Hospital Setting In Australia Research Articles

Insights into rural generalist therapeutic reasoning using a simulated multi-patient emergency scenario.

Therapeutic reasoning focuses on the decisions related to patient disposition and management. This is in contrast to diagnostic reasoning, which is the focus of much of the current discourse in the medical literature. Few studies relate to therapeutic reasoning, and even fewer relate to the rural and remote context. This project sought to explore the therapeutic reasoning used by rural generalists working in a small rural hospital setting in Australia, caring for patients for whom it was unclear if escalation of care, including admission or interhospital transfer, was needed. This study was conducted using an interpretivist approach. A simulation scenario was developed with rural generalists and experts in medical simulation to use as a test bed to explore the reasoning of the rural generalist participants. The simulation context was a small rural Australian hospital with resources and treatment options typical of those found in a similar real-life setting. A simulated patient and a registered nurse were embedded in the scenario. Participants needed to make decisions throughout the scenario regarding the simulated patient and two anticipated patients who were said to be coming to the department. The scenario was immediately followed by a semi-structured interview exploring participants' therapeutic reasoning when planning care for these three patients. An inductive content analysis approach was used to analyse the data, and a mental model was developed. The researchers then tested this mental model against the recordings of the participants' simulation scenarios. Eight rural generalists, with varying levels of experience, participated in this study. Through the semi-structured interviews, participants described five themes: assessing clinician capacity to manage patient needs; availability of local physical resources and team members; considering options for help when local management was not enough; patients' wishes and shared decision making; and anticipating future requirements. The mental model developed from these themes consisted of seven questions: 'What can I do for this patient locally and what are my limits?'; 'Who is in my team and who can I rely on?'; 'What are the advantages and disadvantages of local management vs transfer?'; 'Who else needs to be involved and what are their limits?;' 'How can we align the patient's wants with their needs?'; 'How do we adapt to the current and future situation?'; and 'How do I preserve the capacity of the health service to provide care?' This study explored the therapeutic reasoning of rural generalists using a simulated multi-patient emergency scenario. The mental model developed serves as a starting point when discussing therapeutic reasoning and is likely to be useful when providing education to medical students and junior doctors who are working in rural and remote contexts where resources and personnel may be limited.

Challenges of research with carers in a hospital setting in Australia: trialling the Carer Readiness Tool

A tool to help carers gauge their readiness to provide care to a patient on discharge from acute care – the Carer Readiness Tool – was implemented on two cancer/renal inpatient units. Data on carer needs and concerns obtained from the Carer Readiness Tool revealed that relatively inexperienced carers focused their concerns on practical aspects of care, such as mobility, transfers, aids and equipment, transport and parking. More experienced carers reported fewer needs but more concerns, including respite from caring, costs of caring and end-of-life care. Challenges in engaging carers in research, which impacted the formal evaluation of the Carer Readiness Tool, are discussed.

Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care.

Studies examining hypercalcaemia in inpatients were largely published over 20 years ago, and it is likely the epidemiology of hypercalcaemia has changed related to increased lifespan and changes in the prevalence of the underlying causes such as malignancy. To explore the epidemiology of hypercalcaemia in a modern tertiary hospital setting in Australia and evaluate the risk of mortality associated with hypercalcaemia. A retrospective study was performed in all inpatients with elevated blood calcium levels admitted from July 2013 to June 2018. ICD coding data identified primary diagnoses and mortality. Electronic medical records were reviewed in n = 292 patients admitted across 12 months from January to December 2017, to determine the causes of hypercalcaemia. Hypercalcaemia occurred in 1819 admissions (0.93% of all hospital admissions), during the 5-year period. The admission primary diagnoses were: malignancy (20% of cases), cardiovascular disease (17%) and gastrointestinal disease (11%). The top causes of hypercalcaemia among the 292 cases where electronic records were reviewed were malignancy (26%), primary hyperparathyroidism (25%) and hyperparathyroidism in the setting of chronic kidney disease (12%). Mortality occurred in 17% of these admissions. Non-survivors had significantly higher calcium levels, phosphate and white cell count, and had lower haemoglobin and albumin levels. Hypercalcaemia occurred in ~1% of admissions with main causes being malignancy and primary hyperparathyroidism, similar to historical studies. Hypercalcaemia in hospitalised patients is associated with high mortality and higher levels may be a marker for more severe underlying disease.

