Papers by Marianne Wallis
Health care for women international, 2011
Domestic violence impacts on all aspects of affected women&am... more Domestic violence impacts on all aspects of affected women's lives and results in poor general, reproductive, and psychological health (World Health Organisation, 2010). Despite mounting evidence that current health care responses to women affected by domestic violence are problematic, policies have nevertheless been rolled out without addressing issues identified. Funding cuts, fragmentation of services, and failure to establish good practice has resulted in a discourse where women's needs are pushed to the outside and they are marginalized, lost in the language and discourse of policy, normalizing a discourse of incompletion at policy and bureaucracy levels.
Australian Health Review, 2014
Objectives. The aims of the present study were to identify predictors of admission and describe o... more Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.
International Journal of Older People Nursing, 2008
Best practice for the management of older people with dementia in the acute care setting: a revie... more Best practice for the management of older people with dementia in the acute care setting: a review of the literature Aim. This paper reviews the theoretical and research-based literature related to the management of people with chronic confusion as a consequence of dementia in the acute care setting. Background. People aged 65 years and over are at increased risk of poor outcomes when admitted to the acute care setting as a result of comorbity and mismanagement of their chronic confusion. The challenge of caring for people with dementia in acute care is one that requires special attention.
Journal of Health Organization and Management, 2010
Purpose -This paper aims to show that identification of expectations and software functional requ... more Purpose -This paper aims to show that identification of expectations and software functional requirements via consultation with potential users is an integral component of the development of an emergency department patient admissions prediction tool. Design/methodology/approach -Thematic analysis of semi-structured interviews with 14 key health staff delivered rich data regarding existing practice and future needs. Participants included emergency department staff, bed managers, nurse unit managers, directors of nursing, and personnel from health administration. Findings -Participants contributed contextual insights on the current system of admissions, revealing a culture of crisis, imbued with misplayed communication. Their expectations and requirements of a potential predictive tool provided strategic data that moderated the development of the Emergency Department Patient Admissions Prediction Tool, based on their insistence that it feature availability, reliability and relevance. In order to deliver these stipulations, participants stressed that it should be incorporated, validated, defined and timely. Research limitations/implications -Participants were envisaging a concept and use of a tool that was somewhat hypothetical. However, further research will evaluate the tool in practice. Practical implications -Participants' unsolicited recommendations regarding implementation will not only inform a subsequent phase of the tool evaluation, but are eminently applicable to any process of implementation in a healthcare setting. Originality/value -The consultative process engaged clinicians and the paper delivers an insider view of an overburdened system, rather than an outsider's observations.
International Journal of Nursing Studies, 2013
Patient flow from intensive care to acute care units is often problematic and many discharges fro... more Patient flow from intensive care to acute care units is often problematic and many discharges from intensive care to acute care are unsuccessful on the first attempt. The aim of this study was to explore the factors that influence intensive care patient discharge. This ethnographic study was undertaken in an Australian metropolitan tertiary hospital that had a 14-bed level 3 intensive care unit. Intensive care and acute care unit medical and nursing staff, and other hospital staff who were involved in the intensive care patient discharge process participated in this study. A total of 28 discharges were observed, and 56 one on one interviews were conducted. Data collection techniques including direct observations, semi-structured interviews, and collection of existing documents were used. Activity theory was the theoretical framework that underpinned this study. Three patient activity systems were identified: intensive care patient discharge activity, acute care unit accepting patient activity, and hospital bed management activity. Analysis of the interactions among these activity systems revealed conflicting objects (goals), communication breakdowns, and teamwork issues. Discharge delay was found to be a significant problem, which was associated with limited acute care unit bed availability. Strategies to improve acute care unit bed availability are needed. Routine after-hours ICU discharge could raise patient safety concerns which need to be considered. All team members' input in discharge decision making should be encouraged. Problems identified in clinical handover call for actions to change the handover practice. Activity theory successfully guided the study by providing a practical and descriptive framework for the study, facilitating the understanding of the interrelationships among the activity systems.
International Journal of Nursing Studies, 2009
Background: Managing nurse shortages is a major challenge in Trusts today given the worldwide sho... more Background: Managing nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare. Objective: To analyse bank and agency nursing staffing patterns and factors that impact on these patterns. Design and setting: Case study within the largest hospital in one Welsh Integrated Healthcare Trust. Data sources: De-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff. Results: A predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training. Conclusion: There is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff. Crown
2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2008
Forecasting is an important aid in many areas of hospital management, including elective surgery ... more Forecasting is an important aid in many areas of hospital management, including elective surgery scheduling, bed management, and staff resourcing. This paper describes our work in analyzing patient admission data and forecasting this data using regression techniques. Five years of Emergency Department admissions data were obtained from two hospitals with different demographic techniques. Forecasts made from regression models were compared with observed admission data over a 6-month horizon. The best method was linear regression using 11 dummy variables to model monthly variation (MAPE=1.79%). Similar performance was achieved with a 2-year average, supporting further investigation at finer time scales.
