Lin is a Professor of Nursing Research and Practice Development with the Northern Hospitals Network, South Eastern Sydney Local Health District, with Prince of Wales Hospital and Sydney, Sydney Eye Hospitals.
External contact details
Phone: +61 2 9382 4709
Fax : +61 2 9382 4050
Address: G74, East Wing Edmund Blacket Building, Prince of Wales Hospital, Barker St., Randwick NSW 2031.
Newcastle Institute of Public Health / Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
Barts and The London NHS Trust, London, UK
St Bartholomew School of Nursing and Midwifery, City University, London
Faculty of Health and Social Care Sciences, St George’s Hospital Medical School and Kingston University, London
St George’s Hospital Medical School and Mayday Healthcare NHS Trust, London
University of Plymouth, Plymouth, UK
Tor and South West College of Health, Taunton, UK
Memberships and responsibilities
National Stroke Foundation Guidelines Working Party
Stroke Services New South Wales Stroke Education Committee
Royal College of Nursing representative, Intercollegiate Working Party for Stroke, the UK national multi-professional lead body for stroke
World Stroke Organisation
Resource panel for the Australian Commission on Safety and Quality in Health Care in relation to Clinical Safety and Quality Expertise and Health Issues and Literature Reviews
UK Royal College of Nursing
UK Royal College of Nursing Research Society
UK National Nurses Nutrition Group, former Research Committee member
British Association for Parenteral and Enteral Nutrition
European Society for Clinical Nutrition and Metabolism
Founder member and Research sub-group lead of the UK National Stroke Nursing Forum
Founder member of UK Swallowing Research Group
Awards, scholarships and fellowships
Visiting Scholarship, University of Teeside, UK (2009).
Greater Metropolitan Clinical Taskforce Stroke Education Grant (2008)
Juvenile Diabetes Research Fund award (2008)
Newcastle Institute of Public Health Research Fellowship (2007-9).
Distinguished Visiting Scholarship, Australian Catholic University (2005).
Runner-up for the Nutricia Research Prize (2003).
Royal College of Nursing Educational Scholarship (2003).
Cochrane Library Prize (2000) for best application of research evidence to clinical practice.
Dept of Health Doctoral Fellowship (2000-2002).
Can supervise: YES
Lin's research interests include implementation of evidence-based practice, service and practice development, and organisational change, predominantly within stroke and chronic disease management. She is an Editor of the Journal of Advanced Nursing, and holds a conjoint position with University of Newcastle, NSW.
Implementation of evidence-based practice
Service and practice development and evaluation
Stroke, diabetes, acute cardiovascular disease
Chronic disease management
Nutritional aspects of health and disease, nutritional support
Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. * Evidence-based and practical in style, with case studies and practice examples throughout * Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education * The first text to explore stroke management from UK and international perspectives, and with a nursing focus. © 2010 Blackwell Publishing Ltd.
Al-Ganmi, AHA, Al-Fayyadh, S, Abd Ali, MBH, Alotaibi, AM, Gholizadeh, L & Perry, L 2019, 'Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq', Collegian, vol. 26, no. 3, pp. 355-365.View/Download from: UTS OPUS or Publisher's site
© 2018 Australian College of Nursing Ltd Background: Adherence to cardiac medication regimes is essential for effective treatment of cardiovascular disease but is unsatisfactory in Australia and little studied in Iraq. Aim: This study evaluated and compared adherence to cardiac medications and potentially predictive factors based on the Theory of Planned Behaviour (TPB) in patients with cardiovascular disease admitted to hospital and attending cardiac services in Australia and Iraq. Methods: A cross-sectional multi-centre comparative study involving 246 cardiac patients was conducted in Australia (one hospital in Sydney) and Iraq (three cardiac hospitals in Baghdad) between October 2016 and December 2017. Adherence to medications and related factors were examined using established, validated questionnaires, formally translated and validated into Arabic for Iraqi participants. Binary logistic regression was conducted to determine those factors independently predictive of cardiac medication adherence, in Australia and Iraq. Findings: A significantly higher proportion (64.3%) of Iraqi than Australian (37.5%) cardiac patients reported medium/low levels of adherence to their cardiac medications. After adjusting for confounding factors, the ability to correctly self-administer and refill medications, and beliefs about cardio-protective medication were identified as independent predictors of cardiac medication adherence behaviour in both Australian and Iraqi participants. In Iraq, patients recruited from out-patient cardiac clinics were significantly more likely to report adherent behaviours that patients recruited as in-patients of the cardiac ward. Conclusion: Non-adherence to cardiac medications differed but was sub-optimal in both Australian and Iraqi patient samples, in both countries, adherence was associated with patients' beliefs about medications, and ability to self-administer and refill medications. Clinical nurses and pharmacists need to investigate these fa...
Pierce, H, Perry, L, Gallagher, R & Chiarelli, P 2019, 'Culture, teams, and organizations: A qualitative exploration of female nurses' and midwives' experiences of urinary symptoms at work.', Journal of advanced nursing, vol. 75, no. 6, pp. 1284-1295.View/Download from: UTS OPUS or Publisher's site
AIM:To explore nurses' and midwives' experiences of urinary symptoms at work. BACKGROUND:Lower urinary tract symptoms are common in female nurses and midwives. There is limited understanding of the relationship between urinary symptoms, bladder health practices, and work. DESIGN:Qualitative design providing in-depth exploration of nurses' and midwives' experiences of urinary symptoms at work through focus group discussions. METHODS:Twelve focus groups were held July-September 2016 with 96 Registered Nurses and midwives working at two tertiary-referral hospitals in urban New South Wales, Australia. A semi-structured question schedule was used. An inductive process guided thematic analysis of data using a socioecological framework of health behaviours. RESULTS:Nurses' and midwives' experiences of urinary symptoms at work primarily relate to delaying voiding. This practice is explained by a work culture of "patient-first" care at expense of self-care, relationships in the nursing team, demands of the nursing role, and inadequacy of workplace amenities. The first two themes reflect cultural and social caring dilemmas central to nursing. The second two themes identify issues with workforce management and physical workplace environments. CONCLUSION:Nurses' and midwives' urinary symptoms and behaviours in response to sensory cues for bladder emptying are dependent on several socioecological influences. Occupational health initiatives in the workforce are required to break cultural norms that deter self-care and to promote work environments that support healthy bladder practices. Workforce management and physical workplace environments are key influences on nurses' timely and dignified access to amenities.
Pierce, HM, Perry, L, Gallagher, R & Chiarelli, P 2019, 'Delaying voiding, limiting fluids, urinary symptoms, and work productivity: A survey of female nurses and midwives.', Journal of advanced nursing.View/Download from: Publisher's site
AIM:To examine the relationships between workplace bladder practices, urinary symptoms, and work productivity. DESIGN:Cross-sectional observational survey. METHODS:Surveys were distributed June-November 2016 to at least 600 female nurses and midwives at three urban hospitals in New South Wales, Australia. Nurses self-reported restricted workplace access to toilets, delaying voiding, limiting of fluid intakes and urinary symptoms at work. Logistic modelling was used to examine whether nurses' bladder practices impaired their time management, ability to concentrate or perform physical demands. RESULTS:Of 353 useable surveys, one in five nurses (22.4%; N = 79) reported restricted access to toilets at work, most (77.1%; N = 272) delayed voiding and one in four (26.9%; N = 95) limited fluid intakes to delay voiding at work. Almost half the sample had urinary symptoms at work (46.7%; N = 165); delaying voiding increased the likelihood of impaired mental concentration and limiting fluid intakes increased the likelihood of impaired time management. CONCLUSION:As workplace access to toilets and related bladder practices are modifiable, associated urinary symptoms and productivity loss may be preventable. IMPACT:Nurses' often experience restricted accesses to amenities due to job demands and workplace environments. The impact of nurses' poor bladder practices in the workplace is not known. In this study most nurses delayed voiding and many purposefully limited fluid intakes at work. These behaviours impacted a nurse's ability to manage time and/or concentrate at work. Results have implications for nurses' personal health, the design of workplace environments, workforce management, occupational health policy, and patient care.
Harris, M, James, S, Perry, L, Lowe, J, Dunbabin, J & Steinbeck, K 2019, 'Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose?', Journal of Evaluation in Clinical Practice.View/Download from: Publisher's site
© 2019 John Wiley & Sons, Ltd. Introduction: The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self-management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes-related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. Methods: This qualitative study was undertaken in New South Wales, Australia. Recruitment was based on a snowball sampling technique, which began with members of an established diabetes service group. Data were collected by individual semistructured interviews with 16 health care professionals, most of whom were registered nurses (75%), working at differing levels of expertise and responsibility across metropolitan and regional/rural areas. Data were analysed using thematic analyses. Results: Participants overwhelmingly recognized the time and care needed to support young adults with type 1 diabetes to prepare them for adult self-management and to work with adult diabetes services, and the importance of youth-friendly services. They reported shortfalls and inequitous distribution in services for these young adults. Two themes, addressing the present and future possibilities, expressed their perceptions of services for this population: working with what is available and mapping a route to better services. Conclusion: Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care ser...
Mulcahy, M, Lowry, C, Hoban, K & Perry, L 2018, 'Perspectives and experiences of nurses as facilitators within a Practice Development program', Collegian, vol. 25, no. 1, pp. 3-10.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Nursing Ltd. Background: Health services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this, the 'Essentials of Care' Practice Development program was developed in Australia. Local facilitators play a key role in its delivery and achievements. Aims: This study aimed to gain insights into the experiences of clinical nurses in Practice Development facilitation roles in an acute hospital, including training for the role and changes occurring within themselves and their workplaces. Methods: A qualitative interpretive design used purposive sampling for a two-phase study using semi structured interviews and focus groups with data analysed using Framework Analysis. Results: Twelve Registered Nurses with an average of two years' experience in a facilitator role were interviewed and attended focus groups in 2011. Five key themes were identified: (1) facilitator as enabler, (2) the necessary team approach to facilitation, (3) valuing both internal and external models of facilitation, (4) preparation and training for role, and (5) perceived changes: to the facilitator and to the workplace. Individuals' ongoing development resulted from reflection, mentorship, role-modelling and co-facilitation; facilitation skills were recognised as relevant for nursing beyond their Program role. Ward culture gains were valued as distinct from measurable patient outcomes such as reduced medication errors. Conclusion: Findings provide insights into facilitators' experiences of this Practice Development role and contribute to better understanding of effective processes for nursing practice change in acute health services. Recommendations were proposed to support future role and post-holder development.
Al-Ganmi, AHA, Perry, L, Gholizadeh, L & Alotaibi, AM 2018, 'Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial', Collegian, vol. 25, no. 4, pp. 385-394.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Nursing Ltd. Background: Suboptimal adherence to medication increases mortality and morbidity; individually tailored supportive interventions can improve patients' adherence to their medication regimens. Aims: The study aims to use a pilot randomised controlled trial (RCT) to test the hypothesis that a theory-based, nurse-led, multi-faceted intervention comprising motivational interviewing techniques and text message reminders in addition to standard care will better promote medication adherence in cardiac patients compared to standard care alone. The pilot study will assess self-reported adherence or non-adherence to cardiovascular medication in patients referred to a cardiac rehabilitation program following hospital admission for an acute cardiac event and test the feasibility of the intervention. The study will examine the role of individual, behavioural and environmental factors in predicting medication non-adherence in patients with CVD. Methods: This is a mixed- methods study including a nested pilot RCT. Twenty-eight cardiac patients will be recruited; an estimated sample of nine patients in each group will be required for the pilot RCT with 80% power to detect a moderate effect size at 5% significance, and assuming 50% loss to follow-up over the six month intervention. Participants will complete a paper-based survey (Phase one), followed by a brief semi-structured interview (Phase two) to identify their level of adherence to medication and determine factors predictive of non-adherence. Participants identified as 'non-adherent' will be eligible for the pilot randomised trial, where they will be randomly allocated to receive either the motivational interview plus text message reminders and standard care, or standard care alone. Discussion: Nurse-led multi-faceted interventions have the potential to enhance adherence to cardiac medications. The results of this study may have relevance for cardiac patients in other settings, and f...