Persistent opioid use after hospital discharge in Australia: a systematic review

Objective This systematic review identified studies that provided an estimate of persistent opioid use following patient discharge from hospital settings in Australia. Methods A literature search was performed on 5 December 2020, with no date restrictions to identify studies that reported a rate of persistent opioid use following patient discharge from Australian Hospitals. The search strategy combined all terms relating to the themes ‘hospital patients’, ‘prescribing’, ‘opioids’ and ‘Australia’. Studies that dealt solely with cancer, palliative care or addiction medicine were excluded. The databases searched in this review were Embase, PubMed, Scopus, CINAHL, and International Pharmaceutical Abstracts. Studies were assessed for bias using the Newcastle–Ottawa Scale and considered against international literature. Results In total, 13 publications are included for final analysis in this review. Of these, 11 articles relate to post-surgical opioid use. With one exception, studies were of a ‘good’ quality. Methods of data collection in included studies were a mixture of those conducting follow up of patients directly over time and those utilising dispensing databases. Persistent opioid use among surgical patients generally ranged from 3.9 to 10.5% at between 2 and 4 months after discharge. Conclusions How rates of persistent opioid use following hospital encounters in Australia are established, and how long after discharge rates are reported, is heterogeneous. Literature primarily relates to post-surgical patients, with very few studies investigating other settings such as encounters with the emergency department.

End-user perceptions of a patient- and family-centred intervention to improve nutrition intake among oncology patients: a descriptive qualitative analysis

BackgroundPeople with cancer are at high risk of malnutrition. Nutrition education is an effective strategy to improve patient outcomes, however, little is known regarding the impact of family and/or carer involvement in nutrition education and requires investigation. The purpose of the study was to evaluate PIcNIC (Partnering with families to promote nutrition in cancer care) intervention acceptability from the perspective of patients, families and health care providers.MethodsA descriptive qualitative study was undertaken at an inpatient and an outpatient hospital setting in Australia and an outpatient/home setting in Hong Kong. A patient-and-family centred intervention including nutrition education, goals setting/nutrition plans, and food diaries, was delivered to patients and/or families in the inpatient, outpatient or home setting. Semi-structured interviews were used to explore perceptions of the intervention. 64 participants were interviewed; 20 patients, 15 family members, and 29 health care professionals. Data were analysed using deductive and inductive content analysis.ResultsTwo categories were identified; 1) ‘context and intervention acceptability’; and 2) ‘benefits of patient- and family-centred nutrition care’. Within each category redundant concepts were identified. For category 1 the redundant concepts were: the intervention works in outpatient settings, the food diary is easy but needs to be tailored, the information booklet is a good resource, and the intervention should be delivered by a dietitian, but could be delivered by a nurse. The redundant concepts for category 2 were: a personalised nutrition plan is required, patient and family involvement in the intervention is valued and the intervention has benefits for patients and families. Converging and diverging perceptions across participant groups and settings were identified.ConclusionsIn this paper we have described an acceptable patient- and family-centred nutrition intervention, which may be effective in increasing patient and family engagement in nutrition care and may result in improved nutrition intakes. Our study highlights important contextual considerations for nutrition education; the outpatient and home setting are optimal for engaging patients and families in learning opportunities.

Family violence screening and disclosure in a large metropolitan hospital: A health service users’ survey

Objectives:Assisting patients who are experiencing family violence is an important issue for health services. Rates of screening for family violence in general hospital settings in Australia are unclear. This study was conducted to obtain data on hospital family violence screening rates and health service users’ perceptions of the screening process, in a large metropolitan hospital in Australia.Methods:Clients from the clinical caseloads of social work and psychology staff were invited to participate in a tablet administered, online survey of their family violence screening experiences, within the health service.Results:A total of 59 surveys were completed by hospital users, who had been treated in areas including the emergency department, acute inpatient wards, sub-acute and rehabilitation units, and outpatient clinics. Less than half the sample reported being screened for family violence at the health service. One-quarter of the respondents reported disclosing family violence concerns, with one-fifth wanting to disclose, but not feeling comfortable to do so. The majority of respondents who disclosed family violence felt supported by the response of the staff member and were provided with information they found helpful. However, further work could be done to improve screening rates, environmental and organizational factors to promote users feeling comfortable to disclose, and staff responses to disclosures.Conclusion:The results of the survey will be used to inform the development of a hospital-wide family violence training initiative aimed to improve staff knowledge, confidence, rates of screening, and clinical responses to family violence.

