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Professor Patricia Davidson

Biography

Professor Patricia Davidson RN, BA, MEd, PhD is a member of the Centre for Cardiovascular and Chronic Care at the University of Technology Sydney and Professor of Cardiovascular Research at St Vincent's Hospital Sydney.

Professor Davidson has an established program of research that focuses on chronic cardiovascular disease, heart failure, palliative care for non-malignant conditions, women's health and Indigenous cardiovascular health.

She has secured over $7 million in competitive research funding from national and international funding bodies, and co-authored over 260 peer-reviewed journal articles, 18 book chapters and over 150 peer-reviewed abstracts.

A primary objective of her work has been to improve cardiovascular health of women and underserved populations through development of innovative, acceptable, and sustainable initiatives within Australia and beyond.

Professor Davidson is a Fellow of the Royal College of Nursing Australia, co-chair of the NSW Health Clinical Expert Reference Group for Cardiovascular Disease, Immediate Past President of the Australasian Cardiovascular Nursing College, Chairperson of the Cardiac Nursing Council of Cardiac Society of Australia and New Zealand, Immediate Past Secretary of the International Nursing Doctoral Education, Counsel General of the International Council on Women's Health Issues (ICOWHI) and a Board member of the National Heart Foundation (NSW).

Professor Davidson has supervised and mentored over 33 nurse researchers (since 2003), is the Editor of Collegian and is on the Editorial Board of a number of other journals including the European Journal of Cardiovascular Nursing, Heart Lung and Circulation and the Journal of Cardiovascular Nursing.

Image of Patricia Davidson
Professor, Faculty of Health
Core Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Core Member, Advanced Analytics Institute
Core Member, Health Services and Practice Research Strength
Bachelors of Arts, Master of Education, Doctor of Philosophy
 
Can supervise: Yes

Books

Davidson, P.M., Halcomb, E. & Gholizadeh, L. 2013, Research methods in Health, 2nd, Oxford University Press, Australia and Newzealand.
Research Methods in Health 2nd Edition is an introductory text that shows students different research techniques and how they are of value to the health professions. The text assumes no prior knowledge and is written in an appealing student-friendly style using examples to demonstrate the relevance of research to health care practice. Written to be inclusive of all health professions, fostering a team-based approach to health care practice. Covers qualitative, quantitative and mixed method research methods. Shows how to decide which research method to use and when. Draws sensible links between evidence-based practice and research methodology. Stop & Think boxes encourage students to critically reflect on the content. Research in Practice boxes demonstrate how research can be applied in clinical practice.

Chapters

Davidson, P.M. & Sindhu, S. 2014, 'Becoming a nurse leader' in Daly, J., Speedy, S. & Jackson, D. (eds), Contexts of Nursing, 4th Edition, Elsevier, Sydney, Australia, pp. 233-251.
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Nursing leadership is critical for implementing evidence-based, ethical practice and promoting optimal patient outcomes. Promoting competence in nursing care and ensuring safe and effective work environments are important in providing high-quality patient care. This chapter describes contemporary trends influencing clinical practice, models of nursing care delivery and aspects of leadership in the clinical setting.
Davidson, P.M., Newton, P.J. & Macdonald, P. 2014, 'Chronic heart failure' in Chang, E. & Johnson, A. (eds), Chronic Illness & Disability 2nd edition, Elsevier, Australia, pp. 409-423.
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Several key principles underpin the structure of this chapter. Firstly, it is important to appreciate the pathophysiological and epidemiological basis of CHF to undertake informed clinical practice; secondly the role of the nurses in evidence-based practice strategies to prevent and manage CHF is emphasised; and thirdly the process of reflection in developing your clinical practice from prevention to palliation of CHF is emphasised.
Davidson, P.M. & Ferguson, C. 2014, 'Chapter 25: Management of Patients with Complications for Heart Disease' in Farrell, M. & Dempsey, J. (eds), Smeltzer & Bare's Textbook of Medical Surgical Nursing 3rd Edition, Lippincott Williams & Wilkins Pty Ltd, Sydney, pp. 686-710.
Davidson, P.M., Halcomb, E. & Gholizadeh, L. 2013, 'Focus Groups in Health Research' in Pranee Liamputtong (ed), Research methods in health: Foundations for evidence-based practice, Oxford University Press, Australia & New Zealand, pp. 54-71.
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Obtaining the views and perspectives of individuals, communities and key stakeholders is crucial not only in assessing needs and documenting health issues, but also in developing and evaluating interventions.
Davidson, P.M. & Everett, B. 2012, 'Managing approaches to nursing care delivery' in Chang, E. & Daly, J. (eds), transitions in Nursing 3e, Churchill Livingstone, Australia, pp. 127-143.
Davidson, P.M. & Phillips, J.L. 2012, 'Palliative Care in Chronic Illness' in O'Connor, M., Lee, S. & Aranda, S. (eds), Palliative Care Nursing A Guide to Practice 3rd Edition, AUSMED Publications Pty Ltd, North Melbourne, VIC Australia, pp. 291-307.
Chronic illnesses are a major cause of death and disability globally. Many people now live for an extended period of time with a life-limiting illness. This is particularly pronounced in the context of population ageing. This chapter focuses on the issues involved in providing a palliative approach to care for individuals with chronic life-threatening illnesses other than cancer.
Davidson, P.M. & Newton, P.J. 2012, 'End-of-life care' in Krum, H. & Lueder, T.V. (eds), Advances in Heart Failure Management, Future Medicine Ltd, London, UK, pp. 155-166.
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As many treatments decrease the risk of sudden death, individuals with chronic heart failure (CHF) live for an extended time with a high symptom burden and uncertainty of prognosis.
Davidson, P.M. & Hickman, L. 2012, 'Managing client care' in Crisp, J., Taylor, C., Douglas, C. & Rebeiro, G. (eds), Potter and Perry's Fundamentals of Nursing 4th edition, Mosby Elsevier, Chatswood, Sydney, NSW, pp. 121-136.
Halcomb, E., Gholizadeh, L., DiGiacomo, M., Phillips, J.L. & Davidson, P.M. 2012, 'Considerations in undertaking focus group research with culturally and linguistically diverse groups in Bibliographies and Literature Reviews' in Walden, G.R. (ed), Focus Group Research, part of the SAGE Benchmarks in Social Research Methods, Sage, UK, pp. 1-17.
Focus groups are a popular, widely accepted, and legitimate research method to determine attitudes, experiences, perceptions, and knowledge on a wide range of topics in many fields of endeavor. Focus groups lead to the voicing of attitudes and insights not readily attainable from other qualitative forms of data collection. The spectrum of interest in focus groups covers virtually all disciplines, and the variety of the applications for this technique is extraordinary. As part of the SAGE Benchmarks in Social Research Methods series, Graham Walden explores what a focus group is, how they are best used, the strengths and weaknesses of focus groups and the ethical issues surrounding focus groups, amongst other things. Volume 2, Part 2, 'Bibliographies and Literature Reviews' contains Halcomb et al.'s "Considerations in undertaking focus group research with culturally and linguistically diverse groups". URL: http://www.sagepub.com/books/Book235672/toc
Davidson, P.M., Halcomb, E. & Gholizadeh, L. 2010, 'Focus Groups in Health Research' in Pranee Limputtong (ed), Research methods in health: foundations for evidence-based practice, Oxford University Press, Australia & New Zealand, pp. 61-76.
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Daly, J. & Davidson, P.M. 2010, 'Reciprocal and supportive mentoring (Chapter 77)' in Rollins Gantz, N. (ed), 101 global leadership lessons for nurses: Shared legacies from leaders and their mentees, Sigma Theta Tau International, Indianapolis, USA, pp. 407-411.
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101 Global Leadership Lessons for Nurses covers the daily challenges facing health care leadersâcommunications, negotiations, resource management, and work-life balance, to name a fewâwith the unique feature of a mentor-mentee team authoring each chapter. These established and emerging mentors and mentees come from every corner of the globe and share their lessons learned, providing a rich legacy for nurses everywhere. 101 Global Leadership Lessons for Nurses offers: - An alphabetical subject order for quick topic access. - Authors from 32 countries spanning six continents. - A wealth of resources, with topics ranging from academic-service partnerships to writing for professional journals, and 99 other topics in between. - Reflective questions at the end of each chapter to help you integrate ideas into your professional life.
Davidson, P.M. & Webster, R. 2010, 'Convalescence' in Kucia, A.M. & Quinn, T. (eds), Acute Cardiac Care: A Practical Guide for Nurses, Wiley-Blackwell, West Sussex, UK, pp. 1-308.
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Davidson, P.M. & Webster, R. 2010, 'Discharge Planning and Secondary Prevention' in Kucia, A.M. & Quinn, T. (eds), Acute Cardiac Care: A Practical Guide for Nurses, Wiley-Blackwell, West Sussex, UK, pp. 1-308.
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Davidson, P.M. 2010, 'Management of Patients with Complications from Heart Disease (contribution to Ch 25)' in Lippincott, Williams & Wilkins (eds), Smeltzer & Bare's Textbook of Medical-Surgical Nursing, 2nd ANZ Edition, Wolters Kluwer, Australia, pp. 822-852.
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Davidson, P.M. 2010, 'Becoming a nurse leader' in Daly, J., Speedy, S. & Jackson, D. (eds), Contexts of Nursing 3rd Ed, Churchill- Livingston, Elsevier, Sydney, pp. 1-388.
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Davidson, P.M. & Phillips, J.L. 2010, 'Focus Group Methodology: Being Guided on a Journey from Novice to Expert' in Minichiello, V. & Kottler, J.A. (eds), Qualitative Journeys: Student and Mentor Experiences with Research, SAGE, Thousand Oaks, California, pp. 255-276.
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Phillips, J.L. & Davidson, P.M. 2009, 'Action Research as a Mixed Methods Design: a Palliative Approach in Residential Aged Care' in Andrew, S. & Halcomb, E.J. (eds), Mixed methods research for nursing and the health sciences, Wiley-Blackwell, West Sussex, UK, pp. 1-255.
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The philosophical premises of action research and the pragmatic characteristics of mixed methods researdl are highly congruent. Action research involves the engaging of participants as parblers to improve a situation or address an identified problem through cycles of reflectiOll, planning, action and evaluation (Reason and Bradbury 200]). Importantly, action research is a responsive and dynamic process that allows the complex array of predisposing and contributing issues to be considered, impacts of interventions and interactions observed, outcomes noted and action planned (Winter and Munn-Giddings 2001). A range of data collection methods is applicable to action research, including a mixed methods approach due to its applicability to survey, evaluation and field research. A mixed methods approach is particularly lIsehli as it allows multifaceted observatjons and adaptation of a range of research methodologies to a research setting and questions with unique characteristics (Creswell and Plano Clark 2006).
Davidson, P.M. & Hickman, L. 2009, 'Managing client care' in Crisp, J. & Taylor, K. (eds), Potter and Perry's Fundamentals of Nursing, 3rd Edition, Elsevier, Sydney, Australia, pp. 318-330.
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Jackson, D.E., Daly, J. & Davidson, P.M. 2008, 'Interviews' in McKenna, H., Watson, R., Keady, J. & Cowman, S. (eds), Nursing research: Designs and methods, Elsevier, Edinburgh, pp. 281-288.
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.
Davidson, P.M. & Zambroski, C.H. 2008, 'Palliative Care' in Moser, D.K. & Riegel, B. (eds), Moser Riegel Cardiac Nursing: A Companion to Braunwald's Heart Disease, Saunders Elsevier, St Louis, Missouri, pp. 329-338.
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Heart disease has reached global epidemic proportions. Within the next two decades, cardiovascular disease will become the leading cause of death and disability worldwide. It is estimated that the number of deaths will increase to more than 20 million each year.
Davidson, P.M., Newton, P.J. & Macdonald, P. 2008, 'Chronic Heart Failure' in Chang Johnson (ed), Chronic Illness & Disability: Implications for nursing practice, Elsevier, Australia, pp. 312-332.
Chronic heart failure is a growing publish health problem, both in Australia and New Zealand, and globally. This condition is associated with significant morbidity, mortality and economic burden, particularly among those ages 65 years and older.
Davidson, P.M., Leung, D. & Daly, J. 2006, 'Cardiovascular health breakdown (Chapter 5)' in Chang, E., Daly, J. & Elliott, D. (eds), Pathophysiology Applied to Nursing Practice, Elsevier, Sydney, pp. 105-137.
Davidson, P.M., Leung, D. & Daly, J. 2006, 'Cardiac health breakdown (Chapter 5)' in Chang, E., Daly, J. & Elliott, D. (eds), Pathophysiology applied to nursing practice, Elsevier, Sydney, pp. 105-137.
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Davidson, P.M., Elliott, D. & Daffurn, K. 2004, 'Contemporary approaches to nursing practice' in Daly, J., Speedy, S. & Jackson, D. (eds), Nursing leadership, Churchill Livingstone, Sydney, Australia, pp. 285-297.
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Davidson, P.M. & O'Rourke, M. 2004, 'Governance of practice and leadership: Implications for nursing practice' in Daly, J., Speedy, S. & Jackson, D. (eds), Nursing leadership, Churchill Livingstone, Sydney, pp. 327-344.
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Davidson, P.M., Elliott, D. & Daffurn, K. 2004, 'Leading contemporary approaches to nursing practice' in Daly, J., Speedy, S. & Jackson, D. (eds), Nursing leadership, Churchill Livingstone, Sydney, pp. 285-312.
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Davidson, P.M., Daly, J. & romanini, J. 1996, 'QUM in intensive care (Chapter 7)' in Stein, I. (ed), Quality Use of Medicines in Nursing Practice: Professional Development Series No. 6, Royal College of Nursing, Deakin, ACT, pp. 87-103.
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Davidson, P.M. 1994, 'Multiple organ system failure (Ch 14)' in Romanini Daly (ed), Critical Care Nursing: Australian perspectives, Harcourt Brace & Company, Marrickville, Australia, pp. 718-738.
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Davidson, P.M. 1994, 'Endocrine problems' in Romanini Daly (ed), Critical Care Nursing: Australian perspectives, Harcourt Brace & Company, Marrickville, Australia, pp. 523-587.
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Conferences

Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2014, 'PT453 Disease Management Interventions For Improving Self-Management In Lower-Limb Peripheral Arterial Disease: A Cochrane Review.', Global Heart Supplements, Elsevier, Melbourne, Australia, p. e262.
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Peripheral arterial disease (PAD) contributes to psychological burden, poor quality of life and an increased risk of cardiovascular events. Disease management strategies supporting behavioural change and long-term adherence may improve outcomes for people with PAD. However, to our knowledge the evidence relating to self-management interventions for people with PAD has not yet been systematically reviewed or meta-analysed
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2014, 'The caregiver role in thromboprophylaxis management in atrial fibrillation', 'Young at Heart' : Australian Cardiovascular Nursing College 8th Annual Scientific Meeting, Gold Coast, Australia.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2014, 'The Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study: 90 day outcomes', EUROPEAN JOURNAL OF HEART FAILURE, pp. 282-282.
Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2014, 'Disease Management Interventions For Improving Self-Management In Lower-Limb Peripheral Arterial Disease: A Cochrane Review.', Global Heart Supplements, Elsevier, Melbourne, Australia, p. e262.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., MacDonald, P.S. & Davidson, P.M. 2013, 'Stroke prevention in heart failure: time to rethink risk prediction schemes?', World Federation of Neuroscience Nurses Congress, Gifu, Japan.
Ferguson, C., Inglis, S., Newton, P.J., Davidson, P.M. & Middleton, S. 2012, 'Atrial fibrillation and thromboprophylaxis: methods in risk assessment and addressing barriers to adherence: A review.', 'The Aging Heart' - Australian Cardiovascular Nursing College 6th Annual Scientific Meeting, Crowne Plaza, Coogee, Sydney, Australia..
Background: Globally, stroke is one of the worldâs most prevalent, disabling and chronic conditions. Atrial fibrillation is a common arrhythmia in heart failure and presents a significant risk factor for thrombo-embolic, ischaemic stroke. Risk stratification schemata and therapies exist for the treatment of atrial fibrillation and the prophylaxis of stroke, however commonly these therapies are not applied in practice, even when advised in guidelines for numerous reasons. Objective: This presentation aims to identify available validated risk assessment tools for the prediction of stroke risk in patients with atrial fibrillation. Each tool will be evaluated for their benefits and limitations and their consequential implications for clinical practice. Barriers to adherence of available therapies will also be discussed in relation to stroke risk assessment tools and the World Health Organizationâs multidimensional adherence model (2003) Methods: A comprehensive electronic search of the following databases was undertaken: CINAHL, Medline, EBSCO Host, SCOPUS, and the Cochrane Library. Google and Google Scholar search engines were also used. Results: 6 risk prediction assessment tools featured heavily in the search results. Namely; AFI, SPAF, FRS, FGCRS, CHA2DS2 and CHA2DS2-VASc. Each are evaluated and discussed with regards to their advantage and limitations. Conclusions: Whilst valid risk assessment tools are available and their use recommended within practice guidelines their comprehensiveness and holistic patient assessment is questionable. To date, many risk prediction models focus on physical aspects of health and do not assess criteria related to psycho-social aspects of patientâs health and wellbeing such as the patientâs likeliness to adhere to anticoagulation therapy, their ability to take oral medications or assume responsibility for the safe monitoring of their INR. There is much scope for improvement in stroke risk prediction models in atrial fibrill...

