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Biomedical subjects

Bronagh Blackwood

Publications and source records attributed to Bronagh Blackwood.

7 recordsLinked to original sources
PubMed2006

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: a quasi-experimental study.

BACKGROUND: Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses' views and perceptions has been largely ignored. AIM: To determine the change in intensive care nurses' perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice. METHODS: The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses' perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units. RESULTS: Response rates were 79% (n=140) for Phase 1 and 62% (n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02). CONCLUSION: We conclude that nurse-directed protocolised-weaning had no effect on nurses' views and perceptions due to the high level of satisfaction which encouraged nurses' participation in weaning throughout. Control group changes are attributed to a 'reactive effect' from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

Adult↗
PubMed2006

Methodological issues in evaluating complex healthcare interventions.

AIM: This paper outlines the difficulties in defining and evaluating a complex intervention and a number of currently available models for assisting this process are discussed. BACKGROUND: Interventions aimed at producing change in the delivery and organization of healthcare services require rigorous evaluation to demonstrate their effectiveness. Evaluation poses difficulties, however, because these interventions are usually very complex. METHODS: A framework developed by the United Kingdom Medical Research Council to evaluate complex interventions is described. The use of this framework in designing and evaluating a nurse-led intervention in intensive care for weaning patients from mechanical ventilation is discussed. Semi-structured interviews, a questionnaire survey and observational work were undertaken to define the components of the intervention, which was subsequently evaluated in an exploratory trial using a quasi-experimental design. CONCLUSION: The framework was a useful tool and can be easily applied in developing and evaluating complex nursing interventions. Three key challenges emerge from this experience: (i) relevant research evidence should be used systematically in developing the components of the intervention, (ii) the definition and measurement of complex intervention outcomes needs to be improved and (iii) appropriate research designs must be used when evaluating complex interventions.

Evidence-Based Medicine↗
PubMed2004

Protocolized weaning from mechanical ventilation: ICU physicians' views.

BACKGROUND: The use of protocols during weaning from mechanical ventilation is uncommon in the UK, despite research pointing to their potential benefits. This may be because the research evidence is considered not to apply in different settings. Intensive care unit consultant physicians are the major decision-makers in weaning in the UK and any attempt to introduce protocolized weaning will require consideration of their views. AIM: The aim of this paper is to report a study exploring intensive care physicians' views on (i) weaning from mechanical ventilation, (ii) the utility of weaning protocols and (iii) nurses' roles in the weaning process. A specific goal was to identify potential aids and barriers to developing weaning protocols and their introduction into clinical practice. METHODS: Qualitative interviews were conducted with a purposive sample of 10 consultant physicians in two intensive care units in Northern Ireland and subjected to content analysis. FINDINGS: The primary themes identified were (i) information required for weaning decisions and clinical judgement, (ii) professional boundaries, (iii) protocol issues and (iv) timing of weaning. Three types of information were deemed to be required for weaning decisions - empirical objective, empirical subjective and abstract - and interviewees considered that it would be challenging to incorporate all into a protocol. They were divided on whether protocols were useful when nursing experience was limited. Some groups of patients were thought more suitable than others for protocolized weaning. CONCLUSIONS: Although local physicians were supportive in theory, introduction of protocolized weaning is likely to be difficult because of the breadth of information required for successful decision-making. Consultant views in this study were not consistent with American findings that physicians' caution may unnecessarily prolong weaning.

Attitude of Health Personnel↗
PubMed2003

Can protocolised-weaning developed in the United States transfer to the United Kingdom context: a discussion.

Weaning patients from mechanical ventilation using standardised protocols has been demonstrated to be safe and effective in reducing mechanical ventilation time, intensive care unit (ICU) stay and costs. Studies supporting this have all been conducted in the United States of America and weaning protocols are not widely used in the United Kingdom. With such a strong scientific evidence-base for protocolised-weaning, it is unclear why the introduction of evidence-based practice in this area is so low in the UK. There may be a number of reasons for this. First, it may be that the evidence is considered not to apply to different settings, particularly between the USA and UK where there are many differences in health care cultures. Second, it is suggested that the strength of evidence is not the only factor to account for when trying to introduce research evidence into practice [Qual. Health Care 7 (1998) 149]. The context or environment into which the research is to be implemented and how the implementation process is facilitated are equally important factors to be considered. Kitson et al. [Qual. Health Care 7 (1998) 149] argue that the interplay between the three factors of evidence, context and facilitation, enable the successful implementation of evidence-based practice. This discussion paper explores the factors that influence the introduction of weaning protocols. The discussion is structured around the three core elements from Kitson et al.'s conceptual framework and it draws upon examples of UK and USA contextual differences from Northern Ireland (NI) and Virginia (VA).

Evidence-Based Medicine↗
PubMedDate not supplied

Severe sepsis: patient management focusing on administration of drotrecogin alpha (activated) infusion.

This article presents a case study of a 49-year-old male admitted to the Intensive Care Unit (ICU) via Accident and Emergency following a collapse at home with a diagnosis of severe sepsis. The pathophysiology of sepsis is discussed together with a physiological assessment of the patient's cardiovascular, respiratory and renal systems, coagulation and metabolic responses. The discussion focuses on the period from ICU admission to commencement of drotrecogin alpha (activated) treatment (also known as recombinant human activated protein C). The management of sepsis and the treatment the patient received are outlined with particular focus on the strategic and procedural issues of the drug administration. The article concludes by presenting nursing clinical guidelines which will provide helpful guidance for nurses when caring for patients receiving drotrecogin alpha (activated) treatment. This is especially welcome, as drotrecogin alpha (activated) is internationally recommended in the treatment of severe sepsis.

Anti-Infective Agents↗