Roz qualified as a nurse in London, England in the early 90s. She has worked in intensive care for more than two decades. In 1998 she moved to Sydney. Roz completed her PhD studies with the University of Technology, Sydney, Australia in 2012. She conducted a research study, ‘Improving the quality and amount of sleep for the intensive care patient’. Previously during her Masters studies Roz investigated the effect of a sedation guideline on the duration of ventilation on intensive care patients. In addition to her strong research interest she is an advocate for nursing practices to improve patient comfort and quality of care. She currently works as a Clinical Nurse Specialist in ICU and Clinical Nurse Consultant - translational research co-ordinator for Northern Sydney Local Health District.
Member of the NSW branch of the Australian College of Critical Care Nurses
Can supervise: YES
Sleep and comfort in intensive care patients
Long-term outcomes in critical illness
Quality of care in intensive care
Critical care nursing
Research methods (quantitative)
Elliott, R 2011, ACCCNs Critical Care Nursing. Chapter 7 Psychological Care, 2, Elsevier, Chatswood.
Elliott, R, Martyn, L, Woodbridge, S, Fry, M, Foot, C & Hickson, L 2019, 'Development and Pragmatic Evaluation of a Rapid Response Team.', Critical care nursing quarterly, vol. 42, no. 3, pp. 227-234.View/Download from: UTS OPUS or Publisher's site
In response to national and local drivers, a clinical emergency response system (CERS) incorporating an intensivist-led rapid response team (RRT) was implemented at a Sydney (Australia) hospital. The authors present a pragmatic evaluation of the 5 years since this major initiative was commenced. A "partner not conquer" philosophy was adopted. Implementation of the RRT was based on a collaborative pragmatic quality improvement approach. A team of intensive care specialist trained medical doctors (n = 2) and clinical nurse consultants (n = 2) set up the service with executive support and funding. Roles and responsibilities were clearly detailed, reinforcing a positive, partnership-driven culture. A constantly evolving education strategy was a critical element of implementation and maintenance. Ongoing evaluation includes process and patient outcome data. Serious patient deterioration-related incidents have decreased significantly (from 7 to 1 per year) and the RRT has been universally accepted by clinicians. Key lessons learned include the need for specific protected funding, a partnership approach ensuring hospital clinicians retain responsibility of patient treatment, ongoing education and reinforcement, and strong nursing leadership. However, generalizations cannot be made about the implementation of the CERS. It is important to consider context; "one size does not fit all."
Elliott, R, Yarad, E, Webb, S, Cheung, K, Bass, F, Hammond, N & Elliott, D 2019, 'Cognitive impairment in intensive care unit patients: A pilot mixed-methods feasibility study exploring incidence and experiences for recovering patients.', Australian Critical Care, vol. 32, no. 2, pp. 131-138.View/Download from: UTS OPUS or Publisher's site
Despite improvements in survival after critical illness and intensive care unit (ICU) treatment, some recovering patients still face ongoing challenges. There are few investigations exploring the incidence, risk factors, and trajectory for cognitive impairment (CI) in former ICU patients in Australia.To test the feasibility of a study protocol designed to ascertain the incidence and impact of CI during recovery from a critical illness.We conducted a mixed-methods longitudinal single-centre pilot study. Participants were adult patients mechanically ventilated for ≥48 h. Cognitive function was assessed during hospitalisation and at 1 week, 2 months, and 6 months after hospital discharge, using the Montreal Cognitive Assessment instrument. Factors potentially affecting cognitive function were also collected, including demographic and clinical variables and fatigue, frailty, and muscle strength. Semistructured interviews were conducted to further explore participants' experiences during recovery.We screened 2068 patients (10% met the inclusion criteria). Participants (n = 20) were mostly male with a mean age 61.9 years and a median of 4 days of mechanical ventilation. Data collection was complete for 14 and 11 participants at 2 months and 6 months, respectively. Pre-illness patients were not cognitively impaired; one patient had delirium in ICU. The proportion of patients with CI ranged from 80% (17/18) while in hospital to 35% (5/14) at 6 months. Participants were challenged by fatigue and sleep disruption during recovery but were not particularly concerned about CI.Recruitment in ICU was challenging as few patients received prolonged mechanical ventilation. The protocol was feasible, but some attrition was noted. A significant proportion of patients had mild CI, largely confined to recall, and language cognitive domains; quantitative findings were supported by interview findings. Further investigations are required to ascertain the most appropriate inclusion criter...
Fry, M, Abrahamse, K, Kay, S & Elliott, RM 2019, 'Suicide in older people, attitudes and knowledge of emergency nurses: A multi-centre study', INTERNATIONAL EMERGENCY NURSING, vol. 43, pp. 113-118.View/Download from: UTS OPUS or Publisher's site
Leigh, V, Stern, C, Elliott, R & Tufanaru, C 2019, 'Effectiveness and harms of pharmacological interventions for the treatment of delirium in adults in intensive care units after cardiac surgery: a systematic review.', JBI database of systematic reviews and implementation reports.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:The objective of this review was to synthesize the best available evidence on the effectiveness and harms of pharmacological interventions for the treatment of delirium in adult patients in the intensive care unit (ICU) after cardiac surgery. INTRODUCTION:Patients who undergo cardiac surgery are at high risk of delirium (incidence: 50-90%). Delirium has deleterious effects, increasing the risk of death and adversely affecting recovery. Clinical interventional trials have been conducted to prevent and treat postoperative delirium pharmacologically including antipsychotics and sedatives. These trials have provided some evidence about efficacy and influenced clinical decision making. However, much reporting is incomplete and provides biased assessments of efficacy; benefits are emphasized while harms are inadequately reported. INCLUSION CRITERIA:Participants were ≥ 16 years, any sex or ethnicity, who were treated postoperatively in a cardiothoracic ICU following cardiac surgery and were identified as having delirium. Any pharmacological intervention for the treatment of delirium was included, regardless of drug classification, dosage, intensity or frequency of administration. Outcomes of interest of this review were: mortality, duration and severity of delirium, use of physical restraints, quality of life, family members' satisfaction with delirium management, duration/severity of the aggressive episode, associated falls, severity of accidental self-harm, pharmacological harms, harms related to over-sedation, ICU length of stay, hospital length of stay (post ICU), total hospital length of stay, need for additional intervention medication and need for rescue medication. Randomized controlled trials were considered first and in their absence, non-randomized controlled trials and quasi-experimental would have been considered, followed by analytical observational studies. METHODS:A search was conducted in PubMed, Embase, CINAHL, Web of Science, Cochrane Centra...
