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Professor Lin Perry


Lin is a Professor of Nursing Research and Practice Development with the Northern Hospitals Network, South Eastern Sydney Local Health District, with Prince of Wales Hospital and Sydney, Sydney Eye Hospitals.

External contact details
Phone: +61 2 9382 4709
Fax : +61 2 9382 4050
Address: G74, East Wing Edmund Blacket Building, Prince of Wales Hospital, Barker St., Randwick NSW 2031.

Newcastle Institute of Public Health / Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
Barts and The London NHS Trust, London, UK
St Bartholomew School of Nursing and Midwifery, City University, London
Faculty of Health and Social Care Sciences, St George’s Hospital Medical School and Kingston University, London
St George’s Hospital Medical School and Mayday Healthcare NHS Trust, London
University of Plymouth, Plymouth, UK
Tor and South West College of Health, Taunton, UK


Memberships and responsibilities
National Stroke Foundation Guidelines Working Party
Stroke Services New South Wales Stroke Education Committee
Royal College of Nursing representative, Intercollegiate Working Party for Stroke, the UK national multi-professional lead body for stroke
World Stroke Organisation
Resource panel for the Australian Commission on Safety and Quality in Health Care in relation to Clinical Safety and Quality Expertise and Health Issues and Literature Reviews
UK Royal College of Nursing
UK Royal College of Nursing Research Society
UK National Nurses Nutrition Group, former Research Committee member
British Association for Parenteral and Enteral Nutrition
European Society for Clinical Nutrition and Metabolism
Founder member and Research sub-group lead of the UK National Stroke Nursing Forum
Founder member of UK Swallowing Research Group

Awards, scholarships and fellowships
Visiting Scholarship, University of Teeside, UK (2009).
Greater Metropolitan Clinical Taskforce Stroke Education Grant (2008)
Juvenile Diabetes Research Fund award (2008)
Newcastle Institute of Public Health Research Fellowship (2007-9).
Distinguished Visiting Scholarship, Australian Catholic University (2005).
Runner-up for the Nutricia Research Prize (2003).
Royal College of Nursing Educational Scholarship (2003).
Cochrane Library Prize (2000) for best application of research evidence to clinical practice.
Dept of Health Doctoral Fellowship (2000-2002).

Image of Lin Perry
Professor, Faculty of Health
Core Member, Health Services and Practice Research Strength
Education, DipN, Cert Ed., RN (Plymouth), MSc (Exeter), PhD (London)
+61 2 9514 4846

Research Interests

Lin's research interests include implementation of evidence-based practice, service and practice development, and organisational change, predominantly within stroke and chronic disease management. She is an Editor of the Journal of Advanced Nursing, and holds a conjoint position with University of Newcastle, NSW.

Implementation of evidence-based practice
Service and practice development and evaluation
Organisational change
Stroke, diabetes, acute cardiovascular disease
Chronic disease management
Nutritional aspects of health and disease, nutritional support

Can supervise: Yes

Registered at level 1

PhD Candidate sought
Lin is currently seeking an outstanding graduate student to pursue a PhD project in health risks, health behaviours, health promotion and ageing within the nursing workforce. This scholarship is part of the Australian Research Council-funded project: Fit for the future: Safeguarding the health and wellbeing of the Australian nursing workforce to sustain future healthcare service delivery. 
Find out more and submit an expression of interest.

Research areas
Complex and Chronic Care Long-term care
Critical / Acute Care
Service development and evaluation
Diabetes, stroke
Aged and Extended Care
Action Research
Case Study
Randomised Control Trials
Survey Methods
Mixed methods


Williams, J., Perry, L. & Watkins, C. 2010, Acute Stroke Nursing, Wiley-Blackwell.
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Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. * Evidence-based and practical in style, with case studies and practice examples throughout * Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education * The first text to explore stroke management from UK and international perspectives, and with a nursing focus. © 2010 Blackwell Publishing Ltd.