International Journal of Nursing Practice, 2007
The study evaluated the effect of an evidence-based practice (EBP) educational programme on attit... more The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP.
International Journal of Nursing Studies, 2010
International Journal of Nursing Studies, 2007
Background: Increasingly, nurses in Western countries express positive attitudes to complementary... more Background: Increasingly, nurses in Western countries express positive attitudes to complementary and alternative medicine (CAM) but lack knowledge, access to education and organisational policy to guide practice. It is unclear whether nurses in developed Asian countries mirror or differ from this profile. Objectives: To determine the attitudes towards and use of CAM by registered nurses in Taiwan. Design: Cross sectional survey. Setting: A Nursing College in eastern Taiwan. Participants: Registered nurses (N ¼ 170) working in various clinical settings who were studying a post registration Bachelor of Nursing conversion course. Methods: Questionnaire distributed to nurses during class time. Results: Most nurses had positive attitudes to CAM and most used therapies, like massage, occasionally in practice. However, none had formal qualifications in CAM and most perceived that there were insufficient resources or organisational policy to facilitate practice. Conclusions: Taiwanese nurses need more formal education about CAM and require access to clear policies regarding the safe use of CAM in nursing practice. r
International Journal of Nursing Studies, 2009
Background: Resilience in the workplace has been described as a means of facilitating adaptation ... more Background: Resilience in the workplace has been described as a means of facilitating adaptation in stressful environments, and therefore has application in nursing contexts. However, little research has examined how personal characteristics such as age, nursing experience and education contribute to resilience in clinical environments such as the operating room (OR). Objective: First to identify the level of resilience, and second, investigate whether age, experience and education contribute to resilience in an Australian sample of OR nurses. Methods: A predictive survey design was used. A random sample of 1430 nurses who were members of the Australian College of Operating Room Nurses association were surveyed. The survey included the 25-item Connor-Davidson Resilience Scale, and demographic questions. A standard regression model tested the hypothesis that age, years of OR experience and education contributed to resilience in OR nurses. Results: A total of 735 (51.4%) completed, usable surveys were returned. Pearson's correlations demonstrated modest but statistically significant associations between age ( p<0.001), and years of OR experience ( p<0.0001), and resilience. In the multiple regression model, only years of OR experience predicted resilience ( p<0.0001) and explained a small 3.1% of the variance in resilience. Conclusions: In OR nurses, resilience appears to be predicted by other attributes and is not necessarily dependent on an individual's personal characteristics. Thus, recruitment to the OR should not be based on the conventional notion that an older nursing workforce will have greater longevity and hence be more stable. If younger, less experienced nurses are adequately supported, they may thrive in the OR environment. #
Journal of Orthopaedic Nursing, 2005
Povidone-iodine solution is currently employed for pin-site care in many institutions. There are ... more Povidone-iodine solution is currently employed for pin-site care in many institutions. There are concerns that this agent reacts with the metal pins and can impede healing. This study compared two different treatment protocols for the care of the skin surrounding skeletal pin-sites.
International Journal of Nursing Studies, 2008
Background: The past decade has seen increasing patient acuity and shortening lengths of stays in... more Background: The past decade has seen increasing patient acuity and shortening lengths of stays in acute care hospitals, which has implications for how nursing staff organise and provide care to patients. Objective: The aim of this study was to describe the activities undertaken by enrolled nurses (ENs) and registered nurses (RNs) on acute medical wards in two Australian hospitals. Design: This study used structured observation, employing a work sampling technique, to identify the activities undertaken by nursing staff in four wards in two hospitals. Nursing staff were observed for two weeks. The data collection instrument identified 25 activities grouped into four categories, direct patient care, indirect care, unit related activities and personal activities. Setting: Two hospitals in Queensland, Australia. Results: A total of 114 nursing staff were observed undertaking 14,528 activities during 482 h of data collection. In total, 6870 (47.3%) indirect, 4826 (33.2%) direct, 1960 (13.5%) personal and 872 (6.0%) unit related activities were recorded. Within the direct patient care activities, the five most frequently observed activities (out of a total of 10 activities) for all classifications of nursing staff were quite similar (admission and assessment, hygiene and patient/ family interaction, medication and IV administration and procedures), however the absolute proportion of Level 2 RN activities were much lower than the other two groups. In terms of indirect care, three of the four most commonly occurring activities (out of a total of eight activities) were similar among groups (patient rounds and team meetings, verbal report/handover and care planning and clinical pathways). The six unit related activities occurred rarely for all groups of nurses.
