3,807 research outputs found
Resource: Communicating Effectively in Bedside Nursing Handovers
No full textChapter 6 described the challenges nurses faced at the research site when implementing the mandated policy of bedside handovers. In response to our research findings, and with the strong support of the local health department, we developed a twohour training module ‘Better Bedside Handovers’, and a train-the-trainer package. At time of writing we have delivered this training to more than 300 nurses and nurse-managers. The training is described in full in Slade et al. (in preparation). In this chapter we summarize the training module design and present the communication protocols and tools that we developed
Clinical Handover in Context: Risks and Protections Across a Hospital Patient’s Journey
No full textOne weekday afternoon an 18-year-old patient, we’ll call her Belinda Page,1 arrives at the emergency department of a busy tertiary teaching hospital, complaining of shortness of breath and chest pain due to a flare-up of her asthma. During the six hours Belinda spends in the emergency department she develops additional symptoms – weakness and numbness, particularly down her left side. She undergoes an emergency MRI, x-rays and other tests but the emergency department night registrar, Dr Ken Lee – a relatively junior non-English speaking background doctor – cannot reach a diagnosis. Under pressure to move patients out of the emergency department as quickly as possible, during the night he calls the senior neurology consultant, Dr Richard Lancer, who declines to admit Belinda before reviewing her. Dr Lee then calls the Ward M consultant, Dr Allenanda, who reluctantly agrees to admit Belinda to a general medical assessment ward, until the neurology staff can review her the next day. Over the next day we observed and recorded as many of the interactions with and about Belinda as we could, including consultations and examinations, formal and informal discussions about her case and nursing and medical handovers. The first occurred at 8 am the next morning when, after working a 12-hour shift, Dr Lee fronted up to a large auditorium to give the whole-of-hospital medical handover of all the patients he had admitted overnight. He sat on a solitary chair placed front and center of the auditorium, almost as if he were to be interrogated. In the tiered rows of seats facing him sat those members of the hospital’s day shift medical staff who had the time and motivation to attend (attendance is not compulsory). On this morning, about 25 doctors were present, ranging from interns to senior consultants. They included the two female registrars from Ward M (Dr Pantani and Dr Lingren) and a male cardiology consultant (Dr Davidson). The neurology consultant Dr Lancer arrived about five minutes into this handover. While Dr Lee delivered his handover, referring to a sheet of handwritten notes, another doctor stood at the computer console, front right of the auditorium, and projected the patient’s x-ray, test results and scans on the front screen. Below we reproduce a transcript of this five-minute handover
Communication in Bedside Nursing Handovers
No full textThe previous chapters have described the challenges of emergency department clinical handovers when medical staff change. In this chapter the focus shifts to nursing staff shift changes in a general medical ward. We describe and analyze the practice of bedside handovers in a metropolitan teaching hospital, hospital B, acknowledging the challenges but also the benefits of this semi-public clinical handover mode for nurses and patients. In chapter 7 we then suggest strategies and resources to improve patient safety and to increase nurse and patient satisfaction with the practice
iCARE: an Integrated Translational Model of Effective Clinical Handover Communication
No full textOur final example of a handover event brings together many of the challenges with clinical handover identified in earlier chapters. Early one weekday evening, Sartaj1, a tall, strong man who speaks English as a second language, brought his wife Indira to hospital B’s emergency department. Indira was 33-weeks pregnant and had suffered a miscarriage in the past. The couple were of Indian background. Sartaj told the triage nurse that Indira was complaining of nausea and vomiting and had headaches. Sartaj explained that he had taken Indira to the other major public hospital in the city earlier in the day, but that she had been discharged home after a few hours in their emergency department. Several hours later, hospital B’s emergency department night registrar examined Indira. He found her unwell – still nauseous and complaining of severe headaches. He was unable to reach a diagnosis but wanted to admit Indira for observation and tests. However, no beds were available in the antenatal ward. He made several phone calls to consultants and other wards, looking for a bed where Indira could be cared for while she waited for a bed in antenatal. At around 3 am Indira was admitted to Ward M, the hospital’s general medical ward, where she stayed for 10 hours before being transferred to a bed in the antenatal ward. Throughout her admission and handover, Indira was accompanied by Sartaj. With the consent of Sartaj and Indira, an ECCHo researcher observed and audiorecorded the transfer from Ward M to the antenatal ward