Rolls, K, Massey, D & Elliott, R 2019, 'Social media for researchers – beyond cat videos, over sharing, and narcissism', Australian Critical Care, vol. 32, no. 5, pp. 351-352.View/Download from: UTS OPUS or Publisher's site
Tyndall, A, Bailey, R & Elliott, R 2019, 'Pragmatic development of an evidence-based intensive care unit–specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool', Australian Critical Care.View/Download from: UTS OPUS or Publisher's site
© 2019 Background: Falls may result in significant patient harm. A recommended strategy to prevent falls is the use of a falls risk assessment tool, but these tools are often specific for older people. Evidence suggests context-specific tools are more effective. Although a rare event in the intensive care unit (ICU), patients in the ICU are at high risk of falling. The primary trigger for the current study was an increase in falls in the study ICU. Aim: The objective of this study was to develop and implement a valid and reliable ICU-specific falls risk assessment tool, with the aim of reducing falls. Methods: Retrospective incident-monitoring database audits were performed. Prospective validity and reliability testing of an ICU-specific tool (Tyndall Bailey Falls Risk Assessment Tool [TB FRAT]) and the existing method for assessing falls risk (ONTARIO Modified Stratify [Sydney Scoring] Falls Risk Screen) was conducted. Seven raters (nurse clinicians) independently performed falls risk assessment using both tools on two occasions for six patients. Results: Correlation for risk stratification categories between the two tools was moderate (r = 0.60, P < .001). Intrarater reliability (correlation) for individual rater's scores was strong (r = 0.86, P < .001). Interrater reliability for the TB FRAT was moderate to excellent (interclass correlations = 0.76 [95% confidence interval: 0.54–0.94]), and internal consistency was excellent (Cronbach's alpha, 0.97). Falls resulting in serious injury reduced from 3.35 per 1000 separations 12 months before implementing the specific ICU tool to 0.85 per 1000 in the 12 months after implementation. Conclusions: The TB FRAT provided a more reliable falls risk assessment than the existing method of assessing falls risk in this single-room occupancy ICU. This TB FRAT could be a valuable addition to quality improvement initiatives aimed at improving patient safety related to falls; however, adaptation to the local context should be co...
Caruana, N, McKinley, S, Elliott, R & Gholizadeh, L 2018, 'Sleep Quality During and After Cardiothoracic Intensive Care and Psychological Health During Recovery.', Journal of Cardiovascular Nursing, vol. 33, no. 4, pp. E40-E49.View/Download from: UTS OPUS or Publisher's site
Intensive care patients experience poor sleep quality. Psychological distress and diminished health-related quality of life (HRQOL) are also common among former intensive care unit (ICU) patients. Coronary artery bypass graft (CABG) surgery is a frequent reason adults require treatment in ICU. The effect of on- versus off-pump surgery on sleep and recovery has not been reported.The aim of this study was to assess sleep quality of CABG patients during and after ICU, psychological well-being, HRQOL during recovery, and whether on- versus off-pump surgery affects sleep and recovery.Data were collected in the ICU and hospital ward, and 2 and 6 months after hospital discharge using validated self-report questionnaires.The sample (n = 101) had a mean age of 66.6 ± 11.1 years, was 79% male, and had a median ICU stay of 2 (2-4) days and a mean body mass index of 27.3 ± 4.3; 75% underwent on-pump surgery. Poor sleep was reported by 62% of the patients at 6 months and by 12% of the patients at all time points. Off-pump CABG patients had fewer posttraumatic stress symptoms (P = .02) and better physical HRQOL (P = .01). In multivariate analysis, prehospital insomnia (P = .004), and physical (P < .0005) and mental (P < .0005) HRQOL were independently associated with sleep quality at 6 months. There was no association between on- versus off-pump CABG and sleep quality at 6 months.Sleep quality of postoperative CABG patients was poor in the ICU and hospital ward and up to 6 months after discharge from the hospital. Poor sleep quality at 6 months was associated with prehospital insomnia, and physical and mental HRQOL at 6 months, but not with on- versus off-pump surgery.
Elliott, RM, Burrell, AR, Harrigan, PW, Murgo, M, Rolls, KD, Sibbritt, DW, Iredell, JR & Elliott, D 2018, 'Antimicrobial prescription patterns and ventilator associated pneumonia: findings from a 10-site prospective audit.', BMC research notes, vol. 11, no. 1, pp. 769-769.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:To examine anti-microbial prescribing practices associated with ventilator-associated pneumonia from data gathered during an audit of practice and outcomes in intensive care units (ICUs) in a previously published study. RESULTS:The patient sample of 169 was 65% male with an average age of 59.7 years, a mean APACHE II score of 20.6, and a median ICU stay of 11 days. While ventilator-associated pneumonia was identified using a specific 4-item checklist in 29 patients, agreement between the checklist and independent physician diagnosis was only 17%. Sputum microbe culture reporting was sparse. Approximately 75% of the sample was administered an antimicrobial (main indications: lung infection [54%] and prophylaxis [11%]). No clinical justification was documented for 20% of prescriptions. Piperacillin/tazobactam was most frequently prescribed (1/3rd of all antimicrobial prescriptions) with about half of those for prophylaxis. Variations in prescribing practices were identified, including apparent gaps in antimicrobial stewardship; particularly in relation to prescribing for prophylaxis and therapy de-escalation. Sputum microbe culture reports for VAP did not appear to contribute to prescribing decisions but physician suspicion of lung infection and empiric therapy rather than ventilator-associated pneumonia criteria and guideline concordance.
Fry, M & Elliott, R 2018, 'Pragmatic evaluation of an observational pain assessment scale in the emergency department: The Pain Assessment in Advanced Dementia (PAINAD) scale', Australasian Emergency Care, vol. 21, no. 4, pp. 131-136.View/Download from: UTS OPUS or Publisher's site
© 2018 College of Emergency Nursing Australasia Background: Pain assessment is challenging in older people with cognitive impairment who present to the emergency department and may result in suboptimal management. Therefore, the usefulness of the Pain Assessment in Advanced Dementia (PAINAD) tool for older people with cognitive impairment presenting with a painful injury was evaluated. Methods: In this multi-centre observational sub-study, older people (≥65 years) suspected of a long bone fracture were screened for cognitive impairment using the Six Item Screening (SIS) tool. Patients with SIS ≤ 4 were assessed using the PAINAD. Descriptive and correlation statistical analyses were performed. Cronbach's alpha was used to estimate the reliability of the PAINAD. Results: This predominantly female (63%) sample had a mean age of 85.5 ± 7.5 years and a moderately urgent Australian Triage code (mode: 3). Median pain intensity was low (numerical reporting scale: 5.5 [3.0–8.0]). Median PAINAD score was 'mild' (1.0 [0.0–3.2]) with wide variability (range: 0–9). The PAINAD demonstrated good reliability (Cronbach's α = 0.80). Most PAINAD items appeared worthy of retention. Conclusions: The PAINAD has potential as an effective pain assessment tool for older people with cognitive impairment in emergency departments. Strategies such as partnering with carers and family to collaboratively assess pain require further investigation in this setting.