Perry, L. 2013, 'Stroke Nutritional Management' in Encyclopedia of Human Nutrition, Waltham, MA: Academic Press, United States, pp. 219-230.
Stroke is a common and devastating event, the incidence rising with age. Approximately 125 000 and 500 000 new or recurrent strokes affect individuals each year in the UK and the US, respectively, creating a significant burden of long-term disability in survivors.
Perry, L. & Boaden, E. 2010, 'Nutritional Aspects of Stroke Care' in Acute Stroke Nursing, Wiley-Blackwell, pp. 91-122.
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Clay-Williams, R., Kelly, M.A., Everett, B., Perry, L. & McDonnell, G. 2011, 'Modelling clinical judgement improved health care delivery:using "how nurses think" to manage the deteriorating patient', Selected Abstracts of Free Papers Presented at the SimHealth: Innovation, Education and Research in Healthcare Conference, SimHealth 2011, Wolters Kluwer: Lippincott Williams & Wilkins, Sydney, Australia, pp. 66-66.
This study aims to construct a model for learning reasoning in the workplace, using computer based system dynamic processes, to support clinical decision-making in relation to detection and management of the deteriorating patient. Assessment and timely management of a deteriorating patient is a priority area for improvement highlighted by several Government, independent and health agency reports. Computer modelling of judgement processes can identify areas of difficulty in decision-making and assist nurses and other health care professionals to recognise and seek timely assistance for patients who deteriorate. Seminal work by Benner and Tanner on "how expert nurses think" led to the publication of Tanner's theoretical model of clinical judgement. This model maps the primary processes involved in clinical reasoning, and forms the basis of curricula in nursing courses internationally and within Australia. By explicitly modelling the time nurses take to progress through the processes of decision-making when planning and providing patient care, we can identify points where potential error and harm could occur, and thereby potentially improve patient outcomes.
Clay-Williams, R., Kelly, M.A., Everett, B., Perry, L. & McDonnell, G. 2011, 'Modelling clinical judgement improved health care delivery: using 'how nurses think' to manage the deteriorating patient', SimHealth, Sydney.
This papaer presents a dynamic model of reasoning, using computer based system dynamic processes based on a model of 'how nurses think' to support clinical decision-making in relation to detection and management of the deteriorating patient.
Gall, M., Lennon, S., Clarke, K., Cross, S., Cunningham, R., Edmans, J., Fitzpatrick, C., Hancock, N., Hoffman, A., Jones, A., Perry, L. & Walker, M. 2010, 'Intercollegiate Working Party for Stroke. Profession-specific audit in stroke care: Making rehab practice evidence based', Journal of Human Nutrition and Dietetics, British Dietetic Association, Birmingham, pp. 374-374.

