Papers by Ritin Fernandez
Journal of WOCN
The objective of this review is to determine the effects of clamping short-term indwelling urethr... more The objective of this review is to determine the effects of clamping short-term indwelling urethral catheters before removal on the incidence of urinary tract infection, time to first void, voiding dysfunction, incidence of recatheterization, and the length of hospital stay. Published and unpublished randomized and quasi-randomized controlled trials, completed between January 1966 and July 2004, in English and other languages that compared the effects of clamping short-term indwelling urethral catheters, were systematically reviewed using multiple electronic databases. Determination of eligibility of trials for inclusion in the review, assessment of methodological quality, and data extraction were undertaken independently by 2 reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, a narrative overview has been undertaken. Three trials that investigated the effect of clamping the indwelling urethral catheter compared to free drainage before removal were eligible for inclusion. Two trials reported no significant difference in the incidence of urinary tract infection (UTI), number of patients who developed urinary retention or required recatheterization, and the length of hospital stay between the 2 groups. Another reported that the postvoid residual urine volume for patients who did not receive reconditioning of the bladder increased from 4.25 mL at baseline to 42.25 mL after removal of the indwelling urethral catheter, whereas the residual urine volume for patients who received reconditioning increased from 17.25 mL at baseline to 22 mL at follow-up. The evidence for clamping indwelling urethral catheters before removal remains equivocal. Given the current state of evidence, procedures relating to clamping of indwelling urinary catheters should not be initiated. Until stronger evidence becomes available, however, practices relating to clamping indwelling urethral catheters will continue to be dictated by local preferences and cost factors.
The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation
Monitoring patients' vital signs is an important componen... more Monitoring patients' vital signs is an important component of postoperative observations. To compare the safety and efficacy of the current standard practice for monitoring postoperative observations in one hospital with an experimental protocol. Patients who were classified as American Society of Anaesthesiologists (ASA) Class 1 or 2 and who met the inclusion criteria were randomised to one of two groups. Following their return to the ward from the recovery unit, these patients were monitored according to either the standard practice (n=96) or the experimental protocol (n=93). Data collected included patient demographics, medical and surgical history, the postoperative observations and the number and type of untoward events. The findings indicated that there was no statistically significant difference in the incidence of abnormal vital signs between the groups in the first four hours as well as within the 24 hours following return to the ward from the recovery unit. Additionally, none of the patients required either transfer to the intensive care unit /high dependency unit or management by the intensive care team. Patients in both groups were successfully discharged within 24 hours following surgery. This study provides evidence to inform clinicians of a safe and cost effective regime in the management of the patient in the postoperative period following discharge from the recovery to the ward. Clinicians, however, must utilise clinical judgement to determine which patients require close monitoring during the postoperative period.
The JBI Database of Systematic Reviews and Implementation Reports, 2015
A number of insulin infusion algorithms, with varying methods and effects, have been developed to... more A number of insulin infusion algorithms, with varying methods and effects, have been developed to guide the management of postoperative hyperglycemia in critically ill patients. The objective of this study was to investigate the effect of insulin therapy algorithms on blood glucose levels in patients in critical care environments following cardiac surgery.  