilitation.', Curr Opin Crit Care, vol. 18, no. 5, pp. 503-508.
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PURPOSE OF REVIEW: As numbers of patients who survive a critical illness increase, often within a context of comorbidities and acquired physical, mental or cognitive sequelae [postintensive care syndrome (PICS)], identifying effective recovery and rehabilitation strategies is paramount. In this review, we discuss recent studies that inform our developing understanding for improving the recovery trajectory for survivors of a critical illness during the postintensive care and posthospital periods. RECENT FINDINGS: New studies, although at this stage often presented as pilot work, provide important beginning messages for improving recovery from a critical illness. Some pilot studies demonstrate promise of effective interventions, whereas other studies offer useful baseline information for improving the power of tested interventions. SUMMARY: Innovative rehabilitation and recovery strategies during the postintensive care and posthospital periods are now being published. Further research with larger sample sizes, well-documented usual care and intervention arms and in different critical illness cohorts is required to demonstrate the optimal approaches for screening, implementation, outcome assessment and follow-up periods for rehabilitation interventions in the postintensive care phase of a patient's recovery.
Needham, D., Davidson, J., Cohen, H., Hopkins, R., Weinert, C., Wunsch, H., Zawistowski, C., Bemis-dougherty, A., Berney, S., Bienvenu, O., Brady, S., Brodsky, M., Denehy, L., Elliott, D., Flatley, C., Harabin, A., Jones, C., Louis, D., Meltzer, W., Muldoon, S., Palmer, J.B., Perme, C., Robinson, M., Schmidt, D.M., Scruth, E., Spill, G.R., Storey, P., Render, M., Votto, J. & Harvey, M.A. 2012, 'Improving Long-term Outcomes After Discharge From Intensive Care Unit: Report From A Stakeholders' Conference', Critical Care Medicine, vol. 40, no. 2, pp. 502-509.
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Background: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital
Elliott, D., Denehy, L., Berney, S. & Alison, J.A. 2011, 'Assessing physical function and activity for survivors of a critical illness: a review of instruments.', Aust Crit Care, vol. 24, no. 3, pp. 155-166.
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BACKGROUND: Functional outcomes and health-related quality of life are important measures for survivors of a critical illness. Studies have demonstrated debilitating physical effects for a significant proportion of surviving patients, particularly those with intensive care unit-acquired weakness. Contemporary practice changes include a focus on the continuum of critical illness, with less sedation and more physical activity including mobility while in ICU, and post-ICU and post-hospitalisation activities to support optimal recovery. How to best assess the physical function of patients at different phases of their recovery and rehabilitation is therefore important. PURPOSE: This narrative review paper examined observational and functional assessment instruments used for assessing patients across the in-ICU, post-ICU and post-hospital continuum of critical illness. METHODS: Relevant papers were identified from a search of bibliographic databases and a review of the reference list of selected articles. The clinimetric properties of physical function and HRQOL measures and their relevance and utility in ICU were reported in narrative format. FINDINGS: The review highlighted many different instruments used to measure function in survivors of ICU including muscle strength testing, functional tests and walk tests, and patient centred outcomes such as health related quality of life. In general, the sensitivity and validity of these instruments for use with survivors of a critical illness has not yet been established. CONCLUSION: Based on findings from the review, screening of patients using reliable and valid instruments for ICU patients is recommended to inform both practice and future studies of interventions aimed at improving recovery and rehabilitation.
Hewson-Conroy, K.M., Burrell, A.R., Elliott, D., Webb, S.A.R., Seppelt, I.M., Taylor, C. & Glass, P. 2011, 'Compliance with processes of care in intensive care units in Australia and New Zealand - a point prevalence study', ANAESTHESIA AND INTENSIVE CARE, vol. 39, no. 5, pp. 926-935.
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Elliott, D., McKinley, S., Alison, J., Aitken, L.M., King, M., Leslie, G.D., Kenny, P., Taylor, P., Foley, R. & Burmeister, E. 2011, 'Health-related quality of life and physical recovery after a critical illness: A multi-centre randomised controlled trial of a home-based physical rehabilitation program', Critical Care, vol. 15, no. 3.
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Introduction: Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery.Methods: A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge.Results: Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores.Conclusions: This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving ...
Stewart, A.M., Baker, J.D. & Elliott, D. 2011, 'The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews', JOURNAL OF CLINICAL NURSING, vol. 20, no. 21-22, pp. 3174-3182.
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Elliott, D. 2011, 'Surviving critical illness', Australian Critical Care, vol. 24, no. 3, pp. 152-154.
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Knowles, S., Rolls, K., Elliott, D., Hardy, J. & Middleton, S. 2010, 'Patient care guidelines: a telephone survey of intensive care practices in New South Wales.', Aust Crit Care, vol. 23, no. 1, pp. 21-29.
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BACKGROUND: There are a number of practice areas highlighted in the literature as important for the care of critically ill patients. However, the current implementation of evidence into clinical practice for these areas is largely unknown. The development of clinical practice guidelines can translate the current evidence into useful tools to guide clinicians in providing evidence based care. AIM: To identify existence of current guidelines and informal routine procedures and clinicians' views of same within New South Wales (NSW) Intensive Care Units (ICUs) and High Dependency Units (HDUs) for 11 practice areas, namely, bowel management, endotracheal tube (ETT) stabilisation, tracheostomy tube stabilisation, feeding, analgesia, sedation, thromboembolic prevention, head of bed elevation, ulcer prophylaxis and glucose control. METHOD: A telephone survey conducted with a representative from NSW ICUs and HDUs. RESULTS: There was variation in the number of guidelines and informal routine procedures reported for the 11 practice areas within the study units. Larger ICUs (Joint Faculty of Intensive Care Medicine Level II and Level III) and those who employed an onsite CNC were significantly more likely to have formal guidelines in place. Overall, there were very few audits reportedly conducted for the 11 practice areas. Bowel management was the area of practice most respondents reported as a neglected area of critical care nursing practice and the one they were least satisfied with. CONCLUSION: This survey provides a baseline of current practice and guideline use within NSW ICUs and HDUs. It also highlights areas for consideration to further develop clinical practice guidelines that could benefit critically ill patients.