Journal articles

Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S. & Roche, M. 2015, 'Clinical user experiences of observation and response charts: Focus group findings of using a new format chart incorporating a track and trigger system', BMJ Quality and Safety, vol. 24, no. 1, pp. 65-75.
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Background: Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards. Methods: Across eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2-6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach. Findings: In this exploration of initial user experiences, key emergent themes were: tensions between vital sign 'ranges versus precision' to support decision making; using a standardised 'generalist chart in a range of specialist practice' areas; issues of 'clinical credibility', 'professional autonomy' and 'influences of doctors' when communicating abnormal signs; and 'permission and autonomy' when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of 'increased activity/uncertain benefit' was uncovered. Conclusions: Findings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design chara...
Pierce, H., Perry, L., Gallagher, R. & Chiarelli, P. 2015, 'Pelvic floor health: A concept analysis', Journal of Advanced Nursing.
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Aim: To report an analysis of the concept 'pelvic floor health'. Background: 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. Design: Rodger's evolutionary view was used to guide this analysis. Data sources: Academic literature databases and public domain websites viewed via the Internet search engine Google. Review methods: Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. Results: Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. Conclusion: This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision.
Appel, C., Perry, L. & Jones, F. 2015, 'Testing a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke', Occupational Therapy International, vol. 22, no. 2, pp. 71-84.
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This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention.
Jakimowicz, S. & Perry, L. 2015, 'A concept analysis of patient-centred nursing in the intensive care unit', J Adv Nurs, pp. n/a-n/a.
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Aim To report an analysis of the concept of patient-centred nursing in the context of intensive care. Background Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. Design Concept analysis. Data sources CINAHL, PsycINFO, Medline and PubMed databases (2000–2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. Methods Walker and Avant's eight-stage approach was used. Results Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. Conclusion Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.
Perry, L., Lamont, S., Brunero, S., Gallagher, R. & Duffield, C. 2015, 'The mental health of nurses in acute teaching hospital settings: A cross-sectional survey', BMC Nursing, vol. 14, no. 1.
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Background: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods: A cross sectional survey design was used. Results: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n=49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12month. Conclusion: Nurses and their managers should strive to create workplaces where working practices promote nurses' health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.
Elliott, D., McKinley, S., Perry, L., Duffield, C., Iedema, R., Gallagher, R., Fry, M., Roche, M. & Allen, E. 2014, 'Clinical utility of an observation and response chart with human factors design characteristics and a track and trigger system: Study protocol for a two-phase multisite multiple-methods design', Journal of Medical Internet Research, vol. 16, no. 8, pp. e40-e40.
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Background: Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs. Objective: To describe the study protocol for the clinical testing of these observation and response charts (ORCs). Methods: We propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site's existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources. Results: Site selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress. Conclusions: This detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.
James, S., Gallagher, R., Dunbabin, J. & Perry, L. 2014, 'Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: Systematic literature review', BMC Research Notes, vol. 7, no. 1.
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Background: Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults.
Lamont, S., Brunero, S., Lyons, S., Foster, K. & Perry, L. 2014, 'Collaboration amongst clinical nursing leadership teams: a mixed-methods sequential explanatory study.', J Nurs Manag.
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AIM: To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. BACKGROUND: Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context. METHODS: A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings. RESULTS: The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance. CONCLUSION: These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders. IMPLICATIONS FOR NURSING MANAGEMENT: To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention.
Appel, C., Perry, L. & Jones, F. 2014, 'Shoulder strapping for stroke-related upper limb dysfunction and shoulder impairments: Systematic review', NeuroRehabilitation, vol. 35, no. 2, pp. 191-204.
