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Clinical Practice Research, Innovation and Information Sharing

Evaluation of a Critical Thinking Skills training programme
Funding body: Ako Aotearoa
Project description/update: This is a joint project with Careerforce and Nurse Maude.  This project provides professional development to workplace educators to enable them to deliver tailored and contextualised critical thinking skill development and support to their trainees.  The programme includes four workshops provided by a Careerforce and a Nurse Maude trainer.

The evaluation of the programme includes answering the following questions:
  • What are the key critical thinking skills required in the core learning and assessment components of the National Certificate in Health, Disability, and Aged Support (Core Competencies) (Level 3)?
  • What are the key components of a professional development curriculum required to support workplace educators to deliver the critical thinking skill development required
  • What impact does this professional development in critical thinking skill development have on workplace educators?
Project outcomes: This project was completed in August 2014 and the report provided to Ako Aotearoa.
Further information: gill.coe@nzichc.org.nz
Evaluation of the Nurse Maude Infusion Service
Funding body: Nurse Maude
Project description/update: The aim of this project is to evaluate and articulate the impact of Nurse Maude’s Infusion Service delivery changes in terms of client and nursing user outcomes. The project was designed to:
 
  1. Document and describe whether the service has achieved its planned outcomes and vision.
  2. Document and describe the current client population accessing the Infusion service.
  3. Document the implementation of the Infusion Service and its impact to date on quality outcomes including:
    • Client Satisfaction
    • Referrer Satisfaction
    • Errors / CCIs
    • Infection rates.
  4. Identify current clients who have achieved self-administration in comparison with those who have not. Review the current promotion of self-administration / family administration.
  5. Identify and document barriers and enablers for District Nurses using the Infusion centre.
  6. Review the current exclusion criteria and decision making process and provide recommendations for improvement if required.
  7. Make recommendations on future service delivery for the Infusion Service and on the critical factors required to ensure sustainability of the model (if the value proposition is supported).
Project outcomes: This project was completed in 2014 with a report provided to Nurse Maude.
Further information: gill.coe@nzichc.org.nz
Evaluation of the 'Roll Out' of Mobile Devices to District Nurses and Health Care Workers
Funding body: Nurse Maude
Project description/update: Nurse Maude is introducing mobile devices to record activities and communicate with staff working in the community. The NHS has recently reported on their impact assessment on the implementation of e-devices among some of their community based health workers.    Nurse Maude is also interested in being able to measure the impact on their services of equipping their community based workforce with mobile computers. The project is designed to:
 
  1. Provide a better understanding of requirements for transitioning to an e-environment for their community based workforce.
  2. Evaluate efficiency and effectiveness gains with use of e-mobile technology for the workforce and clients.
  3. Improve the level of understanding of how best to realise the benefits of such technology.
  4. Demonstrate increased productivity and efficiency by reducing clinician travel time to and from community bases and by making changes to the working process.
  5. Build an economic basis for such investment.
  6. Identify any differences between these findings and those reported by the NHS: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213313/mhwp_final_report.pdf
Project outcomes: An interim report was provided to Nurse Maude.
Further information: gill.coe@nzichc.org.nz
Falls and Pressure Injury Data Analysis and Prevalence in a District Nursing Service
Funding body: Nurse Maude
Project description/update: Falls and pressure injury events are identified as nursing sensitive quality indicators. Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care.  The Institute was asked to analyse all of the data collected from incident reports on pressure injures and falls for the past 5 years.  This project was designed to:
 
  • Track events over the years and by month
  • Identify any patterns that could be used to inform any practice changes
  • Develop up a set of indicators and further data that should be collected on these events to monitor the effectiveness of practice changes.
Project outcomes: The final report has been provided to Nurse Maude.
Further information: gill.coe@nzichc.org.nz
Lymphoedema drainage in palliative care: The impact on quality of life
Funding body: Campbell Ballantyne Fellowship funded by the Nurse Maude Foundation
Project description/update: This project was designed to find out whether or not the benefits of needle drainage of lymphoedema out-weigh the complications/potential negative impacts on aspects of patient’s quality of life. 

Aims:
  1. Assess  and record the benefits of needle drainage of lymphoedema on aspects of patients’ quality of life
  2. Assess  and record complications/negative effects of needle drainage of lymphoedema on aspects of patients’ quality of Life
  3. To establish whether benefits out-weigh negative complications
Project outcomes: This study has recruited the ten participants and the key investigator is currently writing up the results with the preliminary findings looking promising.  Genesis Oncology Trust has since funded a multi-centre research study using the existing protocols and study design which includes three other NZ hospices as well as the Nurse Maude hospice. Both studies have been completed and articles have been submitted, with more to follow.  
Further information: amanda.landers@nursemaude.org.nz
Lymphoedema management protocol
Funding body: Campbell Ballantyne Fellowship funded by the Nurse Maude Foundation
Project description/update: This project evaluated the outcomes of a clinical protocol for the management of lymphoedema in patients receiving palliative care or wound management.  Through ongoing conservative treatment, improvements in function, mobility and patient comfort can be achieved.  The physiotherapist received about 60 palliative referrals for treatment annually and treated patients receiving wound care who also have lymphoedema.  To achieve best outcomes for patients, a collaborative approach between the physiotherapist and nurses in the management of lymphoedema has been developed.  A clinical protocol with clearly identified referral points, key assessment and screening tools, has been put in place. This project involved two audits to evaluate the outcomes of the clinical protocol.  A baseline audit before the implementation of the clinical protocol, and an audit after 3-6 months usage of the protocol.  In addition, an anonymous, voluntary written questionnaire survey was undertaken to obtain nurses' views of the usefulness of the clinical protocol.
Project outcomes: This project was completed in July 2011 with the implementation of a lymphoedema management protocol, the development of lymphoedema management training for registered nurses and publication of the project report.  The results of the first audit of lymphoedema management were presented by Mary Thomson at the Hospice and Palliative Care conference in Wellington, New Zealand.  Two publications have resulted:

