A comprehensive evaluation of outcomes from patient handling interventions

Assisting less able people to move in a healthcare setting is a very common occurrence but carries risks to staff and patients. The scientific study of patient handling activities and interventions to help reduce musculoskeletal disorders in the workplace is a relatively new but growing area. Recent literature reviews have identified two key factors, the lack of high quality studies and the lack of strong links between patient handling interventions and reduced musculoskeletal injury. This study has systematically reviewed the available literature and investigated the potential outcome measures used to show benefits of improved patient handling. A wide range of outcomes has been identified concentrated on the benefits to staff, patients and organisations. No methods were identified to compare different benefits, outcomes or intervention strategies. This study used mixed methods to develop a tool to compare the results of all types of interventions: a.Focus group studies in four EU countries recorded a priority list of the 12 most important outcomes from patient handling interventions b.The most suitable method for examining the 12 outcomes was identified c.The Intervention Evaluation Tool (IET) was developed as a single measurement tool d.The IET was translated and used in four EU countries to evaluate its usability and its usefulness to patient handling practitioners The EU trials and subsequent expert review have given favourable feedback for the IET. The IET creates 12 outcome evaluations with detail and differentiation, and an overall performance score to assist an organisation to target its future interventions. The method can be used to compare interventions, and the performance between organisations and countries across the EU. Though the IET needs more field trials and validity testing it is hoped that a wider application may be to create a benchmarking method that can assist in the improvement of patient handling systems across Europe

Dramatic strategies for augmenting nursing student engagement with inter-agency care: a quantitative study

Background: Inter-agency working (IW) is critical to the delivery of safe and effective health care to service users, families, and health-care staff to ensures that high-quality, consistent care is always available for the users. Several studies have advised that pre-registered health students get Inter-professional Education (IPE) to improve their knowledge and attitudes regarding inter-agency collaboration. Students, on the other hand, are unsure of the relevance of these concepts to their careers and demonstrate a lack of interest in studying. Similarly, the optimal approach to learn inter-agency collaboration has yet to be determined. Objectives: The aim of the study is to explore the impact of peer-initiated authentic drama on pre-registered students’ attitudes towards health care team working before and after module implementation with content on health and social care integration/inter-agency working. Methods: In this study, a quantitative (before-and-after) design was chosen. The study included second-year nursing students from Bachelors in Nursing (BN) and Masters in Nursing (MN) programmes who were studying the module 'Effective Interagency Working in Health and Social Care.' A convenience sample of 450 student nurses completed a pre- and post-module questionnaire. For data analysis, descriptive analysis and the Paired Sample T test were used. Results: Overall, there was an increase in the student nurses’ attitudes towards health care team working, understanding of health and social care integration and confidence around working within integrated health and social care landscapes with 80%-90% of participants agreeing or strongly agreeing with the survey questionnaire. With regards to paired sample T test results, these demonstrated that there was no significant difference between the mean pre-module score and mean post-module score ratings (p=.136). Conclusion: Drama-based nursing education is a real-world learning strategy that helps students gain a better understanding of health-care team working. This innovative instructional technique should be employed in the curricula of pre-registration health students in the future

Implementing Protocols in the Emergency Department to Improve Care for Sexual Assault Patient

This quality improvement project answered the following question: Does implementation of sexual assault forensic examination protocols with educational training increase the number of staff who are knowledgeable and available to complete sexual assault forensic examinations and reduce wait times for individuals who present to the emergency department and have indicated that they were sexually assaulted, over no use of protocols, within a 15-week time frame? Evidence-based state protocols for performing sexual assault forensic examinations were implemented through educational training that incorporated national training criteria and hands on simulation skills practice. Evaluation of outcome measures confirmed an increase to over 80% of available and knowledgeable emergency department staff for providing sexual assault forensic examinations and forensic evidence collection. Implications of the findings support the existing evidence for implementing protocols to improve the provision of examination, treatment, and forensic evidence collection for sexual assault patients. The increase in available and knowledgeable staff for performing sexual assault forensic examinations is expected to reduce the wait time for patients who present to the emergency department and report that they have been sexually assaulted

A study of facility management knowledge classification for the effective stewardship of existing buildings