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BACKGROUND: Shoulder impairments are common after stroke, resulting in reduced upper limb function. Shoulder strapping may be beneficial as an adjunct to conventional therapy and warrants further investigation. OBJECTIVES: To determine i) the efficacy and ii) any adverse effects of shoulder strapping used to reduce stroke-related upper limb and shoulder impairments and to improve function. METHODS: Three reviewers independently searched CINAHL, Ovid MEDLINE, EMBASE, AMED and PEDro databases and extracted data. Results were synthesized using descriptive methods and meta-analysis and interpreted in relation to potential risk of bias. RESULTS: Eight studies met inclusion criteria, recruiting 340 stroke participants. Studies predominantly included people with shoulder paralysis and examined shoulder strapping within four weeks of stroke onset for outcomes of increased upper limb function, reduced subluxation and pain. Strapping interventions, outcomes and measures were diverse, some studies encountered high risk of bias and findings were generally inconclusive with some indication of benefit in terms of delaying onset of shoulder pain. CONCLUSIONS: There is insufficient evidence of efficacy or inefficacy with shoulder paralysis but shoulder strapping demonstrated minimal adverse effects and should be rigorously tested with shoulder paresis as well as paralysis after stroke.
Pickler, R., Noyes, J., Perry, L., Roe, B., Watson, R. & Hayter, M. 2014, 'Authors and readers beware the dark side of Open Access.', J Adv Nurs.
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James, S., Perry, L., Gallagher, R., Lowe, J., Dunbabin, J., McElduff, P., Acharya, S. & Steinbeck, K. 2014, 'Service usage and vascular complications in young adults with type 1 diabetes', BMC Endocrine Disorders, vol. 14.
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Background: Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. Methods: A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. Results: A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.Conclusion: Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greate...
Perry, L., Hamilton, S., Williams, J. & Jones, S. 2013, 'Nursing Interventions for Improving Nutritional Status and Outcomes of Stroke Patients: Descriptive Reviews of Processes and Outcomes', WORLDVIEWS ON EVIDENCE-BASED NURSING, vol. 10, no. 1, pp. 17-40.
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Lucas, B., Cox, C., Perry, L. & Bridges, J. 2013, 'Pre-operative preparation of patients for total knee replacement: An action research study', International Journal of Orthopaedic and Trauma Nursing, vol. 17, no. 1, pp. 79-90.
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Aims and objectives: To examine the development and impact of a multidisciplinary preparation clinic for patients undergoing total knee replacement (TKR) surgery.
de Brito-Ashurst, I., Perry, L., Sanders, T.A.B., Thomas, J.E., Dobbie, H., Varagunam, M. & Yaqoob, M.M. 2013, 'The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial', HEART, vol. 99, no. 17, pp. 1256-1260.
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De Brito-Ashurst, I., Perry, L., Sanders, T.A.B., Thomas, J.E., Dobbie, H. & Yaqoob, M.M. 2013, 'Applying research in nutrition education planning: A dietary intervention for Bangladeshi chronic kidney disease patients', Journal of Human Nutrition and Dietetics, vol. 26, no. 4, pp. 403-413.
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Background: Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural changes. However, the integration of theory, research and practice to develop community dietary educational programmes is a challenge that many interventionists feel ill equipped to achieve. Methods: In the present study, a community-based education programme was designed for Bangladeshi patients with chronic kidney disease and hypertension. The goal of this programme was to reduce dietary salt intake in this population group, with a view to reducing their blood pressure and slowing kidney disease progression. Results: The present study sets out the first four steps of a six-step model for creating a behaviour change programme. Conclusions: These four steps were concerned with the translation of theory and evidence into intervention objectives, and illustrate how a practical, community-based intervention was developed from behavioural theory, relevant research, knowledge of practice and the target patient group. Steps 5 and 6, which are concerned with implementation and evaluation, will be reported separately. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.
Lucas, B., Cox, C., Perry, L. & Bridges, J. 2013, 'Changing clinical team practices in preparation of patients for Total Knee Replacement: Using Social Cognitive Theory to examine outcomes of an action research study', International Journal of Orthopaedic and Trauma Nursing, vol. 17, no. 1, pp. 140-150.
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To examine, through the lens of Social Cognitive Theory, the process of change when developing a preparation programme for patients awaiting Total Knee Replacement Surgery.
Wright, L., Hill, K.M., Bernhardt, J., Lindley, R., Ada, L., Bajorek, B.V., Barber, P.A., Beer, C., Golledge, J., Gustafsson, L., Hersh, D., Kenardy, J., Perry, L., Middleton, S., Brauer, S.G. & Nelson, M.R. 2012, 'Stroke management: Updated recommendations for treatment along the care continuum', Internal Medicine Journal, vol. 42, no. 5, pp. 562-569.
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The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management. © 2012 National Stroke Foundation. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.
Pontivivo, G., Rivas, K., Gallard, J., Yu, N. & Perry, L. 2012, 'A new approach to improving hand hygiene practice in an inner city acute hospital in Australia', Healthcare Infection, vol. 17, no. 2, pp. 57-63.