Journal articles

Phillips, J.L., Lovell, M., Luckett, T., Agar, M., Green, A., Davidson, P. & Davidson, P. 2015, 'Australian survey of current practice and guideline use in adult cancer pain assessment and management: The community nurse perspective', Collegian, vol. 22, no. 1, pp. 33-41.
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© 2013 Australian College of Nursing Ltd. Background: Cancer pain remains a major public health concern. Despite effective treatments being available to manage the majority of cancer pain, this debilitating symptom is frequently under treated. As cancer has becomes a chronic disease a range of health professionals, including community nurses in Australia are increasingly caring for people living with cancer related pain. Yet, little is known about community nurses capacity to assess and manage cancer pain in accordance with best available evidence. Objectives: This study aimed to: identify the barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; identify if cancer pain guidelines are currently used; identify barriers and facilitators to guideline use; and establish the need for Australian cancer pain guidelines. This article reports on community nurses' perceptions of managing cancer pain in the community setting. Methods: A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders seeking the views and experiences of health professionals involved in caring for people living with cancer pain. Descriptive statistics were used to summarise the quantitative data, and thematic content analysis were used to describe the qualitative data. Results: Sixty-two community nurses responded to the survey, representing 29% of the total sample. These participants reported high levels of adherence to accepted cancer pain management practices in their workplace, with 71% nominating the Palliative Care Therapeutic Guideline V.3 as being most frequently used to manage community patients' cancer related pain. Key barriers to effective cancer pain management in the community were: difficulties accessing non-pharmacological interventions (89%), lack of coordination by multiple providers (89%), and impact of distance on ability to access pain-related services for ...
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2015, 'The caregiver role in thromboprophylaxis management in atrial fibrillation: A literature review', European Journal of Cardiovascular Nursing, vol. 14, no. 2, pp. 98-107.
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Background: Atrial fibrillation is a common arrhythmia and a risk factor for adverse events including stroke. People living with atrial fibrillation are commonly elderly and have multiple comorbidities. The role of a caregiver in supporting the individual to manage a chronic and complex condition has received limited attention. Objectives: This review aims to summarize available information on the caregiver role in atrial fibrillation, specifically in promoting adherence to thromboprophylaxis and evidence for strategies to support and enable the caregiver. Data sources: A review of electronic databases and search engines was undertaken including Medline, Scopus and CINAHL. The search terms atrial fibrillation, anticoagulation, carer, caregiver, family support were used. Dates searched were from January 1990 to November 2012. Results: The review found limited original clinical research studies. The majority of the literature identified in the initial search included review papers and work which recommends the inclusion of the caregiver in the care of patients with atrial fibrillation but limited empirical evidence. Conclusions: Caregivers have an essential role to play in advocacy, family centred care and shared decision-making. This may influence thromboprophylaxis treatment choices and potentially adherence. Assessment of caregiver needs and support should be central to patient assessment and care planning. There is a need for clinical intervention studies which more target and address the caregiver role.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2015, 'The caregiver role in thromboprophylaxis management in atrial fibrillation', European Journal of Cardiovascular Nursing, vol. Epub.
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Background: Atrial fibrillation is a common arrhythmia and a risk factor for adverse events including stroke. People living with atrial fibrillation are commonly elderly and have multiple comorbidities. The role of a caregiver in supporting the individual to manage a chronic and complex condition has received limited attention.
Allida, S.M., Inglis, S.C., Davidson, P.M., Davidson, P.M., Davidson, P.M., Lal, S., Hayward, C.S., Hayward, C.S. & Newton, P.J. 2015, 'Thirst in chronic heart failure: A review', Journal of Clinical Nursing, vol. 24, no. 7-8, pp. 916-926.
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© 2014 John Wiley & Sons Ltd. Aims and objectives: This review will (1) explore factors related to thirst in chronic heart failure and (2) describe interventions to alleviate thirst in chronic heart failure patients. Background: Thirst is a common and troublesome symptom of chronic heart failure. Despite the burden and prevalence of this symptom, there are limited strategies to assist in its management. Design: This is a review of literature on the burden of thirst, contributors to thirst and potential management strategies of thirst in patients with chronic heart failure. Methods: Medline, Cumulative Index for Nursing and Allied Health, PubMed and Scopus were searched using the key words thirst, chronic heart failure, angiotensin II, fluid restriction and intervention. Of the 165 citations yielded, nine studies (n = 9) were included. The eligibility criteria included participants with confirmed diagnosis of chronic heart failure, randomised controlled studies or any studies with thirst as primary or secondary outcome, in humans and in English. There was no limit to the years searched. Results: Factors related to thirst in chronic heart failure were condition; prolonged neurohormonal activation, treatment; pharmacological interventions and fluid restriction and emotion. No intervention studies were found in chronic heart failure patients. Interventions such as artificial saliva and chewing gum have been investigated for their effectiveness as a thirst reliever in haemodialysis patients. Conclusion: Thirst is a frequent and troublesome symptom for individuals with chronic heart failure. It is highly likely that this contributes to poor adherence with fluid restrictions. Chewing gum can help alleviate thirst, but investigation in people with heart failure is needed. Relevance to clinical practice: Increasing awareness of thirst and interventions to relieve it in clinical practice is likely to improve the quality of care for people with chronic heart failure.
Sayers, J., Salamonson, Y., DiGiacomo, M. & Davidson, P.M. 2015, 'Nurse educators in Australia: High job satisfaction despite role ambiguity', Journal of Nurse Education and Practice, vol. 5, no. 4, pp. 41-51.
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Purpose: The purpose of this study was to describe the nurse educator role in Australian hospitals, including their practice and performance standards. Methods: A cross-sectional, online survey of nurse educators employed in acute care hospitals in Australia was administered over a three-month period. The survey comprised established and researcher-developed scales, and a single open-ended question. Quantitative data was analysed using descriptive statistics. Qualitative data was analysed using a general inductive approach. Results: Nurse educators who were more likely to fulfill nurse educator competency practice domains had master's degrees in education, defined professional development needs, and met regularly with their managers. These educators also had higher levels of job satisfaction. Participants identified that role ambiguity and role confusion adversely impacted nurse educator role expectations, responsibilities, and job satisfaction. Despite this, the majority of educators intended to stay in their role for the foreseeable future. Conclusions: Role ambiguity influenced professional identity and job satisfaction, highlighting the need for clarification of nurse educator roles. These findings suggest the need for review of the nurse educator role and incorporation of professional and educational requirements and practice competencies. Ongoing role monitoring is recommended to identify the effects of role change.
Maneze, D., DiGiacomo, M., Salamonson, Y., Descallar, J. & Davidson, P.M. 2015, 'Facilitators and Barriers to Health-Seeking Behaviours among Filipino Migrants: Inductive Analysis to Inform Health Promotion', Biomed Research International, vol. 2015.
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Understanding factors that influence health-seeking behaviour of migrants is necessary to intervene for behaviour change. This paper explores Filipino migrants' perceptions of facilitators and barriers to maintaining health in Australia. Open-ended survey item responses reflecting factors that assisted and hindered health following migration to Australia were inductively analysed. Three hundred and thirty-seven of the 552 survey respondents (61%) provided open-ended responses. Responses were grouped into two major categories: individual factors, including personal resources and cultural influences, and environmental factors encompassing both the physical conditions in the host country and health service access. Awareness of practices that enhance health was a major personal facilitator of health-seeking behaviour; however, competing priorities of daily living were perceived as barriers. Cultural beliefs and practices influenced health-seeking behaviour. Despite high self-rated English language skills in this population, new migrants and the elderly cited communication difficulties as barriers to accessing health services. Insight into facilitators and barriers to health-seeking behaviour in this less researched migrant population revealed tools for enhancing engagement in health promotion programs addressing healthy lifestyle.
Babatunde-Sowole, O.O., Jackson, D., Davidson, P.M. & Power, T. 2015, '"Coming to a Strange Land": The West African Migrant Women's Establishment of Home and Family in a New Culture Within Australia.', J Transcult Nurs.
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PURPOSE: Migrating and establishing a new life in another culture can have diverse health effects especially for women. This article explores the struggles and social adjustment issues that might constitute negatively to the health of West African migrant women living in Australia. DESIGN: Qualitative storytelling. Audiotaped voluntary stories from 20 West African migrant women living in Sydney, Australia were transcribed and analyzed. FINDINGS: Three themes are presented for discussion: (1) But it is different here: life in a new country; (2) I have to do it all by myself: communal versus individual living; and (3) They don't listen to parents: perceived threats to the family unit. CONCLUSION/IMPLICATION FOR PRACTICE: The demand for and the importance of nurses and midwives in supporting migrant families is demonstrated by findings suggesting that social adjustment into the Australian culture has a significant impact on both the nuclear and extended family unit of women.
Brown, N., Luckett, T., Davidson, P.M. & Di Giacomo, M. 2015, 'Interventions to Reduce Harm from Smoking with Families in Infancy and Early Childhood: A Systematic Review', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 12, no. 3, pp. 3091-3119.
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Chang, S., Davidson, P.M., Newton, P.J., Macdonald, P., Carrington, M.J., Marwick, T.H., Horowitz, J.D., Krum, H., Reid, C.M., Chan, Y.K., Scuffham, P.A., Sibbritt, D. & Stewart, S. 2015, 'Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment', International Journal of Cardiology, vol. 185, pp. 62-68.
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Background A number of composite outcomes have been developed to capture the perspective of the patient, clinician and objective measures of health in assessing heart failure outcomes. To date there has been a limited examination in the composition of these outcomes. Methods and results Three commonly used scoring systems in heart failure trials: Packer's composite, Patient Journey and the African American Heart Failure Trial (A-HeFT) scores were compared in assessing outcomes from the Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care (WHICH(?)) Trial. Comparability and interpretability of these outcomes and the influence of each component to the final outcome were examined. Despite all three composite outcomes incorporating mortality, hospitalisation and quality of life (QoL), the contribution of each individual component to the final outcomes differed. The component with the most influence in deteriorating condition for the Packer's composite was hospitalisation (67.7%), while in Patient Journey it was QoL (61.5%) and for A-HeFT composite score it was mortality (45.4%). Conclusions The contribution made by each component varied in subtle, but important ways. This study emphasises the importance of understanding the value system of the composite outcomes to enable meaningful interpretation of results.
Davidson, P.M. & DiGiacomo, M. 2015, 'Family Caregiving Benefits and Burdens', CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, vol. 8, no. 2, pp. 133-134.
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Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P.S., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey', JOURNAL OF MEDICAL INTERNET RESEARCH, vol. 17, no. 3.
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DiGiacomo, M., Lewis, J., Phillips, J., Nolan, M. & Davidson, P.M. 2015, 'The business of death: A qualitative study of financial concerns of widowed older women', BMC Women's Health, vol. 15, no. 1.
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Background: The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women's experiences in the period soon after their husbands' death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. Methods: This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis. Results: Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband's death. Conclusions: Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models.
Lovell, M., Luckett, T., Boyle, F., Stubbs, J., Phillips, J., Davidson, P.M., Olver, I., von Dincklage, J. & Agar, M. 2015, 'Adaptation of international guidelines on assessment and management of cancer pain for the Australian context', Asia-Pacific Journal of Clinical Oncology.
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Aim: To develop clinical practice guidelines for screening, assessing and managing cancer pain in Australian adults. Methods: This three-phase project utilized the ADAPTE approach to adapt international cancer pain guidelines for the Australian setting. A Working Party was established to define scope, screen guidelines for adaptation and develop recommendations to support better cancer pain control through screening, assessment, pharmacological and non-pharmacological management, and patient education. Recommendations with limited evidence were referred to Expert Panels for advice before the draft guidelines were opened for public consultation via the Cancer Council Australia Cancer Guidelines Wiki platform in late 2012. All comments were reviewed by the Working Party and the guidelines were revised accordingly. Results: Screening resulted in six international guidelines being included for adaptation - those developed by the Scottish Intercollegiate Guidelines Network (2008), National Health Service Quality Improvement Scotland (2009), National Comprehensive Cancer Network (2012), European Society of Medical Oncology (2011), European Association for Palliative Care (2011, 2012) and National Institute of Clinical Excellence (2012). Guideline adaptation resulted in 55 final recommendations. The guidelines were officially launched in November 2013. Conclusion: International guidelines can be efficiently reconfigured for local contexts using the ADAPTE approach. Availability of the guidelines via the Cancer Council Australia Wiki is intended to promote uptake and enable recommendations to be kept up to date. Resources to support implementation will also be made available via the Wiki if found to be effective by a randomized controlled trial commencing in 2015.
Virdun, C., Luckett, T., Davidson, P.M. & Phillips, J. 2015, 'Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important.', Palliat Med.
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BACKGROUND: The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap. AIM AND DESIGN: This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families. DATA SOURCES: Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers. RESULTS: Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients. CONCLUSION: This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.
Maneze, D., Salamonson, Y., Poudel, C., DiGiacomo, M., Everett, B. & Davidson, P.M. 2015, 'Health-Seeking Behaviors of Filipino Migrants in Australia: The Influence of Persisting Acculturative Stress and Depression.', J Immigr Minor Health.
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This study examined the relationships among the constructs of acculturative stress, depression, English language use, health literacy, and social support and the influence of these factors on health-seeking behaviors of Filipino Australians. Using a self-administered questionnaire, 552 respondents were recruited from November 2010 to June 2011. Structural equation modelling was used to examine relationships. A direct and negative relationship between health-seeking behaviors and depression, and an indirect relationship with acculturative stress, was observed mediated through depression. Social support had an important moderating influence on these effects. Although there was an inverse relationship between age and English language usage and depression, age was positively related to health-seeking behavior. Despite their long duration of stay, Filipino Australian migrants continue to experience acculturative stress and depression leading to lower health-seeking behaviors. This study highlights the importance of screening for acculturative stress and depression in migrants and fostering social support.
Jha, S.R., Jha, S.R., Ha, H.S.K., Hickman, L.D., Hannu, M., Davidson, P.M., Davidson, P.M., Macdonald, P.S., Macdonald, P.S. & Newton, P.J. 2015, 'Frailty in advanced heart failure: a systematic review', Heart Failure Reviews.
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© 2015 Springer Science+Business Media New York Frailty is a common geriatric syndrome of increased vulnerability to adverse events. The prevalence of frailty among chronic heart failure (CHF) is high and confers a greater risk of adverse events including falls, hospitalisation and mortality. There have been few studies assessing frailty in CHF. A review of the key databases was conducted from 2004 to 2014 including the key search terms 'frail elderly' and 'heart failure'. The following electronic databases were searched: Medline, Cumulative Index for Nursing and Allied Health and Academic Search Complete, with reference lists being manually searched. Articles were included if frailty was assessed using a valid measuring tool in a population with a confirmed diagnosis of CHF. The search yielded a total of 393 articles with 8 articles being selected for review. The prevalence of frailty among those with CHF was high, ranging from 18 to 54 %. The frailty phenotype and geriatric assessments tools were the most common frailty measures utilised; high rates of co-morbidity, hospitalisation and mortality were identified. Frailty is common in CHF and is associated with adverse outcomes.
Luckett, T., Bhattarai, P., Phillips, J., Agar, M., Currow, D., Krastev, Y. & Davidson, P.M. 2015, 'Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.', Aust Health Rev.
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Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia.Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity.Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment - the Dying with Dignity Victoria Advance Healthcare Directive.Conclusions More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.What is known about the topic? Online availability of ACD templates provides consumers with an opportunity for advance care planning outside of formal healthcare settings. While online availability has advantages, there is a risk that templates may be biased either for or against medical treatment and may not elicit directives that are appropriately informed by reflection on personal values and discussion with family and health professionals.What does this paper add? This is the first attempt at monitoring the quality and bias of online ACD templates designed for use in Australia.What are the implications for practitioners? The results of this review provide a descri...
Chroinin, D.N., Goldsbury, D., O'Connell, D.L., Beveridge, A., Davidson, P., Girgis, A., Ingham, N., Phillips, J.L., Wilkinson, A. & Ingham, J. 2015, 'Hospital services utilisation amongst older patients in the last year of life: a New South Wales (NSW) population-based study', AUSTRALASIAN JOURNAL ON AGEING, vol. 34, pp. 66-67.
Disler, R., Inglis, S., Newton, P., Currow, D., Macdonald, P., Glanville, A., Donesky, D., Carrieri-Kohlman, V. & Davidson, P. 2015, 'ATTITUDES TO ONLINE DELIVERY OF HEALTH INFORMATION AND CHRONIC DISEASE MANAGEMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Disler, R., Spiliopoulos, N., Inglis, S., Currow, D. & Davidson, P. 2015, 'INDIVIDUALS ATTITUDES TO COGNITIVE IMPAIRMENT AND IMPACT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Forber, J., Carter, B., DiGiacomo, M., Davidson, P.M. & Jackson, D. 2015, 'Future proofing undergraduate nurse clinical education: continuing the dialogue', Journal of Nursing Management.
Hayes, C., Power, T., Davidson, P.M., Daly, J. & Jackson, D. 2015, 'Nurse interrupted: Development of a realistic medication administration simulation for undergraduate nurses.', Nurse Educ Today, vol. 35, no. 9, pp. 981-986.
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BACKGROUND: Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. AIM: This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. METHODS: The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. SETTING AND PARTICIPANTS: Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. OUTCOME MAPPING: To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4weeks to extend the reflective learning process and review the impact of the experience from the student perspective. CONCLUSIONS: Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and imp...
Hickman, L.D., Phillips, J.L., Newton, P.J., Halcomb, E.J., Al Abed, N. & Davidson, P.M. 2015, 'Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review.', Arch Gerontol Geriatr.
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BACKGROUND: A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings. METHOD: Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts. RESULTS: Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care. CONCLUSION: The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute c...
Anuruang, S., Hickman, L.D., Jackson, D., Dharmendra, T., Van Balen, J. & Davidson, P.M. 2014, 'Community-based interventions to promote management for older people: An integrative review', Journal of Clinical Nursing, vol. 23, no. 15-16, pp. 2110-2120.
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Aims and objectives: To review community programmes promoting self-care or self-management for older people with chronic disease in Thailand. Background: Identifying successful elements of culturally appropriate and effective community-based interventions to promote self-care with chronic illness is increasingly important. Design: Integrative review. Data sources: CINAHL, Medline, Health Source Nursing Academic databases. Methods: Integrative review of peer-reviewed articles written between 1946-2012. Articles were included if they described self-care, self-management, chronic disease and community care interventions targeting older people in Thailand. Results: Of the 58 articles retrieved, only 13 articles met the eligibility criteria. Elements of effective interventions included: (1) providing culturally sensitive information, (2) including approaches of shared decision-making and mutual goal setting and (3) flexibility within the intervention to adapt to participant needs. Conclusions: Shared decision-making and mutual goal setting between interventionists and patients improved health behaviours and outcomes. Moreover, the flexibility to adopt the intervention to local characteristics demonstrated positive results. Relevance to clinical practice: Promoting effective self-care and self-management behaviours is critical to improving outcomes for chronic conditions. The tailoring and targeting of interventions appropriate to individuals and communities are likely to be most effective in leveraging behaviour change. This review has identified that mutual goal setting improved health behaviours. The flexibility to adopt self-care interventions to community-based settings showed improved patient outcomes. © 2013 John Wiley & Sons Ltd.
Thompson, S.C., Shahid, S., Digiacomo, M., Pilkington, L. & Davidson, P.M. 2014, 'Making progress: The role of cancer councils in Australia in indigenous cancer control', BMC Public Health, vol. 14, no. 1.
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Background: Indigenous Australians have poorer outcomes from cancer for a variety of reasons including poorer participation in screening programs, later diagnosis, higher rates of cancer with poor prognosis and poorer uptake and completion of treatment. Cancer prevention and support for people with cancer is part of the core business of the State and Territory Cancer Councils. To support sharing of lessons learned, this paper reports an environmental scan undertaken in 2010 in cancer councils (CCs) nationwide that aimed to support Indigenous cancer control. Methods. The methods replicated the approach used in a 2006 environmental scan of Indigenous related activity in CCs. The Chief Executive Officer of each CC nominated individuals for interview. Interviews explored staffing, projects, programs and activities to progress cancer control issues for Indigenous Australians, through phone or face-to-face interviews. Reported initiatives were tabulated using predetermined categories of activity and summaries were returned to interviewees, the Aboriginal and Torres Strait Islander Subcommittee and Chief Executive Officers for verification. Results: All CCs participated and modest increases in activity had occurred in most states since 2006 through different means. Indigenous staff numbers were low and no Indigenous person had yet been employed in smaller CCs; no CC had an Indigenous Board member and efforts at capacity building were often directed outside of the organisation. Developing partnerships with Indigenous organisations were ongoing. Acknowledgement and specific mention of Indigenous people in policy was increasing. Momentum increased following the establishment of a national subcommittee which increased the profile of Indigenous issues and provided collegial and practical support for those committed to reducing Indigenous cancer disparities. Government funding of "Closing the Gap" and research in the larger CCs have been other avenues for increasing knowledge...
Fernandez, R., Davidson, P.M., Miranda, C., Everett, B. & Salamonson, Y. 2014, 'Attribution of risk for coronary heart disease in a vulnerable immigrant population: a survey study.', J Cardiovasc Nurs, vol. 29, no. 1, pp. 48-54.
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BACKGROUND: Coronary heart disease (CHD) is a common and costly condition and is increasing at a higher rate among Asian Indians than among other ethnic groups. An understanding of how Asian Indians perceive their risk is important for health providers to develop culturally appropriate programs to raise awareness of the risk of CHD. OBJECTIVE: The aim of this survey was to investigate the attribution of risk factors for CHD among the Asian Indian community in Australia. METHODS: Asian Indian community leaders were recruited to provide their views of how their community perceived the risk of CHD. An online survey collected demographic data and information from the Illness Perception Questionnaire-Revised, which measures 6 domains of illness perception: timeline acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. RESULTS: An 84% response rate (n = 49) was achieved from Asian Indian community leaders. Heart disease and cancer were considered to be the illnesses of major concern. Participants indicated that people in their community perceived hereditary factors (90%), hypertension, stress or worry (84%), and aging (86%) as the major cause of their illnesses. Smoking, high blood pressure, and cholesterol were identified as being major risk factors for CHD. CONCLUSIONS: These data suggest that as well as strategies to address risk factors such as diet and exercise, stress management is an important issue to consider in developing community-based programs.
Al Abed, N.A., Hickman, L., Jackson, D., DiGiacomo, M. & Davidson, P.M. 2014, 'Older Arab migrants in Australia: Between the hammer of prejudice and the anvil of social isolation', Contemporary Nurse, vol. 46, no. 2, pp. 259-262.
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Hunt, L., Frost, S.A., Hillman, K., Newton, P.J. & Davidson, P.M. 2014, 'Management of intra-abdominal hypertension and abdominal compartment syndrome: A review', Journal of Trauma Management and Outcomes, vol. 8, no. 1.
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Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function. © 2014 Hunt et al.; licensee BioMed Central Ltd.
Luckett, T., Phillips, J., Agar, M., Virdun, C., Green, A. & Davidson, P.M. 2014, 'Elements of effective palliative care models: A rapid review', BMC Health Services Research, vol. 14, no. 1.
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Background: Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia. Method. A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006). Results: Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time. Conclusion: Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its...
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2014, 'Atrial fibrillation: Stroke prevention in focus', Australian Critical Care, vol. 27, no. 2, pp. 92-98.
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Introduction: Atrial fibrillation (AF) is a common arrhythmia and a risk factor for stroke and other, adverse events. Internationally there have been recent advancements in the therapies available for, stroke prevention in AF. Nurses will care for individuals with AF across a variety of primary and acute, care settings and should be familiar with evidence based therapies. Aim: This paper provides a review of the epidemiology of AF and stroke, stroke and bleeding risk, assessment tools and evidence based treatments for the prevention of stroke in AF including the use of, novel anti-thrombin agents. Method: A review of key databases was conducted from 2002 to 2012 using the key search terms 'atrial, fibrillation' 'anticoagulation' 'risk assessment' and 'clinical management'. The following electronic, databases were searched: CINAHL, Medline, Scopus, the Cochrane Library and Google Scholar., Reference lists were manually hand searched. Key clinical guidelines from National Institute for, Clinical Excellence (NICE, UK), American Heart Association (AHA, USA), American College of Cardiology, (ACC, USA) and the European Society of Cardiology (ESC) and key government policy documents were, also included. Articles were included in the review if they addressed nursing management with a focus, on Australia. Results: Many treatment options exist for AF. Best practice guidelines make a variety of, recommendations which include cardioversion, ablation, pulmonary vein isolation, pharmacological, agents for rate or rhythm control approaches, and antithrombotic therapy (including anticoagulation, and antiplatelet therapy). Treatment should be patient centred and individualised based upon, persistency of the rhythm, causal nature, risk and co-morbid conditions. Conclusion: AF is a common and burdensome condition where treatment is complex and not without, risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas, understanding the risk of AF ...
Salamonson, Y., Everett, B., Cooper, M., Lombardo, L., Weaver, R. & Davidson, P.M. 2014, 'Nursing as first choice predicts nursing program completion', Nurse Education Today, vol. 34, no. 1, pp. 127-131.
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Background: Attrition from nursing programs is common, costly and burdensome to individuals, nursing faculties and the health care system. Increasingly, nursing faculties are requested to monitor attrition rates as a measure of performance, but little is known of the influence of career choice on program completion. Objectives: The aim of this study was to assess the impact of nursing as a first choice for study on attrition in a baccalaureate nursing program. Design, Setting and Participants: A longitudinal, cohort design was used in this study, which involved undergraduate nursing students enrolled at a university in Australia. Of the 357 participants who completed a baseline survey in 2004 at entry to their Bachelor of Nursing program, 352 were followed up over a six-year period to the end of 2009. Results: Students who selected nursing as their first choice for study were nearly twice as likely (OR: 1.99 95% CI: 1.07-3.68) to complete their nursing program compared to those who did not. These students were also more likely to be older (mean age: 26.8 vs 20.1 years, P< 0.001), and employed in nursing-related work (35% vs 2%, P< 0.001). In addition, the study revealed that male students (OR: 1.93 95% CI: 1.07-3.46) and those who worked more than 16. h per week during semester (OR: 1.80 95% CI: 1.09-2.99) were less likely to complete than their counterparts. Conclusions: These data assist in generating realistic projections of completion and entry to the workforce. Understanding patterns of attrition and individuals' motivations to be a nurse is important not only for supporting nursing students to help them complete their studies but also for developing more targeted strategies directed toward student recruitment and retention. &copy; 2012.
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. &copy; 2014 Patricia M. Davidson et al.
Gholizadeh, L., Davidson, P.M., Heydari, M. & Salamonson, Y. 2014, 'Heart Disease and Depression: Is Culture a Factor?', Journal of Transcultural Nursing, vol. 25, no. 3, pp. 290-295.
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Purpose: This article seeks to review and discuss the evidence linking depression, coronary heart disease (CHD), and culture. Method: PsychInfo, CINAHL, PubMed, and Google were searched for pertinent evidence linking depression, culture, and CHD, and retrieved articles were analyzed using thematic content analysis. Findings: Identified themes were the followings: depression is a factor in development and prognosis of CHD and affects the capacity to self-manage and adhere to treatment recommendations; culture mediates mental health/illness representations and treatment-seeking behaviors; screening and assessment of depression can be affected by cultural factors; and there is a need for culturally appropriate screening and therapeutic strategies. Discussion and Conclusions: As depression is a predictor and moderating variable in the genesis and progression of CHD, understanding how factors such as culture affect screening and management of the disease is important to inform the development of culturally and linguistically competent strategies that ensure accurate screening, detection, and treatment of depression in cardiac patients in clinical practice.
Hosie, A., Agar, M., Lobb, E., Davidson, P.M. & Phillips, J. 2014, 'Palliative care nurses' recognition and assessment of patients with delirium symptoms: A qualitative study using critical incident technique', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 51, no. 10, pp. 1353-1365.
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Ferguson, C. & Davidson, P.M. 2014, 'The importance of communicating your research: The 3 Minute Thesis', Advances in Nursing Doctoral Education and Research, vol. 2, no. 1, pp. 11-14.
Driscoll, A., Currey, J., Allen, J.A., George, M. & Davidson, P.M. 2014, 'New cardiac models of care reduce patient access to specialist nurses: A Victorian cross-sectional pilot study', Australian Critical Care, vol. 27, no. 1, pp. 17-27.
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Background: Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown. Aim: To describe the workforce and workplace resources of adult CCUs in Victoria, Australia. Method: This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010. Results: A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met the international standards for a nursing workforce with critical care qualifications. The CCU/day procedure/HDU models had 24% of critical care qualified staff followed by CCU/cardiology ward model with 35% compared to an average of 54-80% of qualified staff in the other models of care of CCU. Conclusions: This pilot study has highlighted the heterogeneity in models of CCU and a shortage of qualified critical care nurses, particularly in the CCU/cardiology ward model. This may have implications for the quality of care delivered in CCUs. &copy; 2013.
Al Abed, N.A., Davidson, P.M. & Hickman, L.D. 2014, 'Healthcare needs of older Arab migrants: A systematic review', Journal of Clinical Nursing, vol. 23, no. 13-14, pp. 1770-1784.
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Aims and objectives: To explore the healthcare needs of older Arab migrants, focussing on Arab-Australians and their socio-cultural characteristics. Background: Disparities in accessing healthcare services and addressing healthcare needs are evident among ethnic minorities including Arab migrants, particularly, older people. Racial stereotyping can also affect their ability to use these services. Arabs are a populous and diverse group with a long history of global migration. Australia is one of the most multicultural societies in the world, and Arab-Australians constitute an important ethnic minority group. Design: Systematic review. Methods: The electronic databases Academic Search Complete (EBSCO), MEDLINE (Ovid), Ageline, ProQuest, CINAHL, PubMed, PsychINFO and Google Scholar were searched from 1990-October 2012. Search terms included health care needs, aged care, ethnic, cultural, linguistics, social, ethnic groups, culturally and linguistically diverse, nonEnglish speaking, ageing, elderly, Arabs, Arabic-speaking and Australia. Results: Eight articles reviewing the healthcare issues of Australians from Arabic-speaking background were identified using the search strategy. An additional eight articles were identified through hand searching. Conclusions: Racial stereotyping can alter health-seeking behaviours and healthcare treatment. Increasing the understanding of specific cultural attributes of Arab-Australians will contribute to improving health outcomes. Relevance to clinical practice: Healthcare providers and policymakers need to adopt more effective ways of communication with Arab-Australians to provide more culturally competent care and achieve better health outcomes. &copy; 2013 John Wiley & Sons Ltd.
Ferguson, C., Inglis, S.C., Newton, P.J., Cripps, P.J.S., Macdonald, P.S. & Davidson, P.M. 2014, 'Social media: A tool to spread information: A case study analysis of Twitter conversation at the Cardiac Society of Australia & New Zealand 61st Annual Scientific Meeting 2013', Collegian, vol. 21, no. 2, pp. 89-93.
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Background: The World Wide Web has changed the way in which people communicate and consume information. More importantly, this innovation has increased the speed and spread of information. There has been recent increase in the percentage of cardiovascular professionals, including journals and associations using Twitter to engage with others and exchange ideas. Evaluating the reach and impact in scientific meetings is important in promoting the use of social media. Objective: This study evaluated Twitter use during the recent 61st Annual Scientific Meeting at the Cardiac Society of Australia and New Zealand. Methods: During the Cardiac Society of Australia and New Zealand 2013 61st Annual Scientific Meeting Symplur was used to curate conversations that were publicly posted with the hashtag #CSANZ2013. The hashtag was monitored with analysis focused on the influencers, latest tweets, tweet statistics, activity comparisons, and tweet activity during the conference. Additionally, Radian6 social media listening software was used to collect data. A summary is provided. Results: There were 669 total tweets sent from 107 unique Twitter accounts during 8th August 9. a.m. to 11th August 1. p.m. This averaged nine tweets per hour and six tweets per participant. This assisted in the sharing of ideas and disseminating the findings and conclusions from presenters at the conference with a total 1,432,573 potential impressions in Twitter users tweet streams. Conclusion: This analysis of Twitter conversations during a recent scientific meeting highlights the significance and place of social media within research dissemination and collaboration. Researchers and clinicians should consider using this technology to enhance timely communication of findings. The potential to engage with consumers and enhance shared decision-making should be explored further. &copy; 2014 Australian College of Nursing Ltd.
Hayes, C., Power, T., Davidson, P.M. & Jackson, D. 2014, 'Editorial: Interruptions and medication: Is 'Do not disturb' the answer?', Contemp Nurse, vol. 47, no. 1-2, pp. 3-6.
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Abstract &nbsp;
Sheerin, N.J., Newton, P.J., Macdonald, P.S., Leung, D.Y.C., Sibbritt, D., Spicer, S.T., Johnson, K., Krum, H. & Davidson, P.M. 2014, 'Worsening renal function in heart failure: The need for a consensus definition', International Journal of Cardiology, vol. 174, no. 3, pp. 484-491.
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Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associated with heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. We present the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injury with some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease. &copy; 2014 Elsevier Ireland Ltd.
Stewart, S., Carrington, M.J., Horowitz, J.D., Marwick, T.H., Newton, P.J., Davidson, P.M., Macdonald, P., Thompson, D.R., Chan, Y.-.K., Krum, H., Reid, C. & Scuffham, P.A. 2014, 'Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort', International Journal of Cardiology, vol. 174, no. 3, pp. 600-610.
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Objectives We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). Methods We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 &plusmn; 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. Results 280 patients (73% male, aged 71 &plusmn; 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n = 143) or clinic-based (n = 137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint; 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15; p = 0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p = 0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p = 0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p < 0.01 for rate and duration of hospital stay). Conclusions Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. Trial registration Australian New Zealand Clinical Trials Registry number 12607000069459 (http://www.anzctr.org.au/Trial/ Regist...
Close, G.R., Newton, P.J., Fung, S.C., Denniss, A.R., Halcomb, E.J., Kovoor, P., Stewart, S. & Davidson, P.M. 2014, 'Socioeconomic Status and Heart Failure in Sydney', Heart Lung and Circulation, vol. 23, no. 4, pp. 320-324.
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Background: Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. Methods: Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 1999-2003. Standardised rates were analysed according to patients' residential local government area and correlated with an index of socioeconomic disadvantage. Results: Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. Conclusions: Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health. &copy; 2014.
Deek, H., Newton, P., Inglis, S., Kabbani, S., Noureddine, S., Macdonald, P.S. & Davidson, P.M. 2014, 'Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease', Collegian.
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Introduction: Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. Cardiovascular diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated. Aim: To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon. Method: An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search. Results: The search yielded 28 peer-reviewed articles and 15 reports. Cardiovascular diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of cardiovascular diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients' outcomes. Conclusion: Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of cardiovascular risk factors. &copy; 2014 Australian College of Nursing Ltd.
Disler, R.T., Disler, R.T., Green, A., Green, A., Green, A., Luckett, T., Luckett, T., Luckett, T., Newton, P.J., Newton, P.J., Inglis, S., Currow, D.C., Davidson, P.M. & Davidson, P.M. 2014, 'Experience of advanced chronic obstructive pulmonary disease: Metasynthesis of qualitative research', Journal of Pain and Symptom Management, vol. 48, no. 6, pp. 1182-1199.
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&copy; 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. Context Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health care utilization. Objectives To increase understanding of the experience and ongoing needs of individuals living with COPD. Methods Medline, PsycINFO, CINAHL, and Sociological s were searched for articles published between January 1990 and June 2013. Metasynthesis of qualitative data followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Metasyntheses are increasingly used to gain understandings of complex research questions through synthesizing data from individual qualitative studies. Descriptive and analytical themes were developed through thematic synthesis and expert panel discussion of extracted primary quotes, not the primary data themselves. Results Twenty-two studies were included. Four hundred twenty-two free codes were condensed into seven descriptive themes: better understanding of condition, breathlessness, fatigue, frailty, anxiety, social isolation, and loss of hope and maintaining meaning. These seven themes were condensed further into three analytical themes that described the experience and ongoing needs of individuals with COPD: the need for better understanding of condition, sustained symptom burden, and the unrelenting psychological impact of living with COPD. Conclusion Combining discrete qualitative studies provided a useful perspective of the experience of living with COPD over the past two decades. Further studies into the ongoing needs of individuals with COPD are unlikely to add to this well-established picture. Future research should focus on solutions through the development of interventions that address patients' ongoing needs.
O'Connell, D.L., Goldsbury, D.E., Davidson, P., Girgis, A., Phillips, J.L., Piza, M., Wilkinson, A. & Ingham, J.M. 2014, 'Acute hospital-based services utilisation during the last year of life in New South Wales, Australia: Methods for a population-based study', BMJ Open, vol. 4, no. 3.
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Objectives: The aim of this study is to describe healthcare utilisation in the last year of life for people in Australia, to help inform health services planning. The methods and datasets that are being used are described in this paper. Design/Setting: Linked, routinely collected administrative health data are being analysed for all people who died in New South Wales (NSW), Australia's most populous state, in 2007. The data comprised linked death records (2007), hospital admissions and emergency department presentations (2006-2007) and cancer registrations (1994-2007). Participants: There were 46 341 deaths in NSW in 2007. The initial analyses include 45 760 decedents aged 18 years and over. Outcome measures: The primary measures address the utilisation of hospital-based services at the end of life, including number and length of hospital admissions, emergency department presentations, intensive care admissions, palliative-related admissions and place of death. Results: The median age at death was 80 years. Cause of death was available for 95% of decedents and 85% were linked to a hospital admission record. In the greater metropolitan area, where data capture was complete, 83% of decedents were linked to an emergency department presentation. 38% of decedents were linked to a cancer diagnosis in 1994-2007. The most common causes of death were diseases of the circulatory system (34%) and neoplasms (29%). Conclusions: This study is among the first in Australia to give an information-rich census of end-of-life hospital-based experiences. While the administrative datasets have some limitations, these population-wide data can provide a foundation to enable further exploration of needs and barriers in relation to care. They also serve to inform the development of a relatively inexpensive, timely and reliable approach to the ongoing monitoring of acute hospital-based care utilisation near the end of life and inform whether service access and care are optimised.
Lewis, J.M., Digiacomo, M., Currow, D.C. & Davidson, P.M. 2014, 'Social capital in a lower socioeconomic palliative care population: A qualitative investigation of individual, community and civic networks and relations', BMC Palliative Care, vol. 13, no. 1.
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Background: Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group. Methods. Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis. Results: Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources. Conclusion: Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations...
Virdun, C., Brown, N., Phillips, J., Luckett, T., Agar, M., Green, A. & Davidson, P.M. 2014, 'Elements of optimal paediatric palliative care for children and young people: An integrative review using a systematic approach', Collegian.
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Background: Models of palliative care need to address the unmet needs of children, young people and families. Objective: To undertake an integrative review to identify the key elements of optimal paediatric palliative care from the perspectives of children and young people with palliative care needs and their parents. Data sources: Electronic databases including CINAHL, Medline, PsycINFO and AMED searched using combined terms for palliative care, service models and children along with reference lists of included studies. Study selection: Peer reviewed empirical studies reporting on evaluation of paediatric palliative care by children and young people with palliative care needs (0-19 years), or their families, published in English, between 2000 and 2013. The views of health professionals and grey literature were excluded. Quality appraisal completed by two researchers, consensus reached following discussion. Data extraction and synthesis: Data extracted by two researchers, entered into an electronic proforma and synthesised using a narrative approach. Results: Seven studies were identified of which two were quantitative, one was qualitative and four were mixed methods. Synthesis highlighted the need for tailored support enabling flexibility in care, with specific reference to location of care and access to psychosocial support, 24. h specialist support, respite care and sibling support. Conclusions: Paediatric palliative care should be flexible, responsive and tailored to the needs of children and their families. Robust evaluation of models of care that incorporate these elements is required to inform optimal care. &copy; 2014 Australian College of Nursing Ltd.
Chang, S., Newton, P.J., Inglis, S., Luckett, T., Krum, H., Macdonald, P. & Davidson, P.M. 2014, 'Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment', Heart Failure Reviews, vol. 19, no. 2, pp. 153-162.
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Chronic heart failure (CHF) is a multi-dimensional and complex syndrome. Outcome measures are important for determining both the efficacy and quality of care and capturing the patient's perspective in evaluating the outcomes of health care delivery. Capturing the patient's perspective via patient-reported outcomes is increasingly important; however, including objective measures such as mortality would provide more complete account of outcomes important to patients. Currently, no single measure for CHF outcomes captures all dimensions of the quality of care from the patient's perspective. To describe the role of outcome measures in CHF from the perspective of patients, a structured literature review was undertaken. This review discusses the concepts and methodological issues related to measurement of CHF outcomes. Outcome assessment at the level of the patient, provider and health care system were identified as being important. The perspectives of all stakeholders should be considered when developing an outcomes measurement suite to inform CHF health care. This paper recommends that choice of outcome measures should depend on their ability to provide a comprehensive, comparable, meaningful and accurate assessment that are important to patient. &copy; 2012 Springer Science+Business Media New York.
Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S. & Newton, P.J. 2014, 'Measurement of thirst in chronic heart failure- a review.', Contemp Nurse, pp. 5134-5152.
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Abstract Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF. Methods: Medline, PubMed, CINAHL, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies. Results: The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full- text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients (Visual Analogue Scale, Numeric Rating Scale and Thirst Distress Scale). Conclusion: Thirst in CHF is measured in a non- systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital.
Johnson, M.J., Bland, J.M., Davidson, P.M., Newton, P.J., Oxberry, S.G., Abernethy, A.P. & Currow, D.C. 2014, 'The relationship between two performance scales: New York Heart Association Classification and Karnofsky Performance Status Scale', Journal of Pain and Symptom Management, vol. 47, no. 3, pp. 652-658.
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Context. Performance status is used to quantify the well-being and functional status of people with illness. Clinicians and researchers from differing fields may not instinctively understand the scales, typically disease specific, used in other disciplines. Objectives. To provide a preliminary description of the relationship between the Karnofsky Performance Status Scale (KPS) and the New York Heart Association Classification (NYHA) and to stimulate discussion in research and clinical practice. Methods. Simultaneous KPS and NYHA data (172 observations) from three studies of people with chronic heart failure were pooled. Linear regression was used to predict the mean KPS from NYHA. The strength of association between the scales was investigated using a Kendall's Tau-b correlation coefficient. The agreement between the predicted and observed KPS scores was investigated using weighted kappa with quadratic weights. Results. Linear regression demonstrated a relationship between KPS and NYHA (P < 0.0001; R2 = 0.3). Predicted KPS from NYHA class rounded to the nearest 10 gave the following values: Class I, predicted KPS 90%; Class II, predicted KPS 80%; Class III, predicted KPS 70%; and Class IV, predicted KPS 60%. A moderate strength of association between KPS and NYHA (Kendall's Tau-b correlation coefficient of -0.49; P < 0.0001) and agreement between observed and predicted KPS (kappa coefficient = 0.52) was shown. Conclusion. We suggest that the NYHA discriminates poorly between clinically important performance states in people with advanced disease (NYHA III and IV; KPS <50%). The KPS, used in conjunction, would provide useful additional information in research and clinical practice. &copy; 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Page, K., Marwick, T.H., Lee, R., Grenfell, R., Abhayaratna, W.P., Aggarwal, A., Briffa, T.G., Cameron, J., Davidson, P.M., Driscoll, A., Garton-Smith, J., Gascard, D.J., Hickey, A., Korczyk, D., Mitchell, J.-.A., Sanders, R., Spicer, D., Stewart, S. & Wade, V. 2014, 'A systematic approach to chronic heart failure care: A consensus statement', Medical Journal of Australia, vol. 201, no. 3, pp. 147-150.
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The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidencebased, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations.?Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and highquality evidence into practice.
Walczak, A., Henselmans, I., Tattersall, M.H.N., Clayton, J.M., Davidson, P.M., Young, J., Bellemore, F.A., Epstein, R.M. & Butow, P.N. 2014, 'A qualitative analysis of responses to a question prompt list and prognosis and end-of-life care discussion prompts delivered in a communication support program', Psycho-Oncology.
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Objective: Discussing end-of-life (EOL) care is challenging when death is not imminent, contributing to poor decision-making and EOL quality-of-life. A communication support program (CSP) targeting these issues may facilitate discussions. We aimed to qualitatively explore responses to a nurse-led CSP, incorporating a question prompt list (QPL-booklet of questions patients/caregivers can ask clinicians), promoting life expectancy and EOL-care discussions. Methods: Participants met a nurse-facilitator to explore an EOL-focussed QPL. Prognosis and advance care planning (ACP) QPL content was highlighted. Thirty-one transcribed meetings were analysed using thematic text analysis before reaching data saturation. Results: Thirty-one advanced cancer patients (life expectancy <12months) and 11 family caregivers were recruited from six medical oncology clinics in Sydney, Australia. Intent to use the QPL related to information needs, involvement in care and readiness to discuss EOL issues. Many participants did not want life expectancy estimates, citing unreliable estimates, unknown treatment outcomes, or coping by not looking ahead. Most displayed interest in ACP, often motivated by a loved one's EOL experiences, clear treatment preferences, concerns about caregivers or recognition that ACP is valuable regardless of life expectancy. Timing emerged as a reason not to discuss EOL issues; many maintaining it was too early. Conclusion: Patients and caregivers appear ambivalent about acknowledging approaching death by discussing life expectancy but value ACP. Given heterogeneity in responses, individualised approaches are required to guide EOL discussion conduct and content. Further exploration of the role of prognostic discussion in ACP is warranted. &copy; 2014 John Wiley & Sons, Ltd.
Jackson, D., Hickman, L.D., Power, T., Disler, R., Potgieter, I., Deek, H. & Davidson, P.M. 2014, 'Small group learning: graduate health students' views of challenges and benefits.', Contemp Nurse, pp. 5297-5312.
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Abstract Background: For health care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. Aim: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. Method: Online survey; thematic analysis. Results: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. Conclusion: The ability to work effectively in small groups and teams is essential for all health care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.
Brandes, K., Butow, P.N., Tattersall, M.H.N., Clayton, J.M., Davidson, P.M., Young, J., Epstein, R.M. & Walczak, A. 2014, 'Advanced cancer patients' and caregivers' use of a Question Prompt List', Patient Education and Counseling.
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Objective: The objective of this study was to provide insight into how advanced cancer patients and their caregivers use a Question Prompt List (QPL) during a consultation and for preparation for future consultations. Methods: Audiotaped consultations and follow-up phone calls of 28 advanced cancer patients were coded and content analyzed. Questions asked and concerns expressed in consultations were coded for initiator, content, inclusion in the QPL and exact wording. Patients' reported and future use of the QPL were coded from the phone calls. Results: The majority of patients reported that they used the QPL. Questions asked by patients and caregivers predominately coincided with questions from the prognosis section of the QPL. Questions were rarely asked literally from the QPL, instead questions were tailored to patients' own circumstances. Conclusion: QPLs are useful to stimulate discussion on prognosis among advanced cancer patients and caregivers. Patients tailored questions from the QPL to their own circumstances which may suggest high involvement and engagement. The development of more specific tailored communication interventions for advanced cancer patients is warranted. Practice implications: Implementation of QPLs in the advanced cancer setting may be beneficial for patients, caregivers and healthcare providers to facilitate discussion of topics such as prognosis. &copy; 2014 Elsevier Ireland Ltd. All rights reserved.
Lovell, M.R., Luckett, T., Boyle, F.M., Phillips, J., Agar, M. & Davidson, P.M. 2014, 'Patient education, coaching, and self-management for cancer pain', Journal of Clinical Oncology, vol. 32, no. 16, pp. 1712-1720.
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Purpose: Multiple systematic reviews and meta-analyses have identified the effectiveness of patient education in improving cancer pain management. However, the mechanisms by which patient education improves pain outcomes are uncertain, as are the optimal delivery, content, timing, frequency, and duration. This review provides best-bet recommendations based on available evidence to guide service managers and clinicians in developing a patient education program. Methods: We used patient-centered care, self-management, coaching, and a behavior change wheel as lenses through which to consider the evidence for elements of patient education most likely to be effective within the context of other strategies for overcoming barriers to cancer pain assessment and management. Results: The evidence suggests that optimal strategies include those that are patient-centered and tailored to individual needs, are embedded within health professional-patient communication and therapeutic relationships, empower patients to self-manage and coordinate their care, and are routinely integrated into standard cancer care. An approach that integrates patient education with processes and systems to ensure implementation of key standards for pain assessment and management and education of health professionals has been shown to be most effective. Conclusion: Patient education is effective in reducing cancer pain and should be standard practice in all settings. For optimal results, patient education should be integrated with other strategies for implementing evidence-based, person-centered care and overcoming barriers at the levels of patient, provider, and health system. &copy; 2014 by American Society of Clinical Oncology.
Hosie, A., Lobb, E., Agar, M., Davidson, P.M. & Phillips, J. 2014, 'Identifying the Barriers and Enablers to Palliative Care Nurses' Recognition and Assessment of Delirium Symptoms: A Qualitative Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 5, pp. 815-830.
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Deek, H., Abbott, P., Moore, L., Davison, J., Cameron, S., Digiacomo, M., McGrath, S.J., Dharmendra, T. & Davidson, P.M. 2014, 'Pneumococcus in Aboriginal and Torres Strait Islanders: the role of Aboriginal Health Workers and implications for nursing practice.', Contemp Nurse.
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Abstract Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and grey literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
Deek, H., Newton, P., Sheerin, N., Noureddine, S. & Davidson, P.M. 2014, 'Contrast media induced nephropathy: A literature review of the available evidence and recommendations for practice', Australian Critical Care, vol. 27, no. 4, pp. 166-171.
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Background: Contrast media induced nephropathy (CIN) is a sudden compromise of renal function 24-48. h after administering contrast medium during a CT scan or angiography. CIN accounts for 10% of hospital acquired renal failure and is ranked the third cause of acquiring this condition. Identifying patients at risk through proper screening can reduce the occurrence of this condition. Purpose: This review paper aims to critique current evidence, provide a better understanding of CIN, inform nursing practice and make recommendations for bedside nurses and future research. Method: An integrative review of the literature was made using the key terms: "contrast media", "nephritis", "nephropathy", "contrast media induced nephropathy scores", "acute kidney failure", "acute renal failure" and "acute kidney injury". MeSH key terms used in some databases were: "prevention and control", "acute kidney failure" and "treatment". Databases searched included Medline, CINAHL and Academic Search Complete, and references of relevant articles were also assessed. The search included all articles between the years 2000 and 2013. Results: Sixty-seven articles were obtained as a result of the search, including RCTs, systematic reviews, and retrospective studies. Conclusion: Contrast media induced nephropathy is an iatrogenic complication occurring secondary to diagnostic or therapeutic procedures. At times it is unavoidable but a systematic method of risk assessment should be adopted to identify high risk patients for tailored and targeted approaches to management interventions. Clinical implications: As the use of contrast media is increasing for diagnostic purposes, it is important that nurses be aware of the risk factors for CIN, identify and monitor high risk patients to prevent deterioration in renal function when possible.
Luckett, T., Davidson, P.M., Boyle, F., Liauw, W., Agar, M., Green, A. & Lovell, M. 2014, 'Australian survey of current practice and guideline use in adult cancer pain assessment and management: Perspectives of oncologists', Asia-Pacific Journal of Clinical Oncology, vol. 10, no. 2.
