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Conjoint Professor Lin Perry

Conjoint Professor

School of Nursing and Midwifery

Career Summary

Biography

Lin Perry is Professor of Nursing Research and Practice Development, University of Technology Sydney and the Prince of Wales Hospital, Sydney Hospital and Sydney Eye Hospital, South Eastern Sydney Local Health District, New South Wales. The main focus of her work has been broadly around research capacity development, service and practice development and evaluation, with major clinical topics of nutrition support and chronic disease management, particularly stroke and diabetes. She has been extensively involved with nutritional support across all areas, from tube feeding regimes for ventilated patients to requirements of patients and carers using Home Enteral Feeding, effects of stroke on taste and smell function, dietary intake of stroke patients and its effects on quality of life in residential aged care. Her stroke work has spanned intensive monitoring in acute stroke through to carers’ long-term needs. She is currently involved with development and evaluation of new service models to support young people with type 1 diabetes in rural areas of NSW. Her experience of practice and service development has included investigation of change management processes, methods and impact of implementing evidence based guidelines and best practice recommendations in acute and community settings at all levels.

Research Expertise
Knowledge transfer, evidence based practice, multi-method evaluation studies and health services research, particularly in relation to chronic disease management.

Collaborations
Primary collaborations are with NSW Health, and with the Australian Diabetes Council


Qualifications

  • PhD, University of London
  • Registered Nurse, United Kingdom Central Council for Nurs,Midw&HlthV
  • Certificate in Education, University of Plymouth
  • Diploma in Professional Studies in Nursing, University of Plymouth
  • Master of Science (Health Care - Prof Issues), University of Exeter - UK

Keywords

  • Health services research
  • change management
  • chronic disease
  • diabetes
  • evidence based practice
  • health promotion
  • service development
  • stroke

Languages

  • English (Fluent)

Fields of Research

Code Description Percentage
110399 Clinical Sciences not elsewhere classified 100

Professional Experience

Academic appointment

Dates Title Organisation / Department
1/06/2009 -  Professor of Nursing Research & Practice Development University of Technology, Sydney
School of Nursing and Midwifery
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Book (1 outputs)

Year Citation Altmetrics Link
2010 Williams J, Perry L, Watkins C, Acute Stroke Nursing (2010)

Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subseq... [more]

Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. ¿ Evidence-based and practical in style, with case studies and practice examples throughout ¿ Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education ¿ The first text to explore stroke management from UK and international perspectives, and with a nursing focus. © 2010 Blackwell Publishing Ltd.

DOI 10.1002/9781444318838
Citations Scopus - 6

Chapter (1 outputs)

Year Citation Altmetrics Link
2010 Perry L, Boaden E, 'Nutritional Aspects of Stroke Care', Acute Stroke Nursing 91-122 (2010)
DOI 10.1002/9781444318838.ch5

Journal article (100 outputs)

Year Citation Altmetrics Link
2017 Lamont S, Brunero S, Perry L, Duffield C, Sibbritt D, Gallagher R, Nicholls R, '¿Mental health day¿ sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics', Journal of Advanced Nursing, 73 1172-1181 (2017)

© 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd. Aim: To examine the workforce, workplace, psychosocial and health characteristics of nurses ... [more]

© 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd. Aim: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ¿mental health days¿. Background: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a ¿mental health day¿ as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. Design: Online cross-sectional survey. Methods: Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of ¿mental health day¿ reportage were determined using logistic regression. Results: Fifty-four percentage of the n¿=¿5041 nurse and midwife respondents took ¿mental health days¿. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12¿months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. Conclusion: Specific characteristics of nurses and midwives who report taking ¿mental health day¿ sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.

DOI 10.1111/jan.13212
2017 Potter JE, Herkes RG, Perry L, Elliott RM, Aneman A, Brieva JL, et al., 'COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): Protocol for an intervention study', BMC Health Services Research, 17 (2017)

© 2017 The Author(s). Background: Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations... [more]

© 2017 The Author(s). Background: Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation. Methods: This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a "designated requester"; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a "balanced" approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national "Family Don ation Conversation" workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals' adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days. Discussion: The pragmatic design of this study may identify 'what works' in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered).

DOI 10.1186/s12913-016-1964-7
2017 Perry L, 'Publication ethics¿Where are we today? Part 2: Authorship: What constitutes prior publication?', International Journal of Nursing Practice, 23 (2017)
DOI 10.1111/ijn.12579
2017 Perry L, James S, Gallagher R, Dunbabin J, Steinbeck K, Lowe J, 'Supporting patients with type 1 diabetes using continuous subcutaneous insulin infusion therapy: Difficulties, disconnections, and disarray.', J Eval Clin Pract, 23 719-724 (2017)
DOI 10.1111/jep.12703
2017 Perry L, Xu X, Duffield C, Gallagher R, Nicholls R, Sibbritt D, 'Health, workforce characteristics, quality of life and intention to leave: The 'Fit for the Future' survey of Australian nurses and midwives.', J Adv Nurs, (2017)
DOI 10.1111/jan.13347
Co-authors Xiaoyue Xu
2017 Perry L, James S, Steinbeck K, Dunbabin J, Lowe J, 'Young people with type 1 diabetes mellitus: Attitudes, perceptions, and experiences of diabetes management and continuous subcutaneous insulin infusion therapy.', J Eval Clin Pract, 23 554-561 (2017)
DOI 10.1111/jep.12670
2017 Pierce H, Perry L, Gallagher R, Chiarelli P, 'Urinary incontinence, work, and intention to leave current job: A cross sectional survey of the Australian nursing and midwifery workforce.', Neurourol Urodyn, 36 1876-1883 (2017)
DOI 10.1002/nau.23202
Co-authors Pauline Chiarelli
2017 Nicholls R, Perry L, Gallagher R, Duffield C, Sibbritt D, Xu X, 'The personal cancer screening behaviours of nurses and midwives', Journal of Advanced Nursing, 73 1403-1420 (2017)

© 2016 John Wiley & Sons Ltd Aim: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and ident... [more]

© 2016 John Wiley & Sons Ltd Aim: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. Background: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40% are over 50¿years ¿ an age where cancer incidence rises rapidly, but when screening may reduce cancer mortality. Nurses and midwives are important health role models for the population, but their engagement in cancer screening is unknown. Design: A cross-sectional survey conducted in 2014¿2015. Methods: Data were obtained from the ¿Fit for the Future¿ study on 5041 working nurses and midwives in New South Wales, Australia and analyses were conducted on subsets of age-eligible respondents. Demographic, geographical and occupational data were analysed in relation to population-based screening for breast, cervical and bowel cancers and opportunistic screening for prostate and skin cancer screening participation, in line with Australian recommendations. Results: Nurses¿ and midwives¿ recent screening rates were higher than the Australian general population across relevant age groups. Compared with full-time nurses and midwives, part-time/casual/pool workers were significantly more likely to undertake cervical, breast and bowel screening. Compared with those working office hours, shift workers were significantly less likely to undertake breast and bowel screening, but more likely to undertake skin screening. Conclusions: Disparities in reported screening prevalence and factors predictive of screening uptake indicate opportunities for targeted strategies to inform and/or promote workforce engagement with screening programmes and protect the health of this ageing workforce.

DOI 10.1111/jan.13221
Co-authors Xiaoyue Xu
2017 Nicholls R, Perry L, Duffield C, Gallagher R, Pierce H, 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review', Journal of Advanced Nursing, 73 1051-1065 (2017)

© 2016 John Wiley & Sons Ltd Aim: The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses. Background... [more]

© 2016 John Wiley & Sons Ltd Aim: The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses. Background: There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses¿ healthy eating in the workplace. Design: Integrative mixed method review. Data sources: Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000¿2016. Of 26 included papers, 21 were qualitative and five quantitative. Review methods: An integrative literature review was undertaken. Quality appraisal of included studies used standardized checklists. A social-ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis. Results: Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses¿ dietary intake. Conclusion: Reorientation of the workplace to promote healthy eating among nurses is required.

DOI 10.1111/jan.13185
2017 Elliott D, Allen E, Mckinley S, Perry L, Duffield C, Fry M, et al., 'User compliance with documenting on a track and trigger-based observation and response chart: A two-phase multi-site audit study', Journal of Advanced Nursing, (2017)

© 2017 John Wiley & Sons Ltd. Aims: To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid respon... [more]

© 2017 John Wiley & Sons Ltd. Aims: To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated. Background: Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required. Design: Two-phase audit. Methods: Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012). Findings: Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%-14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart. Conclusions: User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.