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Background: Healthcare-associated infections occur in 5-15% of hospitalised patients, with 30-50% preventable. Hand hygiene is a basic and essential but poorly conducted method to limit infection in hospitals. This practice development approach to implementing the '5 Moments for Hand Hygiene' national initiative aimed to increase compliance with the recommended hand hygiene practices, anticipating this outcome would be reflected in lower rates of healthcare-associated infections. Methods: Multiple methods were employed during October 2009-October 2010 within a multi-disciplinary initiative, although nurses were mainly recruited. Three medical wards, four surgical wards and the Intensive Care Unit were targeted. Project activities were informed by principles of practice development, solution-focussed coaching and models of behaviour change. Activities included active learning sessions, coaching, audit and feedback, competitions, creativity and fun. Outcomes were observations of hand hygiene compliance and routinely collected rates of Staphylococcus aureus bacteraemia. Results: Overall hand hygiene audits showed statistically significant improvement in compliance, from 62 to 75% in quarterly audits. Compliance rates among nurses and medical staff increased significantly from 70 to 80% and from 43 to 63%, respectively, while changes for allied health practitioners, from 61 to 65% compliance, did not achieve significance. Recorded rates of Staphylococcus aureus bacteraemia reduced from between 0.6 and 2.55 infections per 10000 occupied bed days pre-project to between 0 and 0.65 infections per 10000 occupied bed days during the project period. Conclusions: Multiple methods using a practice development framework can be successful in effecting changes in hand hygiene behaviour among all health care workers. Study methods took planning and commitment but were highly rewarding, particularly considering the magnitude of the issue for patient and clinician safety. © Austral...
Chan, C.W. & Perry, L. 2012, 'Lifestyle health promotion interventions for the nursing workforce: A systematic review', Journal of Clinical Nursing, vol. 21, no. 15-16, pp. 2247-2261.
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Aims and objectives. Study aims were to identify the efficacy of lifestyle health promotion interventions intended to improve behavioural health risk factors and/or behavioural or clinical outcomes of working-age nurses. Background. Nurses constitute around half the health workforce but global shortages and an ageing profile challenge future supply. The occupational hazards and stresses of nursing are well known. Health promotion, possibly workplace-based, presents opportunities to safeguard the health of nurses. Design. This was a systematic review undertaken in line with guidance for reviews in health care. Methods. Seven electronic databases were searched from 2000-2011 and references of relevant papers. Two reviewers independently reviewed and critiqued retrieved papers and extracted data. Methodological features were described using the CONSORT checklists; risk of bias was assessed using the Cochrane Handbook classification. Results. With design inclusion criteria relaxed to include an uncontrolled trial, only three intervention studies were retrieved, from the United States, Canada and Taiwan. All had limitations and high risk of bias, but benefits were reported. Outcomes included fewer cigarettes smoked during the intervention period, down from mean (SD) 20 (8)-12 (9) per day (p<0001); significantly reduced fat mass (068 vs. 007kg; p=0028); and significant gains across a battery of fitness assessments. The paucity of work focused on nurses' health behaviours was the important finding. Conclusion. The workplace is a potentially fruitful location for health promotion intervention but nurses have seldom been recognised as a target participant group. Given the international priority ascribed to nursing workforce retention, this is a missed opportunity for occupational health planning. Potential benefits to nurses' welfare and well-being may accrue from well-designed intervention studies. Relevance to clinical practice. Nurse leaders have a key role in driv...
Perry, L., Lowe, J.M., Steinbeck, K.S. & Dunbabin, J.S. 2012, 'Services doing the best they can: Service experiences of young adults with type 1 diabetes mellitus in rural Australia', Journal of Clinical Nursing, vol. 21, no. 13-14, pp. 1955-1963.
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Aims and objectives. To describe the healthcare experiences of young adults with type 1 diabetes who access diabetes services in rural areas of New South Wales, Australia. Background. The incidence of type 1 diabetes in childhood and adolescence is increasing worldwide; internationally, difficulties are encountered in supporting young people during their transition from children to adulthood. Consumers' experiences and views will be essential to inform service redesign. Design. This was a qualitative exploratory study. Methods. Semistructured telephone interviews were conducted with 26 people aged 18-28years living rurally, recruited through staff in four regional healthcare centres in 2008. Results. Two key themes were evident: lack of access (comprised of transfer to adult services, access to health professionals and access to up-to-date information) and age-appropriate provision. The impact of place of residence and personal motivation crossed all themes. Participants contrasted unfavourably the seamless care and support received from paediatric outreach services with the shortages in specialist and general practice-based care and information and practical problems of service fragmentation and lack of coordination experienced as adults. They identified a range of issues including need for ongoing education, age-appropriate services and support networks related to developing their ability to self-manage. They valued personal service; online and electronic support was seldom volunteered as an alternative. Conclusion. This was a first view of rural young people's experiences with adult diabetes services. Reported experiences were in line with previous reports from other settings in that they did not perceive services in this rural area of Australia as meeting their needs; suggestions for service redesign differed. Relevance to clinical practice. New models of age-appropriate service provision are required, to meet their needs for personal as well as other forms o...