Hewson-Conroy, K.M., Elliott, D. & Burrell, A.R. 2010, 'Quality and safety in intensive care-A means to an end is critical.', Aust Crit Care, vol. 23, no. 3, pp. 109-129.
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BACKGROUND: To achieve improvement in healthcare quality and safety, all four domains (outcome, process, structure and culture) must be considered in conjunction with the best available clinical evidence to improve patient care and reduce harm. A range of improvement initiatives have targeted processes of care in recognition of: (1) complexities of patient care and (2) evidence that a large portion of adverse events are preventable, occur during ongoing care, and result in poorer patient outcomes. PURPOSE: The aims of this paper are to: (1) outline national and international quality and safety initiatives; (2) identify evidence-based processes of care applicable to the general adult ICU patient population; (3) summarise the literature on relevant quality improvement strategies. METHODS: An integrative literature review was conducted by: (1) database search of Ovid Medline, CINAHL, EMBASE and Cochrane for articles published between 1996 and October 2009; (2) identification of additional studies from articles obtained; (3) purposive internet search identifying relevant quality and safety initiatives. FINDINGS: Quality improvement initiatives across the globe were identified, with ensuing focus on how the development, implementation and evaluation of evidence-based processes of care can lead to improvements in the delivery and outcomes of intensive care practice. Variation in practice and methodological limitations of existing studies were also noted, highlighting the need for innovative approaches to improving processes in the ICU. CONCLUSION: This integrative review has outlined potential for achieving practice improvements in intensive care and highlighted the need for further evaluative research to improve patient care at the bedside.
Burrell, A.R., Elliott, D. & Hansen, M.M. 2009, 'ICT in the ICU: using Web 2.0 to enhance a community of practice for intensive care physicians.', Crit Care Resusc, vol. 11, no. 2, pp. 155-159.
Contemporary information and communicationstechnology (ICT), particularly applications termed "Web2.0", can facilitate practice development and knowledgemanagement for busy clinicians. Just as importantly, theseapplications might also enhance professional socialinteraction and the development of an interprofessionalcommunity of practice that transcends the boundaries ofthe intensive care unit, health service, jurisdiction andnation.We explore the development of Web 2.0 applications inhealth care, and their application to intensive care practicein Australia and New Zealand. The opportunities for usingpodcasts, blogs, wikis and virtual worlds to support cliniciandevelopment and knowledge exchange are clear in theory.However, strategic leadership from the Colleges is neededto fully exploit these technologies and to enable thedevelopment of a strong and sustainable ICU community ofpractice.
Yousefi, H., Abedi, H.A., Yarmohammadian, M.H. & Elliott, D. 2009, 'Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.', J Adv Nurs, vol. 65, no. 9, pp. 1891-1898.
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AIM: This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical-surgical wards in an Iranian hospital. BACKGROUND: Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care. METHOD: This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical-surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes. FINDINGS: One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes - A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family - were identified in the data. CONCLUSION: These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.
Rolls, K., Kowal, D., Elliott, D. & Burrell, A.R. 2008, 'Building a statewide knowledge network for clinicians in intensive care units: Knowledge brokering and the NSW Intensive Care Coordination and Monitoring Unit (ICCMU)', Australian Critical Care, vol. 21, no. 1, pp. 29-37.
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Purpose: This paper describes the initial establishment of the Intensive Care Coordination and Monitoring Unit (ICCMU), and reports on the implementation of a state-based intensive care Listserv, ICUConnect, for staff in ICUs in New South Wales, Australia. The aim of the Listserv was to decrease professional isolation in smaller and less resourced ICUs by developing a network based on professional peer support. The Listserv was launched in December 2003 with 130 clinical nurse consultants and nurse managers. The emphasis was on exchange of both codified and experiential information. Material and methods: Evaluation of the Listserv was undertaken with a user survey piloted in 2004 and conducted in 2005. The survey explored the penetration, activity patterns and opinions of members of the Listserv. Members of the Listserv were mostly Australian intensive care clinicians and academics. Results: At the time of the survey, Listserv membership had grown to over 433 users. As expected rural members tended to ask questions of clinical support and advice, while nurse educators in metropolitan ICUs were the most active members on-list. The free exchange of information, especially in the form of policies and procedures, has led to the development of an information repository on the ICCMU website. Conclusions: The Listserv has created a beginning community of practice with ICCMU taking an active approach to knowledge management by facilitating exchange of information. The creation of ICCMU as a clinician-led resource has developed a structure that is ideally placed to act as a knowledge broker within a network of ICUs. A collaborative process to produce generic guidelines is now underway. &copy; 2007 Australian College of Critical Care Nurses Ltd.
Ladanyi, S. & Elliott, D. 2008, 'Traumatic brain injury: An integrated clinical case presentation and literature review. Part I: Assessment and initial management', Australian Critical Care, vol. 21, no. 2, pp. 86-96.
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Holistic nursing care of critically ill patients continues to be a challenge for all levels of critical care clinicians. Patients with multi-system dysfunction in particular, present complicated clinical challenges that demand care based on sound knowledge and understanding of physiological, psychosocial and spiritual needs. Experiential learning through exposure to a range of patient presentations enables incremental development of professional practice and excellence in nursing care. Case study learning enhances understanding through application of theory to practice in complex clinical presentations. This two-part paper outlines the assessment, interventions and outcome of a person who sustained multiple trauma including severe traumatic brain injury (TBI). Part I explores assessment and initial management from pre-hospital care through to the Emergency Department (ED) and operating theatre. Part II describes the intensive care period as an integral component of the continuum of care. Key issues in the case are presented sequentially with relevant literature integrated and applied to clinical progress, focussing on the complex physiological, psychosocial, spiritual and environmental needs of the patient and his family. The purpose of the paper is to therefore provide a comprehensive learning resource for critical care nurses, particularly for those beginning their practice. &copy; 2008 Australian College of Critical Care Nurses Ltd.
Ladanyi, S. & Elliott, D. 2008, 'Traumatic brain injury: an integrated clinical case presentation and literature review part II: the continuum of care.', Aust Crit Care, vol. 21, no. 3, pp. 141-153.
