South Australian Hospitals Research Articles

The influence of emotional labour and emotional work on the occupational health and wellbeing of South Australian hospital nurses

Nursing is an emotionally complex occupation, requiring performance of both emotional labour (for the benefit of the organisation and professional role) and emotional work (for the benefit of the nurse-patient relationship). According to the Conservation of Resources Theory, such processes can have a significant effect on psychological wellbeing and occupational stress, although little is known about the factors that moderate their effects. This exploratory study investigated the relationship between emotional labour and emotional work on psychological wellbeing and occupational stress in 239 nurses sampled from a South Australian hospital. The multi-component questionnaire study focused on the emotional labour elements of emotion expression and suppression, as well as surface acting and deep acting, and examined the companionship, help, and regulation elements of emotional work. In a multivariate model, emotional work was found to be less strongly predictive of negative psychological outcomes than was emotional labour, but was more strongly predictive of positive outcomes. Social support may moderate or be an antecedent to the performance of emotional labour and emotional work. The findings support the Conservation of Resources Theory with emotional work, rather than emotional labour, enabling the uptake of resources and leading to positive occupational health and wellbeing.

Abstract P256: Women Experience Significant Treatment Delays When Presenting with Acute Myocardial Infarction

Aim: Delays in reperfusion therapy for ST-elevation myocardial infarction (STEMI) have been associated with an increased mortality. These delays are dependent upon both patient and health system factors. The objective of this study was to assess gender differences in door-to-balloon times, in patients undergoing percutaneous coronary intervention (PCI) for STEMI, with respect to its logistical components and evaluate its relationship to 30-day cardiac events (death and/or re-infarction). Methods: Clinical and logistic parameters were prospectively collected between 2005-10 for 735 STEMI patients undergoing primary PCI at two South Australian teaching hospitals. Particular attention was given to the time of patient hospital arrival to the STEMI team notification (Door-Code time), the time from STEMI notification to first balloon inflation (Code-Balloon time), and conventional Door-to-balloon time. Infarct size was estimated by extent of ST elevation on admission and peak creatine kinase levels. Results: Women were significantly older than men (66±14 vs. 60±12years, P<0.001) thus parametric variables were age-adjusted and summarized in the table below (*p < 0.05, **p<0.001 compared with men). Multivariate logistic regression analysis revealed that female gender was the strongest predictor of 30-day death and re-infarction (Odds Ratio for Female = 3.06 (95% CI = 1.45 - 6.42, p = 0.003) Conclusion: Women with STEMI undergoing primary PCI have poorer cardiac outcomes, for which a prolonged door-to-balloon time may contribute. This delay is attributable not only in the recognition of the STEMI in women (Door-to-Code time) but also in attaining mechanical reperfusion (Code-to-Balloon time). Further studies are required to identify the source of these delays.

A Phase II Multicentered, Single-Blind, Randomized, Controlled Trial of the Stroke Self-Management Program

The benefits of chronic disease self-management programs for stroke survivors are uncertain because individuals with severe impairments have been excluded from previous research. We undertook a phase II randomized controlled trial to determine whether a self-management program designed for survivors (SSMP; 8 weeks) was safe and feasible compared to standard care (control) or a generic self-management program (generic; 6 weeks). Stroke survivors were recruited from 7 South Australian hospitals via a letter or indirectly (eg, newspapers). Eligible participants were randomized at a 1:1:1 ratio of 50 per group. Primary outcomes were recruitment, participation, and participant safety. Secondary outcomes were positive and active engagement in life using the Health Education Impact Questionnaire and characteristics of quality of life and mood at 6 months from program completion. Of 315 people screened, 149 were eligible and 143 were randomized (48 SSMP, 47 generic, 48 control); mean age was 69 years (SD, 11) and 59% were female. Demographic features were similar between groups and 41% had severe cognitive impairment; 57% accessed the interventions, with 52% SSMP and 38% generic completing >50% of sessions (P=0.18). Thirty-two participants reported adverse events (7 control, 12 generic, 13 SSMP; P=0.3; 34% severe); however, none was attributable to the interventions. Potential benefits for improved mood were found. SSMP was safe and feasible. Benefits of the stroke-specific program over the generic program included greater participation and completion rates. An efficacy trial is warranted given the forecast growth in the stroke population and improved survival trends.