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Aims: Cancer pain continues to be undertreated in up to half of cases, despite the availability of evidence-based guidelines. This study aimed to: (i) identify barriers and facilitators to adult cancer pain assessment and management, as perceived by Australian health professionals; (ii) establish the perceived need for new Australian guidelines and implementation strategy; (iii) identify which guidelines are used; (iv) identify barriers and facilitators to guideline use. This article focuses on the perceptions of responding oncologists. Methods: A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders. Comments were coded independently by two researchers. Results: In all 76 oncologists self-reported high concordance with evidence-based recommendations, except validated pain scales. Perceived barriers to pain management included insufficient non-pharmacological interventions, access to /coordination between services, and time. Only 22 percent of respondents reported using pain guidelines. Perceived barriers to guideline use included lack of access, awareness and any single standard. Respondents were generally supportive of new Australian guidelines and especially an implementation strategy. Conclusion: Barriers to evidence-based practice and guideline use identified by our survey might be addressed via a clinical pathway that gives step-by-step guidance on evidence-based practice along with a framework for evaluation. Particular attention should be paid to promoting use of validated scales, patient education and non-pharmacological interventions, training of an appropriately skilled workforce and improving care coordination. Challenges are discussed. &copy; 2012 Wiley Publishing Asia Pty Ltd.
Koch, J., Everett, B., Phillips, J. & Davidson, P.M. 2014, 'Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review', Collegian.
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Background: There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. Aim: The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. Methods: Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. Findings: Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. Conclusions: Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience. &copy; 2014 Australian College of Nursing Ltd.
Maneze, D., Maneze, D., Salamonson, Y., Attwood, N. & Davidson, P.M. 2014, 'Acculturative stress in Filipino migrants with functional English: implications for health promotion', International Journal of Culture and Mental Health, vol. 7, no. 4, pp. 357-369.
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&copy; 2013, &copy; 2013 Taylor & Francis. The lack of host language proficiency is an important source of acculturative stress among new immigrants and is known to negatively impact on both physical and mental health. However, the acculturative stress and stressors of migrants from culturally and linguistically diverse (CALD) backgrounds with functional English language skills in Australia are less well-explored. Using the Filipino migrants as examplar, this paper reviews acculturative stress in three sub-population groups in this community: family migrants, Filipino spouses of Australian men and skilled, professional migrants. Despite English language ability, socioeconomic difficulties upon migration are a common source of acculturative stress. Intergenerational and cultural gaps within the family are conflict points that may cause depression and suicidal ideation. Changes in lifestyle and diet, incongruence of Western health practices with cultural beliefs may unfavourably affect health. Skilled and professional migrants experience stress due to underemployment, non-utilisation or non-recognition of qualifications obtained overseas. The health issues of CALD communities with functional English language skills are often overlooked in comparison with migrants lacking host population language skills. Taking sociocultural issues into consideration is pivotal when designing health promotion initiatives to meet the needs of Australian migrants with functional English language skills.
Everett, B., Salamonson, Y., Rolley, J.X. & Davidson, P.M. 2014, 'Underestimation of risk perception in patients at risk of heart disease.', Eur J Cardiovasc Nurs.
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BACKGROUND: Accurate perception of cardiovascular risk is important if people with established, or at high risk of, coronary heart disease are to engage in risk-reducing behaviours. AIM: This study aimed to determine whether the risk perception of patients undergoing a percutaneous coronary procedure was related to their subsequent engagement in risk-reducing behaviours. METHODS: Using a prospective correlational design, patients presenting to a tertiary referral hospital in Sydney, Australia for an interventional cardiology procedure were surveyed at baseline and again at six months. Data collected included demographic and clinical information, relative risk perception (RRP-2), psychological status using the Hospital Anxiety and Depression scale and the Perceived Stress Scale, and physical activity using the Physical Activity Scale. In addition, data on medication adherence and cardiac rehabilitation enrolment were collected at the six-month follow-up. RESULTS: The study cohort consisted of 220 participants. Statistical analysis revealed a reduction in anxiety (p<0.001), depression (p =0.004) and stress (p <0.001), and an increase in physical activity engagement (p <0.001) from baseline to six-month follow-up. Higher risk perception scores at baseline predicted an increased likelihood of enrolment in a cardiac rehabilitation programme (p =0.01) and adherence to medication regimen (p =0.007). CONCLUSIONS: This study revealed an overall underestimation of risk perception among a sample of 'high risk' cardiac patients admitted to hospital for an interventional coronary procedure, with those who reported lower risk perception being less likely to attend cardiac rehabilitation and less likely to adhere to their medication regimen.
Jackson, D., Hickman, L.D., Power, T., Disler, R., Potgieter, I., Deek, H. & Davidson, P.M. 2014, 'Small group learning: Graduate health students' views of challenges and benefits', Contemporary Nurse, vol. 48, no. 1, pp. 117-128.
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Background: For health-care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. Aim: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. Method: Online survey; thematic analysis. Results: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. Conclusion: The ability to work effectively in small groups and teams is essential for all health-care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.
Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S. & Newton, P.J. 2014, 'Measurement of thirst in chronic heart failure - A review', Contemporary Nurse, vol. 48, no. 1, pp. 2-9.
Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF. Methods: Medline, PubMed, Cumulative Index for Nursing and Allied Health, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies. Results: The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full-text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients [Visual Analogue Scale (VAS), Numeric Rating Scale and Thirst Distress Scale]. Conclusion: Thirst in CHF is measured in a non-systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital.
Daly, J., Jackson, D., Mannix, J., Davidson, P. & Hutchinson, M. 2014, 'The importance of clinical leadership in the hospital setting', Journal of Healthcare Leadership, pp. 75-75.
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Deek, H., Newton, P., Sheerin, N., Noureddine, S. & Davidson, P.M. 2014, 'Contrast media induced nephropathy: A literature review of the available evidence and recommendations for practice', Australian Critical Care, vol. 27, no. 4, pp. 166-171.
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Background: Contrast media induced nephropathy (CIN) is a sudden compromise of renal function 24-48. h after administering contrast medium during a CT scan or angiography. CIN accounts for 10% of hospital acquired renal failure and is ranked the third cause of acquiring this condition. Identifying patients at risk through proper screening can reduce the occurrence of this condition. Purpose: This review paper aims to critique current evidence, provide a better understanding of CIN, inform nursing practice and make recommendations for bedside nurses and future research. Method: An integrative review of the literature was made using the key terms: "contrast media", "nephritis", "nephropathy", "contrast media induced nephropathy scores", "acute kidney failure", "acute renal failure" and "acute kidney injury". MeSH key terms used in some databases were: "prevention and control", "acute kidney failure" and "treatment". Databases searched included Medline, CINAHL and Academic Search Complete, and references of relevant articles were also assessed. The search included all articles between the years 2000 and 2013. Results: Sixty-seven articles were obtained as a result of the search, including RCTs, systematic reviews, and retrospective studies. Conclusion: Contrast media induced nephropathy is an iatrogenic complication occurring secondary to diagnostic or therapeutic procedures. At times it is unavoidable but a systematic method of risk assessment should be adopted to identify high risk patients for tailored and targeted approaches to management interventions. Clinical implications: As the use of contrast media is increasing for diagnostic purposes, it is important that nurses be aware of the risk factors for CIN, identify and monitor high risk patients to prevent deterioration in renal function when possible.
Green, A., DiGiacomo, M., Luckett, T., Abbott, P., Davidson, P.M., Delaney, J. & Delaney, P. 2014, 'Cross-sector collaborations in Aboriginal and Torres Strait Islander childhood disability: a systematic integrative review and theory-based synthesis', INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH, vol. 13.
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Hayes, C., Power, T., Davidson, P.M. & Jackson, D. 2014, 'Interruptions and medication: Is 'Do not disturb' the answer?', Contemporary Nurse, vol. 47, no. 1-2, pp. 3-6.
Koch, J., Everett, B., Everett, B., Everett, B., Phillips, J. & Davidson, P.M. 2014, 'Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views', Contemporary Nurse, vol. 49, pp. 15-26.
&copy; eContent Management Pty Ltd. Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.
MacIntyre, C.R., Chughtai, A.A., Seale, H., Richards, G.A. & Davidson, P.M. 2014, 'Respiratory protection for healthcare workers treating Ebola virus disease (EVD): Are facemasks sufficient to meet occupational health and safety obligations?', International Journal of Nursing Studies, vol. 51, no. 11, pp. 1421-1426.
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MacIntyre, C.R., Chughtai, A.A., Seale, H., Richards, G.A. & Davidson, P.M. 2014, 'Response to Martin-Moreno et al. (2014) Surgical mask or no mask for health workers not a defensible position for Ebola', International Journal of Nursing Studies, vol. 51, no. 12, pp. 1694-1695.
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Smith, T.A., Kim, M., Piza, M., Davidson, P.M., Clayton, J.M., Jenkins, C.R. & Ingham, J.M. 2014, 'Specialist respiratory physicians' attitudes to and practice of advance care planning in COPD. A pilot study', Respiratory Medicine, vol. 108, no. 6, pp. 935-939.
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Jackson, D.E., Girvin, J. & Davidson, P.M. 2014, 'Nursing innovation and reform in health care', Contemporary Nurse, vol. 48, no. 2, pp. 130-132.
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Alexandrou, E., Spencer, T.R., Frost, S.A., Mifflin, N., Davidson, P.M. & Hillman, K.M. 2014, 'Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection RatesA Report From 13 Years of Service*', Critical Care Medicine, vol. 42, no. 3, pp. 536-543.
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Siabani, S., Leeder, S.R., Davidson, P.M., Najafi, F., Hamzeh, B., Solimani, A., Siahbani, S. & Driscoll, T. 2014, 'Translation and Validation of the Self-care of Heart Failure Index Into Persian', The Journal of Cardiovascular Nursing, vol. 29, no. 6, pp. E1-E5.
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Prichard, R.A., Juul, M., Gazibarich, G., Davidson, P.M., Mason, C., Keogh, A.M., Macdonald, P.S. & Hayward, C.S. 2014, 'Six-minute walk distance predicts VO2 (max) in patients supported with continuous flow left ventricular assist devices', The International Journal of Artificial Organs, vol. 37, no. 7, pp. 539-545.
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Koch, J., Everett, B., Phillips, J. & Davidson, P.M. 2014, 'Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views', Archivio Italiano di Urologia e Andrologia, vol. 49, no. 1, pp. 15-26.
Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.
Davidson, P.M., DiGiacomo, M. & Jackson, D.E. 2013, 'Enriching doctoral education with student diversity', Advances in Nursing Doctoral Education and Research, vol. 1, no. 1, pp. 10-16.
This article seeks to identify factors to be considered in embracing perspectives of diversity in doctoral programs from the perspective of the extant literature and personal reflec-tion of experienced supervisors
Lewis, J.M., Digiacomo, M., Luckett, T., Davidson, P.M. & Currow, D.C. 2013, 'A social capital framework for palliative care: Supporting health and well-being for people with life-limiting illness and their carers through social relations and networks', Journal of Pain and Symptom Management, vol. 45, no. 1, pp. 92-103.
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Context: Social relations and networks are vital for sustaining and enhancing end-of-life care. The social capital concept supports a framework to understand the association between social relations and well-being; yet, to date, there has been very limited investigation of social capital in the palliative care literature. A framework for understanding social contexts in end-of-life care is necessary. Objectives: To summarize the literature on social capital, well-being, and quality of life for key outcomes to inform a model of social capital in palliative care. Methods: The electronic databases MEDLINE (1997 to March 2011), Embase (1997 to March 2011), CINAHL (1997 to March 2011), and PsycINFO (1997 to March 2011) were searched using key/MeSH search terms of "social capital," "palliative care," and "well-being" and/or "quality of life." The literature was reviewed to identify key concepts to develop and inform a palliative care social capital framework. Results: A total of 93 articles were included in the literature review, with only two articles identifying discourse on social capital and palliative care. Four key areas integrating the social capital outcomes informed a framework for palliative care. Conclusion: The social capital concept provides a structure for understanding how the organization and meaning of social contexts can potentially enhance or hinder end-of-life care. Research that identifies specificity in application of social capital concepts is fundamental to issues of access to services, sustaining levels of care, quality of life, and well-being. The importance of "bridged" social capital relations and networks for improved resource acquisition and information flow was identified in the literature and outlined within the palliative care social capital framework. Differential access to social capital by disadvantaged groups provides further impetus to engage a model of social capital for palliative care. &copy; 2013 Published by Elsevier Inc. on behalf...
Walczak, A., Butow, P.N., Davidson, P.M., Bellemore, F.A., Tattersall, M.H., Clayton, J.M., Young, J., Mazer, B., Ladwig, S. & Epstein, R.M. 2013, 'Patient perspectives regarding communication about prognosis and end-of-life issues: how can it be optimised?', Patient Educ Couns, vol. 90, no. 3, pp. 307-314.
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OBJECTIVE: To explore patients' perspectives across two cultures (Australia and USA) regarding communication about prognosis and end-of-life care issues and to consider the ways in which these discussions can be optimised. METHODS: Fifteen Australian and 11 US patients completed individual semi-structured qualitative interviews. A further 8 US patients participated in a focus group. Interviews and focus group recordings were transcribed verbatim and interpreted using thematic text analysis with an inductive, data-driven approach. RESULTS: Global themes identified included readiness for and outcomes of discussions of prognosis and end-of-life issues. Contributing to readiness were sub themes including patients' adjustment to and acceptance of their condition (together with seven factors promoting this), doctor and patient communication skills, mutual understandings and therapeutic relationship elements. Outcomes included sub themes of achievement of control and ability to move on. A model of the relationships between these factors, emergent cross cultural differences, and how factors may help to optimise these discussions are presented. CONCLUSION: Identified optimising factors illustrate Australian and US patients' perspectives regarding how prognosis and end-of-life issues can be discussed with minimised negative impact. PRACTICE IMPLICATIONS: Recognition of factors promoting adjustment, acceptance and readiness and use of the communication skills and therapeutic relationship elements identified may assist in optimising discussions and help patients plan care, achieve more control of their situation and enjoy an optimal quality-of-life.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2013, 'Atrial fibrillation and thromboprophylaxis in heart failure: The need for patient-centered approaches to address adherence', Vascular Health and Risk Management, vol. 9, no. 1, pp. 3-11.
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Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for atrial fibrillation and emphasizes the importance of tailoring individual risk and the importance of weighing the benefits of treatment. Further, this review provides details of innovative and patient-centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy, a comprehensive risk assessment should include evaluation of associated cardiogeriatric conditions, potential for adherence to prescribed therapy, frailty, and functional and cognitive ability. &copy; 2013 Ferguson et al, publisher and licensee Dove Medical Press Ltd.
Waller, A., Girgis, A., Davidson, P.M., Newton, P.J., Lecathelinais, C., MacDonald, P.S., Hayward, C.S. & Currow, D.C. 2013, 'Facilitating needs-based support and palliative care for people with chronic heart failure: Preliminary evidence for the acceptability, inter-rater reliability, and validity of a needs assessment tool', Journal of Pain and Symptom Management, vol. 45, no. 5, pp. 912-925.
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Context: Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). Objectives: To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF. Methods: A convenience sample of multidisciplinary health professionals working in heart failure care was invited to comment, via an online survey and consultation, on suitability and required modifications to a validated cancer care needs assessment measure to inform the support and palliative care needs of patients with CHF and their caregivers. Psychometric testing was then undertaken with 52 patients with CHF recruited from a multidisciplinary heart failure service to explore inter-rater reliability and concurrent validity of the newly adapted Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF). Results: Health professionals (n = 21) rated the tool as easy to administer, comprehensive, and relevant for the CHF population. Prevalence- and bias-adjusted kappa values indicated good agreement between pairs of raters for each item in the NAT: PD-HF (range 0.54-0.90). Participants indicating a higher severity of concern in the NAT: PD-HF physical, daily living, and spiritual items reported significantly higher Heart Failure Needs Assessment Questionnaire physical and existential scores. Conclusion: This study provides preliminary evidence for the NAT: PD-HF as a potential strategy for identifying and informing the management of physical and psychosocial issues experienced by people with CHF. Further work is needed to examine additional psychometrics, benefits relating to unnecessary symptom burden, futile treatments, and admissions to hospital. &copy; 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
DiGiacomo, M., Davidson, P.M., Byles, J. & Nolan, M.T. 2013, 'An Integrative and Socio-Cultural Perspective of Health, Wealth, and Adjustment in Widowhood', Health Care for Women International, vol. 34, no. 12, pp. 1067-1083.
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Women comprise a larger proportion of the ageing population than men, often outlive their spouses, and face a variety of challenges upon widowhood. Discrete aspects of the health impact of widowhood have been described in the literature; however, the expanse of sociocontextual issues that impact on older women's adjustment is less prominent. We undertook a literature review to synthesize recent research and interventions and identify current trends and gaps in knowledge and services. Although many health, social, cultural, and economic factors impact on recently widowed older women throughout the world, we found that few interventions targeting this population incorporate these factors. &copy; 2013 Copyright Taylor and Francis Group, LLC.
Luckett, T., Davidson, P.M., Lam, L., Phillips, J., Currow, D.C. & Agar, M. 2013, 'Do community specialist palliative care services that provide home nursing increase rates of home death for people with life-limiting illnesses? A systematic review and meta-analysis of comparative studies', Journal of Pain and Symptom Management, vol. 45, no. 2, pp. 279-297.
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Context: Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly. Objectives: To establish whether community SPCSs offering home nursing increase rates of home death compared with other models. Methods: We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed. Results: Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24-6.11; P < 0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97-2.02; P = 0.071). Bias was minimal. Conclusion: A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs. &copy; 2013 U.S. Cancer Pain Relief Committee.
Davidson, P.M. 2013, 'Tailoring and targeting interventions for women with heart disease: The need for gender-based approaches', Evidence-Based Nursing, vol. 16, no. 2, pp. 45-46.
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Yacopetti, N., Davidson, P.M., Blacka, J. & Spencer, T.R. 2013, 'Preventing contamination at the time of central venous catheter insertion: a literature review and recommendations for clinical practice.', J Clin Nurs, vol. 22, no. 5-6, pp. 611-620.
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AIMS AND OBJECTIVES: To evaluate the evidence base and rationale underpinning the various infections control strategies during central venous catheter insertion and to promote discussion about the key, recurring concepts and recommendations in the literature. Logistical and organisational factors relating to central venous catheter insertion are also examined. BACKGROUND: Catheter-related bloodstream infections following the insertion of central venous catheters are associated with significant patient mortality and morbidity, prolonged hospital stays and increased economic costs. Limited published literature specifically examines microbial contamination during the peri-insertion process. METHODS: An integrative literature review supervised by a health informatics librarian was undertaken. On the basis of these data, considerations for clinical practice are provided. Retrieved articles were categorised under the following themes: risk of contamination at insertion; clinical and organisational impact of contamination; strategies for reducing contamination; controversies and challenges with decontamination strategies; recommendations for practice and implications for further research and organisational practice. RESULTS: Specific recommendations for reducing catheter-related bloodstream infections based on recurring themes include the following: reducing microbial burden on skin prior to the central venous catheter insertion; decreasing contact of gloves and insertion equipment with the patient's skin; using specifically trained staff to prepare and maintain a sterile field; and ensuring a sterile technique is adhered to throughout the central venous catheter insertion process. The need for organisational, procedural and clinical practices to support better healthcare outcomes is demonstrated. Highlighting the importance of executive support and regular review of policy and guidelines are necessary to improve patient outcomes. CONCLUSIONS: Preventing infections rela...
Kim Lam, S., Kim Geok, S. & Davidson, P.M. 2013, 'The role of culture in quality improvement in the intensive care unit: A literature review', Journal of Hospital Administration, vol. 2, no. 2, pp. 97-104.
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Improving the quality of patient care and patient outcomes is a major concern internationally. In a developing health care system, implementing quality improvement is challenging due not only to resource and workforce issues but also cultural factors. Using the method of a focused literature review, this paper discusses the importance of assessing a societal view of culture, social mores and customs, and power relationships in quality improvement activities using the intensive care unit as an exemplar. We conclude that implementing quality improvement strategies in a developing health care system needs to address the broader perspectives of social and cultural systems particularly hierarchical relationships and issues of non-disclosure.
Digiacomo, M., Davidson, P.M., Abbott, P., Delaney, P., Dharmendra, T., McGrath, S.J., Delaney, J. & Vincent, F. 2013, 'Childhood disability in Aboriginal and Torres Strait Islander peoples: A literature review', International Journal for Equity in Health, vol. 12, no. 1.
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Introduction. Aboriginal and Torres Strait Islander children have higher rates of disability than non-Indigenous children and are considered doubly disadvantaged, yet there is very little data reflecting prevalence and service access to inform design and delivery of services. Failing to address physical, social, and psychological factors can have life-long consequences and perpetuate longstanding health disparities. Methods. A narrative literature review was undertaken to identify peer reviewed literature describing factors impacting on the prevention, recognition, and access to support and management of disability in Indigenous Australian children. Results: Twenty-seven peer-reviewed journal articles met inclusion criteria. The majority of articles focused on the hearing loss and learning disabilities consequent of otitis media. Few articles reported data on urban or metropolitan Indigenous populations or described interventions. Individual/community-, provider-, and systems level factors were identified as impacting on recognition and management of disability in young Indigenous children. Conclusions: Given the burden of childhood disability, the limited literature retrieved is concerning as this is a barometer of activity and investment. Solutions addressing childhood disability will require collaboration between health, social and educational disciplines as well as an increased investment in prevention, identification and promotion of access. &copy; 2013 DiGiacomo et al.; licensee BioMed Central Ltd.
Davidson, P.M., Jiwa, M., DiGiacomo, M.L., McGrath, S.J., Newton, P.J., Durey, A.J., Bessarab, D.C. & Thompson, S.C. 2013, 'The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery', Australian Health Review, vol. 37, no. 1, pp. 70-78.
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Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples' engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health prof...
Saltman, D., Jackson, D., Newton, P.J. & Davidson, P.M. 2013, 'In pursuit of certainty: Can the systematic review process deliver?', BMC Medical Informatics and Decision Making, vol. 13, no. 1.
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Background: There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension. Methods. We searched the Cochrane database and identified 25 relevant SRs incorporating 443 clinical trials. Reviews with the terms 'blood pressure' or 'hypertension' in the title were included. Once selected for inclusion, the abstracts were assessed independently by two authors for their capacity to inform and influence clinical decision-making. The inclusions were independently audited by a third author. Results: Of the 25 SRs that formed the sample, 12 provided conclusive findings to inform a particular treatment pathway. The evidence-based approaches offer the promise of assisting clinical decision-making through clarity, but in the case of management of blood pressure, half of the SRs in our sample highlight gaps in evidence and methodological limitations. Thirteen reviews were inconclusive, and eight, including four of the 12 conclusive SRs, noted the lack of adequate reporting of potential adverse effects or incidence of harm. Conclusions: These findings emphasise the importance of distillation, interpretation and synthesis of information to assist clinicians. This study questions the utility of evidence-based approaches as a uni-dimensional approach to improving clinical care and underscores the importance of standardised approaches to include adverse events, incidence of harm, patient's needs and preferences and clinician's expertise and discretion. &copy; 2013 Saltman et al; licensee BioMed Central Ltd.
Betihavas, V., Newton, P.J., Frost, S.A., MacDonald, P.S. & Davidson, P.M. 2013, 'Patient, provider and system factors influencing rehospitalisation in adults with heart failure', Contemporary Nurse, vol. 43, no. 2, pp. 244-256.
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Objectives: To identify patient, provider and system factors predicting rehospitalisation in adults with heart failure (HF). Method: The electronic data bases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and PsychInfo were searched from 1996-2008 to identify studies identifying predictors of rehospitalisation from which the factors of patient, provider and systems were extracted. Results: A total of 62 elements were identified. These elements were then sorted into patient, provider and system categories. Risk factors identified for rehospitalisation were predominantly related to clinical factors. There were less factors identifying risk from the perspective of provider and health care systems. Conclusions: In people with HF it is likely that non-clinical factors including provider and system play an important role in rehospitalisation. There is a need to identify individuals at risk of rehospitalisation and tailor disease management programmes accordingly. &copy; eContent Management Pty Ltd.
Chang, S., Davidson, P.M., Newton, P.J., Krum, H., Salamonson, Y. & MacDonald, P. 2013, 'What is the methodological and reporting quality of health related quality of life in chronic heart failure clinical trials?', International Journal of Cardiology, vol. 164, no. 2, pp. 133-140.
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Background: Although the number of clinical trials assessing health related quality of life (HRQoL) in chronic heart failure (CHF) has increased exponentially over the last decade, little is known about the quality of reporting. The purpose of this review was to assess the methodological and reporting rigor of HRQoL in RCTs of pharmacological therapy in CHF. Methods: The electronic data bases, Medline and EMBASE were searched from 1990 to 2009 using the key search terms 'heart failure' combined with 'quality of life', 'pharmacological therapy' and 'randomized controlled trials'. A total of 136 articles were identified and evaluated according to the "Minimum Standard Checklist (MSC) for Evaluating HRQoL Outcomes". Results: According to the MSC criteria, 26 (19.1%) studies were considered 'very limited', 91 (66.9%) were 'limited' and only 19 (14.0%) studies were considered to be of a 'probably robust' in terms of methodological and reporting rigor. In fact, the quality of HRQoL reporting has not improved over time. Conclusion: HRQoL is a critical consideration in CHF management, yet reporting is highly variable. There is a need to develop a standardized method for measuring and reporting HRQoL measures in clinical trials to aid in the interpretation and application of findings. &copy; 2011 Elsevier Ireland Ltd.
Driscoll, A., Tonkin, A., Stewart, A., Worrall-Carter, L., Thompson, D.R., Riegel, B., Hare, D.L., Davidson, P.M., Mulvany, C. & Stewart, S. 2013, 'Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less?', J Clin Nurs, vol. 22, no. 11-12, pp. 1629-1638.
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AIMS AND OBJECTIVES: To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). BACKGROUND: The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. DESIGN: Prospective cohort study of patients participating in heart failure programmes. METHOD: Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ? 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. RESULTS: Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. CONCLUSION: High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. RELEVANCE TO CLINICAL PRACTICE: The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.
Hosie, A., Davidson, P.M., Agar, M., Sanderson, C.R. & Phillips, J. 2013, 'Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review', PALLIATIVE MEDICINE, vol. 27, no. 6, pp. 486-498.
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Davidson, P.M., Inglis, S.C. & Newton, P.J. 2013, 'Self-care in patients with chronic heart failure', Expert Review of Pharmacoeconomics and Outcomes Research, vol. 13, no. 3, pp. 351-359.
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Globally, chronic heart failure is a common, complex syndrome characterized by high levels of healthcare utilization, reduced quality of life and premature mortality. Self-care is a complex decision-making process involving symptom recognition, action and evaluation. The purpose of this article is to define self-care, discuss barriers and facilitators in promoting adherence and summarize the methods available for assessing the individual's capacity to be an active partner in care. The appraisal to undertake self-care will require not only assessment of the individuals' clinical, psychological, social and cultural circumstances, but also the capacity of healthcare providers and healthcare systems to accommodate patients as partners in care. &copy; 2013 Expert Reviews Ltd.
Driscoll, A., Currey, J., George, M. & Davidson, P.M. 2013, 'Changes in health service delivery for cardiac patients: Implications for workforce planning and patient outcomes', Australian Critical Care, vol. 26, no. 2, pp. 55-57.
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Background: Traditional dedicated coronary care units (CCU) are being decommissioned and cardiology precincts are evolving. These precincts often have cardiac and non-cardiac patients with a diverse array of acuity levels. Critical care trained cardiac nurses are frequently caring for lower acuity patients resulting in a deskilling of this experienced workforce. Aim: The aim of this paper was to discuss the implications of restructuring CCUs on nursing workforce and patient outcomes. Method: An integrated literature review was conducted. The following databases were searched for articles published between January 2000 and December 2011: Ovid Medline, CINHAL, EMBASE and Cochrane. Additional studies obtained from the articles searched and policy documents from key professional organisations and government departments were reviewed. Results: This review has highlighted the association between workforce, qualifications and quality of care. Studies have shown the relationship between an increase in critical care qualified nursing staff and an improvement in patient outcomes. Inadequate staffing levels were also shown to be associated with an increase in adverse events. Cardiology precincts have the potential to adversely impact on critical care trained cardiac nursing workforce and patient outcomes. Conclusion: The implications that these new models have on the critical care cardiac nurse workforce are crucial to health care reform, quality of in-hospital care, sentinel events and patient outcomes. &copy; 2012 Australian College of Critical Care Nurses Ltd.
Phillips, J.L., West, P.A., Davidson, P.M. & Agar, M. 2013, 'Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: Evidence from an integrative review?', International Journal of Nursing Studies, vol. 50, no. 8, pp. 1122-1135.
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Objective: This integrative review aimed to appraise the evidence for case conferencing as an intervention to improve palliative care outcomes for older people living with advanced dementia in nursing homes. Design: An integrative review of English language citations from CINHAL, MEDLINE, PSYCHINFO and CareSearch using a palliative care filter was undertaken. Two reviewers screened 238 titles to find 77 relevant articles which were reviewed in detail to identify nine studies that addressed the specific review questions. The analysis process allowed study characteristics, process and outcome measures along with implementation barriers and facilitators to be identified and the results synthesised. Results: The highest level of evidence (Level II) was generated by two randomised controlled case conferencing trials which demonstrated enhance medication management for people with dementia living in a nursing home. Several pre-post test studies suggest that case conferencing enhances palliative symptom management and care outcomes in nursing homes. Qualitative evidence suggests that case conferencing is feasible and worthwhile if the identified barriers are addressed and the facilitators optimised. Conclusions: Case conferencing provides opportunities to improve care palliative care outcomes for older people with dementia by engaging family and all relevant internal and external health providers in prospective care planning. More evidence is needed to determine the efficacy and cost-effectiveness of case conferencing as a strategy for improving care outcomes for older people living with advanced dementia in nursing homes. The evidence generated by this integrative review will be of interest to policy makers, aged care organisations and clinicians alike, especially as services endeavour to meet the increasingly complex care needs of older people admitted to nursing homes with advanced dementia, and the needs of their families. &copy; 2012 Elsevier Ltd.
Digiacomo, M., Delaney, P., Abbott, P., Davidson, P.M., Delaney, J. & Vincent, F. 2013, ''Doing the hard yards': Carer and provider focus group perspectives of accessing Aboriginal childhood disability services', BMC Health Services Research, vol. 13, no. 1.
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Background: Despite a high prevalence of disability, Aboriginal Australians access disability services in Australia less than non-Aboriginal Australians with a disability. The needs of Aboriginal children with disability are particularly poorly understood. They can endure long delays in treatment which can impact adversely on development. This study sought to ascertain the factors involved in accessing services and support for Aboriginal children with a disability. Methods. Using the focus group method, two community forums, one for health and service providers and one for carers of Aboriginal children with a disability, were held at an Aboriginal Community Controlled Health Service (ACCHS) in the Sydney, metropolitan area of New South Wales, Australia. Framework analysis was applied to qualitative data to elucidate key issues relevant to the dimensions of access framework. Independent coding consistency checks were performed and consensus of analysis verified by the entire research team, several of whom represented the local Aboriginal community. Results: Seventeen health and social service providers representing local area government and non-government-funded health and social service organisations and five carers participated in two separate forums between September and October 2011. Lack of awareness of services and inadequate availability were prominent concerns in both groups despite geographic proximity to a major metropolitan area with significant health infrastructure. Carers noted racism, insufficient or non-existent services, and the need for an enhanced role of ACCHSs and AHWs in disability support services. Providers highlighted logistical barriers and cultural and historical issues that impacted on the effectiveness of mainstream services for Aboriginal people. Conclusions: Despite dedicated disability services in an urban community, geographic proximity does not mitigate lack of awareness and availability of support. This paper has enumerated a num...
Luckett, T., Davidson, P.M., Green, A., Boyle, F., Stubbs, J. & Lovell, M. 2013, 'Assessment and management of adult cancer pain: A systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care', Journal of Pain and Symptom Management, vol. 46, no. 2, pp. 229-253.
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Context: Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines. Objectives: To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care. Methods: We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of "Results," 2) organization into "descriptive" themes, and 3) development of "analytical" themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie "fit" for descriptive themes. Results: Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated. Conclusion: Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials. &copy; 2013 U.S....
Hosseini, M., Davidson, P.M., Khoshknab, M.F. & Green, A.R. 2013, 'Spiritual and religious interventions in health care: an integrative review', Iranian Rehabilitation Journal, vol. 11, no. 17, pp. 120-129.
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Objective: To describe research on spiritual and religious interventions in Iran.
Davidson, P.M., Daly, J. & Hill, M.N. 2013, 'Editorial: Looking to the future with courage, commitment, competence and compassion', Journal of Clinical Nursing, vol. 22, no. 19-20, pp. 2665-2667.
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Davidson, P.M. & Himmelfarb, C.D. 2013, 'Population Health Studies - What Do They Tell Us?', Heart Lung and Circulation, vol. 22, no. 11, pp. 885-886.
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Digiacomo, M., Lewis, J., Nolan, M.T., Phillips, J. & Davidson, P.M. 2013, 'Transitioning from caregiving to widowhood', Journal of Pain and Symptom Management, vol. 46, no. 6, pp. 817-825.
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Context: Older women commonly assume a caregiving role for their husbands at the end of life and are more vulnerable to poorer health, well-being, and social and economic challenges. Objectives: The aim of this study was to ascertain older women's experiences of spousal caregiving at the end of life and the ways in which this experience impacts on the transition to widowhood. Methods: Longitudinal, in-depth, semistructured interviews were conducted with older women three times over a one-year period after the death of their husbands. This report focuses on the initial interviews that examined the transition from caregiving to widowhood. Transcripts were analyzed using interpretive phenomenological analysis methods. Participants were community-dwelling women older than 65 years who had recently been caregivers for their husbands who died within the past two years. Results: Older women caregivers described their caregiver role as taxing, particularly in light of their own chronic conditions that they failed to prioritize and address. They did not ask for help in managing their roles and health problems, but quietly endured. Hence, they did not communicate their needs or strains explicitly. The degree of perceived adequacy of communication and interaction with health professionals were important factors impacting on their bereavement. Conclusion: It is imperative for health professionals to appreciate that older women caregivers may need more supportive interaction and information during the end-of-life caregiving, they may have expectations of communication, and they may deny or fail to focus on their own health issues. A patient/family/carer- centered approach could negate this oversight and improve the outcomes for these women as they transition into widowhood. &copy; 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
DeVito Dabbs, A., Song, M., De Geest, S. & Davidson, P.M. 2013, 'Promoting Patient and Caregiver Engagement in Self-Management of Chronic Illness', Nursing Research and Practice, vol. 2013, pp. 1-2.
As a nursing professional you are no doubt aware of the growing prevalence of people with chronic conditions and the problems they face interacting and getting support from health care systems that are designed to deal with acute problems. Chronic diseases, such as heart disease, stroke, cancer, respiratory diseases and diabetes, are by far the leading cause of morbidity and mortality in the world. Furthermore, more than half of individualswith one chronic condition have multiple chronic conditions, increasing the complexity and burden of managing their health.
Soh, K.L., Davidson, P.M., Leslie, G., Digiacomo, M. & Soh, K.G. 2013, 'Nurses' perceptions of standardised assessment and prevention of complications in an ICU', Journal of Clinical Nursing, vol. 22, no. 5-6, pp. 856-865.
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Aims and objectives: To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Background: Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. Design: A qualitative focus group study. Methods: Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Results: Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Conclusion: Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. Relevance to clinical practice: These findings provide valuable information for implementing clinical practice improvement interventions. &copy; 2012 Blackwell Publishing Ltd.
Inglis, S.C., Hermis, A., Shehab, S., Newton, P.J., Lal, S. & Davidson, P.M. 2013, 'Peripheral arterial disease and chronic heart failure: A dangerous mix', Heart Failure Reviews, vol. 18, no. 4, pp. 457-464.
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Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD. &copy; 2012 Springer Science+Business Media, LLC.
Gholizadeh, L., Salamonson, Y., Heydari, M. & Davidson, P.M. 2013, 'Cardiac patients' causal attributions for coronary heart disease', International Journal of Research in Nursing, vol. 4, no. 1, pp. 22-28.
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Accurate casual attributions for CHD have been associated with more congruent risk reduction behaviours and improved health outcomes. This article aimed to assess causal attributions for Coronary Heart Disease (CHD) of Middle Eastern women diagnosed with heart disease using different risk targets and compare these attributions with participants actual.
MacDonald, P.S., Newton, P.J. & Davidson, P.M. 2013, 'The SNAPSHOT ACS study: Getting the big picture on acute coronary syndrome: How snapshot methodology identifies factors limiting translation of evidence to practice', Medical Journal of Australia, vol. 199, no. 3, pp. 147-148.
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Hosseini, M., Salehi, A., Fallahi Khoshknab, M., Rokofian, A. & Davidson, P.M. 2013, 'The effect of a preoperative spiritual/religious intervention on anxiety in Shia Muslim patients undergoing coronary artery bypass graft surgery: a randomized controlled trial.', J Holist Nurs, vol. 31, no. 3, pp. 164-172.
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BACKGROUND: Coronary artery bypass grafting (CABG) is associated with anxiety. Preoperative anxiety is considered a predictor for a range of suboptimal postsurgical outcomes. OBJECTIVE: To evaluate the effect of a spiritual/religious training intervention on anxiety in Shia Muslim individuals scheduled for CABG. METHODS: A randomized controlled trial of a preoperative spiritual/religious training intervention, congruent with Islamic supplication (Zikr), was administered in five sessions of 45 minutes duration to test the impact on anxiety in comparison with standard care. Seventy participants were selected based on inclusion criteria and randomly allocated to treatment and control groups. Baseline levels of anxiety and the impact of the intervention were assessed using the Persian version of the Hamilton Anxiety Scale. RESULTS: Baseline characteristics were comparable between the intervention and control groups. Following the intervention, there was a statistically significant difference in anxiety mean scores between intervention (19.48 &plusmn; 2.03) and control groups (43.27 &plusmn; 5.49), p < .001. CONCLUSIONS: This study demonstrates that preoperative spiritual/religious training can reduce anxiety in Muslim patients undergoing CABG. Further evaluation of this intervention in other population groups is warranted and the study underscores the importance of culturally appropriate and interventions.
Lovell, M., Agar, M., Luckett, T., Davidson, P.M., Green, A. & Clayton, J. 2013, 'Australian Survey of Current Practice and Guideline Use in Adult Cancer Pain Assessment and Management: Perspectives of Palliative Care Physicians', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 11, pp. 1403-1409.
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Davidson, P.M. & Dennison-Himmelfarb, C. 2013, 'Population Health Studies - What Do They Tell Us?', Heart, Lung and Circulation, vol. 22, no. 11, pp. 885-886.
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Macdonald, P., Newton, P.J. & Davidson, P.M. 2013, 'The SNAPSHOT ACS study: getting the big picture on acute coronary syndrome', Medical Journal Of Australia, vol. 199, no. 3, pp. 147-148.
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Davidson, P.M. & Dennison- Himmelfarb, C. 2013, 'Population Health Studies - What Do They Tell Us?', Heart, Lung and Circulation, vol. 22, no. 11.
The burden of cardiovascular disease (CVD) is a globalconcern. People living in resource-limited set-tings are affected disproportionately, with more than 80% of CVD deaths occurring in low and middle-income countries. Although inflammatory and rheumatic heart diseases remain common in these countries atherosclerosis is becoming a critical concern.
Disler, R.T., Inglis, S. & Davidson, P.M. 2013, 'Non-pharmacological management interventions for COPD: an overview of Cochrane systematic reviews (Protocol)', The Cochrane Database of Systematic Reviews, vol. 2, pp. 1-8.
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summarise the evidence, b) identify gaps in the evidence base and c) describe elements of non-pharmacological, non-surgical and non-device interventions for the management of COPD using a standardised taxonomy for disease management adapted from the American Heart Association (Krumholz 2006).
Betihavas, V., Newton, P.J., Frost, S.A., Alexandrou, E., Macdonald, P.S. & Davidson, P.M. 2013, 'Importance of Predictors of Rehospitalisation in Heart Failure: A Survey of Heart Failure Experts', Heart Lung and Circulation, vol. 22, no. 3, pp. 179-183.
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Aims: We investigated the opinion of clinical experts and researchers involved in chronic heart failure disease management regarding the ranking of patient, provider and system factors that predict the risk of rehospitalisation. Methods: Item generation for the online survey was informed by a literature review and current risk prediction models. Consultation with experts was undertaken via a secure online survey platform. Invitations to participate in the 10 question online survey were sent through Listserves of professional nursing and medical associations within Australia and New Zealand. Results: Data were collected in August 2011. A total of 119 respondents completed the survey. Respondents ranged from researchers, registered nurses, cardiologists and allied health personnel. A mean importance score was used to rank risk factors for rehospitalisation. Risk factors that scored high for predicting the risk for rehospitalisation included poor adherence to medications (9.04) and prior hospitalisation for heart failure (8.33). Having private health insurance (4.8) and being female (4.9) scored lower in influencing rehospitalisation for adults with heart failure. Conclusions: No new risk factors were identified from the experts in predicting the risk of rehospitalisation. The survey results will contribute to the development of a nomogram to convey prognostic information related to adults with heart failure that will guide clinicians in management decisions. &copy; 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
Deek, H., Abbott, P., Moore, L., Davison, J., Cameron, S., DiGiacomo, M., McGrath, S.J., Dharmendra, T. & Davidson, P.M. 2013, 'Pneumococcus in aboriginal and Torres Strait Islander peoples: The role of aboriginal health workers and implications for nursing practice', Contemporary Nurse, vol. 46, no. 1, pp. 54-58.
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Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and gray literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: Pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
Westlake, C., Sethares, K. & Davidson, P.M. 2013, 'How Can Health Literacy Influence Outcomes in Heart Failure Patients? Mechanisms and Interventions', Current Heart Failure Reports, vol. 10, no. 3, pp. 232-243.
Health literacy is discussed in papers from 25 countries where findings suggest that approximately a third up to one half of the people in developed countries have low health literacy.
Siabani, S., Leeder, S. & Davidson, P.M. 2013, 'Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies', SpringerPlus, vol. 2, pp. 1-14.
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Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF? Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients?>?18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care were included factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; and factors related to environment and self-care system. Important factors such as socioeconomic situation and education level have not been explored extensively and there were minimal data on the influence of age, gender, self-confidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators to self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF.
Krum, H., Forbes, A., Yallop, J., Driscoll, A., Croucher, J., Chan, B., Clark, R., Davidson, P.M., Huynh, L., Kasper, E.K., Hunt, D., Egan, H., Stewart, S., Piterman, L. & Tonkin, A. 2013, 'Telephone Support to Rural and Remote Patients with Heart Failure: The Chronic Heart Failure Assessment by Telephone (CHAT) study', Cardiovascular Therapeutics, vol. 31, no. 1, pp. 230-237.
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Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses.
Marie, N., Luckett, T., Davidson, P.M., Lovell, M. & Lal, S. 2013, 'Optimal patient education for cancer pain: A systematic review and theory-based meta-analysis', Supportive Care in Cancer, vol. 21, no. 12, pp. 3529-3537.
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Purpose: Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal. Methods: A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews and MEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model. Results: Fifteen randomized controlled trials met the criteria. As expected, meta-analysis identified a small-moderate ES favoring education versus usual care (ES, 0.27 [-0.47, -0.07]; P = 0.007) with substantial heterogeneity (I&Acirc;= 71 %). Subgroup analyses based on the taxonomy found that interventions using "enablement" were efficacious (ES, 0.35 [-0.63, -0.08]; P = 0.01), whereas those lacking this component were not (ES, 0.18 [-0.46, 0.10]; P = 0.20). However, the subgroup effect was nonsignificant (P = 0.39), and heterogeneity was not reduced. Factoring in the variable of individualized versus non-individualized influenced neither efficacy nor heterogeneity. Conclusions: The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement. &copy; 2013 Springer-Verlag Berlin Heidelberg.
Whitty, J.A., Stewart, S., Carrington, M.J., Calderone, A., Marwick, T., Horowitz, J.D., Krum, H., Davidson, P.M., Macdonald, P.S., Reid, C. & Scuffham, P.A. 2013, 'Patient Preferences and Willingness-To-Pay for a Home or Clinic Based Program of Chronic Heart Failure Management: Findings from the Which? Trial', PLoS ONE, vol. 8, no. 3, pp. e58347-e58347.
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Stewart, S., Carrington, M.J., Marwick, T.H., Davidson, P.M., MacDonald, P., Horowitz, J.D., Krum, H., Newton, P.J., Reid, C., Chan, Y.K. & Scuffham, P.A. 2012, 'Impact of home versus clinic-based management of chronic heart failure: The WHICH? (Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care) multicenter, randomized trial', Journal of the American College of Cardiology, vol. 60, no. 14, pp. 1239-1248.
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Objectives: The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Background: Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. Methods: This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 &plusmn; 14 years, and 73% with left ventricular ejection fraction ?45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. Results: The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days; p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (-35%; p = 0.003) and from cardiovascular causes (-37%; p = 0.025) but not for CHF (-24%; p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day; p = 0.030). Conclusions: HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was assoc...
Disler, R.T., Inglis, S., Currow, D. & Davidson, P.M. 2012, 'Palliative and supportive care in COPD: research priorities to decrease suffering.', Journal of Pulmonary and Respiratory Medicine, vol. 1, no. 6, pp. 1-3.
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Chronic obstructive pulmonary disease (COPD) affects 80 million people worldwide, is the fourth most prevalent cause of death globally and accounts for 3.5% of total years lost due to disability. Despite the similarities with malignant disease, many individuals suffer unnecessarily and continue to have limited access to palliative and endof-life care.
Disler, R.T., Currow, D.C., Phillips, J.L., Smith, T., Johnson, M.J. & Davidson, P.M. 2012, 'Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: An integrative review', International Journal of Nursing Studies, vol. 49, no. 11, pp. 1443-1458.
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Background: End-stage chronic obstructive pulmonary disease (COPD) is a debilitating, life-limiting condition. A palliative approach is appropriate for individuals with end-stage COPD, yet currently few interventions embrace this holistic, multidisciplinary and inclusive perspective. Objective: To describe interventions to support a palliative care approach in patients with end-stage COPD. Design: Integrative review. Data sources and review method: Peer reviewed articles meeting the search criteria were accessed from Medline, PsychINFO, CINAHL and Google Scholar databases as well as Caresearch online resource. The domains of quality palliative care developed by Steinhauser were used as the conceptual framework to synthesise information. Results: This review has shown that a range of palliative interventions are used to address the needs of individuals with end-stage COPD. Although evidence exists for discrete elements of palliative management in this patient group, there is limited evidence for health service coordination and models that integrate the multiple domains of palliative care with active management. Conclusion: Further investigation is required to address the complex personal, provider and system elements associated with managing end-stage COPD. A comprehensive and collaborative approach is required to address the complex and varied needs of individuals with end-stage COPD and their families. &copy; 2012 Elsevier Ltd.
Davidson, P.M., Sindhu, S. & Meleis, A.I. 2012, 'Women's health is now core business and a global health issue', Collegian, vol. 19, no. 1, pp. 1-3.
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Deasy, C., Bray, J.E., Smith, K., Harriss, L.R., Bernard, S.A., Davidson, P.M. & Cameron, P. 2012, 'Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities in Melbourne, Australia', Resuscitation, vol. 83, no. 1, pp. 58-62.
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Introduction: CPR in patients in residential aged care facilities (RACF) deserves careful consideration. We examined the characteristics, management and outcomes of out-of-hospital cardiac arrest (OHCA) in RACF patients in Melbourne, Australia. Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for all OHCAs occurring in RACFs in Melbourne. The characteristics and outcomes were compared to non-RACF patients in the VACAR. Results: Between 2000 and 2009 there were 30,006 OHCAs, 2350 (7.8%) occurring in a RACF.A shockable rhythm was present in 179 (7.6%) patients on arrival of paramedics of whom bystander CPR had been performed in 118 (66%); 173 (97%) received an EMS attempted resuscitation. ROSC was achieved in 71 (41%) patients and 15 (8.7%) patients survived to leave hospital. Non shockable rhythm was present in 2171 patients (92%) of whom 804 (37%) had an attempted resuscitation by paramedics. ROSC was achieved in 176 patients (22%) and 10 patients (1.2%) were discharged alive. Survival from OHCA occurring in a RACF was less than survival in those aged >70 years of age who suffered OHCA in their own homes (1.8% vs. 4.7%, p=0.001). On multivariable analysis, witnessed OHCA (OR 3.0, 95% CI 2.4-3.7) and the presence of bystander CPR (OR 4.6, 95% CI 3.7-5.8) was associated with the paramedic decision to resuscitate. Conclusion: Resuscitation of patients in RACF is not futile. However, informed decisions concerning resuscitation status should be made by patients and their families on entry to a RACF. Where it is appropriate to perform resuscitation, outcomes may be improved by the provision of BLS training and possibly AED equipment to RACF staff. &copy; 2011 Elsevier Ireland Ltd.
Davidson, P.M., Mitchell, J.A., DiGiacomo, M., Inglis, S.C., Newton, P.J., Harman, J. & Daly, J. 2012, 'Cardiovascular disease in women: Implications for improving health outcomes', Collegian, vol. 19, no. 1, pp. 5-13.
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Objective: To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. Design: Literature review. Results: *Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction.*Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven.*Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications.*The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors.*Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women.*Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina.*Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. Conclusions: Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government. &copy; 2011 Royal College of Nursing, Australia.
Alexandrou, E., Murgo, M., Calabria, E., Spencer, T.R., Carpen, H., Brennan, K., Frost, S.A., Davidson, P.M. & Hillman, K.M. 2012, 'Nurse-led central venous catheter insertion-Procedural characteristics and outcomes of three intensive care based catheter placement services', International Journal of Nursing Studies, vol. 49, no. 2, pp. 162-168.
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Background: Nurse-led central venous catheter placement is an emerging clinical role internationally. Procedural characteristics and clinical outcomes is an important consideration in appraisal of such advanced nursing roles. Objectives: To review characteristics and outcomes of three nurse-led central venous catheter insertion services based in intensive care units in New South Wales, Australia. Design: Using data from the Central Line Associated Bacteraemia project in New South Wales intensive care units. Descriptive statistical techniques were used to ascertain comparison rates and proportions. Participants: De-identified outcome data of patients who had a central venous catheter inserted as part of their therapy by one of the four advanced practice nurses working in three separate hospitals in New South Wales. Results: Between March 2007 and June 2009, 760 vascular access devices were placed by the three nurse-led central venous catheter placement services. Hospital A inserted 520 catheters; Hospital C with 164; and Hospital B with 76. Over the study period, insertion outcomes were favourable with only 1 pneumothorax (1%), 1 arterial puncture (1%) and 1 CLAB (1%) being recorded across the three groups. The CLAB rate was lower in comparison to the aggregated CLAB data set [1.3 per 1000 catheters (95% CI. = 0.03-7.3) vs. 7.2 per 1000 catheters (95% CI = 5.9-8.7)]. Conclusion: This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities. &copy; 2011.
Smith, T.A., Davidson, P.M., Lam, L.T., Jenkins, C.R. & Ingham, J.M. 2012, 'The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; A systematic review', Respirology, vol. 17, no. 2, pp. 300-307.
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Background and objective: Non-invasive ventilation (NIV) improves outcomes in patients with acute exacerbations of COPD (AECOPD); however, the efficacy in relieving dyspnoea is uncertain. The objective of this systematic review was to identify, synthesize and interpret the data regarding the relief of dyspnoea afforded by NIV in patients admitted with acute respiratory failure occurring during AECOPD. Methods: Randomized controlled trials (RCTs) comparing usual medical care (UMC) to UMC plus NIV and reporting dyspnoea as a patient-reported outcome were identified by searching relevant databases and manual searching. The full text of potentially relevant articles was retrieved. Data describing the impact of NIV on dyspnoea was extracted. Results: Four RCTs met the review criteria. One found NIV did not relieve dyspnoea. The other three RCTs reported NIV relieving dyspnoea. The degree of dyspnoea relief was clinically significant in two of these three studies. However, in all but one RCT, methodological or reporting limitations constrain the confidence that can be had in this conclusion. Conclusions: Limited data exist to determine if NIV relieves subjective dyspnoea in AECOPD. Due to limitations in these studies, it is not possible to definitively conclude if NIV relieves dyspnoea. Standardized reporting and analysis of patient reported outcomes will facilitate objective comparisons of interventions with respect to symptom relief. Future studies involving NIV should routinely incorporate patient reported outcomes in order to answer the important clinical question: 'Does NIV relieve dyspnoea?' Patient with AECOPD are usually dyspnoeic. This systematic review asks: 'Does NIV relieve dyspnoea in AECOPD?' The data contained in the four RCTs meeting inclusion criteria was insufficient to reach a definitive conclusion. An increased focus on patient reported outcomes is essential if this important question is to be answered. &copy; 2011 Asian Pacific Society of Respirology.
Newton, P.J., Davidson, P.M. & Sanderson, C. 2012, 'An online survey of Australian physicians reported practice with the off-label use of nebulised frusemide', BMC Palliative Care, vol. 11.
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Background: Off-label prescribing is common in palliative care. Despite inconsistent reports of the benefit of nebulised frusemide for breathlessness, its use continues to be reported. Methods. An online survey was emailed to 249 members of the Australian and New Zealand Society of Palliative Medicine to estimate the use of nebulised frusemide for breathlessness by Australian physicians involved in palliative care in the previous 12 months. Results: There were 52/249 (21%) respondents to the survey. The majority (44/52; 85%) had not prescribed nebulised frusemide in the previous 12 months. The most common (18/44; 43%) reason for not prescribing nebulised frusemide was a belief that there was not enough evidence to support its use. Whilst only a few respondents (8/52; 15%) reported having used nebulised frusemide, all that had used it thought there was at least some benefit in relieving breathlessness. Conclusion: This report adds to the series of case studies reporting some benefit from nebulised frusemide in relieving breathlessnes. &copy; 2012 Newton et al.; licensee BioMed Central Ltd.