Jakimowicz, S, Perry, L & Lewis, J 2018, 'Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses.', Australian Critical Care, vol. 31, no. 6, pp. 396-405.View/Download from: UTS OPUS or Publisher's site
Compassion satisfaction and compassion fatigue influence nurses' intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units.A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units.Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as 'average' levels of compassion satisfaction and burnout, and 'low' levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p=0.008) and lower STS scores (p=0.025), with site significantly predictive for compassion satisfaction (p<0.024) and STS (p<0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p=0.027), and compassion satisfaction significantly increased with increasing duration of practice (p=0.042) as a nurse and in their current ICU (p=0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p<0.016).These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce.
Jakimowicz, S, Perry, L & Lewis, J 2018, 'Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory.', Journal of Clinical Nursing, vol. 27, no. 7-8, pp. 1599-1611.View/Download from: UTS OPUS or Publisher's site
To explore patient-centred nursing, compassion satisfaction and compassion fatigue from intensive care nurses' perspectives.Compassion satisfaction and compassion fatigue can influence critical care nurses' decisions to either continue or leave the profession, and could impact the compassionate patient-centred nursing care patients receive during their ICU admission.This qualitative research design was informed by Charmaz's Grounded Theory Constructivist methodology.In-depth interviews were conducted with 21 critical care nurses of two ICUs in Australia during 2016. Interview data were analysed using grounded theory processes.Findings reflected positive and negative impacts on critical care nurses' ability to deal compassionately with their patients. Effects on patient-centred nursing and critical care nurses' own well-being were revealed. A core category of "Expectations" emerged, explaining the tension between critical care nurses' biomedical, clinical skills and knowledge versus compassionate, patient-centred nursing care. This tension was clarified and expanded in subcategories of "Life in the Balance," "Passion and Pressure," "Understanding and Advocacy" and "Tenacity and Fragility".Providing patient-centred nursing may enhance critical care nurses' experience of compassion satisfaction, in turn impacting delivery of compassionate patient-centred nursing to generate a virtuous circle. Critical care nurses who feel respected and supported by their management team and colleagues experience feelings of compassion satisfaction, leading to greater engagement and care towards their patient.Systematically addressing critical care nurses' needs to successfully balance biomedical with compassionate nursing care may lead to greater well-being in the critical care nursing workforce and improve patient experience of intensive care.
Perry, L 2018, 'Publication ethics—Where are we today? Part 3: The good, the bad, and the ugly face of publication', International Journal of Nursing Practice, vol. 23, no. 6, pp. 1-2.View/Download from: UTS OPUS or Publisher's site
The first part of this series raised issues encountered by authors as they work out authorship and 'original publication' of a paper (Perry, 2017a). The second presents a consensus statement from the editor and editorial board on what is considered 'prior publication,' and therefore bars publication in this (and probably other similar) journals (Perry, 2017b). This third paper addresses the issue of journal choice. Why do authors choose the journals in which they publish? A variety of good reasons attract authors:
Specific readership: the journal is read by the people you want to read your paper; people interested in the topic, working in the field, who may replicate your findings, take up your recommendations or your suggestions for further research. Journals linked to specific professions, professional bodies, or special interest groups are often targeted for these reasons, and authors can go on to create whole folios of work in favoured journals.
Wide readership: the journal's publications are widely—often freely—available. In the age of Internet‐based publications, this means one of the forms of Open Access (or 'author pays') publications. Accessibility may support study citation—and having a study cited is as important for the authors' curriculum vitae and metrics (such as H‐index) as it is to the publisher, for their Impact Factor.
Quality and reputation: the journal has a reputation for high‐quality work and processes. In a reputational virtuous circle, authors of high‐quality work like to see their work in print alongside work of similar calibre; like therefore attracts like. What also attracts are high‐quality in‐house editorial work: papers dealt with in a timely fashion, receiving relevant and helpful reviews, resulting in papers appearing in print online with minimal delay, in accurate, and attractive format. Increasingly, authors look for provision of measures such as Altmetrics—generalized article metrics comprising non‐traditional ways of assessin...
Smith, S, Gullick, J, Ballard, J & Perry, L 2018, 'A proposed clinical research support career pathway for noninvestigators.', International journal of nursing practice, vol. 24, no. 3, pp. e12641-e12641.View/Download from: UTS OPUS or Publisher's site
To discuss the international experience of clinical research support for noninvestigator roles and to propose a new pathway for Australia, to promote a sustainable research support workforce capable of delivering high-quality clinical research.Noninvestigator research support roles are currently characterized by an ad hoc approach to training, with limited role delineation and perceived professional isolation with implications for study completion rates and participant safety. A focused approach to developing and implementing research support pathways has improved patient recruitment, study completion, job satisfaction, and research governance.The Queensland and New South Wales state-based Nurses' Awards, the Australian Qualifications Framework, and a University Professional (Research) Staff Award. Research nurses in the clinical environment improve study coordination, adherence to study protocol, patient safety, and clinical care.A career pathway that guides education and outlines position descriptions and skill sets would enhance development of the research support workforce. This pathway could contribute to changing the patient outcomes through coordination and study completion of high-quality research. A wide consultative approach is required to determine a cost-effective and feasible approach to implementation and evaluation of the proposed pathway.
Smith, S, Gullick, J, Ballard, J & Perry, L 2018, 'Clinician researcher career pathway for registered nurses and midwives: A proposal.', International journal of nursing practice, vol. 24, no. 3.View/Download from: UTS OPUS or Publisher's site
AIM:To consider clinician researcher career frameworks and propose a new pathway, integrating university and health service components to support research career progression within nursing and midwifery practice. BACKGROUND:Hospitals with research-active clinicians report fewer adverse events and better patient outcomes. Nursing clinician researcher career development is therefore an international priority, yet positions and expectations associated with this are not always well articulated, with nurses and midwives challenged to accommodate research and clinical careers. DESIGN:This discussion paper describes nurse/midwife clinician researcher career frameworks and a new pathway that aligns academic and nursing role descriptions. DATA SOURCES:The new framework was informed by a brief literature search for international framework documents, three Australian state-based Nurses and Midwives Awards: the Australian Qualifications Framework, publically available University Academic (Research) Award schedules and academic staff descriptions, and state health department and health services publications. IMPLICATIONS FOR NURSING:The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement. CONCLUSION:This paper provides a blueprint for clinician researcher career development. It elevates the research domain as an equal alongside clinical, managerial and educational clinical career development.
Welp, A, Johnson, A, Nguyen, H & Perry, L 2018, 'The importance of reflecting on practice: How personal professional development activities affect perceived teamwork and performance', Journal of Clinical Nursing, vol. 27, no. 21-22, pp. 3988-3999.View/Download from: UTS OPUS or Publisher's site
© 2018 John Wiley & Sons Ltd Aims and objectives: To examine the relationships between participation in personal professional development activities (e.g., coaching, mentoring), teamwork and performance; to investigate the mediating and moderating effects of reflective thinking and perceived usefulness of development activities. Background: Professional development is associated with better performance and attitudes towards one's work. This study adds to this research by focusing on understanding this effect and the conditions under which this occurs. Design: Cross-sectional survey study. Methods: Participants were 244 nurses working in a large, metropolitan acute public hospital. They completed a questionnaire consisting of validated measures and provided information on frequency of participation and perceived usefulness of personal professional development activities. We analysed data using regression-based moderated mediation analyses. Results: The relationship between frequency of participation in personal professional development activities and both perceived teamwork and performance was mediated by reflective thinking. Perceived usefulness of development activities moderated the relationship between frequency of participation in personal professional development activities and reflective thinking. Conclusion: Our results highlight the importance of professional development activities that go beyond knowledge- or skill-based training. Activities that cater to nurses' personal professional development needs are also associated with more positively perceived teamwork and performance. Results provide insights into the mediating mechanisms: Participation in personal professional development activities encouraged reflective thinking, which was associated with better perceived teamwork and performance. This association between personal professional development activities and reflective thinking was even stronger where nurses perceived the activities as useful. R...
Alotaibi, A, Gholizadeh, L, Al-Ganmi, AHA & Perry, L 2018, 'Factors influencing nurses' knowledge acquisition of diabetes care and its management: a qualitative study.', Journal of Clinical Nursing, vol. 27, no. 23-24, pp. 4340-4352.View/Download from: UTS OPUS or Publisher's site
The aim of this qualitative study was to identify and explore the factors nurses perceive as influencing their knowledge acquisition in relation to diabetes care and its management in Saudi Arabia.Diabetes continues to pose major healthcare challenges despite advances in diabetes management. Nurses have a crucial role in diabetes care but diabetes knowledge deficits deter effective collaboration with other healthcare providers in educating patients about diabetes self-management.An exploratory descriptive qualitative design.This qualitative study recruited 16 nurses from different specialty areas at a tertiary hospital in Saudi Arabia. Data were obtained through semi-structured interviews and analysed using thematic analysis.Three main themes emerged: (1) diabetes care and education (2) barriers affecting nurses' acquisition of diabetes knowledge (3) factors to support nurses' acquisition of diabetes knowledge.To pursue the goal of continued improvement in diabetes management in the challenging settings of acute care there is a need to develop good practice in diabetes care amongst nursing professionals. Understanding of the complexity of factors that influence nurses' knowledge acquisition in relation to diabetes care and its management provides clinical nurses and nursing mangers with directions for future education, policy development and research. This article is protected by copyright. All rights reserved.
Pierce, HM, Perry, L, Gallagher, R & Chiarelli, P 2018, 'Severity of urinary incontinence and its impact on work productivity among nurses and midwives in urban Australia.', Australian and New Zealand Continence Journal, vol. 24, no. 1, pp. 7-15.View/Download from: UTS OPUS
Potter, JE, Perry, L, Elliott, RM, Aneman, A, Brieva, JL, Cavazzoni, E, Cheng, AT, O'Leary, MJ, Seppelt, IM, Herkes, RG & COMFORT study investigators 2018, 'Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT): a multicentre before-and-after study.', Critical Care and Resuscitation, vol. 20, no. 4, pp. 268-276.View/Download from: UTS OPUS
OBJECTIVE:To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. DESIGN:A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls. SETTING:Nine Australian intensive care units. PARTICIPANTS:Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged ≤ 16 years. INTERVENTION:A multicomponent intervention including offers of deceased organ donation from specially trained designated requesters using a structured conversation separate to end-of-life discussions. MAIN OUTCOME MEASURE:Proportion of families consenting to organ donation. RESULTS:Consent was obtained in 87/164 cases (53%) during the intervention period compared with 14/25 cases (56%) pre-intervention (P = 0.83). The odds ratio (OR) of obtaining consent during the intervention period relative to preintervention was 1.13 (95% CI, 0.48-2.63; P = 0.78). During the intervention period, designated requesters obtained consent in 55/98 cases (56%), compared with 32/66 cases (48%) in which the medical team managing patient care raised donation (P = 0.34). Factors independently associated with increased consent were: family-raised organ donation (OR, 4.34; 95% CI, 1.79-10.52; P = 0.001), presence of an independent designated requester (OR, 3.84; 95% CI, 1.35- 10.98; P = 0.012), and multiple donation conversations per case (OR, 3.35; 95% CI, 1.93-5.81; P < 0.001). Consent decreased when patients were of non-Christian religion (OR, 0.18; 95% CI, 0.04-0.91; P = 0.038) and end-of-life and donation meetings were separate (OR, 0.38; 95% CI, 0.16-0.89; P = 0.026). CONCLUSION:Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry: ACTRN12613000815763. ClinicalTrials.g...