Rates and reasons for emergency department presentations of patients wait-listed for public bariatric surgery in Tasmania, Australia

BackgroundDemand for bariatric surgery in the public hospital setting in Australia is high with prolonged wait-list times. Policy-makers need to consider the consequences of expanding public bariatric surgery including on emergency department (ED) presentations. AimsTo describe and evaluate public ED presentation rates and reasons for presenting in a cohort of patients wait-listed for public surgery. MethodsAll Tasmanians placed on the public wait-list for primary bariatric surgery in 2008–2013 were identified using administrative datasets along with their ED presentations in 2000–2014. The presentations were assigned to one of three periods: before wait-list placement, whilst on the wait-list, and after wait-list removal for publicly-funded surgery or drop-out. A negative binomial mixed-effects regression model was used to derive ED presentation incidence rate ratios (IRR) to compare observation periods and patient groups. Results652 wait-listed patients had 5149 public ED presentations. 178 patients had publicly-funded bariatric surgery — all as laparoscopically adjustable gastric banding (LAGB). Overall, ED presentation rates did not change significantly post-surgery compared with the waiting period (IRR 1.19, 95%CI 0.90–1.56). Presentation rates significantly increased for digestive system (IRR 2.02, 95%CI 1.19–3.45) and psychiatric diseases (IRR 4.85, 95%CI 1.06–22.26) after surgery. The likelihood of being admitted from the ED significantly increased after surgery (31.7%–38.9%, p<0.05). ConclusionED presentations were common for patients wait-listed for public bariatric surgery and rates did not decrease over an average of three years post-LAGB. The likelihood of being admitted to the hospital from the ED increased after surgery.

Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data

ObjectiveTo analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014.MethodsWe calculated yearly PID and EP diagnosis rates...

Loyal employees in difficult settings

PurposeEmployee loyalty is generally a very positive trait. However, when loyal employees are confronted with dysfunctionality in the workplace the impact on their well-being can be significant. The purpose of this paper is to assess the interaction of employee loyalty and employee experience of inter-professional dysfunction in a hospital setting to predict employee job tension.Design/methodology/approachThe paper is based on the analysis of a cross-sectional attitudinal survey of employees within a hospital setting in Australia. The authors use OLS regression and an SPSS macro (by Hayes, 2013) to assess the regions of significance of the interaction effects.FindingsThe authors find, as anticipated, significant direct effects for employee loyalty and inter-professional dysfunction on employee job stress. The authors further find significant interaction effects that suggest that highly loyal employees who experience inter-professional dysfunction also experience disproportionately high levels of job tension.Research limitations/implicationsThe main research implication of this research relates to the confirmation of the presence of an interaction effect between loyalty and inter-professional dysfunction in predicting employee job stress. Further, the zone of significance analysis (following Johnson and Neyman) suggests that this effect is evident at even low levels of inter-professional dysfunction.Practical implicationsOrganisations should appreciate employee loyalty but should also be aware that loyal employees are more vulnerable to the negative consequences of organisational dysfunction than are employees with limited organisational loyalty.Social implicationsThe paper confirms the importance of managing organisational cooperation between groups in organisations as a precursor to positive employee outcomes.Originality/valueThis is the first paper to investigate this interaction and to apply Johnson-Neyman analysis to confirm the regions of significance for the interaction effects noted.

Putting it into practice: Infection control professionals' perspectives on early career nursing graduates' microbiology and infection control knowledge and practice.

The microbiology component of Australian undergraduate nursing programmes varies considerably. Any actual or potential impact of this variation on infection control practice, as a nursing graduate, is relatively unknown. The aim of this study was to explore infection control professionals' perceptions of the importance of microbiology and infection control training in undergraduate nursing curricula and the perceived retention of that knowledge and its transferability to practice. Semi-structured interviews were conducted with eight infection control professionals from a range of hospital settings in Australia. Four main themes emerged: Theory versus practice, importance of role modelling, disjunction between university curricula and 'the real world,' and learning in context. As the underpinning element of infection control practice, the role of microbiology education and training in nursing education will benefit from review. Further discussions about the nature and timing of theoretical microbiology content and assessment of undergraduate students' microbiology knowledge to ensure retention and appropriate application of that knowledge in practice are urgently needed.

