Academic Department
Cabrini – Deakin Centre for Nursing Research
Projects
Healthcare-associated infections: An in-depth review of associated
factors and patient sequelae
Research Team: Anne Gardner, Bev O’Connell,
Mary Hawkins, Robyne Renton, Deana Copley
Healthcare-associated infections are one of the five top adverse events. In Australia, there are an estimated 150,000 health-care associated infections that contribute to 7,000 deaths each year. Bloodstream and urinary tract infections (UTIs) are two of the four main healthcare-associated infections. This study reviewed patient and system factors associated with the development of and subsequent patient outcomes after bloodstream infections and UTIs to inform implementation of appropriate best practice interventions. The aim of this project was to investigate the patient and system factors associated with those patients who develop healthcare-associated infection as compared to those who do not develop infections. The project also explored the similarities and differences in patient outcomes for these two groups of patients and determined the extent to which hospital treatment of healthcare-associated infections meets best practice guidelines.
Decreasing medication error risk in Australian hospitals
Research
Team: Anne Gardner, Bev O’Connell and others
Every year in Australia, almost 200 million prescriptions are dispensed - approximately ten prescriptions per year per person. Medication errors account for up to 20% of all adverse events in health care and are estimated to cost $380 million per year in the public hospital system. Patients can be harmed as a result of these adverse events with outcomes ranging from temporary injuries, which may or may not require medical intervention, to more serious conditions including permanent damage and life-threatening complications. Importantly, a considerable proportion of patient harm caused by medication error is potentially preventable. Phase 1 of the project was an intensive retrospective review of medication errors that involved six acute and subacute hospital sites across metropolitan, regional and rural Victoria. Outcomes include site-specific analysis as well as a major multi-site analysis. In Phase 2, clinician focus groups were conducted discuss findings and to inform the development of a multi-faceted intervention to be tested in Phase 3.
Recovering at home following chemotherapy as a day patient: An exploration
of the management issues for patients and carers
Research team: Bev O’Connell, Mary Hawkins,
Emma Cohen, Amanda Groenewegen
As a result of improved cancer treatments and increased availability of medications for managing side effects, many patients are treated for cancer as day patients. This change in the delivery of cancer services from inpatient care to outpatient services reflects the larger transformation of medical care for most diseases in recent years. Consequently, patients are required to self-care and manage healthcare issues in their homes. Newly diagnosed patients receive a large amount of information on their diagnosis, prognosis and treatment options in a short period of time while they are still reacting emotionally to their diagnosis. This excessive information may overwhelm patients and result in unnecessary fears, confusion and anxiety for both patient and family. However, those patients who are better informed about expected side effects and self-care activities cope better and initiate self-care techniques to a greater extent than those patients who are uninformed. No research has focused on the issues around cancer patients’ recuperation at home after receiving treatment as outpatients. Information is therefore currently lacking on the care needs of these cancer patients, the frequency and type of problems they encounter during this period, and whether the information they receive is sufficient. Consequently, research is needed to understand patient recovery and recuperation in their homes following chemotherapy to ensure that good patient outcomes are maintained in the outpatient setting. The aims of this study are to explore cancer patients’ recovery experience at home and to assess whether the education given to patients addresses the issues they experience within their recuperative phase.
Mapping and intervention for prevention of pressure injury
AusIndustry Grant
Research team:
Anne Gardner, Marlene Eggert, Ann Marie Dunk, Glenn Gardner
The aetiology of pressure injury is not fully understood although it is known that the injuries are the result of a number of forces exerted on the tissues, predominantly pressure. Prolonged pressure applied to a localised area of tissue can result in occlusion of capillary blood flow causing tissue ischaemia, cell destruction and tissue death. Using risk assessment tools nurses endeavour to identify those patients at risk of developing pressure injuries and then use pressure relieving devices such as specialist mattresses. However, the effectiveness of these devices has not been extensively studied in the clinical setting. A three-phase research project was commenced to improve knowledge about risk of pressure injury and the comparative effectiveness of specialist pressure relieving devices. The project investigates the relationship between risk factor scores, interface pressure and capillary blood flow and to undertake a randomised controlled trial of different mattress types currently in use to reduce the risk of pressure injury.