Leigh, V, Tufanaru, C & Elliott, R 2018, 'Effectiveness and harms of pharmacological interventions in the treatment of delirium in adults in intensive care units post cardiac surgery: a systematic review protocol.', JBI database of systematic reviews and implementation reports, vol. 16, no. 5, pp. 1117-1125.View/Download from: UTS OPUS or Publisher's site
REVIEW QUESTION/OBJECTIVE:The review objective is to synthesize the best available evidence on the effectiveness and harms of pharmacological interventions in the treatment of delirium in adults in intensive care units (ICU) after cardiac surgery.The specific review question is: What is the effectiveness and what are the harms of pharmacological interventions in relation to the duration and severity of delirium episodes, length of stay in ICU, length of stay in hospital, functional capacity and quality of life and mortality for critically ill adult patients treated in intensive care after cardiac surgery?
Leigh, V, Tufanaru, C & Elliott, R 2018, 'Erratum to: Effectiveness and harms of pharmacological interventions in the treatment of delirium in adults in intensive care units post cardiac surgery: a systematic review protocol.', JBI database of systematic reviews and implementation reports, vol. 16, no. 9, p. 1903.View/Download from: Publisher's site
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...
Laws, RA, Denney-Wilson, EA, Taki, S, Russell, CG, Zheng, M, Litterbach, EK, Ong, KL, Lymer, SJ, Elliott, R & Campbell, KJ 2018, 'Key lessons and impact of the growing healthy mhealth program on milk feeding, timing of introduction of solids, and infant growth: Quasi-experimental study', JMIR mHealth and uHealth, vol. 6, no. 4.View/Download from: Publisher's site
© Rachel A Laws, Elizabeth A Denney-Wilson, Sarah Taki, Catherine G Russell, Miaobing Zheng, Eloise-Kate Litterbach,Kok-Leong Ong, Sharyn J Lymer, Rosalind Elliott, Karen J Campbell. Background: The first year of life is an important window to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents; however, little is known about the effectiveness of mHealth for child obesity prevention. Objective: The objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability, and impact on key infant feeding outcomes. Methods: A quasi-experimental study was conducted with an mHealth intervention group (Growing healthy) and a nonrandomized comparison group (Baby's First Food). The intervention group received access to a free app and website containing information on infant feeding, sleep and settling, and general support for parents with infants aged 0 to 9 months. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed Web-based surveys when infants were less than 3 months old (T1), at 6 months of age (T2), and 9 months of age (T3). Survival analysis was used to examine the duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between the 2 groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory from birth to T3. Results: A total of 909 parents initiated the enrollment process, and a final sample of 645 parents (Growing health...
Aitken, LM, Elliott, R, Mitchell, M, Davis, C, Macfarlane, B, Ullman, A, Wetzig, K, Datt, A & McKinley, S 2017, 'Sleep assessment by patients and nurses in the intensive care: An exploratory descriptive study.', Australian Critical Care, vol. 30, no. 2, pp. 59-66.View/Download from: UTS OPUS or Publisher's site
Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved.To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep.An exploratory descriptive study was undertaken with communicative adult patients consecutively recruited in 2014-2015. Patients reported sleep using the Richards-Campbell Sleep Questionnaire (score range 0-100mm; higher score indicates better sleep quality), with nursing assessment of sleep documented across a five level ordinal variable. Patients were asked daily to describe strategies that helped or hindered their sleep. Ethical approval for the study was gained. Descriptive statistical analysis was performed [median (interquartile range)]; relationships were tested using Spearman's rank correlation and differences assessed using the Kruskal-Wallis test; p<0.05 was considered significant.Participants (n=151) were recruited [age: 60 (46-71) years; ICU length of stay 4 (2-9) days] with 356 self-reports of sleep. Median perceived sleep quality was 46 (26-65) mm. A moderate relationship existed between patients' self-assessment and nurses' assessment of sleep (Spearman's rank correlation coefficient 0.39-0.50; p<0.001). Strategies identified by patients to improve sleep included adequate pain relief and sedative medication, a peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs.Patients reported on their sleep a median of 2 (1-3) days during their ICU stay, suggesting that routine use of self-report was feasible. These reports revealed low sleep quality. Patients reported multiple facilitators and barriers for sleep, with environmental and patient comfort factors being most comm...
Caruana, N, McKinley, SH, Elliott, R & Gholizadeh, L 2017, 'Sleep during and after cardiothoracic intensive care and psychological health during recovery', Australian Critical Care, vol. 30, no. 2, pp. 109-135.View/Download from: UTS OPUS or Publisher's site
Intensive care patients and former ICU patients experience poor sleep quality. Psychological distress and diminished health-related quality of life are common among former ICU patients. Coronary artery bypass graft (CABG) surgery is the main reason for adults being admitted to ICU in Australia but the effect of on-pump vs off-pump surgery on sleep and recovery has not been reported.
The aim was to assess self-reported sleep quality of CABG patients during and after ICU, psychological wellbeing, HRQOL during recovery and whether on-pump vs off-pump method of surgery affects sleep and recovery.
Patients who underwent CABG surgery completed self-report questionnaires on sleep quality, psychological health and quality of life using validated instruments. Data collection occurred in ICU, on the hospital ward, and two months and six months after hospital discharge.
Patients (n=101) were aged (mean±SD) 66.6±11.1 years, 79% male and had a median ICU stay (IQR) of 2 (2-4) days, BMI 27.3±4.3 and on-pump surgery (75%). Poor sleep was reported by 44 (62%) patients at six months and by 12 patients (12%) at all time points. Patients who had off-pump surgery had lower posttraumatic stress symptoms (p=.02) and better physical HRQOL (p=.01). In multivariate analysis, prehospital insomnia (P=.004), and physical (p<.0005) and mental p<.0005) HRQOL were independently associated with sleep quality at six months. There was no association between on-pump vs off-pump CABG surgical techniques and sleep quality at six months.
Sleep quality of postoperative CABG patients was poor in ICU, in the hospital ward and up to six months. Poor sleep quality at six months was associated with prehospital insomnia, and physical and mental HRQOL at six months, but not with on-pump vs off-pump surgical techniques.
