Nursing Research

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Research Staff

Frank van Haren: ICU Consultant

Mary La Pine: Research Coordinator

Rob Frengley: ICU Consultant
 

Nursing Research Coordinator

The research coordinator role is a dedicated 0.5 FTE position for the purpose of fostering an environment conducive to research being performed in ICU/HDU; to promote and participate in research projects which will enhance patient care and to initiate, conduct and guide nursing projects relevant to ICU/HDU.

The role of the Research ICU consultant is to actively promote and conduct research projects that will enhance patient care, and supervise and guide JFICM trainee projects.

In these roles we are also available to advise and support staff who wish to undertake research projects of their own.

We have developed guidelines for researchers and best interest guidelines for Researchers, Primary Investigators and Research Nurses for studies which involve Intensive Care and High Dependency patients. It is essential that we are aware of these studies and they have been discussed with us prior to commencing.

This is to ensure the safety and good clinical care of the patients enrolled in the study and also for the protection of the ICU and HDU staff caring for these patients. These guidelines have been sent out to researchers and will also be available on the ICU website and Intranet Research Site.

Current Nursing Projects.

Debriefing project

This project looks at the process of debriefing in the ICU and HDU. After discussion with the nurses on the floor, a group of nurses- Angela Goulstone, Ginny Shelley, Joye-Marie Jones and I joined with Caroline Allbon, who was working in the Nursing Research and Development Unit at the time.

Using the person centred /action research approach to engage with staff in ICU and HDU in the exploration and clarification of this issue, we conducted focus groups open to all staff, in both units. The purpose of the focus groups is to ask staff how they perceive and understand debriefing/support and what they would envisage would work effectively in this area.

In addition we have consulted with external service providers on the debriefing processes in their own organisations. Caroline and I presented this process at the 6th International Practice Development, Action Research and Reflective Practice Conference in Edinburgh, in October 2006. We are very grateful for the nurses in ICU who fundraised towards this and to the Nursing Education Fund committee who funded my travel. Our presentation was well received and we gained excellent feedback which we are incorporating into the project. Progress has been slow due to workload and staff commitments, however, Caroline who is no longer working at the NRDU is still available as an independent researcher, and this project is continuing.

Noise Study

Mary La Pine, Kim Cross, Steve Kirby, Ross McBeath.

This study was conducted in two parts, objectively measuring the decibel levels in ICU and HDU and conducting a subjective questionnaire on staff perception of noise. A further phase of working with staff to reduce noise levels is yet to start, due to workload. Phase 1 and 2 are in the process of being written up for publication. Congratulations to Kim Cross who was awarded the Havill Nursing Research Award in March 2007 for her excellent work and commitment in both phases of the study.

Action Research Project

This study as my Masters thesis is also an ongoing project facilitating the nurses in ICU to look at their practice, to understand and define how they care for their patients, and to acknowledge and define where there is a need for practice development.

The reconnaissance phase is now complete and feedback has been given to all those involved. The action phase is commencing at the beginning of September with the nurses who are continuing to be involved now becoming co-researchers in the study.

Best Interests Checklist

This checklist was developed by Diana Young, from Legal and Risk with input from Frank van Haren and Mary La Pine. It is a guide to considering Best Interests under Right 7(4)(a) of the Code of Consumer’s Rights where a patient is not competent to give informed consent in a clinical trial. Most ICU patients, except for cardiac surgery, would be in this category and this checklist was developed to ensure that it was in the patient’s best interests to enrolled in a study. The next of kin/friend can only sign a statement that they think the patient would wish to be involved in the study. Informed consent must be obtained from the patient when they are able. This checklist is available on the WDHB intranet research site and also from us.

No Shift Lag Study

 A major research project conducted in 2001 was lead by Fay Malcomson, a senior staff nurse and flight nurse. Co –researchers were Mary La Pine, Research Nurse, Dr John Torrance, Unit Director, and Dr Nigel Marsh, Clinical Psychologist at Waikato University.  The study looked at what effect a homeopathic remedy, No-Shift-Lag (NSL), had on nurses working night shift in the ICU. This was a randomised, placebo-controlled, crossover trial with both objective and subjective measures. The objective measure was a visual vigilance and reaction-time computer test while the subjective measures included two types of self-report questionnaires.

 The report of the comparison between the No-Shift-Lag and placebo substance is currently under submission to a nursing journal.

A second paper discussing the results of the larger questionnaire, the Standard Shiftwork Index, is in progress. This previously validated questionnaire was adapted to a more suitable format for ICU nurses and was completed once as a baseline prior to the start of the trial, and twice more at the end of each arm of the trial.  The paper will concentrate on the results of the baseline questionnaire.

 A follow up study was conducted by the Research Nurse, looking at the impact the trial had on the patients, the nurse participants and the unit as a whole.

ANZICS Clinical Trial Group Studies

As members of the ANZICS Clinical Trial Group, we are in the final stages of preparation for two CTG studies, DECRA and EPN study.

DECRA (DEcompressive CRAniotomy trial)

Principle Site Investigators: Frank van Haren, Mr Venkataraman Balakrishnan. This study will compare outcomes in head injury patients who are randomised to decompressive craniotomy with patients randomised to standard treatment.

EPN (Early Parenteral Nutrition)

Principle Site Investigator: Frank van Haren. Patients who are not normally fed within the first 48 hours in the ICU will be randomised to receive early parenteral nutrition (Kabivan G19%) or will receive standard ICU care.

