Nursing & Health

Permanent URI for this collectionhttps://research.avondale.edu.au/handle/123456789/457

Browse

Filters

Settings

Search Results

  • Item
    Protocol to Establish Standards for the Elements Infection Prevention and Control Programs and Competencies for Infection Control Professionals in Australian Residential Aged Care Homes
    (PLoS ONE, 2025) Shaban, Ramon Z.; Curtis, Kate; Fry, Margaret; McCormack, Brendan; Parker, Deborah; Macbeth, Deborough; Mitchell, Brett G.; Russo, Phillip L.; Friedman, N. Deborah; Bennett, Noleen; Thompson, Lucy; Dalton, Jo-Ann; Dempsey, Kathy; Henderson, Belinda; Considine, Julie; Bowes, Rachel; Campbell, Elise; Powell, Merrick; Viengkham, Catherine
    The COVID-19 pandemic elucidated the importance of infection prevention and control (IPC) in residential aged care homes (RACHs), both on the health and wellbeing of its residents, and the staff and clinicians who care for them. While considerable efforts have been made in Australia to improve IPC both during and in the aftermath of the COVID-19 pandemic, many of these resources remain reliant on evidence originating from hospitals and acute healthcare settings. This research aims to establish the core minimum components that will populate standards for IPC programs and governance (Stream A) and for professional practice and competencies (Stream B) in RACHs. This research will be completed using a sequential three-phase design. In Phase 1, two integrative literature reviews will be completed to synthesise the elements of current global IPC programs and professional competencies in RACHs. In Phase 2, a qualitative analysis of IPC programs and professional practice in Australian RACHs using a combination of surveys and interviews will be completed. Finally, in Phase 3, an e-Delphi will be conducted to collate expert opinion and generate consensus on the minimum components of the IPC program and professionals who administer them in RACHs. The final standards and resources will be collaboratively designed with aged care partners, industry leaders, professional bodies and key Australian health policymakers. These standards seek to empower IPC and aged care staff, not only by ensuring that they are well-equipped with the knowledge and skills to implement effective IPC programs themselves, but also that the organisation is adequately prepared to provide the resources and governance systems.
  • Item
    “It’s not a Pain you can fix”: A Qualitative Exploration of Working with Vulnerably Positioned Current and Bereaved Carers across Sectors of Health and Social Care
    (Taylor & Francis, 2025) Bindley, Kristin; Lewis, Joanne; DiGiacomo, Michelle
    Caring for someone with a life-limiting illness is associated with complex psychosocial sequelae; amplified for carers experiencing structural vulnerability. Workers across sectors of health and social care provide support for vulnerably positioned carers, yet exploration of the impacts of this work has predominantly focused on health professionals directly engaged with death and dying. This qualitative study explored ways in which palliative care and welfare workers experience work with current and bereaved carers of people with life-limiting illness, in a region associated with socioeconomic disadvantage. Work in this landscape involved: (1) navigation of evocative content, (2) encountering limits of grief literacy, (3) negotiating effects of policy constraints, (4) meaning-making for system survival, and (5) varied utilization of resources and strategies. Findings indicate the need for cross-sectoral recognition of consequences of this work, reflected through initiatives to cultivate grief literacy, acknowledgement of harmful consequences of policy, and structural approaches to workforce well-being.
  • Item
    Determining Timeframes to Death for Imminently Dying Patients: A Retrospective Cohort Study
    (BioMed Central, 2025-01-13) O'Connor, Tricia; Liu, Wai-Man; Samara, Juliane; Lewis, Joanne; Strickland, Karen; Paterson, Catherine
    Background Clinicians are frequently asked ‘how long’ questions at end-of-life by patients and those important to them, yet predicting timeframes to death remains uncertain, even in the last weeks and days of life. Patients and families wish to know so they can ask questions, plan, make decisions, have time to visit and say their goodbyes, and have holistic care needs met. Consequently, this necessitates a more accurate assessment of empirical data to better inform prognostication and reduce uncertainty around time until death. The aims of this study were to determine the timeframes for palliative care patients (a) between becoming comatose and death, and (b) between being totally dependent and bedfast, and then comatose, or death, using Australia-modified Karnofsky Performance Status (AKPS) scores. The secondary aim was to determine if covariates predicted timeframes. Method This is a large retrospective cohort study of 2,438 patients, 18 years and over, cared for as hospice inpatients or by community palliative care services, died between January 2017 and December 2021, and who collectively had 49,842 AKPS data points. An Interval-Censored Cox Proportional Hazards regression model was used. Results Over 53% (n = 1,306) were comatose (AKPS 10) for longer than one day before death (mean = 2 days, median = 1, SD = 2.0). On average, patients were found to be totally dependent and bedfast (AKPS 20) for 24 days, before progressing to being comatose. A difference in life expectancy was observed at AKPS 20 among people with cancer (mean = 14.4, median = 2, SD = 38.8) and those who did not have cancer (mean = 53.3, median = 5, SD = 157.1). Conclusion Results provide clinicians with validated data to guide communication when answering ‘how long’ questions at end-of-life. Knowledge of projected time to death can prompt timely conversations while the patient can understand and engage in meaningful conversations. The importance of considering covariates such as location and diagnosis in determining timeframes has been highlighted. Shared decision-making and essential person-centered end-of-life care can be planned.