Jones, S.E., Hamilton, S., Perry, L., O'Malley, C. & Halton, C. 2011, 'Developing workable research methods: Lessons from a pilot study with vulnerable participants and complex assessments', Journal of Research in Nursing, vol. 16, no. 4, pp. 307-318.
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Following acute stroke, deterioration in nutritional status and weight loss is common; few studies have investigated this, perhaps due to difficulties with recruitment and completion of complex assessments with stroke patients. This study reports the feasibility of a study protocol to determine predictors of nutritional intake in stroke patients. The aim of the study was to test the feasibility of a protocol to measure taste and smell function, and explore links with dietary intake following stroke. Patients were recruited from one Acute Stroke Unit in 2007/8. Data were collected at three time-points and entailed standardised validated assessments of taste and smell function, diet, appetite and mood state. Recruitment of this vulnerable population to a demanding assessment schedule was challenging. Of a cohort of 166 admissions, six were recruited and complete data collected from four participants. Slow recruitment was largely due to exacting inclusion criteria and rapid hospital discharge. Those who completed all assessments reported the schedule as tolerable and acceptable. This study illustrated the difficulties of recruiting this vulnerable population. Identification of reasons for slow recruitment facilitated development of measures to address them. It was possible to format a complex and lengthy assessment schedule to be acceptable to vulnerable participants.
Kilbride, C., Perry, L., Flatley, M., Turner, E. & Meyer, J. 2011, 'Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care', JOURNAL OF INTERPROFESSIONAL CARE, vol. 25, no. 2, pp. 91-97.
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Hodge, A., Perry, L., Daly, B., Hagness, C. & Tracy, D. 2011, 'Revision and Evaluation of an 'advanced' nursing role in an Australian emergency department', Australasian Emergency Nursing Journal, vol. 14, no. 2, pp. 120-128.
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Background: Extended Practice Nurse roles have been initiated in various forms in many Australian Emergency Departments. Although common, evaluation of these roles is scarce in the literature. Methods: A four phase practice development project was launched to review contemporary models of Extended Practice Nurse, revise an existing Extended Practice Nurse model called the Advanced Clinical Nurse (ACN), develop and standardise a supporting education and accreditation structure, and implement an evaluative framework for the revised ACN model. Results: A standardised education and accreditation structure was implemented, an 8 h ACN rostered shift commenced, and a mixed method evaluative framework initiated. Compared to management without an ACN, where an ACN was involved, mean medical management time of limb injuries and mean total length of stay was 42 min and 48 min shorter, respectively. Mean time to analgesia by an ACN was 22 min. Improvement in satisfaction was documented within subacute and waiting room patients. Median 'time to treatment' by an ACN was 6 min. Conclusions: Preliminary evaluation of the revised ACN model indicated practice benefits within early care delivery and patient flow. Continued standardisation of Extended Practice Nurse roles within New South Wales, Australia is necessary. The evaluative framework enabled greater understanding of this ACN role.
Nip, W.F.R., Perry, L., McLaren, S. & MacKenzie, A. 2011, 'Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital', Journal of Human Nutrition and Dietetics, vol. 24, no. 5, pp. 460-469.
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Background: Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. Methods: One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Results: Few (n=9; 10%) consumed ?100% of the estimated average requirement (EAR) for energy within 2weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F=7.503, P=0.001; F=14.558, P<0.001). Conclusions: Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes. &copy; 2011 The Authors. Journal of Human Nutrition and Dietetics &copy; 2011 The British Dietetic Association Ltd.
Perry, L., Bellchambers, H., Howie, A., Moxey, A., Parkinson, L., Capra, S. & Byles, J. 2011, 'Examination of the utility of the Promoting Action on Research Implementation in Health Services framework for implementation of evidence based practice in residential aged care settings', Journal of Advanced Nursing, vol. 67, no. 10, pp. 2139-2150.
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Aim. This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Background. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. Methods. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Findings. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Conclusion. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. &copy; 2011 The Authors. Journal of Advanced Nursing &copy; 2011 Blackwell Publishing Ltd.
