Faculty of Health

School of Nursing and Midwifery

Research Programs

The focus of the research program conducted through the Nursing Research Centre focuses on the delivery of safe, high quality evidence-based clinical care in the acute settings. Case study methodology using mixed methods are used to investigate clinical practice within complex clinical environments.

Living with an artificial heart: Experiences of patients and carers

Early detection and management of ischaemia-reperfusion injury following lung transplantation

Implementing a core dataset for the systematic reporting of medication incidents by critical care nurses

Evaluating the quality of 24-hour acute care delivery: Describing functional outcomes of older people using a model of best practice

The effectiveness of symptom management practices for patients with cancer.

Medication safety in the acute care environment in the context of single checking policy.

Patients' communication of pain in acute care contexts

Barriers and facilitators to patient participation following cardiac surgery.

 

Living with an artificial heart: Experiences of patients and carers

(contact Judy.Currey@deakin.edu.au )

The introduction of artificial hearts in the palliation of patients with end-stage heart failure improves quality of life due to superior symptom control and out-of-hospital management, and may preserve life beyond previous expectations. This advanced technology is being applied more and more frequently, however it imposes a heavy burden on patients and carers, including medical risks and complications, fears and uncertainties, and stresses on crucial relationships. This project aims to develop a systematic understanding of the practical, physical, and psychosocial experiences of patients and carers in order to identify strategies that health professionals might employ to improve outcomes.

 

Early detection and management of ischaemia-reperfusion injury following lung transplantation

(contact Judy.Currey@deakin.edu.au )

Following lung transplantation, patients are at risk of developing a syndrome that involves severe lung damage and breathing difficulties within the first 72 hours. The syndrome is associated with prolonged periods of mechanical ventilation; prolonged intensive care (ICU) lengths of stay; and increased mortality. Although little is known about how to prevent such severe lung injury, early detection and management can reduce the adverse effects of the syndrome. The aim of this study is to evaluate the impact of implementing findings that have emerged from recent research for the early detection and management of the syndrome following lung transplantation on associated adverse outcomes.

 

Implementing a core dataset for the systematic reporting of medication incidents by critical care nurses

(contact Judy.Currey@deakin.edu.au )

In this project, nurse interventions related to medication incidents using a standardised reporting system (core dataset) will be described in order to improve medication safety. The overall aim of this project is to determine the effectiveness of the implementation of the core dataset in capturing nurse interventions. Specific objectives include the following:

1.      To compare the number, types and risk of the nurse
interventions reported pre- and post-implementation of the core dataset reporting project.

2.      To explore potential relationships between nurses' experience
and the frequency and risk rating of nurse interventions.

 

Evaluating the quality of 24-hour acute care delivery: Describing functional outcomes of older people using a model of best practice

(contact Lenore.beddoes@deakin.edu.au)

The purpose of this research program is to develop a model to evaluate and enhance the 24 hour management of the independent functioning of older patients admitted for acute general medical care. Specifically, the findings will provide understanding of current 24 hour management of functional status of acutely ill older patients according to best practice.

Aims

The aims of this study are to: 1) develop an ecologically valid framework of quality indicators that represents best geriatric practice within the Victorian health system; 2) test the capacity of this quality indicator framework to evaluate current 24-hour management of functional status management in general medical patients aged 65+; and to 3) implement this framework to evaluate current 24-hour management of functional status is this patient group.

Research Methods

A literature search identified current best geriatric practice recommendations for the prevention of functional decline in older hospitalised patients. Best geriatric practice recommendations were operationalised as quality indicators in a preliminary framework to evaluate care across the 24 hour acute care continuum. A single case study (one institution) design, using a multi-method approach (interviews, observation, chart review and focus groups) will be used to test the preliminary quality indicator framework and to evaluate current functional status management of older people in acute care. Additionally, barriers and facilitators of independent functioning of older hospitalised patients will be identified. Measurement of these quality indicators will enable continuous practice improvement to promote independent functioning of older adults in acute care

 

The effectiveness of symptom management practices for patients with cancer

Contact: emma.cohen@deakin.edu.au

Background
Symptom management in acute care is complex. There is compelling evidence that many cancer patients do not receive adequate symptom management, supportive or palliative care throughout the course of their disease and treatment. Obstacles to effective symptom management in cancer patients can arise from different sources and interactions among providers, patients, their families and the healthcare system. Symptoms are subjective experiences; effective treatment and evaluation of treatment relies on patients' preferences and self-reports.
Aims
The overall aim of this research program is to develop a model for the evaluation and enhancement of symptom management of patients with cancer in the acute care context that integrates three key components: 1) patients as active participants in symptom assessment and treatment; 2) identification of measurable and accessible quality indicators of symptom management; and 3) establishment of a framework for quality appraisal and feedback of symptom management at a local level to enhance and sustain practice changes.

There are three specific objectives:

  1. Evaluate current symptom management processes with particular focus on patient participation in the acute oncology context.
  2. Describe system, person and process barriers and facilitators to patient participation in symptom management in the acute oncology context.
  3. Identify valid and reliable measures of patient participation in symptom management processes and symptom management outcomes to be used in a future suitably powered, well-designed trial of the effectiveness of audit and feedback as a means of improving and maintaining changes in symptom management in the acute oncology context.

Methods
The proposed study involves a single case-study (one institution) design with data collection using multi-methods and repeated measures to explore symptom management practices in the acute oncology ward at The Alfred Hospital. The findings of this study will provide insights into oncology patients' symptom profile and participation in symptom management at a particular point in time and inform quality of symptom management appraisal and enhancement processes.
Patients admitted to the oncology ward with a diagnosis of cancer will be interviewed using a modified, expanded version of the Memorial Symptom Assessment Scale 48 hours after admission and on the following four days. In addition, a smaller subgroup of patients will be asked to consent to participate in the observation component of the study where symptom management interactions between patients and clinicians will be observed directly. Data collection will involve repeated measures of the presence, severity and level of distress or bother that symptoms have for patients over a five day period, their desire to participate in symptom management decisions, exploration of the impact of symptoms on functional status and observation of the level of patient participation in care related to symptoms. The repeated measures component is important because the symptom profile of cancer patients may be variable and patients' level of participation may also vary based on symptom severity.

Patient medical records will be accessed in order to extract information about patients' diagnosis and treatment to date, concurrent medical history, details relating to prescribed and administered symptom management medications as well as to analyse the way symptom information is documented in patients' medical records. Data collection will take place over a 6 month period.

Significance
The significance of this study lies in improving patient outcomes by providing additional insight into recognising patients as participants in providing patient centred, quality care and as informants in assessing outcomes of interventions.

 

 

 

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6th November 2008