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
Core Member, Health Services and Practice Research Strength
Associate Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
BAppSc(Nurs) (Curtin), Master - Applied Science (Nursing), Doctor of Philosophy
Life Member, Australian College of Critical Care Nurses
 
Phone
+61 2 9514 4832
Fax
+61 2 9514 4835
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

Book 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 Esther Chang & John Daly (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.
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.
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.
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.F., Daly, J., Thompson, D.R., Elliott, D. & Chang, E. 2005, 'Research in Nursing (Chapter 8)' in J. Daly, S. Speedy, D. Jackson, V. Lambert & C. Lambert (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.
NA
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, '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, '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, '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, '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, '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.

Books

Elliott, D., Aitken, L.M. & Chaboyer, W. 2012, ACCCN's Critical Care Nursing, 2nd Edition, Mosby, Sydney.
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).
Schneider, Z., Whitehead, D., Elliott, D., LoBiondo-Wood, G. & Haber, J. 2007, Nursing & midwifery research: methods and critical appraisal for evidence-based practice 3rd Edition, Elsevier, Sydney.
Elliott, D., Aitken, L.M. & chaboyer, w. 2007, ACCCN's Critical Care Nursing, Elsevier, Sydney.
Chang, E., Daly, J. & Elliott, D. 2006, Pathophysiology applied to nursing practice, Elsevier, Australia.
This valuable resource is designed to provide a foundation for understanding major pathophysiological processes, applied pharmacology, and related nursing implications. It includes a holistic framework for assessing major health problems, based on fundamental concepts drawn from biological and behavioral sciences. The book's engaging case study approach builds in complexity with each chapter, illustrating applications of pathophysiology and pharmacology to nursing practice.
Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. 2002, Nursing research: Methods, critical appraisal and utilisation, Mosby, Sydney, Australia.
The second edition of this highly popular text for students of nursing research provides a fully comprehensive introduction to nursing research process and nursing research methods. The text examines the role and uses of research in nursing practice, and provides the rools needed to become a critical consumer of nursing research. Features: * expanded coverage of qualitative research methodologies, written by some of our best qualitative nursing research academics; * free access to website containing student activities, lecturer support materials, additional research papers and relevant nursing research web-links; * expanded coverage of evidence-based nursing and how nursing research relates to professional practice; * actual local examples demonstrate applied research.
Schneider, Z., Elliott, D., LoBiondo-Wood, G. & Haber, J. 2002, Nursing research: methods, critical appraisal and utilisation, 2nd, Mosby, Sydney, Australia.

Conference Papers

Hoang, D.B., Elliott, D., McKinley, S.M., Nanda, P., Schulte, J. & Duc, N.A. 2013, 'Tele-monitoring techniques to support recovery at home for survivors of a critical illness', IEEE International Symposium on Signal Processing and Information Technology, Ho Chi Minh City, Vietnam, December 2012 in Signal Processing and Information Technology 2012, ed Jie Wu, IEEE Computer Society, Ho Chi Minh City - Vietnam, IEEE, Piscataway, USA, 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., Nguyen, V., Hoang, D.B., Elliott, D., McKinley, S.M. & Nanda, P. 2012, 'A remote sensor-based 6-minute functional walking ability test', IEEE Sensors, Taipei, Taiwan, October 2012 in IEEE Sensors 2012, ed NA, IEEE, IEEE Xplore, pp. 1-4.
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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.