Adult patients aged 18 or older who were admitted to a critical care environment after cardiac surgery and who received insulin therapy for glycemic control during the acute postoperative phase of their admission. Types of intervention: The intervention of interest was continuous intravenous insulin therapy. Types of studies: Experimental study designs including randomized controlled trials, non-randomized controlled trials and controlled before and after studies published in the English language were included in this review. Types of outcomes: Primary outcomes of interest included objective measures of glycemic control and secondary outcomes of interest included the incidence of adverse events. The search aimed to find both published and unpublished studies through electronic databases, reference lists, key reports and the World Wide Web. An extensive search was undertaken for the following databases: Medline, CINAHL, PubMed, Embase, Scopus, the Cochrane Library, Dare, Social Science Index, ProQuest, and MedNar. Databases were searched up to March 2014. All studies selected were assessed by two reviewers independently for methodological quality prior to inclusion in the review using the standardized Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument critical appraisal tool. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data was extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. All results were subject to double data entry. Statistical pooling of the data in meta-analysis was carried out using Review Manager meta-analysis software where possible. Odds Ratios, Relative Risks, Weighted Means Differences and their 95% Confidence Interval were calculated where appropriate. Where statistical pooling was not possible due to the heterogeneity of the studies the findings are presented in narrative form including tables and figures. Thirteen studies were included in the final review. Pooled data demonstrated significantly improved mean blood glucose levels (Weighted Means Differences -27.24, 95% Confidence Interval: -27.77 - -26.72), p < 0.00001 and achievement of target blood glucose levels range (Relative Risks 1.43, 95% Confidence Interval: 1.18 - 1.72), p = 0.0002, among participants who received the paper nomogram continuous intravenous insulin method of glucose control compared to the bolus regime group. Studies that investigated paper nomogram directed continuous intravenous insulin compared to computer calculator directed continuous intravenous insulin demonstrated a statistically significant improved mean blood glucose levels (Weighted Means Differences -23.74, 95% Confidence Interval: -24.45 - -23.02), p <0.00001 and higher percentage of time in which glucose levels were within the target range in the computer calculator group. A significantly lower incidence (p < 0.05) of hyperglycemia was observed in the computerized calculator TRUNCATED AT 500 WORDS.
The JBI Database of Systematic Reviews and Implementation Reports, 2015
Journal of Wound, Ostomy and Continence Nursing, 2005
ABSTRACT
Journal of Wound, Ostomy and Continence Nursing, 2006
A systematic review on the effect of duration of catheterization on urinary retention. Published ... more A systematic review on the effect of duration of catheterization on urinary retention. Published and unpublished randomized and nonrandomized control trials from January 1966 to July 2004 comparing the effects of duration of catheterization on patient outcomes were systematically reviewed. Relative risks (RR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, a narrative overview was undertaken. Eight trials were included. Two trials on patients following urethrotomy demonstrated no statistically significant difference in the number of patients developing restenosis, epididymitis, or urethral pain at any follow-up periods. Two trials comparing removal of the indwelling urethral catheter within 24-48 hours to usual surgical criteria after transurethral surgery demonstrated no statistically significant difference in the number of patients requiring recatheterization. However, significant reduction in the length of hospitalization was reported after removal of the indwelling urethral catheter within 24-48 hours. An increased risk of urinary tract infection was found when the catheter was removed after 48 hours. Catheter removal on day 1 compared to day 3 after vaginal or retropubic surgery demonstrated no statistically significant difference in urinary retention or urinary tract infection. No significant differences in patient outcome were found, but the timing of catheter removal is a balance between avoiding infection by early removal and circumventing voiding dysfunction by later removal. Shorter catheterizations appear to reduce mean length of hospital stay.
