Paul Fulbrook

• RN PhD MSc BSc(Hons) PGDipEd
• Professor (Full) at Australian Catholic University and The Prince Charles Hospital

Background Some studies reported research priorities for adult critical care nurses (Egerod et al., 2020, George et al., 2020). However the changing nature of health systems and the recent pandemic raise the question of whether these findings are contemporaneous and internationally relevant. Protocol and progress on the study are provided in this p...

Background: When using a pressure injury risk assessment tool, it is important to consider its interrater reliability (IRR), given that multiple raters may assess individual patients using the tool. For repeated measurements on a scale, intraclass correlation (ICC) is the most appropriate method to assess reliability (de Vet et al., 2006; Streiner...

Background: ICU patients have multiple risk factors and are vulnerable to pressure injury. Previous studies have shown that pressure injury prevalence and incidence are high in ICU compared to non-ICU samples. However, few studies report mucosal injuries, and many exclude Stage 1 pressure injuries, making benchmarking difficult. Aim: To analyse sta...

Aim: To understand, from a nursing perspective, factors affecting the use of prophylactic dressings to prevent pressure injuries in acute hospitalised adults. Background: Pressure injury causes harm to patients and incurs significant costs to health services. Significant emphasis is placed on their prevention. Relatively recently, prophylactic d...

Aim To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk‐stratified intervention bundle. Design Single‐centre, cross‐sectional, observational, prospective. Methods The charts and bedsides of 341 adult inpatients were examined. Data coll...

Aim To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. Design Interrater agreement study. Methods Data were collected from November 2019 to December 2022. Paired nurse‐assessors were allocated randomly...

Objectives: To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool. Design: Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who...

Background A skin tear is a traumatic wound that occurs in up to one in five hospitalized patients. Nursing care includes application of a dressing to create a moist wound healing environment. Aim To compare the effectiveness of two standard dressings (adhesive silicone foam vs. meshed silicone interface) to heal hospital‐acquired skin tear. Meth...

Background: Hospitalised palliative care patients are at risk of pressure injury. The development of pressure injuries causes physical and psychological distress for patients. Therefore, the prevention of hospital-acquired pressure injury is a nursing priority. The first step in prevention is conducting a risk assessment, which should be population...

Objective: The purpose of this study was to evaluate use of a short multi-factor falls-risk screening tool for older people within the emergency department, to enable rapid identification of falls-risk and triggers for multidisciplinary referral for further falls-specific assessment. Methods: Older people, aged ≥70 years, presenting to the emerg...

Aim: The aim of this study was to analyse prevalence of pressure injury in intensive care versus non-intensive care patients. Background: Hospital-acquired pressure injury is an enduring problem. Intensive care patients are more susceptible due to multiple risk factors. Several studies have indicated that intensive care patients are more likely...

Purpose: To examine the status of critical care nursing internationally, assess the impact of the COVID-19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide. Design: A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess in...

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision-making and use of resources, and severe hospital-acquired pre...

Background: Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospit...

Purpose: The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. Design: A pilot study with a pragmatic, open-label, randomi...

Introduction: Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure injury risk assessment, prevention and treatment exists, but limited research exploring the patient and carer experience of living with pressure injury. Aims: The aim o...

Objective To translate an intensive care-specific pressure injury risk assessment tool (the COMHON Index) in English into Chinese Mandarin. Methods A four-step approach to instrument translation was utilised: 1) English-Mandarin forward-translation by three independent bilinguists; 2) Mandarin-English back-translation by two other independent bili...

Hospital-acquired skin tear prevalence is under-reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10-year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whe...

Background Whilst performing a pressure injury risk assessment is not in itself preventive, risk status identification is critical to inform the judicious implementation of prevention strategies. Risk assessment is mostly undertaken using a structured tool informed by clinical judgement, though there is a perception that use of clinical judgement a...

Introduction Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs. Materials and methods An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey i...

Mucous membrane pressure injury (MMPI) is associated with a history of medical device use at the site of injury. The current international guideline recommends they should be reported in incidence and prevalence studies. The aim of this systematic review was to analyse the incidence and prevalence of hospital‐acquired MMPI in adults admitted to acu...

Objective The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. Review method used This is a systematic review and meta-analysis of randomised controlled trials. Data sources Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were sear...

