Search PubMed⌕ Search

Biomedical subjects

R Endacott

Publications and source records attributed to R Endacott.

At least 19 recordsLinked to original sources

The impact of an ICU liaison nurse on discharge delay in patients after prolonged ICU stay.

The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention--the ICU liaison nurse role--in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICUpatients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. The liaison nurse was involved in assessment of patients for transfer to the ward, with a major focus on coordinating patient transfer including liaison with ward staff prior to and following ICU discharge. Logistic regression was used to quantify the risk of discharge delay associated with the liaison nurse intervention with adjustment for potential confounding variables. While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjustingforpotential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer

Adult↗

A formula for diversity: a review of critical care curricula.

This paper is based on a documentary analysis and literature review of critical care nursing commissioned by the English National Board for Nursing, Midwifery and Health Visiting. Five critical care programmes were included in the analysis: ENB 100, 124, 199, 176/183, and 415. In total, 105 curricula were reviewed from 30 institutions. Data were extracted and analysed using an adapted grounded theory approach. The documentary analysis was supplemented by two telephone surveys with lecturers (n = 84) and clinical managers (n = 81). There was great diversity in the programmes in terms of the academic level at which the courses were set, module configuration, approaches to practice assessment and the amount of student effort for the same professional award. Diversity arose because of different university module formulae, different methods to differentiate level 2 and level 3 practice, different views about the purpose of the course, and an attempt to make the programmes increasingly flexible to accommodate a heterogeneous student population. Documentary analysis has its limitations, and although the research team were able to check out issues with lecturers throughout the analysis, they were unable to capture the lived experience of the curriculum. A second study has been commissioned by the ENB to explore how these issues influence practice.

Critical Care↗

Balancing stakeholder needs: a review of ENB 100 and 415 courses. English National Board for Nursing, Midwifery and Health Visiting.

This paper reports the findings of a documentary analysis and literature review of general and paediatric intensive care unit (ICU) courses (ENB 100 and ENB 415). The findings are part of a larger review of critical care courses commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB), also incorporating operating department, coronary care and accident and emergency courses. It was important to set the curriculum review in the context of intensive care practice and education, hence the study also comprised interviews with lecturers and ICU managers. The study findings reveal diversity in major aspects of the critical care courses, including the academic level of the programmes and credits they attracted; the assessment strategies for theory and practice, the extent of shared learning and the amount of student effort. Many factors influenced this diversity including contrary opinion among stakeholders about the purpose of the course: to prime the students for working in the specialty; or to consolidate previous experience (in some cases up to 15 years). Course structure and content have changed in response to local university requirements and directives from the statutory bodies, as well as in response to the higher level of academic credit awarded for pre-registration programmes (qualification inflation). The perceived shift in course content as well as the diversity across programmes had led a group of ICU managers to define their own list of competencies (Crunden 1998). However, the majority of the managers interviewed for this study (63% of General ICU managers (n = 19) and 83% (n = 6) of Paediatric ICU managers) were generally satisfied with the competencies and skills of the nurses who had undertaken the ENB course. The authors conclude from the diverse nature of the courses that there is little national comparability in the courses although this finding might be an artefact of documentary analysis. The extent to which this (apparent) diversity results in different levels of competence in practice requires further exploration.

Attitude of Health Personnel↗

Roles of the allocated nurse and shift leader in the intensive care unit: findings of an ethnographic study.

In the UK, recent policy guidelines emphasize the role of nurses in managing the minute-by-minute care of critically ill patients (Department of Health 1996). This article reports on a study that explored the extent to which the nurse at the bedside (the allocated nurse) and the nurse in charge of the shift (the shift leader) make decisions about the needs of children who are critically ill. The study also identified areas of need using a modified Delphi study and explored how nurses perceive and act on the needs of critically ill children. These aspects are presented elsewhere.

Anthropology, Cultural↗

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study.

The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term 'need'. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.

Child↗

Needs of the critically ill child: a review of the literature and report of a modified Delphi study.

There has been a wealth of guidance from both policy-makers (Department of Health, (DoH) 1991, DoH 1997a, DoH 1997b) and other interested parties (Audit Commission 1993, British Paediatric Association 1993, Paediatric Intensive Care Society 1992) regarding how and where care should be provided for critically ill children. Latest recommendations indicate that designated general ICUs will continue to provide care for children requiring life support and that all general ICUs will need to initiate such care (DoH 1997a). The literature relating to how nurses identify and act on the needs of the critically ill child has been anecdotal in nature (Green 1991, Purcell 1993), whilst published studies focus on comparing outcomes (Pollock et al 1991) and addressing the needs of parents (Farrell & Frost 1992, Kasper & Nyamathi 1988). This paper explores the literature regarding the needs of the critically ill child, incorporating the role of parents and previous studies exploring needs. The findings of a modified Delphi study exploring the needs of the critically ill child are also outlined.

Child↗

Clarifying the concept of need: a comparison of two approaches to concept analysis.

Meeting needs is the aim of health care frequently espoused in textbooks, policy documents and reports of research studies; provision of health care is also now described as 'needs-based', rather than 'service-based'. The purpose of this paper is to explore the concept of need, using concept analysis, with the aim of providing greater clarity. Two approaches to concept analysis are compared: the linear model proposed by Walker and Avant and Rodgers' cyclical model. On both a philosophical and practical level, Rodgers' model was felt to be more appropriate for analysis of the concept of need. The rigid divisions which the Walker and Avant model seeks to establish (particularly in relation to the construction of additional cases) were felt to restrict, rather than clarify the concept. The attributes, antecedents, consequences and references of need are described, following stratified random sampling of the available literature, and a model case is presented. The themes of priority and perception of need arose consistently within the literature, highlighting the value-laden nature of the concept and the importance of achieving a common understanding to enable purchasers, providers and consumers to better satisfy health care needs.

Delphi Technique↗

Nursing dependency scoring: measuring the total workload.

This article discusses the issues surrounding the measurement of nursing work. The authors highlight a Royal College of Nursing (RCN) survey of critical care units which identified the extent of the use of patient scoring systems. The authors also examine the implications of using scoring systems to determine nursing workload and estimate staffing requirements.

Activities of Daily Living↗

Staffing intensive care units: a consideration of contemporary issues.

Intensive care nurses are an expensive and scarce resource. The internal market within the National Health Service requires greater scrutiny of expenditure in all areas, not least staffing. Inevitably questions are raised regarding the evidence to justify the nurse:patient ratios in specialist areas such as intensive care. This paper addresses some of the issues surrounding staffing in intensive care and discusses the impact of changes in medical practice on the nursing role. The nurse:patient ratio is lower in the USA, therefore a brief comparison between the two countries is provided in order to inform discussion and debate. The importance of these issues for all intensive care nurses is emphasised, together with a plea for a substantive study to provide evidence of nursing work and inform future decision-making by the purchasers and providers of intensive care services.

Clinical Competence↗

Evaluating education in intensive care.

In its promotional literature for the Higher Award, the English National Board include a logo promoting 'Quality Education for Quality Care'. The purpose of this paper is to examine how we can assess the impact of continuing education, specifically the English National Board (ENB) Course 100, on quality of care in an Intensive Care Unit (ICU). The paper provides an examination of the relationship between education and practice, methods of evaluating education and the impact that the course can make on clinical practice.

Clinical Competence↗

Auditing in intensive care: comparison of two tools.

This article addresses some of the practical aspects of auditing in the intensive care setting by comparing two audit tools. An overview of each tool is provided together with a description of how it was used. Recommendations for auditing in intensive care are given.

Critical Care↗