DOI 10.1111/jan.13302
2017 Perry L, Nicholls R, Duffield C, Gallagher R, 'Building expert agreement on the importance and feasibility of workplace health promotion interventions for nurses and midwives: A modified Delphi consultation', Journal of Advanced Nursing, (2017)

© 2017 John Wiley & Sons Ltd. Aim: To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support... [more]

© 2017 John Wiley & Sons Ltd. Aim: To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support the health of the Australian nursing and midwifery workforce. Background: The nursing workforce experiences rates of ill health above that of other workforces, yet there is little investment in workplace health promotion. Design: The study used a modified Delphi design conducted between September and November 2015. Methods: Eleven of 19 purposively selected expert panellists discussed, rated and provided feedback through two rounds of an electronic questionnaire about the relative importance and feasibility of 46 workplace health promotion interventions and processes for nurses and midwives. Scores for importance and feasibility were calculated and ranked and a composite score of importance multiplied by feasibility. Results: Mental health strategies were prioritized as the most important and feasible of the intervention topics, followed closely by healthy eating and physical activity interventions; smoking cessation ranked lowest. The most highly ranked interventions targeted healthy eating, stress management and resilience training. Highest ranked processes to support development of a healthy work environment included intersectoral collaboration and employee wellness groups. Conclusions: Study findings prompt consideration of health promotion opportunities to support nurses' health and well-being. Findings identified key workplace health promotion priorities and provide direction for policy makers and managers to promote nursing and midwifery workforce health.

DOI 10.1111/jan.13345
2017 Alotaibi A, Gholizadeh L, Al-Ganmi A, Perry L, 'Examining perceived and actual diabetes knowledge among nurses working in a tertiary hospital', Applied Nursing Research, 35 24-29 (2017)

© 2017 Background With the worldwide increase in the incidence and prevalence of diabetes, there has been an increase in the scope and scale of nursing care and education require... [more]

© 2017 Background With the worldwide increase in the incidence and prevalence of diabetes, there has been an increase in the scope and scale of nursing care and education required for patients with diabetes. The high prevalence of diabetes in Saudi Arabia makes this a particular priority for this country. Aim The aim of this study was to examine nurses¿ perceived and actual knowledge of diabetes and its care and management in Saudi Arabia. Methods A convenience sample of 423 nurses working in Prince Sultan Medical Military City in Saudi Arabia was surveyed in this descriptive, cross-sectional study. Perceived knowledge was assessed using the Diabetes Self-Report Tool, while the Diabetes Basic Knowledge Tool was used to assess the actual knowledge of participants. Results The nurses generally had a positive view of their diabetes knowledge, with a mean score (SD) of 46.9 (6.1) (of maximum 60) for the Diabetes Self-Report Tool. Their actual knowledge scores ranged from 2 to 35 with a mean (SD) score of 25.4 (6.2) (of maximum of 49). Nurses¿ perceived and actual knowledge of diabetes varied according to their demographic and practice details. Perceived competency, current provision of diabetes care, education level and attendance at any diabetes education programs predicted perceived knowledge; these factors, with gender predicted, with actual diabetes knowledge scores. Conclusion In this multi-ethnic workforce, findings indicated a significant gap between participants¿ perceived and actual knowledge. Factors predictive of high levels of knowledge provide pointers to ways to improve diabetes knowledge amongst nurses.

DOI 10.1016/j.apnr.2017.02.014
2017 Perry L, 'Peer review¿An appreciation', International Journal of Nursing Practice, 23 (2017)
DOI 10.1111/ijn.12531
2017 Perry L, 'Publication ethics¿Where are we today?', International Journal of Nursing Practice, 23 (2017)
DOI 10.1111/ijn.12538
Citations Scopus - 1
2016 Pierce H, Perry L, Chiarelli P, Gallagher R, 'A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups', Journal of Advanced Nursing, 72 1718-1734 (2016) [C1]

© 2016 John Wiley & Sons Ltd Aim: To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. Background: Productivity of w... [more]

© 2016 John Wiley & Sons Ltd Aim: To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. Background: Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity. Design: A systematic review of observational studies. Data sources: Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990¿2014. Review methods: The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool. Results: Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity. Conclusion: Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.

DOI 10.1111/jan.12909
Citations Scopus - 3Web of Science - 2
Co-authors Pauline Chiarelli
2016 Perry L, Gallagher R, Duffield C, Sibbritt D, Bichel-Findlay J, Nicholls R, 'Does nurses¿ health affect their intention to remain in their current position?', Journal of Nursing Management, 24 1088-1097 (2016)

© 2016 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd Aim: To investigate and describe nurses¿ and midwives¿ physical health, rates of symptoms... [more]

© 2016 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd Aim: To investigate and describe nurses¿ and midwives¿ physical health, rates of symptoms and disease, and to determine if these factors contribute to intention to leave. Background: The nursing and midwifery workforce is ageing yet little is known about their physical health or its relationship to intention to leave. Methods: An online survey of health and work-related assessments was distributed through the New South Wales Nurses and Midwives Association and professional contacts. Results: Nurses and midwives (n¿=¿5041) reported good-very good health overall. With 22.2% intending to leave in the next 12¿months, older age, better perceived health and job satisfaction, regional residence and not working shifts predicted no intention to leave while breathing problems predicted intention to leave. Conclusions: Study findings flag the importance of health as an influence on intention to leave. Alongside job satisfaction and shift-working, health presents opportunities for workplace initiatives to maintain nurses in the workforce. Implications for nursing management: Educators, managers and policy makers should heed the significant influence of health for retention of staff and consider what strategies may mitigate health risks for this workforce.

DOI 10.1111/jonm.12412
Citations Scopus - 4
2016 Alotaibi A, Al-Ganmi A, Gholizadeh L, Perry L, 'Diabetes knowledge of nurses in different countries: An integrative review', Nurse Education Today, 39 32-49 (2016)

© 2016 Elsevier Ltd. Objective: The aim of this study was to identify, critically appraise and synthesise evidence of nurses' knowledge of diabetes and identify factors that func... [more]

© 2016 Elsevier Ltd. Objective: The aim of this study was to identify, critically appraise and synthesise evidence of nurses' knowledge of diabetes and identify factors that function as barriers to nurses' acquisition of diabetes knowledge. Design: An integrative review. Methods: A systematic search was conducted for English-language, peer reviewed publications of any research design via CINAHL, Medline, EMBASE, and Education Research Complete databases from 2004 to 2014. Of 374 articles retrieved, after removal of duplicates and quality appraisal, 25 studies were included in the review and synthesised based on study characteristics, design and findings. Findings: Studies originated from developed and developing countries and applied a variety of research designs and tools to assess nurses' knowledge of diabetes. Assessed aspects of diabetes care included knowledge of diabetes medications (12 studies), nutrition (7), blood glucose monitoring (7), diabetes complications (6), and pathology, symptoms and diabetes management (9). Factors/barriers affecting nurses' acquisition of diabetes knowledge were identified (11). Overall, findings indicated wide-spread serious and sustained deficiencies in nurses' knowledge of diabetes and diabetes care. Conclusion: With nurses demonstrating significant and long-standing knowledge deficits in many aspects of diabetes care, strategies are urgently required to overcome the identified barriers to knowledge acquisition.

DOI 10.1016/j.nedt.2016.01.017
Citations Scopus - 3
2016 Al-Ganmi AH, Perry L, Gholizadeh L, Alotaibi AM, 'Cardiovascular medication adherence among patients with cardiac disease: a systematic review', Journal of Advanced Nursing, 72 3001-3014 (2016)

© 2016 John Wiley & Sons Ltd Aims: The aim of this study was to critically appraise and synthesize the best available evidence on the effectiveness of interventions suitable fo... [more]

© 2016 John Wiley & Sons Ltd Aims: The aim of this study was to critically appraise and synthesize the best available evidence on the effectiveness of interventions suitable for delivery by nurses, designed to enhance cardiac patients' adherence to their prescribed medications. Background: Cardiac medications have statistically significant health benefits for patients with heart disease, but patients' adherence to prescribed medications remains suboptimal. Design: A systematic quantitative review of intervention effects. Data Sources: We conducted systematic searches for English-language, peer-reviewed randomized controlled trial publications via Medline, EMBASE, CINAHL, the Cochrane Library, ProQuest, Web of Science and Google Scholar published between January 2004¿December 2014. Review methods: According to pre-determined inclusion and exclusion criteria, eligible studies were identified and data extracted using a predefined form. Of 1962 identified papers; 14 studies met the study inclusion criteria, were assessed for risk of bias using the Cochrane Collaboration tool; and included in the review. Results: Study findings were presented descriptively; due to the heterogeneity of studies meta-analysis was not possible. Included papers described interventions categorized as: (1) multifaceted; and (2) behavioural and educational, comprising: (a) text message and mail message; (b) telephone calls; (c) motivational interviewing and (d) nurse-led counselling and education. Conclusions: Substantial heterogeneity limited the robustness of conclusions, but this review indicated that motivational interviewing, education and phone or text messaging appeared promising as means to enhance cardiac medication adherence. Future research should integrate multifaceted interventions that target individual behaviour change to enhance adherence to cardiovascular medications, to build on the beneficial outcomes indicated by this review.

