To illuminate the hospital experience for patients and families when major amputation has been ad... more To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia. While a wealth of clinical outcome data on CLI and amputation exists internationally, little is known about the patient/family-centred experience of hospitalisation to inform preservation of personhood and patient-centred care planning. Longitudinal qualitative study using Heideggerian phenomenology. Fourteen patients and 13 family carers provided a semistructured interview after advice for major amputation. Where amputation followed, a second interview (6 months postprocedure) was provided by eight patients ...
In this paper, we interpret the spatio-temporal experience of people with end-stage kidney diseas... more In this paper, we interpret the spatio-temporal experience of people with end-stage kidney disease and their families in the first months of haemodialysis. While dialysis is the mainstay of end-stage kidney disease management, the actual initiation of treatment is often unexpected by people and families. Poor biopsychosocial preparation means haemodialysis commencement is experienced as a crisis. While previous phenomenological studies suggest that over time, a habitual incorporation of dialysis into one's self concept is possible, the spatio-temporal experience of people new to haemodialysis is not well-understood. Phenomenological study. Following purposive sampling, 18 participants were recruited either during an inpatient admission or while attending a public hospital-based haemodialysis unit in Sydney, Australia. Eleven people who had commenced haemodialysis within the previous three months and five close family members were separately engaged in semi-structured interviews. Hermeneutic interpretation within a Heideggerian framework occurred through a backward-and-forward analysis between the early haemodialysis experience and its relationship to Being. Themes that related to a temporal and spatial understanding of Being-in-the-world as a new haemodialysis patient or carer included: 'compartmentalising life into dialysis and non-dialysis days' (lost time, clock time and lived time); 'compartmentalising before, now and future' (normalising the 'before', dealing with the 'now' and the 'foreverness' of dialysis); and finally, 'compartmentalising space'. In the months after dialysis commencement, patients and family carers compartmentalise time and space with a loss of continuity of meaningful, lived time that had framed peoples' past sense of normal. Resource enhancement activities should focus on social connectivity and provision of personnel and/or infrastructure to reduce boredom, facilitate engagement with meaningful tasks and, where appropriate, to support the continuation of work activities during the dialysis period. This article is protected by copyright. All rights reserved.
Wound Practice & Research: Journal of the Australian Wound Management Association, 2018
This case study illustrates the importance of collaboration in complex care across the hospital -... more This case study illustrates the importance of collaboration in complex care across the hospital - community continuum to improve the patient experience The team engaged the patient by building rapport and trust, providing education, and implementing evidence-based care. These contributed to better outcomes for this patient, who had severe chronic venous leg ulceration and poor treatment concordance. Our objectives were to promote ulcer healing and increase treatment concordance by engaging the patient. Engagement was achieved by enhanced communication and the use of technology such as digital photography and advanced wound therapies. The provision of support, education and assessment of advanced skills competence of clinicians across the care continuum achieved our objectives.
Wound management appears to be evolving as a discrete specialty. Currently, wound management is n... more Wound management appears to be evolving as a discrete specialty. Currently, wound management is not aligned with the predominant medical model, making its 'fit' into the current health care system problematic. This paper describes a nurse-led wound model of care which developed from a community of practice (CoP). It involves multiple clinical nurse consultants (CNCs) embedding both wound prevention and management as part of their specialty practice, while ensuring regular contact with each other to maintain a CoP and support the model of care. We believe this model works well in a large, metropolitan teaching hospital with enhanced outreach into the community setting by specialised nurse clinicians who are key members of interdisciplinary teams.
Introduction: Despite improvements in revascularization, major amputation remains a significant p... more Introduction: Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). Aim: This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. Method: Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. Findings: Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. Conclusion: Major amputation continues to present challenges because of patient frailty and the high rate of complications. These issues need to be considered in a robust care planning framework that includes consideration of cognitive decline and other markers of frailty. Opportunities to optimize the physical condition of these patients and to reduce delays in proceeding to surgery require further investigation. (J Vasc Nurs 2017;35:49-56)
Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing, 2017
Despite improvements in revascularization, major amputation remains a significant part of the cas... more Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. Major amputation continues to present challenges because of patient frailty and the high rate of complications. Thes...