Fry, M, Kay, S & Elliott, RM 2017, 'Emergency department presentations by older people for mental health or drug and alcohol conditions: A multicentre retrospective audit.', Australasian Emergency Nursing Journal, vol. 20, no. 4, pp. 169-173.View/Download from: UTS OPUS or Publisher's site
Emergency department presentations by older people associated with mental health and drug and alcohol related conditions are increasing. However, the characteristics of presentations by older people in Australia are largely unknown. The aim of this research was to explore the characteristics of older people presenting with mental health and drug and alcohol conditions.We used a retrospective electronic medical record audit to explore all emergency department presentations by older people 65 years and over for mental health and drug and alcohol related conditions over a 12 month period. Data were described using descriptive statistics.There were 40,093 presentations; 2% (n=900) were related to mental health or drug and alcohol related conditions. Presentations were mainly associated with primary mental or medical symptoms. The majority were female (n=471; 53%). Predominate conditions were cognitive impairment (n=234; 26%) and affective disorders (n=233; 26.0%). Sixty-three percent of patients were admitted to a hospital ward. Over the study period 106 patients (242 episodes of care) represented.Given the ageing population and increasing prevalence for mental health and drug and alcohol conditions, strategies are required to better recognise these conditions to reduce the burden on the health care system and improve health for older people.
Litton, E, Elliott, R, Ferrier, J & Webb, SAR 2017, 'Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial.', Critical Care and Resuscitation, vol. 19, no. 2, pp. 128-133.View/Download from: UTS OPUS
To assess the feasibility of a definitive, randomised controlled trial of earplugs as a noise-abatement strategy to improve sleep and reduce delirium in patients admitted to the intensive care unit.An open-label trial of 40 patients randomised in a 1:1 ratio to receive earplugs in addition to standard care, or standard care alone, conducted in a 10-bed ICU of a large, private hospital in Perth, Western Australia.Patients were eligible for participation if they were expected to be undergoing mechanical ventilation (MV) on admission to the ICU. Patients assigned to receive earplugs had earplugs placed on admission to the ICU and were offered earplug placement between 10 pm and 6 am for the first night in the ICU once they were extubated. Earplugs were not provided for patients assigned to standard care.The primary outcome of study feasibility was assessed using criteria for acceptability of the intervention and protocol compliance.Of the 20 participants randomised to receive earplugs, 19 had earplugs placed within 6 hours of ICU admission, corresponding to 76% of the MV time (mean time with earplugs, 7.5 hours [SD, 5.3 hours]). Earplugs were placed for 18 of 20 participants during their first full night after extubation, corresponding to 78% of the total overnight time (mean time with earplugs, 6.2 hours [SD, 2.5 hours]).A definitive study of earplugs as a noiseabatement strategy for patients admitted to the ICU is feasible on the basis of participant acceptability of the intervention and protocol compliance.Australian New Zealand Clinical Trials Registry ACTRN12615001125516.
Litton, E, Elliott, R, Thompson, K, Watts, N, Seppelt, I, Webb, SAR & ANZICS Clinical Trials Group and The George Institute for Global Health 2017, 'Using Clinically Accessible Tools to Measure Sound Levels and Sleep Disruption in the ICU: A Prospective Multicenter Observational Study.', Critical Care Medicine, vol. 45, no. 6, pp. 966-971.View/Download from: UTS OPUS or Publisher's site
To use clinically accessible tools to determine unit-level and individual patient factors associated with sound levels and sleep disruption in a range of representative ICUs.A cross-sectional, observational study.Australian and New Zealand ICUs.All patients 16 years or over occupying an ICU bed on one of two Point Prevalence study days in 2015.Ambient sound was measured for 1 minute using an application downloaded to a personal mobile device. Bedside nurses also recorded the total time and number of awakening for each patient overnight.The study included 539 participants with sound level recorded using an application downloaded to a personal mobile device from 39 ICUs. Maximum and mean sound levels were 78 dB (SD, 9) and 62 dB (SD, 8), respectively. Maximum sound levels were higher in ICUs with a sleep policy or protocol compared with those without maximum sound levels 81 dB (95% CI, 79-83) versus 77 dB (95% CI, 77-78), mean difference 4 dB (95% CI, 0-2), p < 0.001. There was no significant difference in sound levels regardless of single room occupancy, mechanical ventilation status, or illness severity. Clinical nursing staff in all 39 ICUs were able to record sleep assessment in 15-minute intervals. The median time awake and number of prolonged disruptions were 3 hours (interquartile range, 1-4) and three (interquartile range, 2-5), respectively.Across a large number of ICUs, patients were exposed to high sound levels and substantial sleep disruption irrespective of factors including previous implementation of a sleep policy. Sound and sleep measurement using simple and accessible tools can facilitate future studies and could feasibly be implemented into clinical practice.
Menear, A, Elliott, R, M Aitken, L, Lal, S & McKinley, S 2017, 'Repeated sleep-quality assessment and use of sleep-promoting interventions in ICU.', Nursing in Critical Care, vol. 22, no. 6, pp. 348-354.View/Download from: UTS OPUS or Publisher's site
To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported. An observational study was conducted in a 58-bed adult intensive care unit. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep-promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open-ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep-promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards-Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards-Campbell Sleep Questionnaire was used on repeated occasions, and sleep-promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards-Campbell Sleep Questionnaire for the subjective self-assessment of sleep quality in intensive care unit patients and the implementation of simple-promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive ...
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.
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...
Taki, S, Lymer, S, Russell, CG, Campbell, K, Laws, R, Ong, K-L, Elliott, R & Denney-Wilson, E 2017, 'Assessing User Engagement of an mHealth Intervention: Development and Implementation of the Growing Healthy App Engagement Index.', JMIR mHealth and uHealth, vol. 5, no. 6, pp. e89-e89.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. OBJECTIVE: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. METHODS: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant's date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models. RESULTS: The overall EI...