DOI 10.1111/jan.13062
2016 Elliott D, Allen E, McKinley S, Perry L, Duffield C, Fry M, et al., 'User acceptance of observation and response charts with a track and trigger system: a multisite staff survey', Journal of Clinical Nursing, 25 2211-2222 (2016)

© 2016 John Wiley & Sons Ltd Aims and objectives: To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes o... [more]

© 2016 John Wiley & Sons Ltd Aims and objectives: To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical¿surgical patients. Background: Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design: Prospective multisite survey of user acceptance of the charts in practice. Methods: New observation and response charts were trialled in parallel with existing charts for 24¿hours across 36 adult acute medical¿surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results: Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration. Conclusions: This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended. Relevance to clinical practice: Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice.

DOI 10.1111/jocn.13303
2016 Perry L, 'Happy New Year!', International Journal of Nursing Practice, 22 3 (2016)
DOI 10.1111/ijn.12427
2016 Perry L, 'Nurses and midwives need health promotion as much as their patients', International Journal of Nursing Practice, 22 216 (2016)
DOI 10.1111/ijn.12457
2016 Perry L, 'A fair go', International Journal of Nursing Practice, 22 419 (2016)
DOI 10.1111/ijn.12491
2015 Pierce H, Perry L, Gallagher R, Chiarelli P, 'Pelvic floor health: A concept analysis', Journal of Advanced Nursing, (2015) [C1]

Aim: To report an analysis of the concept 'pelvic floor health'. Background: 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well ... [more]

Aim: To report an analysis of the concept 'pelvic floor health'. Background: 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. Design: Rodger's evolutionary view was used to guide this analysis. Data sources: Academic literature databases and public domain websites viewed via the Internet search engine Google. Review methods: Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. Results: Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. Conclusion: This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision.

DOI 10.1111/jan.12628
Citations Scopus - 3Web of Science - 1
Co-authors Pauline Chiarelli
2015 Perry L, 'Dementia care in European countries - findings from the RightTimePlaceCare study', Journal of Advanced Nursing, 71 1336-1337 (2015)
DOI 10.1111/jan.12671
2015 Jakimowicz S, Perry L, 'A concept analysis of patient-centred nursing in the intensive care unit', Journal of Advanced Nursing, 71 1499-1517 (2015)

© 2015 John Wiley & Sons Ltd. Aim: To report an analysis of the concept of patient-centred nursing in the context of intensive care. Background: Clarification of patient-centre... [more]

© 2015 John Wiley & Sons Ltd. Aim: To report an analysis of the concept of patient-centred nursing in the context of intensive care. Background: Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. Design: Concept analysis. Data sources: CINAHL, PsycINFO, Medline and PubMed databases (2000-2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. Methods: Walker and Avant's eight-stage approach was used. Results: Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. Conclusion: Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.

DOI 10.1111/jan.12644
Citations Scopus - 4
2015 Pickler R, Noyes J, Perry L, Roe B, Watson R, Hayter M, 'Authors and readers beware the dark side of Open Access', Journal of Advanced Nursing, 71 2221-2223 (2015)
DOI 10.1111/jan.12589
Citations Scopus - 2
2015 Watson R, Pickler R, Noyes J, Perry L, Roe B, Hayter M, Hueter I, 'How many papers can be published from one study?', Journal of Advanced Nursing, 71 2457-2460 (2015)
DOI 10.1111/jan.12600
Citations Scopus - 2
2015 Lamont S, Brunero S, Lyons S, Foster K, Perry L, 'Collaboration amongst clinical nursing leadership teams: A mixed-methods sequential explanatory study', Journal of Nursing Management, 23 1126-1136 (2015)

& Sons Ltd. Aim: To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. Background: Effective working within a wi... [more]

& Sons Ltd. Aim: To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. Background: Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context. Methods: A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings. Results: The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance. Conclusion: These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders. Implications for nursing management: To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention. © 2015 John Wiley

DOI 10.1111/jonm.12267
Citations Scopus - 1
2015 Appel C, Perry L, Jones F, 'Testing a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke', Occupational Therapy International, 22 71-84 (2015)

© 2015 John Wiley & Sons, Ltd. This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early... [more]

© 2015 John Wiley & Sons, Ltd. This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention.

DOI 10.1002/oti.1386
2015 Perry L, 'Working well? Studying the nursing workforce', International Journal of Nursing Practice, 21 337-338 (2015)
DOI 10.1111/ijn.12407
2015 Perry L, 'Beyond bedpans: Celebrating nursing and midwifery', International Journal of Nursing Practice, 21 453-453 (2015)
DOI 10.1111/ijn.12415
2015 Perry L, ''Accentuate the positive': Taking advice from a 1940s song', International Journal of Nursing Practice, 21 687-688 (2015)
DOI 10.1111/ijn.12418
2015 Mulcahy M, Lowry C, Hoban K, Perry L, 'Perspectives and experiences of nurses as facilitators within a Practice Development program', Collegian, (2015)

© 2017 Australian College of Nursing Ltd. Background: Health services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this... [more]

© 2017 Australian College of Nursing Ltd. Background: Health services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this, the 'Essentials of Care' Practice Development program was developed in Australia. Local facilitators play a key role in its delivery and achievements. Aims: This study aimed to gain insights into the experiences of clinical nurses in Practice Development facilitation roles in an acute hospital, including training for the role and changes occurring within themselves and their workplaces. Methods: A qualitative interpretive design used purposive sampling for a two-phase study using semi structured interviews and focus groups with data analysed using Framework Analysis. Results: Twelve Registered Nurses with an average of two years' experience in a facilitator role were interviewed and attended focus groups in 2011. Five key themes were identified: (1) facilitator as enabler, (2) the necessary team approach to facilitation, (3) valuing both internal and external models of facilitation, (4) preparation and training for role, and (5) perceived changes: to the facilitator and to the workplace. Individuals' ongoing development resulted from reflection, mentorship, role-modelling and co-facilitation; facilitation skills were recognised as relevant for nursing beyond their Program role. Ward culture gains were valued as distinct from measurable patient outcomes such as reduced medication errors. Conclusion: Findings provide insights into facilitators' experiences of this Practice Development role and contribute to better understanding of effective processes for nursing practice change in acute health services. Recommendations were proposed to support future role and post-holder development.

DOI 10.1016/j.colegn.2017.01.003
2015 Elliott D, Allen E, Perry L, Fry M, Duffield C, Gallagher R, et al., 'Clinical user experiences of observation and response charts: Focus group findings of using a new format chart incorporating a track and trigger system', BMJ Quality and Safety, 24 65-75 (2015)

© 2015, BMJ Publishing Group. All rights reserved. Background: Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. ... [more]

© 2015, BMJ Publishing Group. All rights reserved. Background: Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards. Methods: Across eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2-6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach. Findings: In this exploration of initial user experiences, key emergent themes were: tensions between vital sign 'ranges versus precision' to support decision making; using a standardised 'generalist chart in a range of specialist practice' areas; issues of 'clinical credibility', 'professional autonomy' and 'influences of doctors' when communicating abnormal signs; and 'permission and autonomy' when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of 'increased activity/uncertain benefit' was uncovered. Conclusions: Findings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design characteristics will be possible when these broader cultural issues are addressed.

DOI 10.1136/bmjqs-2013-002777
Citations Scopus - 7
2015 Perry L, Lamont S, Brunero S, Gallagher R, Duffield C, 'The mental health of nurses in acute teaching hospital settings: A cross-sectional survey', BMC Nursing, 14 (2015)

© Perry et al.; licensee BioMed Central. Background: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality an... [more]

© Perry et al.; licensee BioMed Central. Background: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods: A cross sectional survey design was used. Results: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n=49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12month. Conclusion: Nurses and their managers should strive to create workplaces where working practices promote nurses' health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.

DOI 10.1186/s12912-015-0068-8
Citations Scopus - 12
2015 Perry L, Gallagher R, Duffield C, 'The health and health behaviours of Australian metropolitan nurses: An exploratory study', BMC Nursing, 14 (2015)

© 2015 Perry et al. Background: Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurse... [more]

© 2015 Perry et al. Background: Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models. Anything that diminishes their health status can impact their credibility as role models, their availability and ability to deliver quality care, and is potentially disadvantageous for the health of the population. Study aims were to investigate nurses' overall health and the presence of chronic disease; to describe nurses' health-related behaviours and to compare them to those of the general population, with both groups matched by age and gender. Methods: Cross-sectional descriptive paper-based survey of nurses from two Sydney metropolitan hospitals using established instruments and questions and measurements taken with standardised methods. Results: This nursing sample (n = 381) had a mean age of 39.9 (SD 11.7, range 20-67) years, Most (n = 315; 82.7 %) were female, worked full-time (80.0 %), and were shift workers (93.0 %). The majority (94.0 %) indicated good, very good or excellent health, despite 42.8 % indicating they had chronic disease. The most common risk factors for chronic disease were inadequate vegetable (92.6 %) and fruit intake (80.1 %), overweight and obesity (44.0 %) and risky alcohol intake (34.7 %); health screening behaviours were not ideal. Aside from overweight and obesity, these risk factors were more prevalent in nurses than the equivalent group of the New South Wales population, particularly for risky alcohol intake which was much more common in female nurses and most marked in those aged under 35 years. However, 80 % met the guidelines for physical activity, more than the equivalent group of the New South Wales population. Conclusion: There are early 'warning signs' concerning the health status of nurses. Despite perceiving current good health, support is required for nurses to prevent future chronic disease, particularly in the areas of nutrition and alcohol intake. With these concerns, the nursing workforce ageing and demands for care increasing, it is now time to implement health enhancing strategies for nurses.