The aim of the study was to establish the Facility Management knowledge categories within the life cycle of a building context. The significance of the study stemmed from research undertaken into the compliance to Australian Standards 1851-17:2005 Maintenance of Fire and Smoke Doors within West Australian nursing homes, which demonstrated 87 per cent non-compliance. The level of non-compliance appeared to identify a lack of knowledge, and appropriately qualified and experienced personnel involved within the management of nursing homes (Doleman, 2008). The issues identified prompted the question on how facility management knowledge categories evolves and develops throughout the life cycle of a building. The research used a three Phase, Grounded Theory interpretive analysis of the Facility Management knowledge construct. Phase One involved the examination of 21 international tertiary undergraduate Facility Managers courses. The course content was analysed and assessed through linguistic analysis to extract the knowledge categories and subordinate concepts. The findings identified 14 primary knowledge categories which were presented to 10 Facility Management experts for validation. Phase Two presented the findings of Phase One in a Multi Dimensional Scaling (MDS) survey instrument to Facility Management experts for dissimilarity assessments. The results from the 56 completed surveys were embedded within MDS software to present spatial knowledge proximity cluster analysis. The final phase was the validation of the research findings through semi-structured interviews of 10 industry experts, selected with consideration of heterogeneity in order to validate the findings of the previous phase. The outcome of this study was to develop an understanding of the Facility Management knowledge categories within the life cycle of a building context and the identification of 14 core knowledge base, required as a Facility Manager practitioner. Core knowledge categories included Finance as a central theme within the Facility Management domain with Building Services and Business providing an indication as to the broad nature of Facility Management knowledge construct. Also identified within the research was the lack of legislative harmonisation between different states and territories within the Facility Management domain and the disparity between Facility Management practitioners with regards to knowledge context and application. The role of Facility Management and their involvement within the lifecycle of a building was also identified within the research as being little or none during the design and construction phases of the building. The handover and management of the buildings to Facility Managers occurs within the occupancy phase of the buildings life cycle meaning that the building was inherited without due consideration of continued operational efficiencies or functionality affecting the overall cost effectiveness of the building. Such outcomes lead to a number of recommendations such as a the introduction of central knowledge standard in order to provide context of definitions and well as the continued development and drive of Facility Management practitioners and associations to establish the Facility Management profession as a respected body

An exploration of midwives' experiences and practice in relation to the assessment of maternal postnatal genital tract health

Over the past 15 years the focus of postnatal care has changed. Contemporary professional guidance no longer directs midwives to undertake specific assessment tasks in relation to women’s genital tract, but advocates an holistic and individualised approach. However more recently some concern has been expressed within the professional literature that women’s physical needs may be overlooked. It is unclear how midwives decide upon their approach to maternal genital tract assessment, the involvement of women in this process, what assessment methods they use and the factors that influence this clinical reasoning process. A constructionist grounded theory methodology was employed to guide the research design and processes, including analysis of the data, the use of theoretical sampling to evolve the emerging research categories and the construction of a grounded theory. Ethical approval was gained from the regional research ethics committee and the research and development committee at the data collection site. Sampling was purposeful and data was collected using narrative style in depth interviews involving fourteen midwives and observations of fifteen postnatal assessments involving five midwives and fifteen postnatal women. Three themes were identified from the data and form the framework of the constructed grounded theory; they are Methods, Motivators and Modifiers. Within each theme are a number of categories and focused codes. The Methods theme summarises a range of assessment methods used by the midwives, including risk assessment, questioning and clinical observations. The Motivators theme incorporates factors which motivated how, when and why the midwives undertook genital tract assessment and includes verification, personal preferences and sensitive care. The Modifiers theme consists of factors and contexts, which facilitated or inhibited the midwives’ ability to negotiate an appropriate approach to assessment and includes the categories therapeutic relationship, care in context and evolving midwifery knowledge. The findings of this study suggest that the midwives are aware of a range of assessment methods, however there was less articulation or demonstration of methods pertaining to assessment of uterine health. The motivating and modifying factors highlight midwife, woman and contextual factors, which may enhance and inhibit the midwives clinical reasoning process. The complexity of contemporary midwifery practice is illuminated as these factors conflict and create practice tensions and contradictions for the midwives. There was limited evidence that the midwives involved women in deciding the approach to genital tract assessment. Implications include the need to ensure midwives have the knowledge regarding uterine health and the skills and affective abilities to engage women in health assessments and practice effectively within the complexity of contemporary practice

Factors contributing to falls in a tertiary acute care setting in Cape Town, South Africa: a descriptive study

Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement

The Reliability, Practicality and Acceptability of Using Ultrasonography to Monitor the Progress of Labour and Delivery