Du, H., Everett, B., Newton, P.J., Salamonson, Y. & Davidson, P.M. 2012, 'Self-efficacy: A useful construct to promote physical activity in people with stable chronic heart failure', Journal of Clinical Nursing, vol. 21, no. 3-4, pp. 301-310.
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Aim. To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. Background. The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual's level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. Design. Discursive. Methods. Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. Conclusions. Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. Relevance to clinical practice. The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity. &copy; 2011 Blackwell Publishing Ltd.
Davidson, P.M. & Reid, C. 2012, 'Population screening an important step in identifying and increasing awareness of cardiovascular disease in developing countries', Heart Lung and Circulation, vol. 21, no. 2, pp. 61-62.
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McKenna, H., Daly, J., Davidson, P., Duffield, C. & Jackson, D. 2012, 'RAE and ERA-Spot the difference', International Journal of Nursing Studies, vol. 49, no. 4, pp. 375-377.
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Juntasopeepun, P., Davidson, P.M. & Srisomboon, J. 2012, 'Issues and challenges in implementing cervical cancer screenings in the emergence of HPV vaccination in Thailand', Collegian, vol. 19, no. 1, pp. 45-50.
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The discovery of the HPV vaccine has been a major breakthrough in preventing cervical cancer and other HPV-related diseases around the globe. Cervical cancer is a significant public health problem in Thailand. Despite the long-time availability of cervical cancer screening programs in Thailand, the uptake among the target female population remains low. HPV vaccines were approved by the Food and Drug Administration of Thailand in 2007. As of March 2011, due to financial limitations, HPV vaccines have still not been included in the national immunization program under the public health benefit plans although individuals has the option to pay privately for the vaccine. This paper discusses the issues and challenges in implementing cervical cancer screening programs in the era of HPV vaccination in Thailand. Recommendations to increase the uptake of cervical cancer screening and further research to inform a policy regarding the cervical cancer screening measures are proposed. &copy; 2011 Royal College of Nursing, Australia.
Jiwa, M., Davidson, P.M., Newton, P.J., DiGiacomo, M., McGrath, S. & Lotriet, C. 2012, 'Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia', Journal of Cancer Therapy, vol. 3, no. 4A, pp. 1-6.
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Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two- phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualita-tive thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was con-sidered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people un-der-report morbidity related to smoking and chronic obstructive pulmonary disease; other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes.
Durey, A., Wynaden, D., Thompson, S.C., Davidson, P.M., Bessarab, D. & Katzenellenbogen, J.M. 2012, 'Owning solutions: A collaborative model to improve quality in hospital care for Aboriginal Australians', Nursing Inquiry, vol. 19, no. 2, pp. 144-152.
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Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. &copy; 2011 Blackwell Publishing Ltd.
Disler, R.T., Gallagher, R.D. & Davidson, P.M. 2012, 'Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review', International Journal of Nursing Studies, vol. 49, no. 2, pp. 230-242.
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Background: Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g. personal) and external (e.g. health service) factors. Objectives: This paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research. Design: Integrative review. Data sources: Medline, Embase, PubMed, CINAHL, Google Scholar. Review methods: Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care. Findings: Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management. Conclusions: Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition. &copy; 2011 Elsevier Ltd.
Newton, P.J., Davidson, P.M., Krum, H., Ollerton, R. & Macdonald, P. 2012, 'The Acute Haemodynamic Effect of Nebulised Frusemide in Stable, Advanced Heart Failure', Heart Lung and Circulation, vol. 21, no. 5, pp. 260-266.
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Purpose: To assess the acute haemodynamic effects of nebulised frusemide in a stable advanced heart failure population. Procedure: In this randomised, double blind, placebo controlled trial, people with stable, advanced heart failure undergoing right heart catheterisation were randomised to receive either 40. mg (4. ml) of nebulised frusemide or 4. ml of normal saline. Following inhalation of the study medication, subjects' pulmonary pressures were recorded every 15. min for 1. h. Findings: There were no significant changes in the weighted average time course data of the subjects (n= 32) in either group over the study period, in particular no differences were observed in haemodynamic parameters between the two groups. Weighted average pulmonary capillary wedge pressure after 60. min in the frusemide group was 22.5 (SD 6.5) mmHg (n= 14) compared to the placebo group's 24.0 (SD 7.3) mmHg (n= 18), p= 0.55. The frusemide group had a significantly greater change in the median volume of urine in the bladder over the study period (186. ml IQR 137.8-260.8) compared to the placebo group (76. ml IQR 39.0-148.0) p= 0.02. Conclusion: This study showed that nebulised frusemide had no significant clinical effect on the haemodynamic characteristics of the subjects. &copy; 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
Gallagher, R., Kirkness, A., Armari, E. & Davidson, P.M. 2012, 'Participants' perspectives of a multi-component, group-based weight loss programme supplement for cardiac rehabilitation: a qualitative study.', Int J Nurs Pract, vol. 18, no. 1, pp. 28-35.
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Addressing overweight and obesity in people with cardiovascular risk factors is an important aspect of cardiac rehabilitation, but minimal implementation of targeted strategies has occurred. The aim of this study was to describe participants' perspectives of a multi-component, group-based weight loss supplement to cardiac rehabilitation programmes. Four focus groups of participants completing the intervention (n = 16) and maintenance phases (n = 19) of the Healthy Eating and Exercise Lifestyle Program (HEELP) were conducted. Interviews were transcribed and thematically analyzed using an inductive process. The overall theme of participants' responses was that HEELP helped them reprogramme their lifestyle behaviours to achieve weight loss. The programme was unique compared with other weight loss programmes because it was delivered and developed by familiar and expert health professionals who tailored the programme to participants' health status. Themes included the process of recognizing and deciding to make a commitment to managing their weight problem and feeling supported by the group and the staff to do this. Participants valued the group-based structure and the specific tools used in the programme. The programme content and structure provides a framework for the development of supplemental programmes for overweight and obese people at high cardiovascular risk.
Bernal, D.D.L., Stafford, L., Bereznicki, L.R.E., Castelino, R.L., Davidson, P.M. & Peterson, G.M. 2012, 'Home medicines reviews following acute coronary syndrome: Study protocol for a randomized controlled trial', Trials, vol. 13.
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Background: Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/Design: We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.Discussion: As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the t...
Gallagher, R., Kirkness, A., Armari, E. & Davidson, P.M. 2012, 'Weight management issues and strategies for people with high cardiovascular risk undertaking an Australian weight loss program: a focus group study.', Nurs Health Sci, vol. 14, no. 1, pp. 18-24.
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Obesity is particularly hazardous for people with multiple cardiovascular risk factors and existing cardiovascular disease, although few studies investigate experiences and perceptions of weight loss in this population. This study provides an understanding of participants' knowledge, attitudes, and experiences of managing multiple risk factors and/or existing cardiovascular disease of participants who were undertaking a weight loss program. Thirty-five participants were recruited from the first 50 completing a multicomponent group-based weight loss intervention designed to follow cardiovascular disease and diabetes disease management programs. Four focus group interviews were conducted using a semistructured interview schedule. Data were analyzed using an inductive approach, and themes developed. Participants found the process of weight loss to be complex, dynamic, and challenging, as the conflicting needs of existing health conditions, social support, ambivalence, and time limitations required careful balance. In response, participants determinedly developed and tested strategies based on simplified principles, establishing routines for new health habits and portion control, and going back to basics in food selection. Therefore, weight loss programs for this population need to be specifically tailored to support patients' efforts and strategies.
Salamonson, Y., Everett, B., Koch, J., Andrew, S. & Davidson, P.M. 2012, 'The impact of term-time paid work on academic performance in nursing students: A longitudinal study', International Journal of Nursing Studies, vol. 49, no. 5, pp. 579-585.
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Background: Nursing students in higher education are spending more time in paid employment despite evidence that this can impact negatively on academic performance. Objectives: To examine the effect of paid work on academic performance in undergraduate nursing students. Design: Descriptive, correlational survey with longitudinal follow-up. Participants: Nursing students in metropolitan Sydney, Australia. Methods: First year nursing students surveyed at baseline were followed up at the end of the final year of their nursing program to examine factors influencing academic performance. Results: Of the 566 Year 1 nursing students who were surveyed in the second semester of their Bachelor of Nursing program, 182 students (32%) completed the follow-up survey in Year 3. The percentage of students engaging in paid work during term-time had increased (. p<. 0.001), from 70% in Year 1 to 84% in Year 3. There was an inverse relationship between mean hours in paid work during term-time and nursing students' GPA in their final year. Taking into account demographic factors, the mean hours spent in paid work during term-time had a negative impact on nursing students' GPA (. p<. 0.001). Conclusion: In view of these findings, we suggest that new models of undergraduate nursing education be explored to include faculty approved nursing-related employment with defined opportunities for learning. This would accommodate the dual roles of undergraduate nursing students as students and employees and therefore not endanger their academic performance. &copy; 2011.
Juntasopeepun, P., Davidson, P.M., Suwan, N., Phianmongkhol, Y. & Srisomboon, J. 2012, 'Human Papillomavirus Vaccination Intention among Young Women in Thailand', Asian Pacific Journal Of Cancer Prevention, vol. 13, no. 12, pp. 3213-3219.
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Aims: The aims of this study were to examine knowledge and beliefs regarding HPV and cervical cancer and to predict HPV vaccination intention among young women in Thailand using a cross-sectional descriptive study design. Methods: A sample of young women aged 18-24 years (n = 391) were recruited from universities/colleges located in Chiang Mai, Thailand. An online survey was carried out to obtain young women's demographic, HPV and cervical cancer-related health characteristics, knowledge, and beliefs toward HPV and cervical cancer. Multivariate logistic regression analysis was used to determine significant independent predictors of HPV vaccination intention. Findings: Five participants (1.2%) had received at least one shot of the HPV vaccine. Of 386 participants, 218 (56.5%) reported high intention to obtain the HPV vaccine. Young women's knowledge about HPV and cervical cancer was moderate. The mean knowledge score was 7.89 (SD, 3.99; range, 0-15). Knowledge was significantly and positively related to perceived susceptibility, perceived seriousness, and perceived benefits of HPV vaccination, but negatively related to perceived barriers to HPV vaccination. Participants with a higher level of knowledge were significantly more likely to obtain the vaccine. A multivariate logistic regression model identified predictors of HPV vaccination intention: recommendations from significant others, perceived susceptibility, perceived benefits, and feeling embarrassed about getting the HPV vaccine. Conclusions: Health education efforts are needed to promote further understanding of HPV and cervical cancer, particularly with more attention to the HPV vaccination.
Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D. & Davidson, P.M. 2012, 'Unmet needs in chronic obstructive pulmonary disease: a metasynthesis protocol', International Journal of Research in Nursing, vol. 3, no. 1, pp. 15-20.
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Abstract: Problem statement: Chronic obstructive pulmonary disease is a chronic progressive illness. Despite the high burden experienced by individuals in the advanced stages of illness, individuals with advanced COPD continue to have unmet needs and limited access to palliative care. This Metasynthesis seeks to describe: the barriers and facilitators care access and provision; the unmet needs of individuals with advanced COPD, their families and carers; and the experiences of health professionals. Data sources: Medline, PsychINFO, AMED, CINAHL and Sociological Abstracts were searched for articles published between 1990 and December 31st 2011. Medical Subject Headings (MeSH) and key words will be used to guide the search. The strategy will be reviewed by the CareSearch palliative knowledge network and a health informatics expert. Approach: Metasyntheses are increasingly used to gain new insights and understandings of complex research questions through the amalgamation of data from individual qualitative studies. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and thematic synthesis will be used to achieve consistent reporting and transparency of methods. Results: Inclusion of studies, quality assessment and allocation of free codes into EPPI-Reviewer 4 software will be carried out by two independent investigators. Auditing of random cases will be undertaken and disagreements resolved through group discussion of an expert panel. Descriptive and analytical themes will be developed through thematic synthesis and expert panel discussion. Conclusion: Qualitative data provide useful information in understanding the individual's unique experience. Combining discrete qualitative studies provides an important opportunity to provide a voice to patients, their families and professional careers in managing advanced COPD.
Durey, A., Wynaden, D., Thompson, S., Davidson, P.M., Bessarab, D. & Katzenellenbogen, J. 2012, 'Owning Solutions: A Collaborative Model To Improve Quality In Hospital Care For Aboriginal Australians', Nursing Inquiry, vol. 19, no. 2, pp. 144-152.
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DUREY A, WYNADEN D, THOMPSON SC, DAVIDSON PM, BESSARAB D and KATZENELLENBOGEN JM. Nursing Inquiry 2012; 19: 144152 [Epub ahead of print] Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians Well-documente
Davidson, P.M., Meleis, A.I., McGrath, S.J., DiGiacomo, M., Dharmendra, T., Puzantian, H.V., Song, M. & Riegel, B. 2012, 'Improving Women's Cardiovascular Health: A Position Statement From the International Council on Women's Health Issues', Health Care for Women International, vol. 33, no. 10, pp. 943-955.
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Cardiovascular disease (CVD) is the number one killer of women worldwide, and it remains the primary cause of death and disability in both developed and developing countries. The International Council on Women's Health Issues is an international nonprofit association dedicated to the goals of promoting the health, health care, and the well-being of women. Based on the outcomes of a facilitated discussion at its 18th biannual meeting, delegates aim to raise awareness about the potent influence of gender-specific factors on the development, progression, and outcomes of CVD. Key recommendations for decreasing the burden of CVD are also discussed. &copy; 2012 Copyright Taylor and Francis Group, LLC.
Cao, X., Cao, Y., Salamonson, Y., DiGiacomo, M., Chen, Y., Chang, S., Riegel, B. & Davidson, P.M. 2012, 'Translation and validation of the Chinese version of the Acute Coronary Syndrome Response Index (C-ACSRI)', International Journal of Nursing Studies, vol. 49, no. 10, pp. 1277-1290.
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Background: Patients' knowledge, attitudes, and beliefs toward acute coronary syndrome are important predictors of delay in seeking medical attention. Currently, there is no instrument in China to measure these factors. Without such an instrument, there is limited understanding of the knowledge, attitudes and beliefs of Chinese patients. The Acute Coronary Syndrome Response Index is a validated instrument to measure patients' knowledge, attitudes, and beliefs about the symptoms and responses to acute coronary syndrome. Objectives: The study aims to translate and validate a Chinese version of the Acute Coronary Syndrome Response Index and to assess the knowledge, attitudes, and beliefs of individuals in mainland China with a history of coronary heart disease. Design: Cross-sectional study. Setting: Two tertiary teaching general hospitals and community in Shandong province, Eastern China. Participants: Individuals with a history of coronary heart disease. Method: The Acute Coronary Syndrome Response Index was professionally translated and piloting was undertaken to ensure equivalence of meaning and cultural appropriateness. Two means were used for participant recruitment: (1) direct approach in hospital and (2) advertisement in a popular health magazine in Shandong province. Principal component analysis was performed to examine the construct validity, and internal consistency was assessed using Cronbach's alpha values. Results: 224 participants with coronary heart disease were recruited, including 158 in-patients and 66 individuals living in the community. Participants' mean age was 64.3 &plusmn; 13.8 years. The majority of participants (61.7%) were male. Cronbach's coefficient for total scores of the Chinese version of Acute Coronary Syndrome Response Index was 0.81, 0.79 for knowledge, 0.87 for attitudes, and 0.71 for the beliefs scale. Pearson's method of bivariate correlation test demonstrated convergent validity. Conclusion: The Chinese version of Acute Coronary Synd...
Betihavas, V., Newton, P.J. & Davidson, P.M. 2012, 'An overview of risk prediction models and the implications for nursing practice', British Journal of Cardiac Nursing, vol. 7, no. 6, pp. 259-265.
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Chronic heart failure is a common and costly condition and is one of the most common causes of hospitalisation and emergency department presentations in the elderly. This paper discusses risk prediction models in chronic heart failure, their utility in clinical practice and describes the implications for nursing practice. Based on a review of the literature, a description is presented of current risk models for chronic heart failure; the use of risk models in other conditions and the benefits of applying valid and reliable measurement tools in clinical practice. Consideration is given for clinical as well as non-clinical factors being incorporated into risk prediction models.
Pelter, M.M., Riegel, B., McKinley, S., Moser, D.K., Doering, L.V., Meischke, H., Davidson, P., Baker, H., Yang, W. & Dracup, K. 2012, 'Are there symptom differences in patients with coronary artery disease presenting to the ED ultimately diagnosed with or without ACS?', Am J Emerg Med, vol. 30, no. 9, pp. 1822-1828.
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OBJECTIVES: Symptoms are compared among patients with coronary artery disease (CAD) admitted to the emergency department with or without acute coronary syndrome (ACS). Sex and age are also assessed. METHODS: A secondary analysis from the PROMOTION (Patient Response tO Myocardial Infarction fOllowing a Teaching Intervention Offered by Nurses) trial, an multicenter randomized controlled trial, was conducted. RESULTS: Of 3522 patients with CAD, at 2 years, 565 (16%) presented to the emergency department, 234 (41%) with non-ACS and 331 (59%) with ACS. Shortness of breath (33% vs 25%, P = .028) or dizziness (11% vs 3%, P = .001) were more common in non-ACS. Chest pain (65% vs 77%, P = .002) or arm pain (9% vs 21%, P = .001) were more common in ACS. In men without ACS, dizziness was more common (11% vs 2%; P = .001). Men with ACS were more likely to have chest pain (78% vs 64%; P = .003); both men and women with ACS more often had arm pain (men, 19% vs 10% [P = .019]; women, 26% vs 13% [P = .023]). In multivariate analysis, patients with shortness of breath (odds ratio [OR], 0.617 [confidence interval [CI], 0.410-0.929]; P = .021) or dizziness (OR, .0311 [CI, 0.136-0.708]; P = .005) were more likely to have non-ACS. Patients with prior percutaneous coronary intervention (OR, 1.592 [CI, 1.087-2.332]; P = .017), chest pain (OR, 1.579 [CI, 1.051-2.375]; P = .028), or arm pain (OR, 1.751 [CI, 1.013-3.025]; P <.042) were more likely to have ACS. CONCLUSIONS: In patients with CAD, shortness of breath and dizziness are more common in non-ACS, whereas prior percutaneous coronary intervention and chest or arm pain are important factors to include during ACS triage.
Wan Chik, W.Z., Salamonson, Y., Everett, B., Ramjan, L.M., Attwood, N., Weaver, R., Saad, Z. & Davidson, P.M. 2012, 'Gender difference in academic performance of nursing students in a Malaysian university college', International Nursing Review, vol. 59, no. 3, pp. 387-393.
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Purpose: To examine differences in academic performance between male and female nursing students, and to identify whether professional identity and language usage were explanatory factors of academic performance. Background: Although the numbers of men entering the nursing profession are increasing, societal stereotypes and the lack of male role models in nursing may have a negative impact on motivation, and hence, academic performance. Methods: A total of 147 students who were enrolled in an undergraduate nursing programme in Peninsula Malaysia were surveyed in January 2011. In addition to demographic and academic data, three instruments were administered to measure language acculturation and professional identity. Findings: The mean age of participants was 20.0 (SD: 1.5) years with 81% being female. Almost all students spoke the Malay language at home. Although there were no differences between male and female nursing students in relation to professional identity (P=0.496), male nursing students reported a lower mean English language usage score (9.9 vs. 10.9, P=0.011) and a higher mean Malay language usage score (20.4 vs. 18.8, P=0.017). Males were also found to have lower academic performance than female students, as measured by grade point average (GPA) (2.7 vs. 3.2, P<0.001). Regression analysis revealed gender was the only significant predictor of academic performance (?=-0.44, P<0.001). Conclusions: Males represent less than 10% of the nursing workforce in developed countries, with some developing countries experiencing even lower participation rates. Promoting academic support of male nursing students may assist in increasing the number of male registered nurses in the nursing workforce. &copy; 2012 The Authors. International Nursing Review &copy; 2012 International Council of Nurses.
Woods, J.A., Katzenellenbogen, J.M., Davidson, P.M. & Thompson, S.C. 2012, 'Heart failure among Indigenous Australians: a systematic review.', BMC Cardiovasc Disord, vol. 12, p. 99.
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BACKGROUND: Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated. METHODS: A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications, particularly government reports. RESULTS: There was a paucity of relevant peer-reviewed research, and government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heart failure than their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ?3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics. A recent journal article specifically documented a high prevalence of heart failure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heart failure. CONCLUSIONS: Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest that undiagnose...
Moser, D.K., McKinley, S., Riegel, B., Doering, L.V., Meischke, H., Pelter, M., Davidson, P., Baker, H. & Dracup, K. 2012, 'The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease.', Eur J Cardiovasc Nurs, vol. 11, no. 2, pp. 160-167.
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BACKGROUND: Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that interventions not increase anxiety. PURPOSE: To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms. METHODS: This was a multicenter randomized controlled trial of the intervention in which anxiety data were collected at baseline, 3-months and 12-months. A total of 3522 patients with confirmed coronary artery disease were enrolled; data from 2597 patients with anxiety data at all time points are included. The intervention was a 45 min education and counseling session, in which the social, cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking. Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age, gender, ethnicity, education level, and comorbidities. RESULTS: There were significant differences in anxiety by group (p = 0.03). Anxiety level was stable in patients in the control group, but decreased across time in the intervention group. Perceived control increased across time in the intervention group and remained unchanged in the control group (p = 0.01). CONCLUSION: Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.
Phillips, J.L., Rolley, J.X. & Davidson, P.M. 2012, 'Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies.', Nurs Res Pract, vol. 2012, p. 279431.
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Aims and Objectives. This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEED Model at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments.
Hunt, L., Van Luenen, H., Alexandrou, E., Frost, S.A., Davidson, P.M., Hillman, K. & D'Amours, S. 2012, 'A comparison of fluid instillation volumes to assess intra-abdominal pressure using Kron's methods.', J Trauma Acute Care Surg, vol. 73, no. 1, pp. 152-155.
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BACKGROUND: Intra-abdominal pressure (IAP) measurement has become an important tool in the assessment of critically ill patients. The World Society of the Abdominal Compartment Syndrome consensus guidelines recommend using a maximum volume of 25 mL of sterile saline instilled into the bladder for intermittent IAP measurements. It is postulated that the volume of fluid instilled may have an impact on the estimation of IAP. METHODS: This study sought to compare measured bladder pressures after the instillation of 25, 10, and 0 mL volumes of sterile saline using measurement analysis. Measurement was performed using the modified Kron technique, and treatment allocation was applied by prospective, alternate patient treatment allocation. Transvesical IAP measurements were undertaken using volumes from 0 mL to 25 mL. Recordings were taken with the catheter unclamped, clamped, 10 mL instillation, and 25 mL instillation. This measurement analysis was conducted in a mixed intensive care unit at a Level I trauma hospital over a period of 14 weeks. IAP measurements were performed on 37 patients with varying disease processes using 25, 10, and 0 mL of sterile saline instilled into the bladder. RESULTS: Medical, surgical, and trauma patients were distributed equally across the treatment groups. Twenty-three patients were male, and the mean age was 58 years &plusmn; 18 years. The concordance correlation coefficient between 25 mL and 10 mL was 0.95. The concordance correlation coefficient between 25 mL and no fluid with an unclamped and clamped catheter was 0.55. CONCLUSION: In a general intensive care unit population, measured intra-urinary bladder pressure measurements using a volume of 10 mL fluid instillation provides comparable results to using 25 mL fluid. LEVEL OF EVIDENCE: Diagnostic study, level II.
Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2012, 'Disease management interventions for improving self-management in lower-limb peripheral arterial disease (Protocol)', The Cochrane Database of Systematic Reviews, vol. 3, pp. 1-11.
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Evidence supports the use of chronic disease management interventions to improve self-management in chronic diseases other than PAD, however it is unclear what benefits these interventions offer for people with PAD. To our knowledge, there are no other systematic reviews of the evidence for chronic disease management interventions to improve self-management for lower-limb PAD. The objective of this review is to systematically review, synthesise and quantify the effects of non-pharmacological and non-surgical chronic disease management interventions targeting self-management for people with lower-limb PAD.
Davidson, P.M. & MacDonald, P.S. 2011, 'Interventions for modern times: Complex, collaborative, and culturally appropriate', Circulation: Cardiovascular Quality and Outcomes, vol. 4, no. 6, pp. 584-586.
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Everett, B., DiGiacomo, M., Rolley, J.X., Salamonson, Y. & Davidson, P.M. 2011, 'You won't know if you don't ask: Discrepancy and ambivalence in attitudes toward behavior change', Journal of Cardiovascular Nursing, vol. 26, no. 6, pp. 460-465.
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Background: Behavior change is challenging following an acute cardiac event, and commonly, individuals are ambivalent. Aim: The objective of this study was to describe the experience of behavior change of survivors of an acute cardiac event. Method: Semistructured interviews were undertaken with 25 participants attending 3 cardiac rehabilitation programs. An inductive process of qualitative thematic analysis was used to analyze the transcripts. Results: Analysis revealed ambivalence to change, misconceptions, and confusion about terminology. Discrepancies between what participants felt they should be doing and what they actually were doing reflected their ambivalence. Further inconsistencies were reflected in participants' misunderstandings and confusion regarding disease processes and management of heart disease. Conclusions: These findings reflect the misconception and ambivalence regarding behavior change that individuals experience. Clinicians may require greater skills in detecting conflicting or ambivalent discourse to support patients through sustainable health behavior change. Copyright &copy; 2011 Lippincott Williams & Wilkins.
Davidson, P.M., DiGiacomo, M. & McGrath, S.J. 2011, 'The feminization of aging: How will this impact on health outcomes and services?', Health Care for Women International, vol. 32, no. 12, pp. 1031-1045.
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We conducted an integrative review to identify issues and challenges that face aging women and to distinguish areas for future research. We found that many older women continue to face inequities related to health and often are invisible within the discourse of aging policy. In this article we argue for a greater focus on the unique needs of women, a gendered approach to policy and intervention development, and promotion of the health of women across the life span. Policymakers, health care workers, and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions. &copy; Taylor & Francis Group, LLC.
Lanuza, D.M., Davidson, P.M., Dunbar, S.B., Hughes, S. & De Geest, S. 2011, 'Preparing nurses for leadership roles in cardiovascular disease prevention.', J Cardiovasc Nurs, vol. 26, no. 4 Suppl, pp. S56-S63.
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Cardiovascular disease (CVD) is a critical global health issue, and cardiovascular nurses play a vital role in decreasing the global burden and contributing to improving outcomes in individuals and communities. Cardiovascular nurses require the knowledge, skills, and resources that will enable them to function as leaders in CVD. This article addresses the education, training, and strategies that are needed to prepare nurses for leadership roles in preventing and managing CVD. Building on the World Health Organization core competencies for 21st-century health care workers, the specific competencies of cardiovascular nurses working in prevention are outlined. These can be further strengthened by investing in the development of cultural, system change and leadership competencies. Mentorship is proposed as a powerful strategy for promoting the cardiovascular nursing role and equipping individual nurses to contribute meaningfully to health system reform and community engagement in CVD risk reduction.
Fernandez, R.S., Davidson, P.M., Griffiths, R. & Salamonson, Y. 2011, 'Improving cardiac rehabilitation services - Challenges for cardiac rehabilitation coordinators', European Journal of Cardiovascular Nursing, vol. 10, no. 1, pp. 37-43.
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Background: Cardiac rehabilitation (CR) is a long term multifactorial rehabilitation program aimed at the secondary prevention of cardiovascular events. However, delivery of CR services is less than optimal. Aim: This study explored the perceptions of ca
Rolley, J., Smith, J., DiGiacomo, M., Salamonson, Y. & Davidson, P. 2011, 'The caregiving role following percutaneous coronary intervention', Journal of Clinical Nursing, vol. 20, no. 1-2, pp. 227-235.
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Aim: The aim of this study is to describe the experience of caregivers of individuals who have had a percutaneous coronary intervention (PCI). Background: Decreased lengths of hospital stay and an increased emphasis on chronic disease self-management increase the importance of carers in assisting in recovery and lifestyle modification. Design: Cross-sectional dual-moderated focus group design. Method: Three focus groups using a dual facilitation approach were held in the cardiac rehabilitation setting of a tertiary referral hospital in metropolitan Sydney. All sessions were audio recorded, transcribed and thematically analysed. Results: Four themes emerged from the data: (1) a gendered approach to health, illness and caring; (2) shock, disbelief and the process of adjustment following PCI; (3) challenges and changes of the carer-patient relationship and (4) the needs of the carer for support and information. Issues emerging from this study parallel other findings describing the experience, yet provide new insights into the issues surrounding PCI. Conclusion: These findings highlight the need for including carers in care planning and decision-making and providing them with support and resources. Relevance to clinical practice: Emphasises the importance of preparing carers of the likely experience following a PCI.Demonstrates the degree to which vigilance, deferment of carer-health needs and role conflict impact on the carer's personal relationship.Demonstrates the need for formal support interventions for carers of patients who have had PCI. &copy; 2010 Blackwell Publishing Ltd.
Gholizadeh, L., Digiacomo, M., Salamonson, Y. & Davidson, P.M. 2011, 'Stressors influencing middle eastern women's perceptions of the risk of cardiovascular disease: a focus group study', Health Care for Women International, vol. 32, no. 8, pp. 723-745.
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To better understand Australia-dwelling Middle Eastern women's lack of service utilization in cardiovascular health, we undertook a study to investigate their understandings and meanings of cardiovascular disease (CVD) and its risk factors. Eight focus groups were conducted in community settings with Turkish, Persian, and Arab women. We found that the women understated their risk of CVD, faced many barriers in reducing their risks, and perceived stress as the most significant contributor to CVD. Women described their stress as primarily emanating from issues surrounding. &copy; Taylor & Francis Group, LLC.
Mckinley, S., Aitken, L.M., Marshall, A.P., Buckley, T., Baker, H., Davidson, P.M. & Dracup, K. 2011, 'Delays in presentation with acute coronary syndrome in people with coronary artery disease in Australia and New Zealand', EMA - Emergency Medicine Australasia, vol. 23, no. 2, pp. 153-161.
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Objectives: To report time from the onset of symptoms to hospital presentation in Australian and New Zealand patients with subsequently confirmed acute coronary syndrome, and to identify factors associated with prehospital delay time in these patients. Methods: Patients with coronary artery disease enrolled in a randomized clinical trial testing an intervention to reduce delay in responding to acute coronary syndrome symptoms had been followed for 24months. In cases of admission to the ED for possible acute coronary syndrome, medical records were reviewed to determine the diagnosis, prehospital delay time, mode of transport to the hospital and aspirin use before admission. Clinical and demographic data were taken from the trial database. Results: Patients (n= 140) had an average (SD) age of 67.3 (11.5) years; 36% were female. Two-thirds of patients went to hospital by ambulance and 89.3% had a final diagnosis of unstable angina. The median time from onset of symptoms to arrival at the ED was 2h and 25min (interquartile range 1:25-4:59); 12.1% arrived ? 1h and 66% within 4h. Multiple linear regression analysis showed that use of ambulance (Beta = 0.247, P= 0.012) and younger age (Beta = 0.198, P= 0.043) were independent predictors of shorter delay times. Conclusion: The time from the onset of symptoms to hospital presentation was too long for maximal benefit from treatment in most patients. Further efforts are needed to reduce treatment-seeking delay in response to symptoms of acute coronary syndrome. &copy; 2011 The Authors. EMA &copy; 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Damarell, R., Tieman, J., Sladek, R.M. & Davidson, P.M. 2011, 'Development Of A Heart Failure Filter For Medline: An Objective Approach Using Evidence-Based Clinical Practice Guidelines As An Alternative To Hand Searching', BMC Medical Research Methodology, vol. 11, no. 12, pp. 1-10.
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Background: Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this eviden
Andrew, S., Salamonson, Y., Everett, B., Halcomb, E.J. & Davidson, P.M. 2011, 'Beyond the ceiling effect: Using a mixed methods approach to measure patient satisfaction', International Journal of Multiple Research Approaches, vol. 5, no. 1.
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This study reports patient satisfaction with the nursing care on a neurosurgical critical care unit. A modified version of the Ludwig-Beymer Patient Satisfaction Questionnaire (PSQ-7) was used, and included structured items and semi-structured interview questions. Data were collected from 149 patients. Participants rated their satisfaction as high (Mean = 25.14; SD 2.96). The distribution of scores was skewed and every item demonstrated a ceiling effect. Principal component analysis yielded a one-component solution which explained 48% of the variance. NVivo&reg; was used to match PSQ-7 scores with qualitative data. Participants' comments were categorised as positive, negative or 'yes, but'. Just over half the patients made positive comments and 29% of patients in the low group made negative comments. Three categories: 'communication', 'nursing care delivery' and 'the hospital environment' emerged from the qualitative data. A mixed method approach enables researchers to move beyond the ceiling effect of quantitative measures of patient satisfaction and to gain a more meaningful explanation of patient satisfaction. &copy; 2008-2010 eContent Management.
Du, H.Y., Newton, P.J., Zecchin, R., Denniss, R., Salamonson, Y., Everett, B., Currow, D.C., Macdonald, P.S. & Davidson, P.M. 2011, 'An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: Study protocol for a randomized controlled trial', Trials, vol. 12.
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Background: Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF.Methods/Design: A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain).All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months. The primary outcome of the trial is the physical functioning domain of quality of life, measured by the physical functioning subscale of the Medical Outcome S...
Berry, A.M., Davidson, P.M., Masters, J., Rolls, K. & Ollerton, R. 2011, 'Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial.', Int J Nurs Stud, vol. 48, no. 6, pp. 681-688.
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BACKGROUND: Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene. AIM: The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome). METHODS: A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste. RESULTS: Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 &plusmn; 17 years, simplified acute physiology score II: 44 &plusmn; 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p=0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%. CONCLUSIONS: While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogen...
Matic, J., Davidson, P.M. & Salamonson, Y. 2011, 'Review: bringing patient safety to the forefront through structured computerisation during clinical handover.', J Clin Nurs, vol. 20, no. 1-2, pp. 184-189.
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AIMS AND OBJECTIVES: This review aims to examine critically, the methods and modes of delivery of handover used in contemporary health care settings and explore the feasibility of a computerised handover system for improving patient safety. BACKGROUND: Clinicians play a critical role in promoting patient safety, and the handover ritual is recognised as important in exchanging information and planning patient care. Communication failures have been identified as an important cause of adverse incidents in hospitals. DESIGN: Integrative literature review. METHODS: Search of multiple electronic databases using terms: nursing handover, handoff, shift-to-shift reporting and change of shift report. DISCUSSION: To date, the focus of research has primarily been on the vehicle of the handover, rather than the content and processes involved in ensuring the reliability and quality of clinical information. Employing a computerised handover system in the clinical arena has the potential to improve the quality and safety of clinical care. CONCLUSIONS: Whilst the handover performed from shift-to-shift is a valuable communication strategy, ambiguities and incomplete information can increase the risks of adverse events. Given the importance of effective communication, its key link to patient safety and the frequency of nursing handover, it is imperative that clinical handover undergo increased scrutiny, development and research. RELEVANCE TO CLINICAL PRACTICE: This review underscores the challenge in clinical handover and recommends the use of technological solutions to improve communication strategies.
Davidson, P.M., Jiwa, M., Goldsmith, A.J., McGrath, S.J., Digiacomo, M., Phillips, J.L., Agar, M., Newton, P.J. & Currow, D.C. 2011, 'Decisions for lung cancer chemotherapy: The influence of physician and patient factors', Supportive Care in Cancer, vol. 19, no. 8, pp. 1261-1266.
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Purpose: The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients influence clinical communication, doctor-patient interaction and treatment decisions for lung cancer treatment. Methods: Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011. Results: Wide variability in perceptions of the value of chemotherapy in lung cancer is present among both physicians and patients. There is a mismatch in the degree patients and physicians weigh survival, such that patients value survival benefits highly whilst physicians strongly emphasize toxicity and associated symptoms. This lack of congruence between patients and clinicians is influenced by a range of factors and has implications for treatment decisions, long-term survival and quality of life in people affected by lung cancer. Conclusion: The divergence of treatment priorities indicates a need for improved communication strategies addressing the needs and concerns of both patients and clinicians. Patients should understand the benefits and risks of treatment options, while clinicians can gain a greater awareness of factors influencing patients' decisions on treatments. Reflecting these perspectives and patient preferences for lung cancer treatment in clinical guidelines may improve clinician awareness. &copy; 2011 Springer-Verlag.
Chang, S., Gholizadeh, L., Salamonson, Y., DiGiacomo, M., Betihavas, V. & Davidson, P.M. 2011, 'Health span or life span: The role of patient-reported outcomes in informing health policy', Health Policy, vol. 100, no. 1, pp. 96-104.
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Objectives: Population ageing and the increasing burden of chronic conditions challenge traditional metrics of assessing the efficacy of health care interventions and as a consequence policy and planning. Using chronic heart failure (CHF) as an exemplar this manuscript seeks to describe the importance of patient-reported outcomes to inform policy decisions. Methods: The method of an integrative review has been used to identify patient-reported outcomes (PROs) in assessing CHF outcomes. Using the Innovative Care for Chronic Conditions the case for developing a metric to incorporate PROs in policy planning, implementation and evaluation is made. Results: In spite of the increasing use of PROs in assessing CHF outcomes, their incorporation in the policy domain is limited. Conclusions: Effective policy and planning is of health care services is dependent on the impact on the individual and their families. Epidemiological transitions and evolving treatment paradigms challenge traditional metrics of morbidity and mortality underscoring the importance of assessing PROs. &copy; 2010 Elsevier Ireland Ltd.
Du, H., Davidson, P.M., Everett, B., Salamonson, Y., Zecchin, R., Rolley, J.X., Newton, P.J. & Macdonald, P.S. 2011, 'Correlation between a self-administered walk test and a standardised Six Minute Walk Test in adults', Nursing and Health Sciences, vol. 13, no. 2, pp. 114-117.
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This study was undertaken to assess the correlation between a self-administered, adapted Six Minute Walk Test (the Home-Heart-Walk) and the standard Six Minute Walk Test based on the American Thoracic Society guideline. A correlational study was conducted at a university campus in Sydney, Australia. Thirteen healthy volunteers underwent the Home-Heart-Walk and the standard Six Minute Walk Test on a single occasion. The distance that participants walked during the two tests was assessed using Pearson's correlation. The correlation between the Home-Heart-Walk and the Six Minute Walk Test distance was 0.81. The Home-Heart-Walk distance was highly correlated to the standard Six Minute Walk Test distance in this study. This relationship provides confidence for further research in populations to facilitate monitoring and evaluation. &copy; 2011 Blackwell Publishing Asia Pty Ltd.
Davidson, P.M., Salamonson, Y., Rolley, J., Everett, B., Fernandez, R., Andrew, S., Newton, P.J., Frost, S. & Denniss, R. 2011, 'Perception of cardiovascular risk following a percutaneous coronary intervention: A cross sectional study', International Journal of Nursing Studies, vol. 48, no. 8, pp. 973-978.
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Background: An individual's perception of the risk of, and their susceptibility to, future cardiovascular events is crucial in engaging in effective secondary prevention. Aim: To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk. Methods: This study examined the individual's perception of the risk of a subsequent cardiac event among 220 patients hospitalised for a percutaneous coronary intervention (PCI) at a metropolitan, tertiary referral hospital in Sydney, Australia. Baseline clinical and demographic characteristics were collected, and actual risk (Personal Risk Score) calculated based on the presence or absence of nine cardiovascular risk factors: diabetes, hypertension, high cholesterol, cigarette smoking, previous history of CHD, family history of CHD, depression, overweight or obesity, and physical inactivity. Perception of risk was determined using an investigator-developed 4-item, 11-point Likert scale instrument (Perceived Heart Risk Questionnaire - PHRQ) which measured two dimensions of health threat: perceived seriousness, and perceived susceptibility. The correlation between the Personal Risk Score and the PHRQ was assessed using the Pearson product-moment correlation coefficient. Results: The calculated mean Personal Risk Score was 4.63 &plusmn; 1.71 and the PHRQ was 25.5 &plusmn; 7.04. The correlation between the Personal Risk Score (actual risk) and the PHRQ (perceived risk) was r = 0.26 (p< 0.01). Conclusions: The weak relationship between actual and perceived risk is of concern, particularly in a population at higher risk for future cardiovascular events. Implementing strategies to personalise risk should be explored to improve the accuracy of risk perception, and facilitate tailoring of behaviour change strategies. &copy; 2011 Elsevier Ltd.
Davidson, P.M., Daly, J., Leung, D., Ang, E., Paull, G., DiGiacomo, M., Hancock, K., Cao, Y., Du, H. & Thompson, D.R. 2011, 'Health-seeking beliefs of cardiovascular patients: A qualitative study', International Journal of Nursing Studies, vol. 48, no. 11, pp. 1367-1375.
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Objectives: The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians. Design: Qualitative study. Methods: Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken. Results: Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management. Conclusions: Considering the influence of cultural values in developing health care plans and clinical decision making is important. &copy; 2011 Elsevier Ltd.
Koch, J., Salamonson, Y., Du, H.Y., Andrew, S., Frost, S.A., Dunncliff, K. & Davidson, P.M. 2011, 'Value of Web-based learning activities for nursing students who speak English as a second language.', J Nurs Educ, vol. 50, no. 7, pp. 373-380.
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There is an increasing need to address the educational needs of students with English as a second language. The authors assessed the value of a Web-based activity to meet the needs of students with English as a second language in a bioscience subject. Using telephone contact, we interviewed 21 Chinese students, 24 non-Chinese students with English as a second language, and 7 native English-speaking students to identify the perception of the value of the intervention. Four themes emerged from the qualitative data: (1) Language is a barrier to achievement and affects self-confidence; (2) Enhancement intervention promoted autonomous learning; (3) Focusing on the spoken word increases interaction capacity and self-confidence; (4) Assessment and examination drive receptivity and sense of importance. Targeted strategies to promote language acculturation and acquisition are valued by students. Linking language acquisition skills to assessment tasks is likely to leverage improvements in competence.
Riegel, B., Elmi, A., Moser, D., McKinley, S.M., Meischke, H., Doering, L., Davidson, P.M., Pelter, M., Baker, H. & Dracup, K. 2011, 'Who listens to our advice? A secondary analysis of data from a clinical trial testing an intervention designed to decrease delay in seeking treatment for acute coronary syndrome', Patient Education And Counseling, vol. 85, pp. 33-38.
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Objective: Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work. Methods: In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N = 272 intervention, N = 218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders. Results: Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found. Conclusion: The results of this study challenge existing beliefs. Practice implications: New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
Soh, K.L., Davidson, P.M., Leslie, G. & Bin Abdul Rahman, A. 2011, 'Action research studies in the intensive care setting: a systematic review.', Int J Nurs Stud, vol. 48, no. 2, pp. 258-268.
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OBJECTIVES: To review published studies using action research in the intensive care unit (ICU) in order to provide an intervention framework to improve clinical outcomes. DESIGN: Systematic review. METHODS: Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Scopus, Medline, Embase, PsycINFO, and the World Wide Web were undertaken using MeSH key words including: 'action research'; 'health care research', 'health services evaluation'; 'intensive care unit'. Reference lists of retrieved articles was also undertaken to identify further articles. All studies were reviewed by two authors using a critical appraisal tool. RESULTS: The search strategy generated 195 articles. Only 21 studies projects were identified using action research in the ICU. The majority of studies were conducted in the United Kingdom. The participants in the action research studies ranged from 6 to 253. Predominately studies using action research involved nurses in collaboration with patients and family and other health care practitioners to address identified problems in the ICU. CONCLUSIONS: Based on this review it appears that action research is a promising methodological approach to address clinical practice improvement in the ICU. Studies retrieved focussed primarily on process and formative evaluation but not on clinical outcomes. There is a need to incorporate outcome assessment in action research in the ICU to increase the framework of action research to improve clinical outcomes.
Soh, K.L., Soh, K.G., Japar, S., Raman, R.A. & Davidson, P.M. 2011, 'A cross-sectional study on nurses' oral care practice for mechanically ventilated patients in Malaysia.', J Clin Nurs, vol. 20, no. 5-6, pp. 733-742.
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AIMS AND OBJECTIVES: This study sought to determine the strategies, methods and frequency of oral care provided for mechanically ventilated patients in Malaysian intensive care units. The study also described nurses' attitudes to providing oral care and their knowledge of the mode of transmission of ventilator-associated pneumonia. BACKGROUND: Oral care is an important nursing intervention in the intensive care unit to reduce dental plaque. Dental plaque provides a repository for respiratory pathogens contributing to ventilator-associated pneumonia in the critically ill. DESIGN: Cross-sectional study. METHODS: This study used both survey and observational methods. The observational study was conducted by a nurse, trained in the study protocol. The observation period a selected shift over three weeks in 2007. FINDINGS: Intensive care unit nurses (n = 284) participated in the survey. Respondents had a positive attitude towards providing oral care. On a 10-point Likert scale, aspiration of contaminated secretions from the oropharynx was identified by nurses as the highest risk factor for ventilator-associated pneumonia (mean response 6.8, SD 2.0). The majority of nurses used cotton and forceps for oral care. Toothbrushes were not used in any of the study sites. CONCLUSIONS: Although nurses had a positive attitude to oral hygiene, this study found no intensive care units incorporated a soft toothbrush in oral care protocols which is recommended in best practice guidelines. A review of strategies to implement evidence-based practice in the intensive care unit is warranted. RELEVANCE TO CLINICAL PRACTICE: This study has identified a failure to adhere with evidence-based practice. Implementing and evaluating protocols for oral hygiene in the intensive care unit has the potential to improve patient outcomes.
Phillips, J.L., Halcomb, E.J. & Davidson, P.M. 2011, 'End-of-Life Care Pathways in Acute and Hospice Care: An Integrative Review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 41, no. 5, pp. 940-955.
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Digiacomo, M., Davidson, P.M., Zecchin, R., Lamb, K. & Daly, J. 2011, 'Caring for others, but not themselves: implications for health care interventions in women with cardiovascular disease.', Nurs Res Pract, vol. 2011, p. 376020.
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Cardiovascular disease is the largest killer of women internationally and women often suffer inferior outcomes following an acute cardiac event as compared to men. A gendered approach to investigating cardiovascular disease in women incorporates the unique social, cultural, and economic circumstances that being a woman brings to the health encounter. The multiple roles enacted by many women may be important factors in this health discrepancy. In order to more fully understand the impact of the roles of women on health, a questionnaire was administered to participants of the Heart Awareness for Women group cardiac rehabilitation program which assessed women's role perceptions followed by discussions. We found that caregiving can be both positive and negative. It gives a sense of purpose, meaning, and community connection as well as burden and conflict. Emphasis must be placed on promoting strategies in women to achieve a balance between caregiving responsibilities and prioritisation of cardiovascular health.
Lewis, J.M., Digiacomo, M., Currow, D.C. & Davidson, P.M. 2011, 'Dying in the margins: Understanding palliative care and socioeconomic deprivation in the developed world', Journal of Pain and Symptom Management, vol. 42, no. 1, pp. 105-118.
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Context: Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. Objectives: To evaluate the literature in the developed world for barriers to access for low SE groups. Methods: Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. Results: A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. Conclusion: Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required. &copy; 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Hickman, L.D., Davidson, P.M., Chang, E. & Chenoweth, L. 2011, 'INHospital study: Do older people, carers and older people, carers and nurses share the same priorities of care in the acute aged care setting?', International Journal of Multiple Research Approaches, vol. 5, no. 1.
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The aim of the INHospital study was to compare the level of importance of care priorities and satisfaction levels with care among patients, carers, and nurse caregivers in the acute aged care setting. The INHospital study used sequential mixed methods approach for data collection. Survey data was completed within five metropolitan acute aged care wards on patients in acute aged care wards (n=78), their carers (n=45) and nurses (n=37). The Caring Activity Scale (CAS) survey was administered to participants in order to determine and compare the perceptions of the importance and satisfaction of care. Semi-structured interviews of patients (n=7) and carers (n=7) were conducted after completion of the CAS survey. This qualitative data aimed to probe more deeply into the patient's and carer's care priorities and satisfaction as measured in the CAS. The CAS data demonstrated that patients, carers and nurses rated implementing, observing and reporting doctor's orders similarly, while differences between groups were observed in relation to prioritising physical and psychosocial care and discharge. There were significant differences between patients, carers and nurses on overall importance (p=0.001) and satisfaction in respect of nursing care (p=0.001). Qualitative data generated five themes 1) Nurses doing the best they can in challenging circumstances; 2) Achieving a balancing act in a pressured environment; 3) Striving to maintain and sustain independence; 4) The discharge process: not a shared priority; and 5) Challenges of the carer role. A key implication of this study is the incongruence between what patients consider a priority for care and the priority ascribed to those tasks by nurses. Qualitative findings added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. However, the themes of managing t...
Stewart, S., Carrington, M.J., Marwick, T., Davidson, P.M., MacDonald, P., Horowitz, J., Krum, H., Newton, P.J., Reid, C. & Scuffham, P.A. 2011, 'The WHICH? Trial: Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients', European Journal of Heart Failure, vol. 13, no. 8, pp. 909-916.
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Aims To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patients own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 &plusmn; 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 &plusmn; 2.4). Perspective Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients. Published on behalf of the European Society of Cardiology. All rights reserved. &copy; The Author 2011. For permissions please email: journals.permissionsoup.com.2011 &copy; Published on behalf of the European Society of Cardiology. All rights reserved. &copy; The Author 2011. For permissions please email: journals.permissionsoup.com.
Davidson, P.M., McGrath, S.J., Meleis, A.I., Stern, P., DiGiacomo, M., Dharmendra, T., Correa-De-Araujo, R., Campbell, J.C., Hochleitner, M., Messias, D.K.H., Brown, H., Teitelman, A., Sindhu, S., Reesman, K., Richter, S., Sommers, M.S., Schaeffer, D., Stringer, M., Sampselle, C., Anderson, D., Tuazon, J.A., Cao, Y. & Covan, E.K. 2011, 'The health of women and girls determines the health and well-being of our modern world: A white paper from the international council on women's health issues', Health Care for Women International, vol. 32, no. 10, pp. 870-886.
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The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research.We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally. &copy; Taylor & Francis Group, LLC.
Betihavas, V., Newton, P.J., Du, H.Y., Macdonald, P.S., Frost, S.A., Stewart, S. & Davidson, P.M. 2011, 'Australia's health care reform agenda: Implications for the nurses' role in chronic heart failure management', Australian Critical Care, vol. 24, no. 3, pp. 189-197.
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Introduction: The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. Aim: This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. Method: The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including; "heart failure", "management", "Australia" and "nursing" In addition policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. Results: There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. Conclusion: The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of individuals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care. &copy; 2010 Australian College of Critical Care Nurses Ltd.
Phillips, J., Salamonson, Y. & Davidson, P.M. 2011, 'An instrument to assess nurses' and care assistants' self-efficacy to provide a palliative approach to older people in residential aged care: a validation study.', Int J Nurs Stud, vol. 48, no. 9, pp. 1096-1100.
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OBJECTIVE: This study investigated the psychometric properties of the 'Palliative care self-efficacy scale', an instrument designed to assess clinicians' degree of confidence in engaging in patient and family interactions at the end-of-life. DESIGN: The instrument was administered to 405 aged care professionals employed in nine aged care facilities. Exploratory factor analysis and internal consistency statistics were undertaken. RESULTS: A two-factor solution of the 'Palliative care self-efficacy scale' was extracted with factor loadings above the 0.4 cutoff. Cronbach's alpha of the scale and subscales ranged from 0.87 to 0.92. The 'Palliative care self-efficacy scale' demonstrates good validity and reliability. CONCLUSIONS: The 'Palliative care self-efficacy scale' can be a useful tool in assessing and monitoring clinicians' perceived capacity to provide a palliative approach. Further evaluation in other samples and settings is required.
Moser, D.K., McKinley, S., Riegel, B., Doering, L.V., Meischke, H., Pelter, M., Davidson, P., Baker, H. & Dracup, K. 2011, 'Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease.', Psychosom Med, vol. 73, no. 9, pp. 803-809.
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OBJECTIVE: To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized. METHODS: Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared. RESULTS: Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]). CONCLUSIONS: By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.
Astley, C.M., Tonkin, A.M., Mahar, L.J., Davidson, P.M., Boyden, A.N., Brieger, D.B., Pradhan, M., George, M., Mattschoss, S.F. & Chew, D.P. 2011, 'Clinical effectiveness in everyday practice: improving outcomes for all patients through a national acute coronary syndrome data collaborative.', Intern Med J, vol. 41, no. 2, pp. 206-210.
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The management of acute coronary syndromes (ACS) has an extensive and impressive evidence-base with which to guide clinical practice. Despite this, translation to the clinical environment has proved to be challenging and incomplete and can be attributed to patient, provider and system factors. Causes of suboptimal guideline adherence relate to diverse issues, including patient complexity, barriers in knowledge translation of guideline recommendations and a limited capacity within health services. Addressing these factors may enable more effective guideline implementation. In Australia, the infrastructure for clinical data management is fragmented, uncoordinated and often administratively driven, compromising access to important information, which might improve clinical effectiveness. An integrated approach is required to improve clinical effectiveness in ACS care in Australia. Greater access to information both to assist in clinical decision-making and monitoring outcomes may help direct the focus towards understudied populations and improve performance and clinically relevant outcomes. A peer-led initiative based on common datasets, providing rapid feedback, while developing and disseminating a 'toolbox' of proven and sustainable interventions, could improve clinical effectiveness in the Australian management of ACS and provides a rationale for a national ACS registry.
