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Pearce, L.; Kirkham, S.; Cuthbertson, S. |
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Title |
Quality of follow-up for self-poisoning patients after discharge from intensive care: 1996, one year later |
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1996 |
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DCCM, Auckland Hospital, P.O.Box 92024, Auckland |
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Abstract  |
In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care. |
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NRSNZNO @ research @ 207 |
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207 |
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Author |
Pearce, L.; Cuthbertson, S.; Streat, S.J.; Hay, D. |
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Title |
Dental hygiene in the critically ill: a randomised controlled trial of three methods |
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1996 |
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DCCM, Auckland Hospital, Private Bag 92024, Auck |
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Introduction Critically ill patients cannot clean their own teeth. A variety of methods are used but as the best method is unknown we performed a prospective randomised double-blind controlled trial of three methods.Method Of 359 consecutive admissions to the Department of Critical Care Medicine between 31/01/97 and 25/05/97, 222 were excluded (62 edentulous, 6 unexaminable, 142 transferred alive and 12 dead or dying at 24 hours). The remaining 137 patients had quantitative (picture-linked, ordinal score) assessment of caries, peridontal status and plaque (in 12 segments of teeth) before randomisation (to the use of either toothbrush, jumbo swab or sonic toothbrush) by pre-assigned sealed envelopes. All teeth were cleaned (prescribed four hourly) with 0.2% chlorhexidine solution. Daily plaque scores were obtained (by an assessor (SC) blind to treatment allocation) until withdrawal, death or transfer.Results Toothbrush Jumboswab SonicPatients assigned 50 48 39Withdrawn within 24hrs. 9 3 5Patients remaining 41 45 34Percentage of teeth segments thatare pristine: pre treatment 45 50 51 after 2 days 74 57 90 F(2.63) = 5.00 p = 0.0097 More withdrawals for patient noncompliance after randomisation occurred in the sonic group (5/34 versus 3/86). Conclusion. By the second day the sonic toothbrush was the most effective in plaque removal with the toothbrush the next most effective method |
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NRSNZNO @ research @ 203 |
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203 |
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Margetts, M.; Cuthbertson, S.; Streat, S.J. |
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Title |
Bereavement follow-up – its impact on practice |
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1996 |
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DCCM Auckland Hospital |
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Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care |
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NRSNZNO @ research @ 200 |
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200 |
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Walker, J. |
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Title |
Co-operative learning: an effective teaching method for tertiary education? |
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1996 |
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Author, Christchurch Polytechnic Library |
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Tertiary education aims to develop specialist knowledge and the graduates' ability toapply the knowledge and skills to function effectively in their chosen career or work.Employers have criticised tertiary education when graduates cannot workco-operatively or independently in the work setting and teachers look for alternativesto lecturing to help develop these abilities. Cooperative learning (CL) is one suchmethod and this paper reports on a literature review and pilot study which exploredthe use of CL in a tertiary setting. The study was guided by three questions: 1) Whatarea the teacher's conceptions of effective learning and teaching? 2) How are theyusing CL and what is their role? 3) How are they assessing CL classes?Data was collected through in-depth interviews, using semi-structured questions,with three female and one male teacher from different disciplines in an urbanpolytechnic. Responses to each question were analysed thematically for recurringcodes and these were grouped into categories. Effective teaching was seen aswhere teachers facilitated the learning process by selecting appropriate teachingmethods, fostering classroom climate and monitoring learning. Effective learning waswhere students were actively engaged in the learning process and demonstratedtheir understanding and application of knowledge and skills. CL was used in avariety of ways and their role was to use strategies to foster the learning processand monitor learning. Assessment involved both individual and group presentations.Issues related to cooperative learning are discussed and recommendations forteaching made |
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NRSNZNO @ research @ 194 |
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194 |
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Author |
Andrews, E. |
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Title |
The living power of words |
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1996 |
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E. I. T. Library, Gloucester Street, Taradale, Haw |
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The experience of loneliness within a people-centered profession has supported nursings silencing and invisibility. A literature expedition through communication texts and journals led to an awareness of the paucity of literature which explores and acknowledges how we dialogue together, rather than the more fashionable focus on how we should communicate with others. |
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NRSNZNO @ research @ 158 |
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158 |
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Author |
Cooney, C. |
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The ICN international classification for nursing practice project. Terms used by community-based mental health nurses to describe their practice |
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1996 |
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Massey University Library |
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The ICN International classification for nursing practice project.Terms used by Community-based Mental Health Nurses to describe their practice.In December 1995 a team of advisors from throughout the Asia and pacific region gathered in Taipei, Republic of China, for the International Council of Nurses (ICN) International Classification of Nursing Practice (ICNP) project. During the week long workshop the early draft Classification architecture was presented and exercises were undertaken to test the relevance and accuracy of selected Terms and associated characteristics from the classification. The team of Consultants, who have been working on the Classification since 1990, identified that the most underdeveloped aspects of the hierarchy were community health and mental health nursing. They encouraged the team of Advisors to conduct research with nurses to add to these areas of the Classification in particular.The purpose of the ICP is to make nursing visible through an internationally accepted language which represents nursing diagnoses, interventions and outcomes. The classification is sponsored by ICN and follows a format similar to the WHO International Classification of Diseases (ICD) which is used extensively throughout the world to statistically record work completed by medical practitioners.The research undertaken at Lakeland Health with five Community-based Mental Health Nurses used the retrospective method of nursing diagnosis validation tool and field exercise method provided by the ICNP Consultant team. These were underpinned by participatory action research methodology. Over four sessions the participants identified six Terms and then field tested each to assess the relevance of that Term in practice. At the weekly sessions the participants shared their reflections on the validity of each Term and discussed other outcomes resulting from their involvement in the research process.The research report outlines the ICNP project and associated literature, explains the research methodology, identifies the resulting Terms and characteristics ready for submission to the ICNP Consultant team and examines outcomes from involvement in the participatory process |
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NRSNZNO @ research @ 363 |
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363 |
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Author |
Gasquoine, S.E. |
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Title |
Constant vigilance: the lived experience of mothering a hospitalised child with acute illness or injury |
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1996 |
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Massey University Library |
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This phenomenological study describes the lived experience of mothering a child hospitalised with acute illness or injury. Seven mothers who had experienced this crisis within twelve months of our first interview agreed to share their stories with me. The resulting data were analysed and interpreted using van Manen's interpretation of Heideggerian phenomenology.Four phenomenological themes emerged from this study. Mothers have a special kind of knowing. They have a need to do with and for their child. Handing over to or leaving their child in the care of strangers and waiting for their child to be returned to their care are very difficult things for mothers to do. Their constant vigilance is enabled by their special kind of knowing and their need to do. The difficulty of handing over, leaving and waiting is emphasised by mothers' constant vigilance.Personal experiences during the course of my study presented significant challenges to my ability to offer an effective phenomenological description of the phenomenon under study. Continuous reflection aided by dialogue with fellow phenomenological researchers has resulted in a meaningful narrative.This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalisation of their children. It supports the philosophy of family-centered care and highlights the ability of individual nurses to make a positive difference to a very stressful experience |
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NRSNZNO @ research @ 168 |
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168 |
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