DOI 10.1186/s12912-015-0091-9
Citations Scopus - 6
2014 Appel C, Perry L, Jones F, 'Shoulder strapping for stroke-related upper limb dysfunction and shoulder impairments: Systematic review', NeuroRehabilitation, 35 191-204 (2014)

© 2014 -IOS Press and the authors. BACKGROUND: Shoulder impairments are common after stroke, resulting in reduced upper limb function. Shoulder strapping may be beneficial as an ... [more]

© 2014 -IOS Press and the authors. BACKGROUND: Shoulder impairments are common after stroke, resulting in reduced upper limb function. Shoulder strapping may be beneficial as an adjunct to conventional therapy and warrants further investigation. OBJECTIVES: To determine i) the efficacy and ii) any adverse effects of shoulder strapping used to reduce stroke-related upper limb and shoulder impairments and to improve function. METHODS: Three reviewers independently searched CINAHL, Ovid MEDLINE, EMBASE, AMED and PEDro databases and extracted data. Results were synthesized using descriptive methods and meta-analysis and interpreted in relation to potential risk of bias. RESULTS: Eight studies met inclusion criteria, recruiting 340 stroke participants. Studies predominantly included people with shoulder paralysis and examined shoulder strapping within four weeks of stroke onset for outcomes of increased upper limb function, reduced subluxation and pain. Strapping interventions, outcomes and measures were diverse, some studies encountered high risk of bias and findings were generally inconclusive with some indication of benefit in terms of delaying onset of shoulder pain. CONCLUSIONS: There is insufficient evidence of efficacy or inefficacy with shoulder paralysis but shoulder strapping demonstrated minimal adverse effects and should be rigorously tested with shoulder paresis as well as paralysis after stroke.

DOI 10.3233/NRE-141108
Citations Scopus - 2
2014 James S, Perry L, Gallagher R, Lowe J, Dunbabin J, McElduff P, et al., 'Service usage and vascular complications in young adults with type 1 diabetes', BMC Endocrine Disorders, 14 (2014) [C1]

Background: Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Dia... [more]

Background: Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. Meth ods: A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. Results: A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.Conclusion: Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention. © 2014 James et al.; licensee BioMed Central Ltd.

DOI 10.1186/1472-6823-14-39
Citations Scopus - 5Web of Science - 4
Co-authors Patrick Mcelduff
2014 Elliott D, McKinley S, Perry L, Duffield C, Iedema R, Gallagher R, et al., 'Clinical utility of an observation and response chart with human factors design characteristics and a track and trigger system: Study protocol for a two-phase multisite multiple-methods design', Journal of Medical Internet Research, 16 e40 (2014)

©Doug Elliott, Sharon McKinley, Lin Perry, Christine Duffield, Rick Iedema, Robyn Gallagher, Margaret Fry, Michael Roche, Emily Allen. Background: Clinical deterioration of adult... [more]

©Doug Elliott, Sharon McKinley, Lin Perry, Christine Duffield, Rick Iedema, Robyn Gallagher, Margaret Fry, Michael Roche, Emily Allen. Background: Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs. Objective: To describe the study protocol for the clinical testing of these observation and response charts (ORCs). Methods: We propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site's existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources. Results: Site selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress. Conclusions: This detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.

DOI 10.2196/resprot.3300
Citations Scopus - 4
2014 James S, Gallagher R, Dunbabin J, Perry L, 'Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: Systematic literature review', BMC Research Notes, 7 (2014) [C1]

Background: Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review ha... [more]

Background: Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults. Methods. A quantitative epidemiological systematic review was conducted to identify the prevalence and predictive factors for development of retinopathy, nephropathy and hypertension in young adults (sample age mean [plus 1SD] 18-30 years) with type 1 diabetes, using processes adapted from established review methods set out by the Centre for Reviews and Dissemination. MEDLINE (Ovid), Scopus (Elsevier), CINAHL, Science Direct (Elsevier), Google Scholar and Cochrane databases were searched to identify relevant articles published between 1993 and June 2014. From this eleven papers were retrieved, appraised and results summarised by three reviewers using established methods. Results: Some form of retinopathy occurred in up to almost half of participants; more severe forms affected up to one in ten. One in six was reported with microalbuminuria; one in 14 had macroalbuminuria. Hypertension occurred in almost one in two participants. Applying out-dated high thresholds this decreased to approximately one in ten participants. Glycaemic control was a consistent predictor of vascular disease in this age group. Conclusion: Prevalence rates of retinopathy, nephropathy and hypertension in young adults with type 1 diabetes emphasise the importance of regular complication screening for early detection and treatment. The predictive effect of glycaemic control reinforces its importance for prevention of vascular complications. © 2014 James et al.; licensee BioMed Central Ltd.

DOI 10.1186/1756-0500-7-593
Citations Scopus - 14
2013 Hayter M, Noyes J, Perry L, Pickler R, Roe B, Watson R, 'Who writes, whose rights, and who's right? Issues in authorship', Journal of Advanced Nursing, 69 2599-2601 (2013)
DOI 10.1111/jan.12265
Citations Scopus - 7
2013 De Brito-Ashurst I, Perry L, Sanders TAB, Thomas JE, Dobbie H, Yaqoob MM, 'Applying research in nutrition education planning: A dietary intervention for Bangladeshi chronic kidney disease patients', Journal of Human Nutrition and Dietetics, 26 403-413 (2013)

Background: Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural cha... [more]

Background: Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural changes. However, the integration of theory, research and practice to develop community dietary educational programmes is a challenge that many interventionists feel ill equipped to achieve. Methods: In the present study, a community-based education programme was designed for Bangladeshi patients with chronic kidney disease and hypertension. The goal of this programme was to reduce dietary salt intake in this population group, with a view to reducing their blood pressure and slowing kidney disease progression. Results: The present study sets out the first four steps of a six-step model for creating a behaviour change programme. Conclusions: These four steps were concerned with the translation of theory and evidence into intervention objectives, and illustrate how a practical, community-based intervention was developed from behavioural theory, relevant research, knowledge of practice and the target patient group. Steps 5 and 6, which are concerned with implementation and evaluation, will be reported separately. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

DOI 10.1111/jhn.12022
Citations Scopus - 1
2013 De Brito-Ashurst L, Perry L, Sanders TAB, Thomas JE, Dobbie H, Varagunam M, Yaqoob MM, 'The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: A randomized controlled trial', Heart, 99 1256-1260 (2013)

Background The effectiveness of salt restriction to lower blood pressure (BP) in Bangladeshi patients with chronic kidney disease (CKD) is uncertain. Objective To test the hypothe... [more]

Background The effectiveness of salt restriction to lower blood pressure (BP) in Bangladeshi patients with chronic kidney disease (CKD) is uncertain. Objective To test the hypothesis that a tailored intervention intended to reduce salt intake in addition to standard care will achieve a greater reduction in BP in UK Bangladeshi patients with CKD than standard care alone. Design A randomised parallel-group controlled trial conducted over a 6 month period. Setting A tertiary renal unit based in acute care hospital in East London. Participants 56 adult participants of Bangladeshi origin with CKD and BP > 130/80 mm Hg or on antihypertensive medication. Intervention Participants were randomly allocated to receive a tailored low-salt diet or the standard low-salt advice. BP medication, physical activity and weight were monitored. Main outcome measures The primary outcome was change in ambulatory BP. Adherence to dietary advice was assessed by measurement of 24 h urinary salt excretion. Results Of 56 participants randomised, six withdrew at the start of the study. During the study, one intervention group participant died, one control group participant moved to Bangladesh. Data were available for the primary endpoint on 48 participants. Compared with control group the intervention urinary sodium excretion fell from 260 mmol/d to 103 mmol/d (131 to 76, p < 0.001) at 6 months and resulted in mean (95% CI) falls in 24 h systolic/diastolic BP of 8 mm Hg (11 to 5)/2 (?4 to 2) both p < 0.001. Conclusions A tailored intervention can achieve moderate salt restriction in patients with CKD, resulting in clinically meaningful falls in BP independent of hypertensive medication.