Current Medical Projects

The Effects of Hypertonic Fluid Administration in Patients with Severe Sepsis or Septic Shock Study.

Primary investigator: Frank van Haren. Septic patients who need fluid resuscitation within 24hrs of admission will be randomised to receive Hyperhes or Starquin 6%. Measures include echocardiography, sublingual microcirculation, gastric tonometry, PCR and blood gases. This study was commenced on 22^nd June 2007, with the enrolment of the first patient. 24 patients in total will be recruited over the next year. This study is partially funded by a Waikato Medical Research Foundation grant.

Patterns of sublingual microcirculation before, during and after cardiac surgery (formal project trainee JFICM).

Description of microcirculatory flow patterns as visualized and measured with sublingual sidestream darkfield imaging (Microscan).

Exhaled breath analysis in ICU patients (formal project trainee JFICM).

Measurement of volatile products of bacterial infection that, if detectable in expired breath, might allow early diagnosis of sepsis in intensive care patients.

Completed One day Studies.

SEE 2 ( Sentinel Events Evaluation 2)

17^th January 2007: One day international multi centre cross sectional prospective observational study in parenteral medication errors in ICU.

This involved self reporting of parenteral errors for each doctor and nurse during the 24hour period. These included delayed or missed administration of medication, incorrect dosage or route, the situation and contributing factors. Data were collected for five patients.

EPIC II (Extended study of Prevalence of Infection in Intensive Care II)

8^th May 2007

Multi-centre one day study international prevalence study investigating the types of infection, the site and treatment for patients in ICU during the 24 hour period. In addition, there was an optional sub study looking at the types and doses of antimicrobials, what the infection was and where it was acquired. Data from seven patients were collected.

SAFETRIPS

Determining fluid resuscitation practice internationally following the publication of the SAFE study over single 24 hour period - 18^th April 2007. This entailed collecting data on the time, volume, type, and reason for infusion.

Of the fourteen patients in ICU, six received fluid resuscitation in the 24hour period. These required more intensive data collection including APACHE II and SOFA scoring, haemodynamic measurements, blood results and outcomes.

The SAFE study compared the outcomes for patients randomised to receive albumin with those patients who received saline when requiring fluid resuscitation.

Publications

Malcomson, F.,& La Pine, M.(2003) Shift lag and the stresses of flight, Medic Air, 9-13

Jogia, P.M., Kalkoff, M., Sleigh, J.W., Bertinelli, A., La Pine, M., Richards, A.M., Devlin, G. (2007). NT-pro BNP secretion and clinical endpoints in cardiac surgery intensive care patients. Anaesth Intensive Care 3, 363-369.

Van Haren FMP, Borstlap A, Foudraine N. Tension pneumopericardium in Hodgkin’s disease. Circulation, 2006;114:e77-e79.

Heemskerk S, van Haren FMP, et al. Short-term beneficial effects of methylene blue on kidney damage in septic patients with refractory shock. Accepted for publication in Intensive Care Medicine

Van Haren F.M.P., Sleigh J, Pickkers P, Van der Hoeven J. Gastrointestinal perfusion in septic shock: No Gut, No Glory? Anaesth Intensive Care, 2007; 35: 620-635

Van Haren FMP, Foudraine N, Sleigh J, Pickkers P, Van der Hoeven J. Methylene blue infusion in septic shock patients does not worsen gastrointestinal perfusion. Submitted

Cursons J, van Haren FMP, Sleigh J, Cursons R. The effects of hypertonic saline infusion on lipopolysaccharide-induced endothelial cell activation. In Proceedings: Proceedings of the Waikato Clinical School Research Seminar, Thursday 15 March 2007, New Zealand medical Journal, 29-Jun-2007 - Vol 120 No 1257

Van Haren FMP, Foudraine N. Chapter 35: Infection and Sepsis. In: Cardiothoracic Critical Care. 2007. Elsevier. Editors Sidebotham, McKee, Gillham, Levy.
 

Presentations

Nursing

 2002  ANZICS Conference, February, Hamilton.- Fay Malcomson, No-Shift-Lag Trial. Awarded Best Nursing Paper, joint winner Best New Nursing Presenter.

 2002   Nursing Research Conference, April, Hamilton. Fay Malcomson, Mary La Pine, NSL Trial and the Effects of Shift Lag on ICU Nurses.

 2002   ISAS/FNA Conference, September, Whangarei. Fay Malcomson,  Shift lag and the Stresses of Flight. (Invited  Speaker).

 2002   Professional Nurses Forum, December, Hamilton. Fay Malcomson, Mary La Pine, NSL, shift lag, sleep deprivation and pitfalls of conducting research.

 2003   WINTEC  Research students, June, Hamilton. Fay Malcomson, Mary La Pine, NSL, shift lag and sleep deprivation.

 2003   Professional Nurses Forum, December, Hamilton. Mary La Pine, On the Other Side: Nurses as Research Participants (Follow Up to NSL Trial).

 2004   ANZICS Conference March  Wellington. Mary La Pine, On the Other Side: Nurses as Research Participants.

 2004   WINTEC  Research students, June, Hamilton. Mary La Pine. On the Other Side: Nurses as  Research Participants.

2006    WINTEC 2^nd Year Nursing Students. Evidence Based Practice and Research in clinical practice. 5^th September

2006    6th International Practice Development, Action Research, Reflective PracticeConference, Edinburgh, Scotland. October. Co-presenter: Coffee, counselling or in between.

Medical