Astley, C.M., Macdougall, C.J., Davidson, P.M. & Chew, D.P. 2011, 'Lost in translation: health resource variability in the achievement of optimal performance and clinical outcome.', Circ Cardiovasc Qual Outcomes, vol. 4, no. 5, pp. 512-520.
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BACKGROUND- An evidence-practice gap in acute coronary syndromes (ACS) is commonly recognized. System, provider, and patient factors can influence guideline adherence. Through using guideline facilitators in the clinical setting, the uptake of evidence-based recommendations may be increased. We hypothesized that facilitators of guideline recommendations (systems, tools, and workforce) in acute cardiac care were associated with increased guideline adherence and decreased adverse outcome. METHODS AND RESULTS- A cross-sectional evaluation of guideline facilitators was conducted in Australian hospitals. The population was derived from the Acute Coronary Syndrome Prospective Audit (ACACIA) and assessed performance, death, and recurrent myocardial infarction (death/re-MI) at 30 days and 12 months. Thirty-five hospitals and 2392 patients participated. Significant associations with decreased death/re-MI were observed with hospital strategies to facilitate primary percutaneous coronary intervention for ST-elevation MI patients (38/428 [8.9%] versus 30/154 [19.5%], P<0.001) and after adjustment (odds ratio [OR], 0.47 [95% confidence interval (CI), 0.24 to 0.90], P<0.023), electronic discharge checklists (none: 233/1956 [11.9%], integrated; 43/251[17.1%], P=0.069, electronic; 6/124 [4.8%], P<0.001) and after adjustment (integrated versus none: OR, 1.66 [95% CI, 0.98 to 2.80], P=0.057 and electronic versus none: OR, 0.49 [95% CI, 0.35 to 0.68], P<0.001), and intensive cardiac care unit (ICCU) staff-to-patient ratios (neither: 200/1257 (15.9%), CCU: 135/1051 (12.8%), ICCU: 8/84 (9.5%), P=0.049 and after adjustment (CCU versus neither: OR, 0.74 [95% CI, 0.47 to 1.14], P=0.172 and ICCU versus neither: OR, 0.55; [95% CI, 0.38 to 0.81] P=0.003). CONCLUSIONS- Facilitating uptake of evidence in clinical practice may need to consider quality improvement systems, tools and workforce to achieve optimal ACS outcomes.
Berry, A.M., Davidson, P.M., Nicholson, L., Pasqualotto, C. & Rolls, K. 2011, 'Consensus based clinical guideline for oral hygiene in the critically ill.', Intensive Crit Care Nurs, vol. 27, no. 4, pp. 180-185.
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OBJECTIVES: Oropharyngeal colonisation has been identified as a factor contributing to ventilator associated pneumonia (VAP) in the Intensive Care Unit (ICU). We sought to develop a clinical practice guideline for providing oral hygiene in the critically ill. RESEARCH METHODOLOGY: Following a systematic literature review a prospectively derived consensus development conference was convened and sponsored by a clinical governance unit. RESULTS: The consensus development conference generated 12 recommendations for tools and solutions; frequency and duration of cleaning; oral assessment tools and oral hygiene protocols. These recommendations underwent a validation process. CONCLUSIONS: In light of sparse high level evidence to inform guidelines, further research is needed inform clinical practice. Oral hygiene is a critical element of nursing care and a standardised approach has the potential to improve clinical outcomes.
Clark, A.M., Jaarsma, T., Strachan, P., Davidson, P.M., Jerke, M., Beattie, J.M., Duncan, A.S., Ski, C.F. & Thompson, D.R. 2011, 'Effective communication and ethical consent in decisions related to ICDs.', Nat Rev Cardiol, vol. 8, no. 12, pp. 694-705.
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This Review examines recommendations and principles that promote good decision-making with regard to the insertion, deactivation, and potential malfunction of implantable cardioverter-defibrillators (ICDs). This guidance is important because ICDs are now used for primary and secondary prevention of arrhythmias in more than 20 diverse clinical populations, which accounts for the exponential increase in insertion rates over the past decade. Current guidelines require clinicians to provide personalized, culturally appropriate, and easy to understand information to patients on the benefits and harms of proposed treatment choices; however, obtaining valid informed consent for insertion and deactivation of ICDs is challenging. Initiating early conversations with patients and continuing this dialogue over time, implementation of localized care protocols, increased collaboration (particularly between cardiac and palliative care teams), and the provision of training for all health professionals involved in the care of these patients, can help to ensure that adequate informed consent is maintained throughout their care. In addition to providing information, health professionals should identify and address high levels of anxiety in patients and their next of kin and promote effective communication throughout decision making. In the future, use of standardized checklists or decision aids based on a clear understanding of the principles underlying key topics could support this process.
Haghshenas, A., Davidson, P.M. & Rotem, A. 2011, 'Negotiating norms, navigating care: findings from a qualitative study to assist in decreasing health inequity in cardiac rehabilitation', AUSTRALIAN HEALTH REVIEW, vol. 35, no. 2, pp. 185-190.
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Lanuza, D.M., Davidson, P.M., Dunbar, S.B., Hughes, S. & De Geest, S. 2011, 'Preparing nurses for leadership roles in cardiovascular disease prevention.', Eur J Cardiovasc Nurs, vol. 10 Suppl 2, pp. S51-S57.
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Cardiovascular disease (CVD) is a critical global health issue, and cardiovascular nurses play a vital role in decreasing the global burden and contributing to improving outcomes in individuals and communities. Cardiovascular nurses require the knowledge, skills, and resources that will enable them to function as leaders in CVD. This article addresses the education, training, and strategies that are needed to prepare nurses for leadership roles in preventing and managing CVD. Building on the World Health Organization core competencies for 21st-century health care workers, the specific competencies of cardiovascular nurses working in prevention are outlined. These can be further strengthened by investing in the development of cultural, system change and leadership competencies. Mentorship is proposed as a powerful strategy for promoting the cardiovascular nursing role and equipping individual nurses to contribute meaningfully to health system reform and community engagement in CVD risk reduction.
Sheehan, M., Newton, P.J., Stobie, P. & Davidson, P.M. 2011, 'Implantable cardiac defibrillators and end-of-life care-Time for reflection, deliberation and debate?', Australian Critical Care, vol. 24, no. 4, pp. 279-284.
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Heart failure (HF) is a common condition associated with high rates of morbidity and mortality. Implantable cardiac defibrillators (ICDs) are an important management strategy in HF management and decrease mortality for both primary and secondary prevention. An emerging body of literature identifies the challenges of managing ICDs at the end of life. This report discusses a critical incident experienced by a HF team in a referral centre and outlines the issues to be considered in advancing discussion and debate of managing ICDs at the end of life. Engaging in debate, discussion and consensus guidelines is likely to be crucial in minimising distress and burden for clinicians, patients and their families alike. &copy; 2011 Australian College of Critical Care Nurses Ltd.
Thompson, D.R., Chair, S.Y., Chan, S.W., Astin, F., Davidson, P.M. & Ski, C.F. 2011, 'Motivational interviewing: a useful approach to improving cardiovascular health?', J Clin Nurs, vol. 20, no. 9-10, pp. 1236-1244.
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AIM: To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. BACKGROUND: Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. DESIGN: Systematic review. METHOD: Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. RESULTS: Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. CONCLUSION: Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. RELEVANCE TO CLINICAL PRACTICE: This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.
Thompson, S.C., Shahid, S., Bessarab, D., Durey, A. & Davidson, P.M. 2011, 'Not just bricks and mortar: Planning hospital cancer services for Aboriginal people', BMC Research Notes, vol. 4.
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Background: Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings. Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community. Conclusions: Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes. &copy; 2011 Thompson et al; licensee BioMed Central Ltd.
Daly, J., Davidson, P.M., Duffield, C., Campbell, T. & Ward, R. 2011, 'Interdisciplinary, cross- institutional collaborations: The Academic Health Sciences Centre as a key to addressing complex health problems and advancing research-based health care', Collegian, vol. 18, no. 1, pp. 1-2.
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Haghshenas, A. & Davidson, P.M. 2011, 'Quality service delivery in cardiac rehabilitation: Cross-cultural challenges in an Australian setting', Quality in Primary Care, vol. 19, no. 4, pp. 215-221.
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Background Cardiac rehabilitation is an evidencebased health service model for providing secondary prevention strategies following an acute cardiac event. In spite of the benefits of cardiac rehabilitation, there are striking cultural and ethnic disparities with regard to access to and usage of these programmes. Objective To investigate the challenges in providing cardiac rehabilitation to culturally diverse populations in Australia to inform culturally competent care. Method This was a qualitative study using interviews with 25 health professionals from diverse professional and language backgrounds working in cardiac rehabilitation and participant observation of educational and counselling sessions in four cardiac rehabilitation programmes in metropolitan Sydney, Australia. Results Providing cardiac rehabilitation to patients from culturally and linguistically diverse backgrounds presented greater challenges than did provision to the mainstream population. These challenges resulted from the interaction of multiple and complex factors such as patients, providers, structural and organisational characteristics within the treatment setting. Communication issues, reconciling health messages with culturally specific issues such as diet, social and family structure and implementation of self-management strategies are significant challenges. Conclusion Strategies are needed to overcome cross-cultural challenges and ensure effective and equitable cardiac rehabilitation service delivery. &copy; 2011 Radcliffe Publishing.
Halcomb, E.J., Caldwell, B., Salamonson, Y. & Davidson, P.M. 2011, 'Development and psychometric validation of the general practice nurse satisfaction scale.', J Nurs Scholarsh, vol. 43, no. 3, pp. 318-327.
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PURPOSE: To develop an instrument to assess consumer satisfaction with nursing in general practice to provide feedback to nurses about consumers' perceptions of their performance. DESIGN: Prospective psychometric instrument validation study. METHODS: A literature review was conducted to generate items for an instrument to measure consumer satisfaction with nursing in general practice. Face and content validity were evaluated by an expert panel, which had extensive experience in general practice nursing and research. Included in the questionnaire battery was the 27-item General Practice Nurse Satisfaction (GPNS) scale, as well as demographic and health status items. This survey was distributed to 739 consumers following intervention administered by a practice nurse in 16 general practices across metropolitan, rural, and regional Australia. Participants had the option of completing the survey online or receiving a hard copy of the survey form at the time of their visit. These data were collected between June and August 2009. FINDINGS: Satisfaction data from 739 consumers were collected following their consultation with a general practice nurse. From the initial 27-item GPNS scale, a 21-item instrument was developed. Two factors, "confidence and credibility" and "interpersonal and communication" were extracted using principal axis factoring and varimax rotation. These two factors explained 71.9% of the variance. Cronbach's ? was 0.97. CONCLUSIONS: The GPNS scale has demonstrated acceptable psychometric properties and can be used both in research and clinical practice for evaluating consumer satisfaction with general practice nurses. RELEVANCE TO CLINICAL PRACTICE: Assessing consumer satisfaction is important for developing and evaluating nursing roles. The GPNS scale is a valid and reliable tool that can be utilized to assess consumer satisfaction with general practice nurses and can assist in performance management and improving the quality of nursing services.
Koch, J., Salamonson, Y., Rolley, J.X. & Davidson, P.M. 2011, 'Learning preference as a predictor of academic performance in first year accelerated graduate entry nursing students: a prospective follow-up study.', Nurse Educ Today, vol. 31, no. 6, pp. 611-616.
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The growth of accelerated graduate entry nursing programs has challenged traditional approaches to teaching and learning. To date, limited research has been undertaken in the role of learning preferences, language proficiency and academic performance in accelerated programs. Sixty-two first year accelerated graduate entry nursing students, in a single cohort at a university in the western region of Sydney, Australia, were surveyed to assess their learning preference using the Visual, Aural, Read/write and Kinaesthetic (VARK) learning preference questionnaire, together with sociodemographic data, English language acculturation and perceived academic control. Six months following course commencement, the participant's grade point average (GPA) was studied as a measurement of academic performance. A 93% response rate was achieved. The majority of students (62%) reported preference for multiple approaches to learning with the kinaesthetic sensory mode a significant (p=0.009) predictor of academic performance. Students who spoke only English at home had higher mean scores across two of the four categories of VARK sensory modalities, visual and kinaesthetic compared to those who spoke non-English. Further research is warranted to investigate the reasons why the kinaesthetic sensory mode is a predictor of academic performance and to what extent the VARK mean scores of the four learning preference(s) change with improved English language proficiency.
Rolley, J.X., Salamonson, Y., Wensley, C., Dennison, C.R. & Davidson, P.M. 2011, 'Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions.', Aust Crit Care, vol. 24, no. 1, pp. 18-38.
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AIM: The aim of this paper is to present a set of nursing clinical practice guidelines for individuals undergoing percutaneous coronary interventions (PCIs) together with a summary of the evidence to support these recommendations. BACKGROUND: Percutaneous coronary intervention is a common procedure requiring expert nursing care delivered within an interdisciplinary team. Although evidence-based medical practice guidelines exist, they include minimal information to guide nursing-specific care. GUIDELINES DEVELOPMENT: The guidelines development process used a framework of the patient journey. Three steps leading up to this paper were undertaken: (1) a comprehensive literature review; (2) a consensus development workshop; and (3) a modified Delphi technique to refine the guideline recommendations. SUMMARY: Clinical practice guidelines to support interventional cardiology nursing care are limited. This paper represents an important contribution toward meeting this need. IMPLICATIONS FOR PRACTICE: These guidelines, developed within a context of Australian and New Zealand nursing practice, provide an important foundation to enable benchmarking and ongoing developing clinical practice standards.
Davidson, P.M., DiGiacomo, M., Thompson, S.C., Abbott, P.A., Davison, J., Moore, L., Daly, J., McGrath, S., Taylor, K. & Usherwood, T. 2011, 'Health workforce issues and how these impact on Indigenous Australians', Journal of Australian Indigenous Issues, vol. 14, no. 4, pp. 69-84.
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Indigenous Australians suffer a disproportionate burden of iII health estimated to be 2.5 times higher than other Australians. A number of complex and multifaceted factors impact not only on health inequity but also imbalance in the health workforce. Addressing workforce issues for both Indigenous and non-Indigenous health workers is vital in decreasing the gap in health and social outcomes for Indigenous Australians. It is widely recognised that the capacity of the lndigenous health workforce is a crucial factor in responding effectively to Indigenous health needs. Using the typology of workforce imbalances proposed by Zurn and colleagues, this paper critically analyses issues within Australia impacting on the health workforce, arguing that it is impossible to consider workforce issues for Indigenous health without regard for global, sociodemographic, cultural, geographic and economic factors.
Driscoll, A., Tonkin, A., Stewart, A., Thompson, D.R., Worrall-Carter, L., Riegel, B., Hare, D.L., Davidson, P.M. & Stewart, S. 2011, 'Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital.', J Clin Nurs, vol. 20, no. 21-22, pp. 3011-3019.
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AIM: The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme--the Heart Failure Intervention Score--to facilitate quality improvement and programme auditing. BACKGROUND: The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes. DESIGN: A prospective cross-sectional survey design. METHOD: All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions. RESULTS: Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ?190 (median = 178, interquartile range 176-195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%). CONCLUSION: The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of sta...
Driscoll, A., Worrall-Carter, L., Hare, D.L., Davidson, P.M., Riegel, B., Tonkin, A. & Stewart, S. 2011, 'Evidence-based chronic heart-failure management programmes: reality or myth?', BMJ Qual Saf, vol. 20, no. 1, pp. 31-37.
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BACKGROUND: Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). OBJECTIVE: To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. DESIGN: A prospective cross-sectional survey was used to conduct a national audit. SETTING: Community setting of CHF-MPs for patients postdischarge. SAMPLE: All CHF-MPs operating during 2005-2006 (n=55). Also 10-50 consecutive patients from 48 programmes were recruited (n=1157). MAIN OUTCOME MEASURES: (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. RESULTS: Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26-260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), ?-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). CONCLUSION: CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency...
Kuhn, L., Page, K., Davidson, P.M. & Worrall-Carter, L. 2011, 'Triaging women with acute coronary syndrome: a review of the literature.', J Cardiovasc Nurs, vol. 26, no. 5, pp. 395-407.
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AIMS AND OBJECTIVES: This article analyzes the literature describing factors affecting nurses' triage of emergency department (ED) patients with potential acute coronary syndrome (ACS), with particular attention paid to gender-based differences. INTRODUCTION: Acute coronary syndrome is one of the most time-critical conditions requiring ED nurse triage. This literature review will provide examination of how triage nurses prioritize patients with possible ACS, reflecting on challenges specifically associated with evaluating women for ACS in the ED. The article presents a description of the research findings that may help improve the timely revascularization of ACS in women. METHODS: An electronic search of EBSCOhost CINAHL, Health Source Nursing Academic Edition, MEDLINE, Psychology and Behavioral Sciences Collection databases, online theses, the Cochrane Library, the Joanna Briggs Institute, and National Guideline Clearinghouse resources were used to identify all relevant scientific articles published between 1990 and 2010. Google and Google Scholar search engines were used to undertake a broader search of the World Wide Web to improve completeness of the search. This search technique was augmented by hand searching these articles' reference lists for publications missed during the primary search. RESULTS: : Review of the literature suggests factors such as patient age, sex, and symptoms at ED presentation affect the accuracy of nurses' triage of ACS, particularly for women. However, research examining delays due to ED triage is scant and has predominantly been undertaken by one researcher. Little research has examined triage of ACS specifically in women. CONCLUSIONS: The literature search revealed a small number of articles describing challenges associated with nurse triage of women with ACS. Although most of this published research is North American, the themes uncovered are well supported by broader international research on acute assessment and management of w...
Sayers, J.M., DiGiacomo, M. & Davidson, P.M. 2011, 'The nurse educator role in the acute care setting in Australia: Important but poorly described', Australian Journal of Advanced Nursing, vol. 28, no. 4, pp. 44-52.
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Objective The purpose of this paper is to describe the nurse educator role in the acute care setting in Australia. Method A literature review using Ganong's (1987) method of analysis was undertaken. Computerised databases were searched for articles published in English between 2000 and 2008 using the key words: 'education', 'nursing', 'nurse-educator', 'teaching methods', 'clinical', 'outcomes health care' and 'Australia'. Information was summarised to identify issues impacting on the nurse educator role using a standardised data extraction tool. Results The search strategies generated 152 articles and reports. The review identified that the nurse educator role is fundamental in supporting clinical practice and integral to developing a skilled and competent health workforce. Conclusion Confusion in nursing roles and role ambiguity contribute to the challenges for nurse educators in acute care. The absence of a national, standardised approach to role description and scope of practice in Australia may adversely impact role enactment. Further discussion and debate of the nurse educator role in Australia is warranted.
Davidson, P.M., Homer, C.S.E., Duffield, C. & Daly, J. 2011, 'A moment in history and a time for celebration: The performance of nursing and midwifery in Excellence in Research for Australia', Collegian, vol. 18, no. 2, pp. 43-44.
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Juntasopeepun, P., Davidson, P.M., Chang, S., Suwan, N., Phianmongkhol, Y. & Srisomboon, J. 2011, 'Development and psychometric evaluation of the Thai Human Papillomavirus Beliefs Scale', Nursing and Health Sciences, vol. 13, no. 4, pp. 475-480.
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In this study, we developed and evaluated the psychometric properties of the Thai Human Papillomavirus Beliefs Scale. The Scale was tested on 386 young women aged 18-24years in Chiang Mai, Thailand. Content validity of the Scale was evaluated by a panel of experts, construct validity was determined using exploratory factor analysis, and reliability was assessed for stability and internal consistency. Factor analysis provided empirical support for the existence of four factors, which accounted for 67.7% of the total variance: perceived susceptibility, perceived seriousness, perceived benefits, and perceived barriers. Cronbach's ? reliability coefficients for the four subscales ranged from 0.59 to 0.86. Factors predicting intention to receive the papillomavirus vaccine were perceived susceptibility, perceived benefits, and perceived barriers. The Thai Human Papillomavirus Beliefs Scale demonstrated promising psychometric properties, indicating that it might be a useful instrument for assessing young women's human papillomavirus and cervical cancer-associated beliefs, and for predicting human papillomavirus vaccination intention. &copy; 2011 Blackwell Publishing Asia Pty Ltd..
Davidson, P.M. & Johnson, M.J. 2011, 'Update on the role of palliative oxygen', Current Opinion in Supportive and Palliative Care, vol. 5, no. 2, pp. 87-91.
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On the basis of the findings of this review, the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified. Promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy. If palliative oxygen therapy is considered for individuals with transient or mild hypoxaemia, a therapeutic trial should be conducted with clinical review after 3 days to assess the net clinical benefit and patient preference. &copy; 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Alexandrou, E., Ramjan, L.M., Spencer, T., Frost, S.A., Salamonson, Y., Davidson, P.M. & Hillman, K.M. 2011, 'The Use of Midline Catheters in the Adult Acute Care Setting- Clinical Implications and Recommendations for Practice', Journal of the Association for Vascular Access, vol. 16, no. 1, pp. 35-41.
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Aim and objectives: The aim of this paper was to review published manuscripts on the use of midline catheters, the implications of study findings and recommendations for clinical practice in the acute care setting. Design: Modified integrative literature review Methods: Using key MeSH terms, we searched the electronic databases: CINAHL, Medline, and Embase. The Cochrane and Joanna Briggs databases, Google Search Engine and the reference lists of published materials were also searched. Studies were included if they were in the English language and reported the use of midline catheters in adult acute care populations. Manuscripts that described midlines made of aquavene were excluded. Results: Two hundred and thirty two (232) papers were identified using the search strategy. From these identified papers, thirty (30) were included in the final review. Thematic analysis identified three major themes. These included: (i) advantages of using midline catheters (ii) disadvantages of using midline catheters (iii) insertion and management issues. Conclusion: Midline catheters have both positive and negative implications for clinical practice. They can be used for extended periods of intravenous therapy without requiring repeated cannulations but are not without risk. Midline catheters have been associated with mechanical and chemical phlebitis along with intravascular thrombosis. As such they are not suitable across the entire adult acute population. Midline catheters reduce the number of repeated cannulations which reduces patient discomfort, increases patient satisfaction and also contributes to organisational efficiency.
Davidson, P.M. & Daly, J. 2011, 'An open mind, discussion, debate and the testing of new ideas: The way of the future', Collegian, vol. 18, no. 4, pp. 137-138.
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Watts, G.F., Sullivan, D.R., Poplawski, N., van Bockxmeer, F., Hamilton-Craig, I., Clifton, P.M., OâBrien, R., Bishop, W., George, P., Barter, P.J., Bates, T., Burnett, J.R., Coakley, J., Davidson, P.M., Emery, J., Andrew, M., Farid, W., Freeman, L., Geelhoed, E., Juniper, A., Kidd, A., Kostner, K., Krass, I., Livingston, M., Maxwell, S., O'Leary, P., Owaimrin, A., Redgrave, T.G., Reid, N., Southwell, L., Suthers, G., Tonkin, A., Towler, S. & Trent, R.J. 2011, 'Familial hypercholesterolaemia: A model of care for Australasia', Atherosclerosis Supplements, vol. 12, pp. 221-263.
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Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated. To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes.
DiGiacomo, M., Davidson, P.M., Abbott, P.A., Davison, J., Moore, L. & Thompson, S.C. 2011, 'Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions', International Journal of Environmental Research and Public Health, vol. 8, no. 2, pp. 388-410.
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Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations. &copy; 2011 by the authors; licensee MDPI, Basel, Switzerland.
Lam, S., Davidson, P.M., Leslie, G., DiGiacomo, M., Rolley, J.X., Soh, K. & Rahman, A. 2011, 'Factors to drive clinical practice improvement in a Malaysian intensive care unit: assessment of organizational readiness using a mixed method approach', International Journal of Multiple Research Approaches, vol. 5, no. NA, pp. 104-121.
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This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identifi ed as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.
Davidson, P.M., Cockburn, J., Newton, P.J., Webster, J. & Betihavas, V. 2010, 'Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?', European Journal of Cardiovascular Prevention & Rehabilitation, vol. 17, no. 4, pp. 392-402.
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Background Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes. Aim To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure.
Gholizadeh, L., Davidson, P., Salamonson, Y. & Worrall-Carter, L. 2010, 'Theoretical considerations in reducing risk for cardiovascular disease: Implications for nursing practice', Journal of Clinical Nursing, vol. 19, no. 15-16, pp. 2137-2145.
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Aims and objectives: This article describes the theoretical foundation of risk perception as a key component of changing deleterious health behaviours associated with cardiovascular disease (CVD). Furthermore, perception in increasing cardiovascular risk-reducing behaviours in a socio-cultural framework is discussed, and an empirical development conceptual model presented. Background: Perception of risk is strongly linked with health-seeking behaviours. Understanding how to reduce risk and maximise cardiovascular health is an increasing focus of clinicians, researchers and policy makers. Increasing cultural diversity in contemporary society means that nurses need to develop and evaluate interventions in this context. Design: An integrative literature review. Method: An integrative literature review method was used to assess conceptual models relating to risk perception of developing CVD. On the basis of the findings, a model was developed to inform future intervention studies, considering individual, social and cultural factors. Discussion: Studies examining CVD and health behaviours report that there is limited concordance between actual and perceived risk in people with CVD. This mismatch risk likely impedes the adoption of risk-reducing behaviours. Conclusion: There is a critical need to develop interventions for enhancing an accurate perception of CVD risk considering not only individual but social factors. Relevance to clinical practice: There is limited correlation between knowledge and behaviours, and health behaviours are influenced by individual, social and cultural factors. Appraising the congruence between actual and perceived risk is an important step in developing effective care plans to reduce cardiovascular risk. &copy; 2010 Blackwell Publishing Ltd.
Gholizadeh, L., Salamonson, Y., Davidson, P.M., Parvan, K., Frost, S.A., Chang, S. & Hare, D.L. 2010, 'Cross-cultural validation of the Cardiac Depression Scale in Iran', British Journal of Clinical Psychology, vol. 49, no. 4, pp. 517-528.
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Background. The Cardiac Depression Scale (CDS) is a disease-specific instrument for measuring depression in cardiac patients. This study was designed to validate the CDS in an Iranian population. Methods. Translation and back-translation of the 26-item CDS scale was performed using recommended procedures. The Iranian translation of the CDS (I-CDS) was administered to 261 individuals in Iran, concurrently with the Beck Depression Inventory. The factor structure of the I-CDS was examined using exploratory factor analysis procedures to enable comparison with previous psychometric evaluation ofthe CDS. Receiver operating characteristic curves were used to examine the ability of the I-CDS to discriminate between categories of depression. Results. First-order exploratory factor analysis uncovered two robust factors, consistent with the second-order dimensions originally reported by the developers of this instrument. Cronbach's alpha was .88 for the total 26-item I-CDS, indicating satisfactory internal consistency of the I-CDS. Intercorrelation between the total scores for the I-CDS and BDI was .62 (p < .001). For the I-CDS cut-off of 90, the sensitivity was 85%, and specificity was 61% with a computed area under the curve (AUC) of 0.81 (95% CI, 0.76-0.87). For the I-CDS cut-off of 100, the sensitivity was 81%, and specificity was 63% with a computed AUC of 0.81 (95% CI, 0.76-0.87). Conclusion. This validation study of the Iranian version of theCDSdemonstrated that it is an acceptable, reliable, and valid measure of depression in people with heart disease.Copyright &copy; The British Psychological Society.
Davidson, P.M., Gholizadeh, L., Haghshenas, A., Rotem, A., DiGiacomo, M., Eisenbruch, M. & Salamonson, Y. 2010, 'A review of the cultural competence view of cardiac rehabilitation', Journal of Clinical Nursing, vol. 19, no. 9-10, pp. 1335-1342.
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Aims and objectives: This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background: CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. Design: Systematic review. Methods: Search of electronic databases. Conclusions: Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions. Relevance to clinical practice: There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically diverse backgrounds. &copy; 2010 Blackwell Publishing Ltd.
Halcomb, E.J., Davidson, P.M. & Brown, N. 2010, 'Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers.', Collegian, vol. 17, no. 2, pp. 57-61.
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The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and support to people with a chronic disease for and on behalf of a general practitioner (GP). The uptake of Medicare Item 100997 from 2007 to 2009, to monitor chronic disease interventions provided by general practice nurses has increased dramatically. The rate of uptake of Item 100997 has not been consistent across States and Territories, even allowing for population distributions. Exploring reasons for these regional variations and linking uptake of Medicare Item numbers to patient outcomes is important in developing the nursing role in Australian general practice.
Koch, J., Andrew, S., Salamonson, Y., Everett, B. & Davidson, P.M. 2010, 'Nursing students' perception of a web-based intervention to support learning', Nurse Education Today, vol. 30, no. 6, pp. 584-590.
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Tailoring information to the needs of the learner is an important strategy in contemporary education settings. Web-based learning support, informed by multimedia theory, comprising interactive quizzes, glossaries with audio, short narrated Power Point&reg; presentations, animations and digitised video clips were introduced in a first year Bachelor of Nursing biological sciences subject at a university in metropolitan Sydney. All students enrolled in this unit were invited to obtain access to the site and the number of hits to the site was recorded using the student tracking facility available on WebCT, an online course delivery tool adopted widely by many educational institutions and used in this study. Eighty-five percent of students enrolled in the subject accessed the learning support site. Students' perception of the value of a learning support site was assessed using a web-based survey. The survey was completed by 123 participants, representing a response rate of 22%. Three themes emerged from the qualitative data concerning nursing students' perception of the web-based activities: 'enhances my learning', 'study at my own pace', and 'about the activities: what I really liked/disliked'. Web-based interventions, supplementing a traditionally presented nursing science course were perceived by students to be beneficial in both learning and language development. Although students value interactive, multimedia learning they were not ready to completely abandon traditional modes of learning including face-to-face lectures. The findings of this study contribute to an understanding of how web-based resources can be best used to support students' learning in bioscience. &copy; 2009 Elsevier Ltd.
Riegel, B., Hanlon, A.L., McKinley, S., Moser, D.K., Meischke, H., Doering, L.V., Davidson, P., Pelter, M.M. & Dracup, K. 2010, 'Differences in mortality in acute coronary syndrome symptom clusters.', Am Heart J, vol. 159, no. 3, pp. 392-398.
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BACKGROUND: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. METHODS: In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. RESULTS: The sample was predominantly male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); Stress Symptoms (shortness of breath, sweating, nausea, indigestion, dread, anxiety); and Diffuse Symptoms, with a low frequency of most symptoms. Those in the Diffuse Symptoms cluster tended to be older (P = .08) and the Pain Symptoms group was most likely to have a history of angina (P = .01). After adjusting for differences, the Diffuse Symptoms cluster demonstrated higher mortality at 2 years (17%) than the other 3 clusters (2%-5%, P < .001), although prehospital delay time did not differ significantly. CONCLUSION: Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS.
Yacopetti, N., Alexandrou, E., Spencer, T.R., Frost, S.A., Davidson, P.M., O'Sullivan, G. & Hillman, K.M. 2010, 'Central venous catheter insertion by a clinical nurse consultant or anaesthetic medical staff: a single-centre observational study.', Crit Care Resusc, vol. 12, no. 2, pp. 90-95.
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OBJECTIVE: To compare clinical outcomes of elective central venous catheter (CVC) insertions performed by either a clinical nurse consultant (CNC) or anaesthetic medical staff (AMS). DESIGN, SETTING AND PARTICIPANTS: Prospective audit of a convenience sample of consecutive CVC insertions between July 2005 and October 2007 at a metropolitan teaching hospital in Sydney, Australia. The sample included all outpatients and inpatients requiring a CVC for either acute or chronic conditions. MAIN OUTCOME MEASURES: Number of CVC lines inserted; differences between outcomes in the CNC and AMS groups; complications during and after insertion. RESULTS: Over a 28-month period, 245 CVCs were inserted by AMS and 123 by the CNC. The most common indications for CVC placement in both groups were for the treatment of oncology and autoimmune disorders (61%) and for antibiotic therapy (27%). Other indications were parenteral nutrition (2%) and other therapies (10%). There was no significant difference in complications on insertion between the CNC and AMS groups. AMS failed to obtain access in 12 attempted procedures compared with eight by the CNC. The rate of CVCs investigated for infection was twice as high in the AMS group as in the CNC group (19% v 8%). The confirmed catheter-related bloodstream infection (CRBSI) rate was 2.5/1000 catheters in the AMS group and 0.4/1000 catheters in the CNC group (P = 0.04). CONCLUSION: Insertion outcomes were favourable in both the AMS and CNC groups. Infection outcomes differed between groups, with a higher rate of CRBSI in the AMS group.
Doering, L.V., Moser, D.K., Riegel, B., McKinley, S., Davidson, P., Baker, H., Meischke, H. & Dracup, K. 2010, 'Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease.', Int J Cardiol, vol. 145, no. 2, pp. 188-192.
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BACKGROUND: Incident anxiety and depression are associated separately with cardiac events and mortality in patients after acute coronary syndromes, but the influence of persistent comorbid depression and anxiety on mortality remains unknown. The purpose of this study was to determine the prevalence of comorbid persistent depressive and anxious symptoms in individuals with ischemic heart disease and to evaluate effects on mortality. METHODS: Prospective, longitudinal cohort design in the context of a randomized trial to decrease patient delay in seeking treatment for ischemic heart symptoms (PROMOTION trial) was used, with twelve-month follow-up of 2325 individuals with stable ischemic heart disease. Participants were assessed on enrollment and at 3 months using the Multiple Adjective Affect Checklist and the Brief Symptom Inventory for depressive and anxious symptoms, respectively. RESULTS: At 3 months, 608 individuals (61.7%) reported persistent symptoms of depression, anxiety, or both. Three hundred seventy-nine (42.5%) and 1056 (45.4%) had persistent anxious and depressive symptoms, respectively. Those with persistent, comorbid symptoms had higher mortality compared to others (p=.029). The combined presence of anxious and depressive symptoms contributed significantly to mortality when compared to symptom-free participants (OR 2.35, 95% CI 1.23-4.47, p=.010). The presence of persistent depressive symptoms only and persistent anxious symptoms only were not associated with death, when other demographic and clinical variables were considered. CONCLUSIONS: Persistent symptoms of anxiety and depression increased substantially the risk of death in patients with ischemic heart disease. Future research into shared and unique pathways and treatments is needed.
DiGiacomo, M.L., Thompson, S.C., Smith, J.S., Taylor, K.P., Dimer, L.A., Ali, M.A., Wood, M.M., Leahy, T.G. & Davidson, P.M. 2010, ''I don't know why they don't come': Barriers to participation in cardiac rehabilitation', Australian Health Review, vol. 34, no. 4, pp. 452-457.
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Objectives. To describe health professionals' perceptions of Aboriginal people's access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Design. Qualitative study. Setting. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Participants. Thirty-eight health professionals working in the CR setting. Method. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Results. Emergent themes included (1) a lack of awareness of Aboriginal CR patients' needs; (2) needs related to cultural awareness training for health professionals; and (3) Aboriginal health staff facilitate access for Aboriginal patients. Conclusions. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes. &copy; AHHA 2010.
Fernandez, R.S., Davidson, P.M., Griffiths, R. & Salamonson, Y. 2010, 'Overcoming barriers to guideline implementation: the case of cardiac rehabilitation', Quality and Safety in Health Care, vol. 19, no. 6, pp. 1-5.
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Aims This study explored the strategies used by cardiac rehabilitation (CR) coordinators to overcome the obstacles to implementation of the evidence-based Reducing Risk in Heart Disease guidelines. Methods The study design used qualitative, semistructure
Alexandrou, E., Spencer, T.R., Frost, S.A., Parr, M.J., Davidson, P.M. & Hillman, K.M. 2010, 'A review of the nursing role in central venous cannulation: implications for practice policy and research.', J Clin Nurs, vol. 19, no. 11-12, pp. 1485-1494.
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AIMS AND OBJECTIVES: The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role. DESIGN: Modified integrative literature review. METHODS: Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, Embase, and the World Wide Web were undertaken using MeSH key words. Hand searching for relevant articles was also undertaken. All studies relating to the nurses role inserting central venous cannulae in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. RESULTS: Ten studies met the inclusion criteria for the review, all reported data were from the UK. There were disparate models of service delivery and study populations and the studies were predominantly non experimental in design. The results of this review need to be considered within the methodological caveats associated with this approach. The studies identified did not demonstrate differences in rates of adverse events between a specialist nurse and a medical officer. CONCLUSIONS: There were only a small number of studies found in the literature review and the limited availability of clinical outcome data precluded formal analysis from being generated. RELEVANCE TO CLINICAL PRACTICE: Central vein cannulation is potentially an emerging practice area with important considerations for policy practice and research. Training specialist nurses to provide such a service may facilitate standardising of practice and improving surveillance of lines, and possibly improve the training and accreditation process for CVC insertions for junior medical officers. For this to occur, there is a need to undertake well-conducted clinical studies to clearly document the value and efficacy of this advanced practice nursing role.
Frost, S.A., Tam, V., Alexandrou, E., Hunt, L., Salamonson, Y., Davidson, P.M., Parr, M.J. & Hillman, K.M. 2010, 'Readmission to intensive care: development of a nomogram for individualising risk.', Crit Care Resusc, vol. 12, no. 2, pp. 83-89.
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BACKGROUND: Readmission to intensive care during the same hospital stay has been associated with a greater risk of in-hospital mortality and has been suggested as a marker of quality of care. There is lack of published research attempting to develop clinical prediction tools that individualise the risk of readmission to the intensive care unit during the same hospital stay. OBJECTIVE: To develop a prediction model using an inception cohort of patients surviving an initial ICU stay. DESIGN, SETTING AND PARTICIPANTS: The study was conducted at Liverpool Hospital, Sydney. An inception cohort of 14 952 patients aged 15 years or more surviving an initial ICU stay and transferred to general wards in the study hospital between 1 January 1997 and 31 December 2007 was used to develop the model. Binary logistic regression was used to develop the prediction model and a nomogram was derived to individualise the risk of readmission to the ICU during the same hospital stay. MAIN OUTCOME MEASURE: Readmission to the ICU during the same hospital stay. RESULTS: Among members of the study cohort there were 987 readmissions to ICU during the study period. Compared with patients not readmitted to the ICU, patients who were readmitted were more likely to have had ICU stays of at least 7 days (odds ratio [OR], 2.2 [95% CI, 1.85- 2.56]); non-elective initial admission to the ICU (OR, 1.7 [95% CI, 1.44-2.08]); and acute renal failure (OR, 1.6 [95% CI, 0.97-2.47]). Patients admitted to the ICU from the operating theatre or recovery ward had a lower risk of readmission to ICU than those admitted from general wards, the emergency department or other hospitals. The maximum error between observed frequencies and predicted probabilities of readmission to ICU was estimated to be 3%. The area under the receiver operating characteristic curve of the final model was 0.66. CONCLUSION: We have developed a practical clinical tool to individualise the risk of readmission to the ICU during the same hos...
Digiacomo, M., Lam, P., Roberts, B.L., Lau, T.C., Song, R. & Davidson, P.M. 2010, 'Exploring the reasons for adherence to T'ai chi practice', Journal of Alternative and Complementary Medicine, vol. 16, no. 12, pp. 1245-1246.
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Digiacomo, M., Davidson, P.M., Taylor, K.P., Smith, J.S., Lyn Dimer, E.N., Ali, M., Wood, M.M., Leahy, T.G. & Thompson, S.C. 2010, 'Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: A qualitative study', Quality in Primary Care, vol. 18, no. 1, pp. 17-26.
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Background Aboriginal Australians have low rates of participation in cardiac rehabilitation (CR), despite having high rates of cardiovascular disease. Barriers to CR participation reflect multiple patientrelated issues. However, an examination of the broader context of health service delivery design and implementation is needed. Aims To identify health professionals' perspectives of systems related barriers to implementation of the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples.1 Method Semi-structured interviews were conducted with health professionals involved in CR within mainstream and Aboriginal Community Controlled Health Services in Western Australia (WA). Thirty-eight health professionals from 17 services (ten rural, seven metropolitan) listed in the WA Directory of CR services and seven Aboriginal Medical Services in WA were interviewed. Results Respondents reported barriers encountered in health information management and the impact of access to CR services for Aboriginal people. Crucial issues identified by participants were: poor communication across the health care sector and between providers, inconsistent and insufficient data collection processes (particularly relating to Aboriginal ethnicity identification), and challenges resulting from multiple clinical information systems and incompatible technologies. Conclusions This study has demonstrated that inadequate information systems and communication strategies, particularly those representing the interface between primary and secondary care, contribute to the low participation rates of Aboriginal Australians in CR. Although these challenges are shared by non-Aboriginal Australians, the needs are greater for Aboriginal Australians and innovative solutions are required. &copy; 2010 Radcliffe Publishing.
Digiacomo, M., Abbott, P., Davison, J., Moore, L. & Davidson, P.M. 2010, 'Facilitating uptake of aboriginal adult health checks through community engagement and health promotion', Quality in Primary Care, vol. 18, no. 1, pp. 57-64.
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Background Adult Health Checks (AHCs) for Aboriginal and Torres Strait Islander people (MBS Item 710) promote comprehensive physical and psychosocial health assessments. Despite the poor uptake of health assessments in Aboriginal and Torres Strait Islander people, a small number of successful implementation initiatives have been reported. In order to ensure uptake of these screening initiatives, there remains a need to demonstrate the feasibility of models of implementing AHCs. Aims The aim of mis paper is to address the process issues and overarching outcomes of a two-day targeted screening and assessment programme to increase the uptake of AHCs at an Aboriginal Community Controlled Medical Service. Method Clients of an urban Aboriginal Medical Service (AMS) were invited to undertake an AHC during a two-day screening initiative. On-site general practitioners (GPs), nurses, and Aboriginal Health Workers (AHWs) worked within a team to facilitate screenings at an AMS. Barriers and facilitators to the initiative and strategies for quality improve-ment were discussed by the team. A review of medical notes was undertaken six months following the screening days to document uptake of recommendations. Results Forty clients undertook AHCs as part of the initiative. In total, 113 diagnostic tests, interventions, specialist referrals and medication initiatives had been enacted within the following six months as a result of screening day visits. Benefits to individual clients, the community, the AMS and staff were identified. Conclusions The screening day demonstrated feasibility and acceptability of this approach and provides support for its implementation in other health facilities. Importantly, this service was provided in a culturally sensitive framework and within an interdisciplinary teamwork model This targeted approach increased uptake of assessment items and provided opportunities for health advice and risk factor modification. &copy; 2010 Radcliffe Publishing.
Davidson, P.M., Macdonald, P., Newton, P.J. & Currow, D. 2010, 'End stage heart failure patients: Palliative care in general practice', Australian family physician, vol. 39, no. 12, pp. 2-6.
Background: Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms.
Davidson, P.M., De Geest, S. & Hill, M.N. 2010, 'Nurses addressing the challenges of chronic illness: from primary to palliative care.', Collegian, vol. 17, no. 2, pp. 43-45.
Davidson, P.M., Abbott, P., Davison, J. & DiGiacomo, M. 2010, 'Improving Medication Uptake in Aboriginal and Torres Strait Islander Peoples', Heart Lung and Circulation, vol. 19, no. 5-6, pp. 372-377.
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Background: Poor medication adherence is associated with adverse health outcomes. Improving access and adherence to pharmacological therapy is important in achieving optimal health outcomes for Indigenous populations. In spite of the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence and evidence based practice are less well refined and the challenges for Indigenous populations are more pronounced. Aim: To identify factors impacting on medication adherence in Aboriginal Australians and identify solutions to improve the quality use of medicines. Method: The World Health Organization adherence model was used to classify barriers to adherence. Key elements of this model are (1) health care team/health system; (2) socio-economic factors; (3) therapy; (4) patient; and (5) condition related. Results: Entrenched socio-economic differentials aggravate challenges to medication adherence amongst Aboriginal Australians. Initiatives to promote the quality use of medicines, such as the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX) Program, are important strategies to promote adherence. Conclusions: Medication adherence is a complex issue and addressing modifiable factors is imperative to improve health outcomes. Subsidised access to medications whether living in urban, regional, rural or remote areas is an important strategy in Closing the Gap. &copy; 2010.
Davidson, P.M. & Currow, D. 2010, 'Management of refractory dyspnoea:evidence-based interventions', Cancer Forum, vol. 34, no. 2, pp. 86-90.
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Breathlessness is a common and distressing symptom in both malignant and non-malignant conditions. Both pharmacological and non-pharmacological strategies are necessary to minimise symptom burden and distress. Assessing the individual&acirc;s needs and clarifying the goals of treatment is an important first step in determining an effective treatment plan. Although the evidence supporting the use of some of these therapies is variable, there is an increasing evidence base to inform clinical decision making and treatment plans. Pharmacotherapy with opioids is a common and effective strategy for managing breathlessness, yet requires judicious titration and management. The adverse effects of opioid therapy, including constipation and drowsiness, can be anticipated and managed with adjunctive therapies. The use of oxygen in people who are hypoxaemic is supported, but is of limited value in people who are not hypoxaemic. Individualised strategies and advance care planning is important to avoid unnecessary hospitalisations and futile treatments at the end of life. There is a clear mismatch between the prevalence and burden of this problem and data to inform evidence-based guidelines. Refractory breathlessness is a fertile area for ongoing research and requires increased attention to address the burden of this highly prevalent symptom.
Currow, D.C., Smith, J., Davidson, P.M., Newton, P.J., Agar, M.R. & Abernethy, A.P. 2010, 'Do the Trajectories of Dyspnea Differ in Prevalence and Intensity By Diagnosis at the End of Life? A Consecutive Cohort Study', Journal of Pain and Symptom Management, vol. 39, no. 4, pp. 680-690.
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Context: Breathlessness reportedly worsens as death approaches for many people, but the differences in intensity and time course between underlying causes are not well described. Objectives: To determine differences in the intensity of breathlessness by diagnosis over time as death approaches in a consecutive cohort seen by a specialist palliative care service. Methods: Patients referred to Silver Chain Hospice Care Service over a period of four years (January 2004 to December 2007) had dyspnea evaluated at every clinical encounter until death. A numeric rating scale (NRS) was used to measure the intensity. Patients were categorized into five clusters (lung cancer, secondary cancer to lung, heart failure, end-stage pulmonary disease, and no identifiable cardiorespiratory cause) at three time points (60-53 [T3], 30-23 [T2], and 7-0 [T1] days before death [T0]). Group differences were assessed using analysis of variance. Joinpoint regression models defined significant changes in mean breathlessness intensity. Results: For 5,862 patients, data were collected an average of 20 times (median: 13; 116,982 data points) for an average of 86 days (median: 48). Breathlessness was significantly higher at all three time points in people with noncancer diagnoses. Breathlessness increased significantly at days 10 and 3 before death for people with cancer (P < 0.001 for both), but remained unchanged, albeit significantly higher for patients with noncancer diagnoses. In the three months leading to death, the prevalence of "no breathlessness" decreased from 50% to 35%, and the proportion of patients with severe breathlessness (>7 out of 10) increased from 10% to 26%. Conclusion: Prevalence of breathlessness increases rapidly at life's end, especially for people with primary lung cancer; the levels of breathlessness became close to those experienced by people with noncancer diagnoses despite symptom control measures. &copy; 2010 U.S. Cancer Pain Relief Committee.
Halcomb, E.J., Davidson, P.M., Caldwell, B., Salamonson, Y. & Rolley, J.X. 2010, 'Validation of the Professional Practice Environment Scale in Australian general practice.', J Nurs Scholarsh, vol. 42, no. 2, pp. 207-213.
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PURPOSE: To validate the Professional Practice Environment Scale (PPE) in Australian general practice. METHODS: The PPE was modified slightly for appropriateness for the practice setting and administered to a sample of 342 Australian general practice nurses via an online survey tool. The factor structure of the 38-item PPE was examined using principal components analysis with Varimax rotation. FINDINGS: An eight-factor solution accounted for 71.6% of the variance. Low factor loading (<0.3) or cross-component loadings were detected in eight items. A comparison of Cronbach's alpha values demonstrated little change in the deletion of eight items from four of the eight related components. CONCLUSIONS: Findings demonstrated that a 30-item version of the PPE was reliable and valid for use to assess the professional practice environment of nurses working in Australian general practice. CLINICAL RELEVANCE: A tool to measure the professional practice environment in general practice is important as it will assist in monitoring the impact of the work environment on the recruitment, retention, and satisfaction of nurses in this setting.
Goddard, L., Mackey, S. & Davidson, P.M. 2010, 'Functional clinical placements: a driver for change.', Nurse Educ Today, vol. 30, no. 5, pp. 398-404.
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The aim of the project was to create a supervised professional experience placement model involving undergraduate nursing students, families of children with intellectual disabilities and nursing lecturers. Action research provided the methodological framework for developing a new placement model. Five families with children with disabilities, nine nursing students and two nurse academics worked together through the cycles of the action research process to develop a family health promotion intervention to improve the health and wellness of the family members and reduce risk for illness. Awareness, valuing and understanding were key themes derived from the qualitative data. Findings of this project indicate that this model of university-initiated, community-focused professional experience placement is effective in achieving the competency-based learning outcomes required of undergraduate nursing students and is worthy of ongoing exploration.
Clark, A., Davidson, P.M., Currie, K., Karimi, M., Duncan, A. & Thompson, D. 2010, 'Understanding and promoting effective self-care during heart failure', Current Treatment Options in Cardiovascular Medicine, vol. 12, pp. 1-9.
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Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain life, healthy functioning, and well-being. The people who help patients most (ie, caregivers/family members) should be involved in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed with once-daily dosing, with pharmacists providing medication review and support. Pill boxes should be provided and patients health literacy levels assessed. Psychosocial interventions for smoking cessation should be undertaken. Regular aerobic exercise may benefit patients with mild to moderate HF and some with severe but stable HF; therefore, referral to cardiac rehabilitation should be considered. Exercise regimen must take into account patient-related factors, including functional status, comorbid conditions, and patient preferences. Intake of salt, alcohol, and fluid should be restricted, although these steps are supported by limited evidence. Patients should be educated on appropriate sources of help. They should seek help immediately for persistent chest pain, palpitations, syncope, breathlessness at rest, or a weight increase of = 2 lb. Depression, if present, should be addressed with antidepressants (sertraline and citalopram), cognitive behavioral therapy, and regular exercise. HF disease management programs should be offered if available.
Warner, P., Jelinek, H. & Davidson, P.M. 2010, 'A university clinic: an innovative model for improving clinical practice', Australian Journal of Advanced Nursing, vol. 27, no. 4, pp. 38-42.
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This paper discusses interprofessional learning through interdisciplinary collaboration between undergraduate nursing and podiatry students at a university based cardiovascular screening clinic.
Page, K., Davidson, P.M., Edward, K., Allen, J., Cummins, R., Thompson, D. & Worrall-Carter, L. 2010, 'Recovering from an acute cardiac event - the relationship between depression and life satisfaction', Journal Of Clinical Nursing, vol. 19, no. 5-6, pp. 736-743.
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Aims. This study sought to measure the rates and trajectory of depression over six months following admission for an acute cardiac event and describe the relationship between depression and life satisfaction. Background. Co-morbid depression has an impact on cardiac mortality and is associated with the significant impairment of quality of life and well-being, impairments in psychosocial function, decreased medication adherence and increased morbidity. Design. This was a descriptive, correlational study. Method. The study was undertaken at a large public hospital in Melbourne. Participants were asked to complete a survey containing the cardiac depression scale (CDS) and the Personal Well-being Index.
Hickman, L.D., Rolley, J.X. & Davidson, P.M. 2010, 'Can principles of the Chronic Care Model be used to improve care of the older person in the acute care sector?', Collegian, vol. 17, no. 2, pp. 63-69.
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Background: There is increasing evidence that hospitals are failing to meet the needs of older people. As a consequence acute care needs to be adapted to meet the needs of older people. Although initially developed for chronic conditions the Chronic Care Model (CCM) provides useful strategies for improving continuity and quality of care. Method/aim: This paper describes the elements of the CCM and discusses how a chronic care approach can improve models of care delivery for older persons in the acute care hospital settings. Discussion: The CCM provides a potentially useful approach to improve health care for older people in the acute care setting. Positive policy environments, interdisciplinary care collaboration, evidence-based practice, an emphasis on self-management strategies and empowered communities are essential elements for driving development of effective models of care. Conclusion: Models of care require a multifaceted collaborative approach for sustainability. Implementing elements of the CCM in developing models of acute care may improve patient outcomes and decrease unnecessary admissions to hospital for older people. Implications for practice: This paper provides suggestions for models of care to improve care of the older person in the acute care setting. &copy; 2010 Royal College of Nursing, Australia.
Davidson, P.M. & Phillips, J.L. 2010, 'Facing the inevitable - death from chronic illness', EoL-Towards quality care at the end of life, vol. 2, no. 1, pp. 14-15.
Globally there is an epidemic of chronic illnesses challenging individuals, health care providers and systems.9 In contemporary society, many people live for extended periods with conditions which were in previous decades an immediate death sentence. However, these welcome changes in longevity do not defy the future certainty of death.
Du, H., Davidson, P.M., Everett, B., Salamonson, Y., Zecchin, R., Rolley, J.X., Newton, P.J. & MacDonald, P.S. 2010, 'Assessment of a self-administered adapted 6-minute walk test', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 30, no. 2, pp. 116-120.
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Purpose: This study assessed the reliability and viability of the Home-Heart-Walk (HHW) test, adapting a standardized 6-minute walk test protocol for self-administration. Methods: Twenty-nine volunteers with documented coronary heart disease (CHD) undertook a structured 7-day program using the HHW. Results: The intervention was well received by participants. The intraclass correlation coefficient of the test distance over 7 days was 0.98, and the correlations between investigator and participant measures were high (r = 0.99 for day 1 [first test], r = 0.99 for day 1 [second test], and r = 0.99 on day 7). Conclusion: These data demonstrate the potential of the HHW as a tool to promote and monitor physical activity in community-based settings. These observations require further investigation and testing in other populations.
Askham, J., Kuhn, L., Frederiksen, K., Davidson, P.M., Edward, K. & Worrall-Carter, L. 2010, 'The information and support needs of Faroese women hospitalised with an acute coronary syndrome', Journal Of Clinical Nursing, vol. 19, no. 9-10, pp. 1352-1361.