DOI 10.1136/heartjnl-2013-303688
Citations Scopus - 19
2013 Perry L, Hamilton S, Williams J, Jones S, 'Nursing Interventions for Improving Nutritional Status and Outcomes of Stroke Patients: Descriptive Reviews of Processes and Outcomes', Worldviews on Evidence-Based Nursing, 10 17-40 (2013)

Background: Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes hav... [more]

Background: Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated. Aims: (1) To identify nursing interventions intended to improve nutritional status and related outcomes of stroke survivors, and (2) To examine the outcomes of identified nursing interventions on nutrition-related outcomes, including dietary intake, functional status, complications, activities of daily living, mortality, and quality of life for stroke survivors. Methods: A modified version of Cochrane literature searching and review methods was used to identify studies that described and evaluated nursing nutritional interventions for adult stroke patients in hospital and community settings. A minimum of 10 years content of seven databases and nine journals was searched to March 2011. Findings were presented descriptively. Results: In total 27 papers from 26 studies were included: 5 randomized controlled trials, 5 clinical trials, 6 quasi-experiments, 4 case studies, and 6 qualitative/observational studies. Stroke nursing nutritional care encompassed screening of nutritional status and swallowing function; assessment of nutritional characteristics and preferences; referral; mealtime organization, supervision and monitoring; mealtime assistance and feeding skills. Nurses individualized care, coordinated or managed meal delivery and enteral feeding systems, were responsible for the dining environment and conduct of mealtimes; they taught staff, patients, and carers. There was little indication of integrated or psychosocial nursing nutritional care, or concepts, theories or models of nursing nutritional care. Many interventions were described but not evaluated. Little high quality evidence was of available. Conclusions: This review indicated the parameters of nursing nutritional care, and provided a framework for future research. A functional, supportive, and educational nursing nutritional role was described but little evidence was of sufficient quality to support policy and practice development or inform education. Nutritional care was revealed as an essential but under-recognized element of stroke nursing. © 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International.

DOI 10.1111/j.1741-6787.2012.00255.x
Citations Scopus - 10
2013 Lucas B, Cox C, Perry L, Bridges J, 'Pre-operative preparation of patients for total knee replacement: An action research study', International Journal of Orthopaedic and Trauma Nursing, 17 79-90 (2013)

Aims and objectives: To examine the development and impact of a multidisciplinary preparation clinic for patients undergoing total knee replacement (TKR) surgery. Background: Ther... [more]

Aims and objectives: To examine the development and impact of a multidisciplinary preparation clinic for patients undergoing total knee replacement (TKR) surgery. Background: There is evidence to suggest that patients' preoperative characteristics such as pain and mental state impact the long term results of TKR surgery. Preparation sessions may help in identifying and working with those patients whose preoperative status could reduce the benefits of surgery. Design: Action research. Method: Actions cycles were carried out to develop an information booklet and multidisciplinary Knee Clinic at an acute Trust in outer London, UK. A sample (n=23) of patients was recruited to test changes as they were implemented. Results: The Knee Clinic involved nurse practitioners, occupational therapists, physiotherapists and service users (patients recovered from TKR surgery). Elements of physical and social assessment and interventions were carried out using a Social Cognitive Theory framework. Patients reported they benefitted from the information booklet and attendance at the Knee Clinic. Conclusion: A structured pre-operative information and assessment clinic can be developed using a Social Cognitive Theory framew ork for the benefit of patients. Further studies are required to examine and utilise psychological assessment of patients at such clinics. © 2012 Elsevier Ltd.

DOI 10.1016/j.ijotn.2012.08.005
Citations Scopus - 4
2013 Lucas B, Cox C, Perry L, Bridges J, 'Changing clinical team practices in preparation of patients for Total Knee Replacement: Using Social Cognitive Theory to examine outcomes of an action research study', International Journal of Orthopaedic and Trauma Nursing, 17 140-150 (2013)

Aims and objectives: To examine, through the lens of Social Cognitive Theory, the process of change when developing a preparation programme for patients awaiting Total Knee Replac... [more]

Aims and objectives: To examine, through the lens of Social Cognitive Theory, the process of change when developing a preparation programme for patients awaiting Total Knee Replacement Surgery. Background: Social Cognitive Theory has been used extensively in occupational psychology to explain and change human actions. It has not been widely used to examine the actions of clinical teams when developing practice. Design: Action research. Methods: Four action cycles were undertaken to develop an information booklet and multidisciplinary Knee Clinic at an acute hospital for patients waiting for Total Knee Replacement Surgery. The process of change, led by a staff and service user Project Management Group, was examined through fieldnotes, interviews, observation and a reflective diary. The data were analysed using the theoretical framework of Bandura's Social Cognitive Theory. Results: The change process was influenced by personal, environmental and behavioural factors. Self-efficacy and outcomes expectations of staff and service users varied and impacted the level of their involvement in the study. Environmental factors influenced the scope of the project. The behaviour of the Project Management Group facilitated change through the development of team working and involvement in the action cycles. The results of this initiative achieved clinical changes which had not occurred during previous attempts at service development. Conclusion: Social Cognitive Theory is an appropriate and useful theoretical framework both for retrospective analysis and to inform planning of practice changes within the clinical setting. © 2012 Elsevier Ltd.

DOI 10.1016/j.ijotn.2012.10.002
2012 Perry L, Lowe J, Steinbeck KS, Dunbabin JS, 'Services doing the best they can: Service experiences of young adults with type 1 diabetes mellitus in rural Australia', Journal of Clinical Nursing, 21 1955-1963 (2012) [C1]
DOI 10.1111/j.1365-2702.2011.04012.x
Citations Scopus - 11Web of Science - 8
2012 Perry L, 'Editor's Choice', Journal of Advanced Nursing, 68 247 (2012)
DOI 10.1111/j.1365-2648.2011.05926.x
2012 Perry L, 'Choosing nursing: Becoming, staying, flourishing', Journal of Advanced Nursing, 68 1441-1442 (2012)
DOI 10.1111/j.1365-2648.2012.06074.x
Citations Scopus - 1
2012 Chan CW, Perry L, 'Lifestyle health promotion interventions for the nursing workforce: A systematic review', Journal of Clinical Nursing, 21 2247-2261 (2012)

Aims and objectives. Study aims were to identify the efficacy of lifestyle health promotion interventions intended to improve behavioural health risk factors and/or behavioural or... [more]

Aims and objectives. Study aims were to identify the efficacy of lifestyle health promotion interventions intended to improve behavioural health risk factors and/or behavioural or clinical outcomes of working-age nurses. Background. Nurses constitute around half the health workforce but global shortages and an ageing profile challenge future supply. The occupational hazards and stresses of nursing are well known. Health promotion, possibly workplace-based, presents opportunities to safeguard the health of nurses. Design. This was a systematic review undertaken in line with guidance for reviews in health care. Methods. Seven electronic databases were searched from 2000-2011 and references of relevant papers. Two reviewers independently reviewed and critiqued retrieved papers and extracted data. Methodological features were described using the CONSORT checklists; risk of bia s was assessed using the Cochrane Handbook classification. Results. With design inclusion criteria relaxed to include an uncontrolled trial, only three intervention studies were retrieved, from the United States, Canada and Taiwan. All had limitations and high risk of bias, but benefits were reported. Outcomes included fewer cigarettes smoked during the intervention period, down from mean (SD) 20 (8)-12 (9) per day (p < 0·001); significantly reduced fat mass (0·68 vs. 0·07kg; p=0·028); and significant gains across a battery of fitness assessments. The paucity of work focused on nurses' health behaviours was the important finding. Conclusion. The workplace is a potentially fruitful location for health promotion intervention but nurses have seldom been recognised as a target participant group. Given the international priority ascribed to nursing workforce retention, this is a missed opportunity for occupational health planning. Potential benefits to nurses' welfare and well-being may accrue from well-designed intervention studies. Relevance to clinical practice. Nurse leaders have a key role in driving recognition, spearheading commitment and development of targeted, whole-organisation programmes to promote health profile improvement for the nursing workforce. © 2012 Blackwell Publishing Ltd.

DOI 10.1111/j.1365-2702.2012.04213.x
Citations Scopus - 25
2012 Wright L, Hill KM, Bernhardt J, Lindley R, Ada L, Bajorek BV, et al., 'Stroke management: Updated recommendations for treatment along the care continuum', Internal Medicine Journal, 42 562-569 (2012)

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidel... [more]

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management. © 2012 National Stroke Foundation. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

DOI 10.1111/j.1445-5994.2012.02774.x
Citations Scopus - 19
2012 Pontivivo G, Rivas K, Gallard J, Yu N, Perry L, 'A new approach to improving hand hygiene practice in an inner city acute hospital in Australia', Healthcare Infection, 17 57-63 (2012)

Background: Healthcare-associated infections occur in 5-15% of hospitalised patients, with 30-50% preventable. Hand hygiene is a basic and essential but poorly conducted method to... [more]

Background: Healthcare-associated infections occur in 5-15% of hospitalised patients, with 30-50% preventable. Hand hygiene is a basic and essential but poorly conducted method to limit infection in hospitals. This practice development approach to implementing the '5 Moments for Hand Hygiene' national initiative aimed to increase compliance with the recommended hand hygiene practices, anticipating this outcome would be reflected in lower rates of healthcare-associated infections. Methods: Multiple methods were employed during October 2009-October 2010 within a multi-disciplinary initiative, although nurses were mainly recruited. Three medical wards, four surgical wards and the Intensive Care Unit were targeted. Project activities were informed by principles of practice development, solution-focussed coaching and models of behaviour change. Activities included active learning sessions, coaching, audit and feedback, competitions, creativity and fun. Outcomes were observations of hand hygiene compliance and routinely collected rates of Staphylococcus aureus bacteraemia. Results: Overall hand hygiene audits showed statistically significant improvement in compliance, from 62 to 75% in quarterly audits. Compliance rates among nurses and medical staff increased significantly from 70 to 80% and from 43 to 63%, respectively, while changes for allied health practitioners, from 61 to 65% compliance, did not achieve significance. Recorded rates of Staphylococcus aureus bacteraemia reduced from between 0.6 and 2.55 infections per 10000 occupied bed days pre-project to between 0 and 0.65 infections per 10000 occupied bed days during the project period. Conclusions: Multiple methods using a practice development framework can be successful in effecting changes in hand hygiene behaviour among all health care workers. Study methods took planning and commitment but were highly rewarding, particularly considering the magnitude of the issue for patient and clinician safety. © Australian Infection Control Association 2012.