International Journal of Nursing Practice, 2010
A case study of six wards in two hospitals was undertaken to describe the structures, processes a... more A case study of six wards in two hospitals was undertaken to describe the structures, processes and perceptions of outcomes of bedside handover in nursing. A total of 532 bedside handovers were observed and 34 interviews with nurses conducted. Important structural elements related to the staff, patients, the handover sheet and the bedside chart. A number of processes prior to, during, and after the handover were implemented. They included processes for managing patients and their visitors, sensitive information, and the flow of communication for variable shift starting times. Other key processes identified were the implementation of a safety scan and medication check. The situation, background, assessment, recommendations (SBAR) approach was used only in specific circumstances.
Applied Health Economics and Health Policy, 2014
Background Millions of peripheral intravenous catheters are used worldwide. The current guideline... more Background Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72-96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative. Objectives To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters. Methods A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed. Results The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95 % confidence interval [CI] 4.96-10.62) and a non-significant difference in the phlebitis rate of 0.41 % (95 % CI -1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95 % CI 4.96-10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years. Conclusion The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.
Women & Health, 2004
Community-based continence care for women 2 of 23 Outcome evaluation of a multi-disciplinary comm... more Community-based continence care for women 2 of 23 Outcome evaluation of a multi-disciplinary community-based continence service for Australian women
Scandinavian Journal of Caring Sciences, 2006
Background: Continuity of care (COC) for acutely unwell older adults, particularly those who are ... more Background: Continuity of care (COC) for acutely unwell older adults, particularly those who are nursing home residents, who present to hospital, is complicated by the presence of co-morbid conditions, long waiting times, both for the ambulance and in the department, and poor after-hours general practitioner access. Aim: To present a critical review of the literature on COC for older adults from nursing homes who present to hospital and who are acutely unwell. The review will answer the following questions: (i) What is the contemporary meaning of the construct continuity of care? (ii) What is the relevance of continuity of care to the population of older adults who reside in nursing homes and present to hospital? and (iii) What models exist for promoting continuity of care to older adults who present to hospital? Method: Guided by the conceptual analysis process a database search of CINAHL and MEDLINE was carried out utilizing the search terms 'continuity of care', 'older adults', 'nursing homes', 'emergency department' and 'acute illness'. A hand-search of additional references was also conducted. Retrieved articles were critically reviewed if they focused on older adult patients, the acute care/ community settings and COC. Findings: The contemporary meaning of the COC is that it incorporates care of an individual patient over time by bridging discrete elements in the care pathway. Four distinct models of COC were identified. These were Primary Health Care; General Practice and Primary Medical Care; Consumers; and Health Policy and Systems. All are based on the proviso that the individual is sufficiently independent to be able to coordinate their own care and to take overall responsibility. Conclusions: The connection between COC and acutely unwell older adults who present to hospital is a prolific area for further research. In particular, the effectiveness of programmes aimed at enhancing the advanced nursing practice role and the COC process for older adults, needs investigation.
Nurse Researcher, 2012
To demonstrate the methodological usefulness of interpretive interactionism by applying it to the... more To demonstrate the methodological usefulness of interpretive interactionism by applying it to the example of a study investigating healthcare experiences of women affected by domestic violence. Understanding patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experiences of health, illness and health care is important to nurses. For many years, biomedical discourse has prevailed in healthcare language and research, and has influenced healthcare responses. Contemporary nursing scholarship can be developed by engaging with new ways of understanding therapeutic interactions with patients. Research that uses qualitative methods of inquiry is an important paradigm for nurses who seek to explain and understand or describe experiences rather than predict outcomes. Interpretive interactionism is an interpretive form of inquiry for conducting studies of social or personal problems that have healthcare policy implications. It puts the patient at the centre of the research process and makes visible the experiences of patients as they interact with the healthcare and social systems that surround them. Interpretive interactionism draws on concepts of symbolic interactionism, phenomenology and hermeneutics. Interpretive interactionism is a patient-centred methodology that provides an alternative way of understanding patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experiences. It can contribute to policy and practice development by drawing on the perspectives and experiences of patients, who are central to the research process. It also allows research findings to be situated in and linked to healthcare policy, professional ethics and organisational approaches to care. Interpretive interactionism has methodological utility because it can contribute to policy and practice development by drawing on the perspectives and experiences of patients who are central to the research process. Interpretive interactionism allows research findings to be situated in and linked to health policy, professional ethics and organisational approaches to caring.
Nurse Education Today, 2012
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Papers by Marianne Wallis