Feasibility and Timeliness of Alternatives to Post‐Discharge Home Medicines Reviews for High‐Risk Patients

ABSTRACTBackgroundThe period 7 to 10 days following hospital discharge is associated with a significant risk of medication misadventure, especially in high‐risk patients.AimTo investigate whether post‐discharge hospital‐initiated medication review (HIMR) pathways are more timely than the post‐discharge home medicines review (HMR) pathway.MethodAn implementation study conducted over 9 months in 2008/2009 of patients from 3 South Australian hospitals. A risk stratification instrument was used to identify patients at “high” risk of medication misadventure. Feasibility was assessed and time to conduct the post‐discharge medication reviews was determined for the HMR and HIMR pathways.ResultsOf the 97 consenting patients, 92 were stratified as “high” risk. HIMR were organised for 59 patients − 52 patients completed the HIMR process. Of the 22 HMRs organised via the patient's general practitioner, 18 patients completed the HMR process. The time from request to conducting the HIMR and HMR were statistically significantly different – HIMR and HMR took 6.5 ± 4.7 days and 11 ± 7.4 days, respectively (p = 0.02).ConclusionThis study has demonstrated the feasability of alternative pathways to post‐discharge medication reviews. The HIMRs were conducted sooner than HMRs organised via existing community processes. If post‐discharge medication reviews are organised via the HIMR pathway, there is potential to reduce medication misadventure in high risk patients in a more timely manner than when post‐discharge HMRs are organised.

A randomised controlled trial to compare opt-in and opt-out parental consent for childhood vaccine safety surveillance using data linkage: study protocol

BackgroundThe Vaccine Assessment using Linked Data (VALiD) trial compared opt-in and opt-out parental consent for a population-based childhood vaccine safety surveillance program using data linkage. A subsequent telephone interview of all households enrolled in the trial elicited parental intent regarding the return or non-return of reply forms for opt-in and opt-out consent. This paper describes the rationale for the trial and provides an overview of the design and methods.Methods/DesignSingle-centre, single-blind, randomised controlled trial (RCT) stratified by firstborn status. Mothers who gave birth at one tertiary South Australian hospital were randomised at six weeks post-partum to receive an opt-in or opt-out reply form, along with information explaining data linkage. The primary outcome at 10 weeks post-partum was parental participation in each arm, as indicated by the respective return or non-return of a reply form (or via telephone or email response). A subsequent telephone interview at 10 weeks post-partum elicited parental intent regarding the return or non-return of the reply form, and attitudes and knowledge about data linkage, vaccine safety, consent preferences and vaccination practices. Enrolment began in July 2009 and 1,129 households were recruited in a three-month period. Analysis has not yet been undertaken. The participation rate and selection bias for each method of consent will be compared when the data are analysed.DiscussionThe VALiD RCT represents the first trial of opt-in versus opt-out consent for a data linkage study that assesses consent preferences and intent compared with actual opting in or opting out behaviour, and socioeconomic factors. The limitations to generalisability are discussed.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000332022

An Examination of Maternity Staff Attitudes Towards Implementing Baby Friendly Health Initiative (BFHI) Accreditation in Australia

The Baby Friendly Hospital Initiative (BFHI) influences health care practices and increases the initiation and duration of exclusive breastfeeding. Consistent definitions enable the accurate monitoring of breastfeeding rates and behaviour. This information refines policy and helps reach national breastfeeding targets. Only 21% (66/317) of Australian hospitals are BFHI accredited. To examine the factors perceived to promote or hinder BFHI accreditation. Focus group interviews explored opinions of 31 participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals. The results suggest that staffs' understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding. Upper management support, specific funding, a dedicated co-ordinator with "area leaders", development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions, are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants. Full implementation of BFHI across Australia will assist the development of nationally accepted breastfeeding definitions, improve monitoring and evaluation of rates and practices, and improve breastfeeding outcomes.