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The following paper continues the presentation of a case scenario outlining the assessment, interventions and outcome of a person who sustained multiple trauma with a focus on traumatic brain injury (TBI). Part I explored assessment and initial management of the patient from pre-hospital care through to the emergency department and operating theatre. Part II describes the intensive care period as an integral component of the continuum of care. Key issues in the case are presented sequentially with relevant theory integrated and applied to the clinical case throughout the discussion with a focus on the complex physiological, psychological, and spiritual needs of the patient and their family.
Aitken, L.M., Currey, J., Marshall, A.P. & Elliott, D. 2008, 'Discrimination of educational outcomes between differing levels of critical care programmes by selected stakeholders in Australia: a mixed-method approach.', Intensive Crit Care Nurs, vol. 24, no. 2, pp. 68-77.
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OBJECTIVE: This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes. BACKGROUND: Postgraduate speciality education has proliferated within Australia over the past 20 years. However, there is little agreement regarding the expected characteristics, or relevant priorities, of these characteristics of graduates successfully completing these programmes of study. METHOD: This study used a mixed-method approach comprising two phases. Initially a survey was mailed to volunteers between March and June 2005 to obtain priorities in educational outcomes for graduates of critical care programmes. This was followed by a stakeholder focus group in May 2006 to refine expected outcomes. RESULTS: Survey respondents rated educational outcomes that described professional and legal aspects of practice to ensure safe patient care as highest priority for programme graduates. Although most educational outcome statements were considered important for graduates from all levels of courses, increasing levels of practice was described for increasingly higher levels of programmes from Graduate Certificate to Masters Degree. CONCLUSION: This study provides an emerging description of the priorities of critical care nursing programmes, with priority given to professional and legal aspects of practice. Further delineation of priorities is necessary to inform ongoing educational development.
Gallagher, R., Marshall, A.P., Fisher, M.J. & Elliott, D. 2008, 'On my own: experiences of recovery from acute coronary syndrome for women living alone.', Heart Lung, vol. 37, no. 6, pp. 417-424.
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OBJECTIVE: Women who live alone are becoming an increasing proportion of our population, yet few studies have examined the experiences that these women have during recovery from an acute cardiac event. This study aims to describe women's experiences of recovering alone from acute coronary syndrome. METHODS: Women attending cardiac rehabilitation were interviewed 3 to 9 months after acute coronary syndrome using a life history approach to address their personal/social background, professional life, and work-related processes, and to acquire an in-depth narrative of their recovery from illness in relation to this background. The sample included 11 women aged from 44 to 82 years who lived alone. RESULTS: "Being on my own" was the pervasive theme, with independence being both required and valued. One subtheme included the complexity of social support arrangements women needed for their recovery. This was particularly important because women felt vulnerable when they were alone, particularly if they had experienced a sudden cardiac event or recurrent symptoms. Recurrent cardiac symptoms were an important subtheme because of the pervasive influence on women's lives, including their ability to work and plan ahead. Finally, the work and financial issues subtheme was a central concern for women, first because work was an important source of income and enjoyment, and second because loss of work meant loss of income. For some women, this meant selling their home or moving to another house. CONCLUSION: Women who live alone are an increasing proportion of patients with cardiac disease. Although they share many similar issues with other women and men who live alone, they seem to have unique concerns related to vulnerability, recurrent cardiac symptoms, social support, work, and finances.
Rolls, K.D. & Elliott, D. 2008, 'Using consensus methods to develop clinical practice guidelines for intensive care: the intensive care collaborative project.', Aust Crit Care, vol. 21, no. 4, pp. 200-215.
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BACKGROUND: Clinical practices or procedures based on the best available evidence are an essential resource within an intensive care unit (ICU). Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of staff with relevant skills to interrogate the literature. The aim of the Intensive Care Collaborative (ICC) project was to use the synergism of group processes to develop state-based clinical guidelines for six common intensive care practices - eye care, oral care, endotracheal tube management, suctioning, arterial line management, and central venous catheter (CVC) management. METHODS: Participants were 55 senior nurse clinicians from all nine area health services in NSW, seven academic facilitators, and staff from the Intensive Care Coordination and Monitoring Unit (ICCMU). A range of approaches were used to develop the six clinical practice guidelines (CPG) and related systematic literature reviews, including a preparatory educational seminar for participants, formation of working groups of clinicians, with subsequent teleconferences, e-mail and online forums to identify the scope of each guideline and review the literature. A consensus development conference (CDC) was conducted to finalise the reviews with a nominal group technique (NGT) used to develop recommendations for practice. External Validation Panels (EVP) verified the recommendations in each clinical practice guideline. Group voting was undertaken using a Likert scale (1-3 disagree, 4-6 neutral, 7-9 agree) with consensus agreement set as a median of at least seven. RESULTS: Eighty-three recommendations for practice were developed for the six Clinical Practice Guidelines; 50% were based on research literature evidence (23% with high levels of evidence). The balance were based on consensus opinion of the panel members. Only five recommendations were not validated by external validat...
Chalmers, A., Mitchell, C., Rosenthal, M. & Elliott, D. 2007, 'An exploration of patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber.', J Clin Nurs, vol. 16, no. 8, pp. 1454-1459.
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AIMS AND OBJECTIVES: To examine patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber of a hyperbaric medicine unit in Australia. BACKGROUND: There is minimal literature available documenting patients' feelings and memories of hyperbaric oxygen therapy, particularly in a multiplace chamber. DESIGN: Exploratory. METHODS: A convenience sample of seven non-emergency patients was interviewed separately at the conclusion of their multi-session therapy. A semi-structured approach elicited in-depth information regarding their experiences and memories of the hyperbaric oxygen therapy. Interviews were 30-45 minutes long and audiotaped for transcription and analysis. Field notes were also used to note non-verbal cues and other observations not evident from the audio material. Data collection ceased when data saturation was evident from the interviews. Interview transcripts were examined using a content analysis approach, with textual coding and thematic development. RESULTS: Issues derived from the data included: the uncertainty of the treatment; the noise and cold of the chamber; the discomfort of the mask or hood; and the boredom. Participant responses to the therapy related to previous noxious experiences and the individual's personality. CONCLUSIONS: This information was used to examine ways of reducing any negative feelings and experiences associated with hyperbaric oxygen therapy, thus improving the service provided to patients. RELEVANCE TO CLINICAL PRACTICE: Identification of these stressors and related issues may also enable subsequent development of a risk-stratification instrument to predict patients who do not complete treatment.
