Australian Critical Care RSS feed: Current Issue. Australian Critical Care is a peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to our members. Australian Critical Care is published quarterly. Original contributions relevant to critical care nursing are invited. The editor welcomes manuscripts reporting original research or innovative practices and technologies, continuing education articles, descriptions of instructive case studies and editorials and book reviews sought by the editor. Authors may also contribute unsolicited editorials and book reviews by arrangement with the editor. Nursing Consult Visit our new nursing resource, Nursing Consult To purchase books on Critical Care Nursing or to browse our comprehensive range of nursing titles, please visit us at shop.elsevier.com.au. For a limited time we are offering 10% discount and free freight to all ANZ orders. Shop.elsevier.com.au/CriticalCare http://www.australiancriticalcare.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Australian Critical Care1036-7314251February 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.australiancriticalcare.com/article/PIIS1036731412000100/abstract?rss=yesContents10.1016/S1036-7314(12)00010-0Australian Critical Care 25, 1 (2012)2012-02-01Australian Critical Care2012-02-01251S1036-7314(12)X0002-Xiihttp://www.australiancriticalcare.com/article/PIIS1036731412000124/abstract?rss=yesEditorial Board10.1016/S1036-7314(12)00012-4Australian Critical Care 25, 1 (2012)2012-02-01Australian Critical Care2012-02-01251S1036-7314(12)X0002-Xivivhttp://www.australiancriticalcare.com/article/PIIS1036731412000173/abstract?rss=yesNote of Thanks from the Editor in Chief10.1016/S1036-7314(12)00017-3Australian Critical Care 25, 1 (2012)2012-02-01Australian Critical Care2012-02-01251S1036-7314(12)X0002-Xvivihttp://www.australiancriticalcare.com/article/PIIS1036731411001366/abstract?rss=yesAccording to Meleis and colleagues, the core of nursing practice is to coach patients through transition(s). Transitions are passages from one life phase, physical condition, or social role to another, resulting in a temporarily disconnectedness of the normal way of living, which demands an adjustment of the patient and the environment. As the primary caregivers for patients and their families, nurses need to support, educate and counsel patients, resulting in a successful transition experience for the patient. Furthermore, nurses have to facilitate the development of new skills, knowledge and behaviours in patients to achieve favourable transition outcomes.Coaching through transition: A challenge for critical care nursesEva Goossens, Deborah Hilderson, Philip Moons10.1016/j.aucc.2011.08.001Australian Critical Care 25, 1 (2012)2011-09-12Australian Critical Care2011-09-12251S1036-7314(12)X0002-XGuest Editorial12http://www.australiancriticalcare.com/article/PIIS1036731412000240/abstract?rss=yesChest X-ray quiz (Question)10.1016/S1036-7314(12)00024-0Australian Critical Care 25, 1 (2012)2012-02-01Australian Critical Care2012-02-01251S1036-7314(12)X0002-X33http://www.australiancriticalcare.com/article/PIIS1036731411000555/abstract?rss=yesSummary: Background: End-of-life care is a significant component of work in intensive care. Limited research has been undertaken on the provision of end-of-life care by nurses in the intensive care setting. The purpose of this study was to explore the end-of-life care beliefs and practices of intensive care nurses.Methods: A descriptive exploratory qualitative research approach was used to invite a convenience sample of five intensive care nurses from one hospital to participate in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach.Findings: Three major categories emerged from analysis of the interviews: beliefs about end-of-life care, end-of-life care in the intensive care context and facilitating end-of-life care. The first two categories incorporated factors contributing to the end-of-life care experiences and practices of intensive care nurses. The third category captured the nurses’ end-of-life care practices.Conclusions: Despite the uncertainty and ambiguity surrounding end-of-life care in this practice context, the intensive care setting presents unique opportunities for nurses to facilitate positive end-of-life experiences and nurses valued their participation in the provision of end-of-life care. Care of the family was at the core of nurses’ end-of-life care work and nurses play a pivotal