Thomson, M. (2012) Working together to improve lymphoedema management in community palliative care. Kai Tiaki Nursing New Zealand,18(10), 18-19

Thomson, M and Walker, J. (2011) Collaborative Lymphoedema management: developing a clinical protocol. International Journal of Palliative Nursing,17(5), 231-237
Further information: gill.coe@nzichc.org.nz
Nursing guidelines for administering subcutaneous dexamethasone
Funding body: Nurse Maude & the NZ Institute of Community Health Care
Project description/update: The project developed best practice guidelines for the administration of subcutaneous dexamethasone in the palliative care setting. This project was started because anecdotally, there was variation in practice and there was little published evidence. A survey of NZ community hospice palliative care services was undertaken to get 'expert' opinion to standardise the subcut administration of dexamethasone. The survey was conducted via email and telephone using a structured questionnaire. The survey results were used to develop best practice clinical guidelines for the administration of subcut dexamethasone. These guidelines were piloted and approved for use within the Nurse Maude generalist and specialist services and also shared with other palliative care services. They have been implemented into the Nurse Maude District Nursing Service and Hospice Palliative Care Service.
Project outcomes: Walker, J., Lane, P., & McKenzie, C. (2010). Evidence-based guidelines: a survey of subcutaneous dexamethasone administration in palliative care. International Journal of Palliative Nursing, 16(10), 494-498.
Report on the 'Guidelines for the nursing administration of subcutaneous dexamethasone in the palliative setting: a survey of NZ Hospice palliative care services'.
 
Further information: jane.rollings@nursemaude.org.nz
Time and cost comparison of wound assessment tools
Funding body: ARANZ Ltd and Nurse Maude Association
Project description/update: This study aimed to perform a cost-benefit comparison between Silhouette Mobile and traditional wound measurement techniques, by quantifying the costs associated with each method.  This included both the time taken to take measurements (e.g. size, depth and photograph) and to capture wound documentation.  Questionnaire data was collected from both patients and nurses to evaluate their experiences with the different wound measurement methods.  This study investigated whether the reliability and utility advantages of one electronic wound measurement system justified the capital outlay and running costs.
Project outcomes: The following paper was published as a result of the research:
http://www.medscape.com/viewarticle/581775_2
Further information: Catherine Hammond, Clinical Nurse Specialist Wound Care, Nurse Maude
catherine.hammond@nursemaude.org.nz
 
RCT to evaluate a new wound care product
Funding Body: Clinical Trials Unit, University of Auckland and CoDa Therapeutics
Project description/update: Over 2009/10, the NOVEL trial investigated whether NexagonTM was a safe and effective treatment for venous leg ulcers when used with standard compression bandaging.  The trial was a prospective, randomised, double blind, placebo controlled trial conducted at five sites in New Zealand and three sites in the USA.  Participation period for the trial was 14 weeks.  The trial involved participants receiving the study drug as a topical agent on three occasions over four weeks in addition to standardised dressings and compression bandaging.  The main endpoints were ulcer healing and safety.
Project outcomes: A project report was published in-house by CoDa Therapeutics.
Further information: Catherine Hammond, Clinical Nurse Specialist Wound Care, Nurse Maude
catherine.hammond@nursemaude.org.nz
Dermatology needs of leg ulcer patients
Funding Body: Christchurch Hospital and Nurse Maude
Project description/update: The specific aims of the project were to:
  1. To find out the proportion of leg ulcer patients who would benefit from dermatology input.
  2. To find out if the wound clinic nurses can identify appropriate patients for referral to dermatology.
  3. To develop collaboration between the Nurse Maude Wound Management service and the Dermatology Department of Christchurch Hospital.
This was a prospective study where 54 patients with leg ulcers attending the Nurse Maude clinic were seen by a dermatologist for an assessment.  Nurses treating those patients then completed a nursing assessment form to identify patients for dermatology referral.  The similarities and differences between the two assessments and the need for dermatology referral were then examined. 

The findings showed that for patients who were chosen by both the dermatologist and nurse as needing a dermatology referral, the reasons given for the referral were the same.  This suggested that nurses were referring appropriately.  Nine additional patients were selected by the nurses for referral which were not selected by the dermatologists.  There was moderate agreement between them, except for diagnosing vasculitis and ordering mycology tests for fungal infections.
Project outcomes: The study produced guidelines for patient referral to the Dermatology department via one nominated nurse, who developed expertise and acts as a resource for other nurses.
Further information: gill.coe@nzichc.org.nz
Keratin wound dressing: patient and nurse acceptability study
Funding Body: Keretec Limited and Nurse Maude Specialist Wound Management Service
Project description/update: The aim of the study was to examine the user acceptability for patients and nurses of three new types of Keratin wound dressings used to treat leg ulcers.  Using a written questionnaire, both nursing and patient participants were asked to comment on the use of the dressing, its ease of use, comfort, simplicity and another other points they wished to identify.
Project outcomes: http://www.awma.com.au/journal/1804_05.pdf
Further information: Cathy Hammond, Clinical Nurse Specialist Wound Care, Nurse Maude
catherine.hammond@nursemaude.org.nz
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