Honours - Nursing, Midwifery and Paramedicine

Pressure injuries (PI), also known as pressure ulcers, increase the cost of health- care (Lim & Ang, 2017; Nguyen, Chaboyer & Whitty, 2015), impact on patient quality of life, and cause significant patient harm, pain (Jackson et al., 2017) and even death (Padula & Pronovost, 2018).International guidelines indicate that PI preventative interventions should be implemented to mitigate PI risk according to risk level (NPUAP et al., 2014). The importance of appropriate body positioning and repositioning as a PI prevention strategy cannot be overstated (Jackson et al., 2017; Miles et al., 2013b). Following patient risk assessment, planning of PI prevention strategies is undertaken, which includes planning for timely repositioning of immobile patients (NPUAP et al., 2014). There is no clear guideline for how often to reposition patients (Miles et al., 2013b), with the generally accepted timeframe being two hours, since PI can occur within as little as two hours (Van Rijswijk & Lyder, 2008). There is minimal research regarding the effectiveness of repositioning (Miles et al., 2013b), but it is generally accepted as an important strategy that continues to contribute to decreasing PI prevalence (Miles et al., 2013b). There is limited evidence of how often repositioning occurs in a hospital setting, and whether most patients contribute to their own self-repositioning or if nurses undertake most repositioning interventions.

Project aim: The aim of this study is to identify and analyse patient body positioning and repositioning when lying in a hospital bed using a thermal imaging device designed to recognise body position, monitor and store patient position changes and dynamically measure accumulated pressure time for each individual bony prominence.

Prof Paul Fulbrook, Dr Sandra Miles, Josephine Lovegrove paul.fulbrook@acu.edu.au

Protein energy malnutrition (PEM) is a condition characterised by subcutaneous fat loss and muscle wasting (BAPEN n.d.). The prevalence of malnutrition varies greatly due to the heterogeneity of patients with acute illness and chronic diseases (Morris et al., 2016). It is well recognised that malnutrition is associated with many adverse health outcomes resulting in increased healthcare utilisation, such as frequent hospital readmissions (Kellett et al., 2016). In Australia, the estimated costs of malnutrition per patient is approximately $3,500 per annum (Agarwal et al., 2015). Although various screening tools exist to detect malnutrition risk, these screening tools vary in length and complexity and usually screen for weight loss (Morris et al. 2018a). However, due to the subtle and sometimes overt nature of malnutrition (ref), consideration of other chronic disease factors needs to be tested to predict individuals’ risk of rehospitalisation so dietetic management can be initiated in both community and hospital settings (Morris et al. 2018b).

Project aims:
1. To test a validated absolute risk model to describe factors that predict the risk of
rehospitalisation in patients with PEM; and
2. To identify the clinical relevance of the absolute risk model to predict an individual’s
risk of hospital readmission at 28 days and 1 year.

Supervisors: Dr Natasha Franklin & A/Prof Vasiliki Betihavas Natasha.franklin@acu.edu.au

Please contact either Mr Heath Gangell or Ms Kylie Kendrick for further information.

Heath.gangell@acu.edu.au   kylie.kendrick@acu.edu.au

This research project aims to understand why mental health nursing has staffing shortages and what can be implemented to attract and recruit new staff to this important area of healthcare.

What are the reasons for the shortages of mental health nurses in Australia and what strategies can be implemented to attract, recruit and retain staff in this area?

Supervisor: Dr Xanthe Glaw Xanthe.glaw@acu.edu.au

Transition to practice programs support the professional, organisational, personal and clinical transition of registered and enrolled nurses into mental health nursing. Nurses in mental health need to develop the relevant knowledge and skills for this specialist field, which includes comprehensive mental health evidence-based care and providing psychosocial interventions to people experiencing mental distress. However, nurses can experience transition shock and challenges associated with the interpersonal nature of this work as well as structural challenges such as high workloads and poor staff skill-mix. These can impact newly transitioned nurses’ mental health and wellbeing and affect the retention of nurses in the workforce.

Project aim: To synthesise existing knowledge on the type and nature of transition to practice programs into mental health nursing and associated outcomes in relation to mental health, wellbeing and resilience for nurses transitioning into this specialty field.

Supervisor: Professor Kim Foster kim.foster@acu.edu.au

Please contact either Mr Heath Gangell or Ms Kylie Kendrick for further information.