Gallagher, R, Perry, L, Duffield, C, Sibbritt, D & Ying Ko, CM 2018, 'The health of working nurses: Hypertension prevalence, awareness, treatment and control by medication.', Journal of nursing management, vol. 26, no. 4, pp. 403-410.View/Download from: UTS OPUS or Publisher's site
AIMS:To investigate hypertension awareness, prevalence and treatment in nurses. BACKGROUND:Nurses are the largest health workforce group, currently facing an ageing demographic and the risk of chronic disease such as hypertension. Little is known about hypertension in nurses despite the potential impact on work productivity. METHODS:A cross-sectional online survey was distributed to nurses and midwives via the professional association and nursing directors. Questions were taken from published longitudinal health studies for blood pressure, hypertension and key sociodemographic and health factors. RESULTS:The participants' (n = 5,041) mean age was 47.99 (SD 11.46) years. The majority knew their blood pressure, more so if they were female, of higher body mass index and aged 45-64 years, but less so if they were smokers. Hypertension prevalence increased with age, peaking at the oldest ages and the majority were treated (anti-hypertensive medication), less so if aged <55 years. Many nurses treated for hypertension had poor blood pressure control, were most often aged 45-54 years and were smokers. CONCLUSIONS:Hypertension prevalence is less in nurses than in the general population, however, once diagnosed treatment is not optimized. IMPLICATIONS FOR NURSING MANAGEMENT:The potential impact of hypertension on older nurses' work productivity justifies work-based support for risk reduction behaviours.
Perry, L, Xu, X, Gallagher, R, Nicholls, R, Sibbritt, D & Duffield, C 2018, 'Lifestyle Health Behaviors of Nurses and Midwives: The 'Fit for the Future' Study.', International journal of environmental research and public health, vol. 15, no. 5.View/Download from: UTS OPUS or Publisher's site
Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and age. An electronic cross-sectional survey delivered in 2014⁻2015 recruited 5041 nurses through the NSW Nurses and Midwives Association and professional networks. Validated health behavior measures were collected and compared to Australian National Health Survey data. Compared with younger nurses, older nurses reported greater adherence to fruit and vegetable guideline recommendations, but were more likely to be overweight or obese. Younger nurses (25⁻34 years) had the highest risk of harmful drinking. Compared with the Australian general population, slightly higher percentages of nurses met dietary recommendations and slightly fewer were obese, had central adiposity or smoked. Nurses had lower physical activity levels and higher levels of risky drinking across most gender and age groups. Many nurses have lifestyle health behaviors that place them at high risk for developing non-communicable diseases, sometimes at higher risk than the Australian population to whom they deliver health education. Health promotion strategies for nurses are urgently required.
Yates, M, Perry, L & Jackson, D 2018, 'Women travelling without men, and their health care needs.', International Journal of Nursing Practice, vol. 24, no. 5, pp. e12701-e12701.View/Download from: Publisher's site
Nicholls, R, Perry, L, Duffield, C, Gallagher, R & Pierce, H 2017, 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review.', Journal of Advanced Nursing, vol. 73, no. 5, pp. 1051-1065.View/Download from: UTS OPUS or Publisher's site
AIM: The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses. BACKGROUND: There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses' healthy eating in the workplace. DESIGN: Integrative mixed method review. DATA SOURCES: Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000-2016. Of 26 included papers, 21 were qualitative and five quantitative. REVIEW METHODS: An integrative literature review was undertaken. Quality appraisal of included studies used standardized checklists. A social-ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis. RESULTS: Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses' dietary intake. CONCLUSION: Reorientation of the workplace to promote healthy eating among nurses is required.
Perry, L, James, S, Steinbeck, K, Dunbabin, J & Lowe, J 2017, 'Young people with type 1 diabetes mellitus: Attitudes, perceptions, and experiences of diabetes management and continuous subcutaneous insulin infusion therapy.', Journal of Evaluation in Clinical Practice, vol. 23, no. 3, pp. 554-561.View/Download from: UTS OPUS or Publisher's site
RATIONALE, AIMS, AND OBJECTIVES: Continuous subcutaneous insulin infusion (CSII; insulin pump) use is increasing. However, there is little information about how this technology is used compared with other insulin delivery methods (ie, injections) by young people with type 1 diabetes mellitus in Australia. This study explored young people's attitudes, perceptions, and experiences with diabetes management comparing those using with those not using CSII, and proportions likely to transition to adult services requiring initiation and/or support for CSII use. METHODS: A survey was undertaken of young people (aged 12 to 18 years) with type 1 diabetes mellitus and their parents/guardians living in Hunter New England, Australia, using a questionnaire designed to collect quantitative, descriptive, and demographic data. Most questions were based on previously developed and validated instruments. In total, 107 respondents returned partially or fully completed questionnaires. RESULTS: Respondents had positive attitudes and perceptions of their self-efficacy and diabetes management, but were moderately disturbed by their diabetes and reported experiencing suboptimal management outcomes. Patterns of associations were demonstrated between knowledge, attitudes, and experiences of diabetes modeled by regression analysis. There were no statistically significant differences in responses between users and nonusers of CSII. Over 40% indicated their intention to use the technology as adults. CONCLUSIONS: Opportunities for enhanced diabetes service support were clear, and CSII did not appear to be used to its full potential. Service redesign could enhance support for this young population using all preferred insulin delivery methods and should align to patients' goals and preferences to maximize service and patient gain.
Pierce, H, Perry, L, Gallagher, R & Chiarelli, P 2017, 'Urinary incontinence, work, and intention to leave current job: A cross sectional survey of the Australian nursing and midwifery workforce.', Neurourology and Urodynamics.View/Download from: UTS OPUS or Publisher's site
AIMS: To determine the prevalence and severity of urinary incontinence (UI) in a group of female nurses and midwives, and to examine the relationship between UI, work and intention to leave current job. METHODS: An electronic survey "Fit for the future" was distributed to nurses and midwives in NSW, Australia between May 2014 and February 2015. UI was investigated using the International Consultation on Incontinence UI-Short Form. Examined work characteristics included: work role, location, setting, contract, shift, job satisfaction, and plans to leave current job. Logistic regression modelling was performed to determine whether the severity of UI had an independent effect on intention to leave. RESULTS: Of 5041 survey responses, 68.5% answered the question on urine leakage. Of the included female sample (n = 2,907) the prevalence of UI was 32.0% (95% CI: 30-34%): of these 40.5% experienced moderate and 4.4% "severe or very severe" symptoms. UI was more likely to be reported in nurses or midwives working part-time or days only (not shifts). Those with "severe or very severe UI" were more likely to indicate an intention to leave at 12 months (OR: 2.68; 95% CI: 1.18-6.06) than those with slight or moderate symptoms, after accounting for age, body mass index, parity, pelvic organ prolapse, anxiety, depression, work contract, shift, and job satisfaction. CONCLUSIONS: UI is a condition of high prevalence and significant severity in female nurses and midwives. In this workforce, severe UI was associated with intentions related to future employment.
Alotaibi, A, Gholizadeh, L, Al-Ganmi, A & Perry, L 2017, 'Examining perceived and actual diabetes knowledge among nurses working in a tertiary hospital.', Applied Nursing Research, vol. 35, pp. 24-29.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: With the worldwide increase in the incidence and prevalence of diabetes, there has been an increase in the scope and scale of nursing care and education required for patients with diabetes. The high prevalence of diabetes in Saudi Arabia makes this a particular priority for this country. AIM: The aim of this study was to examine nurses' perceived and actual knowledge of diabetes and its care and management in Saudi Arabia. METHODS: A convenience sample of 423 nurses working in Prince Sultan Medical Military City in Saudi Arabia was surveyed in this descriptive, cross-sectional study. Perceived knowledge was assessed using the Diabetes Self-Report Tool, while the Diabetes Basic Knowledge Tool was used to assess the actual knowledge of participants. RESULTS: The nurses generally had a positive view of their diabetes knowledge, with a mean score (SD) of 46.9 (6.1) (of maximum 60) for the Diabetes Self-Report Tool. Their actual knowledge scores ranged from 2 to 35 with a mean (SD) score of 25.4 (6.2) (of maximum of 49). Nurses' perceived and actual knowledge of diabetes varied according to their demographic and practice details. Perceived competency, current provision of diabetes care, education level and attendance at any diabetes education programs predicted perceived knowledge; these factors, with gender predicted, with actual diabetes knowledge scores. CONCLUSION: In this multi-ethnic workforce, findings indicated a significant gap between participants' perceived and actual knowledge. Factors predictive of high levels of knowledge provide pointers to ways to improve diabetes knowledge amongst nurses.
Perry, L, James, S, Gallagher, R, Dunbabin, J, Steinbeck, K & Lowe, J 2017, 'Supporting patients with type 1 diabetes using continuous subcutaneous insulin infusion therapy: Difficulties, disconnections, and disarray.', Journal of Evaluation in Clinical Practice, vol. 23, no. 4, pp. 719-724.View/Download from: UTS OPUS or Publisher's site
RATIONALE, AIMS, AND OBJECTIVES: Use of continuous subcutaneous insulin infusion therapy in type 1 diabetes management is high. However, the incorporation of this technology into self-care is not without challenges, and the support of an appropriately skilled health care team is recommended. This study aimed to examine the support context for patients using continuous subcutaneous insulin infusion therapy from the health care professional perspective, as well as contextual influences for health care professionals and their patients. METHODS: This ethnographic qualitative study was undertaken in New South Wales, Australia. Recruitment occurred using a snowball sampling technique, beginning with members of an established diabetes service group. Data were collected through the use of semistructured interviews undertaken by telephone and analysed using thematic analysis. RESULTS: Data were obtained from 26 interviews with staff from diverse professional backgrounds. An overarching theme of difficulties, disconnections, and disarray emerged, with findings indicating that participants perceived difficulties in relation to shortages of health care professional continuous subcutaneous insulin infusion-related expertise, and disconnected and disarrayed service structures and process, with barriers to access to these devices. Individual health care professionals were left to manage somehow or opted not to engage with related care. CONCLUSIONS: Findings provide insights from health care professionals' perspectives into the complexity of providing support for patients using continuous subcutaneous insulin infusion therapy across diverse contexts, and provide a platform for further research and service development. The need for consistent and coordinated care, and the infrastructure to facilitate this, flags an opportunity to drive integration of care and teamworking across as well as within settings and disciplines.
Elliott, D, Allen, E, McKinley, S, Perry, L, Duffield, CM, Fry, M, Gallagher, R, Iedema, R & Roche, M 2017, 'User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site audit study.', Journal of Advanced Nursing, vol. 73, no. 12, pp. 2892-2902.View/Download from: UTS OPUS or Publisher's site
To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated.
Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required.
Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012).
Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%–14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart.
User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.
Perry, L, Nicholls, R, Duffield, C & Gallagher, R 2017, 'Building expert agreement on the importance and feasibility of workplace health promotion interventions for nurses and midwives: A modified Delphi consultation.', Journal of Advanced Nursing, vol. 73, no. 11, pp. 2587-2599.View/Download from: UTS OPUS or Publisher's site
AIM: To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support the health of the Australian nursing and midwifery workforce. BACKGROUND: The nursing workforce experiences rates of ill health above that of other workforces, yet there is little investment in workplace health promotion. DESIGN: The study used a modified Delphi design conducted between September and November 2015. METHODS: Eleven of 19 purposively selected expert panellists discussed, rated and provided feedback through two rounds of an electronic questionnaire about the relative importance and feasibility of 46 workplace health promotion interventions and processes for nurses and midwives. Scores for importance and feasibility were calculated and ranked and a composite score of importance multiplied by feasibility. RESULTS: Mental health strategies were prioritized as the most important and feasible of the intervention topics, followed closely by healthy eating and physical activity interventions; smoking cessation ranked lowest. The most highly ranked interventions targeted healthy eating, stress management and resilience training. Highest ranked processes to support development of a healthy work environment included intersectoral collaboration and employee wellness groups. CONCLUSIONS: Study findings prompt consideration of health promotion opportunities to support nurses' health and well-being. Findings identified key workplace health promotion priorities and provide direction for policy makers and managers to promote nursing and midwifery workforce health.
Potter, JE, Herkes, RG, Perry, L, Elliott, RM, Aneman, A, Brieva, JL, Cavazzoni, E, Cheng, ATH, O'Leary, MJ, Seppelt, IM, Gebski, V & COMFORT study investigators 2017, 'COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): protocol for an intervention study.', BMC Health Services Research, vol. 17, no. 42, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation.This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a "designated requester"; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a "balanced" approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national "Family Donation Conversation" workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals' adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days.The pragmatic design of this study may identify 'what works' in usual clinical settings when requesting organ donation in critical care areas, both in terms of chan...