Clinicians’ Voices: What Healthcare Professionals Say About Handover Practice
No full textThe following patient story is taken verbatim from a junior doctor’s recount of an adverse event submitted to the ECCHo handover surve
À la découverte de Justin Daraniyagala ජස්ටින් දැරණියගල (1903–1967)
No full textNé à Colombo, Justin Daraniyagala est l'un des fondateurs du Groupe 43. Après l'obtention de son diplôme de droit au Trinity College (Cambridge) en 1925, il s'initie à la peinture à la Slade School of Art (1926-1927) et à l'Académie Julian (Paris, 1928) avant de rentrer à Sri Lanka en 1929... Des présentation en français et en anglais de la vie et de l’œuvre de l'artiste sri lankais du XXe siècle sont disponible sur le site de l'association Suravi: http://www.suravi.fr/justin-daraniyagala.htm
Characterisation of a re-cast composite Nafion® 1100 series of proton exchange membranes incorporating inert inorganic oxide particles
No full textA series of cation exchange membranes was produced by impregnating and coating both sides of a quartz web with a Nafion® solution (1100 EW, 10 %wt in water). Inert filler particles (SiO2, ZrO2 or TiO2; 5–20 %wt) were incorporated into the aqueous Nafion® solution to produce robust, composite membranes. Ion-exchange capacity/equivalent weight, water take-up, thickness change on hydration and ionic and electrical conductivity were measured in 1 mol dm-3 sulfuric acid at 298 K. The TiO2 filler significantly impacted on these properties, producing higher water take-up and increased conductivity. Such membranes may be beneficial for proton exchange membrane (PEM) fuel cell operation at low humidification. The PEM fuel cell performance of the composite membranes containing SiO2 fillers was examined in a Ballard Mark 5E unit cell. While the use of composite membranes offers a cost reduction, the unit cell performance was reduced, in practice, due to drying of the ionomer at the cathode
À la découverte de Justin Daraniyagala ජස්ටින් දැරණියගල (1903–1967)
No full textNé à Colombo, Justin Daraniyagala est l'un des fondateurs du Groupe 43. Après l'obtention de son diplôme de droit au Trinity College (Cambridge) en 1925, il s'initie à la peinture à la Slade School of Art (1926-1927) et à l'Académie Julian (Paris, 1928) avant de rentrer à Sri Lanka en 1929... Des présentation en français et en anglais de la vie et de l’œuvre de l'artiste sri lankais du XXe siècle sont disponible sur le site de l'association Suravi: http://www.suravi.fr/justin-daraniyagala.htm
A prospective study of the substance use and mental health outcomes of young adult former and current cannabis users
No full textINTRODUCTION AND AIMS: The extent to which young adult former cannabis users fare better than infrequent users is unclear. We investigated the association between cannabis use status at age 23 and substance use and mental health outcomes at age 27. DESIGN AND METHODS: Data were from the 20+ year cohort of the PATH Through Life Study. Lifetime cannabis users (n = 1410) at age 23 were classified as former/occasional/regular users. Multivariable logistic regression was used to estimate the association between cannabis use status at age 23 and six outcomes assessed at age 27. RESULTS: Compared with occasional cannabis users: (i) former users had odds of subsequent tobacco use [odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.52-0.85], illicit drug use (cannabis, OR = 0.22, 95% CI 0.17-0.28; other illicit drugs, OR = 0.29, 95% CI 0.22-0.39) and mental health impairment (OR = 0.71, 95% CI 0.55-0.92) that were 29-78% lower; and (ii) regular users had odds of subsequent frequent alcohol use (OR = 2.34, 95% CI 0.67-1.34), tobacco use (OR = 3.67, 95% CI 2.54-5.30), cannabis use (OR = 11.73, 95% CI 6.81-20.21) and dependence symptoms (OR = 12.60, 95% CI 8.38-18.94), and other illicit drug use (OR = 2.95, 95% CI 2.07-4.21) that were 2-13 times greater. Associations attenuated after covariate adjustment, and most remained significant. DISCUSSION AND CONCLUSIONS: Clear associations exist between cannabis use status in young adulthood and subsequent mental health and substance use. While early intervention remains important to prevent regular cannabis use and the associated harms, experimentation with cannabis use in the years leading into young adulthood may not necessarily determine an immutable pathway to mental health problems and illicit substance use. [Silins E, Swift W, Slade T, Toson B, Rodgers B, Hutchinson DM. A prospective study of the substance use and mental health outcomes of young adult former and current cannabis users. Drug Alcohol Rev 2017;00:000-000]
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