Perry, L. & Middleton, S. 2011, 'An investigation of family carers' needs following stroke survivors' discharge from acute hospital care in Australia', DISABILITY AND REHABILITATION, vol. 33, no. 19-20, pp. 1890-1900.
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Appel, C., Mayston, M. & Perry, L. 2011, 'Feasibility study of a randomized controlled trial protocol to examine clinical effectiveness of shoulder strapping in acute stroke patients', Clinical Rehabilitation, vol. 25, no. 9, pp. 833-843.
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Objective: The majority of stroke patients experience upper limb motor impairment and reduced ability to perform basic activities. Shoulder strapping has been reported as a beneficial adjunct to rehabilitation therapies but has not been rigorously trialled. This study tested the feasibility of recruitment, intervention and outcome assessment protocols for future trial of the clinical effectiveness of shoulder strapping.Design and setting: Feasibility study using a randomized controlled trial in an East London stroke service.Subjects: Fourteen acute stroke patients with mild to moderate upper limb hemiparesis were recruited between October 2004 and July 2005.Intervention: Five strapping methods and criteria for use were identified from the literature. Shoulder strapping applied for one month in addition to routine rehabilitation was compared to routine rehabilitation only.Main measures: The Motor Assessment Scale, Fugl Meyer Scale-Arm section and the Nine Hole Peg Test were measured at baseline and 1, 2, 3 and 5 weeks later. The Stroke-specific Quality of Life questionnaire was delivered at 6 and 12 weeks post stroke.Results: Useful findings were demonstrated in relation to the feasibility of all elements of the protocol. Motor Assessment Scale findings showed a small-moderate (0.27) effect size for the strapping intervention used as an adjunct to routine rehabilitation compared to routine rehabilitation alone. Sample size calculation indicated 312 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation.Conclusion: Findings supported the value of pilot-testing, and enabled revision of the study protocol for future definitive trial. &copy; 2011 The Author(s).
de Brito-Ashurst, I., Perry, L., Sanders, T.A.B., Thomas, J.E., Yaqoob, M.M. & Dobbie, H. 2011, 'Barriers and facilitators of dietary sodium restriction amongst Bangladeshi chronic kidney disease patients', JOURNAL OF HUMAN NUTRITION AND DIETETICS, vol. 24, no. 1, pp. 86-95.
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Perry, L., Steinbeck, K.S., Dunbabin, J.S. & Lowe, J.M. 2010, 'Lost in transition? Access to and uptake of adult health services and outcomes for young people with type 1 diabetes in regional New South Wales', Medical Journal of Australia, vol. 193, no. 8, pp. 444-449.
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Objective: To document diabetes health services use and indices of glycaemic management of young people with type 1 diabetes from the time of their first contact with adult services, for those living in regional areas compared with those using city and state capital services, and compared with clinical guideline targets. Design, setting and subjects: Case note audit of 239 young adults aged 18-28 years with type 1 diabetes accessing five adult diabetes services before 30 June 2008 in three geographical regions of New South Wales: the capital (86), a city (79) and a regional area (74). Main outcome measures: Planned (routine monitoring) and unplanned (hospital admissions and emergency department attendance for hypoglycaemia or hyperglycaemia) service contacts; recorded measures of glycated haemoglobin (HbA1c), body mass index (BMI), and blood pressure (BP). Results: Routine preventive service uptake during the first year of contact with adult services was significantly higher in the capital and city. Fewer regional area patients had records of complications assessment and measurements of HbA1c, BMI and BP across all audited years of contact (HbA1c: 73% v 94% city, 97% capital; P < 0.001). Across all years, regional area patients had the highest proportion of HbA 1c values > 8.0% (79% v 62% city, 56% capital) and lowest proportion < 7% (4% v 7%, 22%) (both P < 0.001). Fewer young people made unplanned use of acute services for diabetes crisis management in the capital (24% v 49% city, 50% regional area; P < 0.001). In the regional area, routine review did not occur reliably even annually, with marked attrition of patients from adult services after the first year of contact. Conclusion: Inadequate routine specialist care, poor diabetes self-management and frequent use of acute services for crisis management, particularly in regional areas, suggest service redesign is needed to encourage young people's engagement.
Perry, L. 2009, 'Is BMI an accurate measure of nutritional status in older people.', Nurs Times, vol. 105, no. 37, p. 12.
Perry, L., Grange, A., Heyman, B. & Noble, P. 2008, 'Stakeholders' perceptions of a research capacity development project for nurses, midwives and allied health professionals.', J Nurs Manag, vol. 16, no. 3, pp. 315-326.
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AIMS: To evaluate stakeholders perceptions of the extent to which a research facilitator post was addressing aims of: * providing academic support to enable research involvement of nurses, midwives and allied health professionals; * supporting dissemination of research into practice; * contributing to research strategy development. BACKGROUND: Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. METHODS: A mixed methods approach was used. RESULTS: Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. CONCLUSION: The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. IMPLICATIONS FOR NURSING MANAGEMENT: Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this.