Background Hospital-acquired pressure injuries cause significant harm to afflicted individuals, and financially burden hospitals. Most pressure injuries are avoidable with the use of preventative interventions. However, within acute hospital settings the effectiveness of pressure injury preventative interventions as demonstrated by high-level evide...

Background Pressure injuries are a ubiquitous, yet largely preventable, hospital acquired complication commonly seen in critically ill patients in the intensive care unit. Objectives The objectives of this study were to implement targeted evidence-based pressure injury prevention strategies and evaluate their effect through measurement of patient...

Background: Formal assessment by nurses of a patient's pressure injury (PI) risk level is often highlighted as being key to PI prevention. However, if no action is taken to address the determined risk (i.e., if appropriate preventative interventions are not implemented), the patient remains vulnerable to PI development, and the assessment process...

Dear Editors, We thank the authors of this commentary for their interest and feedback on our paper,1 and the International Wound Journal for the opportunity to respond. We agree that pressure injury (PI) prevention in clinical practice is complex and challenging. Given the negative impacts of PI2-4 and the ongoing occurrence of PI in hospital5 and...

Background : Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. Objectives : To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted...

This modified Delphi study aimed to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive‐care‐specific risk‐assessment‐scale (COMHON Index), and panel members (n =...

Purpose: To examine the activities, concerns, and expectations of critical care nurses and professional critical care nursing organizations worldwide. Design: A descriptive survey methodology was used. This study is the fifth worldwide quadrennial review of its type to monitor variations in critical care nursing needs and provide robust evidence...

Objective To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients’ self-efficacy and self-management and changes in behaviour at, and following, hospital discharge. Design This study used a convergent mixed methods design. Participants Twenty-one participants...

Background: Chronic venous leg ulcers (VLUs) are costly to the healthcare system and a burden to patients, significantly reducing quality of life. Nitric oxide (NO) is important to wound healing, with a small study demonstrating a NO donor, topical glyceryl trinitrate (GTN), was effective for VLU healing. The aim of this study is to examine the app...

Background: Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and healthcare costs. Within the hospital setting, it is considered to be largely preventable and regarded as an adverse event. In this context, prophylactic use of a protective sa...

Background Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-manag...

The aim of this study was to profile the information and readability of parent-focused resources to support care at home following a child’s discharge from a paediatric emergency department (ED). Analysis included recording the scope, source, readability scores and benchmarking the contents against previous recommendations for discharge information...

Background Due to changes in critical care worldwide, the World Federation of Critical Care Nurses Board of Directors commissioned a review of its 2005 Declaration of Buenos Aires: Position Statement on the Provision of a Critical Care Nursing Workforce. Aim To provide international recommendations to inform and assist critical care nursing associ...

Purpose: The aim of this study was to assess nurses' knowledge of pressure injuries in order to gather benchmark data, identify knowledge gaps, and based on results, implement educational strategies to improve practice. Design: Cross-sectional survey. Subjects and setting: The study setting was a large Australian tertiary general hospital empl...

Purpose: The purpose of this study was to provide a rich description of the lived experiences of parents whose child had received care in a new paediatric emergency department. Procedures: A descriptive phenomenological design was used. Semistructured interviews were conducted with 18 parents. Participants were asked to describe their experience...

Objective:: Hospital-acquired pressure ulcers (PU) continue to occur despite an ongoing focus on prevention. The aim of this review was to identify and evaluate primary research which links pressure ulcer risk assessment with prescription and implementation of preventative interventions for hospitalised adults. Method:: A systematic review of th...

Introduction: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the...

Background: Indigenous Australians carry a greater burden of cardiovascular disease than other Australians. A variety of programs has been implemented with the broad aim of improving Indigenous cardiovascular health, however, relatively few have been evaluated rigorously. In terms of effectiveness, understanding how to best manage cardiovascular d...

This exploratory, descriptive study aimed to identify and describe the pressure injury preventative interventions prescribed by nurses following the assessment of a patient's pressure injury risk and to compare the prescribed interventions relative to the assessed risk level. A total of 200 inpatients in a tertiary Australian hospital were included...

