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Author |
Harris, C.; Crozier, I.; Smyth, J.; Elliot, J.; Watson, P.B.; Sands, J.; Cuddihy, R. |
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Title |
An audit of percutaneous coronary intervention (PCI) patients representing acutely with chest pain within six months of PCI |
Type |
Manuscript |
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Year |
2007 |
Publication |
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Abbreviated Journal |
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Issue |
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Pages |
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Keywords |
Hospitals; Clinical assessment; Cardiovascular diseases; Guidelines; Teaching methods |
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Abstract |
This reports an audit of the assessment practices at Christchurch Hospital, compared to international guidelines. The clinical notes of all patients who were re- admitted acutely with chest pain within six months of PCI procedures performed between 1/4/05 and 30/9/05 were audited. Ethics approval was granted and an audit tool was designed based on the 2000 ACC/AHA Guidelines for the management of patients with unstable angina. The purpose of the audit was to determine to what extent best practice guidelines were followed in the assessment of patients re-admitted with chest pain and to determine if there were any indicators (lesional, procedural or risk factors for restenosis) that predicted a normal or abnormal repeat coronary angiogram. 448 consecutive patients had PCI procedures, 36 patients represented acutely with chest pain and had repeat coronary angiography. In 18 patients the coronary angiogram was unchanged, 11 patients demonstrated instent restenosis, one patient demonstrated thrombus and six patients developed new lesions. The authors concluded that at Christchurch Hospital assessment practices are consistent with international guidelines. Of the patients who had repeat angiography, 50% had no coronary obstruction for the cause of pain. There was a relatively low incidence of acute representation with chest pain. These results suggest a revision of the guidelines for repeat angiography following PCI is warranted. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1157 |
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Author |
Scrymgeour, G. |
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Title |
Using diagnostic reasoning in nursing practice: Ectopic pregnancy: A case study approach |
Type |
Journal Article |
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Year |
2005 |
Publication |
Vision: A Journal of Nursing |
Abbreviated Journal |
Available online at Eastern Institute of Technology |
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Volume |
13 |
Issue |
1 |
Pages |
13-17 |
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Keywords |
Nursing; Pregnancy; Clinical assessment |
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Abstract |
This paper explores, through the use of a case study, an evidence-based diagnostic reasoning process utilising the framework followed by Dains, Baumann and Scheibel (1998). This framework, as described by these authors, involves an inductive process of reasoning, which leads to formulation of a hypothesis that is then analysed using an evidence-based approach. From this analysis, a likely diagnosis can be made and appropriate therapeutic intervention initiated. This research demonstrates that although an evidence-based approach is the ideal, sometimes clinical intuition is equally important to the clinical outcome. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1305 |
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Author |
Turnwald, A.B. |
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Title |
Acute Hypercarbia in Chronic Obstructive Pulmonary Disease (COPD): Presentations to a New Zealand emergency department |
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Year |
2006 |
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 |
Chronically ill; Clinical assessment; Emergency nursing |
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Abstract |
A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1210 |
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Author |
Kuehl, S. |
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Title |
Emergency Department re-presentations following intentional self-harm |
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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 |
Emergency nursing; Psychiatric Nursing; Mental health; Clinical assessment |
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Abstract |
The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1214 |
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Author |
Kussmaul, Joerg |
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Title |
An investigation of occupational health and safety workplaces and working conditions in comparison to nursing care quality in residential aged care facilities (RACFs) in New Zealand |
Type |
Book Whole |
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Year |
2020 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
270 p. |
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Keywords |
Residential Aged Care Facilities; Ocuupational health and safety; Working conditions; InterRAI; Clinical Assessment Protocols Job stress; Registered nurses; Enrolled nurses; Healthcare assistants |
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Abstract |
Identifies critical factors related to the occupational health and safety of workplaces and working conditions in residential aged-care facilities (RACF), from the perspective of nursing staff. Correlates quality indicators for occupational health and safety for workplaces and in working conditions with nursing care quality based on the InterRAI Clinical Assessment Protocols (CAP). Uses a mixed-method approach to conduct an audit of workplace health and safety and environmental conditions in 17 RACFs. Surveys 398 registered nurses (RN), enrolled nurses (EN), and Healthcare Assistants (HCA) about the mental and physical stressors in their work. |
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Call Number |
NZNO @ research @ |
Serial |
1655 |
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Author |
Whittle, R. |
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Title |
Decisions, decisions: Factors that influence student selection of final year clinical placements |
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Year |
2007 |
Publication |
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Abbreviated Journal |
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Volume |
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Issue |
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Pages |
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Keywords |
Clinical assessment; Nursing; Education; Students |
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Abstract |
Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment. |
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Call Number |
NRSNZNO @ research @ |
Serial |
1103 |