Elliott, R, McKinley, S, Fien, M & Elliott, D 2016, 'Posttraumatic Stress Symptoms in Intensive Care Patients: An Exploration of Associated Factors', REHABILITATION PSYCHOLOGY, vol. 61, no. 2, pp. 141-150.View/Download from: UTS OPUS or Publisher's site
Litton, E, Carnegie, V, Elliott, R & Webb, SAR 2016, 'The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis', Critical Care Medicine, vol. 44, no. 5, pp. 992-999.View/Download from: UTS OPUS or Publisher's site
Objective: A systematic review and meta-analysis to assess the efficacy of earplugs as an ICU strategy for reducing delirium. Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of controlled trials were searched using the terms "intensive care," "critical care," "earplugs," "sleep," "sleep disorders," and "delirium." Study Selection: Intervention studies (randomized or nonrandomized) assessing the efficacy of earplugs as a sleep hygiene strategy in patients admitted to a critical care environment were included. Studies were excluded if they included only healthy volunteers, did not report any outcomes of interest, did not contain an intervention group of interest, were crossover studies, or were only published in abstract form. Data Extraction: Nine studies published between 2009 and 2015, including 1,455 participants, fulfilled the eligibility criteria and were included in the systematic review. Studies included earplugs as an isolated intervention (n = 3), or as part of a bundle with eye shades (n = 2), or earplugs, eye shades, and additional sleep noise abatement strategies (n = 4). The risk of bias was high for all studies. Data Synthesis: Five studies comprising 832 participants reported incident delirium. Earplug placement was associated with a relative risk of delirium of 0.59 (95% CI, 0.44-0.78) and no significant heterogeneity between the studies (I2, 39%; p = 0.16). Hospital mortality was reported in four studies (n = 481) and was associated with a relative risk of 0.77 (95% CI, 0.54-1.11; I2, 0%; p < 0.001). Compliance with the placement of earplugs was reported in six studies (n = 681). The mean per-patient noncompliance was 13.1% (95% CI, 7.8-25.4) of those assigned to receive earplugs. Conclusions: Placement of earplugs in patients admitted to the ICU, either in isolation or as part of a bundle of sleep hygiene improvement, is associated with a significant reduction in risk of delirium. The potential effect of cointerventions and the o...
McKinley, S, Fien, M, Elliott, R & Elliott, D 2016, 'Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge.', American Journal of Critical Care, vol. 25, no. 1, pp. 52-58.View/Download from: UTS OPUS or Publisher's site
Intensive care unit survivors often have diminished health-related quality of life.To describe health-related quality of life of former intensive care patients and identify associated factors 6 months after hospital discharge.Six months after discharge, 193 patients from an intensive care unit completed the Short Form-36 Health Survey; measures of sleep; Intensive Care Experience Questionnaire; Depression, Anxiety and Stress Scales; and Posttraumatic Stress Disorder Checklist. Norm-based scores were calculated for the Short Form-36. Bivariate associations with Short Form-36 scores were tested by using the Pearson correlation. Multiple linear regression was used to identify independent associations with health-related quality of life.All scores on the Short Form-36 (physical component summary, 41.8; mental component summary, 48.2) were less than population norms. Bivariate associations with health-related quality of life (P < .05) were scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, awareness of surroundings and frightening experiences, depression, anxiety, stress, posttraumatic symptoms, and sleep quality at 2 and 6 months. In linear regression, scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, and sleep quality at 6 months were independently associated with Short Form-36 physical summary scores (P < .001); depression and stress were independently associated with mental summary scores (P < .001).Sleep, depression, and stress are potential targets for interventions to improve health-related quality of life and improve recovery.
Laws, RA, Litterbach, E-KV, Denney-Wilson, EA, Russell, G, Taki, S, Ong, K-L, Elliott, RM, Lymer, SJ & Campbell, KJ 2016, 'A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program.', Journal of Medical Internet Research, vol. 18, no. 9, pp. e248-e248.View/Download from: UTS OPUS or Publisher's site
Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs.The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention.The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants' baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews.A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3...
Russell, G, Taki, S, Azadi, L, Campbell, KJ, Laws, R, Elliott, R & Denney-Wilson, E 2016, 'A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment.', BMC Pediatrics, vol. 16, pp. 69-69.View/Download from: UTS OPUS or Publisher's site
Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the CO...
Russell, G, Taki, S, Laws, R, Azadi, L, Campbell, KJ, Elliott, R, Lynch, J, Ball, K, Taylor, R & Denney-Wilson, E 2016, 'Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis', BMC PUBLIC HEALTH, vol. 16, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
Background: Despite the crucial need to develop targeted and effective approaches for obesity prevention in
children most at risk, the pathways explaining socioeconomic disparity in children's obesity prevalence remain
Methods: We conducted a systematic review of the literature that investigated causes of weight gain in children
aged 0–5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries.
Major electronic databases were searched from inception until December 2015. Key words identified studies
addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and
child weight in disadvantaged samples.
Results: A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the
studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between
parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating
child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in
the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity
precluded identification of independent effects of each of these risk factors.
Conclusions: This review has highlighted significant gaps in our mechanistic understanding of the relative
importance of different aspects of parent and child behaviours in disadvantaged population groups
Elliott, D, Elliott, R, Burrell, A, Harrigan, P, Murgo, M, Rolls, K & Sibbritt, D 2015, 'Incidence of ventilator associated pneumonia in Australian intensive care units: Use of a consensus-developed clinical surveillance checklist in a multi-site prospective audit', BMJ Open, vol. 5, no. 10, pp. e008924-e008924.View/Download from: UTS OPUS or Publisher's site
Objectives: With disagreements on diagnostic criteria
for ventilator-associated pneumonia (VAP) hampering
efforts to monitor incidence and implement
preventative strategies, the study objectives were to
develop a checklist for clinical surveillance of VAP, and
conduct an audit in Australian/New Zealand intensive
care units (ICUs) using the checklist.
Setting: Online survey software was used for checklist
development. The prospective audit using the checklist
was conducted in 10 ICUs in Australia and New Zealand.
Participants: Checklist development was conducted
with members of a bi-national professional society for
critical care physicians using a modified Delphi
technique and survey. A 30-day audit of adult patients
mechanically ventilated for >72 h.
Primary and secondary outcome measures:
Presence of items on the screening checklist; physician
diagnosis of VAP, clinical characteristics, investigations,
treatments and patient outcome.
Results: AVAP checklist was developed with five items:
decreasing gas exchange, sputum changes, chest X-ray
infiltrates, inflammatory response, microbial growth.
Of the 169 participants, 17% (n=29) demonstrated
characteristics of VAP using the checklist. A similar
proportion had an independent physician diagnosis
(n=30), but in a different patient subset (only 17% of
cases were identified by both methods). The VAP rate
per 1000 mechanical ventilator days for the checklist
and clinician diagnosis was 25.9 and 26.7, respectively.
The item 'inflammatory response' was most associated
with the first episode of physician-diagnosed VAP.
Conclusions: VAP rates using the checklist and
physician diagnosis were similar to ranges reported
internationally and in Australia. Of note, different
patients were identified with VAP by the checklist and
physicians. While the checklist items may assist in
identifying patients at risk of developing VAP, and
demonstrates synergy with the recently developed
Centers for Disease Control (CDC) guidelines, dec...