To illuminate the hospital experience for patients and families when major amputation has been ad... more To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia. While a wealth of clinical outcome data on CLI and amputation exists internationally, little is known about the patient/family-centred experience of hospitalisation to inform preservation of personhood and patient-centred care planning. Longitudinal qualitative study using Heideggerian phenomenology. Fourteen patients and 13 family carers provided a semistructured interview after advice for major amputation. Where amputation followed, a second interview (6 months postprocedure) was provided by eight patients ...
In this paper, we interpret the spatio-temporal experience of people with end-stage kidney diseas... more In this paper, we interpret the spatio-temporal experience of people with end-stage kidney disease and their families in the first months of haemodialysis. While dialysis is the mainstay of end-stage kidney disease management, the actual initiation of treatment is often unexpected by people and families. Poor biopsychosocial preparation means haemodialysis commencement is experienced as a crisis. While previous phenomenological studies suggest that over time, a habitual incorporation of dialysis into one's self concept is possible, the spatio-temporal experience of people new to haemodialysis is not well-understood. Phenomenological study. Following purposive sampling, 18 participants were recruited either during an inpatient admission or while attending a public hospital-based haemodialysis unit in Sydney, Australia. Eleven people who had commenced haemodialysis within the previous three months and five close family members were separately engaged in semi-structured interviews. Hermeneutic interpretation within a Heideggerian framework occurred through a backward-and-forward analysis between the early haemodialysis experience and its relationship to Being. Themes that related to a temporal and spatial understanding of Being-in-the-world as a new haemodialysis patient or carer included: 'compartmentalising life into dialysis and non-dialysis days' (lost time, clock time and lived time); 'compartmentalising before, now and future' (normalising the 'before', dealing with the 'now' and the 'foreverness' of dialysis); and finally, 'compartmentalising space'. In the months after dialysis commencement, patients and family carers compartmentalise time and space with a loss of continuity of meaningful, lived time that had framed peoples' past sense of normal. Resource enhancement activities should focus on social connectivity and provision of personnel and/or infrastructure to reduce boredom, facilitate engagement with meaningful tasks and, where appropriate, to support the continuation of work activities during the dialysis period. This article is protected by copyright. All rights reserved.
Wound Practice & Research: Journal of the Australian Wound Management Association, 2018
This case study illustrates the importance of collaboration in complex care across the hospital -... more This case study illustrates the importance of collaboration in complex care across the hospital - community continuum to improve the patient experience The team engaged the patient by building rapport and trust, providing education, and implementing evidence-based care. These contributed to better outcomes for this patient, who had severe chronic venous leg ulceration and poor treatment concordance. Our objectives were to promote ulcer healing and increase treatment concordance by engaging the patient. Engagement was achieved by enhanced communication and the use of technology such as digital photography and advanced wound therapies. The provision of support, education and assessment of advanced skills competence of clinicians across the care continuum achieved our objectives.
Wound management appears to be evolving as a discrete specialty. Currently, wound management is n... more Wound management appears to be evolving as a discrete specialty. Currently, wound management is not aligned with the predominant medical model, making its 'fit' into the current health care system problematic. This paper describes a nurse-led wound model of care which developed from a community of practice (CoP). It involves multiple clinical nurse consultants (CNCs) embedding both wound prevention and management as part of their specialty practice, while ensuring regular contact with each other to maintain a CoP and support the model of care. We believe this model works well in a large, metropolitan teaching hospital with enhanced outreach into the community setting by specialised nurse clinicians who are key members of interdisciplinary teams.
Introduction: Despite improvements in revascularization, major amputation remains a significant p... more Introduction: Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). Aim: This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. Method: Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. Findings: Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. Conclusion: Major amputation continues to present challenges because of patient frailty and the high rate of complications. These issues need to be considered in a robust care planning framework that includes consideration of cognitive decline and other markers of frailty. Opportunities to optimize the physical condition of these patients and to reduce delays in proceeding to surgery require further investigation. (J Vasc Nurs 2017;35:49-56)
Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing, 2017
Despite improvements in revascularization, major amputation remains a significant part of the cas... more Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. Major amputation continues to present challenges because of patient frailty and the high rate of complications. Thes...
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Papers by susan monaro