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Author |
Blair, K.M. |
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Title |
Recognising the sick patient: An emergency nurses view: A research paper |
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Year |
2006 |
Publication |
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Abbreviated Journal |
Victoria University of Wellington Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing; Patient safety; Diagnosis; Training; Clinical decision making |
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Abstract |
This paper reports on a literature review that examines how health professionals (mainly nurses) recognise the signs of physical deterioration in their patients. It includes discussion of how nurses' clinical decision making skills influence how physical deterioration is identified and determines what changes in the delivery of care could have an impact on emergency department patients at risk of life threatening deterioration. |
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Call Number  |
NRSNZNO @ research @ |
Serial |
467 |
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Author |
Hughes, M.; Farrow, T. |
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Title |
Invisible borders: Sexual misconduct in nursing |
Type |
Journal Article |
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Year |
2005 |
Publication |
Nursing Praxis in New Zealand |
Abbreviated Journal |
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Volume |
21 |
Issue |
2 |
Pages |
15-25 |
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Keywords |
Patient safety; Nursing; Guidelines |
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Abstract |
This paper identifies the issue of sexual misconduct by nurses in New Zealand. There is evidence that some nurses have been involved in sexual misconduct, resulting in disciplinary proceedings against them. Despite this, there is an absence of guidelines and discussion for New Zealand nurses to prevent such occurrences. This article identifies difficulties in naming and defining sexual misconduct, and discusses sexual misconduct as an abuse of power by nurses. New Zealand and international literature about sexual misconduct by nurses and other health professionals is described, as are guidelines designed to prevent sexual misconduct. Finally, the authors make recommendations for actions needed to facilitate New Zealand nurses in identifying and avoiding sexual misconduct in practice. |
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Call Number |
NRSNZNO @ research @ |
Serial |
537 |
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Author |
Warren, B.L. |
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Title |
Intramuscular injection angle: Evidence for practice? |
Type |
Miscellaneous |
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Year |
2002 |
Publication |
Nursing Praxis in New Zealand |
Abbreviated Journal |
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Volume |
18 |
Issue |
2 |
Pages |
42-51 |
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Keywords |
Patient safety; Immunisation |
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Abstract |
This article presents the findings of a search for evidence to support the 45-60 degree angle of insertion for intramuscular injection of vaccine which is recommended in New Zealand. With the objective of discovering the evidence base for an intramuscular injection angle which differs from that recommended by the World Health Organisation and the accepted practice experienced by the author in the UK, Canada, Malawi and the USA, a comprehensive library and internet literature search was undertaken. Information was also sought by personal correspondence and contact with a range of immunisation specialists. Both the literature specifically on needle angle and that which includes needle angle within a wider investigation of technique is included. Overwhelmingly the evidence supports a 90 degree angle of needle insertion for intramuscular injection as being most effective in terms of patient comfort, safety and efficacy of vaccine. |
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Call Number |
NRSNZNO @ research @ |
Serial |
616 |
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Author |
McBride-Henry, K.; Foureur, M. |
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Title |
A secondary care nursing perspective on medication administration safety |
Type |
Journal Article |
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Year |
2007 |
Publication |
Journal of Advanced Nursing |
Abbreviated Journal |
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Volume |
60 |
Issue |
1 |
Pages |
58-66 |
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Keywords |
Patient safety; Drug administration; Organisational culture; Nursing |
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Abstract |
This paper reports on a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, or undermine, safe practice during this process. Data were collected in 2005 using three focus groups of nurses that formed part of a larger study examining organisational safety and medication administration from a nursing perspective. A narrative approach was employed to analyse the transcripts. Participants had good understandings of organisational culture in relation to medication safety and recognised the importance of effective multi-disciplinary teams in maintaining a safe environment for patients. Despite this, they acknowledged that not all systems work well, and offered a variety of ways to improve current medication practices. These findings highlight the meaningful contribution nurses can make to patient safety and emphasise the importance of including the nursing voice in any quality improvement initiatives. |
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Call Number |
NRSNZNO @ research @ |
Serial |
648 |
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Author |
McBride-Henry, K.; Foureur, M. |
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Title |
Medication administration errors: Understanding the issues |
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Journal Article |
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Year |
2006 |
Publication |
Australian Journal of Advanced Nursing |
Abbreviated Journal |
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Volume |
23 |
Issue |
3 |
Pages |
33-41 |
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Keywords |
Nursing; Patient safety; Medical errors; Drug administration; Quality assurance |
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Abstract |
This literature review focused on research that primarily addresses the issues related to medications that arise in tertiary care facilities. It finds that investigations into medication errors have primarily focused on the role of nurses, and tended to identify the nurse as deliverer of unsafe practice. Over the past few years a shift in how medication errors are understood has led to the identification of systems-related issues that contribute to medication errors. The author suggests that nurses should contribute to initiatives such as the 'Quality and Safe Use of Medicines' and develop nursing led research, to address some of the safety related issues with a view to enhancing patient safety. |
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Call Number |
NRSNZNO @ research @ |
Serial |
715 |
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Author |
McBride-Henry, K.; Foureur, M. |
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Title |
Organisational culture, medication administration and the role of nurses |