Jakimowicz, S, Perry, L & Lewis, J 2017, 'An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit', JOURNAL OF CLINICAL NURSING, vol. 26, no. 23-24, pp. 4153-4171.View/Download from: UTS OPUS or Publisher's site
Johnson, A, Nguyen, H, Parker, SK, Groth, M, Coote, S, Perry, L & Way, B 2017, '"That was a good shift".', Journal of Health, Organization and Management, vol. 31, no. 4, pp. 471-486.View/Download from: UTS OPUS or Publisher's site
Purpose The purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors' learning and improve patient management during the overtime shift. Design/methodology/approach A mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 "regular" shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews. Findings The intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors' engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors' total tasks. Interviews suggested the initiative reduced junior doctors' work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being. Originality/value Junior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors' learning and well-being.
Alotaibi, A, Perry, L, Gholizadeh, L & Al-Ganmi, A 2017, 'Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview.', Journal of Epidemiology and Global Health, vol. 7, no. 4, pp. 211-218.View/Download from: UTS OPUS or Publisher's site
This study aimed to report on the trends in incidence and prevalence rates of diabetes mellitus in Saudi Arabia over the last 25 years (1990-2015).A descriptive review.A systematic search was conducted for English-language, peer reviewed publications of any research design via Medline, EBSCO, PubMed and Scopus from 1990 to 2015. Of 106 articles retrieved, after removal of duplicates and quality appraisal, 8 studies were included in the review and synthesised based on study characteristics, design and findings.Studies originated from Saudi Arabia and applied a variety of research designs and tools to diagnosis diabetes. Of the 8 included studies; three reported type 1 diabetes and five on type 2 diabetes. Overall, findings indicated that the incidence and prevalence rate of diabetes is rising particularly among females, older children/adolescent and in urban areas.Further development are required to assess the health intervention, polices, guidelines, self-management programs in Saudi Arabia.
Perry, L 2017, 'Publication ethics—Where are we today? Part 2: Authorship: What constitutes prior publication?', International Journal of Nursing Practice, vol. 23, no. 4.View/Download from: UTS OPUS or Publisher's site
Potter, JE, Gatward, JJ, Kelly, MA, McKay, L, McCann, E, Elliott, RM & Perry, L 2017, 'Simulation-Based Communication Skills Training for Experienced Clinicians to Improve Family Conversations About Organ and Tissue Donation.', Progress in Transplantation, vol. 27, no. 4, pp. 339-345.View/Download from: UTS OPUS or Publisher's site
The approach, communication skills, and confidence of clinicians responsible for raising deceased organ donation may influence families' donation decisions. The aim of this study was to increase the preparedness and confidence of intensive care clinicians allocated to work in a "designated requester" role.We conducted a posttest evaluation of an innovative simulation-based training program. Simulation-based training enabled clinicians to rehearse the "balanced approach" to family donation conversations (FDCs) in the designated requester role. Professional actors played family members in simulated clinical settings using authentic scenarios, with video-assisted reflective debriefing. Participants completed an evaluation after the workshop. Simple descriptive statistical analysis and content analysis were performed.Between January 2013 and July 2015, 25 workshops were undertaken with 86 participants; 82 (95.3%) returned evaluations. Respondents were registered practicing clinicians; over half (44/82; 53.7%) were intensivists. Most attended a single workshop. Evaluations were overwhelmingly positive with the majority rating workshops as outstanding (64/80; 80%). Scenario fidelity, competence of the actors, opportunity to practice and receive feedback on performance, and feedback from actors, both in and out of character, were particularly valued. Most (76/78; 97.4%) reported feeling more confident about their designated requester role.Simulation-based communication training for the designated requester role in FDCs increased the knowledge and confidence of clinicians to raise the topic of donation.
Dimitrelis, S, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D, Nicholls, R & Xu, X 2017, 'Does nurses' role, health or symptoms influence their personal use of ingestible complementary and alternative medicines?', Complementary Therapies in Medicine, vol. 35, pp. 39-46.View/Download from: UTS OPUS or Publisher's site
To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce.CAM use is widespread worldwide, but there is little research into nurses' and midwives' personal use of ingestible CAM in Australia.An online survey in 2014-15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks.A small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine±Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations.Findings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce.
Lamont, S, Brunero, S, Perry, L, Duffield, C, Sibbritt, D, Gallagher, R & Nicholls, R 2017, ''Mental health day' sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics.', Journal of Advanced Nursing, vol. 73, no. 5, pp. 1172-1181.View/Download from: UTS OPUS or Publisher's site
AIM: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'. BACKGROUND: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a 'mental health day' as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. DESIGN: Online cross-sectional survey. METHODS: Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of 'mental health day' reportage were determined using logistic regression. RESULTS: Fifty-four percentage of the n = 5041 nurse and midwife respondents took 'mental health days'. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. CONCLUSION: Specific characteristics of nurses and midwives who report taking 'mental health day' sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.
Nicholls, R, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D & Xu, X 2017, 'The personal cancer screening behaviours of nurses and midwives.', Journal of Advanced Nursing, vol. 73, no. 6, pp. 1403-1420.View/Download from: UTS OPUS or Publisher's site
AIM: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. BACKGROUND: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40% are over 50 years - an age where cancer incidence rises rapidly, but when screening may reduce cancer mortality. Nurses and midwives are important health role models for the population, but their engagement in cancer screening is unknown. DESIGN: A cross-sectional survey conducted in 2014-2015. METHODS: Data were obtained from the 'Fit for the Future' study on 5041 working nurses and midwives in New South Wales, Australia and analyses were conducted on subsets of age-eligible respondents. Demographic, geographical and occupational data were analysed in relation to population-based screening for breast, cervical and bowel cancers and opportunistic screening for prostate and skin cancer screening participation, in line with Australian recommendations. RESULTS: Nurses' and midwives' recent screening rates were higher than the Australian general population across relevant age groups. Compared with full-time nurses and midwives, part-time/casual/pool workers were significantly more likely to undertake cervical, breast and bowel screening. Compared with those working office hours, shift workers were significantly less likely to undertake breast and bowel screening, but more likely to undertake skin screening. CONCLUSIONS: Disparities in reported screening prevalence and factors predictive of screening uptake indicate opportunities for targeted strategies to inform and/or promote workforce engagement with screening programmes and protect the health of this ageing workforce.
Perry, L, Xu, X, Duffield, CM, Gallagher, R, Nicholls, R & Sibbritt, D 2017, 'Health, workforce characteristics, quality of life and intention to leave: The 'Fit for the Future' survey of Australian nurses and midwives', Journal of Advanced Nursing, vol. 73, no. 11, pp. 2745-2756.View/Download from: UTS OPUS or Publisher's site
To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave.
Few studies have examined nurses' and midwives' quality of life and little is known of its effects on workforce longevity.
This was a cross-sectional survey conducted in 2014-2015.
The "Fit for the Future" electronic survey, delivered to nurses and midwives, examined demographic, work and health-related factors, which were compared with Australian general population normative values for physical and mental components of quality of life (the Short Form-12). Univariate and multivariate logistic regression models assessed associations with workforce intention to leave.
Physical and mental component scores, calculated for 4,592 nurses and midwives, revealed significantly higher physical but lower mental component scores than the general population. Physical component scores decreased with increasing age; higher scores were seen in nurses with better health indices and behaviours. Mental well-being scores increased with increasing age; in nurses who reported job satisfaction, no work injury, sleep problems or frequent pain and non-smokers. The odds of intention to leave decreased with increasing mental well-being.
Managers and decision-makers should heed study recommendations to implement health promotion strategies for nurses and midwives, aiming to improve mental health, specifically to promote workforce retention.
Al-Ganmi, AH, Perry, L, Gholizadeh, L & Alotaibi, AM 2016, 'Cardiovascular Medication Adherence among Patients with Cardiac Disease: A Systematic Review.', Journal of Advanced Nursing, vol. 72, no. 12, pp. 3001-3014.View/Download from: UTS OPUS or Publisher's site
To critically appraise and synthesise the best available evidence on the effectiveness of interventions suitable for delivery by nurses, designed to enhance cardiac patients' adherence to their prescribed medications.Cardiac medications have significant health benefits for patients with heart disease, but patients' adherence to prescribed medications remains suboptimal.A systematic quantitative review of intervention effects.We conducted systematic searches for English-language, peer-reviewed randomised controlled trial publications via Medline, EMBASE, CINAHL, the Cochrane Library, ProQuest, Web of Science and Google Scholar published between January 2004 - December 2014.According to pre-determined inclusion and exclusion criteria, eligible studies were identified and data extracted using a predefined form. Of 1,962 identified papers; 14 studies met the study inclusion criteria, were assessed for risk of bias using the Cochrane Collaboration tool; and included in the review.Study findings were presented descriptively; due to the heterogeneity of studies meta-analysis was not possible. Included papers described interventions categorised as: 1) multifaceted; and 2) behavioural and educational, comprising: 2a) text message and mail message; 2b) telephone calls; 2c) motivational interviewing; and 2d) nurse-led counselling and education.Substantial heterogeneity limited the robustness of conclusions, but this review indicated that motivational interviewing, education and phone or text messaging appeared promising as means to enhance cardiac medication adherence. Future research should integrate multifaceted interventions that target individual behaviour change to enhance adherence to cardiovascular medications, to build on the beneficial outcomes indicated by this review. This article is protected by copyright. All rights reserved.
James, S, Perry, L, Gallagher, R & Lowe, J 2016, 'Diabetes Educators: Perceived Experiences, Supports and Barriers to Use of Common Diabetes-Related Technologies.', Journal of Diabetes Science and Technology, vol. 10, no. 5, pp. 1115-1121.View/Download from: UTS OPUS or Publisher's site
Various technologies are commonly used to support type 1 diabetes management (continuous subcutaneous insulin infusion therapy, continuous glucose monitoring systems, smartphone and tablet applications, and video conferencing) and may foster self-care, communication, and engagement with health care services. Diabetes educators are key professional supporters of this patient group, and ideally positioned to promote and support technology use. The aim of this study was to examine diabetes educators' perceived experiences, supports, and barriers to use of common diabetes-related technologies for people with type 1 diabetes.This qualitative ethnographic study recruited across metropolitan, regional and rural areas of Australia using purposive sampling of Australian Diabetes Educators Association members. Data were collected by semistructured telephone interviews and analyzed using thematic analysis.Participants (n = 31) overwhelmingly indicated that overall the use of technology in the care of patients with type 1 diabetes was burdensome for them. They identified 3 themes involving common diabetes-related technologies: access to technology, available support, and technological advances. Overall, these themes demonstrated that while care was usually well intentioned it was more often fragmented and inconsistent. Most often care was provided by a small number of diabetes educators who had technology expertise.To realize the potential benefits of these relatively new but common diabetes technologies, many diabetes educators need to attain and retain the skills required to deliver this essential component of care. Furthermore, policy and strategy review is required, with reconfiguration of services to better support care delivery.
Alotaibi, A, Al-Ganmi, A, Gholizadeh, L & Perry, L 2016, 'Diabetes Knowledge of Nurses in Different Countries: An Integrative Review', Nurse Education Today, vol. 39, pp. 32-49.View/Download from: UTS OPUS or Publisher's site
Pierce, H, Perry, L, Chiarelli, P & Gallagher, R 2016, 'A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups.', Journal of Advanced Nursing, vol. 72, no. 8, pp. 1718-1734.View/Download from: Publisher's site
To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups.Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity.A systematic review of observational studies.Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014.The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool.Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity.Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.
Elliott, D, Allen, E, McKinley, S, Perry, L, Duffield, C, Fry, M, Gallagher, R, Iedema, R & Roche, M 2016, 'User acceptance of observation and response charts with a track and trigger system: a multisite staff survey.', Journal of Clinical Nursing, vol. 25, no. 15-16, pp. 2211-2222.View/Download from: Publisher's site
To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients.Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice.Prospective multisite survey of user acceptance of the charts in practice.New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences.Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and res...