Heath.gangell@acu.edu.au   kylie.kendrick@acu.edu.au

Scope of Practice for many health professionals has changes in response to the COVID-19 pandemic. Health professionals, such as student nurses, midwives and paramedics are being transitioned into many different roles to help manage the increased demand for patient care. These include roles such as Registered Undergraduate Students of Nursing (RUSON), Registered Undergraduate Student of Midwifery (RUSOM), vaccination clinics and COVID-19 testing. As these roles continue to evolve, analysis of the roles and their impact of patient and health service outcomes are crucial.

Project aim: To explore the outcomes on patients, health services and students of changes in scope of practice in Australian health services.

Supervisor: Professor Elisabeth Jacob Elisabeth.jacob@acu.edu.au

Please contact either Mr Heath Gangell or Ms Kylie Kendrick for further information.

Heath.gangell@acu.edu.au   kylie.kendrick@acu.edu.au

Peripheral intravenous cannula (PIVC) are a universally undertaken intervention for patients for managing acute health conditions. They are inserted in both the pre-hospital and hospital wards and are the most commonly inserted vascular access device. PIVCs are commonly inserted to administer intravenous fluids, medications or to obtain pathology blood tests.  There is a great degree of variance in practice regarding dwell time, insertion techniques, obtaining blood samples and management of intravenous cannulas between health services, states in Australia, disciplines and individual health professionals.

Project aim: To explore the evidence for best practice in peripheral intravenous care in Australian health services.

Supervisor: Professor Elisabeth Jacob Elisabeth.jacob@acu.edu.au

Pressure injuries (PI), also known as pressure ulcers, increase the cost of health- care (Lim & Ang, 2017; Nguyen, Chaboyer & Whitty, 2015), impact on patient quality of life, and cause significant patient harm, pain (Jackson et al., 2017) and even death (Padula & Pronovost, 2018). Patients undergoing operative and invasive procedure have a particularly high risk of developing PI due to both extrinsic and intrinsic factors, including prolonged periods of induced immobility, reduced conscious level through use of anaesthetic and sedation, use of medications altering sensation and perfusion, altered body temperature control, altered nutrition (pre- and post-operative fasting), and potential poor positioning and infection (Alderden, 2017; Goudas & Bruni, 2019; Grap et al., 2019), as well as the usual pressure, shear and friction forces (EPUAP, NPIAP, PPPIA, 2019). The actual PI incidence for patients undergoing operative surgical procedures and any relationship to length of surgery is unknown.

Project aim: The aim of this exploratory cross-sectional study is to determine the incidence of PI in adult patients within 72 hours of surgery in the operating theatre.  

Prof Paul Fulbrook, Dr Sandra Miles, Josephine Lovegrove paul.fulbrook@acu.edu.au

Please contact either Mr Heath Gangell or Ms Kylie Kendrick for further information.

Heath.gangell@acu.edu.au   kylie.kendrick@acu.edu.au

Registered Nurses provide frontline leadership in the delivery of nursing care and in the coordination, delegation and supervision of care provided by enrolled nurses (ENs) and personal care workers (PCWs) (NMBA, 2020). In the residential aged care setting, staffing is characterised by a limited presence of RNs and an increasing reliance on PCWs (Mavromaras et al., 2017)  and recommendations have been made in the Royal Commission into Quality and Safety in Aged care to make urgent adjustments to staffing arrangements. However, debate exists regarding ‘appropriate’ skill mix and the future of staffing arrangements in the aged care sector remain unknown. At this time, the unclear scope of practice and heterogenous approach to PCW training, and a lack of familiarity between nurses and PCWs associated with the casualisation of the aged care workforce serve to undermine registered nurses’ confidence when delegating tasks. Whilst previous studies have identified that decisions to transfer to hospital take into consideration the RNs’ perceptions of capacity to meet the needs of residents at the time of deterioration as well as the ability to continue to provide safe oversight of the other residents (Laging et al, 2018), there is a paucity of research regarding effective delegation strategies (Hopkins et al., 2012) and significant concerns regarding delegation to PCWs and patient safety risk (Blay, & Roche, 2020). To date, little is known about the experiences of RNs delegating tasks to PCWs when a resident’s health deteriorates and it remains unclear how staffing arrangements need to be adjusted when the needs of resident’s increase. This qualitative descriptive study of registered nurses’ experiences of delegating tasks when a resident’s health deteriorates will support the nursing profession to contribute to policy reform regarding safer delegation practices in the residential aged care setting.