Use of the Australian Childhood Immunisation Register for vaccine safety data linkage

We linked the Australian Childhood Immunisation Register (ACIR) to South Australian (SA) hospital outcome data in order to evaluate the association between Measles Mumps and Rubella (MMR) and Diphtheria Tetanus Pertussis (DTP) vaccines and convulsions. Linkage occurred using probabilistic matching and data was analysed using the self-controlled case series methodology. An increase in febrile convulsions 6–11 days post-MMR vaccination was demonstrated which equates to a vaccine-attributable risk of 1 convulsion per 6753 vaccines. This study confirms the known association between MMR vaccination and febrile convulsions and in doing so demonstrates the feasibility of using the ACIR for data linkage and vaccine safety surveillance.

Clinical and socio-demographic profile of an Australian multi-institutional prostate cancer cohort

Aims: To describe the clinical and socio-demographic data from a South Australian prostate cancer cohort (PCCOD). Methods: Clinical data for 2329 prostate cancer patients treated at three South Australian teaching hospitals between 1998 and 2007 were analyzed by place of residence, time of diagnosis and socioeconomic status (SES). χ2 tests were used to investigate differences in stage, grade and prostate-specific antigen (PSA) at diagnosis, among subgroups and over time. Logistic regression was used to examine predictors of treatment modalities. Five-year survival was assessed using Kaplan–Meier methods. Results: The distributions of age, SES and place of residence of PCCOD patients closely reflected those of the state-based prostate cancer population, with rural patients slightly underrepresented. Lower SES or rural residence was not associated with higher stage, grade, PSA level or disease-specific survival. Treatment modalities varied with SES (for radical prostatectomy), rural residence (radical prostatectomy, radiotherapy and androgen ablation), age and clinical characteristics. There was a trend over time towards a younger age at diagnosis and more favorable clinical profiles, consistent with earlier diagnosis. However, the current risk profile for this cohort is similar to that reported approximately a decade earlier in a US series. Conclusion: PCCOD patients have a broadly similar socio-demographic profile to prostate cancer patients statewide. Socioeconomic status is not associated with clinical characteristics at diagnosis, but does predict treatment type. The clinical characteristics of the cohort are consistent with a much later stage presentation than reported in current US case series.

The effect on medication errors of pharmacists charting medication in an emergency department

To determine the frequency and clinical significance of medication errors when (a) pharmacists elicit medication histories in the Emergency Department after medications have been prescribed by doctors and (b) pharmacists obtain and chart medication histories prior to doctors' approval. The Queen Elizabeth Hospital, a 350 bed South Australian teaching hospital, serving the local adult community. Emergency Department patients at risk of medication misadventure were recruited in two phases with a 'usual practice' arm (6 weeks) and a 'pharmacist medication charting' arm (5 weeks) reflecting an alternative intervention. In the 'usual care' arm, medication histories were compiled by a pharmacy researcher after a doctor had completed the medication chart. The researcher-elicited medication histories were compared with the doctors' medication charts and unintentional discrepancies were recorded. In the 'pharmacist medication charting' arm, the same process was followed except the researcher compiled the patients' medication histories at triage, prior to patients seeing a doctor. The medication history was then transcribed onto a medication chart for authorisation by a doctor. In addition, whether resolution of unintentional discrepancies for patients in the 'usual care' arm had occurred by discharge was determined by examining patients' medical records. Main outcome measure Frequency of unintentional discrepancies and medication errors. The study included 45 and 29 patients in the 'usual care' and intervention arms, respectively. In the 'usual care' arm, 75.6% of patients had one or more unintentional discrepancies compared with 3.3% in the 'pharmacist medication charting' arm. This resulted in an average of 2.35 missed doses per patient in the 'usual care' arm and 0.24 in the intervention arm. In addition, an average of 1.04 incorrect doses per patient were administered in the 'usual care' arm and none in the 'pharmacist medication charting' arm. The differences observed between the arms were statistically significant (P < 0.05) and deemed clinically significant by a multidisciplinary panel. This study provides evidence for pharmacists eliciting medication histories to prepare medication charts at the earliest possible opportunity following a patient's presentation to the Emergency Department.

Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion

Conversion to an open procedure during laparoscopically assisted colorectal resection may be necessary because of technical, patient, or pathologic factors. Recent literature has indicated that converted patients may have poorer outcomes than those undergoing open or completed laparoscopically assisted procedure. This study aimed to audit the authors' experience with laparoscopically assisted colectomy and to assess the clinical outcomes of patients undergoing conversion. All laparoscopic right hemicolectomies or anterior resections performed at seven South Australian hospitals from 1997 to 2006 were reviewed. Data pertaining to patient sex, age, American Society of Anesthesiology (ASA) score, pathology, operative outcomes including operating time, conversion, reason for conversion, length of hospital stay, and intra- and postoperative complications were analyzed. Laparoscopic anterior resection had a higher rate of open conversion than laparoscopic right hemicolectomy (18.7% vs 10.4%; p = 0.028). In the right hemicolectomy group, none of the investigated risk factors for conversion were statistically significant, and the morbidity rates for the two groups were similar. The median hospital stay was significantly longer in the anterior resection group (p < 0.001), and the wound morbidity rate was higher in the converted group (12.8% vs 3.0%; p = 0.022). Age older than 75 years and a high ASA status were independent risk factors for conversion in anterior resection. Conversion of laparoscopic anterior resection to open procedure is associated with higher wound morbidity and a longer hospital stay. The authors recommend that surgeons carefully consider the selection of patients 75 years of age or older and high ASA status for laparoscopic anterior resection.

When, what and how South Australian pre-registration junior medical officers' career choices are made

This study aimed to provide better understanding of how pre-registration junior medical officers (PJMOs) make their career choices by investigating when decisions are made, what factors impact on choices, and the role of experience in this process. A third (n = 54) of PJMOs from the 2003 cohort at South Australian teaching hospitals participated in the current research. Inductive content analysis was used to discover themes in data gathered from semistructured interviews. Interviews revealed that although 26% (14/54) of participants had made their career decisions in their pre-registration year, 50% (27/54) had still to decide on a career choice. The factors identified as impacting on career choice were grouped into 5 main categories: job satisfaction; lifestyle; career path; training programme, and the wider environment. Depending on the demographic profile of the PJMO, different relative importance was assigned to these factors. The most important elements used to confirm or disconfirm PJMOs' potential career choices were the experiences they had of different specialty areas. This study allowed an in-depth exploration of the factors that affect the decision-making process of PJMOs. It also found that defined groups of PJMOs place different degrees of importance on these factors, which may have implications for medical workforce planning. It is clear that experience and role models are a crucial component of the career decision-making process. This has importance for specialties that are not incorporated into junior medical training.

Trends in hospital admissions and mortality from asthma and chronic obstructive pulmonary disease in Australia, 1993–2003

To examine evolving changes in asthma and chronic obstructive pulmonary disease (COPD) in South Australia and Australia as a whole from the perspective of hospital admissions, ventilatory support and mortality data. Retrospective analyses, for the period 1993-2003, of hospital separations data from the Australian Institute of Health and Welfare and the Integrated South Australian Activity Collection, and mortality data from the Australian Bureau of Statistics and South Australian hospital morbidity collection. Hospital separations, ventilatory support episodes, mortality rates, burden-of-disease rankings. Between 1993 and 2003, in SA and nationally, hospital separations for asthma declined but separations for COPD increased significantly. Falling mortality rates from asthma in both men and women, and from COPD in men, contrast with increasing rates of COPD-related hospitalisation and mortality in women. Hospital admissions and mortality associated with asthma have fallen. Admission rates for COPD are declining for men, but there is no indication that admission rates for women have reached a peak. There is a need for higher prioritisation of COPD, including policies to reduce smoking in women, and medical practice initiatives to support primary and secondary prevention, pulmonary rehabilitation and appropriate drug therapies.

