http://hdl.handle.net/11434/19 Sat, 23 May 2026 00:09:55 GMT 2026-05-23T00:09:55Z http://hdl.handle.net/11434/2349 Title: An exploration of factors that contribute to clinical deterioration and activation of emergency team (MET) calls. Epworth Authors: Jelly-Butterworth, Sarah; Burdeu, Gabrielle; Hutchinson, Ana Abstract: Background: This study was conducted in a large private not-for-profit acute healthcare service. It has a 24/7 Medical Emergency Team as part of its Rapid Response System (RRS). The team responded to 313 MET calls a month in 2024, 41% were concurrent, and some potentially preventable. Objectives: 1) Explore the experiences and perceptions of the MDT (medical doctors and nurses) using current Rapid Response Systems at the study site. 2) Explore the members of the MDT’s perceptions of factors contributing to potentially preventable MET Calls at the study site. 3) Explore members of the MDTs perceptions surrounding the occurrence of medication related MET calls at the study site. Fri, 01 Aug 2025 00:00:00 GMT http://hdl.handle.net/11434/2349 2025-08-01T00:00:00Z http://hdl.handle.net/11434/2299 Title: Factors that influence critical care nurses’ management of sedation for ventilated patients in critical care: A qualitative study. Epworth Authors: Hutchinson, Ana; Macpherson, Danielle Abstract: Background: Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce. Aim: To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making. Design: Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis. Setting and participants: This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate. Findings: Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation. Conclusion: Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns. Implications for clinical practice: Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making. Thu, 01 Aug 2024 00:00:00 GMT http://hdl.handle.net/11434/2299 2024-08-01T00:00:00Z http://hdl.handle.net/11434/2298 Title: Understanding the provision of goal-concordant care in the intensive care unit: A sequential two-phase qualitative descriptive study. Epworth Authors: Hutchinson, Ana; Saffer, Laurie Abstract: Background: Goal-concordant care in intensive care is care that aligns with the patient's expressed goals, values, preferences and beliefs. Communication and shared decision-making are key to ensuring goal-concordant care. Aims: The aims of his study were to explore (i) critical care clinicians' perspectives on how patient goals of care were communicated between clinicians, patients, and family in the intensive care unit; (ii) critical care nurses' role in this process; and (iii) how goals of care were used to guide care. Method: Sequential two-phase qualitative descriptive design. Data were collected from February to June 2022 in a level-3 intensive care unit in a private hospital in Melbourne, Australia. In Phase One, individual interviews were conducted with critical care nurse participants (n = 11). In Phase Two, the findings were presented to senior clinical leaders (n = 2) to build a more comprehensive understanding. Data were analysed using Braun and Clarke's six step reflexive thematic analysis. Findings: There was poor consensus on the term 'goals of care', with some participants referring to daily treatment goals or treatment limitations and others to patients' wishes and expectations beyond the ICU. Critical care nurses perceived themselves as information brokers and patient advocates responsible for ensuring patient goals of care were respected, but engaging in goals-of-care conversations was challenging. A lack of role clarity, poor team communication, and inadequate processes to communicate patient goals impeded goal-concordant care. Senior clinical leaders affirmed these views, emphasising the need to utilise critical care nurses' insight for practical solutions to improve patient care. Conclusions: Clarity in both, the term 'goals of care' and the critical care nurses' role in these conversations, are the essential first steps to ensuring patients' values, preferences, and beliefs to guide shared-decision-making and goal-concordant care. Improved verbal and written communication that is inclusive of all members of the treating team is key to addressing these issues. Mon, 01 Apr 2024 00:00:00 GMT http://hdl.handle.net/11434/2298 2024-04-01T00:00:00Z http://hdl.handle.net/11434/2210 Title: Tako-tsubo cardiomyopathy: how stress can mimic acute coronary occlusion. Epworth Authors: Padayachee, Laven Abstract: To the Editor: Abdulla and Ward's excellent article on tako-tsubo cardiomyopathy (TTC)1 raises two important issues. The first issue is the diagnostic dilemma faced by emergency physicians and cardiologists in differentiating TTC from ST-elevation myocardial infarction (STEMI) in centres that lack coronary angiogram capabilities. In patients presenting with chest pain and ST elevation on electrocardiography, the diagnosis of TTC might be suspected on recognition of risk factors and the common psychological, physical and emotional stressors that precipitate TTC.1 Supporting evidence can be obtained by demonstration of basal hyperkinesis and apical or midventricular hypokinesis on transthoracic echocardiography. This modality is now available in many centres without coronary angiography. However, if the diagnosis is incorrectly made as STEMI rather than TTC, the patient runs the risk of unnecessary thrombolysis. Alternatively, after risk–benefit analysis, the clinicians may transfer the patient to a facility with coronary angiography to confirm TTC. The second issue is the therapeutic dilemma facing intensivists treating TTC-related shock with adrenergic inotropes. Although cardiogenic shock in TTC is uncommon, it can still occur (4.2%).2 As increased endogenous catecholamines are thought to be central to the pathophysiology of TTC,3 treating shock with inotropes puts the clinician in a quandary. Agents such as adrenaline, dobutamine, dopamine, milrinone and noradrenaline increase cyclic AMP within the myocardial cell, and are commonly used to restore blood pressure and cardiac output. However, in TTC, inotropes may theoretically delay resolution of the apical ballooning. A recent echocardiographic study showed no improvement in apical and midventricular akinesis with the use of low-dose dobutamine.4 Levosimendan is a calcium sensitiser that has been used successfully to stabilise shock secondary to TTC (with and without use of an intra-aortic balloon pump).5 Levosimendan is non-adrenergic and allows earlier introduction of β-blockers than would be possible with adrenergic inotropes. I agree that prospective trials are needed to guide management in this intriguing condition. Sat, 01 Mar 2008 00:00:00 GMT http://hdl.handle.net/11434/2210 2008-03-01T00:00:00Z