role in supporting the patient and their family to have positive and meaningful experiences at the end-of-life. Variation in personal beliefs and organisational support may influence nurses’ experiences and the care provided to patients and their families. Strategies to promote an organisational culture supportive of quality end-of-life care practices, and to mentor and support nurses in the provision of this care are needed.End-of-life care in the intensive care setting: A descriptive exploratory qualitative study of nurses’ beliefs and practicesKristen Ranse, Patsy Yates, Fiona Coyer10.1016/j.aucc.2011.04.004Australian Critical Care 25, 1 (2012)2011-05-12Australian Critical Care2011-05-12251S1036-7314(12)X0002-XResearch Papers412http://www.australiancriticalcare.com/article/PIIS1036731411001378/abstract?rss=yesSummary: Introduction: The work activities of an Intensive Care Unit (ICU) nurse is frequently dynamic and variable. The activities are not necessarily linear actions that occur in a structured manner but are more complex and not well documented. A greater understanding of the type and level of activity assists in informing workload models.Objective: The aim of this study was to describe and analyse the work activities of bedside Intensive Care Unit (ICU) nurses during the day shift.Methods: Time and motion observational methodology was used to observe 10 bedside ICU nurses during the day shift, Monday to Friday. All activities undertaken by the nurses during their shift were timed and recorded and then were coded according to whether they involved direct or indirect patient activities, or were unit or personally related.Results: Just over 76h of observations occurred over 10 days and 3081 activities documented during this time. The major work activity groups for the ICU nurses were; ‘direct care’ 1857 activities and 40.5% of their time, ‘indirect care’ 986 activities and 32.4% of their time, ‘personal’ activities 140 activities and 21.9% of their time and ‘unit-related’ 98 activities and 5.0% of their time. The ICU nurses undertook two activities simultaneously for 43% of the study timeframe.Conclusion: This study provides baseline evidence on the activities nurses undertake on a daily basis, with only about a quarter of their time not being spent on patient care activities, either directly or indirectly.Understanding the work of intensive care nurses: A time and motion studyM. Abbey, W. Chaboyer, M. Mitchell10.1016/j.aucc.2011.08.002Australian Critical Care 25, 1 (2012)2011-09-22Australian Critical Care2011-09-22251S1036-7314(12)X0002-XResearch Papers1322http://www.australiancriticalcare.com/article/PIIS1036731411000968/abstract?rss=yesSummary: Background: Critical care nurses frequently and independently manage oxygen therapy. Despite the importance of oxygen therapy, there is limited evidence to inform or support critical care nurses’ oxygen therapy practices.Aim: To establish if there is variability in oxygen therapy practices of critical care nurses and examine the degree of variability.Method: On-line questionnaire of ACCCN members between April and June 2010.Results: The response rate was 36% (542/1523 critical care nurses). Overall, 378 (70%) respondents practiced in metropolitan critical care units; 278 (51%) had ≥14 years of specialty practice. In response to falling SpO2, 8.9% of nurses would never escalate oxygen therapy without a doctor's request, and 51% of nurses would not routinely escalate oxygen therapy in the absence of medical orders. Only 56% of nurses reported always increasing FiO2 prior to endotracheal suctioning. In mechanically ventilated patients, 33% of nurses believed oxygen toxicity was a greater threat to lung injury than barotrauma. More than >60% of respondents reported a tolerance for a stable SpO2 of 90%. Nurses in rural critical care units were less likely to independently titrate oxygen to their own target SpO2, but more likely to independently treat a falling SpO2 with higher FiO2.Conclusion: Critical care nurses varied in their self-reported oxygen therapy practices justifying observational and interventional studies aimed at improving oxygen therapy for critically ill patients.Critical care nurses’ opinion and self-reported practice of oxygen therapy: A surveyGlenn M. Eastwood, Michael C. Reade, Leah Peck, Ian Baldwin, Julie Considine, Rinaldo Bellomo10.1016/j.aucc.2011.05.001Australian Critical Care 25, 1 (2012)2011-06-30Australian Critical