Denney-Wilson, E, Laws, R, Russell, G, Ong, K-L, Taki, S, Elliot, R, Azadi, L, Lymer, S, Taylor, R, Lynch, J, Crawford, D, Ball, K, Askew, D, Litterbach, EK & J Campbell, K 2015, 'Preventing obesity in infants: the Growing healthy feasibility trial protocol.', BMJ Open, vol. 5, no. 11, pp. e009258-e009258.View/Download from: UTS OPUS or Publisher's site
Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services.This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself.This study received approval from the University of Technology Sydney Eth...
Taki, S, Russell, G, Elliot, R, Campbell, KJ, Laws, R & Denney-Wilson, E 2015, 'Infant Feeding Websites and Apps:A Systematic Assessment ofQuality and Content', Interactive Journal of Medical Research, vol. 4, no. 3.View/Download from: UTS OPUS or Publisher's site
Elliott, R 2014, 'The development of a clinical practice guideline to improve sleep in intensive care patients: A solution focused approach', Intensive and Critical Care Nursing, vol. Online.View/Download from: Publisher's site
Objective: Our objective was to develop a guideline to improve the opportunity for intensive care patients to rest and sleep.Design and setting: A pragmatic solution focused approach to guideline development and implementation was used in which data from international literature and original research from the study ICU were appraised in extensive consultation with intensive care staff. Audits were conducted early in the implementation phase to measure adoption rates.Results: Over 320 suggestions were made for inclusion in a practice guideline. Information was integrated to create the guideline. A comprehensive `rest and sleep for the intensive care patient guideline was developed comprising two main themes: `Optimise the environment(for example, `Quiet conversation) and `Rest and sleep interventions (for example, `Provide optimal conditions for night-time sleep). Audit data suggested that adoption of the guideline had begun but was not yet embedded in practice.Conclusion: The solution focused approach to addressing improvements ICU patients sleep and the consideration of multiple sources of evidence resulted in the development of a comprehensive, context specific guideline. The process, based on a solution focus, may overcome difficulties faced by clinicians endeavouring to improve health care when there is a lack of high level evidence.
Elliott, R 2014, 'Typical sleep patterns are absent in mechanically ventilated patients and their circadian melatonin rhythm is evident but the timing is altered by the ICU environment', Australian Critical Care, vol. in press.
Elliott, R, Rai, T & McKinley, SM 2014, 'Factors affecting sleep in the critically ill: An observational study', Journal of Critical Care, vol. 29, no. 5, pp. 859-863.View/Download from: UTS OPUS or Publisher's site
Purpose The aims of the current study were to describe the extrinsic and intrinsic factors affecting sleep in critically ill patients and to examine potential relationships with sleep quality. Materials and Methods Sleep was recorded using polysomnography (PSG) and self-reports collected in adult patients in intensive care. Sound and illuminance levels were recorded during sleep recording. Objective sleep quality was quantified using total sleep time divided by the number of sleep periods (PSG sleep period time ratio). A regression model was specified using the PSG sleep period time ratio as a dependent variable. Results Sleep was highly fragmented. Patients rated noise and light as the most sleep disruptive. Continuous equivalent sound levels were 56 dB (A). Median daytime illuminance level was 74 lux, and nighttime levels were 1 lux. The regression model explained 25% of the variance in sleep quality (P = .027); the presence of an artificial airway was the only statistically significant predictor in the model (P = .007). Conclusions The presence of an artificial airway during sleep monitoring was the only significant predictor in the regression model and may suggest that although potentially uncomfortable, an artificial airway may actually promote sleep. This requires further investigation.
Elliott, R, McKinley, SM, Cistulli, P & Fien, M 2013, 'Characterisation of sleep in intensive care using 24-hour polysomnography: An observational study', Critical Care, vol. 17, no. 2, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
Introduction: Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients,
McKinley, SM, Fien, M, Elliott, R & Elliott, D 2013, 'Sleep and psychological health during early recovery from critical illness: An observational study', Journal of Psychosomatic Research, vol. 75, no. 6, pp. 539-545.View/Download from: UTS OPUS or Publisher's site
Introduction: Intensive care patients often report sleep disruption in ICU and during recovery fromcritical illness. Objectives: To assess: (i) patients' self-reported sleep quality in ICU, on the hospital ward after transfer from ICU and two and six months after hospital discharge; (ii) whether patients who report sleep disruption in ICU continue to report sleep disruption in recovery and (iii) whether prehospital insomnia, experiences in intensive care, quality of life and psychological health are associated with sleep disruption six months after hospital discharge. Methods: Patients completed self-report measures on sleep quality at Five time points: prior to hospitalization, in ICU, the hospital ward, two months and six months after hospital discharge, their intensive care experiences two months after discharge and psychological health and quality of life six months after discharge. Results: Patients (n=222)were aged (mean±SD) 57.2±17.2 years, 35% female, had mean ICU stay of 5±6 days and BMI of 26±5. Over half the participants (57%) reported poor sleep at six months; for 10% this was at all time points after ICU admission. Prehospitalization insomnia (p=.0005), sleep quality on theward (p=.006), anxiety (p=.002), and mental (p=.0005) and physical health (p=.0005) were independently associated with poorer sleep quality in survivors six months after ICU treatment. Conclusions: Sleep is a significant issue for more than half of survivors 6 months after ICU treatment. Some influencing factors, such as hospital sleep quality, anxiety, physical health and mental health, are potentially modifiable and should be targeted in recovery programs.
Aitken, LM, Marshall, AP, Elliot, RM & McKinley, SM 2011, 'Comparison of 'think aloud' and observation as data collection methods in the study of decision making regarding sedation in intensive care patients', International Journal of Nursing Studies, vol. 48, no. 3, pp. 318-325.View/Download from: UTS OPUS or Publisher's site
Background: There is recognition that different data collection methods gather different aspects of decision making data. Although the selection of a method to explore nurses decision making is partially determined by the theoretical perspective that informs each study, some flexibility remains. Description of the relative benefits of each method will enable future researchers to selectively identify which method is most suited to answering their specific research question. Objectives: To describe the decisions identified using observation and think aloud in the study of decision making related to sedation assessment and management within intensive care, as well as to examine the strengths and weaknesses of each method in the context of this study. Design: Secondary analysis of data collected during an observational study. Settings: This study was conducted in one intensive care unit in a tertiary teaching hospital in Australia. Participants: Seven self-identified expert critical care nurses. Methods: Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during 2 h of care, with follow-up interviews conducted up to 4 days later to clarify information collected. Data were analysed independently by an investigator not involved in data collection. Analysis involved identification of decision tasks with comparison of number and type of tasks identified with each of the two data collection techniques.