Journal Articles

McKinley, S.M. & 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
Conroy, K., Elliott, D. & Burrell, A. 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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Early evidence suggests that checklists are one way of ensuring required processes of care are delivered to intensive care unit patients. Evidence to date however, has not explicitly detailed methods of checklist validation in these settings. This study aimed to test the validity of a `process-of-care+ checklist for measuring and ensuring daily care delivery in an intensive care unit. A retrospective audit of a random selection of patient medical records was undertaken to compare with checklist data completed during the same timeframe. Documentation in the patients+ medical records was used as a proxy measure for actual completion of care. A specific audit tool extracted information from both the checklist and the medical record on the following processes of care: nutrition, weaning from ventilation, pain, glucose control, sit out of bed, bowel management, deep vein thrombosis and stress ulcer prophylaxis. These two data sources were compared using the Spearman+s rho correlation coefficient. The two forms of documentation were significantly correlated (P=0.01) for all but one of the checklist items (pain). Findings provided support for the concurrent validity of an intensive care unit process-of-care checklist. Further research is required for checklist validity and reliability testing prior to, or in conjunction with, a planned prospective intervention study.
Elliott, D., Aitken, L.M., Bucknall, T.K., Seppelt, I., Webb, S.A., Weisbrodt, L.P. & McKinley, S.M. 2013, 'Patient comfort in the intensive care unit: a muiticentre, 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.
Conroy, K., Elliott, D. & Burrell, A. 2013, 'Developing content for a process-of-care checklist for use in intensive care units: a dual-method approach to establishing construct validity', BMC Health Services Research, vol. 13, pp. 380-1-380-11.
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Background: In the intensive care unit (ICU), checklists can be used to support the delivery of quality and consistent clinical care. While studies have reported important benefits for clinical checklists in this context, lack of formal validity testing in the literature prompted the study aim; to develop relevant `process-of-care+ checklist statements, using rigorously applied and reported methods that were clear, concise and reflective of the current evidence base. These statements will be sufficiently instructive for use by physicians during ICU clinical rounds. Methods: A dual-method approach was utilized; semi-structured interviews with local clinicians; and rounds of surveys to an expert Delphi panel. The interviews helped determine checklist item inclusion/exclusion prior to the first round Delphi survey. The panel for the modified-Delphi technique consisted of local intensivists and a state- wide ICU quality committee. Minimum standards for consensus agreement were set prior to the distribution of questionnaires, and rounds of surveys continued until consensus was achieved. Results: A number of important issues such as overlap with other initiatives were identified in interviews with clinicians and integrated into the Delphi questionnaire, but no additional checklist items were suggested, demonstrating adequate checklist coverage sourced from the literature. These items were verified by local clinicians as being relevant to ICU and important elements of care that required checking during ward rounds. Two rounds of Delphi surveys were required to reach consensus on nine checklist statements: nutrition, pain management, sedation, deep vein thrombosis and stress ulcer prevention, head-of-bed elevation, blood glucose levels, readiness to extubate, and medications. Conclusions: Statements were developed as the most clear, concise, evidence-informed and instructive statements for use during clinical rounds in an ICU. Initial evidence in support of the checklist+s construct validity was established prior to further prospective evaluation in the same ICU.
McKinley, S.M., 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 fromcritical 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 (meanSD) 57.217.2 years, 35% female, had mean ICU stay of 56 days and BMI of 265. 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 theward (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.
Needham, D.M., Davidson, J., Cohen, H., Hopkins, R.O., Weinert, C., Wunsch, H. & Elliott, D. 2012, 'Improving long-term outcomes after discharge from intensive care unti: Report from a stakeholders' conference', Critical Care Medicine, vol. 40, no. 2, pp. 502-509.
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Alison, J.A., Kenny, P.M., King, M.T., McKinley, S.M., Leslie, G., Aitken, L.M. & Elliott, D. 2012, 'Repeatability of the six-minute walk test and relation to physical function in survivors of a critical illness', Physical Therapy, vol. 92, no. 12, pp. 1556-1562.
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Objectives. 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; 3) the relationship between physical functioning (PF) score of the SF-36 and the 6MWT. Design. Repeated measures of 6MWT and SF-36 Health Survey Methods. Eligible participants had an ICU length of stay 48 hours and mechanically ventilated for 24 hours. Two 6MWT and the SF-36 were conducted in participants homes at Weeks 1, 8, and 26 after hospital discharge.
Connolly, B., Denehy, L., Brett, S., Elliott, D. & Hart, N. 2012, 'Exercise rehabilitation following hospital discharge in survivors of a critical illness: an integrative review', Critical Care, vol. 16, no. 3, pp. 226-235.
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Although clinical trials have shown benefi t 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 benefi t 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 specifi ed 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 benefi t and to determine the optimum content and format of exercise rehabilitation programmes for patients following critical illness post-hospital discharge.
McKinley, S.M., Aitken, L.M., Alison, J.A., King, M.T., 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.
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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Objective: To explore the effects of a pilonidal sinus wound on patients++ psychological wellbeing.
Denehy, L. & Elliott, D. 2012, 'Strategies for post ICU rehabilitation', Current Opinion in Critical Care, vol. 18, 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.
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., McKinley, S.M., Alison, J.A., Aitken, L.M., King, M.T., Leslie, G., Kenny, P.M., Taylor, P.A., 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, pp. 1-10.
