Managing deteriorating patients: registered nurses' performance in a simulated setting

AIM: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. BACKGROUND: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. METHODS: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. RESULTS: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. CONCLUSION: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance

Postural threat increases sample entropy of postural control

IntroductionPostural threat elicits modifications to standing balance. However, the underlying neural mechanism(s) responsible remain unclear. Shifts in attention focus including directing more attention to balance when threatened may contribute to the balance changes. Sample entropy, a measure of postural sway regularity with lower values reflecting less automatic and more conscious control of balance, may support attention to balance as a mechanism to explain threat-induced balance changes. The main objectives were to investigate the effects of postural threat on sample entropy, and the relationships between threat-induced changes in physiological arousal, perceived anxiety, attention focus, sample entropy, and traditional balance measures. A secondary objective was to explore if biological sex influenced these relationships.MethodsHealthy young adults (63 females, 42 males) stood quietly on a force plate without (No Threat) and with (Threat) the expectation of receiving a postural perturbation (i.e., forward/backward support surface translation). Mean electrodermal activity and anterior–posterior centre of pressure (COP) sample entropy, mean position, root mean square, mean power frequency, and power within low (0–0.05 Hz), medium (0.5–1.8 Hz), and high-frequency (1.8–5 Hz) components were calculated for each trial. Perceived anxiety and attention focus to balance, task objectives, threat-related stimuli, self-regulatory strategies, and task-irrelevant information were rated after each trial.Results and DiscussionSignificant threat effects were observed for all measures, except low-frequency sway. Participants were more physiologically aroused, more anxious, and directed more attention to balance, task objectives, threat-related stimuli, and self-regulatory strategies, and less to task-irrelevant information in the Threat compared to No Threat condition. Participants also increased sample entropy, leaned further forward, and increased the amplitude and frequency of COP displacements, including medium and high-frequency sway, when threatened. Males and females responded in the same way when threatened, except males had significantly larger threat-induced increases in attention to balance and high-frequency sway. A combination of sex and threat-induced changes in physiological arousal, perceived anxiety, and attention focus accounted for threat-induced changes in specific traditional balance measures, but not sample entropy. Increased sample entropy when threatened may reflect a shift to more automatic control. Directing more conscious control to balance when threatened may act to constrain these threat-induced automatic changes to balance

Graduate Nurse Program Coordinators\u27 perspectives on graduate nurse programs in Victoria, Australia: A descriptive qualitative approach

Aims: The purpose of this study was to describe the formal preparation nursing graduates are given throughout their first year of nursing in terms of educational structure and content of work-based year-long graduate nurse programs, from the perspectives of Graduate Nurse Program Coordinators. Background: In Australia, graduate nurse programs aim to provide a supportive learning environment, assisting nursing graduates in applying their theory to practice and supporting them in becoming safe, competent and responsible professionals. Internationally, research has demonstrated an increase in the job satisfaction and more importantly retention rates of newly qualified nurses who are supported in their first year of employment in some type of transition program. Method: Using a descriptive qualitative approach, individual semi-structured interviews were used. These interviews were audio recorded, transcribed verbatim and thematically analysed to reveal themes and sub-themes. Results: The interviews provided an insight into the various aspects of preparation that nursing graduates are given in their first year of practice with the main theme to emerge from analysis, nature of transition programs. The three subthemes associated with nature of transition programs consisted of composition of rotations and study days and supernumerary strategies. Findings indicate variation in pedagogical models underpinning graduate nurse programs across Victoria. Clinical rotations varied between three to twelve months, the number of study days offered were between four and thirteen days and there was variation in supernumerary time and strategies within the programs investigated

Objections to economic restructuring and the strategies of coercion: an analytical evaluation of policies and practices in Australia and the United States

N.B. Professor Clark was based at the Department of Geography and Environmental Science at Monash University, Melbourne, Australia when this paper was published. We are not permitted to provide full-text of this article in ORA. Citation: Clark, G. L. et al. (1992). 'Objections to economic restructuring and the strategies of coercion: an analytical evaluation of policies and practices in Australia and the United States', Economic Geography, 68(1), 43-59

Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines.Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE).Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas

Apportionment of Sulfur Oxides at Canyonlands During the Winter of 1990--I. Study Design and Particulate Chemical Composition

Spherical aluminosilicate (SAS) particles, total fluoride and particulate trace elements are potential endemic tracers for determining and quantifying the presence of coal-fired power plant and other sulfur oxide source emissions at far downwind distances. These endemic tracers, and sulfate and SO2 were collected at Canyonlands National Park, at seven ambient sampling sites located in air mass transport paths to Canyonlands and from the stacks of coal-fired power plants in central Utah during January-March of 1990 for use in source apportionment analyses. These data have been combined with results obtained in concurrent studies by the National Park Service (EPIC study) and Salt River Project to provide a complete data set for the characterization of the regional and point sources that can influence air quality in the Canyonlands area. This paper gives details on the study design and on the chemical composition of fine particulate matter in the study area. While concentrations of SOx(SO2(g) plus particulate sulfate) were in good agreement among the various studies, accurate concentrations for sulfate and SO2 were only obtained using a diffusion denuder sampling system because of the absorption of SO2(g) by particles in all filter pack sampling systems. Concentrations of FTTotal (HF(g) plus particulate fluoride), and particulate Se, As, and Pb determined by multiple techniques were generally in good agreement. Sulfate (assumed present as ammonium sulfate) and nitrate (assumed present as ammonium nitrate) accounted for an average of 19 and 4%, respectively, of the fine particulate mass collected at Canyonlands and 8 and 2% of the fine particulate mass at Green River, Utah. Data were available at the Edge of the Cedars, Utah, sampling site to estimate the complete chemical composition of the fine particles. The average concentration of fine particles at Edge of the Cedars was 15 μg m−3. Sulfate (as the ammonium salt) averaged 15% of the fine particulate mass, comparable to Canyonlands. Nonsulfate inorganic compounds averaged 58% of the mass. The majority of these inorganic species are background desert particles. The remainder of the mass, 27%, is presumably water, and organic and elemental carbon

Incorporating cardiopulmonary resuscitation training into a cardiac rehabilitation programme: A feasibility study

The European Society of Cardiology 2017. Background: Patients with a cardiac history are at future risk of cardiac events, including out-of-hospital cardiac arrest. Targeting cardiopulmonary resuscitation (CPR) training to family members of cardiac patients has long been advocated, but is an area in need of contemporary research evidence. An environment yet to be investigated for targeted training is cardiac rehabilitation. Aim: To evaluate the feasibility of providing CPR training in a cardiac rehabilitation programme among patients, their family members and staff. Methods: A prospective before and after study design was used. CPR training was delivered using video self-instruction CPR training kits, facilitated by a cardiac nurse. Data was collected pre-training, post-training and at one month. Results: Cardiac patient participation rates in CPR classes were high (n = 56, 72.7% of eligible patients) with a further 27 family members attending training. Patients were predominantly male (60.2%), family members were predominantly female (81.5%), both with a mean age of 65 years. Confidence to perform CPR and willingness to use skills significantly increased post-training (both p < 0.001). Post training participants demonstrated a mean compression rate of 112 beats/min and a mean depth of 48 mm. Training reach was doubled as participants shared the video self-instruction kit with a further 87 people. Patients, family members and cardiac rehabilitation staff had positive feedback about the training. Conclusions: We demonstrated that cardiac rehabilitation is an effective and feasible environment to provide CPR training. Using video self-instruction CPR training kits enabled further training reach to the target population