James, S, Perry, L, Gallagher, R & Lowe, J 2016, 'Diabetes Educators' Intended and Reported use of Common Diabetes-Related Technologies: Discrepancies and Dissonance', Journal of Diabetes Science and Technology, vol. 10, no. 6, pp. 1277-1286.View/Download from: UTS OPUS or Publisher's site
Technology provides adjuvant and/or alternative approaches to care and may promote self-care, communication, and engagement with health care services. Common recent technologies for diabetes include continuous subcutaneous insulin infusions (insulin pumps), continuous glucose monitoring systems, smartphone and tablet applications, and telehealth (video conferencing). This study reports Australian diabetes educators' intentions and reported professional use of these technologies for people with type 1 diabetes, and factors predictive of this.
An anonymous, web-based questionnaire based on the technology acceptance model was distributed to members of the Australian Diabetes Educators Association through their electronic newsletter. Exploratory factor analysis revealed a 5-factor solution comprising confidence and competence, improving clinical practice, preparation (intentions and training), ease of use, and subjective norms. Logistic regression analyses identified factors predicting intention and use of technology.
Respondents (n = 228) had high intentions to use technology. The majority reported using continuous subcutaneous insulin infusions, continuous glucose monitoring systems, and applications with patients, but usage was occasional. Confidence and competence independently predicted both intentions and use of all 4 technologies. Preparation (intentions and training) independently predicted use of each technology also.
Discrepancies and dissonance appear between diabetes educators' intentions and behavior (intentions to use and reported technology use). Intentions were higher than current use, which was relatively low and not likely to provide significant support to people with type 1 diabetes for disease management, communication, and engagement with health care services. Continuing education and experiential learning may be key in supporting diabetes educators to align their intentions with their practice.
Perry, L, Gallagher, R, Duffield, CM, Sibbritt, D, Bichel-Findlay, J & Nicholls, R 2016, 'Does nurses' health affect their intention to remain in their current position', Journal of Nursing Management, vol. 24, no. 8, pp. 1088-1097.View/Download from: UTS OPUS or Publisher's site
Elliott, D, Allen, E, Perry, L, Fry, M, Duffield, C, Gallagher, R, Iedema, R, McKinley, S & Roche, M 2015, 'Clinical user experiences of Observation and Response Charts: Focus group findings of using a new format chart incorporating a track and trigger system', BMJ Quality and Safety, vol. 24, no. 1, pp. 65-75.View/Download from: UTS OPUS or Publisher's site
Background Optimising clinical responses to
deteriorating patients is an international indicator
of acute healthcare quality. Observation charts
incorporating track and trigger systems are an
initiative to improve early identification and
response to clinical deterioration. A suite of track
and trigger 'Observation and Response Charts'
were designed in Australia and initially tested in
simulated environments. This paper reports initial
clinical user experiences and views following
implementation of these charts in adult general
Methods Across eight trial sites, 44 focus
groups were conducted with 218 clinical ward
staff, mostly nurses, who received training and
had used the charts in routine clinical practice for
the preceding 2–6 weeks. Transcripts of audio
recordings were analysed for emergent themes
using an inductive approach.
Findings In this exploration of initial user
experiences, key emergent themes were:
tensions between vital sign 'ranges versus
precision' to support decision making; using a
standardised 'generalist chart in a range of
specialist practice' areas; issues of 'clinical
credibility', 'professional autonomy' and
'influences of doctors' when communicating
abnormal signs; and 'permission and autonomy'
when escalating care according to the protocol.
Across themes, participants presented a range of
positive, negative or mixed views. Benefits were
identified despite charts not always being used
up to their optimal design function. Participants
reported tensions between chart objectives and
clinical practices, revealing mismatches between
design characteristics and human staff
experiences. Overall, an initial view of 'increased
activity/uncertain benefit' was uncovered.
Conclusions Findings particularly reinforced the
significant influences of organisational workbased
cultures, disciplinary boundaries and
interdisciplinary communication on
implementation of this new practice chart.
Optimal use of all chart design characteri...
Lamont, S, Brunero, S, Lyons, S, Foster, K & Perry, L 2015, 'Collaboration amongst clinical nursing leadership teams: a mixed-methods sequential explanatory study.', Journal of nursing management, vol. 23, no. 8, pp. 1126-1136.View/Download from: UTS OPUS or Publisher's site
To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney.Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context.A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings.The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance.These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders.To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention.
Pickler, R, Noyes, J, Perry, L, Roe, B, Watson, R & Hayter, M 2015, 'Authors and readers beware the dark side of Open Access', JOURNAL OF ADVANCED NURSING, vol. 71, no. 10, pp. 2221-2223.View/Download from: Publisher's site
Appel, C, Perry, L & Jones, F 2015, 'Testing a Protocol for a Randomized Controlled Trial of Therapeutic versus Placebo Shoulder Strapping as an Adjuvant Intervention Early after Stroke.', Occupational Therapy International, vol. 22, no. 2, pp. 71-84.View/Download from: Publisher's site
This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention.
Jakimowicz, S & Perry, L 2015, 'A concept analysis of patient-centred nursing in the intensive care unit', Journal of Advanced Nursing, vol. 71, no. 7, pp. 1499-1517.View/Download from: Publisher's site
Aim To report an analysis of the concept of patient-centred nursing in the context of intensive care. Background Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. Design Concept analysis. Data sources CINAHL, PsycINFO, Medline and PubMed databases (2000–2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. Methods Walker and Avant's eight-stage approach was used. Results Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. Conclusion Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.
Perry, L, Lamont, S, Brunero, S, Gallagher, R & Duffield, C 2015, 'The mental health of nurses in acute teaching hospital settings: a cross-sectional survey.', BMC Nursing, vol. 14, pp. 15-15.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. METHODS: A cross sectional survey design was used. The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected. RESULTS: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month. Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating. CONCLUSION: Nurses and their managers should strive to create workplaces where wo...
Perry, L, Gallagher, R & Duffield, C 2015, 'The health and health behaviours of Australian metropolitan nurses: an exploratory study.', BMC Nursing, vol. 14, pp. 45-45.View/Download from: Publisher's site
BACKGROUND: Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models. Anything that diminishes their health status can impact their credibility as role models, their availability and ability to deliver quality care, and is potentially disadvantageous for the health of the population. Study aims were to investigate nurses' overall health and the presence of chronic disease; to describe nurses' health-related behaviours and to compare them to those of the general population, with both groups matched by age and gender. METHODS: Cross-sectional descriptive paper-based survey of nurses from two Sydney metropolitan hospitals using established instruments and questions and measurements taken with standardised methods. RESULTS: This nursing sample (n = 381) had a mean age of 39.9 (SD 11.7, range 20-67) years, Most (n = 315; 82.7 %) were female, worked full-time (80.0 %), and were shift workers (93.0 %). The majority (94.0 %) indicated good, very good or excellent health, despite 42.8 % indicating they had chronic disease. The most common risk factors for chronic disease were inadequate vegetable (92.6 %) and fruit intake (80.1 %), overweight and obesity (44.0 %) and risky alcohol intake (34.7 %); health screening behaviours were not ideal. Aside from overweight and obesity, these risk factors were more prevalent in nurses than the equivalent group of the New South Wales population, particularly for risky alcohol intake which was much more common in female nurses and most marked in those aged under 35 years. However, 80 % met the guidelines for physical activity, more than the equivalent group of the New South Wales population. CONCLUSION: There are early 'warning signs' concerning the health status of nurses. Despite perceiving current good health, support is required for nurses to prevent future chronic disease, particu...
Dunbabin, J, Perry, L, Steinbeck, K, Haas, MR, James, S & Lowe, J 2015, 'Can Telehealth engage young people with Type 1 Diabetes? Experiences from the YOuR-Diabetes Project', Australian Diabetes Educator, vol. 18, no. 3, pp. 32-34.
Watson, R, Pickier, R, Noyes, J, Perry, L, Roe, B, Ilayter, M & Hueter, I 2015, 'How many papers can be published from one study?', JOURNAL OF ADVANCED NURSING, vol. 71, no. 11, pp. 2457-2460.View/Download from: UTS OPUS or Publisher's site
Lamont, S, Brunero, S & Perry, L 2015, 'Workforce needs its own care plan', Nursing review, vol. 1, no. 1, pp. 2-5.
Lamont, S, Brunero, S & Perry, L 2015, 'The emotional labour of nursing: implications and future directions', Nursing Review.
Lamont, S, Brunero, S & Perry, L 2015, 'The emotional labour of nursing takes a toll', Nursing Review.
Appel, C, Perry, L & Jones, F 2014, 'Shoulder strapping for stroke-related upper limb dysfunction and shoulder impairments: Systematic review', NEUROREHABILITATION, vol. 35, no. 2, pp. 191-204.View/Download from: Publisher's site
James, S, Perry, L, Gallagher, R, Lowe, J, Dunbabin, J, McElduff, P, Acharya, S & Steinbeck, K 2014, 'Service usage and vascular complications in young adults with type 1 diabetes', BMC ENDOCRINE DISORDERS, vol. 14.View/Download from: Publisher's site
Elliott, D, McKinley, SM, Perry, L, Duffield, CM, Iedema, RA, Gallagher, R, Fry, M, Roche, MA & allen, E 2014, 'Clinical utility of an observational and response chart with human factors design characteristics and a track and trigger system: study protocol of a two-phase multi-site multiple methods design', JMIR Research Protocols, vol. 3, no. 3, pp. e40-e40.View/Download from: UTS OPUS or Publisher's site
James, S, Gallagher, RD, Dunbabin, J & Perry, L 2014, 'Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review', BMC Research Notes, vol. 7, no. 593, pp. 1-11.View/Download from: Publisher's site
Background: Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults.
Perry, L, Hamilton, S, Williams, J & Jones, S 2013, 'Nursing Interventions for Improving Nutritional Status and Outcomes of Stroke Patients: Descriptive Reviews of Processes and Outcomes', Worldviews on Evidence-Based Nursing, vol. 10, pp. 17-40.View/Download from: UTS OPUS or Publisher's site
Background: Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated.
Lucas, B, Cox, C, Perry, L & Bridges, J 2013, 'Pre-operative preparation of patients for total knee replacement: An action research study', International Journal of Orthopaedic and Trauma Nursing, vol. 17, no. 1, pp. 79-90.View/Download from: UTS OPUS or Publisher's site
Aims and objectives: To examine the development and impact of a multidisciplinary preparation clinic for patients undergoing total knee replacement (TKR) surgery.
de Brito-Ashurst, I, Perry, L, Sanders, T, Thomas, JE, Dobbie, H, Varagunam, M & Yaqoob, MM 2013, 'The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial', Heart, vol. 99, no. 17, pp. 1256-1260.View/Download from: UTS OPUS or Publisher's site
Background The effectiveness of salt restriction to lower blood pressure (BP) in Bangladeshi patients with chronic kidney disease (CKD) is uncertain. Objective To test the hypothesis that a tailored intervention intended to reduce salt intake in addition
de Brito-Ashurst, I, Perry, L, Sanders, T, Thomas, JE, Dobbie, H & Yaqoob, MM 2013, 'Applying research in nutrition education planning: a dietary intervention for Bangladeshi chronic kidney disease patients', Journal Of Human Nutrition And Dietetics, vol. 26, no. 4, pp. 403-413.View/Download from: UTS OPUS or Publisher's site
Background Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural changes. However, the integration of theory, research and practice to develop c
Lucas, B, Cox, C, Perry, L & Bridges, J 2013, 'Changing clinical team practices in preparation of patients for Total Knee Replacement: Using Social Cognitive Theory to examine outcomes of an action research study', International Journal of Orthopaedic and Trauma Nursing, vol. 17, no. 1, pp. 140-150.View/Download from: UTS OPUS or Publisher's site
To examine, through the lens of Social Cognitive Theory, the process of change when developing a preparation programme for patients awaiting Total Knee Replacement Surgery.