Project aim:  To explore nurses’ experiences of delegation when a resident’s health deteriorates in the aged care setting. Supervisor: 

Dr Bridget Laging bridget.laging@acu.edu.au 

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO, 2007).  A fall may cause a patient a minor or major injury, increase their hospital length of stay and in severe cases may lead to death.  After a fall a patient may develop a fear of further falling which can lead to reduced mobility, loss of independence and increase the risk of subsequent falls.  Nurses assess each patient’s risk of falling by using a formal assessment tool and plan interventions to prevent falls and harm from falls.  It is the implementation of prevention interventions that are most likely to reduce falls risk and potentially prevent falls.  It is currently unknown if all possible falls prevention interventions are implemented following risk assessment and planning. The aim of this study is to identify the patient-specific falls injury prevention strategies that have been implemented, praise staff for what they have done well and educate them regarding any further areas of knowledge required.

Research Question: What is the relationship between assessed level of falls risk and prescription and implementation of falls preventative interventions in a specific hospital setting?
The aim of this study is to explore and describe the actual completion of patient-specific falls risk assessment, prescribing/planning and implementing of falls and falls injury prevention intervention strategies within the wards of The Prince Charles Hospital. The secondary aim is to praise nursing and health care professional staff for what they have done well and educate when knowledge deficits identified.

Prof Paul Fulbrook, Dr Sandra Miles, Josephine Lovegrove paul.fulbrook@acu.edu.au

Identifying and addressing challenges in health management in NSW and Australia

Supervisor: Dr Xanthe Glaw Xanthe.glaw@acu.edu.au

Older people are frequently transferred to hospital, yet many transfers are considered to be ‘avoidable’. Little is known about the decision-making practices that contribute to a decision to manage the resident onsite after an ambulance has been called. Further insight is needed into the factors that influence paramedics decisions not to transfer an older person from residential aged care to the emergency department to support future decision-making practices and resource allocations for the residential aged care sector.

Project Aim: To explore paramedics decisions not to transfer older people from residential aged care to hospital.

Supervisor:  Dr Bridget Laging bridget.laging@acu.edu.au (Full-time student preferred). 

NSW mental health nurses are restricted in their use of therapeutic interventions such a Cognitive Behavioural Therapy in individual or group therapy programs compared to other Australian states and Western countries. This restricts their scope of practice and aligns it more with set tasks, such as medication administration, rather than more therapy-based interventions.

Research question: Are NSW mental health nurses able to practice therapeutic interventions such a Cognitive Behavioural Therapy in their practice and run individual or group therapy programs, and if not why?

Supervisor: Dr Xanthe Glaw Xanthe.glaw@acu.edu.au

Whilst prevalence has decreased greatly over the last ten years (Van Gilder et al., 2017) maintenance of low prevalence levels is proving to be both a challenge and an economic burden (Walker et al., 2017); despite evidence that prevention is effective (Miles et al., 2013). It has thus become important to focus attention on areas where PI may be generated, such as during transfer to hospital and within the emergency department (ED), so that early intervention may be implemented. To date, there is little specific research in this area. This study will examine the relationship between emergency department (ED) length of stay (LOS) and the development of pressure injury (PI) in patients admitted to hospital from ED. The medical records of all patients admitted to hospital in 2017 via the ED, that subsequently developed a PI within the first 48 hours of their hospital stay (cases), will be examined. These cases will then be matched with patients who were also admitted to hospital via the ED during 2017 but did not develop a PI within the first 48 hours of their admission (controls). The medical records of both cases and controls will be compared to identify factors associated with PI development. The 2017 cases and controls will also be compared to similar data collected in 2012.

Project aim: The aim of this study is to examine the relationship between of ED LOS and the development of hospital- acquired PI (HAPI) during the first 48 hours of admission to hospital. It is hypothesised that shorter ED LOS is associated with fewer HAPI.

Prof Paul Fulbrook, Dr Sandra Miles, Josephine Lovegrove paul.fulbrook@acu.edu.au

In Australia, workforce shortages in the aged care sector present a significant challenge for the aged care industry. Growing demands to meet the needs of an ageing population are met with significant shortfalls in workforce supply. Aged care work continues to be an undesirable, low status career option. Exploration of undergraduate nurses’ perceptions of aged care work is needed to support recruitment strategies into the aged care sector.

Project Aim: Explore the evidence-based literature to identify factors influencing undergraduate nurses’ perceptions of working in residential aged care.

