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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
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
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.
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.
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.
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.
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. 2013, 'Tele-monitoring techniques to support recovery at home for survivors of a critical illness', Signal Processing and Information Technology 2012, 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 2012, 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

Aitken, L.M., Burmeister, E., McKinley, S.M., Alison, J.A., King, M.T., Leslie, G. & Elliott, D. 2014, 'The effect of home based rehabilitation and other predictors on physical recovery in ICU survivors: a cohort analysis', American Journal of Critical Care.
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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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.
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.', Australas Emerg Nurs J.
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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.
Allen, E., Jackson, D.E. & Elliott, D. 2014, 'Designing an instrumental case study: a protocol to investigate interprofessional relations and socio-cultural practices of a Rapid Response System', Nurse Researcher.
Abbenbroek, B., Duffield, C.M. & Elliott, D. 2014, 'The intensive care unit volume-mortality relationship, is bigger better? An integrative literature review.', Aust Crit Care, vol. 27, no. 4, pp. 157-164.
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To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality.
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.', JMIR Res Protoc, vol. 3, no. 3, p. e40.
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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.
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.', Crit Care Med, vol. 42, no. 12, pp. 2518-2526.
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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.
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.A.Y.E.D.E.N.I.S.E., HANSEN, M.A.R.G.A.R.E.T., JACKSON, D.E.B.R.A. & ELLIOTT, D.O.U.G. 2014, 'Analysis of the Social Network Development of a Virtual Community for Australian Intensive Care Professionals', CIN: Computers, Informatics, Nursing, vol. 32, no. 11, pp. 536-544.
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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 de-identified 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 multi-organizational 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.
Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S. & Roche, M. 2014, 'Clinical user experiences of observation and response charts: focus group findings of using a new format chart incorporating a track and trigger system.', BMJ Qual Saf.
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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.
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.
Elliott, D., Aitken, L.M., Bucknall, T.K., Seppelt, I.M., Webb, S.A., Weisbrodt, L., McKinley, S., Australian and New Zealand Intensive Care Society Clinical Trials Group & George Institute for Global Health 2013, 'Patient comfort in the intensive care unit: a multicentre, binational point prevalence study of analgesia, sedation and delirium management.', Crit Care Resusc, vol. 15, no. 3, pp. 213-219.
To measure the prevalence of assessment and management practices for analgesia, sedation and delirium in patients in Australian and New Zealand intensive care units.
McKinley, S. & Elliott, D. 2013, 'Twenty-five years of critical care nursing scholarship in Australia.', Aust Crit Care, vol. 26, no. 1, pp. 7-11.
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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.
McKinley, S., Fien, M., Elliott, R. & Elliott, D. 2013, 'Sleep and psychological health during early recovery from critical illness: an observational study.', J Psychosom Res, vol. 75, no. 6, pp. 539-545.
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Intensive care patients often report sleep disruption in ICU and during recovery from critical illness.
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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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.
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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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.
Connolly, B., Denehy, L., Brett, S., Elliott, D. & Hart, N. 2012, 'Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review.', Crit Care, vol. 16, no. 3, p. 226.
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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.
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 Med, vol. 38, no. 4, pp. 627-633.
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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.
Stewart, A.M., Baker, J.D. & Elliott, D. 2012, 'The psychological wellbeing of patients following excision of a pilonidal sinus.', J Wound Care, vol. 21, no. 12, pp. 595-600.
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To explore the effects of a pilonidal sinus wound on patients' psychological wellbeing.
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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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.
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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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.
Hewson-Conroy, K.M., Burrell, A.R., Elliott, D., Webb, S.A., 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.', Anaesth 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., 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.', Crit Care, vol. 15, no. 3, p. R142.
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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.M., Baker, J.D. & Elliott, D. 2011, 'The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews.', J Clin Nurs, vol. 20, no. 21-22, pp. 3174-3182.
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To describe the effects sacrococcygeal pilonidal sinus wounds had on participants' activities of living.
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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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.
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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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.
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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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.
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).', Aust Crit 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.', Aust Crit 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.', 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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This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes.
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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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.
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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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.
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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To examine patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber of a hyperbaric medicine unit in Australia.
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.', Aust Crit Care, vol. 20, no. 3, pp. 89-99.
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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.
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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Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians.
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.
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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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.
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].', Crit Care, vol. 10, no. 3, p. R90.
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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.
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.
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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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.
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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The study assessed health-related quality of life (HRQOL) of patients before and after cardiac surgery.
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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This paper reports the development and testing of an instrument assessing attitudes of Korean intensive care unit nurses.
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.
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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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.
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.
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.
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.
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.
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.
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.
The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known.
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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