Marshall, A.P., Currey, J., Aitken, L.M. & Elliott, D. 2007, 'Key stakeholders' expectations of educational outcomes from Australian critical care nursing courses: A Delphi study', Australian Critical Care, vol. 20, no. 3, pp. 89-99.
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Background: Educational preparation for critical care nursing in Australia varies considerably in terms of the level of qualification resulting in a lack of clarity for key stakeholders about student outcomes. Objectives: The study aim was to identify and reach consensus regarding the desired learning outcomes from Australian post-registration critical care education programs as demonstrated through the graduate's knowledge, skills and attitudes. Design: A Delphi technique was used to establish consensus between educators, managers, clinicians and students regarding learning outcomes expected of graduates with a Graduate Certificate, Graduate Diploma and Master level qualification in critical care nursing. Participants: A total of 164 critical care nurses (66 clinicians, 48 educators, 32 managers and 18 students) participated and 99 questionnaires were returned in the first round (response rate 60%). Fifty-seven questionnaires were returned for Round 2 (response rate 58%). Methods: Learning outcomes were obtained from the Australian College of Critical Care Nurses Competency Standards for Specialist Critical Care Nurses. Some statements included more than one characteristic, and these were split to create learning outcomes with one characteristic per item. A survey of Australian higher education providers of critical care education provided additional learning outcomes, for a total of 73 learning outcomes for the first Delphi round. Results: Findings suggest that patient comfort, safety, professional responsibility and ethical conduct are deemed most important for all three levels of educational preparation. There was a lack of emphasis on clinical practice issues for all levels. Participants placed higher emphasis on learning outcomes related to complex decision-making, leadership, supervision, policy development and research for Graduate Diploma and Master level programs. Conclusion: The findings have implications for curriculum development and the profession w...
Ladanyi, S. & Elliott, D. 2007, 'Experiences of uncertainty for relatives in ICU: A review of a qualitative Danish study.', Aust Crit Care, vol. 20, no. 4, pp. 146-148.
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Kim, J.R., Fisher, M.J. & Elliott, D. 2006, 'Undergraduate nursing students' knowledge and attitudes towards organ donation in Korea: Implications for education.', Nurse Educ Today, vol. 26, no. 6, pp. 465-474.
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Organ donation from brain dead patients is a contentious issue in Korea within the cultural context of Confucian beliefs. Each year thousands of patients wait for organ donation note poor donation rates and importance of nurses in identifying potential donors. It is therefore important to identify knowledge levels and attitudes towards organ donation from brain dead patients of nursing students as future health workers. Using a 38-item instrument previously developed by the researchers, 292 undergraduate students in a Korean nursing college were surveyed in 2003 in Korea (response rate 92%). Validity and reliability of the instrument was demonstrated using a multiple analytical approach. A lack of knowledge regarding diagnostic tests and co-morbid factors of brain death were noted among students. Their attitudes toward organ donation were somewhat mixed and ambiguous, but overall they were positive and willing to be a potential donor in the future. While this study identified that an effective educational program is necessary for nursing students in Korea to improve their knowledge of brain death and organ donation, further research is also required to verify these single-site findings and improve the generalisability of results.
Davidson, P.M., Elliott, D. & Daly, J. 2006, 'Clinical leadership in contemporary clinical practice: implications for nursing in Australia.', J Nurs Manag, vol. 14, no. 3, pp. 180-187.
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BACKGROUND: Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM: The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES: Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS: Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.
Aitken, L.M., Currey, J., Marshall, A. & Elliott, D. 2006, 'The diversity of critical care nursing education in Australian universities.', Aust Crit Care, vol. 19, no. 2, pp. 46-52.
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A range of critical care nursing educational courses exist throughout Australia. These courses vary in level of award, integration of clinical and academic competence and desired educational outcomes; this variability potentially leads to confusion by stakeholders regarding educational and clinical outcomes. The study objective was to describe the range of critical care nursing courses in Australia. Following institutional ethics approval, all relevant higher education providers (n=18) were invited to complete a questionnaire about course structure, content and nomenclature. Information about desired professional and general graduate characteristics and clinical competency was also sought. A total of 89% of providers (n=16) responded to the questionnaire. There was little consistency in course structure in regard to the proportion of each programme devoted to core, speciality or generic subjects. In general, graduate certificate courses concentrated on core aspects of critical care, graduate diploma courses provided similar amounts of critical care core and speciality content, while master's level courses concentrated on generic nursing issues. The majority of courses had employment requirements, although only a small proportion specified the minimum level of critical care unit required for clinical experience. The competency standards developed by the Australian College of Critical Care Nurses (ACCCN) were used by 83% of providers, albeit in an adapted form, to assess competency. However, only 60% of programmes used personnel with a combined clinical and educational role to assess such competence. In conclusion, stakeholders should not assume consistency in educational and clinical outcomes from critical care nursing education programmes, despite similar nomenclature or level of programme. However, consistency in the framework for speciality nurse education has the potential to prove beneficial for all stakeholders.
Kim, J.R., Fisher, M. & Elliott, D. 2006, 'Knowledge levels of Korean intensive care nurses towards brain death and organ transplantation.', J Clin Nurs, vol. 15, no. 5, pp. 574-580.
