The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design.

Introduction: Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality.

Objectives: To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients.

Removing modifications to the New Zealand Early Warning Score- does ethnicity matter? A multimethod research design.

Background: Previous research on a modified New Zealand Early Warning Score (M-NZEWS) used in predominately medical ward patients identified removing the modifications would significantly reduce the number of M-NZEWSs triggering the medical emergency team (MET), particularly in Māori patients.

Aim: To firstly, explore the impact of removing the modifications from the M-NZEWS on medical and surgical ward patients' early warning score MET triggers and secondly, determine if the M-NZEWS MET triggers resulted in MET activations and if the MET activations were a result of M-NZEWS MET triggers.

Method: The study used a multimethod research design.

The impact of a modified New Zealand Early Warning Score (M-NZEWS) and NZEWS on ward patients triggering a medical emergency team activation: A mixed methods sequential design.

Introduction: Limited research exists on the effectiveness of the New Zealand Early Warning Score (NZEWS).

Aim: To determine the impact of a modified NZEWS (M-NZEWS) and NZEWS on ward patients' medical emergency team activation triggers.

Research Design: Mixed methods sequential design.

Nasal high flow oxygen therapy in the ward setting: A prospective observational study.

Background: Whilst research demonstrates the benefits of nasal high flow oxygen in the intensive care setting, limited literature exists on its benefits in ward patients.

Objectives: This study evaluated the use of nasal high flow oxygen in adult ward patients with respiratory failure or at risk of respiratory deterioration. Primary outcome was an improvement in pulmonary function as indicated by decreases in respiratory and heart rates and an increase in arterial oxygen saturation via pulse oximetry RESEARCH METHODOLOGY: Using a prospective observational research design, purposeful sampling recruited 67 adult ward patients receiving nasal high flow oxygen between May and July 2015 (inclusive).

Documentation of cardiopulmonary resuscitation decisions in a New Zealand hospital: A prospective observational study.

Introduction: Documentation of cardiopulmonary resuscitation (CPR) decisions is often poor. Lack of documented decisions risks inappropriate CPR and staff, patient and family distress.

Objective: To examine documented evidence of CPR decisions.

The effectiveness of a patient at risk team comprised of predominantly ward experienced nurses: A before and after study.

Introduction: Improving care to deteriorating ward patients require systems to trigger a response and a response team. This paper describes the effectiveness of a Patient at Risk team (PART) comprised predominantly of experienced ward nurses.

Method: The study used a single site before and after historical control design.

Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study.

Background: Nurse practitioners perform a diagnostic role previously delivered by doctors. Multiple studies demonstrate nurse practitioners are as effective as doctors when managing chronic conditions and minor illnesses and injuries. No studies have focused on how nurse practitioners compare to doctors in their management of complex cases presenting for the first time.

Using a combined nursing and medical approach to reduce the incidence of central line associated bacteraemia in a New Zealand critical care unit: a clinical audit.

Objective: Research suggests a median central line associated bacteraemia rate of zero is achievable. This paper outlines the effectiveness of using a combined nursing and medical approach in reducing central line associated bacteraemia in a New Zealand critical care unit.

Method: The study used a before and after audit design.

A critical care nurse practitioner's prescribing using standing orders and authorised prescribing when performing a critical care outreach role: a clinical audit.

Objective: This paper assesses the frequency of prescribing and the types of medications prescribed by a New Zealand critical care nurse practitioner (NP) whilst performing a critical care outreach role.

Method: A before and after audit was conducted from June 2006 to July 2008. Audit data were collected prospectively and analysed retrospectively.

Local experience with the use of sustained low efficiency dialysis for acute renal failure.

Renal replacement therapy (RRT) is a common therapy used to treat critically ill patients in acute renal failure. Currently a number of dialysis modalities are used such as haemodialysis, continuous renal replacement therapy (CRRT), and sustained low efficiency dialysis (SLED). As SLED is a recently implemented RRT, very little literature is available on the nursing aspects of SLED.

The role and effectiveness of a nurse practitioner led critical care outreach service.

Research measuring the effectiveness of critical care outreach (CCOR) has been mixed. The objective of this paper is to describe the role and effectiveness of a nurse practitioner (NP) led critical care outreach service (CCORS). Using a comparative study design, data on the number of intensive care unit (ICU) readmissions <72h were analysed 12 months prior to, and 12 months following implementation of the service.

The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making.

The combination of intensive care knowledge, and the ability to articulate analytical decision-making processes to the interdisciplinary team, enhances the clinical credibility of the intensive care unit (ICU) nurse. The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand.

Local experience with the use of nasal bubble CPAP in infants with bronchiolitis admitted to a combined adult/paediatric intensive care unit.

Bronchiolitis is an acute inflammatory disease of the lower small airways predominantly occurring in infants younger than 1 year of age. As a result of the respiratory distress associated with bronchiolitis, infants frequently require admission to an intensive care unit for respiratory support. Thirty-five infants diagnosed with bronchiolitis were admitted to a combined adult/paediatric tertiary intensive care unit over a 2-year period for nasal bubble continuous positive airway pressure (CPAP).

A preoperative scoring system to identify patients requiring postoperative high dependency care.

Introduction: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring.

Objective: A nursing preoperative assessment tool was developed to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU.

Method: All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool.

Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements.

Introduction: An identification system utilizing the therapeutic intervention scoring system (TISS) was developed to differentiate between intensive care and high-dependency unit (HDU) patients.

Objective: To overcome the staff recruitment and retention problem, ward nursing staff were recruited into the unit. To ensure patient care requirements did not exceed nursing skill level, TISS was utilized to differentiate ICU from HDU patients and to identify nursing skill requirements.