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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.
Stewart, A., 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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Aims and objective. To describe the effects sacrococcygeal pilonidal sinus wounds had on participants+ activities of living. Background. A sacrococcygeal pilonidal sinus commonly occurs in healthy young people and is associated with considerable morbidity and discomfort. Surgery is frequently required, and patients are often discharged home with large open wounds. Most research has addressed the technical aspects of surgery and treatment. Design. An interpretive descriptive approach guided by The Model of Living framework. Methods. Purposive sampling was used to recruit four women and seven men, age range 17+39 years, from a metropolitan hospital in NSW, Australia. Data were collected through semi-structured interviews that were audio-taped, transcribed verbatim and analysed using thematic analysis. Results. Three themes and eight subthemes emerged from the analysis: (1) `Adaption+ included subthemes, learning to live with the wound, difficulty living with the wound and living life despite the wound; (2) `Perception+ embraced subthemes, embarrassment, lack of understanding and changed body image; and (3) `Control+ included subthemes, loss of control and gaining control. Participants whose pain was not managed, who were unprepared for the postoperative recovery at home or experienced delayed wound healing had most difficulty with activities of living. Conclusions. This research gives some insight into the pilonidal wound experience from the person+s perspective. All activities of living were affected by the pilonidal sinus wound. The effect was variable and influenced by pain, embarrassment and a general lack of understanding about the condition and the care of the wound. The specific wound location was an underlying factor causing problems for participants.
Hewson-Conroy, K., Burrell, T., Elliott, D., Webb, S.A., Seppelt, I., Taylor, C. & Glass, P. 2011, 'Compliance with processes of care in intensive care units in Australia and New Zealand: a point prevalence survey', Anaesthesia and Intensive Care, vol. 39, no. 5, pp. 926-935.
There are indications that compliance with routine clinical practices in intensive care units (ICU) varies widely internationally, but it is currently unknown whether this is the case throughout Australia and New Zealand. A one-day point prevalence study measured the prevalence of routine care processes being delivered in Australian and New Zealand ICUs including the assessment and/or management of: nutrition, pain, sedation, weaning from mechanical ventilation, head of bed elevation, deep venous thrombosis prophylaxis, stress ulcer prophylaxis, blood glucose, pressure areas and bowel action. Using a sample of 50 adult ICUs, prevalence data were collected for 662 patients with a median age of 65 years and a median Acute Physiology and Chronic Health Evaluation II score of 18. Wide variations in compliance were evident in several care components including: assessment of nutritional goals (74%, interquartile range [IQR] 51 to 89%), pain score (35%, IQR 17 to 62%), sedation score (89%, IQR 50 to 100%); care of ventilated patients e.g. head of bed elevation > 30 degrees (33%, IQR 7 to 62%) and setting weaning plans (50%, IQR 28 to 78%); pressure area risk assessment (78%, IQR 18 to 100%) and constipation management plan (43%, IQR 6 to 87%). Care components that were delivered more consistently included nutrition delivery (100%, IQR 100 to 100%), deep venous thrombosis (96%, IQR 89 to 100%) and stress ulcer (90%, IQR 78 to 100%) prophylaxis, and checking blood sugar levels (93%, IQR 88 to 100%). This point prevalence study demonstrated variability in the delivery of 'routine' cares in Australian and New Zealand ICUs. This may be driven in part by lack of consensus on what is best practice in intensive care units, prompting the need for further research in this area.
Elliott, D. 2011, 'Surviving critical illness', Australian Critical Care, vol. 24, no. 3.
pages 152-154
Berney, S., Elliott, D. & Denehy, L. 2011, 'ICU-acquired weakness: a call to arms (and legs)', Critical Care and Resuscitation, vol. 13, no. 1.
Pages 3-4
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', Australian Critical 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
Knowles, S., Rolls, K.D., Elliott, D., Hardy, J. & Middleton, S. 2010, 'Patient care guidelines: A telephone survey of intensive care practices in New South Wales', Australian Critical 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.
Hewson-Conroy, K., Elliott, D. & Burrell, A. 2010, 'Quality and safety in intensive care - A means to an end is critical', Australian Critical 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.
Yousefi, H., Abedi, H., Yamohammadian, M. & Elliott, D. 2009, 'Comfort as a basic need in hospitalized patients in Iran: A hermeneutic phenomenological study', Journal of Advanced Nursing, 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.
Burrell, A., Elliott, D. & Hansen, M. 2009, 'ICT in ICU: using Web 2.0 to enhance a community of practice for intensive care clinicians', Critical Care and Resuscitation, vol. 11, no. 2, pp. 155-159.
Contemporary information and communications technology (ICT), particularly applications termed "Web2.0", can facilitate practice development and knowledge management for busy clinicians. Just as importantly, these applications might also enhance professional social interaction and the development of an interprofessional community of practice that transcends the boundaries of the intensive care unit, health service, jurisdiction and nation. We explore the development of Web 2.0 applications in health care, and their application to intensive care practice in Australia and New Zealand. The opportunities for using podcasts, blogs, wikis and virtual worlds to support clinician development and knowledge exchange are clear in theory. However, strategic leadership from the Colleges is needed to fully exploit these technologies and to enable the development of a strong and sustainable ICU community of practice
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 and Critical Care Nursing, 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.
Rolls, K.D., Kowal, D., Elliott, D. & Burrell, A. 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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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.
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. 86-95.
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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.
Ladanyi, S. & Elliott, D. 2008, 'Traumatic brain injury: An integrated clinical case presentation and literature review Part II: The continuum of care', Australian Critical 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.
