Jeanne Young

Aims and Objectives: The purpose of this study was to assess the safety, feasibility and effectiveness of a nurse‐led glaucoma assessment clinic service.Background: Glaucoma is a group of serious, irreversible optic neuropathies that progressively damage the optic nerve resulting in blindness. Over 64.3 million people globally are affected by glaucoma with numbers projected to increase to 111.8 million by 2040. Glaucoma is a major public health concern that requires the development of innovative models of care to meet current and future health care demands.Methods/Design: A mixed method design was used to evaluate the assessment of non‐complex glaucoma patients attending a new nurse‐led clinic. Under an ophthalmologist's supervision, the glaucoma nurse completed 100 hof clinical training and assessment to ensure they were competent in completing and interpreting the required glaucoma assessment protocols.Interrater reliability between the glaucoma nurse and ophthalmology doctor was undertaken. Glaucoma patient waitlist appointment data were also compared before and after the introduction of the nurse‐led clinics. This study adhered to the SQUIRE checklist for the reporting of excellence with quality improvement projects.Patient Contribution: Patients contributed to the evaluation of this new nurse‐led service by providing follow‐up feedback on their experience.Results: Agreement between clinicians for appropriate follow‐up appointment times was high with 93% (n = 315) agreement achieved. Furthermore in 297 (87.5%) cases, both clinicians agreed on the patient being referred to the doctor for follow‐up review. Glaucoma consultations were shown to increase from 3,115 appointments in 2019/20 to 3,504 appointments in 2020/21 after the introduction of the nurse‐led clinic. The nurse‐led clinics accounted for 14.5% (n = 512) of clinic appointments.Conclusions: The introduction of the nurse‐led glaucoma assessment clinic service allowed patients to be reviewed safely, efficiently and satisfactorily. This new service subsequently allowed for more complex glaucoma patients to be seen by the ophthalmologists.Relevance to clinical practice: Findings revealed that suitably trained glaucoma nurses are able to clinically assess and safely monitor stable non‐complex glaucoma patients.Highlights the need for appropriate investment in clinical training and supervision to ensure that glaucoma assessment nurses are adequately prepared to undertake this new practice role.

This study investigated the effectiveness of high‐fidelity immersive simulation education to support inter‐professional hospital clinical staff in recognizing and responding to aggression, violence, and clinical deterioration of patients admitted with mental health issues. Increased incidents of aggression and violence have been reported in many clinical hospital settings, especially in mental health wards. Patients experiencing severe psychological distress/agitation can result in the escalation of physiological symptoms such as chest pain, difficulty breathing, traumatic injury, etc. Mental health staff do receive aggression prevention training and medical emergency team training. However, there is added complexity when dealing with a mental health patient who is exhibiting aggressive, violent behaviour while also experiencing a medical or psychological emergency. Therefore, mental health staff needed a combined training programme that enhanced their delivery of recovery focussed care, de‐escalation, and medical emergency crisis resource management skills. This study used a prospective quasi experimental research design with repeated measures. Hospital clinical staff were immersed in two mental health emergency response and clinical deterioration scenarios and debriefing sessions. Self‐efficacy was evaluated using a 10‐item validated tool which addressed non‐technical skills of Leadership, Management, Communication, and Teamwork. The sample consisted of 122 clinical staff, with the majority from mental health wards (52%; n = 63) who were nurses (68%; n = 83). Mean self‐efficacy scores increased significantly across the three time points (F = 11.555; df = 2; P = 0.000). Post hoc pairwise comparisons showed that self‐efficacy scores increased between pretest (mean 62.9; n = 122) and posttest 1 (mean 83.2; n = 122) and follow up, 3 months later (posttest 2; mean 81.9; n = 24). Between pre‐ and posttest 1, significant improvements in self‐efficacy were observed for both the Leadership/Management domain (t = 8.2; df 119; P < 0.000; 95% CI 13.3–21.7) and the Communication/Teamwork domain (t = 8.0; df 119; P < 0.000; 95% CI 11.1–18.4). Immersive simulation with high fidelity education was found to be effective in improving hospital nursing and medical staffs' confidence, when responding to incidents of aggression/violence and clinical deterioration of a mental health patient.