Introduction: It had been suggested by a number of recent studies that ultrasonography could become an alternative to digital vaginal examination (VE) for assessing the progress of pregnant women in labour. However, no systematic review and meta-analysis on the effectiveness of ultrasonography was available. Systematic Review: A systematic review and meta-analysis was conducted to investigate the success rate of ultrasonography in comparison with digital VE and the level of agreement between the two methods, in terms of estimating fetal head position, head station and cervical dilatation. Systematic Review Findings: This review found that ultrasonography has a higher success rate than digital VE in estimating fetal head position. Ultrasonography was also in high agreement with digital VE in estimating cervical dilatation, with insignificant difference in the success rate of the two methods in terms of detecting cervical dilatation. There was also a significant correlation between the two methods in estimating head station. However, it was also found by the review that, existing primary studies were mainly conducted in tertiary settings of developed countries. Further research was therefore needed from the perspective of non-tertiary settings and also from developing country settings. In addition, further research was also needed to assess the diagnostic performance of ultrasound in detecting active labour, since it is associated with cervical dilatation. The diagnostic performance of ultrasound in detecting engaged fetal head had also not been investigated, which is necessary because it is associated with head station. Primary Research Aim: As a consequence of these systematic review findings, a primary study was conducted in another clinical setting in a developing country. The aim was to investigate the reproducibility, practicality and acceptability of using ultrasonography to monitor the progress of pregnant women in labour. Research Methods: A cross-sectional study was conducted in a teaching hospital in Ghana. The agreement between ultrasound and digital VE was statistically analysed for the estimation of fetal head position, head station and cervical dilatation. Further statistical analysis was conducted on the diagnostic performance of ultrasound in detecting engaged fetal head, and the diagnostic performance of ultrasound in detecting active labour. A quantitative survey of mothers’ acceptance of intrapartum ultrasound was also conducted. Lastly, caregivers’ views on the practicality of using ultrasound in this developing country setting was also investigated in a qualitative survey. Results of Primary Research: The results regarding reproducibility were as follows: (i) a high between-method agreement was found in the estimation of cervical dilatation, with high ultrasound sensitivity and specificity in detecting active labour; (ii) a statistically significant between-method agreement was found in the estimation of head station, with high ultrasound sensitivity and specificity in detecting engaged fetal head; (iii) a weak between-method agreement was found in the estimation of fetal head position, with ultrasound having a higher success rate than digital VE. The results regarding acceptability showed that most mothers accepted the use of intrapartum ultrasound, and were willing to have the procedure for their future care during labour and childbirth. They also preferred ultrasound to digital VE. With regards to practicality, the responses of caregivers indicate that the introduction of intrapartum ultrasound in this setting could serve as a good complement to digital VE in a number of ways. However, putting it into practice would require wider availability of physical and technical resources. Conclusion: The findings of the reproducibility study were consistent with existing studies in other clinical settings which were investigated in the systematic review. This suggests that ultrasound is a reliable method for assessing the progress of pregnant women in labour. In addition, the unique contribution to existing knowledge obtained from this study was a high ultrasound sensitivity and specificity in detecting active labour and engaged fetal head which were reported for the first time. The findings on mothers’ acceptability were also consistent with existing studies in other settings, which is an indication that there is high acceptance of intrapartum ultrasound by mothers from different settings and cultures. Lastly, caregivers’ views on the practicality of the use of ultrasound during labour indicate that the regular use of intrapartum ultrasound for assessing the progress of labour in pregnant women may require additional resources to make it practicable in this and other similar settings

Discussing risk during pregnancy : the experiences of midwives and women with pre-existing diabetes

This portfolio thesis contains three separate parts: a systematic literature review, an empirical study and corresponding appendices.Part one is a systematic literature review, which uses meta-ethnography to synthesise qualitative empirical studies investigating the female experience of living and coping with Type 1 Diabetes mellitus and the impact on identity. A systematic database search identified nine articles which were included. The synthesis of findings resulted in seven subthemes and four super-ordinate themes: ‘Identity shaped by the grip of blood glucose levels’, ‘The influence of others’, ‘Resistance against a ‘diabetic’ identity’ and ‘Creating Stability: integrating diabetes’. The quality of included studies was reviewed and the overall strength of literature considered. Results are discussed in relation to implications for clinical practice in diabetes care and areas for future research.Part two is an empirical study exploring the experience of discussing risk from the perspective of midwives and pregnant women with Type 1 diabetes mellitus. Five midwives and eight women with Type 1 diabetes were interviewed. Data was analysed using Interpretative Phenomenological Analysis. Twelve subthemes and four super-ordinate themes were identified: ‘Understanding and responding to risk’, ‘Talking about risk’, ‘Negotiating choice and control’ and ‘The relationship buffer’. Results are discussed in relation to relevant theory, implications for clinical practice in maternity care and suggestions for future research.Part three includes appendices which support the meta-ethnography and empirical study. This contains an epistemological statement and a reflective statement detailing the research processes and underpinnings