The Journal of Cardiovascular Nursing, 2006
Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for co... more Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for coronary heart disease; however, there is limited research investigating the risk factor status of patients 1 year after the procedure. This cross-sectional study was conducted to investigate the self-reported risk factor status by patients who had undergone a PCI at a major teaching hospital in Sydney, Australia. : Two hundred seventy participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 1 year after the PCI. After obtaining informed consent, a follow-up self-administered questionnaire was mailed to participants. Information was collected relating to the following coronary risk factors: smoking, and physical activity status, blood pressure and cholesterol levels, body mass index, depression, anxiety, and stress levels. Two hundred two participants (75%) returned a completed questionnaire. Approximately one third of participants had at least two modifiable risk factors. The most common cardiovascular risk factors identified were physical inactivity, increased body mass index, high blood pressure, and high cholesterol. Approximately half the women (46%) and a quarter of the men had at least two modifiable risk factors. Only a minority (11%) of the participants continued to smoke at 1-year follow up. Participating in physical activity for a total time of 150 minutes or more per week was reported by only 42% of the participants. Depression and anxiety were present in 25% and stress in 17% of the participants. A third of the participants (n = 64) erroneously believed that they had no heart problems. The findings reveal inadequate management of modifiable risk factors among post-PCI participants 12 to 18 months after revascularization, which highlights a need for tailored secondary prevention interventions to address factors contributing to cardiovascular risk. The evidence obtained from this study will inform the development of an intervention to address cardiovascular risk factor modification.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2007
Challenges in achieving optimal participation rates in cardiac rehabilitation (CR) are well descr... more Challenges in achieving optimal participation rates in cardiac rehabilitation (CR) are well described and include factors pertaining to health system and patient and clinical characteristics. Of note, participation rates of patients following percutaneous coronary intervention (PCI) are low. The aim of this study was to examine the psychometric properties of the Revised Cardiac Rehabilitation Preference Form (CRPF-R) in an Australian sample following a PCI and to determine the preferences of PCI patients in relation to CR. One hundred forty participants who had PCI completed the self-administered CRPF-R scale. Principal component factor analysis was performed to detect underlying dimensionality of the scale. The internal consistency of the total scale and the subscales was tested with the Cronbach alpha analysis. Comparison for differences in CRPF-R scores, as well as demographic characteristics and CR attendance, was performed. Factor analysis revealed 2 distinct factors, supporting the validity of a 2-factor structure CRPF-R. Cronbach alpha coefficient values were high, with .87 for the total CRPF-R, .85 for factor 1 (program features), and .81 for factor 2 (convenience features). Women were more likely to place greater importance in the convenience features of a CR program than men. Those who were recommended by a healthcare professional to attend CR were more likely to place greater importance in the program features than those who were not. This study has demonstrated the acceptability and utility of the CRPF-R in the Australian setting. In addition, the study also identified important considerations in the structuring and delivery of CR programs.
Drug and Alcohol Review, 2007
Introduction and Aims. The widespread use of alcohol and other drugs poses particular problems du... more Introduction and Aims. The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug-and alcohol-related problems. Design and Methods. A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards. Results. Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients. Discussion and Conclusions. The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services. [Griffiths RD, Stone A, Tran DT, Fernandez RS, Ford K. Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol? Drug Alcohol Rev 2007;26: 545 -552]
Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac ... more Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications.
Nurse education today
BACKGROUND: Students who enroll in graduate-entry nursing programs are described as more highly m... more BACKGROUND: Students who enroll in graduate-entry nursing programs are described as more highly motivated, scoring higher in most learning strategies, and achieving greater academic success than standard-entry nursing students. DESIGN: A prospective correlational design was used to compare the demographic and academic-related characteristics of standard-entry and graduate-entry nursing students in their first year of study. METHODS: Between 2007 and 2011, students enrolled in the Bachelor of Nursing, Standard Entry and the Bachelor Nursing, Graduate Entry at a large Australian university were surveyed in the first year of their program. Data included English-language usage and time spent in paid work, as well as four dimensions of Pintrich's Motivated Strategies for Learning Questionnaire. Survey data was linked to students' academic grades at the end of the semester. RESULTS: A total of 730 students completed the survey and consented to collection of their academic grades. ...
