Information needs and information seeking behaviour of paediatric nurses of Christchurch hospital

<p>The professional information needs of nurses, and the situations which cause nurses to seek information have not been widely studied. A small scale study involving questionnaire based interviews of paediatric nurses at Christchurch Hospital showed paediatric nurses viewed access to professional information as vital to the performance of their work. Work situations which required these nurses to seek additional information included the admission of patients with unknown or rare conditions, patient education, questions from other staff, and the development of ward protocols or standards. The most frequently consulted sources were patient records, nursing colleagues, and ward texts. These provided the bulk of nursing information, but the Nursing Library and nurses' private libraries were also used. Given the dependence on other nursing staff displayed here, it is vital that nurses keep up to date with their practice. There was a strong trend to passing information on to other nurses once it had been accessed.</p>

Information needs and information seeking behaviour of paediatric nurses of Christchurch hospital

<p>The professional information needs of nurses, and the situations which cause nurses to seek information have not been widely studied. A small scale study involving questionnaire based interviews of paediatric nurses at Christchurch Hospital showed paediatric nurses viewed access to professional information as vital to the performance of their work. Work situations which required these nurses to seek additional information included the admission of patients with unknown or rare conditions, patient education, questions from other staff, and the development of ward protocols or standards. The most frequently consulted sources were patient records, nursing colleagues, and ward texts. These provided the bulk of nursing information, but the Nursing Library and nurses' private libraries were also used. Given the dependence on other nursing staff displayed here, it is vital that nurses keep up to date with their practice. There was a strong trend to passing information on to other nurses once it had been accessed.</p>

An Observational Study of Peripherally Inserted Central Cather(PICC)-Related Complications Amongst Oncology Patients

<p>This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days (range 6-412, IQR 39-126) for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days (range 2-160, IQR 25-77). Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer (p=0.001). These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate. This benchmark study should be followed by further prospective studies examining the relationship of cancer diagnosis to PICC complication rates in oncology patients.</p>

An Observational Study of Peripherally Inserted Central Cather(PICC)-Related Complications Amongst Oncology Patients

<p>This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days (range 6-412, IQR 39-126) for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days (range 2-160, IQR 25-77). Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer (p=0.001). These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate. This benchmark study should be followed by further prospective studies examining the relationship of cancer diagnosis to PICC complication rates in oncology patients.</p>

Reducing hospital admissions for COPD: perspectives following the Christchurch Earthquake

The devastating 2011 earthquake in Christchurch destroyed or badly damaged healthcare infrastructure, including Christchurch Hospital. This forced change in management of exacerbations of chronic obstructive pulmonary disease (COPD), which until that point had frequently led to admission to hospital and focused attention on providing safe community options for care. This paper describes the process of understanding factors contributing to high admission frequency with exacerbations of COPD and also describes a process of change, predominantly to healthcare delivery systems and philosophies, and the subsequent outcomes. What became clear in understanding admissions with COPD to Christchurch Hospital was that the behaviour of the patient, in the context of exacerbations, and the subsequent response of the system to the patient, led to admission being the default option, in spite of low severity of the exacerbation itself. By altering systems’ responses to exacerbations, with a linked care process between ambulances, community care and hospitals, we were able to safely reduce admissions for COPD, with a sustained overall reduction in bed-day occupancy for COPD of ~48%. We would encourage these discussions and changes to occur without the stimulus of an earthquake in your healthcare environment!