Treatment and survival from breast cancer: the experience of patients at South Australian teaching hospitals between 1977 and 2003

Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines. To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines. Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977-2003 (n=4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan-Meier product limit estimates and multivariable Cox proportional hazards regression. The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997-2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997-2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977-1990 to 76.8% in 1997-2003 for stage I (P<0.001) and from 31.1% to 52.2% across these periods for stage II (P<0.001). Adjuvant radiotherapy also became more common (P<0.001), with 20.6% of patients receiving this treatment in 1977-1990 compared with 60.7% in 1997-2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P<0.001), from 19.6% in 1977-1990 to 36.9% in 1997-2003, and the proportion having hormone therapy also increased (P<0.001), from 34.3% to 59.4% between these periods. Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based.

South Australia's First Family Therapist — Jeff Gerrard Remembers: An Interview

Jeff Gerrard can claim the distinction of being the first family therapist in South Australia. Early on in his career as a psychiatrist he explored the growing field of psychotherapy overseas and observed, studied, and trained with some of the historical greats in the area. When he returned to South Australia in the early 70s, it seems to have been a natural step for him to begin practising family therapy and training other health professionals in the theory and practice of family therapy. The early training that Jeff led at the South Australian Children's Hospital enabled a cooperation between a number of early family therapists, such as Michael White and Anne Sved Williams, to train the first cohort of people who would later go on to become significant contributors to the family therapy field in Australia. In this interview, Lorraine Read invites Jeff to explore his early contributions to the field and to discuss the training and supervision experiences which were/are important in his development as a family therapist.

Antimicrobial utilisation in South Australian hospitals 2002-2004

The South Australian statewide antimicrobial utilisation surveillance programme collects and reports on in-hospital antimicrobial usage data from South Australian metropolitan hospitals. Antimicrobial usage rates over the period of January 2002 – December 2004 are reported.There has been a 3% increase in total annual usage over the period, with monthly analysis suggesting a small upward trend in total antimicrobial consumption. Antimicrobial consumption in intensive care units (ICUs) has shown a reduction of 14% over the 3 year surveillance period; however, monthly data demonstrates variable usage, making assessment of trends difficult. Changes in usage patterns for fluoroquinolones and third generation cephalosporins have occurred, and should be the focus of antibiotic stewardship efforts. Comparison to international data shows that South Australian antimicrobial usage rates are high and efforts to optimise use of these agents should be encouraged.

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. An observational study of a sequential sample. The orthopaedic ward of a South Australian metropolitan teaching hospital. Sixty-eight patients aged > or =70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. MAJOR OUTCOME METHODS: Dietary energy and protein intake. Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

Neonatal resuscitation educational experience of staff in New South Wales and Australian Capital Territory hospitals

There is international recognition that health personnel involved in deliveries should be adequately trained in neonatal resuscitation. A survey was carried out in New South Wales (NSW) and the Australian Capital Territory (ACT) to ascertain the type, frequency and availability of training in neonatal resuscitation to staff who may need to resuscitate an infant at birth. The survey included a self-perception rating of confidence and competence in neonatal resuscitation. Questionnaires were sent to 117 hospitals carrying out deliveries in NSW and ACT. Questionnaires were distributed to staff members who may be present at a delivery in a designated 24-h period. In total, 1457 questionnaires from 101 hospitals were returned and analysed. Overall response rate was 86.3% with 96.1% able to be assigned to tertiary, urban non-tertiary or rural areas. Eighty-five per cent of tertiary respondents had a training programme available to them compared with 59% of urban non-tertiary staff and 31% of rural practitioners. Approximately one-third of respondents in rural and urban non-tertiary units had either never been trained or had training more than 2 years before the survey. In rural areas more than 25% staff were not confident in their resuscitation skills and only 9% felt very competent. Three-quarters of all births in NSW and ACT take place in rural or urban non-tertiary hospitals where one-third of health personnel are inadequately trained in neonatal resuscitation and many do not feel confident in their skills. Effective neonatal resuscitation training for these areas is urgently required.

