How to be involved in the FOC Node activities

Co-convenors: Alison Kitson & Suzi Robertson-Malt

Professor Alison KitsonProfessor of NursingSchool of NursingUniversity of AdelaideAUSTRALIA

Dr Suzanne Robertson-MaltSenior Clinical Planning Consultant (Education)Clinical Planning DepartmentSidra Medical & Research CenterQatar FoundationDoha QATAR

Stage 1 Where to start: Guiding Questions

What is the evidence base upon which the fundamentals of (nursing) care is delivered?

Where do we currently source the information to establish the evidence base for the work nurses (and other carers) do?

How do we identify the key dimensions/elements for each area?

How do we link these fundamental aspects of care to discrete clinical interventions?

Slide 3

Level of agreement on elements of care

International Journal of Nursing Practice: Kitson A, et.al, 2010, 16: 423-34

Results of 2010 meta narrative review

Nutrition Safety

Elimination Comfort (including pain Mx)

Mobility Dignity

Sleep & rest Respecting Choice

Personal hygiene Communication

Temperature control Privacy

Respiration Sexuality

Published in International Journal of Nursing Practice: Kitson A, et.al, 2010, 16: 423-34

Focus of work for FOC Node

Steps to Follow Step 1: Listen to the Podcast: “Critically

reviewing the inclusiveness of FOC within existing Cochrane Systematic Reviews”

Step 2: Choose a CSR from the Cochrane Database of systematic reviews

Step 3: Carefully read the review and highlight any references made to FOC concepts – see worked examples 1 & 2

Step 4: Populate the standardized template with terms/ concepts from the CSR

Step 5: Submit recommendations to FOC Node site on CNCF

Example 1: Maternal Position & First Term Labour Cochrane Review Group: Cochrane Pregnancy

and Childbirth Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003934. DOI:

10.1002/14651858.CD003934.pub2.

Review Title: Maternal positions and mobility during first stage labour

Primary Objective of the review: To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.

Outcomes of interest that focused the SRPrimary maternal outcomes: length of first stage of labour; type of delivery (spontaneous vaginal delivery, operative vaginal or caesarean); maternal satisfaction with positioning and with the childbirth experience.

Primary fetal and neonatal outcomes: fetal distress requiring immediate delivery; use of neonatal mechanical ventilation.

Secondary maternal outcomes: pain as experienced by the woman; use of analgesics (amount and type, e.g. epidural/opioid); length of second stage of labour; augmentation of labour using oxytocin; artificial rupture of membranes; spontaneous rupture of membranes; hypotension requiring intervention; estimated blood loss > 500 ml; perineal trauma (including episiotomy and third and fourth degree tears)

Secondary neonatal outcomes: Apgar of less than seven at five minutes following delivery; admission to the neonatal intensive care unit.

Review author(s) conclusion There is evidence that walking and upright

positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.

Sample 1:Maternal Positions, First stage labour

FOC Terms used

Interventions

Relationship btw FOC & intervention

Safety Safety walking Potentially unsafe

Communication

Respiration

Eating & Drinking

Elimination

Personal hygiene

Temperature Control

Sexuality

Rest & Sleep

Comfort (including pain Mx) Pain Upright positions

Increased sense of controlReduced need for analgesia

Dignity Not explicitly addresses

Privacy Not explicitly addressed

Respecting Choice Decision making

walking Freedom to move

Mobility Movement Walking; upright positions

Reduced pain; increased sense of control

Recommendations to Cochrane Review Group(s)

Recommended title for Cochrane Pregnancy and Childbirth Review Group to consider

Interventions to increase ambulation for women in 1st stage labour that promote maternal satisfaction with positioning and mobility embracing fundamental care elements including: having an increased sense of control; being able to move around freely and spontaneously; having privacy and maintaining sense of dignity.

Example 2:Oxygen therapy for acute myocardial infarction Cochrane Review Group: Cochrane Heart

Group Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007160. DOI:

10.1002/14651858.CD007160.pub2.

Review Title: Oxygen therapy for Acute Myocardial Infarction

Primary Objective of the review: To review the evidence from randomised controlled trials to establish whether routine use of inhaled oxygen in acute myocardial infarction (AMI) improves patient-centred outcomes, in particular pain and death.

Outcomes of interest that focused the SR

The primary outcome: Mortality The secondary outcomes: pain and any other complications (such as

heart failure, pericarditis and rhythm disorders)

Review author(s) conclusion

There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.

Sample 2: Oxygen Therapy & Acute Angina

FOC Terms used

Interventions

Relationship btw FOC & intervention

Safety harm Reducing risk of harm

Communication

Respiration Breathing Air or oxygen therapy

Reducing size of infarction

Eating & Drinking

Elimination

Personal hygiene

Temperature Control

Sexuality

Rest & Sleep

Comfort (including pain Mx) Ischemic pain

Oxygen therapy

Reduced need for analgesia; reduced pain of ischemia

Dignity

Privacy

Respecting Choice

Mobility

Recommendations to Cochrane Review Group(s)

Recommended title for Cochrane Heart Review Group to consider : Interventions to increase comfort in patients suffering Acute Angina

How to volunteer Find colleague to undertake the FOC analysis

with you Timeframe – try not to spend more that 2

weeks working on analysing a CSR using the FOC review template

Once completed send your completed analysis to the following email addresses:

Alison Kitson: alison.kitson@adelaide.edu.au Suzi Robertson-Malt: smalt@sidra.org