The JBI Database of Systematic Reviews and Implementation Reports, 2015
Kidney transplantation has been recognized as the best renal replacement therapy option for peopl... more Kidney transplantation has been recognized as the best renal replacement therapy option for people with end stage renal disease. With an estimated 170,000 people waiting for a kidney transplant around the world and a limited supply of donor organs, the waiting time is often prolonged for many years. The aim of this review was to examine the existing evidence of patients' experiences of living on dialysis and waiting for a renal transplant from a deceased donor.  This review considered studies that included adult patients aged 18 years and over who had been on dialysis (hemodialysis or peritoneal dialysis) for up to 15 years and who were waiting for a renal transplant from a deceased donor. Types of intervention(s)/phenomena of interest: The phenomena of interest were the experiences of adults waiting for a renal transplant from a deceased donor and more specifically, the impact of waiting on their lifestyle and day to day living. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: This review considered studies that included the experiences of people who were waiting on dialysis for a kidney transplant from a deceased donor. The search strategy aimed to find both published and unpublished studies through electronic databases, reference list searches and the World Wide Web. Extensive searches were undertaken of the CINAHL, Embase, Medline and PsychInfo databases of published literature, the Cochrane Database of Systematic Reviews and the Virginia Henderson International Nursing Library, OpenGrey and the New York Academy of Medicine databases of unpublished literature. Each study was assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist. Disagreements between the reviewers were resolved through discussion or with a third reviewer. Qualitative data was extracted from papers included in the review using the standardized data extraction tool from JBI- Qualitative Assessment and Review Instrument. Qualitative research findings were pooled to generate a set of statements that represented the aggregation and categorizing of these findings on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. A total of 12 studies were included in the final review. Thirty-seven findings from the 12 studies were extracted and aggregated into 11 categories and then into three synthesized findings. The three synthesized findings were: 1.  People who are waiting for a kidney transplant from a deceased donor are affected by the experience of living on dialysis with end stage renal disease and its impact on their physical health and normal activities of living. 2. The experience of waiting for a kidney transplant from a deceased donor impacts a person's psychological wellbeing. 3. People who are waiting TRUNCATED AT 500 WORDS.
Journal of infusion nursing : the official publication of the Infusion Nurses Society
Loss of peripheral intravenous (PIV) catheter patency is a common problem in the clinical setting... more Loss of peripheral intravenous (PIV) catheter patency is a common problem in the clinical setting. A survey of all private and public hospitals in a metropolitan city in Australia was conducted to identify practices related to maintaining patency of PIV catheters. Eighty-three hospitals were surveyed and responses were obtained from all of them. Normal saline was the most commonly used solution for flushing. The frequency for flushing ranged from 4 to 12 hours, and the volume of the irrigant used ranged from 2 to 10 mL in those hospitals where flushing is routine practice. Policy documents were available from only a few hospitals to validate the practice reported. Significant diversity in practices was documented among healthcare organizations.
International Journal of Nursing Practice, 2008
Magnet hospitals are recognized institutions of nursing excellence that provide an environment fo... more Magnet hospitals are recognized institutions of nursing excellence that provide an environment for the promotion of nursing and high-quality patient care. The Magnet Recognition Program, developed by the American Nurses Credentialing Centre, acknowledges health-care institutions that not only attract and retain nursing staff but also recognize nursing excellence in the delivery of quality patient care. Our study aimed to adapt the existing Practice Environment Scale to the Australian context and to pilot its use in measuring the nursing practice environment at a metropolitan hospital in Sydney, Australia. Nursing staff from four wards at a 400 bed major metropolitan acute general hospital in Sydney, Australia completed a self-administered questionnaire about their practice environment. Data were compared with the published norms from magnet and non-magnet hospitals in the USA, and means of two subscales were not significantly different from magnet hospital means. Hospitals could benefit from undertaking a similar practice environment baseline measure prior to applying for accreditation, thus enabling targeting of pre-identified service gaps and areas for improvement.