Type |
Journal Article |
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Year |
2006 |
Publication |
Practice Development in Health Care |
Abbreviated Journal |
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Volume |
5 |
Issue |
2 |
Pages |
208-222 |
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Keywords |
Patient safety; Medical errors; Organisational culture; Nursing; Drug administration |
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Abstract |
This research study was designed to identify ways of enhancing patient safety during the administration of medications within the New Zealand context. The researchers employed a multi-method approach that included a survey using the Safety Climate Survey tool, focus groups and three clinical practice development groups. The authors conclude that the outcomes of this study indicate that practice development initiatives, such as the ones outlined in this project, can have a positive effect on nurses' perceptions of organisational safety, which in turn has been demonstrated to have a positive impact on patient safety. |
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Call Number |
NRSNZNO @ research @ |
Serial |
784 |
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Author |
Smythe, E. |
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Title |
Uncovering the meaning of 'being safe' in practice |
Type |
Journal Article |
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Year |
2003 |
Publication |
Contemporary Nurse |
Abbreviated Journal |
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Volume |
14 |
Issue |
2 |
Pages |
196-204 |
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Keywords |
Childbirth; Patient safety; Advanced nursing practice; Midwifery |
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Abstract |
This paper moves away from the prevalent discourse of competence to consider the meaning of the experience of 'being safe' within the context of childbirth. It offers findings from a doctoral study, informed by the philosophies of Heidegger and Gadamer. Following ethical approval, the data was collected in New Zealand by tape-recorded interviews of 5 midwives, 4 obstetricians, 1 general practitioner and 10 women. The method was informed by van Manen. The findings reveal that in seeking the meaning of being safe one needs to be aware that the unsafety may already be present in the situation. Practitioners may be able to do little to rectify the unsafeness. There is, however, a spirit of safe practice, explicated in this paper, that is likely to make practice as safe as it can possibly be. Wise practitioners are ever mindful that a situation may be or become unsafe, and are always aware of their own limitations. |
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Call Number |
NRSNZNO @ research @ |
Serial |
877 |
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Author |
Evans, S. |
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Title |
Silence kills: Challenging unsafe practice |
Type |
Journal Article |
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Year |
2007 |
Publication |
Kai Tiaki: Nursing New Zealand |
Abbreviated Journal |
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Volume |
13 |
Issue |
3 |
Pages |
16-19 |
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Keywords |
Medical errors; Organisational change; Organisational culture; Patient safety; Interprofessional relations |
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Abstract |
The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals. |
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Call Number |
NRSNZNO @ research @ |
Serial |
994 |
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Author |
Horsburgh, M.; Merry, A.; Seddon, M.; Baker, H.; Poole, P.; Shaw, J.; Wade, J. |
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Title |
Educating for healthcare quality improvement in an interprofessional learning environment: A New Zealand initiative |
Type |
Journal Article |
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Year |
2006 |
Publication |
Journal of Interprofessional Care |
Abbreviated Journal |
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Volume |
20 |
Issue |
5 |
Pages |
555-557 |
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Keywords |
Quality of health care; Multidisciplinary care teams; Nursing; Education; Maori; Patient safety |
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Abstract |
This article describes two interprofessional learning modules offered by the Faculty of Medical and Health Sciences at the University of Auckland to undergraduate medicine, nursing and pharmacy students. The modules, 'Maori Health“ and ”Patient Safety", have a focus on quality improvement in healthcare and are used to bring together students for a shared learning programme.The specific dimensions of healthcare quality covered in the programme are: patient safety, equity, access, effectiveness, efficacy and patient-centeredness. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1042 |
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Author |
McCloskey, B.A.; Diers, D. |
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Title |
Effects of New Zealand's health reengineering on nursing and patient outcomes |
Type |
Journal Article |
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Year |
2005 |
Publication |
Medical Care |
Abbreviated Journal |
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Volume |
43 |
Issue |
11 |
Pages |
1140-1146 |
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Keywords |
Patient safety; Organisational change; Nursing; Hospitals |
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Abstract |
This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1052 |
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Author |
Stokes, G. |
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Title |
Who cares? Accountability for public safety in nurse education |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
Online at Research Space @ Auckland University |
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Volume |
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Issue |
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Pages |
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Keywords |
Nursing; Education; Accountability; Patient safety |
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Abstract |
The focus of this study is the management of unsafe nursing students within the tertiary education context. The moral dilemmas experienced by nurse educators, specifically linked to the issue of accountability for public safety, are explored. The theoretical framework for the thesis is informed by the two moral voices of justice and care identified by Gilligan and further developed using the work of Hekman and Lyotard. Case study methodology was used and data were collected from three schools of nursing and their respective educational organisations. Interviews were conducted with nurse educators and education administrators who had managed unsafe nursing students. Interviews were also conducted with representatives from the Nursing Council of New Zealand and the New Zealand Nurses Organisation to gain professional perspectives regarding public safety, nurse education and unsafe students. Transcripts were analysed using the strategies of categorical aggregation and direct interpretation. Issues identified in each of the three case studies were examined using philosophical and theoretical analyses. This thesis explores how students come to be identified as unsafe and the challenges this posed within three educational contexts. The