No longer hungry in hospital : improving the hospital mealtime experience for older people through Action Research

‘The definitive version is available at www.blackwell-synergy.com.’ Copyright Blackwell Publishing DOI: 10.1111/j.1365-2702.2007.02063.xAims and objectives.  This study aimed to improve the mealtime experience of older people in a hospital setting through helping staff to make changes to their clinical practice and the ward environment. Background.  Poor nutritional care has been a persistent and seemingly intractable problem for many years. Methods.  We used an action research design for the study, drawing on techniques from practice development to support the action phase of the work, including action learning, role modelling good practice and reflection. The ward context was explored at the beginning and end of the study using focus groups, interviews, observation and benchmarking. Results.  Ward staff made a number of changes to their nursing practice. The most significant was that all staff became engaged with, prioritized and were involved in the mealtime, ensuring that there was sufficient time and expertise available to assist patients with eating. Conclusions.  This study demonstrates that it is possible to change nursing practice at mealtimes and that this change leads to improvements in patients’ experience through ensuring they receive the help they need. Relevance to clinical practice.  Although hospital mealtimes are frequently viewed as problematic, we have shown that nurses can be enabled to make changes to their practice that have a positive impact on both the mealtime experience and wider patient care.Peer reviewe

When a Child Dies in the PICU: Practice Recommendations From a Qualitative Study of Bereaved Parents

OBJECTIVES: Around the world, the PICU is one of the most common sites for hospitalized children to die. Although ensuring the best possible care experience for these children and their families is important, clear recommendations for end-of-life and bereavement care, arising from the parents themselves, remain limited within current literature. This report aims to describe bereaved parents' recommendations for improvements in end-of-life care and bereavement follow-up when a child dies in intensive care. DESIGN: Thematic analysis of incidental data from a larger grounded theory study. SETTING: Four Australian PICUs. SUBJECTS: Twenty-six bereaved parents participated in audio-recorded, semi-structured interviews in 2015-2016. Interviews explored their experiences of having a child die in intensive care and their experiences of end-of-life care and bereavement follow-up. Data pertaining to this report were analyzed via thematic analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Bereaved parents identified several areas for care delivery and improvement across three time periods: during hospitalization; during the dying phase; and during bereavement. During hospitalization, parents' recommendations focused on improved communication, changes to the physical environment, better self-care resources, and provision of family support. During the dying phase, parents suggested private, demedicalized rooms, familiar staff members, and support to leave the hospital. Recommendations for care after death focused mainly on the provision of ongoing support from the hospital or local bereavement services, as well as improved information delivery. CONCLUSIONS: Findings from this study offer many concrete recommendations for improvements in care both during and after a child's death. These recommendations range from simple practice changes to larger organizational modifications, offering many potential avenues for change and improvement both on an individual healthcare provider level and within individual PICUs

Should UK Physiotherapists Choose Wisely?

In 2012 the Choose Wisely campaign was launched in the United States in order to address concerns regarding medicalisation, over diagnosis and medical consumerism. The campaign has now spread internationally and includes a number of countries including Canada, Australia, New Zealand and Germany. The primary aim of the campaign is to facilitate healthcare professionals and patients to question the overall utility of medical interventions. Professionals through their professional organisations identify at least five commonly used interventions or tests, within their areas of speciality, which they feel provided no or little benefit to patients.This paper provides the background to the Choose Wisely campaign. The paper reviews the concepts of medicalisation, over diagnosis and medical consumerism, before considering the utility of the campaign in the UK alongside other forms of governance such as NICE. The paper goes on to consider distributive justice as the principal ethical issue related to the campaign. The paper concludes by asking if UK based Physiotherapists should Choose Wisely

How do Chinese migrant nurses construct their identities while living in Australia?

Identity affects real human experience. Migrant nurses have a complex sense of identity as their identities are contested and renegotiated in new contexts. This study applied Giddens\u27 identity theory to present an understanding of how the identity of Chinese nurses in Australia is impacted through migration

Informed consent in physiotherapy practice: it is not what is said but how it is said

This paper discusses the concept of informed consent in the context of contemporarybiomedical ethics. A change in UK law regarding what information should be provided topatients has brought to the fore the role of physiotherapists in the process of gaining informedconsent. It is important that physiotherapists are aware of how this change in the law will affecttheir practice.For an individual to consent, they need to have both the capacity and freedom to exerciserational thought. These concepts are challenged in contemporary biomedical ethics. Anindividual’s ability to make rational decisions has been increasingly questioned by empiricalevidence from behavioural psychology. In addition, the concept of freedom in contemporaryneoliberal societies has also been critically examined. Liberal paternalism has been advocatedby some as a means of helping patients to make better decisions about their care. Actualised asa ‘nudge’, liberal paternalism has been influential in a number of health policies, and has recently been discussed as a means of gaining consent from patients for assessments andtreatments.Physiotherapists engage directly with patients and, through this engagement, construct atherapeutic environment that aims to build mutual trust. This paper questions the legitimacy ofinformed consent, and presents the argument that, through communicative actions,physiotherapists nudge patients into consenting to assessments and treatments