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AIMS AND OBJECTIVES: To develop and examine the reliability and validity of an instrument assessing knowledge levels of Korean intensive care unit nurses. To conduct a survey with Korean ICU nurses. BACKGROUND: Organ donation from brain dead patients is a contentious issue in Korea following recent legal recognition of brain death, given the context of a Confucian belief system. Implementation of the new Organ Transplant Act has highlighted the importance of identifying Korean intensive care unit nurses' knowledge regarding brain death and organ donation. DESIGN: Multi-stage multi-method development of an original instrument with a cross-sectional analysis survey of participants. METHOD: An 18-item instrument was developed based on previous literature and key informant interviews, and validated by an expert panel and a pilot study. A survey was conducted with Korean intensive care unit nurses (n=520). Principal component analysis with varimax rotation was used to determine construct validity. Item-to-total correlations and Cronbach's coefficient alpha were used to determine the scale's internal consistency. RESULTS: Principal component analysis yielded a two-component structure: Diagnostic testing and Co-morbid factors of brain death. The scale demonstrated acceptable internal consistency for the two components (alpha=0.74, 0.64, respectively). Most of the participants had a sound knowledge of diagnostic testing for brain death, but demonstrated a lack of knowledge regarding co-morbid factors of brain dead patients. CONCLUSIONS: The knowledge scale was reliable and valid for this cohort. Further research is warranted in related areas of nursing practice. RELEVANCE TO CLINICAL PRACTICE: Effective education for intensive care unit nurses is necessary to increase the organ donor pool in Korea.
Elliott, D., McKinley, S., Alison, J.A., Aitken, L.M. & King, M.T. 2006, 'Study protocol: Home-based physical rehabilitation for survivors of a critical illness [ACTRN12605000166673]', Critical Care, vol. 10, no. 3.
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Introduction: Numerous primary studies and several review papers have highlighted delayed physical and psychological recovery for survivors of critical illness, often beyond 6 months after discharge. This randomized controlled trial with blinded assessment aims to test the effects of an 8-week, home-based, individually tailored physical rehabilitation programme on physical and psychological recovery for survivors of a critical illness after discharge from hospital. Method: Participants are survivors of a critical illness discharged from nine intensive care units (ICUs) in Australia, who are aged 18 years or older, in an ICU longer than 48 hours, discharged home to self-care or carer (non-institutional care), able to participate in physical rehabilitation, and within the hospitals' local geographical areas for home visits. The study is based in participants' home environments. Blinded assessments at weeks 1, 8 and 26 after hospital discharge examine physical functioning, exercise capacity, health-related quality of life and psychological well being. The intervention is graded, individualized endurance and strength training prescribed by a pulmonary rehabilitation physiotherapist over an 8-week period, with three home visits, five follow-up phone calls, and a printed exercise manual supporting the training. Initial focus is on lower limb exercises and walking, with warm-up stretches, and progresses to the addition of core stabilization and upper limb exercises. Results: The burden of a critical illness is well documented. This novel study will determine whether a home-based physical rehabilitation programme improves the recovery trajectory for survivors of critical illness. The projected sample size of 200 patients aims to detect a clinically important 10% improvement in physical functioning. The study will also examine whether other important physical and psychological measures are improved. Conclusion: This multicentre, randomized controlled trial will examine ou...
Chaboyer, W., Thalib, L., Foster, M., Elliott, D., Endacott, R. & Richards, B. 2006, 'The impact of an ICU liaison nurse on discharge delay in patients after prolonged ICU stay.', Anaesth Intensive Care, vol. 34, no. 1, pp. 55-60.
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The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention--the ICU liaison nurse role--in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICUpatients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. The liaison nurse was involved in assessment of patients for transfer to the ward, with a major focus on coordinating patient transfer including liaison with ward staff prior to and following ICU discharge. Logistic regression was used to quantify the risk of discharge delay associated with the liaison nurse intervention with adjustment for potential confounding variables. While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjustingforpotential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer
Elliott, D., Lazarus, R. & Leeder, S.R. 2006, 'Proxy respondents reliably assessed the quality of life of elective cardiac surgery patients.', J Clin Epidemiol, vol. 59, no. 2, pp. 153-159.
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BACKGROUND AND OBJECTIVE: The level of agreement between index and proxy respondents on assessment of health status of clinical cohorts is variable. There is limited information regarding agreement between cardiac surgery patients and their proxies, and levels of agreement examined across repeated measures. This study examined the level of agreement between index and proxy respondents' perceptions of the patient's health status prior to and following cardiac surgery. METHODS: A prospective, paired-respondent, repeated measures observational study of elective cardiac surgical patients and their next of kin, from the cardiac surgical unit of a tertiary hospital in Sydney, Australia. Health status domains were examined using the15D and SF-36 instruments at three points: prior to surgery, at hospital discharge, and at 6 months post discharge. RESULTS: Moderate to good level of agreement was noted for physical function (physical functioning, role functioning-physical, mobility, breathing, speech, hearing, usual activities, sexual activities) and some psychosocial dimensions (role functioning-emotional, sleeping, depression, mental health). Agreement was highest for presurgery and 6 months post discharge. Differences in scores were not clinically important. CONCLUSION: Proxy respondents can reliably assess the quality of life of a cardiac surgical patient using 15D or SF-36, particularly for domains reflecting physical function.
Elliott, D., Lazarus, R. & Leeder, S.R. 2006, 'Health outcomes of patients undergoing cardiac surgery: repeated measures using Short Form-36 and 15 Dimensions of Quality of Life questionnaire.', Heart Lung, vol. 35, no. 4, pp. 245-251.
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OBJECTIVE: The study assessed health-related quality of life (HRQOL) of patients before and after cardiac surgery. DESIGN: This was a prospective repeated-measures observational study. SETTING: The study took place in a 650-bed tertiary referral hospital in Sydney, Australia. METHODS: HRQOL was measured using the Medical Outcomes Study Short Form 36-item health survey (SF-36) and the 15 Dimensions of Quality of Life questionnaire before surgery, at hospital discharge, and 6 months postdischarge. RESULTS: Participants were representative of the cardiac surgery population. Scores for several concepts deteriorated at hospital discharge when compared with presurgery. There were significant improvements in health status at 6 months postdischarge when compared with previous measures for the majority of SF-36 and 15 Dimensions of Quality of Life questionnaire concepts, although mental health and social functioning demonstrated significant deterioration. SF-36 scores were substantially lower than population norms, but similar to previous studies of patients undergoing cardiac surgery except for mental health. CONCLUSION: Deterioration in health status at hospital discharge when compared with presurgery status reinforces the need for further patient care and support after discharge. All dimensions improved after 6 months, except mental health. This information can guide patient expectations regarding rehabilitation posthospitalization, and cardiac surgical services should implement and evaluate formal "outreach programs" for these patients.