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Aim and objectives. The aim of this study was to describe the information and support needs of Faroese women after their hospitalisation for acute coronary syndrome. The Faroe Islands are located between Iceland and Norway. There are no published studies examining recovery for women following an acute cardiac event. Background. Coronary heart disease remains the greatest killer of women worldwide, including on the Faroe Islands. Describing womens experiences of their recovery processes following acute coronary syndrome can enable timely information and support for the women who are affected. It is important that this information is tailored to the cultural context of women. Design. This qualitative study used a descriptive-exploratory approach. Method. Data were obtained by semi-structured interviews with participants three to four weeks after hospital discharge for their first acute coronary syndrome event.
Chang, E., Easterbrook, S., Hancock, K., Johnson, A. & Davidson, P.M. 2010, 'Evaluation of an information booklet for caregivers of people with dementia: An Australian perspective', Nursing and Health Sciences, vol. 12, no. 1, pp. 45-51.
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The need for improved communication around end-of-life issues has been identified in cancer care. However, caregivers assisting those with dementia have been given scant attention. This study investigated the application of a new dementia information booklet for family caregivers, accessing those that were both community-based and linked to a residential aged-care facility through the distribution of 672 information booklets. This occurred via 14 dementia advisory services and 48 residential aged-care facilities throughout New South Wales, Australia. A total of 233 carers (33%) completed the booklet questionnaire evaluation. The descriptive statistics indicated that most carers found the booklet useful and thought that the booklet should be freely available to them. Almost half of the carers said that they wanted to receive the information at the time of, or soon after, the diagnosis of dementia. Only a small group of respondents considered the information to be confronting. The reported anxiety was thought to be part of a larger issue of dementia education and dealing with loss and not specifically related to the booklet itself.
Rolley, J.X., Salamonson, Y., Dennison, C.R. & Davidson, P.M. 2010, 'Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses.', J Cardiovasc Nurs, vol. 25, no. 1, pp. 75-84.
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BACKGROUND: Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care. AIM: This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand. METHOD: Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system. RESULTS: Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area. CONCLUSION: This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.
Rapley, P. & Davidson, P.M. 2010, 'Enough of the problem: a review of time for health care transition solutions for young adults with a chronic illness.', J Clin Nurs, vol. 19, no. 3-4, pp. 313-323.
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AIMS AND OBJECTIVES: In this article, we critically assess the state of the science of transition care in chronic conditions using diabetes care as an exemplar and provide a case for the adoption of the principles of the Chronic Care Model in driving health care reform. BACKGROUND: Globally, there is an increasing burden of chronic conditions including among adolescents and young adults. As a consequence adolescents are transitioning, at an increasing rate, from paediatric services into mainstream adult services, which are often ill equipped to meet their needs. DESIGN: Integrative literature review. METHODS: An integrative literature review method was used to summarise key issues facing adolescents with chronic illness and generate strategies for improving health care services. CONCLUSION: Strengthening the capacity for transitioning from a service that is family focused to one with an individual orientation requires a paradigmatic shift and clear identification of roles and responsibilities in the health care system. The absence of empirically developed models of care, in a context of growing need, signals the importance of ongoing discussion, debate and research. IMPLICATIONS FOR CLINICAL PRACTICE: There is a need for a change in philosophical orientation to promote service provision on the basis of need, rather than a model based on diagnosis and chronology. Nurses and other health professionals need to increase their awareness of issues facing adolescents with chronic conditions making the transition to adult health services.
Gholizadeh, L. & Davidson, P.M. 2010, 'Coronary heart disease issues for Middle Eastern women', Diversit-e, vol. 3, pp. 11-12.
Cao, Y., Davidson, P.M., Digiacomo, M. & Yang, M. 2010, 'Prehospital delay for acute coronary syndrome in China', Journal of Cardiovascular Nursing, vol. 25, no. 6, pp. 487-496.
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Background: Despite the effectiveness of timely reperfusion therapy for acute coronary syndrome, prehospital delay remains a global concern. Objective: This article assesses the state-of-the-science regarding prehospital delay for acute coronary syndrome in China. Method: Electronic databases and hand searching were undertaken using key words such as prehospital delay, care-seeking delay, coronary heart disease, heart disease, acute coronary syndrome, unstable angina pain, acute myocardial infarction, cardiovascular disease, chest pain, and Chin (China/Chinese). The Chinese search was supervised by a Chinese health librarian. Results: Based on the search criteria, 28 studies were identified and reviewed using a standardized data extraction tool. Older age, attribution of symptoms to noncardiac causes, lack of health insurance coverage, poor access to transportation, and female sex were identified as contributing to prehospital delay. Conclusion: Health system reforms in China are necessary, particularly with regard to addressing the needs of older people, women, and other vulnerable populations in the context of the rising number of people with coronary heart disease. Developing targeted strategies, learned from both national and international experience, are required to develop targeted interventions. Copyright &copy; 2010 Wolters Kluwer Health. Lippincott Williams & Wilkins.
Alexandrou, E., Spencer, T., Frost, S., Parr, M., Davidson, P.M. & Hillman, K. 2010, 'Establishing a nurse-led central venous catheter insertion service', The Journal of Vascular Access, vol. 15, no. 1, pp. 21-27.
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Background: Health care systems provide care models that deliver both quality and safety. Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes. The aim of this paper is to discuss the process of establishing a nurse-led central venous catheter (CVC) insertion service in a university affiliated hospital using a process evaluation method.
Dracup, K., McKinley, S., Riegel, B., Moser, D.K., Meischke, H., Doering, L.V., Davidson, P., Paul, S.M., Baker, H. & Pelter, M. 2009, 'A randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome.', Circ Cardiovasc Qual Outcomes, vol. 2, no. 6, pp. 524-532.
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BACKGROUND: Delay from onset of acute coronary syndrome (ACS) symptoms to hospital admission continues to be prolonged. To date, community education campaigns on the topic have had disappointing results. Therefore, we conducted a clinical randomized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time. METHODS AND RESULTS: Participants (n=3522) with documented coronary heart disease were randomized to experimental (n=1777) or control (n=1745) groups. Experimental patients received education and counseling about ACS symptoms and actions required. Patients had a mean age of 67+/-11 years, and 68% were male. Over the 2 years of follow-up, 565 patients (16.0%) were admitted to an emergency department with ACS symptoms a total of 842 times. Neither median prehospital delay time (experimental, 2.20 versus control, 2.25 hours) nor emergency medical system use (experimental, 63.6% versus control, 66.9%) was different between groups, although experimental patients were more likely than control to call the emergency medical system if the symptoms occurred within the first 6 months following the intervention (P=0.036). Experimental patients were significantly more likely to take aspirin after symptom onset than control patients (experimental, 22.3% versus control, 10.1%, P=0.02). The intervention did not result in an increase in emergency department use (experimental, 14.6% versus control, 17.5%). CONCLUSIONS: The education and counseling intervention did not lead to reduced prehospital delay or increased ambulance use. Reducing the time from onset of ACS symptoms to arrival at the hospital continues to be a significant public health challenge. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier NCT00734760.
Thompson, S.C., DiGiacomo, M.L., Smith, J.S., Taylor, K.P., Dimer, L., Ali, M., Wood, M.M., Leahy, T.G. & Davidson, P.M. 2009, 'Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: An assessment of CR Services across Western Australia', Australia and New Zealand Health Policy, vol. 6, no. 1.
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Background: Cardiovascular disease is the major cause of premature death of Indigenous Australians, and despite evidence that cardiac rehabilitation (CR) and secondary prevention can reduce recurrent disease and deaths, CR uptake is suboptimal. The National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples, published in 2005, provide checklists for services to assist them to reduce the service gap for Indigenous people. This study describes health professionals' awareness, implementation, and perspectives of barriers to implementation of these guidelines based on semi-structured interviews conducted between November 2007 and June 2008 with health professionals involved in CR within mainstream health services in Western Australia (WA). Twenty-four health professionals from 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services were interviewed.Results: The majority of respondents reported that they were unfamiliar with the NHMRC guidelines and as a consequence implementation of the recommendations was minimal and inconsistently applied. Respondents reported that they provided few in-patient CR-related services to Indigenous patients, services upon discharge were erratic, and they had few Indigenous-specific resources for patients. Issues relating to workforce, cultural competence, and service linkages emerged as having most impact on design and delivery of CR services for Indigenous people in WA.Conclusions: This study has demonstrated limited awareness and poor implementation in WA of the recommendations of the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples: A Guide for Health Professionals. The disproportionate burden of CVD morbidity and mortality among Indigenous Australians mandates urgent attention to this problem and alternative approaches to CR d...
Rolley, J.X., Davidson, P.M., Salamonson, Y., Fernandez, R. & Dennison, C.R. 2009, 'Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach.', J Clin Nurs, vol. 18, no. 17, pp. 2394-2405.
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AIM: To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. DESIGN: Systematic review. METHOD: The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). RESULTS: Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. CONCLUSIONS: Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. RELEVANCE TO CLINICAL PRACTICE: To improve the care given to individuals undergoing percutaneous coronary intervention, it i...
Frost, S.A., Alexandrou, E., Bogdanovski, T., Salamonson, Y., Davidson, P.M., Parr, M.J. & Hillman, K.M. 2009, 'Severity of illness and risk of readmission to intensive care: a meta-analysis.', Resuscitation, vol. 80, no. 5, pp. 505-510.
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BACKGROUND: Almost one in every 10 patients who survive intensive care will be readmitted to the intensive care unit (ICU) during the same hospitalisation. The association between increasing severity of illness (widely calculated in ICU patients) with risk of readmission to ICU has not been systematically summarized. OBJECTIVE: The meta-analysis was designed to combine information from published studies to assess the relationship between severity of illness in ICU patients and the risk of readmission to ICU during the same hospitalisation. DATA SOURCES: Studies were identified by searching MEDLINE (1966 to August 2008), EMBASE (1980-2008), and CINAHL (1982 to August 2008). REVIEW METHODS: Studies included only adult populations, readmissions to ICU during the same hospitalisation and reports of valid severity of illness index. RESULTS: Eleven studies (totaling 220000 patients) were included in the meta-analysis. Severity of illness (APACHE II, APACHE III, SAPS and SAPS II) measured at the time of ICU admission or discharge, was higher in patients readmitted to the ICU during the same hospitalisation compared to patients not-readmitted (both p-values<0.001). The risk of readmission to ICU increased by 43% with each standard deviation increase in severity of illness score (regardless if measured on admission to, or discharge from the ICU) (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.3-1.6). CONCLUSIONS: A relationship between increasing intensive care severity of illness and risk of readmission to ICU was found. The effect was the same regardless of the time of measurement of severity of illness (at admission to ICU or the time of discharge from ICU). However, further research is required to develop more comprehensive tools to identify patients at risk of readmission to ICU to allow the targeted interventions, such as ICU-outreach to follow-up these patients to minimize adverse events.
Everett, B., Salamonson, Y., Zecchin, R. & Davidson, P.M. 2009, 'Reframing the dilemma of poor attendance at cardiac rehabilitation: an exploration of ambivalence and the decisional balance.', J Clin Nurs, vol. 18, no. 13, pp. 1842-1849.
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AIM: To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence. BACKGROUND: Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence - the experience of simultaneously wanting to and yet not wanting to, or the 'I want to, but I don't want to' dilemma. DESIGN: Discussion paper. METHOD: This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation. CONCLUSIONS: This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes. RELEVANCE TO CLINICAL PRACTICE: Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward.
Du, H., Newton, P.J., Salamonson, Y., Carrieri-Kohlman, V.L. & Davidson, P.M. 2009, 'A review of the six-minute walk test: Its implication as a self-administered assessment tool', European Journal of Cardiovascular Nursing, vol. 8, no. 1, pp. 2-8.
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Background: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. Aim: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. Method: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. Conclusions: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity. &copy; 2008 European Society of Cardiology.
Driscoll, A., Worrall-Carter, L., Hare, D.L., Davidson, P.M., Riegel, B., Tonkin, A. & Stewart, S. 2009, 'Evidence-based chronic heart failure management programs: reality or myth?', Qual Saf Health Care, vol. 18, no. 6, pp. 450-455.
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BACKGROUND: Chronic heart failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). OBJECTIVE: To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. DESIGN: Prospective cross-sectional survey was used to conduct a national audit. SETTING: Community setting of CHF-MPs for patients after discharge. SAMPLE: All CHF-MPs operating during 2005-2006 (n = 55). 10-50 consecutive patients from 48 programmes were also recruited (n = 1157). MAIN OUTCOME MEASURES: (1) Characteristics and interventions used within each CHF-MP and (2) characteristics of patients enrolled into these programmes. RESULTS: Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 post-discharge CHF patients (median, 126; IQR, 26-260) were managed via CHF-MPs representing only 20% of the potential national case load. Significantly, 16% of the case load comprised patients in functional New York Heart Association class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident with 70% of CHF-MPs offering a hybrid model (a combination of heart failure outpatient clinics and home visits), 20% conducting home visits and 16% an extended rehabilitation model of care. Less than half (44%) allowed heart failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n = 23, 96%), beta-blockers (n = 17, 71%), ACE inhibitors (n = 14, 58%) and spironolactone (n = 9, 38%). CONCLUSION: CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and ...
Davidson, P.M. & Stewart, S. 2009, 'Heart failure nursing in Australia: past, present and future.', Aust Crit Care, vol. 22, no. 3, pp. 108-110.
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Briffa, T.G., Kinsman, L., Maiorana, A.J., Zecchin, R., Redfern, J., Davidson, P.M., Paull, G., Nagle, A. & Denniss, A.R. 2009, 'An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia: Policy statement from the Australian Cardiovascular Health and Rehabilitation Association', Medical Journal of Australia, vol. 190, no. 12, pp. 683-686.
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* Implementing existing knowledge about cardiac rehabilitation (CR) and heart failure management could markedly reduce mortality after acute coronary syndromes and revascularisation therapy. * Contemporary CR and secondary prevention programs are cost-effective, safe and beneficial for patients of all ages, leading to improved survival, fewer revascularisation procedures and reduced rehospitalisation. * Despite the proven benefits attributed to these secondary prevention interventions, they are not well attended by patients. * Modern programs must be flexible, culturally safe, multifaceted and integrated with the patient's primary health care provider to achieve optimal and sustainable benefits for most patients.
Salamonson, Y., Everett, B., Koch, J., Wilson, I. & Davidson, P.M. 2009, 'Learning strategies of first year nursing and medical students: a comparative study.', Int J Nurs Stud, vol. 46, no. 12, pp. 1541-1547.
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BACKGROUND: Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives. OBJECTIVE: To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers. DESIGN: A comparative survey design. SETTING: Nursing and medical nursing schools in a large university in the western region of Sydney, Australia. PARTICIPANTS: Six hundred and sixty-five first year nursing (n=565) and medical (n=100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected. RESULTS: Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p<0.001), and there were also more females in the nursing student group (82% versus 56%; p<0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p<0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p=0.003), help seeking (p=0.008), critical thinking (p=0.058), and time and study environment management (p<0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3...
Gholizadeh, L., Salamonson, Y., Worrall-Carter, L., Digiacomo, M. & Davidson, P.M. 2009, 'Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia', Journal of Women's Health, vol. 18, no. 9, pp. 1385-1393.
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Objective: Coronary heart disease (CHD) is a major cause of morbidity and mortality globally, and risk factors for CHD are associated with social and cultural attribution as well as individual psychological factors. The aims of this study were to explore the causal attributions of risk factors for CHD and to describe the relationship between their physiological status and causal attributions among immigrant Arabic, Turkish, and Iranian women living in Australia. Methods: Fifty-five women of Turkish, Iranian, and Persian backgrounds were recruited from community groups in metropolitan Sydney using snowball sampling and the assistance of bilingual health care workers. Body weight and blood pressure were assessed, and a questionnaire, including investigator-developed instruments and the Depression, Anxiety and Stress Scale, was administered. Health interpreters assisted with study procedures and translation of study instruments. Results: There was a low level of awareness of the risk of heart disease among women, although participants had knowledge of risk factors for heart disease broadly. The most highly attributed risk factors for CHD among participants were obesity, physical inactivity, and psychological distress. Women who rated highly on psychological distress scores were more likely to attribute negative emotions as causative factors for heart disease. Conclusions: Strategies to promote the awareness of the association between heart disease and women are required among migrant women. Further investigation is required to overcome the barriers to engaging in effective risk minimizing behaviors for heart disease. &copy; 2009 Mary Ann Liebert, Inc.
Fernandez, R.S., Davidson, P.M., Griffiths, R., Juergens, C. & Salamonson, Y. 2009, 'Development of a health-related lifestyle self-management intervention for patients with coronary heart disease', Heart & Lung: the journal of acute and critical care, vol. 38, no. 6, pp. 491-498.
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Risk-factor modification after an acute coronary event is imperative, and intervention strategies are Continuously being developed to assist patients with behavioral change and, consequently, decreasing the risk Of further coronary episodes. This article
Phillips, J.L., Davidson, P.M. & Willcock, S. 2009, 'An Insight Into the Delivery of a Palliative Approach in Residential Aged Care : The General Practitioner Perspective', Journal of Applied Gerontology, vol. 28, no. 3, pp. 395-405.
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Managing the complex care needs of older people is a global concern. General practitioners (GPs) play a pivotal role in aged care, yet little is known abouttheir capacity to provide palliative care in nursing homes. This study aimed to investigate GPs' perceptions and understanding of a palliative approach. A convenience sample of rural GPs (n = 13) participated in a series of three focus groups undertaken in August, 2005. These focus groups were all audio-taped, transcribed, and analyzed using thematic content analysis. Four key themes emerged: uncertainty about a palliative approach, a need to reorientate providers, the challenges of managing third parties, and making it work and moving forward. These preliminary findings suggest that integrating a palliative approach in aged care requires GPs to have a greater awareness of this paradigm and to be more effectively engaged in multidisciplinary care planning.
Everett, B., Salamonson, Y. & Davidson, P.M. 2009, 'Bandura's exercise self-efficacy scale: validation in an Australian cardiac rehabilitation setting.', Int J Nurs Stud, vol. 46, no. 6, pp. 824-829.
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BACKGROUND: Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise. OBJECTIVES: To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting. DESIGN: Validation study. SETTING: Cardiac rehabilitation. PARTICIPANTS: One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years). METHODS: Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrollment and on completion of a 6-week CR program. RESULTS: Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p=0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r=0.28, p=0.035) was seen. CONCLUSIONS: The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.
Cao, Y., Davidson, P.M. & DiGiacomo, M. 2009, 'Cardiovascular disease in China: An urgent need to enhance the nursing role to improve health outcomes', Journal of Clinical Nursing, vol. 18, no. 5, pp. 687-693.
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Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. &copy; 2009 Blackwell Publishing Ltd.
Arndt, M., Murchie, F., Schembri, A.M. & Davidson, P.M. 2009, '"Others had similar problems and you were not alone": evaluation of an open-group mutual aid model in cardiac rehabilitation.', J Cardiovasc Nurs, vol. 24, no. 4, pp. 328-335.
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BACKGROUND: Dealing with psychological and social issues is an important aspect of comprehensive cardiac rehabilitation (CR) programs. STUDY AIM: This study aims to evaluate the use of an open-group mutual aid model facilitated by a social worker and occupational therapist in a secondary prevention CR program. METHOD: A mixed-method study, using questionnaires, focus group data, and reflective interviews of group facilitators, was used to evaluate the program. STUDY FINDINGS: Key themes emerging from this study were (1) the need for provision of hope; (2) a desire for structure and support; (3) appreciation of support of fellow group participants; and (4) the need for individuals to review, process, and interpret their illness trajectory. CONCLUSIONS: In this single site study, an open-group model using a mutual aid model was acceptable and helpful as a method to facilitate adjustment after an acute cardiac event. Further evaluation of this approach using experimental methods is warranted.
Fernandez, R.S., Davidson, P.M., Griffiths, R., Juergens, C., Stafford, B. & Salamonson, Y. 2009, 'A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: Implications for a larger clinical trial', Australian Critical Care, vol. 22, no. 1, pp. 17-27.
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Purpose: This pilot study was to assess the feasibility of the health-related lifestyle self-management (HeLM) intervention as a strategy to decrease cardiovascular risk following acute coronary syndrome. Methods: Participants in this randomised controll
Driscoll, A., Davidson, P.M., Clark, R., Huang, N. & Aho, Z. 2009, 'Tailoring consumer resources to enhance self-care in chronic heart failure', Australian Critical Care, vol. 22, no. 3, pp. 133-140.
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Background: Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patient
Wood, S.K., Campbell, A.K., Marden, J.D., Schmidtman, L., Blundell, G.H., Sheerin, N.J. & Davidson, P.M. 2009, 'Inpatient care to community care: improving clinical handover in the private mental health setting', MEDICAL JOURNAL OF AUSTRALIA, vol. 190, no. 11, pp. S144-S149.
Davidson, P., Digiacomo, M., Zecchin, R., Clarke, M., Paul, G., Lamb, K., Hancock, K., Chang, E. & Daly, J. 2008, 'A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease', Journal of Women's Health, vol. 17, no. 1, pp. 123-134.
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Background and aims: Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs. Methods: The Heart Awareness for Women program (HAFW) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts. The program was then trialed in an 8-week program in a convenience sample of 6 women. Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program. A total of 54 women participated in this phase, 48 of whom completed baseline questionnaires. A mixed-method evaluation, using questionnaires, interviews, and observation, assessed the impact of the intervention on psychological and social aspects of women's recovery following an acute coronary event. Results: Women welcomed the opportunity to discuss their individual stories, fears, and challenges and to derive support from contact with other women. Via health professional facilitation, women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health. No statistically significant changes in depression, anxiety, stress, cardiac control, role integration, or perceived social support were found; however, descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support. Conclusions: On the basis of this study, a cardiac rehabilitation program tailored to the needs of women appears to be feasible and acceptable. The efficacy of this intervention to improve health-related outcomes needs to be tested i...
Goddard, L., Davidson, P.M., Daly, J. & Mackey, S. 2008, 'People with an intellectual disability in the discourse of chronic and complex conditions: An invisible group?', Australian Health Review, vol. 32, no. 3, pp. 405-414.
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People with an intellectual disability and their families experience poorer health care compared with the general population. Living with an intellectual disability is often challenged by coexisting complex and chronic conditions, such as gastrointestinal and respiratory conditions. A literature review was undertaken to document the needs of this vulnerable population, and consultation was undertaken with mothers of children with disabilities and with professionals working within disability services for people with an intellectual disability and their families. Based on this review, there is a need to increase the profile of people with an intellectual disability in the discourse surrounding chronic and complex conditions. Strategies such as guideline and competency development may better prepare health professions to care for people with disabilities and chronic and complex care needs and their families.
Halcomb, E.J., Davidson, P.M., Griffiths, R. & Daly, J. 2008, 'Cardiovascular disease management: time to advance the practice nurse role?', AUSTRALIAN HEALTH REVIEW, vol. 32, no. 1, pp. 44-55.
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Gholizadeh, L. & Davidson, P. 2008, 'More similarities than differences: An international comparison of CVD mortality and risk factors in women', Health Care for Women International, vol. 29, no. 1, pp. 3-22.
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In this article we describe global cardiovascular risk factor trends in women, both physiological and behavioral, in order to improve the understanding of cardiovascular health of women. Our aim in presenting this information is to inform interventions and policies to improve the cardiovascular health of women. Although differences are apparent between developing and developed countries, a range of commonalities exist that allow a global approach to improving women's health. A multifaceted approach considering physiological, social, economic, and political determinants is critical to improve the cardiovascular health outcomes of women.
Phillips, J.L., Davidson, P.M., Jackson, D. & Kristjanson, L.J. 2008, 'Multi-faceted palliative care intervention: aged care nurses' and care assistants' perceptions and experiences', JOURNAL OF ADVANCED NURSING, vol. 62, no. 2, pp. 216-227.
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Rolley, J., Salamonson, Y. & Davidson, P.M. 2008, 'Diabetes and heart disease', Australian Nursing Journal, vol. 16, no. 1, pp. 33-34.
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Rapley, P. & Davidson, P.M. 2008, 'Adolescent health and diabetes: Time to rethink service delivery', Australian Nursing Journal, vol. 16, no. 1, pp. 30-31.
or adolescents with diabetes the transition to adutt health care coincides with transitions on many levels including psychosocial development, family and peer relationships, and school. The task of seif-management determines long term outcomes yet health risktaking is de rigueur for adolescents trying to establish their identity and independence (CarrGreg et al 2003).
Phillips, J.L., Davidson, P.M., Newton, P.J. & DiGiacomo, M. 2008, 'Supporting Patients and Their Caregivers After-Hours at the End of Life: The Role of Telephone Support', Journal of Pain and Symptom Management, vol. 36, no. 1, pp. 11-21.
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Twenty-four hour access is accepted as a gold standard for palliative care service delivery, yet minimal data exist to justify the cost of this initiative to health care planners and policy makers. Further, there is scant information concerning optimal and efficient methods for delivering after-hours palliative care advice and support, particularly in regional and rural settings. This article reports on an evaluation of a local after-hours telephone support service in regional Australia. A centralized after-hours telephone support service was provided by generalist nurses at a Multipurpose Service in a rural community. A mixed-method evaluation, including semistructured interviews, was undertaken after 20 months of operation. During the period March 31, 2005 until November 15, 2006, 357 patients were registered as part of the Mid North Coast Rural Palliative Care Program. Ten percent of patients or their caregivers accessed the After-Hours Telephone Support Service, representing 55 occasions of service. The most common reason for contacting the service was for reassurance surrounding medication usage, symptom management, and anxiety. This experience demonstrates proof of concept that acceptable palliative care advice can be provided by generalist nurses in a cost-efficient manner. Common patterns emerged in utilization that can assist in service planning and staffing formulae. There is also a need to investigate mechanisms of interfacing with larger scale call centers, to explore the differences within generic and disease-specific approaches, and assess the appropriateness of after-hours telephone support with different cultural groups. &copy; 2008 U.S. Cancer Pain Relief Committee.
Halcomb, E., Davidson, P.M. & Hardaker, L. 2008, 'Using the consensus development conference method in healthcare research', Nurse Researcher, vol. 16, no. 1, pp. 56-71.
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Consensus methods are increasingly being used in healthcare research, particularly for formulating policy and strategic directions. This paper discusses the issues central to the planning and conduct of the consensus development conference, and offers practical recommendations to researchers intending to use this approach.
Goddard, L., Davidson, P.M., Daly, J. & Mackey, S. 2008, 'People with an intellectual disabilitiy in the discourse of chronic and complex conditions: an invisible group?', Australian Health Review, vol. 32, no. 3, pp. 405-414.
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People with an intellectual disability and their families experience poorer health care compared with the general population. Living with an intellectual disability is often challenged by coexisting complex and chronic conditions, such as gastrointestinal and respiratory conditions. A literature review was undertaken to document the needs of this vulnerable population, and consultation was undertaken with mothers of children with disabilities and with professionals working within disability services for people with an intellectual disability and their families. Based on this review, there is a need to increase the profile of people with an intellectual disability in the discourse surrounding chronic and complex conditions. Strategies such as guideline and competency development may better prepare health professions to care for people with disabilities and chronic and complex care needs and their families
Fernandez, R.S., Salamonson, Y., Juergens, C., Griffiths, R. & Davidson, P.M. 2008, 'Development and preliminary testing of the Cardiac Rehabilitation Enrolment Obstacles (CREO) scale: Implications for service development', European Journal of Cardiovascular Nursing, vol. 7, no. 2, pp. 96-102.
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Background: In spite of the benefit in participating in cardiac rehabilitation (CR) programs, low participation rates are well documented. Participation rates are potentially lower in people who have undergone percutaneous coronary interventions (PCI). Assessment of the barriers to CR participation in PCI patients could provide vital information for the development of alternate strategies for coronary risk factor modification. Aim: The aim of this study was to develop and evaluate the sychometric properties of a scale to assess obstacles to cardiac rehabilitation enrolment in patients following PCI. Methods: Item generation for the 15 items of this scale was based on a comprehensive review of the literature and data collected from telephone interviews of CR coordinators related to cardiac rehabilitation enrolment obstacles (CREO). Content validity of the scale was undertaken using a reference group comprising of clinicians and patients. Construct validity was undertaken using a factor analysis. Data for the CREO scale was collected from December 2004 to March 2005 from 114 PCI patients recruited from a cardiology database in a Sydney metropolitan hospital. Results: Factor analysis revealed a two-factor structure: patient-related obstacles and health service-related obstacles, which accounted for 58%of cumulative explained variance. The scale showed good internal consistency (Cronbach's alpha=0.89) and satisfactory divergent validity. Conclusion: This scale can be used as a useful tool for the early identification of patients who would not normally enrol into CR and offer them alternate strategies for health-related lifestyle modification.
Salamonson, Y., Everett, B., Koch, J., Andrew, S. & Davidson, P.M. 2008, 'English-Language Acculturation Predicts Academic Performance in Nursing Students Who Speak English as a Second Language', Research in Nursing and Health, vol. 38, no. 31, pp. 86-94.
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Students who speak English as a second language (ESL) face considerable challenges in English language universities, but little is known about the relationship betweenEnglish-language acculturation and academic performance. A prospective, correlational design was used to validate the English Language Acculturation Scale (ELAS), a measure of the linguistic aspect of acculturation, and to determine the relationship between English language acculturation and academic achievement among 273 first-year nursing students. Exploratory factor analyses demonstrated that the ELAS was a valid and reliable measure (a &Acirc;&frac14;.89).WhenELAS scoreswere examined in relation to students grades, students with the lowest ELAS scores also had the lowest mean subject grades, highlighting the need to place greater emphasis on identifying English-language acculturation among ESL students.
Rolley, J.X., Davidson, P.M., Dennison, C.R., Ong, A., Everett, B. & Salamonson, Y. 2008, 'Medication adherence self-report instruments: Implications for practice and research', Journal of Cardiovascular Nursing, vol. 23, no. 6, pp. 497-505.
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BACKGROUND:: After an acute cardiac event, adhering to recommendations for pharmacologic therapy is important in achieving optimal health outcomes. Considering the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence are less well developed. Furthermore, accessing reliable, valid, and cost-effective mechanisms of monitoring adherence in the research and clinical settings is challenging. AIM:: The aim of this article was to review published self-report measures assessing and monitoring medication adherence in cardiovascular disease and provide recommendations for research into medication adherence. METHODS:: The electronic databases CINAHL, Medline, and Science Direct were searched using the key search terms medication adherence and/or compliance, cardiovascular, self-report measures, and questionnaires. The World Wide Web was searched using the Google and Google Scholar search engines, and reference lists of retrieved documents were reviewed. The search strategy was verified by a health librarian. Instruments were included if they specifically addressed medication adherence as a discrete construct rather than a disease-specific or a generic health status measurement. FINDINGS:: Despite of the problems with medication adherence identified in the literature, only 7 instruments met the search criteria. There was limited use of instruments across studies and settings to enable comparison across populations and extensive psychometric evaluation. CONCLUSIONS:: Medication adherence is a complex, multifaceted construct dependent on a range of physical, social, economic, and psychological considerations. In spite of the importance of adherence in ensuring optimal cardiovascular outcomes, conceptual underpinnings and methods of assessing medication adherence require further discussion and debate. &copy; 2008 Lippincott Williams & Wilkins.
Halcomb, E.J., Davidson, P.M., Salamonson, Y., Ollerton, R. & Griffiths, R. 2008, 'Nurses in Australian general practice: implications for chronic disease management.', J Clin Nurs, vol. 17, no. 5A, pp. 6-15.
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AIMS: The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. BACKGROUND: Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. DESIGN: National postal survey embedded in a sequential mixed method design. METHODS: 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. RESULTS: Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. CONCLUSION: Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to...
Everett, B., Davidson, P.M., Sheerin, N., Salamonson, Y. & DiGiacomo, M. 2008, 'Pragmatic insights into a nurse-delivered motivational interviewing intervention in the outpatient cardiac rehabilitation setting', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 1, pp. 61-64.
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PURPOSE: Despite an increasing interest in motivational interviewing as a strategy to facilitate behavior change in people with cardiovascular disease, its use in cardiac rehabilitation (CR) appears minimal. Therefore, it is unclear whether the clinical method of motivational interviewing requires modification for the CR population, in which it could be argued that people are motivated and engaged. The purposes of this report are to describe processes in incorporating motivational interviewing in the CR setting and to discuss insights gained regarding the use of this intervention. METHODS: As part of a randomized controlled trial currently recruiting in the CR setting, patients allocated to the intervention group participate in 2 motivational interviewing sessions with a motivational interviewing-trained nurse. To ascertain treatment fidelity, this process review comprised 3 sources: (1) the extant literature on motivational interviewing, (2) reflections of the project team, and (3) data derived from audiotaped interviews. RESULTS: Key observations reflect that the motivational interviewing technique is well received, with patients appreciating the opportunity to "tell their story." Preliminary qualitative data revealed that patients rate "health" and "family" as their most important values, with many commenting on their recovery phase as a "second chance." CONCLUSIONS: This report demonstrates that motivational interviewing is potentially useful and has significant promise in the CR setting. Discussion of pragmatic considerations as well as outcome data should assist clinicians in implementing this model of intervention in the CR setting. &copy; 2008 Lippincott Williams & Wilkins, Inc.
DiGiacomo, M., Davidson, P.M., Davison, J., Moore, L. & Abbott, P. 2008, 'Butting out at AMSWS', Australian Nursing Journal, vol. 15, no. 10, pp. 35-35.
he high rate (50%) of smoking among Aboriginal people (ABS 2005) coupled with limited culturally appropriate smoking cessation interventions makes addressing this important public health issue a challenge. The Aboriginal Medical Service of Western Sydney (AMSWS) offers a high intensity smoking cessation program which provides support, counselling, and subsidised nicotine replacement therapy to its clients through theleadership and community advocacy of Aboriginal Health Workers. The Butt Busters program arose from significant community consultation in 2005 and has now screened over 120 clients, several of whom have quit smoking and many others who are making positive steps toward this behavioural change.
Davidson, P.M., DiGiacomo, M., Abbott, P., Zecchin, R., Heal, P.E., Mieni, L., Sheerin, N., Smith, J., Mark, A., Bradbery, B. & Davison, J. 2008, 'A partnership model in the development and implementation of a collaborative, cardiovascular education program for Aboriginal Health Workers', Australian Health Review, vol. 32, no. 1, pp. 139-146.
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A partnership model was established among key education providers, policy makers, non-government organisations, the local area health service and Aboriginal community controlled organisations aimed at increasing collaboration, skill development, cultural competence and increasing access to mentorship and expertise for Aboriginal Health Workers (AHWs). A group of 21 AHWs, within two cohorts, undertook the program between October 2005 and June 2006. A mixed-method evaluation using quantitative and qualitative data collection methods was undertaken prospectively. Knowledge and confidence scores significantly increased for all participants over the course duration. Student evaluation demonstrated a desire for group-based activities and the high value placed on clinical visits. Feedback on both outcome and process measures will inform course delivery and design.
Davidson, P.M., Cockburn, J. & Newton, P.J. 2008, 'Unmet needs following hospitalization with heart failure: Implications for clinical assessment and program planning', Journal of Cardiovascular Nursing, vol. 23, no. 6, pp. 541-546.
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BACKGROUND:: Measuring health status is increasingly important in both clinical practice and research. The Heart Failure Needs Assessment Questionnaire (HFNAQ) is a self-administered, disease-specific, 30-item questionnaire that measures an individual's perception of his/her needs in the physical, psychological, social, and spiritual domains. OBJECTIVES:: To assess the prevalence of needs in patients with heart failure (HF) recently discharged from hospital. METHODS:: The HFNAQ was administered to participants (n = 132; mean [SD] age, 72.3 [9.69] years; 63% male) consenting to attend an HF-specific cardiac rehabilitation program. RESULTS:: The total mean HFNAQ score was 67.3 (95% confidence interval, 65.03-69.75), indicating an average level of need around the midrange of the scale. In this vulnerable postdischarge phase, there was evidence of predominance of psychological and social concerns over physical needs. None of the variables that were examined for associations with the measures of needs reached statistical significance, highlighting the strongly individualized perception of need. CONCLUSIONS:: Higher levels of unmet needs in the psychological and social domains, compared with physical needs, identify psychosocial care as an important consideration for nursing interventions for people with HF. This study further demonstrates the importance of assessing the needs from the perspective of the individual to ascertain each person's unique perspective of the HF illness experience. Study findings further underscore the importance of individualized care planning for patients with HF after discharge from hospital to address their unique needs and circumstances. &copy; 2008 Lippincott Williams & Wilkins.
Alexandrou, E., Spencer, T. & Davidson, P.M. 2008, 'Nursing central line service prevents catheter related infections', Australian Nursing Journal, vol. 15, no. 11, p. 49.
Davidson, P.M., DiGiacomo, M., Zecchin, R., Clarke, M., Paul, G., Lamb, K., Hancock, K., Chang, E. & Daly, J. 2008, 'A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease', Journal of Women's Health, vol. 17, no. 1, pp. 123-134.
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Background and aims: Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs. Methods: The Heart Awareness for Women program (HAFW) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts. The program was then trialed in an 8-week program in a convenience sample of 6 women. Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program. A total of 54 women participated in this phase, 48 of whom completed baseline questionnaires. A mixed-method evaluation, using questionnaires, interviews, and observation, assessed the impact of the intervention on psychological and social aspects of womens recovery following an acute coronary event. Results: Women welcomed the opportunity to discuss their individual stories, fears, and challenges and to derive support from contact with other women. Via health professional facilitation, women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health. No statistically significant changes in depression, anxiety, stress, cardiac control, role integration, or perceived social support were found; however, descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support.
Davidson, P.M., Driscoll, A., Clark, R., Newton, P.J. & Stewart, S. 2008, 'Heart failure nursing in Australia: Challenges, strengths, and opportunities', Progress in Cardiovascular Nursing, vol. 23, no. 4, pp. 195-197.
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Butterfield, J.A., Faddy, S.C., Davidson, P.M. & Ridge, B. 2008, 'Exercise training in patients with stable chronic heart failure - Effects onthoracic impedance cardiography and B-type natriuretic peptide', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 1, pp. 33-37.
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PURPOSE: Recent evidence has suggested that patients with stable chronic heart failure (CHF) may respond favorably to a progressive exercise program. The use of noninvasive hemodynamic monitoring and B-type natriuretic peptide (BNP) measurement in these patients is not well reported. This study investigated the utility of noninvasive hemodynamic monitoring and point-of-care BNP in a cardiac rehabilitation outpatient setting.
Davidson, P.M., Salamonson, Y., Webster, J., Andrew, S., DiGiacomo, M., Gholizadeh, L., Newton, P. & Moser, D. 2008, 'Changes in depression in the immediate postdischarge phase in a cardiac rehabilitation population assessed by the cardiac depression scale', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 5, pp. 312-315.
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? INTRODUCTION: Depression is increasingly a focus of attention in the management of heart disease. Clinicians in cardiac rehabilitation (CR) are well placed to assess and facilitate management of symptoms of depression, yet the timing and interpretation of measurements remain unclear. ? METHODS: We administered the Hare-Davis Cardiac Depression Scale (CDS) in a usual care, outpatient CR program in a metropolitan setting. As part of routine assessment and monitoring of outcomes in a 6-week outpatient CR program, we administered the CDS at entry, at completion of the 6-week program, and at 12 months. ? RESULTS: Data were available on 151 patients for the 3 measurement points. At baseline, the mean CDS score was 76.07 (&plusmn;22.38), which dropped at 6 weeks to 64.85 (&plusmn;21.69) but increased slightly at 12 months to 69.79 (&plusmn;24.36). The changes in these scores were statistically significant for all measurement points (P < .03). The trend of change for the CDS was reflected in the subscale scores, which dropped at 6 weeks but increased slightly at 12 months. ? DISCUSSION: Findings demonstrate a positive impact of CR on CDS scores at 6 weeks and 12 months, although there was a trend for increased scores at 1 year. This observation requires further investigation and underscores the importance of longitudinal studies. &copy; 2008 Lippincott Williams & Wilkins, Inc.
Fernandez, R.S., Salamonson, Y., Griffiths, R., Juergens, C. & Davidson, P.M. 2008, 'Sociodemographic predictors and reasons for participation in an outpatient cardiac rehabilitation programme following percutaneous coronary intervention', International Journal Of Nursing Practice, vol. 14, no. 3, pp. 237-242.
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Evidence-based guidelines recommend participation in cardiac rehabilitation (CR) to reduce subsequent cardiovascular events following percutaneous coronary intervention (PCI). The objective of this study was to investigate the reasons for and the demogra
Fernandez, R.S., Davidson, P.M. & Griffiths, R. 2008, 'Cardiac rehabilitation coordinators' perceptions of patient-related barriers to implementing cardiac evidence-based guidelines', Journal of Cardiovascular Nursing, vol. 23, no. 5, pp. 449-457.
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Background: Coronary heart disease remains the leading cardiovascular cause of mortality and morbidity globally. Implementing evidence-based guidelines after a coronary event is vital to prevent recurrence of an acute episode. However, various barriers t
Halcomb, E.J., Davidson, P.M. & Patterson, E. 2008, 'Promoting leadership and management in Australian general practice nursing: what will it take?', J Nurs Manag, vol. 16, no. 7, pp. 846-852.
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AIM: This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. BACKGROUND: Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. CONCLUSIONS: The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. IMPLICATIONS FOR NURSING MANAGEMENT: There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.
Fernandez, R.S., Salamonson, Y., Griffiths, R., Juergens, C. & Davidson, P.M. 2008, 'Awareness of risk factors for coronary heart disease following interventional cardiology procedures: A key concern for nursing practice', International journal of nursing practice, vol. 14, no. 6, pp. 435-442.
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Cardiovascular risk factor modification to prevent progression of coronary heart disease is important for patients following percutaneous coronary intervention. The aims of this study were to assess patient's awareness of modifiable cardiac risk factors
Cao, Y., Digiacomo, M., Du, H.Y., Ollerton, E. & Davidson, P. 2008, 'Cardiovascular disease in chinese women: An emerging high-risk population and implications for nursing practice', Journal of Cardiovascular Nursing, vol. 23, no. 5, pp. 386-394.
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Globally, cardiovascular disease (CVD) is the leading cause of death among women. In China, the burden of CVD is increasing at an alarming rate; yet, it is underestimated and has important primary, secondary, and tertiary prevention issues. AIM:: This article seeks to document the issues surrounding the increased rate of CVD among Chinese women and describe the etiological factors and potential strategies to decrease the burden of disease. METHODS:: The Medline, Current Information in Nursing and Allied Health Literature, Ovid, Science Direct, and Government Reports were searched using the key words heart disease, cardiovascular, ischemic heart disease, coronary, women, and Chin (China, Chinese). Articles were selected if they described epidemiological factors and/or interventions to address heart disease in Chinese women. FINDINGS:: Rapid industrialization and urbanization in China have extended the life expectancy of the population, particularly among women. Social, political, and economic factors have caused lifestyle changes that have a direct bearing on health. Heart disease has become the most common cause of death among Chinese women and the second most common cause among men. Paradoxically, prevention and management strategies are sparse in relation to the high prevalence. A number of modifiable risk factors have been identified as major contributors of CVD and should be a focus of primary, secondary, and tertiary prevention. CONCLUSION:: Cardiovascular disease is already a leading cause of death and disability among Chinese women. The high prevalence of risk factors and low rate of awareness, treatment, and control signal an urgent need for focusing on this issue in Chinese women. Strategies on individual, community, and government levels are recommended. Involving Chinese nurses in these strategies is essential. &copy; 2008 Lippincott Williams & Wilkins.
Newton, P.J., Davidson, P.M., Macdonald, P., Ollerton, R. & Krum, H. 2008, 'Nebulized Furosemide for the Management of Dyspnea: Does the Evidence Support Its Use?', Journal of Pain and Symptom Management, vol. 36, no. 4, pp. 424-441.
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Dyspnea is a common and distressing symptom associated with multiple chronic illnesses and high levels of burden for individuals, their families and health care systems. The subjective nature dyspnea and a poor understanding of pathophysiological mechanisms challenge the clinician in developing management plans. Nebulized furosemide has been identified as a novel approach to dyspnea management. This review summarizes published studies, both clinical and experimental, reporting the use of nebulized furosemide. The search criteria yielded 42 articles published in the period 1988 to 2004. Although nebulized furosemide appeared to have a positive influence on dyspnea and physiological measurements, caution must be taken with the results primarily coming from small-scale clinical trials or observation trials. Despite the limitations of the studies reported, given the range of conditions reporting effectiveness of nebulized furosemide, further investigation of this potential novel treatment of dyspnea is warranted. &copy; 2008 U.S. Cancer Pain Relief Committee.
Halcomb, E.J., Davidson, P.M., Yallop, J., Griffiths, R. & Daly, J. 2007, 'Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.', Contemp Nurse, vol. 26, no. 1, pp. 125-135.
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Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.
Brookes, K., Davidson, P.M., Daly, J. & Halcomb, E.J. 2007, 'Role theory: A framework to investigate the community nurse role in contemporary health care systems', CONTEMPORARY NURSE, vol. 25, no. 1-2, pp. 146-155.
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Davidson, P.M., MacDonald, P., Moser, D.K., Ang, E., Paull, G., Choucair, S., Daly, J., Gholizadeh, L. & Dracup, K. 2007, 'Cultural diversity in heart failure management: Findings from the DISCOVER study (part 2)', Contemporary Nurse, vol. 25, no. 1-2, pp. 50-62.
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Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an individual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies. The Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and individual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While individual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups. Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This sample reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will...
Davidson, P.M., Dracup, K., Phillips, J., Daly, J. & Padilla, G. 2007, 'Preparing for the worst while hoping for the best - The relevance of hope in the heart failure illness trajectory', JOURNAL OF CARDIOVASCULAR NURSING, vol. 22, no. 3, pp. 159-165.
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Davidson, P.M., Dracup, K., Phillips, J., Padilla, G. & Daly, J. 2007, 'Maintaing hope in transition - A Theoretical framework to guide interventions for people with heart failure', JOURNAL OF CARDIOVASCULAR NURSING, vol. 22, no. 1, pp. 58-64.
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Phillips, J.L., Davidson, P.M., Ollerton, R., Jackson, D. & Kristjanson, L. 2007, 'A survey of commitment and compassion among nurses in residential aged care.', Int J Palliat Nurs, vol. 13, no. 6, pp. 282-290.
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AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.
Fernandez, R., Salamonson, Y., Juergens, C., Griffiths, R. & Davidson, P.M. 2007, 'Validation of the Revised Cardiac Rehabilitation Preference Form in Patients With Post-Percutaneous Coronary Intervention', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 27, no. 6, pp. 390-394.
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BACKGROUND: Challenges in achieving optimal participation rates in cardiac rehabilitation (CR) are well described and include factors pertaining to health system and patient and clinical characteristics. Of note, participation rates of patients following percutaneous coronary intervention (PCI) are low. AIM: The aim of this study was to examine the psychometric properties of the Revised Cardiac Rehabilitation Preference Form (CRPF-R) in an Australian sample following a PCI and to determine the preferences of PCI patients in relation to CR.
Smith, L.M., Davidson, P.M., Halcomb, E.J. & Andrew, S. 2007, 'Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?', Aust Crit Care, vol. 20, no. 4, pp. 137-145.
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INTRODUCTION: The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. AIM: This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. METHOD: The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. RESULTS: Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. CONCLUSION: Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.
Salamonson, Y., Everett, B., Andrew, S., Koch, J. & Davidson, P.M. 2007, 'Differences in universal diverse orientation among nursing students in Australia.', Nurs Outlook, vol. 55, no. 6, pp. 296-302.
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With globalization and intensified migration, an attitude of awareness and acceptance of both similarities and differences among people-known as universal-diverse orientation (UDO)-is a positive benefit that students may bring to a nursing program. Using a cross-sectional survey design, this study measured students' UDO using the Miville-Guzman Universality-Diversity Scale-Short Form (M-GUDS-S). Among 816 nursing students, those born in a non-English-speaking country had higher M-GUDS-S scores (P < 0.001), and those who spoke both English and non-English at home had consistently higher scores in all three M-GUDS-S subscales. However, those who never spoke English at home had low scores in the "Comfort with Differences" subscale if they had lived in Australia for only a few years. Nursing students from a non-English-speaking background could potentially enrich cross-cultural educational experiences for all students, but students who have recently settled in Australia may need support to feel a sense of connectedness.
Salamonson, Y., Everett, B., Davidson, P.M. & Andrew, S. 2007, 'Magnitude of change in cardiac health-enhancing behaviours 6 months following an acute myocardial infarction', European Journal of Cardiovascular Nursing, vol. 6, no. 1, pp. 66-71.
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Background: The adoption of health-enhancing behaviours is essential to reduce the likelihood of recurrent coronary events. Aims: This study assessed the magnitude of health behaviour change 6 months following a first acute myocardial infarction (AMI), and examined differences between cardiac rehabilitation attendees and non-attendees. Methods: One hundred and six first AMI patients (males n=76, Australian-born n=71) participated in a 6-month follow-up of a descriptive longitudinal survey. Data on non-smoking behaviour, weight normalisation, adequate physical activity, low dietary fat intake, medication adherence and cardiac rehabilitation attendance were collected. The magnitude of change in health-enhancing behaviours from baseline to follow-up was calculated. Results: Whilst there was an overall increase in health-enhancing behaviours at the 6-month follow-up (P<0.001), nonsmoking behaviour, low dietary fat intake and medication adherence were more likely to be achieved than adequate physical activity and weight normalisation. Attendees at cardiac rehabilitation were more likely to report positive lifestyle change (P=0.001) and feeling healthier (P=0.040) than non attendees. Conclusion: The wide variation in the adoption of health-enhancing behaviours at the 6-month follow-up suggested that participants were selective about which behaviours they changed. Cardiac rehabilitation personnel need to emphasise the importance of undertaking all health enhancing behaviours in order to maximise their multiplicative benefits.
Rolley, J. & Davidson, P.M. 2007, 'Modifying risk in men's health', Australian Nursing Journal, vol. 15, no. 1, pp. 35-35.
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In Australia, cardiovascular disease [CVD] remains the leading cause of death for both men and women and is also a msyor cause of disability (NSW Health 2006). The process of recovery following an acute cardiac event can impact on physical, social and psychological ac^ustment and factors such as returning to paid work. Heart disease occurs at a younger age for men than women and men have unique needs and concerns
Patterson, E., Halcomb, E. & Davidson, P.M. 2007, 'Practice Nursing in Australia: Whose Responsibility?', Collegian, vol. 14, no. 4, pp. 2-3.
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The increasing burden of chronic conditions, shortages in the health care workforce and adverse health outcomes of socially marginalised and disadvantaged populations, challenge contemporary health care systems to provide acceptable, accessible, affordable, equitable and sustainable health care (World Health Organization, 2003). These epidemiological, social, economic and political factors, are driving health policy, practice and research from focussing predominantly on the secondary and tertiary care sectors to looking to the primary care setting for viable and sustainable solutions. Australian general practice has responded to this trend through a range of initiatives, including employing increasing numbers of nurses and developing their scope of practice (Pascoe, Foley, Hutchinson, Watts, Whitecross & Snowden, 2005). Currently in Australia, 60% of general practices employ a practice nurse indicating that they are primed to be a driving force in
Parry, A., Worrall-Carter, L., Page, K., Kuhn, L., DiGiacomo, M. & Davidson, P.M. 2007, 'Returning to work: Exploring the experiences of women with acute coronary syndromes', British Journal of Cardiac Nursing, vol. 2, no. 6, pp. 292-301.
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Aims: The aim of this study was to explore the transition experiences of Australian women in resuming paid employment after an acute coronary syndrome (ACS) event. Background: Until recently cardiovascular research has focused predominantly on men but this is changing and research exploring womens experiences of ACS has increased. Despite knowing that many women do not resume paid employment following an ACS event, little is known about the experience of those women who do, even though it is understood that returning to the previous level of employment after an ACS event is a positive outcome. Design: An exploratory qualitative approach underpinned by naturalistic inquiry was undertaken. Methods: A purposive sample of seven women who had experienced their first ACS event 12 months ago was selected. Each woman was interviewed using a semistructured format and their interviews were transcribed verbatim. Thematic analysis of the transcript set and conceptual mapping were employed to formulate key themes. Findings: All women (mean age 52.6 years) resumed paid employment at various stages during their recovery, but reported similar transition processes. Three key themes representing this process were identified: primary motivation; influence through guidance and support; and resuming paid employment. Conclusions: Study findings revealed that these women required substantial support from family, friends and employers, with ongoing guidance from health professionals to return to paid work. The timeframes for their return varied and some modified their roles within the workforce to enable them to return to paid work. However, formal cardiac rehabilitation did not appear to have a significant impact on these participants decisions to return to work. They felt that more information about this decision may have been helpful if given at the time of cardiac rehabilitation.
Newton, P.J., Davidson, P.M., Halcomb, E.J. & Denniss, A.R. 2007, 'Barriers and facilitators to the implementation of the collaborative method: Reflections from a single site', Quality and Safety in Health Care, vol. 16, no. 6, pp. 409-414.