justice and care moral voices of nurse educators and administrators and the ways in which these produced different ways of caring are made visible. Different competing and conflicting discourses of nursing and education are revealed, including the discourse of safety – one of the language games of nursing. The way in which participants positioned themselves and positioned others within these discourses are identified. Overall, education administrators considered accountability for public safety to be a specific professional, nursing responsibility and not a concern of education per se. This thesis provides an account of how nurse educators attempted to make the educational world safe for patients, students, and themselves. Participants experienced different tensions and moral dilemmas in the management of unsafe students, depending upon the moral language games they employed and the dominant discourse of the educational organisation. Nurse educators were expected to use the discourses of education to make their case and manage unsafe students. However, the discourses of nursing and education were found to be incommensurable and so the moral dilemmas experienced by nurse educators were detected as differends. This study bears witness to these differends. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1106 |
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Author |
Whitehead, N. |
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Title |
Quality and staffing: Is there a relationship in aged residential care |
Type |
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Year |
2007 |
Publication |
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Abbreviated Journal |
University of Auckland Library |
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Volume |
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Issue |
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Pages |
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Keywords |
Rest homes; Patient safety; Older people; Nursing specialties |
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Abstract |
This thesis reports a mixed methods study, longitudinal in nature, of consenting Age Related Residential Care (ARRC) hospitals in the upper half of the North Island, which was conducted to examine several factors, including AARC hospital efficiency at producing adverse event free days for residents. An interpretativist approach examined what best practice strategies were implemented by the ARRC hospitals that were identified to be most successful at producing adverse event free days for the residents. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1159 |
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Author |
Rudd, J. |
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Title |
From triage to treatment: An exploration of patient flow systems in emergency departments |
Type |
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Year |
2005 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Emergency nursing; Hospitals; Risk management; Patient safety |
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Abstract |
To find an effective approach to managing or reducing waiting times for lower triage category patients processed through one particular metropolitan emergency department, an extensive search of the literature revealed several different patient flow processes. These approaches are discussed, in relation to suitability for the particular emergency department. The history of triage, including how and why it evolved, plus the realities of triage today are explored. Included are case examples of two patients on a journey through the department the way it is presently, and how it could be if particular approaches are introduced. Extending nursing practice by introducing nurse-initiated x-rays at triage and the introduction of a separate stream for minor category patients in a dedicated ambulatory care area is one approach that could improve waiting times for these patients. There would be the added advantage of improving triage compliance figures for category three patients. The additional costs involved in such a process could be offset by improved efficiency in terms of waiting times, improved triage compliance figures, happier patients and clinical staff, and an emptier waiting room. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1209 |
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Author |
Fairhall, M. |
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Title |
An observational study of Peripherally Inserted Central Cather(PICC)-related complications amongst oncology patients |
Type |
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Year |
2008 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Patient safety; Equipment and Supplies; Nursing specialties; Cancer; Oncology |
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Abstract |
This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days. Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer. These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1222 |
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Author |
Börner, Heidi.E |
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Title |
Evaluating safe patient handling systems: Is there a better way? |
Type |
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Year |
2008 |
Publication |
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Abbreviated Journal |
ResearchArchive@Victoria |
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Volume |
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Issue |
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Pages |
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Keywords |
Patient safety; Evaluation research; Occupational health and safety |
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Abstract |
This observational study analyses the responses of 38 nurses from two similar units that use different patient handling systems to test the reliability and validity of the Safe Patient Handling Survey (TM) SPH Survey(TM), a perception survey and improvement tool for employees and employers. Currently there is a lack of tools for evaluating patient handling systems. The survey contains 55 questions divided into 6 clusters, staff and patient injury and violence questions, and picture questions depicting unsafe techniques. The data were analysed to see how the SPH Survey(TM) scores correlate with incidents, and its ability to detect differences between the two units. The results of the Pearson and Cronbach(TM) alpha tests show strong reliability, validity and consistency of the SPH Survey(TM). ANOVA comparison of means and Spearman(TM) rho tests shows that higher (better) scores on the SPH Survey(TM) clusters correlate with lower numbers of patient injuries, lower reports of verbal and physical violence episodes, and lower staff injuries. Differences were detected between the units with Unit 2 scoring higher than Unit 1 in all SPH Survey(TM) clusters and scoring lower in staff and patient injuries and violence incidents. Although the analysis was limited by the small sample size, the study has created a sound basis for further investigation. The SPH Survey(TM) is shown to be an easy way to reliably evaluate patient handling systems and workplace culture, target improvement initiatives, and continually monitor the level of patient handling risk in the workplace. Low-risk patient handling gives health care providers the means to focus on delivering high quality patient care, without endangering their own health and well-being. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1224 |
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