Kim, J., Fisher, M. & Elliott, D. 2006, 'Knowledge levels of Korean intensive care nurses towards brain death and organ transplantation', Journal of Clinical Nursing, vol. 15, no. 5, pp. 574-580.
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Aims and objectives. To develop and examine the reliability and validity of an instrument assessing knowledge levels of Korean intensive care unit nurses. To conduct a survey with Korean ICU nurses. Background. Organ donation from brain dead patients is a contentious issue in Korea following recent legal recognition of brain death, given the context of a Confucian belief system. Implementation of the new Organ Transplant Act has highlighted the importance of identifying Korean intensive care unit nurses' knowledge regarding brain death and organ donation. Design. Multi-stage multi-method development of an original instrument with a cross-sectional analysis survey of participants. Method. An 18-item instrument was developed based on previous literature and key informant interviews, and validated by an expert panel and a pilot study. A survey was conducted with Korean intensive care unit nurses (n = 520). Principal component analysis with varimax rotation was used to determine construct validity. Item-to-total correlations and Cronbach's coefficient alpha were used to determine the scale's internal consistency. Results. Principal component analysis yielded a two-component structure: Diagnostic testing and Co-morbid factors of brain death. The scale demonstrated acceptable internal consistency for the two components (alpha = 0.74, 0.64, respectively). Most of the participants had a sound knowledge of diagnostic testing for brain death, but demonstrated a lack of knowledge regarding co-morbid factors of brain dead patients. Conclusions. The knowledge scale was reliable and valid for this cohort. Further research is warranted in related areas of nursing practice.
Kim, J.R., Fisher, M.J. & Elliott, D. 2006, 'Attitudes of intensive care nurses towards brain death and organ transplantation: instrument development and testing.', J Adv Nurs, vol. 53, no. 5, pp. 571-582.
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AIMS: This paper reports the development and testing of an instrument assessing attitudes of Korean intensive care unit nurses. BACKGROUND: Reluctance by healthcare professionals to identify brain-dead patients as a potential donor is one reason for a shortfall in transplantable organs in all countries. Organ donation from brain-dead patients is a particularly contentious issue in Korea, following recent legal recognition of brain death within the cultural context of Confucian beliefs. METHOD: A 38-item instrument was developed from the literature and key informant interviews, and validated by an expert panel and a pilot study. A survey was conducted with Korean intensive care unit nurses (n = 520) from October 2003 to January 2004. Principal component analysis with varimax rotation was used to determine construct validity. Item-to-total correlations and Cronbach's coefficient alpha were used to determine the scale's internal consistency and unidimensionality. RESULTS: The scale demonstrated high internal consistency (alpha = 0.88). Principal component analysis yielded a four-component structure: Discomfort, Enhancing quality of life, Willingness to be a donor and Rewarding experience. Overall, Korean intensive care unit nurses showed positive attitudes towards organ transplantation, despite some mixed feelings. CONCLUSION: The attitude scale was reliable and valid for this cohort. Areas were identified where professional development may enhance positive attitudes towards organ transplantation from brain-dead donors. Effective education for intensive care unit nurses is necessary to increase the organ donor pool in Korea. Further research could test the instrument with other populations.
Halcomb, E., Daly, J., Davidson, P., Elliott, D. & Griffiths, R. 2005, 'Life beyond severe traumatic injury: an integrative review of the literature.', Aust Crit Care, vol. 18, no. 1, pp. 17-24.
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It is only recently that recognition of the serious and debilitating sequelae of trauma has prompted exploration of outcomes beyond survival, such as disability, health status and quality of life. This paper aims to review the literature describing outcomes following severe traumatic injury to provide clinicians with a greater understanding of the recovery trajectory following severe trauma and highlight the issues faced by those recovering from such injury. Electronic databases, published reference lists and the Internet were searched to identify relevant literature. The heterogeneous nature of published literature in this area prohibited a systematic approach to inclusion of papers in this review. Trauma survivors report significant sequelae that influence functional status, psychological wellbeing, quality of life and return to productivity following severe injury. Key themes that emerge from the review include: current trauma systems which provide inadequate support along the recovery trajectory; rehabilitation referral which is affected by geographical location and provider preferences; a long-term loss of productivity in both society and the workplace; a high incidence of psychological sequelae; a link between poor recovery and increased drug and alcohol consumption; and valued social support which can augment recovery. Future research to evaluate interventions which target the recovery needs of the severely injured patients is recommended. Particular emphasis is required to develop systematic, sustainable and cost-effective follow-up to augment the successes of existing acute trauma services in providing high quality acute resuscitation and definitive trauma management.
Elliott, D. & Adamson, H. 2005, 'Quality of life after a critical illness: a review of general ICU studies 1998-2003', Australian Critical Care, vol. 18, no. 2, pp. 50-60.
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It is now acknowledged that acritical illness (CI) is a continuum that begins before an Intensive Care Unit (ICU) admission and continues to impact on a patient's quality of lifeafter they have been discharged home. Measuring health related quality of life (HRQOL) is a complex and difficult issue because of its multifaceted, subjective and dynamic nature. There has been a lack of consensus in the literature regarding the most appropriate methodological approaches and measuring instruments to use. This disparity has impeded comparison between studies, synthesis of the evidence base, and limited any resultant recommendations for practice.
Gardner, G., Elliott, D., Gill, J., Griffin, M. & Crawford, M. 2005, 'Patient experiences following cardiothoracic surgery: an interview study.', Eur J Cardiovasc Nurs, vol. 4, no. 3, pp. 242-250.