Treatment and Survival from Colorectal Cancer: The Experience of Patients at South Australian Teaching Hospitals Between 1980 and 2002

To evaluate trends in colorectal cancer survival and treatment at South Australian teaching hospitals and degree of adherence to treatment guidelines which recommend adjuvant chemotherapy for Dukes' C colon cancers and combined chemotherapy and radiotherapy for high-risk rectal cancers. Trends in disease specific survival and primary treatment were analysed, and comparisons drawn between diagnostic epochs, using cancer registry data from South Australian teaching hospitals. Statistical methods included univariate and multivariable disease specific survival analyses. Five-year survival increased from 48% in 1980-1986 to 56% in 1995-2002. Largest gains were for stage C, where survivals were higher when chemotherapy was part of the primary treatment. By comparison, gains in 1-year survival were largest for stage D. Chemotherapy was provided for 4% of patients with colorectal cancers in 1980-1986, increasing to 32% in 1995-2002. Among stage C cases below 70 years at diagnosis, the proportion having chemotherapy increased to 83% in 1995-2002. The most common chemotherapy was fluorouracil (5FU) as a single agent in 1980-1986 and 5FU with leucovorin in 1995-2002. As expected, radiotherapy was used more frequently for rectal than colon cancers, and particularly for stage C. Among stage C rectal cases below 70 years, the proportion having radiotherapy increased from 10% in 1980-1986 to 57% in 1995-2002. Approximately 93% of colorectal cancers were treated surgically. Patients not treated surgically tended to be aged 80 years or more and to present with distant metastases. Trends in chemotherapy and radiotherapy accord with evidence-based recommendations. There have been reassuring gains in survivals after adjusting for stage, grade and other prognostic indicators. The data show survival gains and treatment patterns that individual hospitals can use as benchmarks when evaluating their own experience.

Nursing observations during the first 24 hours after a surgical procedure: what do we do?

The purpose of the study was to describe what constitutes postoperative nursing monitoring during the initial 24 hours on the ward including the components of observation, frequency and time spent with patients. The literature provides little guidance as to the best practice of postoperative surveillance. To understand the practice of monitoring patients after returning to the ward from a surgical procedure it is important to describe the current practice. The study involved a non-participant observation of nursing practice. Data were generated via observation of postoperative patients in the first 24 hours after returning to the ward. This occurred in the general surgical units of two different South Australian hospitals over an 8-week period. A total of 81 patients were observed for 282 patient hours. Vital sign collection generally reflected a traditional pattern of hourly for the first four hours, reducing to four hourly across the 12- to 24-hour period. The frequency and duration of patient-nurse interactions, observations recorded and the collection of other clinical data such as pain, oxygen saturations and nausea are also discussed. The findings presented here depict the current nursing practice of postoperative monitoring in two different settings, providing insight into what constitutes contemporary postoperative surveillance. Before inroads can be made to identify the best practice of postoperative patient surveillance a clear cognisance of practice needs to be identified.

Establishing an Australian Nurse Practitioner-Led Colorectal Cancer Screening Clinic

In Australia, colorectal cancer is the most commonly occurring internal cancer affecting both men and women, and the second most common cause of cancer-related death. Flexible sigmoidoscopy has not been commonly used as a screening tool in Australia due primarily to lack of resources. Until now, people at average risk of developing bowel cancer frequently undergo colonoscopy after referral to a specialist. To fill an identified need, a nurse practitioner-led colorectal screening service providing fecal occult blood testing and flexible sigmoidoscopy, health education and promotion, patient counseling, information and a referral point for general practitioners, and a referral service for above average-risk patients was established in a South Australian metropolitan teaching hospital. Establishment of this clinic required advanced and extended theoretical and clinical preparation for the nurse practitioner, as well as development of interdisciplinary relationships, referral processes, clinical infrastructure, and a marketing strategy. An audit of the first 100 flexible sigmoidoscopy patients revealed service and procedural outcomes that compared favorably with other colorectal screening services as well as a high level of patient satisfaction.