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Background: A collaborative is an effective method of implementing evidence-based practice across multiple sites through the sharing of experience and knowledge of others in a similar setting, over a short period of time. Collaborative methods were first used in the USA but have been adopted internationally. Aim: This paper sought to document the facilitators and barriers to the implementation of the collaborative method, based on a single site's experience of participating in a multisite, state-wide heart failure collaborative. Method: Qualitative data was collected using three complementary methods: participant observation, reflective journalling and key informant interviews. Quantitative monitoring of team performance occurred monthly according to prespecified performance indicators. Findings: Barriers and facilitators that were identified by this study included: organisational factors, team composition, dynamics and networking, changing doctor behaviour, clinical leadership and communication. Conclusion: The findings from this study underscore the importance of leadership, communication and team cohesion for the successful implementation of the collaborative method at individual sites. In addition, the importance of a preparatory stage that deals with known barriers and facilitators to the collaborative method before the commencement of the official study period was highlighted. The potential for the collaborative approach to improve clinical outcomes warrants further systematic evaluation of process issues and consideration of the barriers and facilitators to implementation in various settings.
Hammond, J., Salamonson, Y., Davidson, P.M., Everett, B. & Andrew, S. 2007, 'Why do women underestimate the risk of cardiac disease? A literature review', Australian Critical Care, vol. 20, no. 2, pp. 53-59.
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Background: Despite the quantity of information available to women about risk factors for cardiovascular disease (CVD), many women do not perceive this risk. Aim: This paper seeks to identify factors in the published literature that influence womens risk perception of heart disease, and how these perceptions influence health outcomes. Method: A literature search from 1985 to 2006 using the CINAHL, Medline, Embase and PsycINFO electronic databases was undertaken. The keywords used were perceived risk, cardiac risk factors, cardiovascular disease, risk misconception, and heart disease, combined with women and/or gender. Additional data was obtained by manual searches of bibliographies of articles identified in the electronic searches, and Internet searches. Findings: Until the late 1980s, CVD was perceived as a disease which primarily affected men, as few large clinical trials recruited women. This resulted in a lack of data documenting the relationship between known risk factors and gender. Until recently, health professionals have not focused on disseminating gender-specific information about CVD risks to women, causing women to underestimate their risk of developing CVD even when risk factors are clearly evident. Furthermore, women are less likely than men to recognise the signs and symptoms of CVD, delay in seeking treatment, and fail to adopt healthy lifestyles, all of which increase the incidence of mortality and morbidity in a disease that is largely preventable. Conclusion: This review highlights the need for health professionals to bridge the gap between perceived and actual risk of CVD in women, and to develop educational programs that specifically target women.
Halcomb, E.J., Davidson, P.M. & Patterson, E. 2007, 'Exploring the development of Australian general practice nursing: where we have come from and where to from here?', Contemp Nurse, vol. 26, no. 1, pp. 145-153.
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Significant development has occurred in the role and scope of Australian general practice nursing in the last decade. Although there has been a nursing presence in Australian general practice for many years (Linn 1977), current workforce shortages and the growing need for chronic and complex disease management and provision of preventive health care in the community have fuelled role development (Halcomb, Patterson & Davidson 2006). In an effort to explore and document the evolution of scholarship and professional development in Australian general practice nursing a content analysis of the proceedings of the four Australian practice nursing conferences was undertaken. This framework allows the mapping of the trajectory related to professional development issues, policy, research and scholarship. Content analysis revealed that the papers presented at each of the four conferences could be broadly divided into six major themes, namely: (1) role of the practice nurse, (2) education and training, (3) research, (4) legal, ethical and risk issues, (5) innovation in clinical practice, and (6) operational and management issues in general practice. Documenting the evolution of this emerging specialty is important in planning initiatives to maximise practice nurses' important contribution to primary health care.
Davidson, P.M. & Digiacomo, M. 2007, 'Illness perceptions influence involvement in rehabilitation programs and adoption of lifestyle changes following acute myocardial infarction: Commentary', Australian Occupational Therapy Journal, vol. 54, no. 4, pp. 318-319.
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J, P., Davidson, P.M., Ollerton, R., Jackson, D.E. & Kristjanson, L. 2007, 'Pain is a common symptom at the end of life in Residential Aged Care and Targeted Education can improve symptom managament: P1154', Pain Practice, vol. 7, no. Supplement 1, pp. 62-62.
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Fernandez, R., Davidson, P.M., Salamonson, Y., Griffiths, R. & Juergens, C. 2007, 'The Health-Related Quality of Life Trajectory in Patients After Percutaneous Coronary Intervention', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 27, no. 4, pp. 223-226.
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PURPOSE: The purpose of this study was to describe the trajectory of cardiac patient's perceptions of health-related quality of life (HRQoL) during a 24-month period in a community-based population. METHODS: After obtaining informed consent, a self-administered questionnaire was mailed to participants. Using the MacNew questionnaire, which assesses the emotional, physical, social, and global domains, HRQoL outcomes were assessed.
Hickman, L., Newton, P., Halcomb, E.J., Chang, E. & Davidson, P. 2007, 'Best practice interventions to improve the management of older people in acute care settings: A literature review', Journal of Advanced Nursing, vol. 60, no. 2, pp. 113-126.
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Aim. This paper is a report of a literature review of experimental evidence describing interventions to manage the older adult in the acute care hospital setting. Background. Older people are increasingly being cared for in a system largely geared towards acute care. This approach is often inadequate to meet the needs of older patients with chronic and complex conditions. In response to these challenges, evidence-based interventions are required to improve health outcomes. Method. The MEDLINE and CINAHL databases and the Internet were searched using the keywords elderly, older, geriatric and aged care. Studies published between 1985 and 2006 were included if they reported, in English, a controlled trial of an intervention designed to improve the management of older adults in the acute care setting. The findings were synthesized using the method of a modified integrative literature review. Findings. Only 26 controlled trials met the inclusion criteria. The following elements of interventions appear critical in providing optimal health outcomes for older people admitted to acute care: (1) a team approach to care delivery either directly in a designated unit for older patients or indirectly using gerontological expertise in a consultancy model; (2) targeted assessment techniques to prevent complications; (3) an increased emphasis on discharge planning and (4) enhanced communication between care providers across the care continuum. Conclusion. A multidisciplinary team approach, using gerontological expertise, in acute care settings is recommended to improve the care of older patients. Care delivery should occur in a specially designed unit, with communication strategies that emphasize discharge planning. &copy; 2007 Blackwell Publishing Ltd.
Halcomb, E., Moujalli, S., Griffiths, R. & Davidson, P.M. 2007, 'Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults', International Journal of Evidence-Based Healthcare, vol. 5, no. 3, pp. 269-295.
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Background Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness.
Halcomb, E.J., Gholizadeh, L., DiGiacomo, M., Phillips, J. & Davidson, P.M. 2007, 'Literature review: Considerations in undertaking focus group research with culturally and linguistically diverse groups', Journal of Clinical Nursing, vol. 16, no. 6, pp. 1000-1011.
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Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background. The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. Methods. The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms 'focus group', 'cultural sensitivity', 'transcultural nursing', 'transcultural care', 'cultural diversity' and 'ethnic groups'. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. Results. Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. Conclusions. Focus groups are a useful tool to expand existing knowledge about service provision an...
Fernandez, R., Davidson, P.M., Griffiths, R., Juergens, C. & Salamonson, Y. 2007, 'What do we know about the long term medication adherence in patients following percutaneous coronary intervention?', Australian Journal of Advanced Nursing, vol. 25, no. 2, pp. 53-61.
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Background Percutaneous coronary intervention (PCI) is a revascularisation intervention for patients with acute coronary syndrome. It is a common procedure, increasingly used over the past decade. Along with PCI, patients are also prescribed a number of medications and adherence to the pharmacological therapies is vital to improved morbidity and mortality. Objective This cross sectional study sought to evaluate the long term adherence to medications in patients following PCI. Subjects 270 participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 12 -24 months following the PCI.
DiGiacomo, M., Davidson, P.M., Vanderpluym, A., Snell, R. & Worrall-Carter, L. 2007, 'Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention', Australian Critical Care, vol. 20, no. 2, pp. 69-76.
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Objective: To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome. Design: Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey. Setting: A metropolitan teaching hospital in Melbourne, Australia. Participants: The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study. Main outcome measures: Scores on Depression, Anxiety, and Stress Scale (DASS 21). Results: Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found. Conclusions: The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended. &copy; 2007 Australian College of Critical Care Nurses Ltd.
DiGiacomo, M., Davidson, P.M., Davison, J., Moore, L. & Abbott, P. 2007, 'Stressful life events, resources, and access: Key considerations in quitting smoking at an Aboriginal Medical Service', Australian and New Zealand Journal of Public Health, vol. 31, no. 2, pp. 174-176.
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Objective: Aboriginal and Torres Strait Islander people experience adverse health outcomes and have high rates of smoking and related illnesses. This brief report describes stress as a barrier to quitting smoking derived from reflections within an Aboriginal Medical Service and makes recommendations for intervention development. Methods: A high-intensity smoking cessation program was conducted within a suburban Aboriginal Medical Service in Western Sydney, Australia, over a 10-month period. The intervention included weekly cessation counselling sessions and dispensation of free nicotine replacement therapy (NRT). Results: During the observation period, 32 clients made quit attempts. To date, three clients (9%) have quit smoking. Chronic and intercurrent life stressors were noted to be the main barriers to smoking cessation described by participants. Conclusions: Achieving smoking cessation among Indigenous people is made significantly more complex because of multiple life stressors experienced. Implications: Future interventions targeting Indigenous Australians should take greater account of stressful life events and their impact on quitting smoking. &copy; 2007 The Authors. Journal Compilation &copy; 2007 Public Health Association of Australia.
Davidson, P.M., Halcomb, E. & Patterson, E. 2007, 'Practice nursing in Australia: ready for prime time', Contemporary Nurse, vol. 26, no. 1, pp. 5-6.
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Berry, A.M., Davidson, P.M., Masters, J. & Rolls, K. 2007, 'Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation.', Am J Crit Care, vol. 16, no. 6, pp. 552-562.
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BACKGROUND: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia in intensive care units. Although considered basic and potentially nonessential nursing care, oral hygiene has been proposed as a key intervention for reducing ventilator-associated pneumonia. Nevertheless, evidence from randomized controlled trials that could inform best practice is limited. OBJECTIVE: To appraise the peer-reviewed literature to determine the best available evidence for providing oral care to intensive care patients receiving mechanical ventilation and to document a research agenda for this important activity in optimizing patients' outcomes. METHODS: Articles published from 1985 to 2006 in English and indexed in the CINAHL, MEDLINE, Joanna Briggs Institute, Cochrane Library, EMBASE, and DARE databases were searched by using the key terms oral hygiene, oral hygiene practices, oral care, mouth care, mouth hygiene, intubated, mechanically ventilated, intensive care, and critical care. Reference lists of retrieved journal articles were searched for publications missed during the primary search. Finally, the Google search engine was used to do a comprehensive search of the World Wide Web to ensure completeness of the search. The search strategy was verified by a health librarian. RESULTS: The search yielded 55 articles: 11 prospective controlled trials, 20 observational studies, and 24 descriptive reports. Methodological issues and the heterogeneity of samples precluded meta-analysis. CONCLUSIONS: Despite the importance of providing oral hygiene to intensive care patients receiving mechanical ventilation, high-level evidence from rigorous randomized controlled trials or high-quality systematic reviews that could inform clinical practice is scarce.
Astley, C.M., Portelli, L., Whalley, G.A. & Davidson, P.M. 2007, 'Coming of age: affiliate member profile and participation in the annual scientific meeting of the cardiac society of Australia and New Zealand.', Heart Lung Circ, vol. 16, no. 6, pp. 447-451.
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BACKGROUND: Nursing, allied health and technical personnel are increasingly being recognised as pivotal in the diagnosis and management of heart disease. This recognition is mirrored in research, scholarship and professional development activities. Documenting the evolution and progression of a group's professional development is a useful strategy in informing future strategic initiatives. AIM: The purpose of this paper is to illustrate the development and participation of the Affiliates group within the Cardiac Society of Australia and New Zealand (CSANZ). METHOD: Data related to CSANZ membership, participation in the Annual Scientific Meeting as well as the number, type and ranking of abstracts were retrieved from CSANZ records for the period 1995-2003. These data were analysed using descriptive statistics. RESULTS: Since the introduction of the Affiliate member status in 1988, membership has grown steadily, as has participation of members in the governance of the CSANZ. Mean abstract grades of Affiliate members are increasingly comparable with those of the FCSANZ, Ordinary and Associate members. CONCLUSIONS: Affiliate members are increasing their profile in the highly competitive environment of the Annual Scientific Meeting, demonstrating the critical role of nursing, allied health and technical professions in cardiovascular health and science.
Fernandez, R., Griffiths, R., Everett, B., Davidson, P.M., Salamonson, Y. & Andrew, S. 2007, 'Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic review', International Journal of Evidence-Based Healthcare, vol. 5, no. 4, pp. 370-405.
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Background The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established. Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low. Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors.
Chang, E., Hancock, K., Hickman, L., Glasson, J. & Davidson, P. 2007, 'Outcomes of acutely ill older hospitalized patients following implementation of tailored models of care: A repeated measures (pre- and post-intervention) design', International Journal of Nursing Studies, vol. 44, no. 7, pp. 1079-1092.
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Background: There is a lack of research investigating models of nursing care for older hospitalised patients that address the nursing needs of this group. Objectives: The objective of this study is to evaluate the efficacy of models of care for acutely older patients tailored to two contexts: an aged care specific ward and a medical ward. Design: This is a repeated measures design. Efficacy of the models was evaluated in terms of: patient and nurses' satisfaction with care provided; increased activities of daily living; reduced unplanned hospital readmissions; and medication knowledge. Settings: An aged care specific ward and a medical ward in two Sydney teaching hospitals. Participants: There were two groups of patients aged 65 years or older who were admitted to hospital for an acute illness: those admitted prior to model implementation (n=232) and those admitted during model implementation (n=116). Patients with moderate or severe dementia were excluded. The two groups of nurses were the pre-model group (n=90) who were working on the medical and aged care wards for the study prior to model implementation, and the post-model group (n=22), who were the nurses working on the wards during model implementation. Methods: Action research was used to develop the models of care in two wards: one for an aged care specific ward and another for a general medical ward where older patients were admitted. The models developed were based on empirical data gathered in an earlier phase of this study. Results: The models were successful in both wards in terms of increasing satisfaction levels in patients and nurses (p<0.001), increasing functional independence as measured by activities of daily living (p<0.01), and increasing medication knowledge (p<0.001). Conclusions: Findings indicate that models of care developed by nurses using an evidence-based action research strategy can enhance both satisfaction and health outcomes in older patients. &copy; 2006 Elsevier Ltd. All rights rese...
Davidson, P.M., Elliott, D. & Daly, J. 2006, 'Clinical leadership in contemporary clinical practice: implications for nursing in Australia.', J Nurs Manag, vol. 14, no. 3, pp. 180-187.
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BACKGROUND: Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM: The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES: Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS: Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.
Phillips, J., Davidson, P.M., Jackson, D., Kristjanson, L., Daly, J. & Curran, J. 2006, 'Residential aged care: the last frontier for palliative care', JOURNAL OF ADVANCED NURSING, vol. 55, no. 4, pp. 416-424.
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Phillips, J.L., Davidson, P.M., Jackson, D., Kristjanson, L., Bennett, M.L. & Daly, J. 2006, 'Enhancing palliative care delivery in a regional community in Australia.', Aust Health Rev, vol. 30, no. 3, pp. 370-379.
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Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.
Newton, P.J., Davidson, P.M., Halcomb, E.J., Denniss, A.R. & Westgarth, F. 2006, 'An introduction to the collaborative methodology and its potential use for the management of heart failure.', The Journal of cardiovascular nursing., vol. 21, no. 3, pp. 161-168.
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BACKGROUND: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. AIM: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. METHODS: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review. RESULTS: On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process. CONCLUSION: The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease.
Halcomb, E. & Davidson, P.M. 2006, 'The role of practice nurses in an integrated model of cardiovascular disease management in Australian general practice', Australian Journal of Primary Health, vol. 12, no. 2, pp. 34-44.
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While various models of chronic disease management have been developed and evaluated, minimal data is available relating specifically to Australian general practice and, in particular; the role of the nurse within the multidisciplinary general practice team. This paper presents a multidisciplinary model of cardio vascular disease management, focused on Australian general practice, and identifies barriers and facilitators to its implementation. This model was developed from data arising from a series of investigations that (1) examined the epidemiology and current general practice management of cardiovascular disease (2) explored the demographics and role of the pmctice nurse, and (3) established strategic recommendations for future practice development. The model proposes an integrated and multidisciplinary cardiovascular disease management framework to inform policy-makers and health planners in the development of primary health services in Australian general practice.
Halcomb, E.J. & Davidson, P.M. 2006, 'Is verbatim transcription of interview data always necessary?', Appl Nurs Res, vol. 19, no. 1, pp. 38-42.
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Verbatim transcription of interview data has become a common data management strategy in nursing research and is widely considered to be integral to the analysis and interpretation of verbal data. As the benefits of verbal data are becoming more widely embraced in health care research, interviews are being increasingly used to collect information for a wide range of purposes. In addition to purely qualitative investigations, there has been a significant increase in the conduct of mixed-method inquiries. This article examines the issues surrounding the conduct of interviews in mixed-method research, with particular emphasis on the transcription and data analysis phases of data management. It also debates on the necessity to transcribe all audiorecorded interview data verbatim, particularly in relation to mixed-method investigations. Finally, it provides an alternative method to verbatim transcription of managing audiorecorded interview data.
Fernandez, R., Griffiths, R., Juergens, C., Davidson, P.M. & Salamonson, Y. 2006, 'Persistence of coronary risk factor status in participants 12 to 18 months after percutaneous coronary intervention', Journal of Cardiovascular Nursing, vol. 21, no. 5, pp. 379-387.
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Background: Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for coronary heart disease; however, there is limited research investigating the risk factor status of patients 1 year after the procedure. Objective: This cross-sectional study was conducted to investigate the self-reported risk factor status by patients who had undergone a PCI at a major teaching hospital in Sydney, Australia. Subjects: Two hundred seventy participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 1 year after the PCI. Methods: After obtaining informed consent, a follow-up self-administered questionnaire was mailed to participants. Information was collected relating to the following coronary risk factors: smoking, and physical activity status, blood pressure and cholesterol levels, body mass index, depression, anxiety, and stress levels.
Davison, J., Moore, L., DiGiacomo, M. & Davidson, P.M. 2006, 'Partnerships improve cardiovascular health', Australian Nurses Journal, vol. 14, no. 2, pp. 31-31.
Cardiovascular disease (CVD) is the leading cause of death in the AiLstralian Indigenous population (ABS and AIHW 2001). Unfortunately, Australian Aboriginals have not benefited from the reductions in CVD seen in other sectors of the population
Davidson, P., Halcomb, E., Hickman, L., Phillips, J. & Graham, B. 2006, 'Beyond the rhetoric: What do we mean by a 'model of care'?', Australian Journal of Advanced Nursing, vol. 23, no. 3, pp. 47-55.
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Background: Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. Aim: This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. Methods: Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. Results: This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Conclusion: Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. nation...
Davidson, P.M. & DiGiacomo, M. 2006, 'Improving cardiovascular health: a collaborative education program for AHWs', Australian Nurses Journal, vol. 14, no. 2, pp. 26-26.
The high rate of cardiovascular morbidity and mortality among Indigenous Australians is of k ^ concern and demands novel aiid innovative strategies (Brown et al 2005). Aboriguial Healtli Workers (AHW) play a vital role in accessing communities in order to address cardiovascular risk factor modification
Berry, A.M. & Davidson, P.M. 2006, 'Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit.', Intensive Crit Care Nurs, vol. 22, no. 6, pp. 318-328.
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BACKGROUND: The role of oral hygiene in maintaining the health and well being of patients in the intensive care unit (ICU) is indisputable. This importance is not reflected in the body of research related to ICU practice. While a number of studies have examined oral hygiene practices in oncological patients there is significantly less attention devoted to these practices in the critically ill. AIM: This paper has two discrete yet interrelated aims. Firstly, in relation to current available evidence and based on a sound knowledge of oral physiology, identify barriers to effective oral hygiene and subsequent effectiveness of the most commonly used and recommended methods of providing oral hygiene in the critically ill population. Secondly, informed by the critical review, identify recommendations for practice and future intervention studies. FINDINGS: To date, there is no definitive evidence to determine the most appropriate method of oral hygiene including the use of beneficial mouth rinses. Barriers identified in this review to providing optimal hygiene include: (1) mechanical barriers and equipment issues, (2) perceptions of the importance of mouth care and empathy with patient discomfort by nurses, (3) altered patient sensory perception and discomfort and (4) difficulties in patient communication. In spite of these challenges opportunities for collaborative research and increasing expertise in nurse researchers creates a climate to derive solutions to these factors. CONCLUSIONS: It is clearly evident from this review of oral hygiene practices in intensive care that the need for ongoing research is of paramount importance. ICU nurses undeniably require rigorous research studies in order to inform their practice in the provision of oral hygiene for critically ill patients.
Newton, P.J., Davidson, P.M., Halcomb, E., Denniss, R. & Westgarth, F. 2006, 'An introduction to the collaborative methodology and its potential use for the management of heart failure', Journal of Cardiovascular Nursing, vol. 21, no. 3, pp. 161-168.
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Background: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. Aim: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. Methods: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review.
Berry, A., Davidson, P.M., Masters, J. & Rolls, K. 2006, 'Towards a model for best practice for oral hygiene in ICU: a systematic review of the literature', Australian Critical Care, vol. 19, no. 4, pp. 154-154.
Salamonson, Y., van Heere, B., Everett, B. & Davidson, P.M. 2006, 'Voices from the floor: Nurses' perceptions of the medical emergency team', Intensive and Critical Care Nursing, vol. 22, no. 3, pp. 138-143.
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Nurses are the main group of clinicians who activate the medical emergency team (MET), placing them in an excellent position to provide valuable insights regarding the effectiveness of this system. This descriptive study aimed to explore nurses satisfaction with the MET, perceived benefits and suggestions for improvement. The study also sought to examine the characteristics of nurses who were more likely to activate the MET. Using a survey design, descriptive statistics as well as content analysis were used to analyse the data. Seventy-three nurses (79% response rate) returned their completed surveys. A positive and significant relationship was found between years of nursing experience and MET activation (p = 0.018). Overall, nurses were satisfied with the MET, with suggestions for improvement including more education on medical emergencies for both ward and MET staff. Whilst the MET system is meeting the expectations of the majority of ward nurses, there is room for improvement, which includes a more positive attitude of the MET when summoned for borderline cases. Investment in ongoing education of clinicians and interdisciplinary communication is likely to encourage less experienced nurses to utilise this system, whilst decreasing the reticence of some nurses to call the MET.
Yallop, J., Chan, B., Piterman, L., Tonkin, A., Forbes, A., Davidson, P.M., Halcomb, E., Clark, R., Nangle, A., Stewart, S., Croucher, J. & Krum, H. 2006, 'The Chronic Heart-failure Assistance by Telephone (CHAT) Study:Assessment of telephone support for vulnerable patients with chronic disease', Asia Pacific Family Medicine, vol. 2006, no. 5, pp. 30-39.
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Aim: To determine whether telephone support using an evidence-based protocol for chronic heart failure (CHF) management will improve patient outcomes and will reduce hospital readmission rates in patients without access to hospital-based management programs. Methods: The rationale and protocol for a cluster-design randomised controlled trial (RCT) of a semi-automated telephone intervention for the management of CHF, the Chronic Heart-failure Assistance by Telephone (CHAT) Study is described. Care is coordinated by trained cardiac nurses located in Heartline, the national call center of the National Heart Foundation of Australia in partnership with patients general practitioners (GPs). Conclusions: The CHAT Study model represents a potentially cost-effective and accessible model for the Australian health system in caring for CHF patients in rural and remote areas. The system of care could also be readily adapted for a range of chronic diseases and health systems.
Halcomb, E.J., Patterson, E. & Davidson, P.M. 2006, 'Evolution of practice nursing in Australia.', J Adv Nurs, vol. 55, no. 3, pp. 376-388.
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AIM: This paper describes the evolution of Australian practice nursing and documents seminal events in crystallizing the importance of the nursing role in general practice. BACKGROUND: Internationally, the potential for nurses to improve health in primary care settings is acknowledged. The general practice setting is a focal point for primary care in many health systems. Despite the important role played in the delivery of primary health care by nurses working in general practice in the United Kingdom and New Zealand, the role of nurses in Australian general practice is much less clearly defined, as reflected by the paucity of research and scholarship in this area. Fuelled by the increasing challenges of workforce shortages and the increasing need for multidisciplinary care, interest in the developing role of the Australian practice nurse among clinicians, researchers and policy makers is increasing. DISCUSSION: Australian practice nursing has reached a critical point in its evolution. It is imperative for the promotion of nursing in general practice that knowledge from descriptive, exploratory research be used to inform strategic decision-making in terms of professional development issues, policy, research and scholarship. These data also need to inform systematic outcome studies. To date, the embryonic nature of practice nursing as a discrete professional entity in Australia has inhibited its representation in nursing curricula and professional bodies. CONCLUSION: In order to advance the Australian practice nurse movement and demonstrate its important contribution to primary health care, nurses need to take the lead in strategic planning of this emerging specialty. As well as leadership from an academic, research and policy perspective, clinical leaders need to be fostered among the ranks of practice nurse clinicians to drive clinical practice development and the delivery of evidence-based primary care.
Hancock, K., Chang, E., Johnson, A., Harrison, K., Daly, J., Easterbrook, S., Noel, M., Luhr-Taylor, M. & Davidson, P.M. 2006, 'Palliative care for people with advanced dementia: Illuminating evidence-based practice needs', Alzheimer's Care Quarterly, vol. 7, no. 1, pp. 49-57.
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AB The aims of this article are to (1) identify the barriers associated with palliative care for persons with advanced dementia, (2) argue the need for increased collaboration and partnerships between aged care and palliative key providers, and (3) discuss the need for the development and evaluation of evidence-based guidelines for care. Studies addressing these issues are discussed. A key finding of the material reviewed for this article underscores the importance of the development, implementation, and evaluation of guidelines that are empirically based, developed collaboratively, and incorporated into models of care for people with advanced dementia
Halcomb, E., Daly, J., Davidson, P., Elliott, D. & Griffiths, R. 2005, 'Life beyond severe traumatic injury: an integrative review of the literature.', Aust Crit Care, vol. 18, no. 1, pp. 17-24.
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It is only recently that recognition of the serious and debilitating sequelae of trauma has prompted exploration of outcomes beyond survival, such as disability, health status and quality of life. This paper aims to review the literature describing outcomes following severe traumatic injury to provide clinicians with a greater understanding of the recovery trajectory following severe trauma and highlight the issues faced by those recovering from such injury. Electronic databases, published reference lists and the Internet were searched to identify relevant literature. The heterogeneous nature of published literature in this area prohibited a systematic approach to inclusion of papers in this review. Trauma survivors report significant sequelae that influence functional status, psychological wellbeing, quality of life and return to productivity following severe injury. Key themes that emerge from the review include: current trauma systems which provide inadequate support along the recovery trajectory; rehabilitation referral which is affected by geographical location and provider preferences; a long-term loss of productivity in both society and the workplace; a high incidence of psychological sequelae; a link between poor recovery and increased drug and alcohol consumption; and valued social support which can augment recovery. Future research to evaluate interventions which target the recovery needs of the severely injured patients is recommended. Particular emphasis is required to develop systematic, sustainable and cost-effective follow-up to augment the successes of existing acute trauma services in providing high quality acute resuscitation and definitive trauma management.
McKinley, S.M., Dracup, K., Moser, D., Aitken, L.M., Baker, H., Davidson, P.M. & Marshall, A.P. 2005, 'The Association Of Anxiety, Depression And Hostility With Acute Coronary Syndrome Events', Circulation, vol. 112, no. 17, pp. 1-1.
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Davidson, P., Paull, G., Rees, D., Daly, J. & Cockburn, J. 2005, 'Activities of home-based heart failure nurse specialists: A modified narrative analysis', AMERICAN JOURNAL OF CRITICAL CARE, vol. 14, no. 5, pp. 426-433.
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Hancock, K., Davidson, P.M., Daly, J., Weber, D. & Chang, E. 2005, 'An exploration of the usefulness of motivational interviewing in facilitating secondary prevention gains in cardiac rehabilitation', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 25, no. 1, pp. 200-206.
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Motivational interviewing is a client-centered, directive counseling approach aimed at promoting motivation in clients to change certain behaviors. Its effect is to reduce defensiveness and promote disclosure, engagement, and participation, thereby motivating the client to make behavioral changes. Motivational interviewing marries well with the principles of cardiac rehabilitation (CR) in terms of increasing motivation among CR clients, promoting a client-centered approach and in the cost- and time-effective practices of CR. Very little research has been conducted examining the effectiveness of motivational interviewing in enhancing CR outcomes.
Ketefian, S., Davidson, P.M., Daly, J., Chang, E. & Srisuphan, W. 2005, 'Issues and challenges in international doctoral education in nursing (solicited paper)', Nursing and Health Sciences, vol. 7, no. 3, pp. 150-156.
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Education is a driving force in improving the health and welfare of communities globally. Doctoral education of nurses has been identified as a critical factor for provision of leadership in practice, scholarship, research, policy and education. Since the genesis of doctoral education in nursing in the USA in the 1930s, this movement has burgeoned to over 273 doctoral programs in over 30 countries globally. The present article seeks to identify the issues and challenges in nursing doctoral education globally, and those encountered by doctoral program graduates in meeting the challenges of contemporary health care systems. Information was derived from a comprehensive literature review. Electronic databases and the Internet, using the Google search engine, were searched using the key words 'doctoral education'; 'nursing'; 'International Network for Doctoral Education in Nursing'; 'global health'; 'international research collaboration'. Doctoral education has been a critical force in developing nurse leaders in education, management, policy and research domains. An absence of consensus in terminology and of accurate minimum data sets precludes comparison and debate across programs. The complexity and dynamism of contemporary globalized communities render significant challenges in the conduct of doctoral programs. Addressing funding issues and faculty shortages are key issues for doctoral programs, especially those in developing countries, to achieve an identity uniquely their own
Chang, E., Hancock, K., Harrison, K., Daly, J., Johnson, A., Easterbrook, S., Noel, M., Luhr-Taylor, M. & Davidson, P.M. 2005, 'Palliative care for end-stage dementia: A discussion of the implications for education of health care professionals', NURSE EDUCATION TODAY, vol. 25, no. 4, pp. 326-332.
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Halcomb, E.J., Davidson, P.M., Daly, J.P., Griffiths, R., Yallop, J. & Tofler, G. 2005, 'Nursing in Australian general practice: directions and perspectives.', Aust Health Rev, vol. 29, no. 2, pp. 156-166.
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Primary health care services, such as general practices, are the first point of contact for many Australian health care consumers. Until recently, the role of nursing in Australian primary care was poorly defined and described in the literature. Changes in policy and funding have given rise to an expansion of the nursing role in primary care. This paper provides a review of the literature and seeks to identify the barriers and facilitators to implementation of the practice nurse role in Australia and identifies strategic directions for future research and policy development.
Davidson, P.M. 2005, 'Caring, coordination and communication: the challenge to write about it!', Transplant Nurses Journal, vol. 4, no. 2, pp. 4-5.
Mott, B., Zarb, N., Nolan, J., Arnison, V., Chan, R., Jenkins, B., Ulrych, G., Blackburn, C., Codner, T., Glandfield, L., Halcomb, E. & Davidson, P.M. 2005, 'Clinical nurses knowledge of evidence based practice: Constructing a framework to evaluate a mulitfaceted intervention for implementing EBP', Contemporary Nurse, vol. 19, no. 1, pp. 96-104.
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Critical reflection upon nursing practice is pivotal in achieving optimal patient outcomes. Implicit in this statement is knowledge about and an understanding of the implementation of evidence-based practice (EBP). This study sought to evaluate baseline knowledge in order to assess and inform a multifaceted intervention to promote EBP in a multi-site facility in Western Sydney, Australia. On two consecutive days in February 2003, a convenience sample of 229 nurses were surveyed using a five-item, investigator developed, written survey tool. Data were analysed using descriptive statistics. Although the majority of respondents (n=143: 62%) stated that they were aware of EBP, a considerable number (n=86: 38%) stated they had not previously heard of the term. Of concern, 43% (n=99) of respondents were unable to identify a source of information and resources about EBP. The results of this observational, descriptive survey underscore the importance of ongoing strategic interventions to improve knowledge, access and implementation of EBP amongst clinical nurses. This study also provides baseline data upon which to evaluate local interventions to promote knowledge of EBP amongst clinicians.
Halcomb, E. & Davidson, P.M. 2005, 'Using the illness trajectory framework to describe recovery from traumatic injury', Contemporary Nurse, vol. 19, no. 1-2, pp. 232-241.
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This paper seeks to highlight the utility of the Corbin and Strauss Chronic Illness Trajectory Framework in describing recovery from traumatic injury and encourages consideration of its implementation into contemporary trauma nursing (Corbin and Strauss, 1991; 1992).To date, few such frameworks have been proposed to sensitize health professionals to the path of recovery following traumatic injury. Although this framework was initially conceived for use in the domain of chronic illness, the lasting effects of severe traumatic injury have significant parallels to chronic conditions such as stroke (Burton, 2000) and multiple sclerosis (Miller, 1993) to which the framework has previously been applied.This paper demonstrates the Trajectory Framework as a useful structure to potentially enhance the development of post-discharge interventions for trauma survivors and encourages consideration of its implementation into the nursing management of this complex patient group.
Davidson, P.M., Worrall-Carter, L., Finn, J.C. & Stewart, S. 2005, 'Beyond competition: a new paradigm for collaborative cardiovascular research in Australia.', Eur J Cardiovasc Nurs, vol. 4, no. 3, pp. 181-182.
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Davidson, P., Rees, D.M., Brighton, T.A., Enis, J., McCrohon, J., Elliott, D., Cockburn, J., Paull, G. & Daly, J. 2004, 'Non-valvular atrial fibrillation and stroke: implications for nursing practice and therapeutics.', Aust Crit Care, vol. 17, no. 2, pp. 65-73.
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Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.
Dracup, K., McKinley, S.M., Doering, L., Riegel, B.J., Davidson, P.M., Meischke, H. & Pelter, M. 2004, 'What Do Cardiac Patients Know About Heart Attack Symptoms?', Circulation, vol. 110, no. 17, pp. 663-664.
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Davidson, P.M., Macdonald, P., Ang, E., Paull, G., Choucair, S., Daly, J., Moser, D.K. & Dracup, K. 2004, 'A case for consideration of cultural diversity in heart failure management--Part 1: Rationale for the DISCOVER Study.', Contemp Nurse, vol. 17, no. 3, pp. 204-210.
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Heart failure is a condition increasing in prevalence and responsible for high health care utilization, morbidity and mortality. Randomised controlled trials of nurse-coordinated interventions have determined self-care and the incorporation of the patient and their family in care planning as critical elements of service delivery. Coping with a chronic illness, such as heart failure, forces the individual to adjust to changed physical, social and emotional functioning and to modify their lifestyle accordingly. Clinicians increasingly use models of care that focus care delivery on the community setting. In order to develop strategies to assist patients and their families with self-care it is important that clinicians understand the health-care seeking behaviours of all individuals targeted in the community. Australia is a culturally diverse nation, yet evaluations of models of care have been undertaken largely in individuals from predominately Anglo-Celtic origins. The end result of this approach is failure to understand the full range of diverse perspectives that individuals hold that can have an impact on self-care behaviours. Consideration of cultural diversity should extend beyond language to a broader appreciation of cultural values, health seeking beliefs and engagement of culturally unique communities. The 'Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) Study' seeks to uncover information on the health patterns, information needs and the adjustment process for overseas-born individuals with heart failure. Such information will assist clinicians to tailor health care service delivery and ensure the delivery of appropriate, quality care. This manuscript provides the background, rationale and methods for this study.
Brookes, K., Davidson, P., Daly, J. & Hancock, K. 2004, 'Community health nursing in Australia: a critical literature review and implications for professional development.', Contemp Nurse, vol. 16, no. 3, pp. 195-207.
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BACKGROUND: Increasing emphasis on community-based mandates an examination of the community health nurse (CHN). AIM: A critical literature review of the CHN role internationally, with an emphasis on Australia, was undertaken in order to understand historical precedents and inform policy and strategic directions for the CHN. METHOD: A search of the CINAHL, EMBASE, and COCHRANE electronic data-bases from 1982 to June 2002 using community' and 'nursing' as key words and hand searching of books and government reports was undertaken. FINDINGS: This search strategy revealed a lack of literature compared with other areas of nursing. Key themes emerging from this review are: (1) an absence of clear role definitions and lack of clarity of roles; (2) variability in educational requirements for CHNs; (3) diminished CHN power in policy decision making; (3) conflicting role expectations between different facets of the health care system; (4) underutilisation and untapped potential of the role of the CHN in the contemporary health care system; (5) the emerging influence of specialist nurses in community based-care; (6) uptake of traditional nursing roles by non-nurses and (7) an absence of a cohesive model of professional development of CHN that is able to articulate with contemporary social, political and economic trends in health care delivery. CONCLUSIONS: Community health nursing in Australia has a low professional profile when compared to other nursing specialties. An emerging issue, gleaned from the literature review is the tension and debate between specialist and generalist services. It is apparent from this review that CHN have to more actively participate in research and peer reviewed debate in order to have their voice heard and promote their unique and valuable contribution to the nursing profession and the health care system.
Halcomb, E., Davidson, P., Daly, J., Yallop, J. & Tofler, G. 2004, 'Australian nurses in general practice based heart failure management: implications for innovative collaborative practice.', Eur J Cardiovasc Nurs, vol. 3, no. 2, pp. 135-147.
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BACKGROUND: The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235-240]. AIM: This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. METHODS: Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including 'Australia', 'practice nurse', 'office nurse', 'nurs*', 'heart failure', 'cardiac' and 'chronic illness'. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. RESULTS: There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary preve...
Halcomb, E., Daly, J., Jackson, D. & Davidson, P. 2004, 'An insight into Australian nurses' experience of withdrawal/withholding of treatment in the ICU.', Intensive Crit Care Nurs, vol. 20, no. 4, pp. 214-222.
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BACKGROUND: The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. AIM: This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. METHODS: Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. RESULTS: Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. CONCLUSION: The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.
Lambert, V.A., Lambert, C.E., Daly, J., Davidson, P.M., Kunaviktikul, W. & Shin, K.R. 2004, 'Nursing education on women's health care in Australia, Japan, South Korea, and Thailand.', J Transcult Nurs, vol. 15, no. 1, pp. 44-53.
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Only within the last 3 decades have a select number of countries addressed issues surrounding the all-inclusive health and well-being of women. This factor has had a major influence on nursing education within these countries and the subsequent development of curricula. Because the preparation of nurses is pivotal in shaping a society's health care agenda, this article compares and contrasts demographic characteristics, curricular frameworks, the role of the nurse, quality control of nursing curricula, and the focus of nursing courses related to women's health care among the countries of Australia, Japan, South Korea, and Thailand. Recommendations based on infant mortality rates, life expectancy, leading causes of death, and country-based health care issues are provided to inform and guide the future focus of nursing education courses on women's health care within these countries.
Davidson, P., Cockburn, J., Daly, J. & Sanson Fisher, R. 2004, 'Patient-centered needs assessment: rationale for a psychometric measure for assessing needs in heart failure.', J Cardiovasc Nurs, vol. 19, no. 3, pp. 164-171.
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Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.
Davidson, P.M., Hancock, K., Daly, J., Cockburn, J., Moser, D., Goldston, K., Elliott, D., Webster, J., Speerin, R., Wade, V., Clarke, M., Anderson, M., Newman, C. & Chang, E. 2003, 'A cardiac rehabilitation program to enhance the outcomes of older women with heart disease: development of the group rehabilitation for older women (GROW) program', Journal of the Australasian Rehabilitation Nurses Association, vol. 6, no. 4, pp. 8-15.
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Davidson, P.M., Daly, J., Hancock, K. & Jackson, D. 2003, 'Australian women and heart disease: trends, epidemiological perspectives and the need for a culturally competent research agenda.', Contemp Nurse, vol. 16, no. 1-2, pp. 62-73.
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Heart disease commonly manifests as acute coronary syndromes (unstable angina pectoris, or myocardial infarction) and heart failure (HF). These conditions are major causes of morbidity and mortality in Australia and internationally. Australian faces particular challenges in health care delivery given the cultural and ethnic diversity of society and unique issues related to rurality. These factors have significant implications for health care delivery. Following an acute cardiac event women have poorer outcomes: higher mortality rates, higher incidence of complications and greater psychological morbidity compared with men. Language barriers, socioeconomic factors, psychological trauma related to migration and alternate health seeking behaviors and varying perceptions of risk are likely to impact adversely on health outcomes. Self-management in chronic cardiovascular disease underscores the importance of models of care that incorporate aspects related to self-care and promotion of adherence to primary and secondary prevention initiatives. Implicit in this statement is the inclusion of the individual in negotiating and developing their care plan. Therefore health professionals need to be aware of the patient's needs, values, beliefs and health seeking behaviours. These factors are strongly influenced by culture and ethnicity. The cultural diversity of Australian society mandates cultural competence in health care. This paper presents an overview of nursing science related to women and heart disease in Australia and suggests directions for culturally-competent research and development and evaluation of models of care to improve health outcomes for all Australians.
Davidson, P.M., Daly, J., Hancock, K., Moser, D., Chang, E. & Cockburn, J. 2003, 'Perceptions and experiences of heart disease: a literature review and identification of a research agenda in older women.', Eur J Cardiovasc Nurs, vol. 2, no. 4, pp. 255-264.
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BACKGROUND: Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease. This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease. METHODS: The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women. RESULTS: Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs. CONCLUSION: Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.
Davidson, P., Hancock, K., Leung, D., Ang, E., Chang, E., Thompson, D.R. & Daly, J. 2003, 'Traditional Chinese Medicine and heart disease: what does Western medicine and nursing science know about it?', Eur J Cardiovasc Nurs, vol. 2, no. 3, pp. 171-181.
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BACKGROUND: Interest in Traditional Chinese Medicine (TCM) is growing rapidly beyond China. This interest is driven by a combination of factors including recognition of potential benefits of TCM; dissatisfaction with the traditional Western medical model; an increasing commitment to holistic care and increasing evidence for the interaction of psychological factors and outcomes of disease and treatment and health consumer demand. AIMS: This review article was prompted by the need to understand and interpret the increasing trend towards the use of TCM in heart disease. In particular, this article defines and describes TCM, and analyses implications and challenges for Western health care delivery models. LITERATURE SEARCH: This article provides a review of accessible evidence, to English speaking health care professionals. The CINAHL, MEDLINE, HealthSTAR, Academic ASAP and Cochrane databases were searched, identifying literature published from 1982. Search engines on the Internet were also used. Examples of keywords used were "Traditional Chinese Medicine" and "heart". CONCLUSION: Difficulties in accessing information regarding TCM have implications for health education in coronary heart disease and patient safety. The rapid uptake of TCM in both Western and Chinese societies mandates an understanding of the principles and potential interactions when TCM is complemented with Western medical treatment for heart disease. Development of this knowledge and understanding is essential in order to provide safe and effective health care to patients who use combination therapies.
Davidson, P.M., Meleis, A., Daly, J. & Douglas, M.M. 2003, 'Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice.', Contemp Nurse, vol. 15, no. 3, pp. 162-174.
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The events of September 11th, 2001 in the United States and the Bali bombings of October 2002 are chastening examples of the entangled web of the religious, political, health, cultural and economic forces we experience living in a global community. To view these forces as independent, singular, linearly deterministic entities of globalisation is irrational and illogical. Understanding the concept of globalisation has significant implications not only for world health and international politics, but also the health of individuals. Depending on an individual's political stance and world-view, globalisation may be perceived as an emancipatory force, having the potential to bridge the chasm between rich and poor or, in stark contrast, the very essence of the divide. It is important that nurses appreciate that globalisation does not pertain solely to the realms of economic theory and world politics, but also that it impacts on our daily nursing practice and the welfare of our patients. Globalisation and the closer interactions of human activity that result, have implications for international governance, policy and theory development as well as nursing education, research and clinical practice. Nurses, individually and collectively, have the political power and social consciousness to influence the forces of globalisation to improve health for all. This paper defines and discusses globalisation in today's world and its implications for contemporary nursing education, science, research and clinical practice.
Davidson, P., Introna, K., Daly, J., Paull, G., Jarvis, R., Angus, J., Wilds, T., Cockburn, J., Dunford, M. & Dracup, K. 2003, 'Cardio respiratory nurses' perceptions of palliative care in nonmalignant disease: Data for the development of clinical practice', AMERICAN JOURNAL OF CRITICAL CARE, vol. 12, no. 1, pp. 47-53.
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Davidson, P.M., Introna, K., Cockburn, J., Daly, J., Dunford, M., Paull, G. & Dracup, K. 2002, 'Synergizing acute care and palliative care to optimise nursing care in end-stage cardiorespiratory disease.', Aust Crit Care, vol. 15, no. 2, pp. 64-69.
Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.
Daly, J., Sindone, A.P., Thompson, D.R., Hancock, K., Chang, E. & Davidson, P. 2002, 'Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review.', Prog Cardiovasc Nurs, vol. 17, no. 1, pp. 8-17.
Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.
Daly, J., Davidson, P., Chang, E., Hancock, K., Rees, D. & Thompson, D.R. 2002, 'Cultural aspects of adjustment to coronary heart disease in Chinese-Australians: a review of the literature', JOURNAL OF ADVANCED NURSING, vol. 39, no. 4, pp. 391-399.
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Davidson, P., Stewart, S., Elliott, D., Daly, J., Sindone, A. & Cockburn, J. 2001, 'Addressing the burden of heart failure in Australia: the scope for home-based interventions.', J Cardiovasc Nurs, vol. 16, no. 1, pp. 56-68.
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The growing burden of heart failure (HF) challenges health practitioners to implement and evaluate models of care to facilitate optimal health related outcomes. Australia supports a publicly funded universal health insurance system with a strong emphasis on primary care provided by general practitioners. The burden of chronic HF, and a social and political framework favoring community-based, noninstitutionalized care, represents an ideal environment in which home-based HF programs can be implemented successfully. Cardiovascular nurses are well positioned to champion and mentor implementation of evidence-based, patient-centered programs in Australian communities. This paper describes the facilitators and barriers to implementation of best practice models in the Australian context. These include the challenge of providing care in a diverse, multicultural society and the need for clinical governance structures to ensure equal access to the most effective models of care.
Davidson, P., Daly, J., Romanini, J. & Elliott, D. 2001, 'Quality use of medicines (QUM) in critical care: an imperative for best practice.', Aust Crit Care, vol. 14, no. 3, pp. 122-126.
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Quality use of medicines (QUM) as a discrete concept is gaining increasing importance in Australia and is supported by a policy platform which has federal government and health professional support. The QUM movement is also supported by a strong consumer base and this lobby group has been responsible for endorsement as a major health initiative. However, the importance of QUM to achievement of optimal patient outcomes has not achieved sufficient recognition in the critical care literature. Implicit in the discussion of QUM is the rational, ethical, safe and effective use of drugs within a best practice framework. Successful implementation of QUM requires appropriate infrastructure and the commitment and cooperation of medical, nursing and pharmacy staff. Support, education and training provide the prerequisites of knowledge, skills and awareness for quality use of medicines for all groups. An emphasis upon evidence based practice and the prevalence of polypharmacy in contemporary health care systems requires examination of factors that are barriers to best practice. QUM in critical care areas requires appropriately skilled staff who are competent to manage patients with a wide range of selected drugs, often in highly stressful situations. In many situations in critical care, the role of the critical care nurse is one of patient advocate. It is important to note that the delivery of critical care is not limited to a discrete setting and is inclusive of management at the trauma scene, assessment and delivery of care in the emergency department, through to intensive, coronary care and high dependency units. This paper presents a discussion of the concept of QUM and its relevance in the critical care context. Key theoretical, policy and research considerations for establishment of QUM in critical care are reviewed and discussed. This paper seeks to describe key issues in QUM and endorse the need for a research agenda in critical care.
Daly, J., Elliott, D., Cameron-Traub, E., Salamonson, Y., Davidson, P., Jackson, D., Chin, C. & Wade, V. 2000, 'Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction.', Am J Crit Care, vol. 9, no. 1, pp. 62-69.
BACKGROUND: The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known. OBJECTIVE: To explore health status, perceptions of coping, and social support among survivors of a recent myocardial infarction in the first 3 weeks after discharge from hospitals in southwestern Sydney, Australia. METHODS: A descriptive, exploratory approach with a triangulated methodology was used to assess the experiences of 38 survivors, detect patterns in these experiences, explore the health-support needs of survivors, and determine changes in health status in the first 3 weeks after discharge. Quantitative data were collected with the Medical Outcomes Study SF-36, New York Heart Association classification, Canadian Cardiovascular Society Angina Scale, and the Jalowiec Coping Scale. A semistructured interview schedule provided additional qualitative data about the experiences of the survivors. RESULTS: The health status of participants was relatively stable during the 3-week period; most had no activity limitation due to dyspnea or angina. However, the subjects' health status was considerably lower than that of their age-matched population. The most common and most effective coping strategies adopted during this period were confrontation, optimism, and self-reliance. In addition, the subjects experienced anxiety, depression, ambiguity and uncertainty, fear of recurrence of the infarction and of deterioration in health, of boredom and of inertia. CONCLUSION: These findings can help nurses in hospital and community settings assist survivors of acute myocardial infarction to prepare for and deal effectively with experiences during convalescence.
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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Lenton, S. & Davidson, P.M. 1999, 'Raves, drugs, dealing and driving: qualitative data from a West Australian sample', Drug And Alcohol Review, vol. 18, no. 2, pp. 153-161.
This qualitative paper from a study of 83 people who attended raves or dance parties in Perth, Western Australia describes what respondents saw as the attractions and less good things about the rave/dance party scene, their views of the place of drug use
Daly, J., Jackson, D., Davidson, P.M., Wade, V., Chin, C. & Brimelow, V. 1998, 'The experiences of female spouses of survivors of acute myocardial infarction: a pilot study of Lebanese-born women in south-western Sydney, Australia', JOURNAL OF ADVANCED NURSING, vol. 28, no. 6, pp. 1199-1206.
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Worrall-Carter, L., Ski, C.F., Thompson, D.R., Davidson, P.M., Cameron, J., Castle, D. & Page, K., 'Recognition and referral of depression in patients with heart disease', European Journal of Cardiovascular Nursing.
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Background: Routine screening and assessment for depression occurs rarely in clinical practice for a variety of reasons, including the absence of systems to facilitate the process. Aim: To identify nurses' knowledge and practice regarding depression screening and referral for cardiac patients following the implementation of education workshops and a validated screening tool with referral actions. Methods: Pre and post-test design using surveys and semi-structured interviews was conducted with a purposive sample of nurses in a large Australian metropolitan tertiary referral hospital. Prior to the introduction of the screening and referral tool, nurses engaged in an interactive one hour education workshop on the topic of depression and the tool; introduced to improve depression screening following an acute cardiac event. Results: In the pre and post-survey 40 and 30 nurses, respectively, participated with 14 also engaging in semi-structured interviews. Eighty percent reported a 'good' understanding of depression post-program compared to 30% at baseline. Sixty percent reported routinely using the depression screening and referral tool. The interviews identified three main themes that supported the utility of the education and instrument: knowledge improvement; perceived self-efficacy and new knowledge into practice. Conclusion: The vast majority of participants reported increased skill, knowledge and confidence to screen and refer for depression post an acute cardiac event. The substantial increase in the number of nurses who engaged in screening and referral actions further demonstrated the success of the program. These encouraging results provide evidence that screening for depression can be achieved through adopting formalised processes. &copy; 2011 European Society of Cardiology.