Purpose: To identify paediatric emergency department nurses' perceptions of factors influencing parents' understanding of discharge information. Procedures: Content analysis was used to analyse data from three semi-structured focus groups with nurses from a paediatric ED. Findings: Findings were interpreted within the three domains of structur...

Aims and objectives: To explore the experiences of men and women with cystic fibrosis in becoming parents. Background: As lifespan for people with cystic fibrosis increases, and reproductive technology advances, having a child of their own becomes a possibility. Design: This study utilised a phenomenological framework. Methods: Seven Austral...

Background: The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses' ability to maintain the safety of those in their...

Aim: To understand the experiences of high-risk respiratory patients undergoing bronchoscopy with conscious sedation. Background: Due to possible complications, high-risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as 'conscious sedation', this facilitates depression of the...

Aim: To understand the patient's perspective of falling in hospital. Background: A fall in hospital can affect a patient physically and psychologically, increasing their hospital length of stay and potentially putting them at risk of further complications. Despite a wealth of literature on falls that focuses on risk assessment, preventive interv...

Aim: To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. Background: Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovat...

Background: Pressure injuries contribute significantly to patient morbidity and healthcare costs. Critically ill patients are a high risk group for pressure injury development and may suffer from skin failure secondary to hypoperfusion. The aim of this study was to report hospital acquired pressure injury incidence in intensive care and non-intens...

Introduction: The stages of change model suggests that individuals seeking treatment are in the 'preparation' or the 'action' stage of change, which is the desired outcome of successful Motivational Interviewing (MI) interventions. MI is known to enhance treatment attendance among individuals with mental health problems. Aim: This study examined...

Aim: To explore Indigenous people's experiences of hospitalisation for acute cardiac care. Background: Indigenous Australians suffer a higher burden of cardiovascular ill health and hospitalisation rates in comparison to other Australians, but there is little research that explores their perspectives of hospitalisation. Design: Narrative inqui...

Aim To assess the utility of a multiple-encounter in-situ (MEIS) simulation as an orientation tool for multidisciplinary staff prior to opening a new paediatric emergency service. Methods A single-group pretest/post-test study was conducted. During the MEIS simulation, multidisciplinary staff with participant or observer roles managed eight childr...

Background: Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging 'navigator' role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement thro...

Objective: The objective of this study was to explore Indigenous people's experiences and perceptions of hospitalisation and acute care. Methods: Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using t...

Rationale: Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery. Methods: We conducted a prospective observational study on all adult patients undergoing sur...

Background: Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. Objective: To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compare...

The risks imposed by mechanical ventilation can be mitigated by nurses’ use of strategies that promote early but appropriate reduction of ventilatory support and timely extubation. Weaning from mechanical ventilation is confounded by the multiple impacts of critical illness on the body's systems. Effective weaning strategies that combine several in...

Background Anxiety and depression are common after heart transplantation. This study aimed to pilot test the feasibility of a clinical model of psychological care for heart transplant recipients. The model of care involved nurse-led screening for anxiety and depression followed by referral for a course of telephone-delivered cognitive behaviour the...

Universal screening of very early school-age children (age 4-7 years) is important for early identification of learning problems that may require enhanced learning opportunity. In this context, use of standardized instruments is critical to obtain valid, reliable, and comparable assessment outcomes. A wide variety of standardized instruments is ava...

Method: A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants mee...

Purpose: The aim of this study was to assess the validity and reliability of psychological screening tools in outpatient heart transplant recipients. Methods: Forty-eight heart transplant recipients completed the Patient Health Questionnaire 9-item scale (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Kessler Psychological Distress 1...

Background: Provision of paediatric specific service areas within a hospital servicing both adult and paediatric populations is relatively novel. In Australia this is an emerging model for service delivery that takes into account the specific health needs of paediatric patients. To date, information related to the practice transition required by s...

Review question: The question that this systematic review aims to address is: does the use of evidence-based, treatment-oriented, clinical practice guidelines by healthcare professionals result in improvements in patient outcomes?

AimTo test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index.Background Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that...

Background: Screening and brief intervention in the emergency department (ED) has almost exclusively focused on individuals with alcohol-use problems. The early detection of mental health problems before problems become severe will enable early intervention and support which may improve health and prevent further deterioration. The main aim of thi...

To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns. This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009. An...