Putting it into practice: Infection control professionals’ perspectives on early career nursing graduates’ microbiology and infection control knowledge and practice

Background: The microbiology component of Australian undergraduate nursing programmes varies considerably. Any actual or potential impact of this variation on infection control practice, as a nursing graduate, is relatively unknown. Aims: The aim of this study was to explore infection control professionals’ perceptions of the importance of microbiology and infection control training in undergraduate nursing curricula and the perceived retention of that knowledge and its transferability to practice. Method: Semi-structured interviews were conducted with eight infection control professionals from a range of hospital settings in Australia. Findings: Four main themes emerged: Theory versus practice, importance of role modelling, disjunction between university curricula and ‘the real world,’ and learning in context. Conclusion: As the underpinning element of infection control practice, the role of microbiology education and training in nursing education will benefit from review. Further discussions about the nature and timing of theoretical microbiology content and assessment of undergraduate students’ microbiology knowledge to ensure retention and appropriate application of that knowledge in practice are urgently needed.

Professional Confidence: A Powerful Enabling Mechanism in the Transition to Becoming a Specialist RN: Qualitative Findings from a Mixed Method Study

Although the seminal work of Patricia Benner’s Novice to Expert clearly identifies the five levels of nursing practice, there is a paucity of research on the learning and transitional processes that occur between these levels. The objective of this paper is to explore the transition to Specialist Registered Nurse (RN) in the learning and professional context. The study utilises a concurrent nested design based on complementarity strategies as part of the mixed method design. The study was undertaken in a large tertiary hospital setting in Australia. Participants were RNs undertaking postgraduate specialist nursing courses (n = 39) with a nested cohort of Intensive Care Nursing Course participants (n = 7). The quantitative component investigated the influence of learner attributes (e.g. approach to learning, strategic control of study and self-efficacy) on the participants’ academic learning outcomes. Questionnaires were distributed to RNs on all specialist courses (n = 39). The qualitative component utilised a case study approach to explore and explain the learning and transitional experiences of the Intensive Care Nursing Course participants. The paper reports the key findings from the qualitative component of this study. The transition from RN to Specialist RN involved a qualitative cognitive shift in thinking, the development of competence and transformation in the level of nursing practice. Additional learning and cultural phenomena assisted the RNs’ patterns of learning and knowledge acquisition. The emergence of ‘professional confidence’ was at the heart of the learning and transitional process from a competent to proficient level of nursing practice (specialist RN). ‘Professional confidence’ emerged as an outcome and a property of learning in the professional context. ‘Professional confidence’ is a powerful enabling mechanism in the transition to become a Specialist RN. There are several implications for nursing and nursing education derived from this study.

Burden of asthma in the hospital setting: an Australian analysis

Objectives:This study was designed to report factors associated with asthma hospital admission, such as patient characteristics, type of admission and subsequent outcome i.e. discharge or death, for the years 2000–2005. These data are used for health economic models regarding asthma burden in the hospital setting in Australia.Methods:Data was obtained from the Australian Centre for Asthma Monitoring using their amalgamated dataset from all states and territories. Admissions under ICD-10 codes J45 ‘Asthma’ plus all subcodes, and J46 ‘acute severe asthma’ were included. Codes for associated comorbidity at the time of admission were identified, as well as the month of death, age, gender and length and the type of stay. Confidence intervals for death rate assumed a binomial distribution because of the rarity of event.Results:The total number of all-cause deaths for the 5-year observation period was 289 from 202,739 asthma separations or 0.14% or 143 deaths/100,000 separations and the highest rate was seen in patients over 45 years. Acute upper respiratory tract infections were reported in up to 25% of all asthma hospital admissions. Length of stay was up to a mean average of 10.2 days in patients who died (SD 15.3). In 5 years observation there was 152,758 emergency asthma admissions which contributed greatly to Australian healthcare burden.Conclusions:The study demonstrates that emergency admissions dominate asthma care in the hospital setting in Australia, which suggests poor asthma control in some patients with subsequent economic burden. Asthma-related mortality remains a risk for specific patients in the hospital setting.