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Author |
Neville, S.J.; Gillon, D.; Milligan, K. |
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Title |
New Zealand registered nurses' use of physical assessment skills: A pilot study |
Type |
Journal Article |
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Year |
2006 |
Publication |
Vision: A Journal of Nursing |
Abbreviated Journal |
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Volume |
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Issue |
14(1) |
Pages |
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Keywords |
Clinical assessment; Nursing; Evaluation |
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Abstract |
The objective of this project was to ascertain registered nurses' use of selected physical assessment skills before and after participation in a health assessment course. A pre- (also referred to as part I) and post- (part II) test design was used to investigate the research aim. Participants were obtained via a convenience sample. A questionnaire was completed at the beginning of the educational programme and then four to six weeks after completion of the assessment course. A two tailed t-test was used to identify any significant differences in the characteristics of participants from part I (N = 206) to part II (N = 145), with no differences identified. However, there was an overall mean percentage difference of 17.1% in the use of physical assessment skills after having completed the educational programme. In conclusion, the researchers found that four to six weeks after completion of a health assessment course, nurses were using the skills learned to improve their nursing practice more frequently than before the programme. |
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Call Number |
NRSNZNO @ research @ 879 |
Serial |
863 |
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Author |
Richardson, S.; Ardagh, M.; Hider, P. |
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Title |
New Zealand health professionals do not agree about what defines appropriate attendance at an emergency department |
Type |
Journal Article |
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Year |
2006 |
Publication |
New Zealand Medical Journal |
Abbreviated Journal |
Access is free to articles older than 6 months, and abstracts. |
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Volume |
119 |
Issue |
1232 |
Pages |
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Keywords |
Hospitals; Clinical assessment; Interprofessional relations |
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Abstract |
This study aims to examine the concept of 'inappropriate' emergency department attendances in relation to the emergency department at Christchurch Hospital. It specifically seeks to determine whether there is a consensus opinion among healthcare providers regarding a definition of 'inappropriate'. An exploratory survey of health professionals involved with the referral, assessment, transport, and treatment of emergency department patients in Christchurch was carried out. A range of health professionals, including ambulance personnel, general practitioners, emergency department physicians, emergency nurses, and hospital managers were approached. A series of questions relating to definition and response to 'inappropriate' patients was asked, with an additional open-ended question relating to the definition of 'appropriateness'. The researchers found significant differences in the attitudes and perceptions of key health professionals involved in the referral, treatment, and admission of patients to the emergency department. This has implications for any interventions aimed at addressing emergency department 'overcrowding' that assume the presence of a consensus understanding of this concept. |
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Call Number |
NRSNZNO @ research @ |
Serial |
526 |
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Author |
Ardagh, M.; Wells, E.; Cooper, K.; Lyons, R.; Patterson, R.; O'Donovan, P. |
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Title |
Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: A controlled prospective trial |
Type |
Journal Article |
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Year |
2002 |
Publication |
New Zealand Medical Journal |
Abbreviated Journal |
Access is free to articles older than 6 months, and abstracts. |
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Volume |
115 |
Issue |
1157 |
Pages |
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Keywords |
Emergency nursing; Time factors; Clinical assessment; Clinical decision making |
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Abstract |
The aim of this study was to test the hypothesis that triaging certain emergency department patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. During the five weeks of the RAC clinic a total of 2263 patients attended the emergency department, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the emergency department. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The researchers found that the rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources. |
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Call Number |
NRSNZNO @ research @ |
Serial |
617 |
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Author |
Fraser, A.G.; Williamson, S.; Lane, M.; Hollis, B. |
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Title |
Nurse-led dyspepsia clinic using the urea breath test for Helicobacter pylori |
Type |
Journal Article |
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Year |
2003 |
Publication |
New Zealand Medical Journal |
Abbreviated Journal |
Access is free to articles older than 6 months, and abstracts. |
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Volume |
116 |
Issue |
1176 |
Pages |
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Keywords |
Advanced nursing practice; Hospitals; Clinical assessment; Evaluation |
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Abstract |
Reports the audit of a nurse-led dyspepsia clinic at Auckland Hospital. Referrals to the Gastroenterology Department for gastroscopy were assessed in a dyspepsia clinic. Initial evaluation included consultation and a urea breath test (UBT). Patients given eradication treatment prior to initial clinic assessment were excluded. Patients with a positive UBT were given eradication treatment and were reviewed two months later for symptom assessment and follow-up UBT. Patients with a negative UBT were usually referred back to the GP. There were 173 patients with a mean age 38 years. The urea breath test was found to be useful as part of the initial assessment of selected patients who would otherwise have been referred for endoscopy. It is likely that the need for gastroscopy was reduced, but longer follow up will be required to determine whether or not this effect is simply due to delayed referral. This approach is likely to have value only in patients who have a relatively high chance of being H. pylori positive. |
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Call Number |
NRSNZNO @ research @ 625 |
Serial |
611 |
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