Reforming healthcare: Nurse practitioners and workforce redesign
Research Team: Glenn Gardner, Anne Gardner, Sandy Middleton, Phillip
Della
ARC Linkage
A nurse practitioner or midwifery practitioner (hereafter abbreviated collectively as NP) is a registered nurse with advanced educational preparation that allows autonomous function in an expanded clinical role while working collaboratively with medical practitioners and other health care professionals. This extended role includes prescribing medications, initiating diagnostic investigations and referring patients and NPs are authorised to practice by their state registration authority. The NP is now an established and legitimized entity of health service in six Australian jurisdictions, with the remaining in process of legislative change. The crisis in health care means that NP service is on the agenda for governments seeking creative solutions to health workforce restructure. The NP delivers service at lower cost with potential to improve access and timely health care for under serviced populations. However, little is known about this new level of health care. The aim of this national study is to use an innovative research approach over a three year period to study the profile, process and outcome of NP service in Australia. We also aim to inform health workforce planning and develop an operational platform to evaluate and guide implementation of new NP roles to meet priority health service areas.
Putting the National Guidelines for Falls Prevention and Management
into Practice
Project team: Anne Gardner, Sandra Legg
Medibank Private Safety and Clinical
Improvement Incentive Pool
Reflective of a global concern for patient safety in health care, Cabrini Health has prioritised the implementation of a Falls Prevention and Management Program. In late 2005, the Nursing Quality, Safety and Research Committee gave a directive to establish a Falls Prevention and Management Group. This group was instructed to move this initiative forward with the use of the national guidelines for falls prevention and management that were released in November 2005. These guidelines include comprehensive risk assessment tools and suggestions for the monitoring of processes. In parallel with this initiative, the Cabrini-Deakin Centre for Nursing Research, Nursing Administration and the Cabrini Clinical Educational and Research Institute have been planning a project to evaluate the integration of research evidence into practice. Several meetings have been conducted and we have identified patient safety initiatives as a priority for this research integration process, with falls prevention and management seen as the most urgent patient safety issue. This issue provides an excellent exemplar in the evaluation of research into practice. Research into falls prevention and management is also one of the Centre for Nursing Research’s main areas of interest. The aim of the project is to evaluate the effectiveness (process and associated outcomes) of the implementation into practice of the National Best Practice Guidelines for Preventing Falls and Harm from Falls in Older People in relation to patient, staff and system outcomes.
Palliative HomeCare Satisfaction Report: Carers’ perspectives
of quality of present service and suggested future improvements
Research
team: Anne Gardner, Lera O’Connor, Peter Bennett
Peter Meese Grant
According to Carers Victoria, “Carers are usually family members who provide support to children or adults who have a disability, mental illness, chronic condition or who are frail aged. Carers can be parents, partners, brothers, sisters, friends or children of any age… These people all provide unpaid, informal care”. As a result family caregivers are becoming involved in all phases of care throughout the cancer trajectory, including death. The presence of an (informal) carer is a prerequisite in the successful management of cancer care in the home, especially during palliative phases. This role has a large impact on the carer both during the period of care as well as during the bereavement period. No statistics on the number of family members who take on a carer role during the cancer patients illness exist. However, studies have shown that informal caregivers provided an average of 55 percent of the needed care. The physical changes of patients with cancer either as a result of their disease and/or treatment has resulted in them being dependent on others for very basic and personal activities of daily living which can change the relationship between the person with cancer and their family and friends. The project aims were to explore carers’ levels of satisfaction with the Cabrini Palliative HomeCare Service six weeks after the death of the patient through a systematic analysis of the existing dataset and to develop a targeted questionnaire that can be used to measure carers’ satisfaction levels with Cabrini Palliative HomeCare Services after the death of the patient.
Development on strategies to improve clinical handover
Research team: Sandra Legg, Tracey Bucknall and others
Nursing handovers provide a vital link in the continuity and communication of patient care. There are many types of handovers that have developed over time to accommodate changes in rostering and staff skill mix. Handovers in which information exchange is not performed in an effective manner may compromise patient safety. This problem has occurred at Cabrini on a number of occasions. In the proposed research, we will work with nursing staff to identify how current handover practices can be improved at Cabrini. Nurse handovers serve many purposes including transfer of information, debriefing of nurses (e.g., provides support for nurses), and education primarily of neophyte nurses. Patient safety should be the primary focus of nursing handover. There are many ways of conducting handovers, including verbal handover in an office or nurses’ station, tape-recorded handovers, bedside handovers, and written handovers. As shown in the table, each type of handover has positive features and drawbacks. The effectiveness of each type of handover may depend on the particular needs of the nurses on each ward and the way in which the handovers are conducted. For example, the strengths of the verbal handover in an office or nurses’ station may be enhanced, and the limitations addressed, through developing a structured approach to reporting in this type of handover The purpose of the proposed research is to develop handover practices that can improve the safety of patients at Cabrini Malvern.