Non traditional outputs

Ferguson, C. & Davidson, P.M. 2012, 'Energy drink binge leaves teens with more than a hangover', The Conversation, https://theconversation.edu.au/energy-drink-binge-leaves-teens-with-more....
Manufacturers of energy drinks are coming under pressure from governments and regulatory bodies following concerns about the health impacts of their products on teenagers and other at-risk groups.
Ferguson, C. & Davidson, P.M. 2012, 'Getting to the heart of the matter on stroke', The Conversation, The Conversation.
Every year, as many as three million people across the world will have a stroke attributable to abnormal heartbeats called atrial fibrillation.

Other

DiGiacomo, M. & Davidson, P.M. 2013, 'Australian women outlive men then struggle with disadvantage', The Conversation Media Trust.
This article refers to the recent Council of Australian Government (COAG) Reform Council's report, Tracking equity: Comparing outcomes for women and girls across Australia, which charts Australia's gender disparities over a lifetime. It contains discussion of older women's experiences of ageing in Australia, where some find themselves isolated, poor, and ill-equipped to meet the challenges of living alone with multiple chronic conditions. It The article highlights the need for innovative strategies to identify women at higher risk of poor outcomes and the imperative to deliver cross-sector strategies.
Ferguson, C., DiGiacomo, M. & Davidson, P.M. 2012, 'Ladykiller: the hidden danger to women's health', The Conversation.
Cardiovascular disease is the biggest killer of women in Australia. It accounts for more than 40% of all female deaths, which means it kills more Australian women than breast cancer and lung cancer combined. But few women are aware of their risk and many wouldn't necessarily be able to recognise warning signs. Part of the difficulty stems from the fact that heart disease is often not obvious and, sometimes, it has no symptoms. High blood pressure (hypertension), for instance, is a major risk factor in cardiovascular disease and can easily go undetected for years. So many women remain unaware that heart disease and stroke are major health issues for them.