Management of hospital-acquired pressure ulcers (PUs) is an essential aspect of nursing practice that requires knowledge of risk assessment, prevention, identification, and treatment strategies. The aim of this study was to assess nurses' knowledge of PU management in order to identify knowledge gaps. The study setting was a large Australian health...

With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing. To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care. Sequential mixed methods study using cross sectional survey with follow-on focu...

The aim of this study was to validate a modified version of the Paddington Alcohol Test for use in the Australian emergency department (ED) setting. A cross sectional survey was used to screen patients attending an Australian tertiary hospital ED. Data were collected over a three-month period at randomly allocated time periods and days. Consenting...

Accessible Summary Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health‐care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group re...

In Australia, community child health services provide comprehensive primary health care to infants, children and their families with the goal of optimising infant and family health in the first five years of life. Child health surveillance clinics are one important aspect of this service which provide infant growth and development monitoring, and p...

Rationale, aims and objectivesFalls in hospital are costly and may impact psychologically on fallers causing them to avoid mobilization, thereby affecting recovery rate and hospital length of stay. The study aim was to investigate the relationships between fear of falling, falls risk, in-hospital falls and hospital length of stay.MethodA convenienc...

Treatment for Tongue-Tie: Almost all tongue-ties can be treated with a very simple procedure called a frenotomy (also known as a frenulotomy). Frenotomy is a minor surgical procedure to cut the frenulum. It is done using sterile scissors and does not need an anesthetic. A frenotomy should be done only by a trained clinician. No complications, excep...

Background Previous studies indicate that medication compliance within chronic disease populations, including coronary heart disease (CHD), is poor. Aim To determine lipid-lowering medication (LLM) self-reported compliance of CHD patients 12 months following hospital discharge. Methods Two 1-year follow-up studies were conducted in tertiary, priv...

PIs cause discomfort and pain, decrease quality of life (Gorecki et al 2009) and increase patient length of stay and health care costs (Van Den Bos et al 2011; Graves et al 2005). Australian health care organisations are required to be accredited for Standard 8: Preventing and Managing Pressure Injuries (ACSQHC, 2013). Funding penalties for hospita...

Care of patients at the end-of-life (EOL) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care. To investigate South African critical care nurses' experiences and perceptions of EOL care. Cross-sectional survey. South African critical care nurses completed a modified version of the 'VENICE' survey tool...

To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory. Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive se...

Bronchiolitis is a major cause of children's admission to hospital. The study aim was to describe the experiences of parents who had, or nurses who cared for, a child admitted to hospital for severe bronchiolitis requiring oxygen therapy. A descriptive phenomenological approach was used to interview 12 mothers and 12 nurses. The findings were clust...

Introduction Current government guidelines for physical activity are 30 minutes of moderate intensity on most days of the week. Sub-optimal physical health contributes to increased stress levels. Health professionals with poor levels of physical activity combined with shift work are at greater risk of overweight/obesity. The purpose of this study...

Background Type 2 diabetes is a leading cause of morbidity and mortality in midlife and older Australian women with known modifiable risk factors for type 2 diabetes including smoking, nutrition, physical activity and obesity. In Australia little research has been done to investigate the perceived barriers to healthy lifestyle activities in midlife...

Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Aus...

Matched case-control research designs can be useful because matching can increase power due to reduced variability between subjects. However, inappropriate statistical analysis of matched data could result in a change in the strength of association between the dependent and independent variables or a change in the significance of the findings. We s...

Background: Tongue-tie or ankyloglossia is a congenital condition that negatively affects breastfeeding. The thickened, tightened, or shortened frenulum affects the infant's ability to suck and frequently results in sore and painful nipples. Although several studies have investigated outcomes associated with treatment of tongue-tie, none have inve...

Abstract Purpose This presentation will discuss a research study conducted on emotional and physical health and its relationship to job satisfaction. The context of stress, workplace demands and limited resources for nurses, midwives and paramedics will be explored. The current study and the specific locations will be overviewed. The methods will b...

Aims and objectivesTo explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who...

Pressure injuries (PIs) are adverse events associated with health care that can cause significant patient harm and discomfort, and have been identified as a cause of death. Some governments have established penalty funding for the occurrence of Stages 3 or 4 hospital-acquired PI; indicating that quality health care should prevent their occurrence....