Elliot, RM, McKinley, SM & Cistulli, P 2011, 'The quality and duration of sleep in the intensive care setting: An integrative review', International Journal of Nursing Studies, vol. 48, no. 3, pp. 384-400.View/Download from: UTS OPUS or Publisher's site
Background: Sleep is essential for well-being and recovery from illness. The critically ill are in significant need of sleep but at increased risk of sleep loss and disruption. Objectives: To determine the quality and duration of sleep experienced by adults who are patients in intensive care units and factors affecting their sleep. Design: An integrative approach was used for this literature review in order to explore the available evidence on this topic, which has yet to be fully investigated. Data sources: PubMed, CINAHL, Psychinfo, the Australian Digital Theses Program and ProQuest Dissertations and Theses (Interdisciplinary) databases were searched for studies conducted about sleep in adult intensive care units. Manual searches of papers identified from this search were performed to find additional studies. Review methods: Data related to the quality and duration of sleep along with study design, sample size and intensive care context were extracted, evaluated and summarised. Results: Total sleep time is normal or reduced with significant fragmentation. Light sleep is prolonged and deep and rapid eye movement sleep are reduced. The most likely factors affecting sleep quality are high sound levels, frequent interventions and medications. Data obtained from polysomnography are supported by patient self reports. Considerable variation in data exists between patients and studies affecting generalizability. Existing criteria for staging sleep may be inadequate for quantifying sleep in intensive care patients. Conclusions: There is evidence that intensive care patientsâ sleep is significantly disrupted. Alternative methods of quantifying sleep for intensive care patients may be required. Few large observational or interventional studies have used polysomnography and simultaneous recordings of intrinsic and extrinsic disruptive factors. These studies are required in order to improve sleep for intensive care patients.
Elliott, R, McKinley, SM & Eager, DM 2010, 'A pilot study of sound levels in an Australian adult general intensive care unit', Noise and Health, vol. 12, no. 46, pp. 26-36.View/Download from: UTS OPUS or Publisher's site
High technology and activity levels in the intensive care unit (ICU) lead to elevated and disturbing sound levels. As noise has been shown to affect the ability of patients to rest and sleep, continuous sound levels are required during sleep investigations. The aim of this pilot study was to develop a robust protocol to measure continuous sound levels for a larger more substantive future study to improve sleep for the ICU patient. A review of published studies of sound levels in intensive care settings revealed sufficient information to develop a study protocol. The study protocol resulted in 10 usable recordings out of 11 attempts to collect pilot data. The mean recording time was 17.49 ± 4.5 h. Sound levels exceeded recommendations made by the World Health Organization (WHO) for hospitals. The mean equivalent sound level (LAeq) was 56.22 ± 1.65 dB and LA90 was 46.8 ± 2.46 dB. The data reveal the requirement for a noise reduction program within this ICU.
Aitken, LM, Marshall, AP, Elliott, R & McKinley, SM 2009, 'Critical care nurses decision making: sedation assessment and management in intensive care', Journal Of Clinical Nursing, vol. 18, no. 1, pp. 36-45.View/Download from: UTS OPUS or Publisher's site
Aims. This study was designed to examine the decision making processes that nurses use when assessing and managing sedation for a critically ill patient, specifically the attributes and concepts used to determine sedation needs and the influence of a sedation guideline on the decision making processes. Background. Sedation management forms an integral component of the care of critical care patients. Despite this, there is little understanding of how nurses make decisions regarding assessment and management of intensive care patients' sedation requirements. Appropriate nursing assessment and management of sedation therapy is essential to quality patient care. Design. Observational study. Methods. Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during two separate occasions for two hours of care. Follow-up interviews were conducted to collect data from five expert critical care nurses pre- and postimplementation of a sedation guideline. Data from all sources were integrated, with data analysis identifying the type and number of attributes and concepts used to form decisions. Results. Attributes and concepts most frequently used related to sedation and sedatives, anxiety and agitation, pain and comfort and neurological status. On average each participant raised 48 attributes related to sedation assessment and management in the preintervention phase and 57 attributes postintervention. These attributes related to assessment (pre, 58%; post, 65%), physiology (pre, 10%; post, 9%) and treatment (pre, 31%; post, 26%) aspects of care. Conclusions. Decision making in this setting is highly complex, incorporating a wide range of attributes that concentrate primarily on assessment aspects of care
Elliott, R, Marshall, AP, Rolls, K, Schacht, S & Martin, B 2008, 'Eyecare in the critically ill: clinical practice guideline', Australian Critical Care, vol. 21, no. 2, pp. 97-109.View/Download from: UTS OPUS or Publisher's site
Objective: The Intensive Care Collaborative project was established with the specific aim of developing recommendations for clinical practice that are underpinned by the best available evidence to support the objective of improving the standard of care delivered in NSW Intensive Care Units.
Elliott, R, McKinley, SM & Fox, V 2008, 'Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit', American Journal Of Critical Care, vol. 17, no. 4, pp. 328-334.View/Download from: UTS OPUS or Publisher's site
Background Critically ill patients are at increased risk for pressure ulcers, which increase patients' morbidity and mortality. Quality improvement projects decrease the frequency of pressure ulcers. Objectives To improve patients' outcomes by reducing the prevalence of pressure ulcers, identifying areas for improvement in prevention of pressure ulcers, and increasing the adoption of preventive strategies in an intensive care unit. Method Quasi-experimental methods were used for this quality improvement project in which 563 surveys of patients' skin were performed during 22 audits conducted during a 26-month period. One-on-one clinical instruction was provided to bedside nurses during the surveys, and pressure ulcer data were displayed in the clinical area. Results The frequency of pressure ulcers of all stages showed an overall downward trend, and the prevalence decreased from 50% to 8%. The appropriate allocation of pressure-relieving devices increased from 75% up to 95% to 100%. The likely origin of the ulcer (ie, whether it was hospital or community acquired) and the anatomical site of the pressure ulcers did not change during the study period. Conclusions This program was successful in reducing the prevalence of pressure ulcers among vulnerable intensive care patients and indicates that quality improvement is a highly effective formula for improving patients' outcomes that is easily implemented by using clinical expertise and existing resources.