Is paediatric endotracheal suctioning by nurses’ evidence based? An International Survey

Background: Endotracheal suction (ETS) is essential in intubated patients to prevent tube occlusion and is one of the most common nursing interventions performed in intensive care.Aim: To explore how paediatric endotracheal suctioning (ETS) practices reflect Evidence-based Practice (EBP) recommendations in Paediatric intensive care units (PICU) worldwide.Study design and methods: A cross-sectional electronic survey linked to a real patient suction episode. Nurses completed the survey following a recent ETS episode. EBP was defined based on four of the American Association for Respiratory Care (AARC) best evidence recommendations: pre-oxygenation before suction, use of a suction catheter no more than half the diameter of the tracheal tube, shallow depth of suction and the continuous suction applied upon withdrawal of the catheter. Participants included PICU nurses who performed ETS in children (0-17 years) excluding preterm neonates.Results: Four hundred and forty-six complete surveys were received from 20 countries. Most nurses (80%, 367/446) reported that their unit had local guidelines for ETS. The most common reason for suctioning (44%) was audible/visible secretions. Over half of ETS episodes (57%) used closed suction. When exploring the individual components of suction, 63% (282/446) of nurses pre-oxygenated their patient prior to suction, 71% (319/446) suctioned no further than 0.5cm past end of the endotracheal tube, 59% (261/446) used a catheter no more than half the diameter of the endotracheal tube and 78% (348/446) used continuous negative pressure. 24% of nurses gave patients an additional bolus of sedative, analgesic and/or muscle-relaxant medication prior to suction; this decision was not related to the child’s history of instability with suction, as there was no significant difference in those who reported patients had a history of being unstable with suction (p=0.80). 26% (117/446) of nurses complied with all four EBP components in the reported suctioning episode.Conclusions: Considerable variation in paediatric endotracheal suctioning practices exists internationally. While most nurses applied single components of evidence-based recommendations during ETT suctioning, just a quarter applied all four elements. Relevance for clinical practice: Nurses’ need to consider and strive to apply EBP principles to common nursing interventions such as ETS

Gradually Disengaging: Parent-Health care Provider Relationships After a Child's Death in the Pediatric Intensive Care Unit

When a child dies in the intensive care unit, many bereaved parents want relationships with their child’s health care staff to continue in the form of follow-up care. However, the nature of these relationships and how they change across the parents’ bereavement journey is currently unknown. This article explores early and ongoing relationships between parents and health care staff when a child dies in intensive care. Constructivist grounded theory methods were used to recruit 26 bereaved parents from four Australian pediatric intensive care units into the study. Data were collected via audio-recorded, semistructured interviews and analyzed using the constant comparative methods and theoretical memoing. Findings show that these relationships focus on Gradually disengaging, commonly moving through three phases after the child dies: Saying goodbye, Going home, and Seeking supports. These findings provide guidance to health care staff on what families need as they leave the intensive care unit and move through bereavement

Bereaved parents' experiences of research participation

Background: As understandings of the impacts of end-of-life experiences on parents’ grief and bereavement increase, so too does the inclusion of bereaved parents into research studies exploring these experiences. However, designing and obtaining approval for these studies can be difficult, as guidance derived from bereaved parents’ experiences of the research process are limited within the current literature. Methods: We aimed to explore bereaved parents’ experiences of research participation in a larger grounded theory study exploring experiences of the death of a child in the paediatric intensive care unit. Data were obtained during follow-up phone calls made to 19 bereaved parents, five of whom provided data from their spouse, 1 week after their participation in the study. Participants were asked to reflect on their experiences of research participation, with a focus on recruitment methods, timing of research contact, and the location of their interview. Parents’ responses were analysed using descriptive content analysis. Results: Our findings demonstrate that despite being emotionally difficult, parents’ overall experiences of research participation were positive. Parents preferred to be contacted initially via a letter, with an opt in approach viewed most favourably. Most commonly, participants preferred that research contact occurred within 12–24 months after their child’s death, with some suggesting contact after 6 months was also appropriate. Parents also preferred research interviews conducted in their own homes, though flexibility and parental choice was crucial. Conclusions: Findings from this study offer further insight to researchers and research review committees, to help ensure that future studies are conducted in a way that best meets the unique needs of bereaved parents participating in research