Introduction: Ongoing professional education is an essential activity to ensure that hospital staff are using the best available evidence to deliver healthcare. Hospital staff from a range of professional groups cite increasing work volume and being too time poor to complete or attend education. To address this issue, a new 5-minute online education format (Take 5) was developed. Methods: A descriptive study using a short evaluation survey was undertaken at Royal Perth Hospital in Perth, Western Australia, to evaluate interprofessional healthcare staffs’ levels of engagement with the new education format. Results: The Take 5 education format facilitated the development of over 120 topics available via an intranet library page. During the study, it received 26,623 hits, averaging 19.3 visits per day. Topics were downloaded 45,611 times. Medication discrepancies (n = 1,326) and personal protective equipment (PPE) conservation (n = 1,115) were the most frequently downloaded. A total of 2,001 evaluation surveys were received, with nursing and medicine having the highest participation. The majority of staff (n = 1,895; 94.4%) rated the resource as having “good” to “high” quality content. Qualitative data showed that the topics were informative, easy to access and understand and perceived to help the participants change their clinical practice.Conclusion: The Take 5 uptake has been strong and sustained, as highlighted by the substantive utilisation and evaluation. The concept was not designed to replace formal education but to act as an adjunct, providing key education to meet staff demands. It provided immediacy of information and quality evidence-based content and directed the learner to more formal learning content and resources.

The aim of this study was to describe bowel problems, self-care practices, and information needs of patients who have recovered from the acute effects of sphincter-saving surgery for colorectal cancer. A retrospective, descriptive survey was conducted using a structured telephone interview and mailed questionnaires. The sample consisted of 101 patients who had undergone sphincter-saving surgery for colorectal cancer in the last 6 to 24 months. Most participants (71.3%) reported a change in bowel habits after surgery. The 6 most frequently reported gastrointestinal problems were incomplete evacuation (75.2%), excessive flatus (75.2%), urgency (73.3%), straining (61.4%), perianal soreness or itching (49.5%), and bloating (43.6%). Incontinence of feces (varying from smears to complete bowel action) was reported by 37.6% of participants. The most frequently reported information needs were related to diet (50.5%) and managing conditions such as diarrhea (31.7%), bloating/wind/gas (28.7%), pain (21.8%), and incomplete emptying of the bowel (18.8%). Patients who had recovered from the acute effects of sphincter-saving surgery for colorectal cancer reported a wide range of bowel problems and ongoing concerns about managing symptoms. Findings from this study provide valuable information to guide the development of educational resources to prevent or better manage bowel problems after surgery.

The impact of a new high dependency unit (HDU) that was developed from an adjoining ward was evaluated from both an organizational and consumer perspective. Satisfaction of patients and relatives with nursing care on the ward of origin was measured before and after the development of the HDU, and nurses were surveyed regarding the impact of the change on nursing practices. Patients’ perceptions of pain and pain management was compared between patients admitted to the ward prior to the development of the HDU, and a later group admitted to the HDU. Results showed that despite high satisfaction prior to the development of the HDU, satisfaction of patients and relatives improved on the ward after the development of the HDU. Nurses in both areas also described higher satisfaction levels after the change. Patients admitted to the HDU expressed higher levels of satisfaction with nurses’ response to analgesia requests and clinical data showed a trend toward lower pain scores in this group compared with pre‐HDU patients. The HDU was found to be effective in providing high level care and monitoring for a group of patients at risk of postoperative complications. It was also associated with additional benefits in the running of the adjacent ward.

Research confirms that laparoscopic cholecystectomy (LC) results in shorter lengths of hospital stay and earlier return to usual activity than the traditional cholecystectomy procedure. Research in this area, however, focuses more on the medical aspects of patient recovery, but very few studies have evaluated how these patients manage their recovery at home or what types of problems they encounter. A total of 28 LC patients were randomly assigned to two groups: (1) 23 h stay (overnight) in a general surgical ward or (2) day procedure unit (DPU) stay. Data was collected by a self-administered Postoperative Symptoms Diary and telephone interview. Results showed no significant difference between the two groups of patients recovery symptoms scores. Problems with mobility, pain and elimination recorded the highest mean scores for both groups of patients. Overnight patients also experienced problems with tiredness and eating. All DPU patients were able to manage their postoperative symptoms, compared to only 44% of patients who had stayed in overnight. Carer assistance was needed with regard to activities of daily living, child care and reassurance. Results showed that with careful selection of patients, LC cases performed as day procedures did not impact at all on the patients' recovery trajectory.