McKinley, SM & Elliott, R 2008, 'Implications for Australian practice of North American guidelines for the support of the family in patient-centred intensive care', Collegian, vol. 15, no. 1, pp. 11-17.View/Download from: UTS OPUS or Publisher's site
Patient-centred care, in which health care professionals inform patients and families, maintain active involvement in decision making, coordinate care across disciplines, provide families with physical comfort and emotional support and ensure care is culturally sensitive, is recommended over clinician- or disease-centred care for better patient outcomes. Patients in intensive care are often too ill to participate in communication and decision making, so the patient's family should be involved in communication and decision making about the patient's care. The Society of Critical Care Medicine published clinical practice guidelines for the support of the family in the patient-centred intensive care unit. The purpose of this paper is to assess whether the 42 recommendations in the guidelines are valid and applicable in Australia. We used a recognised framework for evaluation of clinical practice guidelines. It was found that the guidelines were developed systematically using accepted methods of guideline development as much as possible. An extensive literature review was conducted and publications containing all levels of evidence were considered for inclusion. There were some weaknesses in the guideline development, especially lack of consultation with patients and families and a lack of high-level evidence, however the authors have provided comprehensive recommendations to guide all aspects of patient-centred care. We conclude that the recommendations are largely applicable to the patients and families receiving treatment and support within intensive care units in Australia. Where strong evidence is lacking, the recommendations should be a stimulus to conduct studies that test interventions that may benefit intensive care patients, their families, and intensive care staff.
Elliott, R 2006, 'Research Review: Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the ICU', Australian Critical Care, vol. 19, no. 4, pp. 158-159.
A review of 'Fourrier IV, Dubois D, Pronnler P, Herbecq P, Leroy O, Desmettre T, Pottier-Cau E, Boutigny H, Di Pompeo C, Durocher A & Roussel-Delvallez M, for the PIRAD Study Group. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicentre study. Crit Care Med 2005; 33(8):1728.1735'
Elliott, R, McKinley, SM & Aitken, LM 2006, 'Adoption of a sedation scoring system and sedation guideline in an intensive care unit', Journal Of Advanced Nursing, vol. 54, no. 2, pp. 208-216.View/Download from: UTS OPUS or Publisher's site
Aim. The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. Background. Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care.
Elliott, R, McKinley, SM, Aitken, LM & Hendrikz, J 2006, 'The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit', Intensive Care Medicine, vol. 32, no. 10, pp. 1506-1514.View/Download from: UTS OPUS or Publisher's site
To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. The intervention was tested in a pre-intervention, post-int
Tinker, M & Elliott, R 2006, 'Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the ICU', Australian Critical Care, vol. 19, no. 4, pp. 158-159.View/Download from: Publisher's site
Moran, D, Elliott, R & McKinley, SM 2005, 'The Royal North Shore Hospital ICU nurse initiated telephone follow up service', Intensive and Critical Care Nursing, vol. 21, no. 1, pp. 47-50.View/Download from: UTS OPUS
Elliott, R & Wright, L 1999, 'Verbal communication: What do critical care nurses say to their unconscious or sedated patients?', Journal of Advanced Nursing, vol. 29, no. 6, pp. 1412-1420.View/Download from: Publisher's site
The importance of using verbal communication in the care of critically ill patients has long been known. Both qualitative and quantitative studies have presented evidence of the benefits of effective communication. This non-participant observational study aimed to explore how much and what types of verbal communication critical care nurses use when caring for unconscious or sedated patients. Sixteen critical care nurses were observed in 4-hour episodes and their verbal communication was transcribed and timed at source. Seven categories of verbal communication and a 'core concept' emerged on analysis of the raw data. Medical investigations/interventions performed on the patients increased the amount of communication used. The participants in this study were found to use a greater variety and amount of verbal communication than participants in other studies. The findings of this study highlight the need for formal support systems and continued education for nurses about the benefits of verbal communication.
Elliott, R, McKinley, SM, Cistulli, P & Fien, M 2013, 'An Intervention Study To Improve Sleep In The Critical Care Setting', American Thoracic Society Conference Abstracts, American Thoracic Society International Conference, American Thoracic Society, Philadelphia, Pennsylvania, United States of America.
Elliott, R 2011, 'A study to improve the quality and quantity of sleep for patients in an Australian ICU is inconclusive', Australian Critical Care, Elsevier, Brisbane, Australia, pp. 119-119.
Elliott, R 2012, 'Quantification of sleep fragmentation in intensive care patients', Journal of Sleep Research, Journal of Sleep Research, Paris, France, pp. 201-201.
Elliott, R 2010, 'ICU patients sleep in an Australian ICU is poor: A study using polysomnography', Australian Critical Care, Elsevier, Melbourne, Australia, p. 54.
Khushaba, RN, Elliott, R, Alsukker, A, Al-Ani, A & McKinley, SM 2010, 'Orthogonal locality sensitive fuzzy discriminant analysis in sleep-stage scoring', Proceedings - 2010 International Conference on Pattern Recognition, International Conference on Pattern Recognition, IEEE, Istanbul, Turkey, pp. 165-168.View/Download from: UTS OPUS or Publisher's site
Sleep-stage scoring plays an important role in analyzing the sleep patterns of people. Studies have revealed that Intensive Care Unit (ICU) patients do not usually get enough quality sleep, and hence, analyzing their sleep patterns is of increased import
Elliott, R 2009, 'A pilot study of sound levels in an Australian adult general intensive care unit', Conference presentation (nursing free paper), 34th World congress on Intensive Care,, Minerva Anestesiologica, Florence, Italy.
Elliott, R, McKinley, SM & Eager, DM 2009, 'A pilot study of sound levels in an Australian adult general intensive care unit', 6th Annual Congress of the World Federation of Critical Care Nurses and 10th Congress of the World Federation of the Societies of Intensive and Critical Care Medicine, Florence, Italy.
BACKGROUND/OBJECTIVES: High technology and activity levels in the intensive care unit (ICU) lead to high sound levels. As noise has been shown to affect the ability of patients to rest and sleep continuous sound levels are required during sleep investigations. The aim of this pilot study was to develop a robust protocol to measure continuous sound levels for a larger more substantive future study to improve sleep for the ICU patient. METHODS: A review of published studies of sound levels revealed sufficient information to develop a study protocol (twenty-three papers were used). An integrated sound level meter Class 1 was used. The microphone was placed 0.75 to 1m above the patientâs head. Sound recording was simultaneous to 24 hour sleep monitoring (polysomnography). Five broadband parameters were set: LAeq, LCpeak, LAFmax, LAFmin and LCeq along with LZ spectra recorded at a sampling and logging frequency of one sample per second. RESULTS: The study protocol resulted in 10 usable recordings out of 11 attempts to collect pilot data. The mean recording time was 17.49Â±4.5 hours. Sound levels exceeded recommendations made by the World Health Organization (WHO) for hospitals. The mean equivalent sound level (LAeq) was 56.22Â±1.65 dB and LA90 was 46.8Â±2.46 dB. CONCLUSION: The data reveal the requirement for a noise reduction program within this ICU. GRANT ACKNOWLEDGEMENT: Australian College of Critical Care Nurses awarded a research grant of A$15,000 in 2008.
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