Gallagher, R.D., Marshall, A.P., Fisher, M. & Elliott, D. 2008, 'On my own; experiences of recovery from acute coronary syndrome for women living alone', Heart & Lung: the journal of acute and critical care, 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', Australian Critical Care, vol. 21, no. 4, pp. 200-215.
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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. 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.
Marshall, A.P., Currey, J., Aitken, L.M. & Elliott, D. 2007, 'Key stakeholders' expectations of education 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.
Chalmers, A., Mitchell, C., Rosenthal, M. & Elliott, D. 2007, 'An exploration of patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber', Journal Of Clinical Nursing, 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.
Ladanyi, S. & Elliott, D. 2007, 'Experiences of uncertainty for relatives in ICU: A review of a qualitative Danish study', Australian Critical Care, vol. 20, no. 4, pp. 146-148.
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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 and 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
Elliott, D., Lazarus, R. & Leeder, S.R. 2006, 'Proxy respondents reliably assessed the quality of life of elective cardiac surgery patients', Journal of Clinical Epidemiology, 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 the 15D 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.
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', Anaesthesia and Intensive Care, vol. 34, 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 stud) One hundred and eighty-six ICU patients (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 adjusting for potential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer.
Kim, J.R., Fisher, M. & Elliott, D. 2006, 'Attitudes of intensive care nurses towards brain death and organ transplantation: instrument development and testing', Journal of Advanced Nursing, vol. 53, no. 5, pp. 571-582.
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Kim, J.R., Fisher, M. & Elliott, D. 2006, 'Undergraduate nursing students' knowledge and attitudes towards organ donation in Korea: Implications for education', Nurse Education Today, vol. 26, no. 6, pp. 465-474.
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Davidson, P.M., Elliott, D. & Daly, J. 2006, 'Clinical leadership in contemporary clinical practice: implications for nursing in Australia', Journal of Nursing Management, vol. 14, no. 3, pp. 180-187.
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Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. 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. 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. 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.
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.
Aitken, L.M., Currey, J., Marshall, A.P. & Elliott, D. 2006, 'The diversity of critical care nursing education in Australian universities', Australian Critical Care, vol. 19, no. 2, pp. 46-53.
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Elliott, D., McKinley, S.M., Alison, J.A., Aitken, L.M. & King, M.T. 2006, 'Study protocol: Home-based physical rehabilitation for survivors of a critical illness', Critical Care, vol. 10, no. R90, pp. 1-7.
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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 assessmen
Halcomb, E., Daly, J., Davidson, P.M., Elliott, D. & Griffiths, R. 2005, 'Life beyond severe traumatic injury: an integrative review of the literature', Australian Critical Care, vol. 18, no. 1, pp. 17-23.
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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', European Journal of Cardiovascular Nursing, vol. 4, 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.
Kim, J., Fisher, M. & Elliott, D. 2004, 'Korean health professionals' attitudes and knowledge toward organ donation and transplantation', International Journal of Nursing Studies, vol. 41, pp. 299-307.
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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 (a + 074, 064, 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.
Kim, J., Elliott, D. & Hyde, C.D. 2004, 'The influence of socio-cultural factors on organ donation and transplantation in Korea: findings from key informant interviews', Journal of Transcultural Nursing, vol. 15, pp. 299-307.
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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., Rees, D., Brighton, T., 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', Australian Critical Care, vol. 17, 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., Martin, B., Kerr, S., Crawford, M. & Elliott, D. 2004, 'Memories of intensive care and experiences of survivors of a critical illness: an interview study', Intensive and Critical Care Nursing, vol. 20, 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.
Martin, B., 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', Australian Critical 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., Elliott, D. & Hyde, C.D. 2004, 'The influence of socio-cultural factors on organ donation and transplantation in Korea: findings from key informant interviews.', Journal of Transcultural Nursing, 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.M., Stewart, S., Elliott, D., Daly, J., Sindone, A. & Cockburn, J. 2001, 'Addressing the burden of heart failure in Australia: the scope of home based interventions', Journal of Cardiovascular Nursing, 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.M., Daly, J., Romanini, J. & Elliott, D. 2001, 'Quality use of medicines (QUM) in critical care: an imperative for best practice', Australian Critical 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.M., Jackson, D.E., Chin, C. & Wade, V. 2000, 'Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction', American Journal of Critical Care, vol. 9, pp. 62-69.
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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 and Critical Care Nursing, 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-oflife 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.E., Daly, J., Davidson, P.M., 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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Although myocardial infarction (MI) is a leading cause of death and disablement for women internationally, little is known about women's recovery. This paper describes an exploratory descriptive study that was informed by feminist principles, and which aimed to explore the recovery experiences of a group of women survivors of rst-time MI in the initial period following discharge from hospital.