  • Item
    How Long do you Think? Unresponsive Dying Patients in a Specialist Palliative Care Service: A Consecutive Cohort Study
    (SAGE, 2024-05-01) O'Connor, Tricia; Liu, Wai-Man; Samara, Juliane; Lewis, Joanne; Paterson, Catherine
    Background: Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care. Aim: To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death. Design: Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient’s final phase of life, taking into account variation across age, gender, diagnosis and location of death. Setting/participants: A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022. Results: The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days. Conclusion: This study provides valuable new knowledge to support clinicians’ confidence when responding to the ‘how long’ question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering ‘how long’ questions across the illness trajectory.
  • Item
    Chaplaincy and Spiritual Care in Australian Ambulance Services: An Exploratory Cross-Sectional Study
    (Taylor & Francis, 2024) Tunks Leach, Katie; Demant, Daniel; Simpson, Paul; Lewis, Joanne; Levett-Jones, Tracy
    Ambulance staff wellbeing programs aim to support the bio-psycho-social and sometimes spiritual needs of paramedics. While evidence demonstrates strong connections between spirituality and/or religion to wellbeing outcomes, little is known about spiritual care in ambulance services or its impact. The aim of this study was to investigate paramedics’ perspectives on the role and value of Australian ambulance chaplains. A cross-sectional online study of registered paramedics in Australia was conducted between November and December 2022. Analysis of the 150 responses identified that paramedics viewed the chaplain’s role as one built on professional caring relationships that provided proactive and reactive care in paramedic workplaces. Chaplains were perceived to promote wellbeing by incorporating emotional, psychological, social and spiritual care, and assisting paramedics to access additional support. Perceived religiousness of chaplains and organisational factors were barriers to paramedics accessing chaplains, while pre-existing relationships and shared experiences positively influenced paramedics decision to seek chaplain support.
  • Item
    Infection Prevention and Control Professionals: Stress, Resilience and Personality Traits and Views about their Workforce and Profession
    (Elsevier, 2025) Mitchell, Brett; Russo, Philip
    Background The COVID-19 pandemic placed considerable strain on the infection control professional workforce, who were at the forefront of pandemic response in their organisations and beyond. In order to support infection control professionals and inform future initiatives, it is important to further understand the infection control workforce. The objective of this study was to determine stress and resilience levels, personality traits and workforce intentions of infection control professionals in Australia and New Zealand. Methods We undertook an anonymous, cross-sectional online survey of infection control professionals in Australia and New Zealand. Validated tools, the brief resilience tool, workforce stressor tool and the Big Five personality test, were used to evaluate levels of stress, resilience and personality traits. Results Three hundred and fifty-six infection control professionals started the survey, with representation from all Australian jurisdictions and New Zealand. The mean stress score was 4.28 (SD 3.39) and 3.34 (SD 0.65) for resilience. Younger participants and those with less experience in infection control had higher levels of stress and lower levels of resilience. Individual personality traits vary by age, level of education and credentialing status. Approximately one-fifth of participants indicated that they planned to leave the IC workforce in the next three years. Conclusions Our study was the largest published study involving infection control professionals in Australia and New Zealand. Findings highlight the need for mentoring, peer support and wellbeing initiatives to support the profession. Understanding personality traits may also be beneficial for further enhancing communication and interpersonal relationships.
  • Item
    Cleaning Time and Motion: An Observational Study on the Time Required to Clean Shared Medical Equipment in Hospitals Effectively
    (Elsevier, 2024) Matterson, Georgia; Browne, Katrina; Tehan, Peta E.; Russo, Philip L.; Kiernan, Martin; Mitchell, Brett G.
    Background Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively. Methods An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process. Main results The time to clean equipment effectively ranged from 50 s [blood glucose testing kit; 95% confidence interval (CI) 0:40–1:00 (min:s)] to 3 min 53 s [medication trolley; 95% CI 3:36–4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (N = 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning. Conclusion This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.