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BACKGROUND: Numerous studies have investigated patient outcomes of cardiac surgery, including some examining health-related quality of life. While these studies have provided some insight into patients' physical function, social abilities and perceived quality of life, studies examining the experiences of individuals recovering from cardiac surgery have received only limited investigation. AIMS: This paper presents a thematic analysis of interviews conducted with patients recovering from cardiothoracic surgery, about their memories and experiences of hospital and recovery post-hospital discharge. METHODS: Using an exploratory qualitative approach, eight participants were interviewed 6 months following their surgery. Transcripts of interviews were examined using a content analysis approach, with open coding of text and categorising of similar concepts into themes. FINDINGS: Participants reported varying degrees of pain and physical dysfunction during their recovery from surgery and some had still not returned to optimal function. Seven themes emerged from the data: impressions of ICU; comfort/discomfort; being sick/getting better; companionship/isolation; hope/hopelessness; acceptance/apprehension; and life changes. A number of the themes were constructed as a continuum, with participants often demonstrating a range of views or experiences. Many had little or no memory of their stay in the intensive care unit, although others had vivid recollections. Their impressions of hospital were mostly positive, although many experienced fear, apprehension, and mood disturbances at some time during their recovery. Most participants recalled being sick, reaching a turning point, and then getting better. Many participants reported a change in life view since their recovery from surgery. CONCLUSIONS: Attention to specific areas of patient orientation, education and support was identified to facilitate realistic expectations of recovery. In addition, some form of systematic foll...
Davidson, P., Rees, D.M., Brighton, T.A., Enis, J., McCrohon, J., Elliott, D., Cockburn, J., Paull, G. & Daly, J. 2004, 'Non-valvular atrial fibrillation and stroke: implications for nursing practice and therapeutics.', Aust Crit Care, vol. 17, no. 2, pp. 65-73.
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Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.
Adamson, H., Murgo, M., Boyle, M., Kerr, S., Crawford, M. & Elliott, D. 2004, 'Memories of intensive care and experiences of survivors of a critical illness: an interview study.', Intensive Crit Care Nurs, vol. 20, no. 5, pp. 257-263.
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Recovery from a critical illness can be a complex and protracted process. It is known that for some, health-related quality of life (HRQOL) does not return to pre-illness levels for many months, and in some disease processes this may be longer. This study was undertaken as part of a larger project examining the pain and health status of survivors of a critical illness. The aims of the qualitative aspect of the study were to examine the participants' memories of intensive care and hospitalisation at 6 months post-discharge, and to explore the impact of the critical illness experience on their recovery. Purposive sampling was used to enable rich descriptions of the experience of recovery from those patients best able to articulate their experiences. Three common themes were found with our six participants: recollections, responses, and comfort/discomfort. Recovery from their critical illness continued to affect the participants and carers, some profoundly so. Better integration of services and continued support is required for survivors of a critical illness up to and beyond 6 months.
Elliott, D., Mudaliar, Y.M. & Kim, C. 2004, 'Examining discharge outcomes and health status of critically ill patients: some practical considerations', Intensive and Critical Care Nursing, vol. 20, pp. 367-377.
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This prospective observational study examined the outcomes of 200 consecutive admissions to an adult tertiary level Intensive Care Unit (ICU). Eligible and consenting participants were also involved in a sub-study that examined health status at four measurement points from pre-illness to 6 months postdischarge. Of the 189 individual patients admitted, 23% died in ICU and 57% were discharged home. The health status sub-study enrolled 34 participants (39% of eligible patients) who were representative of the ICU population for demographic and clinical variables. Surviving participants returned to a similar, though not identical state of health at 6 months post-discharge, when compared to their pre-ICU health-state using the 15D and SF-36 instruments. Health status at ICU discharge was significantly impaired when compared to other measurement points, particularly for mobility, breathing, eating, usual activities and vitality. A number of methodological challenges were evident, particularly for the health status sub-study, including prospective subject recruitment and retention, losses to follow-up and instrument responsiveness. Despite the limitations noted, the study provided useful findings and recommendations for the continued development of methods to examine the health status of critically ill patients.
Boyle, M., Murgo, M., Adamson, H., Gill, J., Elliott, D. & Crawford, M. 2004, 'The effect of chronic pain on health related quality of life amongst intensive care survivors.', Aust Crit Care, vol. 17, no. 3, pp. 104-113.
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Intensive care unit (ICU) survivors report reductions in health-related quality of life (HR-QOL), whilst chronic pain is common in the general population. However, it is unknown whether there are associations between the experience of ICU and the incidence of chronic pain. A questionnaire--Pain Scale, Pain Self-Efficacy Questionnaire (PSEQ), Centre of Epidemiology Study Depression Scale (CES-D Scale) and the Short Form Health Survey (SF-36)--was sent to 99 consenting patients who had been in the ICU for >48 hours. Sixty-six and 52 questionnaires were returned at 1 and 6 months respectively. There was a general limitation in activities of daily living; younger ages (36-65 years) experienced a decease in work performance and other physical activities. Bodily pain increased, general health diminished, and engagements in social activities were severely affected. There was a decline in mental health for those 36-65 years of age. HR-QOL improved over time; 28% experienced chronic pain and had longer hospital length of stay (LOS), tended to have longer ICU LOS and were ventilated for longer. Those with chronic pain had significant reductions in physical function, bodily pain, general health and vitality. Ventilator hours and hospital LOS were associated with risk of chronic pain (OR 1.09, p=0.033 and OR 1.27, p=0.046). HR-QOL in ICU survivors declined, although there was a general improvement from 1-6 months. This decline in HR-QOL affected younger people (less than 65 years) more than older people. Chronic pain is a significant issue post ICU and is associated with poorer HR-QOL.
Kim, J.R., Elliott, D. & Hyde, C. 2004, 'The influence of sociocultural factors on organ donation and transplantation in Korea: findings from key informant interviews.', J Transcult Nurs, vol. 15, no. 2, pp. 147-154.
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Although brain death was formally recognized in Korea in 2000 for the purpose of organ donation, traditional Confucian-based thought still prevails. The aim of this study was to explore sociocultural perspectives that influence health professionals' attitudes and perceptions regarding organ donation. Semistructured interviews were conducted with nine key informants from three major hospitals providing transplant services in South Korea. Several themes were identified as barriers to organ donation: Confucianism, misunderstandings and myths, organs as spare for selling, lack of clarity in the definition of death in the new legislation, and limited medical insurance coverage. It remains difficult for brain death to be accepted as true death, and there is currently a poor rate of organ procurement. Findings of the study will help identify socioculturally appropriate strategies to promote acceptance and accessibility of organ transplantation among South Koreans.