DOI 10.1071/HI12007
Citations Scopus - 3
2011 Perry L, Bellchambers HL, Howie AJ, Moxey AJ, Parkinson L, Capra S, Byles JE, 'Examination of the utility of the Promoting Action on Research Implementation in Health Services framework for implementation of evidence based practice in residential aged care settings', Journal of Advanced Nursing, 67 2139-2150 (2011) [C1]
DOI 10.1111/j.1365-2648.2011.05655.x
Citations Scopus - 15Web of Science - 11
Co-authors Julie Byles, Helen Bellchambers, L Parkinson
2011 De Brito-Ashurst I, Perry L, Sanders TAB, Thomas JE, Yaqoob MM, Dobbie H, 'Barriers and facilitators of dietary sodium restriction amongst Bangladeshi chronic kidney disease patients', Journal of Human Nutrition and Dietetics, 24 86-95 (2011) [C1]
DOI 10.1111/j.1365-277x.2010.01129.x
Citations Scopus - 13Web of Science - 11
2011 Appel C, Mayston M, Perry L, 'Feasibility study of a randomized controlled trial protocol to examine clinical effectiveness of shoulder strapping in acute stroke patients', Clinical Rehabilitation, 25 833-843 (2011)

Objective: The majority of stroke patients experience upper limb motor impairment and reduced ability to perform basic activities. Shoulder strapping has been reported as a benefi... [more]

Objective: The majority of stroke patients experience upper limb motor impairment and reduced ability to perform basic activities. Shoulder strapping has been reported as a beneficial adjunct to rehabilitation therapies but has not been rigorously trialled. This study tested the feasibility of recruitment, intervention and outcome assessment protocols for future trial of the clinical effectiveness of shoulder strapping.Design and setting: Feasibility study using a randomized controlled trial in an East London stroke service.Subjects: Fourteen acute stroke patients with mild to moderate upper limb hemiparesis were recruited between October 2004 and July 2005.Intervention: Five strapping methods and criteria for use were identified from the literature. Shoulder strapping applied for one month in addition to routine rehabilitation was compared to routine rehabilitation only.Main measures: The Motor Assessment Scale, Fugl Meyer Scale-Arm section and the Nine Hole Peg Test were measured at baseline and 1, 2, 3 and 5 weeks later. The Stroke-specific Quality of Life questionnaire was delivered at 6 and 12 weeks post stroke.Results: Useful findings were demonstrated in relation to the feasibility of all elements of the protocol. Motor Assessment Scale findings showed a small-moderate (0.27) effect size for the strapping intervention used as an adjunct to routine rehabilitation compared to routine rehabilitation alone. Sample size calculation indicated 312 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation.Conclusion: Findings supported the value of pilot-testing, and enabled revision of the study protocol for future definitive trial. © 2011 The Author(s).

DOI 10.1177/0269215510397392
Citations Scopus - 5
2011 Perry L, 'Evidence-based nursing interventions warrant rigorous development methods', Journal of Advanced Nursing, 67 459 (2011)
DOI 10.1111/j.1365-2648.2011.05620.x
Citations Scopus - 1
2011 Nip WFR, Perry L, McLaren S, MacKenzie A, 'Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital', Journal of Human Nutrition and Dietetics, 24 460-469 (2011)

Background: Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcome... [more]

Background: Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. Methods: One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Results: Few (n=9; 10%) consumed =100% of the estimated average requirement (EAR) for energy within 2weeks of admission and 13 (33%) had energy intakes < 50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F=7.503, P=0.001; F=14.558, P < 0.001). Conclusions: Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

DOI 10.1111/j.1365-277X.2011.01173.x
Citations Scopus - 11
2011 Perry L, Middleton S, 'An investigation of family carers' needs following stroke survivors' discharge from acute hospital care in Australia', Disability and Rehabilitation, 33 1890-1900 (2011)

Purpose.To expand understanding of informal stroke care-giving, validated tools previously used in Hong Kong and in the UK were used with Australian stroke carers to assess their ... [more]

Purpose.To expand understanding of informal stroke care-giving, validated tools previously used in Hong Kong and in the UK were used with Australian stroke carers to assess their stroke-related knowledge, perceived needs, satisfaction with services received and sense of burden after stroke patients' discharge home from acute hospital care. Methods.Record audit and telephone interviews with two cohorts of 32 carers recruited in Sydney and Brisbane 1 and 3 months post-hospital discharge, using validated scales and open questions in MayJuly 2006. Results.Female carers, those with prior care-giving responsibility, and those interviewed at three compared to one month post-discharge reported greatest needs and burden from the care-giving role; needs alone significantly predicted burden. Getting information and being prepared for life after discharge were central concerns. Some felt this was accomplished, but inadequate information giving and communication mismatches were apparent. Conclusions.Service providers need to develop partnership working with stroke families and provide a network of services and inputs that cut across conventional boundaries between health and social care, public, private and voluntary organisations, with care plans that deliver what they delineate. Stroke care-givers have common issues across countries and healthcare systems; collaborative research-based service development is advocated. © 2011 Informa UK, Ltd.

DOI 10.3109/09638288.2011.553702
Citations Scopus - 15
2011 Kilbride C, Perry L, Flatley M, Turner E, Meyer J, 'Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care', Journal of Interprofessional Care, 25 91-97 (2011)

Much emphasis is placed on expert knowledge like evidence-based stroke guidelines, with insufficient attention paid to processes required to translate this into delivery of everyd... [more]

Much emphasis is placed on expert knowledge like evidence-based stroke guidelines, with insufficient attention paid to processes required to translate this into delivery of everyday good care. This paper highlights the worth of creating a Community of Practice (CoP) as a means to achieve this. Drawing on findings from a study conducted in 20002002 of processes involved in establishing a nationally lauded high quality Stroke Unit, it demonstrates how successful development of a new service was linked to creation of a CoP. Recent literature suggests CoPs have a key in implementing evidence-based practice; this study supports this claim whilst revealing for the first time the practical knowledge and skills required to develop this style of working. Findings indicate that participatory and democratic characteristics of Action Research are congruent with the collaborative approach required for developing a CoP. The study is an exemplar of how practitioner researchers can capture learning from changing practice, thus contributing to evidence-based healthcare with theoretical and practical knowledge. Findings are relevant to those developing stroke services globally but also to those interested in evidence-based practice. © 2011 Informa UK, Ltd.

DOI 10.3109/13561820.2010.483024
Citations Scopus - 21
2011 Hodge A, Perry L, Daly B, Hagness C, Tracy D, 'Revision and evaluation of an 'advanced' nursing role in an Australian emergency department', Australasian Emergency Nursing Journal, 14 120-128 (2011)

Background: Extended Practice Nurse roles have been initiated in various forms in many Australian Emergency Departments. Although common, evaluation of these roles is scarce in th... [more]

Background: Extended Practice Nurse roles have been initiated in various forms in many Australian Emergency Departments. Although common, evaluation of these roles is scarce in the literature. Methods: A four phase practice development project was launched to review contemporary models of Extended Practice Nurse, revise an existing Extended Practice Nurse model called the Advanced Clinical Nurse (ACN), develop and standardise a supporting education and accreditation structure, and implement an evaluative framework for the revised ACN model. Results: A standardised education and accreditation structure was implemented, an 8 h ACN rostered shift commenced, and a mixed method evaluative framework initiated. Compared to management without an ACN, where an ACN was involved, mean medical management time of limb injuries and mean total length of stay was 42 min and 48 min shorter, respectively. Mean time to analgesia by an ACN was 22 min. Improvement in satisfaction was documented within subacute and waiting room patients. Median 'time to treatment' by an ACN was 6 min. Conclusions: Preliminary evaluation of the revised ACN model indicated practice benefits within early care delivery and patient flow. Continued standardisation of Extended Practice Nurse roles within New South Wales, Australia is necessary. The evaluative framework enabled greater understanding of this ACN role. © 2011 College of Emergency Nursing Australasia Ltd.