Care2011-06-30251S1036-7314(12)X0002-XResearch Papers2330http://www.australiancriticalcare.com/article/PIIS1036731411001330/abstract?rss=yesSummary: Background: Risk prediction models can assist in identifying individuals at risk of adverse events and also the judicious allocation of scare resources. Our objective was to describe risk prediction models for the rehospitalisation of individuals with chronic heart failure (CHF) and identify the elements contributing to these models.Methods: The electronic data bases MEDLINE, PsychINFO, Ovid Evidence-Based Medicine Reviews and Scopus (1950–2010), were searched for studies that describe models to predict all-cause hospital readmission for individuals with CHF. Search terms included: patient readmission; risk; chronic heart failure, congestive heart failure and heart failure. We excluded non-English studies, pediatric studies, and publications without original data.Results: Only 1 additional model was identified since the review undertaken by Ross and colleagues in 2008. All models were derived from data sets collected in the United States and patients were followed from 60 days to 18 months. The only common predictors of re-hospitalisation in the models identified by Ross and colleagues were a history of diabetes mellitus and a history of prior hospitalisation. The additional model extends its scope to include the non clinical factors of social instability and socioeconomic status as predictors of rehospitalisation.Conclusions: In spite of the burden of hospitalisation in CHF, there are limited tools to assist clinicians in assessing risk. Developing risk prediction models, based on patient, provider and system characteristics may assist in identifying individuals in the community at greatest risk and in need of targeted interventions to improve outcomes.What are the factors in risk prediction models for rehospitalisation for adults with chronic heart failure?Vasiliki Betihavas, Patricia M. Davidson, Phillip J. Newton, Steven A. Frost, Peter S. Macdonald, Simon Stewart10.1016/j.aucc.2011.07.004Australian Critical Care 25, 1 (2012)2011-09-05Australian Critical Care2011-09-05251S1036-7314(12)X0002-XResearch Papers3140http://www.australiancriticalcare.com/article/PIIS103673141100138X/abstract?rss=yesSummary: Background: There is a lack of evidence to direct and support nursing practice in the specialty of paediatric intensive care (PIC). The development of national PIC nursing research priorities may facilitate the process of undertaking clinical research and translating evidence into practice.Purpose: To (a) identify research priorities for the care of patients and their family as well as for the professional needs of PIC nurses, (b) foster nursing research collaboration, (c) develop a research agenda for PIC nurses.Methods: Over 13 months in 2007–2008, a three-round questionnaire, using the Delphi technique, was sent to all specialist level registered nurses working in Australian and New Zealand PICUs. This method was used to identify and prioritise nursing research topics. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data.Results: In Round I, 132 research topics were identified, with 77 research priorities (mdn>6, mean MADmedian 0.68±0.01) identified in subsequent rounds. The top nine priorities (mean>6 and median>6) included patient issues related to neurological care (n=2), pain/sedation/comfort (n=3), best practice at the end of life (n=1), and ventilation strategies (n=1), as well as two priorities related to professional issues about nurses’ stress/burnout and professional development needs.Conclusion: The research priorities identified reflect important issues related to critically ill patients and their family as well as to the nurses caring for them. These priorities can be used for the development of a research agenda for PIC nursing in Australia and New Zealand.A Delphi study on National PICU nursing research priorities in Australia and New ZealandAnne S. Ramelet, Fenella Gill, The ACCCN Paediatric Intensive Care Special Interest Group10.1016/j.aucc.2011.08.003Australian Critical Care 25, 1 (2012)2011-09-26Australian Critical Care2011-09-26251S1036-7314(12)X0002-XResearch Papers4157http://www.australiancriticalcare.com/article/PIIS1036731412000215/abstract?rss=yesChest X-Ray (Answer and Discussion)10.1016/S1036-7314(12)00021-5Australian Critical Care 25, 1 (2012)2012-02-01Australian Critical Care2012-02-01251S1036-7314(12)X0002-X5959