Davidson, P.M., Hancock, K., Daly, J., Cockburn, J., Moser, D., Goldston, K., Elliott, D., Webster, J., Speerin, R., Wade, V., Clarke, M., Anderson, M., Newman, C. & Chang, E. 2003, 'A cardiac rehabilitation program to enhance the outcomes of older women with heart disease: development of the group rehabilitation for older women (GROW) program', Journal of the Australasian Rehabilitation Nurses Association, vol. 6, no. 4, pp. 8-15.
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Davidson, P., Stewart, S., Elliott, D., Daly, J., Sindone, A. & Cockburn, J. 2001, 'Addressing the burden of heart failure in Australia: the scope for home-based interventions.', J Cardiovasc Nurs, vol. 16, no. 1, pp. 56-68.
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The growing burden of heart failure (HF) challenges health practitioners to implement and evaluate models of care to facilitate optimal health related outcomes. Australia supports a publicly funded universal health insurance system with a strong emphasis on primary care provided by general practitioners. The burden of chronic HF, and a social and political framework favoring community-based, noninstitutionalized care, represents an ideal environment in which home-based HF programs can be implemented successfully. Cardiovascular nurses are well positioned to champion and mentor implementation of evidence-based, patient-centered programs in Australian communities. This paper describes the facilitators and barriers to implementation of best practice models in the Australian context. These include the challenge of providing care in a diverse, multicultural society and the need for clinical governance structures to ensure equal access to the most effective models of care.
Davidson, P., Daly, J., Romanini, J. & Elliott, D. 2001, 'Quality use of medicines (QUM) in critical care: an imperative for best practice.', Aust Crit Care, vol. 14, no. 3, pp. 122-126.
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Quality use of medicines (QUM) as a discrete concept is gaining increasing importance in Australia and is supported by a policy platform which has federal government and health professional support. The QUM movement is also supported by a strong consumer base and this lobby group has been responsible for endorsement as a major health initiative. However, the importance of QUM to achievement of optimal patient outcomes has not achieved sufficient recognition in the critical care literature. Implicit in the discussion of QUM is the rational, ethical, safe and effective use of drugs within a best practice framework. Successful implementation of QUM requires appropriate infrastructure and the commitment and cooperation of medical, nursing and pharmacy staff. Support, education and training provide the prerequisites of knowledge, skills and awareness for quality use of medicines for all groups. An emphasis upon evidence based practice and the prevalence of polypharmacy in contemporary health care systems requires examination of factors that are barriers to best practice. QUM in critical care areas requires appropriately skilled staff who are competent to manage patients with a wide range of selected drugs, often in highly stressful situations. In many situations in critical care, the role of the critical care nurse is one of patient advocate. It is important to note that the delivery of critical care is not limited to a discrete setting and is inclusive of management at the trauma scene, assessment and delivery of care in the emergency department, through to intensive, coronary care and high dependency units. This paper presents a discussion of the concept of QUM and its relevance in the critical care context. Key theoretical, policy and research considerations for establishment of QUM in critical care are reviewed and discussed. This paper seeks to describe key issues in QUM and endorse the need for a research agenda in critical care.
Daly, J., Elliott, D., Cameron-Traub, E., Salamonson, Y., Davidson, P., Jackson, D., Chin, C. & Wade, V. 2000, 'Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction.', Am J Crit Care, vol. 9, no. 1, pp. 62-69.
BACKGROUND: The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known. OBJECTIVE: To explore health status, perceptions of coping, and social support among survivors of a recent myocardial infarction in the first 3 weeks after discharge from hospitals in southwestern Sydney, Australia. METHODS: A descriptive, exploratory approach with a triangulated methodology was used to assess the experiences of 38 survivors, detect patterns in these experiences, explore the health-support needs of survivors, and determine changes in health status in the first 3 weeks after discharge. Quantitative data were collected with the Medical Outcomes Study SF-36, New York Heart Association classification, Canadian Cardiovascular Society Angina Scale, and the Jalowiec Coping Scale. A semistructured interview schedule provided additional qualitative data about the experiences of the survivors. RESULTS: The health status of participants was relatively stable during the 3-week period; most had no activity limitation due to dyspnea or angina. However, the subjects' health status was considerably lower than that of their age-matched population. The most common and most effective coping strategies adopted during this period were confrontation, optimism, and self-reliance. In addition, the subjects experienced anxiety, depression, ambiguity and uncertainty, fear of recurrence of the infarction and of deterioration in health, of boredom and of inertia. CONCLUSION: These findings can help nurses in hospital and community settings assist survivors of acute myocardial infarction to prepare for and deal effectively with experiences during convalescence.
Chaboyer, W. & Elliott, D. 2000, 'Health-related quality of life of ICU survivors: review of the literature.', Intensive Crit Care Nurs, vol. 16, no. 2, pp. 88-97.
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The importance of health-related quality of life (HRQL) as a relevant outcome measure for patients requiring intensive care unit (ICU) management has only recently been recognized. A better understanding of how this expensive service affects the health and well-being of its survivors will allow nurses and other health care professionals to plan for and provide appropriate follow-up care. This paper contains a review of the theoretical basis for quality-of-life measures, discussion of some of the methodological issues, and examination of the findings from recent studies of the quality of life of ICU patients. Although not conclusive, the review identified that ICU survivors generally have poorer HRQL scores after a 6-12 month period of recovery than during their pre-admission period. This cohort also have lower HRQL than the age-adjusted general population. Despite this apparent poorer state of health, participants often claimed to be satisfied with their HRQL. Methodological weaknesses were evident in the studies reviewed, Challenges in terms of recruitment and retention of subjects, instrumentation and data collection became evident from this review. Continued research in this area is recommended and should address the weaknesses identified.
Jackson, D., Daly, J., Davidson, P., Elliott, D., Cameron-Traub, E., Wade, V., Chin, C. & Salamonson, Y. 2000, 'Women recovering from first-time myocardial infarction (MI): a feminist qualitative study', JOURNAL OF ADVANCED NURSING, vol. 32, no. 6, pp. 1403-1411.
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