Supervisor:  Dr Bridget Laging bridget.laging@acu.edu.au

Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke.  However, despite the compelling evidence for stroke unit care, only 30% of European stroke patients receive stroke unit care. Further, the focused care stroke patients receive on a stroke unit has the potential to improve management of physiological variables such as hyperglycaemia, fever and dysphagia, which are associated with significantly worse outcomes following stroke. As demonstrated in the Quality in Acute Stroke Care (QASC) trial, facilitated implementation of a nurse-led intervention to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS protocols) in Australian stroke units led to a significant 16% absolute reduction in death and dependency for patients with stroke. Optimal management of these three clinical variables are therefore pivotal for favourable stroke patient outcomes. Yet, to date, there are limited data on how well these variables are managed in European stroke patients. There is an urgent need for improvements in the quality of stroke care across Europe as well as delivery of key evidence-based acute stroke treatments such as the FeSS protocols in the immediate post-stroke period.

This is a substudy of the recently concluded QASC Europe project (2017-2021), the first cross European pre-test/post-test study to implement the evidence-based FeSS protocols in 64 hospitals in 17 countries in Europe, in collaboration with the Nursing Research Institute, the European Stroke Organisation and the Boehringer Ingelheim Angels Initiative – the latter a not-for-profit initiative dedicated to the advancement of stroke care across the world.

Project aim: To compare FeSS protocol adherence in patients receiving care in stroke unit hospitals and those receiving care in non-stroke unit hospitals.

Supervisors:  Dr Oyebola Fasugba and Professor Liz McInnes liz.mcinnes@acu.edu.au

Older people living in residential aged care and their family members are frequently advised of the futility of invasive treatments when engaging in advance care planning. To date, little is known about the collective evidence regarding outcomes for older people from residential aged care admitted to the intensive care unit during a hospital admission.

Project Aim: A scoping review to map and collate the evidence on outcomes for older people from residential aged care who are admitted to intensive care.

 Supervisor:  Dr Bridget Laging bridget.laging@acu.edu.au (Full-time student).

Graduate Registered Nurses are expected to commence their careers with the ability to ensure safe nursing practice. The preparedness of nursing graduates to integrate into the workforce and undertake safe independent practice is debated within the nursing profession. Health services require that along with clinical skills graduate nurses have skills in time management, critical thinking, teamwork, delegation and communication on entering the workforce. There are numerous approaches utilise by health educators to assist the transition from student to practitioner and yet there has been no consensus reached between education faculty and industry on what it means to be ‘work ready’.

Project aim: Examine practices to prepare and assess graduate nurses ‘work readiness’.Supervisor: Professor Elisabeth Jacob Elisabeth.jacob@acu.edu.au

This project will examine practices used to prepare and assess graduate nurses’ readiness for safe work practice.

Supervisor: Professor Elisabeth Jacob   Elisabeth.jacob@acu.edu.au

Hospital-acquired pressure injury is a largely preventable adverse outcome of hospitalisation, which is associated with negative consequences for afflicted patients and increased burdens for admitting health care facilities.   As pressure injury is largely preventable, occurrence is considered to be an indicator of the quality of preventative care provided. Pressure injury prevention is comprised of a three-step process, starting with a pressure injury risk assessment (step one). Preventative interventions should then be prescribed (planned) based on the risk identified (step two), and the selected interventions implemented to mitigate said risk (step three). Previous research has indicated that, within the study hospital, preventative interventions are not always adequately prescribed and implemented following a risk assessment (Lovegrove, Fulbrook & Miles, 2018; Lovegrove, Fulbrook & Miles, 2020). Subsequently, a pressure injury prevention bundle which prescribes a minimum set of interventions for use at each pressure injury risk level (not at risk, at risk, high risk, very high risk) was developed (Lovegrove et al., 2018) and recommended (Lovegrove et al., 2020), and has since been integrated into clinical practice. However, it is unclear whether use of the prevention bundle has improved preventative intervention use to date. Therefore, the aim of this cross-sectional study was to examine whether preventative intervention prescription and implementation use relative to assessed risk has improved following integration of the prevention bundle into practice.

Project aim: the aim of this audit is to examine nurses’ prescription and implementation of PI preventative interventions following a risk assessment when using a risk level-based PI prevention bundle.

Prof Paul Fulbrook, Dr Sandra Miles, Josephine Lovegrove  paul.fulbrook@acu.edu.au

People and families from migrant, refugee and disadvantaged backgrounds experience poorer maternal and neonatal health outcomes plus experience less equitable access to quality, appropriate care during pregnancy, birth and the postnatal period. Our projects focus on improving health service access for these populations of people by gaining insight and understanding into their perceptions of health and wellbeing.

This project will be in collaboration with Murdoch Children’s Research Institute and sits in their Intergeneration health research stream. Specific research questions will be determined when funding and research personnel are confirmed.

Supervisor: Dr Heather Wallace  heather.wallace@acu.edu.au