Hayter, M, Noyes, J, Perry, L, Pickler, R, Roe, B & Watson, R 2013, 'Who writes, whose rights, and who's right? Issues in authorship', JOURNAL OF ADVANCED NURSING, vol. 69, no. 12, pp. 2599-2601.View/Download from: UTS OPUS or Publisher's site
Wright, LC, Hill, KD, Bernhardt, J, Lindley, R, Ada, L, Bajorek, B, Barber, P, Beer, C, Golledge, J, Gustafsson, L, Hersh, D, Kenardy, J, Middleton, S, Brauer, S & Nelson, MP 2012, 'Stroke Management: Updated Recommendations For Treatment Along The Care Continuum', Internal Medicine Journal, vol. 42, no. 5, pp. 562-569.View/Download from: UTS OPUS or Publisher's site
The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the
Pontivivo, G, Rivas, K, Gallard, J, Yu, N & Perry, L 2012, 'A new approach to improving hand hygiene practice in an inner city acute hospital in Australia', Healthcare Infection, vol. 17, no. 2, pp. 57-63.View/Download from: UTS OPUS or Publisher's site
Healthcare-associated infections occur in 5-15% of hospitalised patients, with 30-50% preventable. Hand hygiene is a basic and essential but poorly conducted method to limit infection in hospitals. This practice development approach to implementing the '5 Moments for Hand Hygiene' national initiative aimed to increase compliance with the recommended hand hygiene practices, anticipating this outcome would be reflected in lower rates of healthcare-associated infections. Methods: Multiple methods were employed during October 2009-October 2010 within a multi-disciplinary initiative, although nurses were mainly recruited. Three medical wards, four surgical wards and the Intensive Care Unit were targeted. Project activities were informed by principles of practice development, solution-focussed coaching and models of behaviour change. Activities included active learning sessions, coaching, audit and feedback, competitions, creativity and fun. Outcomes were observations of hand hygiene compliance and routinely collected rates of Staphylococcus aureus bacteraemia. Results: Overall hand hygiene audits showed statistically significant improvement in compliance, from 62 to 75% in quarterly audits. Compliance rates among nurses and medical staff increased significantly from 70 to 80% and from 43 to 63%, respectively, while changes for allied health practitioners, from 61 to 65% compliance, did not achieve significance. Recorded rates of Staphylococcus aureus bacteraemia reduced from between 0.6 and 2.55 infections per 10000 occupied bed days pre-project to between 0 and 0.65 infections per 10000 occupied bed days during the project period. Conclusions: Multiple methods using a practice development framework can be successful in effecting changes in hand hygiene behaviour among all health care workers. Study methods took planning and commitment but were highly rewarding, particularly considering the magnitude of the issue for patient and clinician safety.
Chan, C & Perry, L 2012, 'Lifestyle health promotion interventions for the nursing workforce: a systematic review', Journal Of Clinical Nursing, vol. 21, pp. 2247-2261.View/Download from: UTS OPUS or Publisher's site
Aims and objectives. Study aims were to identify the efficacy of lifestyle health promotion interventions intended to improve behavioural health risk factors and/or behavioural or clinical outcomes of working-age nurses. Background. Nurses constitute around half the health workforce but global shortages and an ageing profile challenge future supply. The occupational hazards and stresses of nursing are well known. Health promotion, possibly workplace-based, presents opportunities to safeguard the health of nurses. Design. This was a systematic review undertaken in line with guidance for reviews in health care. Methods. Seven electronic databases were searched from 2000â2011 and references of relevant papers. Two reviewers independently reviewed and critiqued retrieved papers and extracted data. Methodological features were described using the CONSORT checklists; risk of bias was assessed using the Cochrane Handbook classification.
Perry, L, Lowe, JM, Steinbeck, KS & Dunbabin, JS 2012, 'Services doing the best they can: service experiences of young adults with type 1 diabetes mellitus in rural Australia', Journal Of Clinical Nursing, vol. 21, no. 13-14, pp. 1955-1963.View/Download from: UTS OPUS or Publisher's site
Aims and objectives. To describe the healthcare experiences of young adults with type 1 diabetes who access diabetes services in rural areas of New South Wales, Australia. Background. The incidence of type 1 diabetes in childhood and adolescence is increasing worldwide; internationally, difficulties are encountered in supporting young people during their transition from children to adulthood. Consumers experiences and views will be essential to inform service redesign. Design. This was a qualitative exploratory study. Methods. Semistructured telephone interviews were conducted with 26 people aged 18-28 years living rurally, recruited through staff in four regional healthcare centres in 2008.
Jones, SE, Hamilton, S, Perry, L, O'Malley, C & Halton, C 2011, 'Developing workable research methods: Lessons from a pilot study with vulnerable participants and complex assessments', Journal of Research in Nursing, vol. 16, no. 4, pp. 307-318.View/Download from: UTS OPUS or Publisher's site
Following acute stroke, deterioration in nutritional status and weight loss is common; few studies have investigated this, perhaps due to difficulties with recruitment and completion of complex assessments with stroke patients. This study reports the feasibility of a study protocol to determine predictors of nutritional intake in stroke patients. The aim of the study was to test the feasibility of a protocol to measure taste and smell function, and explore links with dietary intake following stroke. Patients were recruited from one Acute Stroke Unit in 2007/8. Data were collected at three time-points and entailed standardised validated assessments of taste and smell function, diet, appetite and mood state. Recruitment of this vulnerable population to a demanding assessment schedule was challenging. Of a cohort of 166 admissions, six were recruited and complete data collected from four participants. Slow recruitment was largely due to exacting inclusion criteria and rapid hospital discharge. Those who completed all assessments reported the schedule as tolerable and acceptable. This study illustrated the difficulties of recruiting this vulnerable population. Identification of reasons for slow recruitment facilitated development of measures to address them. It was possible to format a complex and lengthy assessment schedule to be acceptable to vulnerable participants.
Kilbride, C, Perry, L, Flatley, M, Turner, E & Meyer, J 2011, 'Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care', Journal of Interprofessional Care, vol. 25, no. 2, pp. 91-97.View/Download from: UTS OPUS or Publisher's site
Much emphasis is placed on expert knowledge like evidence-based stroke guidelines, with insufficient attention paid to processes required to translate this into delivery of everyday good care. This paper highlights the worth of creating a Community of Practice (CoP) as a means to achieve this. Drawing on findings from a study conducted in 2000â2002 of processes involved in establishing a nationally lauded high quality Stroke Unit, it demonstrates how successful development of a new service was linked to creation of a CoP. Recent literature suggests CoPs have a key in implementing evidence-based practice; this study supports this claim whilst revealing for the first time the practical knowledge and skills required to develop this style of working. Findings indicate that participatory and democratic characteristics of Action Research are congruent with the collaborative approach required for developing a CoP. The study is an exemplar of how practitioner researchers can capture learning from changing practice, thus contributing to evidence-based healthcare with theoretical and practical knowledge. Findings are relevant to those developing stroke services globally but also to those interested in evidence-based practice.
Hodge, A, Perry, L, Daly, B, Hagness, C & Tracy, D 2011, 'Revision and Evaluation of an 'advanced' nursing role in an Australian emergency department', Australasian Emergency Nursing Journal, vol. 14, no. 2, pp. 120-128.View/Download from: UTS OPUS or Publisher's site
Background: Extended Practice Nurse roles have been initiated in various forms in many Australian Emergency Departments. Although common, evaluation of these roles is scarce in the literature. Methods: A four phase practice development project was launched to review contemporary models of Extended Practice Nurse, revise an existing Extended Practice Nurse model called the Advanced Clinical Nurse (ACN), develop and standardise a supporting education and accreditation structure, and implement an evaluative framework for the revised ACN model. Results: A standardised education and accreditation structure was implemented, an 8 h ACN rostered shift commenced, and a mixed method evaluative framework initiated. Compared to management without an ACN, where an ACN was involved, mean medical management time of limb injuries and mean total length of stay was 42 min and 48 min shorter, respectively. Mean time to analgesia by an ACN was 22 min. Improvement in satisfaction was documented within subacute and waiting room patients. Median 'time to treatment' by an ACN was 6 min. Conclusions: Preliminary evaluation of the revised ACN model indicated practice benefits within early care delivery and patient flow. Continued standardisation of Extended Practice Nurse roles within New South Wales, Australia is necessary. The evaluative framework enabled greater understanding of this ACN role.
Nip, W, Perry, L, Mclaren, S & Mackenzie, A 2011, 'Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital', Journal of Human Nutrition and Dietetics, vol. 24, no. 5, pp. 460-469.View/Download from: UTS OPUS or Publisher's site
Background: Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. Methods: One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Results: Few (n = 9; 10%) consumed equal to or less than 100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001). Conclusions: Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes.
Perry, L, Bellchambers, H, Howie, A, Moxey, A, Parkinson, L, Capra, S & Byles, JE 2011, 'Examination of the utility of the Promoting Action on Research Implementation in Health Services framework for implementation of evidence based practice in residential aged care settings', Journal of Advanced Nursing, vol. 67, no. 10, pp. 2139-2150.View/Download from: UTS OPUS or Publisher's site
Aim. This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Background. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. Methods. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Findings. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Conclusion. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change.
Perry, L & Middleton, S 2011, 'An investigation of family carers' needs following stroke survivors' discharge from acute hospital care in Australia.', Disability and Rehabilitation, vol. 33, no. 19-20, pp. 1890-1900.View/Download from: UTS OPUS or Publisher's site
Purpose. To expand understanding of informal stroke care-giving, validated tools previously used in Hong Kong and in the UK were used with Australian stroke carers to assess their stroke-related knowledge, perceived needs, satisfaction with services received and sense of burden after stroke patients' discharge home from acute hospital care. Methods. Record audit and telephone interviews with two cohorts of 32 carers recruited in Sydney and Brisbane 1 and 3 months post-hospital discharge, using validated scales and open questions in May-July 2006. Results. Female carers, those with prior care-giving responsibility, and those interviewed at three compared to one month post-discharge reported greatest needs and burden from the care-giving role; needs alone significantly predicted burden. Getting information and being prepared for life after discharge were central concerns. Some felt this was accomplished, but inadequate information giving and communication mismatches were apparent. Conclusions. Service providers need to develop partnership working with stroke families and provide a network of services and inputs that cut across conventional boundaries between health and social care, public, private and voluntary organisations, with care plans that deliver what they delineate. Stroke care-givers have common issues across countries and healthcare systems; collaborative research-based service development is advocated.
Appel, C, Mayston, M & Perry, L 2011, 'Feasibility study of a randomized controlled trial protocol to examine clinical effectiveness of shoulder strapping in acute stroke patients', Clinical Rehabilitation, vol. 25, no. 9, pp. 833-843.View/Download from: UTS OPUS or Publisher's site
Objective: The majority of stroke patients experience upper limb motor impairment and reduced ability to perform basic activities. Shoulder strapping has been reported as a beneficial adjunct to rehabilitation therapies but has not been rigorously triall
de Brito-Ashurst, I, Perry, L, Sanders, T, Thomas, JE, Dobbie, H & Yaqoob, MM 2011, 'Barriers and facilitators of dietary sodium restriction amongst Bangladeshi chronic kidney disease patients', Journal of Human Nutrition and Dietetics, vol. 24, no. 1, pp. 86-95.View/Download from: UTS OPUS or Publisher's site
Background: People of Bangladeshi origin have the highest mortality ratio from coronary heart disease of any minority ethnic group in UK and their rate of kidney disease is three- to five-fold higher than that of the European UK population. However, there is little information regarding their dietary customs or knowledge, beliefs and attitudes towards health and nutrition. This multi-method qualitative study aimed to identify: (i) barriers and facilitators to dietary sodium restriction; (ii) traditional and current diet in the UK; and (iii) beliefs and attitudes towards development of hypertension, and the role of sodium. Methods: Methods included focus group discussions, vignettes and food diaries. Twenty female chronic kidney disease patients attended four focus group discussions and maintained food diaries; ten responded to vignettes during telephone interviews. Triangulation of the results obtained from the three methods identified categories and themes from qualitative thematic analysis. Results: Identified barriers to sodium restriction were deeply-rooted dietary beliefs, attitudes and a culturally-established taste for salt. Facilitators of change included acceptable strategies for cooking with less salt without affecting palatability. Dietary practices were culturally determined but modified by participants' prosperity in the UK relative to their previous impoverished agrarian lifestyles in Bangladesh.