DOI 10.1016/j.aenj.2011.02.004
Citations Scopus - 5
2011 Jones SE, Hamilton S, Perry L, O'Malley C, Halton C, 'Developing workable research methods: Lessons from a pilot study with vulnerable participants and complex assessments', Journal of Research in Nursing, 16 307-318 (2011)

Following acute stroke, deterioration in nutritional status and weight loss is common; few studies have investigated this, perhaps due to difficulties with recruitment and complet... [more]

Following acute stroke, deterioration in nutritional status and weight loss is common; few studies have investigated this, perhaps due to difficulties with recruitment and completion of complex assessments with stroke patients. This study reports the feasibility of a study protocol to determine predictors of nutritional intake in stroke patients. The aim of the study was to test the feasibility of a protocol to measure taste and smell function, and explore links with dietary intake following stroke. Patients were recruited from one Acute Stroke Unit in 2007/8. Data were collected at three time-points and entailed standardised validated assessments of taste and smell function, diet, appetite and mood state. Recruitment of this vulnerable population to a demanding assessment schedule was challenging. Of a cohort of 166 admissions, six were recruited and complete data collected from four participants. Slow recruitment was largely due to exacting inclusion criteria and rapid hospital discharge. Those who completed all assessments reported the schedule as tolerable and acceptable. This study illustrated the difficulties of recruiting this vulnerable population. Identification of reasons for slow recruitment facilitated development of measures to address them. It was possible to format a complex and lengthy assessment schedule to be acceptable to vulnerable participants. © The Author(s) 2010.

DOI 10.1177/1744987110380335
Citations Scopus - 1
2011 Perry L, 'Nursing role redesign: rising to challenges or sticking in mud?', Journal of advanced nursing, 67 1645 (2011)
DOI 10.1111/j.1365-2648.2011.05804.x
2010 Perry L, Steinbeck KS, Dunbabin JS, Lowe JM, 'Lost in transition? Access to and uptake of adult health services and outcomes for young people with type 1 diabetes in regional New South Wales', Medical Journal of Australia, 193 444-449 (2010) [C1]
Citations Scopus - 21Web of Science - 19
2010 Perry L, 'Editor's Choice', Journal of Advanced Nursing, 66 1901-1901 (2010)
DOI 10.1111/j.1365-2648.2010.05366.x
2010 Perry L, 'Audit and feedback: examining the effectiveness of practice-based learning.', Journal of advanced nursing, 66 709 (2010)
DOI 10.1111/j.1365-2648.2010.05308.x
2010 Perry L, 'Guidelines and person-centred care: the devil in the detail.', Journal of advanced nursing, 66 1901 (2010)
Citations Scopus - 1
2009 De Brito-Ashurst I, Perry L, Sanders TAB, Thomas JE, Yaqoob MM, Dobbie H, 'Dietary salt intake of Bangladeshi patients with kidney disease in East London: An exploratory case study', e-SPEN, 4 E35-E40 (2009) [C1]
DOI 10.1016/j.eclnm.2008.10.002
Citations Scopus - 7
2009 Perry L, 'A patient-focused business model: Contradiction in terms?', Journal of Advanced Nursing, 65 921 (2009) [C3]
DOI 10.1111/j.1365-2648.2009.05022.x
2009 Perry L, 'Is BMI an accurate measure of nutritional status in older people.', Nursing times, 105 12 (2009) [O1]
Citations Scopus - 1
2009 Perry L, 'Editor's Choice: Consulting bereaved relatives of stroke patients', Journal of Advanced Nursing, 65 1991 (2009)
DOI 10.1111/j.1365-2648.2009.05148.x
2008 Perry L, 'Assisted feeding', Journal of Advanced Nursing, 62 511 (2008)
DOI 10.1111/j.1365-2648.2008.04715.x
2008 Perry L, 'Health care on the front line', Journal of Advanced Nursing, 64 213 (2008)
DOI 10.1111/j.1365-2648.2008.04857.x
2008 Perry L, Grange A, Heyman B, Noble P, 'Stakeholders' perceptions of a research capacity development project for nurses, midwives and allied health professionals', Journal of Nursing Management, 16 315-326 (2008)

Aims To evaluate stakeholders' perceptions of the extent to which a research facilitator post was addressing aims of: providing academic support to enable research involvement of ... [more]

Aims To evaluate stakeholders' perceptions of the extent to which a research facilitator post was addressing aims of: providing academic support to enable research involvement of nurses, midwives and allied health professionals; supporting dissemination of research into practice; contributing to research strategy development. Background Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. Methods A mixed methods approach was used. Results Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. Conclusion The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. Implications for nursing management Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this. © 2008 Blackwell Publishing Ltd.

DOI 10.1111/j.1365-2834.2007.00801.x
Citations Scopus - 26
2007 Mackenzie A, Perry L, Lockhart E, Cottee M, Cloud G, Mann H, 'Family carers of stroke survivors: Needs, knowledge, satisfaction and competence in caring', Disability and Rehabilitation, 29 111-121 (2007)

Purpose. To examine the support required by family carers for stroke survivors. Methods. Forty-two family carers were recruited for surveys of needs, knowledge, satisfaction, and ... [more]

Purpose. To examine the support required by family carers for stroke survivors. Methods. Forty-two family carers were recruited for surveys of needs, knowledge, satisfaction, and competence in caring before and 4-6 weeks after discharge from an Acute Stroke Unit (ASU). Results. Information deficits about dealing with psychological, emotional, and behavioural problems and local service information were priorities before and after discharge. Younger female carers (under 56 years) were least satisfied with communication with ASU staff. Face to face contact was valued. After discharge younger female carers, particularly of non-White ethnic groups, reported lower levels of competence in caring and higher burden. Knowledge of stroke risk factors was low in all groups. High satisfaction with treatment and therapy in the ASU, was not transferred to the community. Carers reported feeling alone and described uncoordinated services. Conclusions. Carers are able to anticipate and prioritise their needs, value communication with staff and involvement with discharge-planning, but particular difficulties were experienced by younger female carers and those from non-White ethnic groups. This requires particular attention when developing targeted interventions for family carers from a mixed ethnic community. In-depth and longitudinal studies are needed to detail psychosocial needs and guide practice particularly amongst non-White family carers.

DOI 10.1080/09638280600731599
Citations Scopus - 65
2006 Perry L, 'Promoting evidence-based practice in stroke care in Australia.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 20 35-42 (2006)

AIM: To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joan... [more]

AIM: To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joanna Briggs Institute, an international network of academic centres. METHOD: A semi-structured interview schedule was developed, piloted and used to guide interviews with academic and clinical staff in five state capital cities in Australia. Data were analysed and findings reviewed by clinical and academic participants. FINDINGS: Four distinct but not mutually exclusive models and common but variously applied pathways for translation of evidence into clinical practice were identified. Key influential factors included context and local culture, the nature of evidence and role of clinical expertise. Implementation and change management strategies were recognised as emerging priorities. CONCLUSION: A range of methods to advance research synthesis, dissemination and knowledge transfer into clinical practice were demonstrated and may warrant consideration for the UK.

Citations Scopus - 1
2006 Perry L, Hamilton S, Williams J, 'Formal dysphagia screening protocols prevent pneumonia [7]', Stroke, 37 765 (2006)
DOI 10.1161/01.STR.0000204140.01459.dc
Citations Scopus - 2
2004 Perry L, Brooks W, Hamilton S, 'Exploring nurses perspectives of stroke care.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 19 33-38 (2004)

In recent years stroke has been recognised as a national clinical, research and policy priority. Stroke nurses and stroke nursing are important contributors, but previous studies ... [more]

In recent years stroke has been recognised as a national clinical, research and policy priority. Stroke nurses and stroke nursing are important contributors, but previous studies have highlighted lack of clarity and contradictions in the nursing role. A stroke nursing conference in 2002 offered the opportunity to explore nurses' vision for the future through a series of focus group meetings. Many examples of good practice were identified, for example, nursing contributions to risk factor management and secondary prevention, service co-ordination and development, follow-up and support of stroke patients and their families. However, areas for further development include realigning services to a patient focus and ensuring equitable access, integrating services, supporting development of the nursing research evidence base and providing career and educational frameworks for nurses in stroke care. Nurses set out a vision for stroke nursing in which current strengths and developments are consolidated and disseminated in a dynamic, multiprofessional, integrated patient-focused service.