Cleansing is a vital component of wound management. However, there is limited research to inform ... more Cleansing is a vital component of wound management. However, there is limited research to inform protocols. Although research has focussed on types of dressings, little attention has been given to the solutions and techniques to be used for cleansing purposes. The available evidence about the effectiveness of solutions and techniques in the prevention of wound infection and the promotion of
The JBI Database of Systematic Reviews and Implementation Reports, 2013
A range of studies found that spending time outdoors in daylight provided substantial benefits fo... more A range of studies found that spending time outdoors in daylight provided substantial benefits for the psychosocial well-being of older people. Good psychosocial well-being is essential in maintaining overall health as people age and often contributes to adequate physical functioning. Objectives: The overall objective of this study was to undertake a systematic review on the effects of spending time outdoors in daylight on the psychosocial well-being of older people and their family carers. Inclusion criteria Types of participants This review considered studies that included older people aged 55 years or more, including those living in a community or residential accommodation setting. In addition, this review considered family carers, who were defined as unpaid relatives or friends of an older person, who helped that individual with their activities of daily living. Types of intervention(s): The intervention of interest was spending time outdoors in daylight. Types of studies All experimental and epidemiological study designs including randomized controlled trials and non-randomized controlled trials published in the English language were included in this review. . Methodological quality: Methodological quality was assessed independently by three reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument ( JBI-MAStARI) checklists. Disagreements that arose between the reviewers were resolved through discussion. Data collection: Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data was individually extracted by two reviewers. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry. Data synthesis: For this review statistical pooling of the data was not possible due to the heterogeneity of the studies; therefore, the findings are presented in narrative form. Results: A total of 13 studies were included in the final review. In the four studies that evaluated the effects of exposure to daylight on behavioral disturbances, there was no evidence of effect of daylight hours on physical and verbal aggression. There was some evidence to indicate that exposure to daylight for a period of time resulted in fewer depressive symptoms. Increasing the frequency of going outdoors was associated with better cognitive preservation over a one year period. Similarly exposure to daylight resulted in improved social functioning and improved quality of life. There were no studies that evaluated the effect of spending time outdoors in daylight on the psychosocial well-being of family carers, including carer satisfaction or carer stress.
The JBI Database of Systematic Reviews and Implementation Reports, 2013
Review question/objective The overall objective of this research is to undertake a systematic rev... more Review question/objective The overall objective of this research is to undertake a systematic review of the effects of spending time outdoors in daylight on the physical health of older adults and family carers. The specific questions to be addressed are: Which aspects of physical health are affected by spending time outdoors in daylight for older adults and family carers? To what extent is spending time outdoors in daylight effective for improving aspects of physical health in older adults and family carers?
International journal of nursing practice, 2008
Evidence-based guidelines recommend participation in cardiac rehabilitation (CR) to reduce subseq... more Evidence-based guidelines recommend participation in cardiac rehabilitation (CR) to reduce subsequent cardiovascular events following percutaneous coronary intervention (PCI). The objective of this study was to investigate the reasons for and the demographic characteristics of patients who participate in CR programmes following PCI in a single metropolitan setting in Australia. Logistic regression models were used to examine the data obtained using self-reports through mailed questionnaires from 202 patients 12-24 months following the index PCI. Thirty-five per cent of subjects reported to have participated in CR programmes, of whom less than a quarter were female. In this sample the main reason for programme participation was a recommendation given by the general practitioner (GP). The likelihood of participating in a CR programme decreased with age and absence of a partner. Additional research on determinants of participation in CR programmes among this cohort of patients could assist in the development of new strategies to encourage healthy behaviours and reduce the risk of further cardiac events.
International journal of nursing practice, 2008
Cardiovascular risk factor modification to prevent progression of coronary heart disease is impor... more Cardiovascular risk factor modification to prevent progression of coronary heart disease is important for patients following percutaneous coronary intervention. The aims of this study were to assess patient's awareness of modifiable cardiac risk factors and examine if patients with modifiable risk factors were more likely to identify these risk as amenable to change. Awareness of risk factors was measured using the Indiana Cardiac Rehabilitation Knowledge Questionnaire in a cohort of prospective, consecutive participants post percutaneous coronary intervention. Completed questionnaires were received from 75% of the participants. The majority were able to identify high cholesterol (87%), smoking (83%) and hypertension (82%) as modifiable risk factors. Less than half (46%) of the respondents identified diabetes as a modifiable risk factor. Only a third of participants recognized all six modifiable risk factors. A large proportion of patients who were smokers, or who had high cholesterol or hypertension, identified these as risk factors. A third of people with documented diabetes did not recognize this condition as a risk factor for heart disease. The findings have important implications for nursing practice in terms of directing educational efforts for the modification of risk factors for coronary heart disease.
International Journal of Nursing Studies, 2011
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Papers by Ritin Fernandez