Perry, L., Grange, A., Heyman, B. & Noble, P. 2008, 'Stakeholders' perceptions of a research capacity development project for nurses, midwives and allied health professionals', Journal of Nursing Management, vol. 16, no. 3, pp. 315-326.
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Aims To evaluate stakeholders perceptions of the extent to which a research facilitator post was addressing aims of: &acirc;&cent; providing academic support to enable research involvement of nurses, midwives and allied health professionals; &acirc;&cent; supporting dissemination of research into practice; &acirc;&cent; contributing to research strategy development. Background Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. Methods A mixed methods approach was used. Results Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. Conclusion The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. Implications for nursing management Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this.
Mackenzie, A., Perry, L., Lockhart, E., Cottee, M., Cloud, G. & Mann, H. 2007, 'Family carers of stroke survivors: needs, knowledge, satisfaction and competence in caring', DISABILITY AND REHABILITATION, vol. 29, no. 2, pp. 111-121.
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Perry, L. 2006, 'Promoting evidence-based practice in stroke care in Australia.', Nurs Stand, vol. 20, no. 34, pp. 35-42.
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AIM: To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joanna Briggs Institute, an international network of academic centres. METHOD: A semi-structured interview schedule was developed, piloted and used to guide interviews with academic and clinical staff in five state capital cities in Australia. Data were analysed and findings reviewed by clinical and academic participants. FINDINGS: Four distinct but not mutually exclusive models and common but variously applied pathways for translation of evidence into clinical practice were identified. Key influential factors included context and local culture, the nature of evidence and role of clinical expertise. Implementation and change management strategies were recognised as emerging priorities. CONCLUSION: A range of methods to advance research synthesis, dissemination and knowledge transfer into clinical practice were demonstrated and may warrant consideration for the UK.
Kilbride, C., Meyer, J., Flatley, M. & Perry, L. 2005, 'Stroke units: The implementation of a complex intervention', Educational Action Research, vol. 13, no. 4, pp. 479-504.
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This article reports on selected findings from an action research study that looked at the lessons learnt from setting up a new in-patient stroke service in a London teaching hospital. Key participants in the design and evaluation of this 2-year study included members of the multi-professional stroke team and support staff within the unit, the hospital management team and representatives of patients and carers. Mixed methods (focus groups, indepth interviews, audits, documentary analysis, participant observation field notes) were used to generate data. Findings demonstrated positive change over time with four main themes emerging from the process: building a team; developing practice-based knowledge and skills in stroke; valuing the central role of the nurse in stroke care; and creating an organisational climate for supporting change. The interplay of these non-linear, but interrelated factors is supported by complexity theory, which includes exploration of how the sum of a whole can be more than its constituent parts. Findings are likely to be of interest to practitioners, managers and policy makers interested in supporting change in a learning organisation.
Perry, L., Brooks, W. & Hamilton, S. 2004, 'Exploring nurses perspectives of stroke care.', Nurs Stand, vol. 19, no. 12, pp. 33-38.
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In recent years stroke has been recognised as a national clinical, research and policy priority. Stroke nurses and stroke nursing are important contributors, but previous studies have highlighted lack of clarity and contradictions in the nursing role. A stroke nursing conference in 2002 offered the opportunity to explore nurses' vision for the future through a series of focus group meetings. Many examples of good practice were identified, for example, nursing contributions to risk factor management and secondary prevention, service co-ordination and development, follow-up and support of stroke patients and their families. However, areas for further development include realigning services to a patient focus and ensuring equitable access, integrating services, supporting development of the nursing research evidence base and providing career and educational frameworks for nurses in stroke care. Nurses set out a vision for stroke nursing in which current strengths and developments are consolidated and disseminated in a dynamic, multiprofessional, integrated patient-focused service.


Perry, L. National Stroke Foundation 2010, National Clinical Guidelines for Stroke Management, pp. 1-167, Melbourne, Australia.
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National Clinical Guidelines for Stroke Management
Gall, M.J., Lennon, S., Clarke, K., Cross, S., Cunningham, R., Edmans, J., Fitzpatrick, C., Hancock, N., Hoffman, A., Jones, A., Perry, L. & Walker, M. St Bartholomew and Royal London Charitable Foundation December 2007 2007, Profession-specific audit in stroke care: making rehab practice evidence based, London, City University.