Hodge, A, Perry, L, Daly, B, Tracey, D & Hagness, C 2011, 'Revision and evaluation of an emergency extended practice nursing role', Australasian Emergency Nursing Journal, vol. 14, pp. S3-S4.View/Download from: UTS OPUS or Publisher's site
Perry, L 2010, 'Is BMI an accurate measure of nutritional status in older people?', Nursing Times, vol. 105, no. 37, pp. 12-12.
Perry, L, Steinbeck, K, Dunbabin, J & Lowe, J 2010, 'Lost In Transition? Access To And Uptake Of Adult Health Services And Outcomes For Young People With Type 1 Diabetes In Regional New South Wales', Medical Journal of Australia, vol. 193, no. 8, pp. 444-449.View/Download from: UTS OPUS
Objective: To document diabetes health services use and indices of glycaemic management of young people with type 1 diabetes from the time of their first contact with adult services, for those living in regional areas compared with those using city and s
Eriksson, S & Perry, L 2010, 'Silver hydrogel catheters are associated with reduced catheter related bacteriuria in stroke patients - a quality project', Australian journal of neuroscience, vol. 20, no. 2, pp. 35-40.
Perry, L 2010, 'Guidelines and person-centred care: the devil in the detail', Journal of Advanced Nursing, vol. 66, no. 9, pp. 1901-1901.
de Brito-Ashurst, I, Perry, L, Sanders, TAB, Thomas, JE, Yaqoob, MM & Dobbie, H 2009, 'Dietary salt intake of Bangladeshi patients with kidney disease in East London: An exploratory case study', e-SPEN, vol. 4, no. 1.View/Download from: Publisher's site
Background & aims: Reducing dietary salt intake is a health promotion priority. This is particularly important in persons with kidney disease. Food surveys indicate that UK South Asian populations have high salt intakes, yet little is known of the cooking and eating habits of these groups. The aim of this study was to explore and describe salt-related dietary practices of Bangladeshi chronic renal failure patients. Methods: Case study methodology was employed with 10 Bangladeshi renal patients and their partners in East London. Understanding of the processes of preparation and consumption of the mid-day meal within the cultural context was the phenomenon of interest; mixed methods including non-participant observation, interviews and weighed food analysis were used. Results: The typical Bangladeshi meal comprised two meat, one lentil and one vegetable dish. Two such meals a day were eaten. These provided a mean 10 g salt/day from two main meals, plus more from breakfast and snacks. Salt was added during cooking and to meals in various other ways. Conclusions: These findings reveal opportunities and information to support development of collaborative, culturally sensitive health promotion education. © 2008 European Society for Clinical Nutrition and Metabolism.
Perry, L 2009, 'Consulting bereaved relatives of stroke patients', Journal of Advanced Nursing, vol. 65, no. 10, pp. 1991-1991.
Perry, L, Grange, A, Heyman, B & Noble, P 2008, 'Stakeholders perceptions of a research capacity development project for nurses, midwives and allied health professionals', Journal of Nursing Management, vol. 16, no. 3, pp. 315-326.View/Download from: UTS OPUS or Publisher's site
Aims To evaluate stakeholders perceptions of the extent to which a research facilitator post was addressing aims of: providing academic support to enable research involvement of nurses, midwives and allied health professionals; supporting dissemination of research into practice; contributing to research strategy development. Background Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. Methods A mixed methods approach was used. Results Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. Conclusion The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. Implications for nursing management Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this.
Perry, L, Grange, A, Heyman, B & Noble, P 2008, 'Stakeholders' perceptions of a research capacity development project for nurses, midwives and allied health professionals', Journal of Nursing Management, vol. 16, no. 3, pp. 315-326.View/Download from: UTS OPUS or Publisher's site
Aims To evaluate stakeholders perceptions of the extent to which a research facilitator post was addressing aims of: â¢ providing academic support to enable research involvement of nurses, midwives and allied health professionals; â¢ supporting dissemination of research into practice; â¢ contributing to research strategy development. Background Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. Methods A mixed methods approach was used. Results Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. Conclusion The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. Implications for nursing management Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this.
Mackenzie, A, Perry, L, Lockhart, E, Cottee, M, Cloud, G & Mann, H 2007, 'Family carers of stroke survivors: Needs, knowledge, satisfaction and competence in caring', Disability And Rehabilitation, vol. 29, no. 2, pp. 111-121.View/Download from: UTS OPUS
Purpose: To examine the support required by family carers for stroke survivors. Methods: Forty-two family carers were recruited for surveys of needs, knowledge, satisfaction, and competence in caring before and 4 - 6 weeks after discharge from an Acute Stroke Unit (ASU). Results: Information deficits about dealing with psychological, emotional, and behavioural problems and local service information were priorities before and after discharge. Younger female carers (under 56 years) were least satisfied with communication with ASU staff. Face to face contact was valued. After discharge younger female carers, particularly of non-White ethnic groups, reported lower levels of competence in caring and higher burden. Knowledge of stroke risk factors was low in all groups. High satisfaction with treatment and therapy in the ASU, was not transferred to the community. Carers reported feeling alone and described uncoordinated services. Conclusions: Carers are able to anticipate and prioritise their needs, value communication with staff and involvement with discharge-planning, but particular difficulties were experienced by younger female carers and those from non-White ethnic groups. This requires particular attention when developing targeted interventions for family carers from a mixed ethnic community. In-depth and longitudinal studies are needed to detail psychosocial needs and guide practice particularly amongst non-White family carers.
To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joanna Briggs Institute, an international network of academic centres. A semi-structured interview schedule was developed, piloted and used to guide interviews with academic and clinical staff in five state capital cities in Australia. Data were analysed and findings reviewed by clinical and academic participants. Four distinct but not mutually exclusive models and common but variously applied pathways for translation of evidence into clinical practice were identified. Key influential factors included context and local culture, the nature of evidence and role of clinical expertise. Implementation and change management strategies were recognised as emerging priorities.
This article reports on selected findings from an action research study that looked at the lessons learnt from setting up a new in-patient stroke service in a London teaching hospital. Key participants in the design and evaluation of this 2-year study included members of the multi-professional stroke team and support staff within the unit, the hospital management team and representatives of patients and carers. Mixed methods (focus groups, indepth interviews, audits, documentary analysis, participant observation field notes) were used to generate data. Findings demonstrated positive change over time with four main themes emerging from the process: building a team; developing practice-based knowledge and skills in stroke; valuing the central role of the nurse in stroke care; and creating an organisational climate for supporting change. The interplay of these non-linear, but interrelated factors is supported by complexity theory, which includes exploration of how the sum of a whole can be more than its constituent parts. Findings are likely to be of interest to practitioners, managers and policy makers interested in supporting change in a learning organisation.
In recent years stroke has been recognised as a national clinical, research and policy priority. Stroke nurses and stroke nursing are important contributors, but previous studies have highlighted lack of clarity and contradictions in the nursing role. A stroke nursing conference in 2002 offered the opportunity to explore nurses' vision for the future through a series of focus group meetings. Many examples of good practice were identified, for example, nursing contributions to risk factor management and secondary prevention, service co-ordination and development, follow-up and support of stroke patients and their families. However, areas for further development include realigning services to a patient focus and ensuring equitable access, integrating services, supporting development of the nursing research evidence base and providing career and educational frameworks for nurses in stroke care. Nurses set out a vision for stroke nursing in which current strengths and developments are consolidated and disseminated in a dynamic, multiprofessional, integrated patient-focused service.
Perry, L & McLaren, S 2004, 'An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke', HEALTH & SOCIAL CARE IN THE COMMUNITY, vol. 12, no. 4, pp. 288-297.View/Download from: Publisher's site
Perry, L & Mclaren, SM 2004, 'Implementing guidelines and changing nursing practice: Intentions and outcomes', Worldviews on Evidence-Based Nursing, vol. 1, no. 4, p. 225.View/Download from: Publisher's site
Perry, L 2004, 'Eating and dietary intake in communication-impaired stroke survivors: a cohort study from acute-stage hospital admission to 6 months post-stroke', CLINICAL NUTRITION, vol. 23, no. 6, pp. 1333-1343.View/Download from: Publisher's site
Background and aims: Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study aimed to develop, implement and evaluate evidence-based guidelines for nutrition support following acute stroke using a multifaceted change management strategy. Methods: Prospective quasi-experimental design. Documentation of two groups of 200 acute stroke patients admitted to medical and care of the elderly wards of an acute NHS Trust in South London was surveyed using a checklist before and after implementation of 24 guidelines for nutritional screening, assessment and support. Guidelines were based on systematic literature review and developed by consensus in a nurse-led multiprofessional group; implemented via a context-specific, multifaceted strategy including opinion leaders and educational programmes linked to audit and feedback. Staff outcomes: Compliance with guidelines by doctors, nurses, therapists. Patient outcomes: Changes in Barthel Index scores and Body Mass Index in hospital, infective complications, length of stay, discharge destination. Results: Statistically significant improvements in compliance with 15 guidelines occurred in the post-test group. Infective episodes showed a significant reduction in the post-test group but other patient outcomes were unaffected. Conclusions: Implementation of evidence-based guidelines for nutritional support following acute stroke using a multi-faceted strategy was associated with improvements in documented practice and selected patient outcomes. © 2003 Elsevier Science Ltd. All rights reserved.
Perry, L & McLaren, S 2003, 'Coping and adaptation at six months after stroke: experiences with eating disabilities', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 40, no. 2, pp. 185-195.View/Download from: Publisher's site
Luck, AJ, Morgan, JF, Reid, F, O'Brien, A, Brunton, J, Price, C, Perry, L & Lacey, JH 2002, 'The SCOFF questionnaire and clinical interview for eating disorders in general practice: Comparative study', British Medical Journal, vol. 325, no. 7367, pp. 755-756.
Perry, L, Morgan, J, Reid, F, Brunton, J, O'Brien, A, Luck, A & Lacey, H 2002, 'Screening for symptoms of eating disorders: Reliability of the SCOFF screening tool with written compared to oral delivery', INTERNATIONAL JOURNAL OF EATING DISORDERS, vol. 32, no. 4, pp. 466-472.View/Download from: Publisher's site
Aim: to explore eating disabilities persisting at 6 months post stroke, and relationship with dietary intake. Design: prospective survey of a cohort of stroke survivors in South London. Participants: consecutive admissions to a District General Hospital in South London with a clinical diagnosis of acute stroke during the period March 1998 to February 1999 were interviewed at discharge from hospital. If the patient was English-speaking, with a Mental Status Questionnaire score ≥7 and Frenchay Aphasia Screening Test scores indicating adequate comprehension and communication skills, or a live-in carer met these conditions, follow up was sought via interview in their own home at 6 months post stroke. Main outcome measures: the Barthel Index, the Eating Disabilities Assessment Scale (EDAS) and a 24-hour recall of food intake. Results: a range of enduring stroke-related eating disabilities was revealed, most commonly arm movement, chewing and swallowing impairment, visual/perceptual and communication deficits. Substantial dietary inadequacy was also revealed, although in this group (which excluded the most disabled stroke survivors) there was no significant relationship between EDAS score and dietary intake. Conclusion: Further work is required to explore the relationship between eating disabilities and representative groups of stroke survivors, and to explore factors related to inadequate intake in less-disabled subjects. © 2001 Harcourt Publishers Ltd.
Perry, L 2001, 'Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses', JOURNAL OF CLINICAL NURSING, vol. 10, no. 4, pp. 474-481.View/Download from: Publisher's site
Perry, L 2001, 'Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses', JOURNAL OF CLINICAL NURSING, vol. 10, no. 4, pp. 463-473.View/Download from: Publisher's site
Dysphagia represents a varying group of swallowing difficulties commonly encountered in patients in both acute and community settings. It accompanies a variety of disease states, can be neuromuscular or mechanical/obstructive in origin and encompasses varied prognoses and outcomes. Its consequences include dehydration, malnutrition, bronchospasm, airways obstruction, aspiration pneumonia and chronic chest infection, social isolation, depression and detrimental psychosocial effects. Current "best evidence" in screening, assessment and management is of variable quality but demonstrates that nurses have an important role to play in interventions entailing multiprofessional collaboration within individually tailored programmes. Clear benefits for patients have been indicated. There are gaps in the knowledge base, especially in relation to psychosocial effects and treatment strategies and the nursing contribution in this area.