  • Item
    Air Purifiers and Acute Respiratory Infections: A Randomised Clinical Trial
    (JAMA Network, 2024) Thottiyil Sultanmuhammed Abdul Khadar, Bismi; Sim, Jenny; McDonald, Vanessa M.; McDonagh, Julee; Clapham, Matthew; Mitchell, Brett G.
    Importance The effectiveness of in-room air purification for the reduction of acute respiratory infections (ARIs) in residential aged-care facilities (RACFs) is unknown. Objective To investigate the effectiveness of in-room air purifiers with high-efficiency particulate air (HEPA)–14 filters in reducing the incidence of ARIs among residents of RACFs. Design, Setting, and Participants This randomized clinical trial used a multicenter, double-blind, 2-period, 2-treatment crossover design for 6 months from April 7 to October 26, 2023, in 3 RACFs with a bed capacity of 50 to 100 in New South Wales, Australia. The purposive sampling approach included permanent residents in private rooms in the enrolled RACFs. Data collection was performed every 2 weeks and required no additional follow-up beyond the final data collection on October 31, 2023. Intervention An air purifier containing a HEPA-14 filter was placed in rooms of participants in the intervention group, and an air purifier without a HEPA-14 filter was placed in rooms of the control participants. The groups crossed over after 3 months. Main Outcomes and Measures The primary outcome was the incidence of ARIs, assessed with logistic mixed-model regression. Results Among 135 participants randomized (70 to the intervention-first group and 65 to the control-first group), 78 (57.8%) were female; mean (SD) age was 85.2 (8.6) years. In the intention-to-treat analysis, the use of air purifiers with HEPA-14 filters did not reduce ARIs compared with the control (OR, 0.57; 95% CI, 0.32-1.04; P = .07). Among the 104 participants who completed the entire study, the intervention reduced ARI incidence from 35.6% (37 participants) in the control group to 24.0% (25 participants) in the intervention group (OR, 0.53; 95% CI, 0.28-1.00; P = .048). Conclusions and Relevance In this clinical trial investigating use of air purifiers with HEPA-14 filters for reducing ARIs, no significant between-group difference was found in the intention-to-treat analysis. However, a significant reduction in ARIs was identified among participants who completed the entire study. These findings may help inform future large-scale studies of respiratory infectious diseases.
  • Item
    Oral Care Practices and Hospital-acquired Pneumonia Prevention: A National Survey of Australian Nurses
    (Elsevier, 2024) Tehan, Peta E.; Browne, Katrina; Matterson, Georgia; Cheng, Allen C.; Dawson, Sonja; Graves, Nicholas; Johnson, Douglas; Kiernan, Martin; Madhuvu, Auxillia; Marshall, Caroline; McDonagh, Julee; Northcote, Maria; O'Connor, Jayne; Orr, Liz; Rawson, Helen; Russo, Philip; Sim, Jenny; Stewardson, Andrew J.; Wallace, Janet; White, Nicole; Wilson, Rhonda; Mitchell, Brett G.
    Background Hospital-acquired pneumonia (HAP) also known as non-ventilator associated pneumonia, is one of the most common infections acquired in hospitalised patients. Improving oral hygiene appears to reduce the incidence of HAP. This study aimed to describe current practices, barriers and facilitators, knowledge and educational preferences of registered nurses performing oral health care in the Australian hospital setting, with a focus on the prevention of HAP. We present this as a short research report. Methods We undertook a cross sectional online anonymous survey of Australian registered nurses. Participants were recruited via electronic distribution through existing professional networks and social media. The survey used was modified from an existing survey on oral care practice. Results The survey was completed by 179 participants. Hand hygiene was considered a very important strategy to prevent pneumonia (n = 90, 58%), while 45% (n = 71) felt that oral care was very important. The most highly reported barriers for providing oral care included: an uncooperative patient; inadequate staffing; and a lack of oral hygiene requisite. Patients' reminders, prompts and the provision of toothbrushes were common ways believed to help facilitate improvements in oral care. Conclusion Findings from this survey will be used in conjunction with consumer feedback, to help inform a planned multi-centre randomised trial, the Hospital Acquired Pneumonia PrEveNtion (HAPPEN) study, aimed at reducing the incidence of HAP. Findings may also be useful for informing studies and quality improvement initiatives aimed at improving oral care to reduce the incidence of HAP.
  • Item
    Which Trial do we Need? Gown and Glove use Versus Standard Precautions for Patients Colonized or Infected with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus
    (Elsevier, 2024-08) Browning, Sarah; White, Nicole M.; Raby, Edward; Davis, Joshua S.; Mitchell, Brett G.
    Background Gown and glove use as a component of ‘contact precautions’ was first recommended by the United States Healthcare Infection Control Practices Advisory Committee in 1996 and remains widely adhered to today. Despite a lack of randomized trial evidence in support of this practice, donning of gowns and gloves upon entry to the patient area (room or cubicle) continues to be ‘strongly recommended’ when the patient is infected or colonized with pathogens of epidemiological importance