Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, ...deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff.
This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent.
Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19; 2) Impact of isolation on family; 3) Challenges to patients' health and safety; 4) Impact on staff; 5) Challenging standards of care; 6) Contextual influences: policy, decision-makers and the environment.
Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.
A detailed, 1:10,500-scale, surficial geology and glacial geomorphology map of Svínafellsjökull and Virkisjökull-Falljökull glacier forelands in southeast Iceland depicts the landsystem imprint of ...Holocene glacier fluctuations, volcanogenic outburst floods and recent (post-1990) climate-induced rapid ice-front retreat. The map is based on field survey data in combination with 2012 airborne LiDAR data, 2009-2012 terrestrial LiDAR data and 2007 colour aerial photography. The base digital elevation model (DEM) is compiled from an ice-cap wide airborne LiDAR dataset. The mapped glacial landforms are dominated by sequences of recessional moraines laid down in the mid-Holocene, the Little Ice Age, and the last ∼100 years; the state of landform preservation generally decreasing with age. Interspersed with glaciofluvial sedimentation associated with typical ice-marginal retreat sequences is key geomorphological evidence of high-magnitude volcanogenic outburst floods (jökulhlaups) associated with the eruptions of Öraefajökull in 1362 and 1727 CE. Ice-front retreat has accelerated since c.2005 leaving a rapidly evolving buried-ice landscape in front of Virkisjökull-Falljökull - including an ice-cored esker, a large ice-floored (supraglacial) lake, and numerous actively forming kettle holes and ice caverns. This map could act as a 'reference frame' for geomorphologists studying the temporal evolution of glacial landform-sediment assemblages undergoing rapid change.
To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria.
A qualitative design ...comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital.
A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted.
Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk.
This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration.
This is among the first study to investigate barriers influencing decision-making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
This paper presents the results of a detailed study of a complex hydrofracture system and host diamictons exposed within a longitudinal section through an elongate drumlin located to the west of ...Cemlyn Bay, Anglesey, NW Wales. This complex, laterally extensive sand, silt and clay filled hydrofracture system was active over a prolonged period and is thought to have developed beneath the Late Devensian (Weichselian) Irish Sea Ice Stream as it overrode this part of NW Anglesey. The sediment-fill to the hydrofracture system is deformed with kinematic indicators (folds, thrusts, augen) recording a SW-directed sense of shear, consistent with the regional ice flow direction across this part of the island. The lack of any geomorphological evidence for active retreat of the Irish Sea ice across Anglesey has led to the conclusion that hydrofracturing at the Cemlyn Bay site occurred within the bed of the Irish Sea Ice Stream whilst this relatively faster flowing corridor of ice was actively overriding the island. Shear imposed by the overriding ice led to the development of a subglacial shear zone which facilitated the propagation of the hydrofracture system with the laterally extensive feeder sills occurring parallel to Y-type Riedel shears. Although a subglacial setting beneath the active Irish Sea Ice Stream can be argued for the Cemlyn Bay hydrofracture system, its relationship to the formation of the ‘host’ drumlin remains uncertain. However, evidence presented here suggests that hydrofracturing may have occurred during the later stages or post landform development in response to the migration of overpressurised meltwater within the bed of the Irish Sea ice; possibly accompanying the local thinning and shutdown of the Irish Sea Ice Stream on Anglesey.
Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional ...frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.
In order to evaluate and protect ecosystem services provided by peat and peaty soils, accurate estimations for the depth of the surface organic horizon are required. This study uses linear mixed ...models (LMMs) to test how topographic (elevation, slope, aspect) and superficial geology parameters can contribute to improved depth estimates across a Scottish upland catchment. Mean (n = 5) depth data from 283 sites (representing full covariate ranges) were used to calibrate LMMs, which were tested against a validation dataset. Models were estimated using maximum likelihood, and the Akaike Information Criterion was used to test whether the iterative addition of covariates to a model with constant fixed effects was beneficial. Elevation, slope and certain geology classes were all identified as useful covariates. Upon addition of the random effects (i.e. spatial modelling of residuals), the RMSE for the model with constant‐only fixed effects reduced by 24%. Addition of random effects to a model with topographic covariates (fixed effects = constant, slope, elevation) reduced the RMSE by 13%, whereas the addition of random effects to a model with topographic and geological covariates (fixed effects = constant, slope, elevation, certain geology classes) reduced the RMSE by only 3%. Therefore, much of the spatial pattern in depth was explained by the fixed effects in the latter model. The study contributes to a growing research base demonstrating that widely available topographic (and also here geological) datasets, which have national coverage, can be included in spatial models to improve organic horizon depth estimations.
Aims and objectives
To explore and describe nurses' role in the rehabilitation and care of patients in one subacute care facility in Melbourne, Australia.
Background
The role of nurses in subacute ...care and within the rehabilitation team is evolving and remains unclear.
Design
Mixed methods.
Methods
Fourteen nurses from seven rehabilitation and geriatric evaluation and management wards in one subacute facility in Melbourne, Australia, were observed in practice for two hours and then interviewed. Activities were recorded electronically. Interviews were audio‐recorded and transcribed. Data were analysed using content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Results
Three main themes are as follows: (a) Nurses as rehabilitators; (b) Teamwork in rehabilitation; and (c) The changing context of subacute care. Nurses prioritised patient personal and clinical care above other responsibilities. They were largely excluded from team decision‐making because clinical responsibilities precluded them from attending team meetings. Unsuitable buildings, increased patient acuity and time constraints were further challenges.
Conclusions
Nurses have a multifaceted role in patient rehabilitation that is poorly understood. An evaluation of the nursing role within the interdisciplinary team, skills and processes of care may increase understanding, and improve communication and relationships between disciplines potentially benefiting patients. Role clarity and differentiation in nursing skills are required within the nursing workforce.
Relevance to clinical practice
Nurses have a unique role in both clinical care and rehabilitation of patients, and as part of the interdisciplinary team.
Respectful professional relationships need fostering within the interdisciplinary team to achieve optimal patient outcomes.
The way that team meetings and decision‐making occur in the subacute wards requires adjustment to ensure that the valuable contribution of nurses, both to the interdisciplinary team and to the rehabilitation of patients, is used and acknowledged to improve patient care.
PDF