Stroke is a common problem, producing a variety of neurological problems that affect eating. Dysphagia is a particular concern because of its potential for airway obstruction, malnutrition, and aspiration pneumonia. With chest infection reported in up to 32% of stroke patients, this is a major clinical issue. The following research questions are raised: (1) What are the incidence and outcomes of dysphagia and aspiration in acute stroke? (2) What screening interventions are available to detect dysphagia in patients with acute stroke and what effect have they on patient outcomes? A systematic review was carried out using methods and quality criteria of the NHS Centre for Reviews and Dissemination (1996), focusing on studies of adults with acute stroke. Data were extracted, collated, and presented descriptively. Two hundred forty-eight articles were retrieved with 26 meeting inclusion and quality criteria. Clinical dysphagia is common, associated with a range of deleterious outcomes and clearly linked to development of chest infection. Interpretation of aspiration on videofluoroscopy is not as straightforward but probably also confers additional risk. Further work is required on the relationship between aspiration and pneumonia, and pneumonia prevention. This will include exploration of the effects of screening, and the further development and validation of screening methods. While studies indicate current "best practice," in this important area of patient care further work is urgently required.
Perry, L & McLaren, SM 2000, 'Dysphagia screening, assessment and outcomes in stroke patients: Phase 1 of an evidence-based practice project', Journal of Clinical Excellence, vol. 1, no. 4, pp. 201-208.
Objectives: To (1) survey and audit documentation of patients admitted with acute stroke for screening and assessment of dysphagia in relation to professional standards; (2) investigate associations between screening, patient characteristics and outcomes; and (3) make recommendations for future practice. Setting: Acute trust hospital of 640 beds in South London. Subjects: Documentation of 200 patients consecutively admitted with clinical diagnosis of acute stroke (ICD-10 codes 160-164) between March and August 1998. Main outcome measures: (1) Adherence to Royal Colleges of Physicians and Speech and Language Therapists' standards for dysphagia screening, referral and assessment; and (2) patient admission characteristics and rehabilitation, infective complications and discharge destination in relation to swallow screening and function. Results: Screening for dysphagia was recorded for 53% of stroke patients, citing a variety of methods, most commonly checking gag reflex. Swallowing problems were documented for 38.5%, predominantly amongst screened patients. Where assessment was required this took place within 72 h of admission for 39% and 2 working days of referral in 87% of cases. Delays derived from both screening and referral processes. Whilst dysphagia was strongly associated with increased morbidity and mortality, the dysphagic group was significantly older, more impaired and disabled than those with intact swallow. Unscreened dysphagic patients were significantly less disabled than screened dysphagic patients. Although a significant proportion of swallowing problems were detected, screening and assessment did not appear to achieve the improved outcomes found in other studies. Conclusions: The audit revealed variability, delay points, scope to bring practice closer in line with research evidence and opportunities to explore the impact of evidence-based standards on patient outcomes.
Perry, L & McLaren, SM 2000, 'An evaluation of implementation of evidence-based guidelines for dysphagia screening and assessment following acute stroke: Phase 2 of an evidence-based practice project', Journal of Clinical Excellence, vol. 2, no. 3, pp. 147-156.
Objectives: To (1) evaluate the impact of implementing evidence based guidelines on dysphagia screening, assessment and patient outcomes; and (2) make recommendations for future practice. Setting: Acute trust hospital of 670 beds in south London. Subjects and methods: Quasi-experimental study design. Documentation of two groups of 200 patients consecutively admitted with clinical diagnosis of acute stroke (ICD 10 codes 160-164) was audited before and after guideline implementation. A multifaceted approach to guideline implementation combined the use of a project leader, and education programme for nursing and medical staff with an audit framework. Main outcome measures: (1) Adherence to Royal Colleges of Physicians and Speech and Language Therapists' standards for dysphagia screening, referral and assessment; and (2) patient characteristics and rehabilitation, infective complications and discharge destination in relation to swallow screening and function. Results: Whilst 100% compliance with guidelines was not achived, following implementation significantly more patients were screened on admission for swallowing dysfunction (pre-test 57.3% vs post-test 74.5%, P < 0.001). Length of time waiting for swallowing assessment was significantly reduced (pre-test range 1-25, median 4 days vs post-test range 1-14, median 3 days, P < 0.001). The time dysphagic patients spent nil orally prior to receiving nutritional support was significantly reduced (pre-test mean 9 days vs post-test mean 3.7 days, P < 0.001). The incidence of chest infections and sepsis of unknown origin was significantly reduced in dysphagic patients (pre-test 35% vs post-test 15%, P < 0.005). Conclusion: Implementation of evidence-based guidelines using an approach combining a project leader, educational programme and audit framework led to significant improvements in multi-professional management and patient outcomes.
Perry, L 1999, 'Nurse-teacher roles--1. Nurse teachers' dilemma on how to manage their split role.', NT learning curve, vol. 3, no. 8, pp. 8-9.
Perry, L 1999, 'Nurse-teacher roles--2. Balancing provision of education and service needs--is there a way?', NT learning curve, vol. 3, no. 9, pp. 4-6.
Perry, L 1997, 'Assessing nutritional status.', Nursing times, vol. 93, no. 36, p. 51.
Perry, L 1997, 'Nutrition: A hard nut to crack. An exploration of the knowledge, attitudes and activities of qualified nurses in relation to nutritional nursing care', Journal of Clinical Nursing, vol. 6, no. 4, pp. 315-324.View/Download from: Publisher's site
* Provision of adequate nutrition is recognized as essential, yet malnutrition continues to be reported in patients admitted to hospital. * The effects of malnutrition in hospital patients have been well documented; however, most work relating to nutritional management has been produced by members of Nutrition Support Teams, nurse specialists and interested clinicians, whilst the majority of hospitals are still without such specialist posts. * This study used two data collection methods to gain information about the attitudes, nutritional knowledge base and nutrition-related nursing care in a large trust hospital in the South of England. * A survey of care plans for documentation of nutrition-related nursing activities, carried out on the day of discharge for all patients from five wards over a period of a fortnight (totalling 141 sets of documentation), was followed by a questionnaire to all qualified nurses on these and a further four wards (110 nurses). * Results demonstrated that nurses generally felt that nutritional assessment was primarily their responsibility. * Whilst there was evidence of knowledgeable and proactive nursing care, it also appeared that there were fairly widespread deficiencies in the knowledge, communication and co-ordination required to ensure consistent good practice. © 1997 Blackwell Science Ltd.
Perry, L 1997, 'Critical incidents, crucial issues: insights into the working lives of registered nurses.', Journal of clinical nursing, vol. 6, no. 2, pp. 131-137.View/Download from: Publisher's site
The critical incident technique has been used in nursing in a number of ways: in developing understanding of the nursing role, as a quality assurance strategy, as an assessment and evaluation tool, and as an aid in the fostering of reflective practice. This article describes how the technique, used as a theoretical course assessment for a group of students studying long ENB courses, could be used to shed light upon issues regarded as crucial in the daily working lives of this group of registered nurses, and upon the reflective skills which they were able to employ.
Perry, L 1997, 'Nutrition: A hard nut to crack. An exploration of the knowledge, attitudes and activities of qualified nurses in relation to nutritional nursing care', JOURNAL OF CLINICAL NURSING, vol. 6, no. 4, pp. 315-324.View/Download from: Publisher's site
Perry, L 1997, 'Fishing for understanding: nurses knowledge and attitudes in relation to nutritional care', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 34, no. 6, pp. 395-404.View/Download from: Publisher's site
Perry, L 1993, 'Gut feelings about gut feeding: enteral feeding for ventilated patients in a district general hospital', Intensive and Critical Care Nursing, vol. 9, no. 3, pp. 171-176.View/Download from: Publisher's site
This article looks at the role that nutrition plays in the maintenance of gut integrity and function in the critically ill patient. It refers to previous studies that have highlighted the relevance of facilitating the bacteriocidal function of gastric secretions as a means to minimise the development of nosocomial pneumonias in ventilated patients. A small trial was set up to investigate the merits and difficulties associated with two different enteral feeding regimes for ventilated patients in the intensive therapy unit (ITU) of a district general hospital. This project and its results are described and evaluated; conclusions and issues for practice are highlighted. © 1993.
Perry, L 2013, 'Stroke Nutritional Management' in Caballero, B (ed), Encyclopedia of Human Nutrition, Waltham, MA: Academic Press, United States, pp. 219-230.
Stroke is a common and devastating event, the incidence rising with age. Approximately 125 000 and 500 000 new or recurrent strokes affect individuals each year in the UK and the US, respectively, creating a significant burden of long-term disability in survivors.
Perry, L 2011, 'Using research evidence to change how services are delivered' in Craig, JV & Smyth, R (eds), The evidence-based practice manual for nurses, Churchill Livingstone, Edinburgh.
Pierce, H, Perry, L, Gallagher, R & Chiarelli, P 2018, '417 Limited fluid and restricted toileting are associated with reduced work productivity in women at work.', Triennial Congress of the International Commission on Occupational Health, Dublin, Ireland.View/Download from: UTS OPUS or Publisher's site
Duffield, CM, Perry, L, Gallagher, R, Sibbritt, D & Nicholls, R 2016, 'Fit for the future? The health and health behaviours of the nursing and midwifery workforce.', RCN International nursing research conference, Edinburgh, Scotland..
Clay-Williams, R, Kelly, MA, Everett, B, Perry, L & McDonnell, G 2011, 'Modelling clinical judgement improved health care delivery:using "how nurses think" to manage the deteriorating patient', Selected Abstracts of Free Papers Presented at the SimHealth: Innovation, Education and Research in Healthcare Conference, SimHealth 2011, Wolters Kluwer: Lippincott Williams & Wilkins, Sydney, Australia, pp. 66-66.
This study aims to construct a model for learning reasoning in the workplace, using computer based system dynamic processes, to support clinical decision-making in relation to detection and management of the deteriorating patient. Assessment and timely management of a deteriorating patient is a priority area for improvement highlighted by several Government, independent and health agency reports. Computer modelling of judgement processes can identify areas of difficulty in decision-making and assist nurses and other health care professionals to recognise and seek timely assistance for patients who deteriorate. Seminal work by Benner and Tanner on "how expert nurses think" led to the publication of Tanner's theoretical model of clinical judgement. This model maps the primary processes involved in clinical reasoning, and forms the basis of curricula in nursing courses internationally and within Australia. By explicitly modelling the time nurses take to progress through the processes of decision-making when planning and providing patient care, we can identify points where potential error and harm could occur, and thereby potentially improve patient outcomes.
Clay-Williams, R, Kelly, MA, Everett, B, Perry, L & McDonnell, G 2011, 'Modelling clinical judgement improved health care delivery: using 'how nurses think' to manage the deteriorating patient', SimHealth, Sydney.
This papaer presents a dynamic model of reasoning, using computer based system dynamic processes based on a model of 'how nurses think' to support clinical decision-making in relation to detection and management of the deteriorating patient.
Gall, M, Lennon, S, Clarke, K, Cross, S, Cunningham, R, Edmans, J, Fitzpatrick, C, Hancock, N, Hoffman, A, Jones, A, Perry, L & Walker, M 2010, 'Intercollegiate Working Party for Stroke. Profession-specific audit in stroke care: Making rehab practice evidence based', Journal of Human Nutrition and Dietetics, British Dietetic Association, Birmingham, pp. 374-374.
National Clinical Guidelines for Stroke Management
Gall, MJ, Lennon, S, Clarke, K, Cross, S, Cunningham, R, Edmans, J, Fitzpatrick, C, Hancock, N, Hoffman, A, Jones, A, Perry, L & Walker, M St Bartholomew and Royal London Charitable Foundation December 2007 2007, Profession-specific audit in stroke care: making rehab practice evidence based, London, City University.