Citations Scopus - 9
2004 Perry L, 'Eating and dietary intake in communication-impaired stroke survivors: A cohort study from acute-stage hospital admission to 6 months post-stroke', Clinical Nutrition, 23 1333-1343 (2004)

Background & Aims: Stroke is a major cause of chronic morbidity but despite the importance of nutrition for recovery and rehabilitation, nutritional features have received limit... [more]

Background & Aims: Stroke is a major cause of chronic morbidity but despite the importance of nutrition for recovery and rehabilitation, nutritional features have received limited attention, particularly amongst those with communication impairments. This study reports a group of patients followed through acute hospital admission and at 6 months post-stroke. Methods: Subjects were survivors of a consecutive cohort admitted to a South London hospital with clinical diagnosis of acute stroke March-August 2001, with motor and communication deficits at initial assessment. Sequential assessments were undertaken from one week after admission to hospital discharge; then in normal residence at 6 months. Assessments focused on stroke-related impairments; functional abilities in activities of daily living and eating; nutritional indices; dietary intake derived from food diaries maintained by carers. Local Research Ethics Committee approval was obtained. Results & Conclusion: Thirty-six participants were studied in hospital; 18 at 6 months. Severely impaired and disabled at initial assessment (median Barthel Index score 1), significant improvements occurred by hospital discharge (to median score 7) despite substantial nutritional inadequacies and significant body tissue loss; mean energy intake met 60% Estimated Average Requirements. At 6 months the median Barthel Index score of survivors was 12.5 but multiple eating-related difficulties persisted, linked with dietary deficits; mean energy intake was 81% of Estimated Average Requirements. Body tissue losses continued across domiciliary settings. Closer attention to assessment and monitoring of nutrition-related aspects of stroke management is warranted across the continuum of care. © 2004 Elsevier Ltd. All rights reserved.

DOI 10.1016/j.clnu.2004.04.009
Citations Scopus - 23
2004 Perry L, McLaren S, 'An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke', Health and Social Care in the Community, 12 288-297 (2004)

Quality of life (QoL) is increasingly recognised as an important healthcare outcome, especially for those living with enduring disability. Stroke is a major source of long-term di... [more]

Quality of life (QoL) is increasingly recognised as an important healthcare outcome, especially for those living with enduring disability. Stroke is a major source of long-term disablement and many aspects of life after stroke have been explored. Little attention has been paid to nutritional issues despite the cultural and hedonistic importance of food and eating, and the deleterious effects of malnutrition. The present study employed an epidemiological survey to investigate the contribution of dietary and nutritional factors in relation to QoL after stroke. The participants were 206 survivors of a cohort of acute stroke patients consecutively admitted to a National Health Service trust hospital in South London, UK, between March 1998 and April 1999. They were interviewed in their homes at 6 months post-stroke. Cognitively or communication-impaired patients were precluded from interview except where a live-in carer participated as a proxy (n = 10). The participation rate for those who were eligible and could be contacted was 206 out of 218 (94%). Participants were assessed using standardised, validated tools for functional abilities in activities of daily living and eating, cognition and mood state, social support and economic indices, nutritional status, dietary intake, and QoL. Overall group scores demonstrated relatively minor degrees of physical disablement; exclusion of those with limited cognition and communication precluded assessment of a small subgroup with greater disablement at hospital discharge. Nonetheless, the overall assessment results were not dissimilar to other reported groups. Indices of poor nutritional status and substantial dietary inadequacy were revealed, linked with reduced appetite and depression. Multiple regression analyses revealed the dominant impact of mood state in relation to QoL scores; additional significant effects were identified for social support, eating-related disabilities and age. The effects of mood and social support are well-recognised, whilst nutrition-related effects have previously received little attention. Intervention in these areas might achieve improvements in survivors' perceived QoL.

DOI 10.1111/j.1365-2524.2004.00494.x
Citations Scopus - 35
2004 Perry L, Mclaren SM, 'Implementing guidelines and changing nursing practice: Intentions and outcomes', Worldviews on Evidence-Based Nursing, 1 225 (2004)
DOI 10.1111/j.1524-475X.2004.04067.x
2003 Perry L, McLaren S, 'Coping and adaptation at six months after stroke: Experiences with eating disabilities', International Journal of Nursing Studies, 40 185-195 (2003)

Stroke produces a range of enduring impairments and survivors' coping and adaptation styles are influential features of life after stroke. Many stroke-sequelae affect ability to e... [more]

Stroke produces a range of enduring impairments and survivors' coping and adaptation styles are influential features of life after stroke. Many stroke-sequelae affect ability to eat but survivors' perceptions and responses to these have not been explored. Methods. Survivors of a cohort of patients admitted to hospital with acute stroke March 1998-April 1999 participated in semi-structured interviews in their homes at 6 months post-stroke. Interviews were tape recorded and transcribed; 113 interviews with eating-disabled subjects were entered onto QSR NUD*IST 4 for thematic analysis. Findings. Two major emergent themes of 'getting back to normal' and 'getting by' were revealed which encompassed a range of responses in relation to food and eating. A high level of congruence was demonstrated with pre-existent frameworks but with some unique features. Reportage demonstrated non-linear and inconsistent effects of impairments within patients' lives and the importance of this topic for survivors and healthcare professionals was clear. © 2002 Elsevier Science Ltd. All rights reserved.

DOI 10.1016/S0020-7489(02)00060-3
Citations Scopus - 18
2003 Perry L, McLaren S, 'Nutritional support in acute stroke: The impact of evidence-based guidelines', Clinical Nutrition, 22 283-293 (2003)

Background and aims: Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study... [more]

Background and aims: Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study aimed to develop, implement and evaluate evidence-based guidelines for nutrition support following acute stroke using a multifaceted change management strategy. Methods: Prospective quasi-experimental design. Documentation of two groups of 200 acute stroke patients admitted to medical and care of the elderly wards of an acute NHS Trust in South London was surveyed using a checklist before and after implementation of 24 guidelines for nutritional screening, assessment and support. Guidelines were based on systematic literature review and developed by consensus in a nurse-led multiprofessional group; implemented via a context-specific, multifaceted strategy including opinion leaders and educational programmes linked to audit and feedback. Staff outcomes: Compliance with guidelines by doctors, nurses, therapists. Patient outcomes: Changes in Barthel Index scores and Body Mass Index in hospital, infective complications, length of stay, discharge destination. Results: Statistically significant improvements in compliance with 15 guidelines occurred in the post-test group. Infective episodes showed a significant reduction in the post-test group but other patient outcomes were unaffected. Conclusions: Implementation of evidence-based guidelines for nutritional support following acute stroke using a multi-faceted strategy was associated with improvements in documented practice and selected patient outcomes. © 2003 Elsevier Science Ltd. All rights reserved.

DOI 10.1016/S0261-5614(02)00213-3
Citations Scopus - 39
2003 Perry L, McLaren S, 'Eating difficulties after stroke', Journal of Advanced Nursing, 43 360-369 (2003)

Background. Stroke is a common and enduring problem, producing a wide range of effects that may impact on all aspects of life. One area that has seldom been investigated is the ef... [more]

Background. Stroke is a common and enduring problem, producing a wide range of effects that may impact on all aspects of life. One area that has seldom been investigated is the effects of stroke on ability to eat and, particularly, stroke survivors' subjective experiences of eating-related difficulties. Aim. To investigate stroke survivors' reports of eating-related experiences 6 months after stroke. Methods. Participants were 206 survivors of acute stroke who were admitted to hospital between March 1998 and April 1999. Those able to communicate and who gave informed consent participated in a semi-structured interview and assessment of eating abilities in their homes 6 months after their stroke. Interviews were tape recorded and transcribed and 113 interviews with eating disabled participants were entered onto QSR NUD*IST 4 for thematic analysis. Analyses were later checked independently. Findings. At 6 months, 34%, 61% and 5% had no, slight and moderate eating disablements, respectively. A range and variety of difficulties were discussed, but relationships between degrees of disablement and handicap were not straightforward; effects seemed more closely related to participants' responses than objective difficulties. Eating and related activities were clearly important aspects of life for these stroke survivors, socially and psychologically, as well as functionally. Prestroke activities were sometimes maintained, with considerable effort. Conclusions. Findings indicated issues of relevance for those involved with early rehabilitation interventions and highlighted aspects of continuing care service delivery that warrant review. The relative lack of attention paid to eating-related aspects of care is an important oversight.

DOI 10.1046/j.1365-2648.2003.02724.x
Citations Scopus - 21
2003 Perry L, Mclaren S, 'Implementing evidence-based guidelines for nutrition support in acute stroke', Evidence-Based Nursing, 6 68-71 (2003)
DOI 10.1136/ebn.6.3.68
Citations Scopus - 9
2002 Perry L, Morgan J, Reid F, Brunton J, O'Brien A, Luck A, Lacey H, 'Screening for symptoms of eating disorders: Reliability of the SCOFF screening tool with written compared to oral delivery', International Journal of Eating Disorders, 32 466-472 (2002)

Objective: The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also oc... [more]

Objective: The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also occurs via written format, for example, in occupational health settings. The objective was to compare responses to the SCOFF between verbal and written administration. Method: In a volunteer group of nursing and midwifery students at a South London University SCOFF was delivered orally at interview and via written questionnaire. Order was allocated randomly with repeat administration interrupted by distraction questions. Results: There were 185 students who participated, providing 178 fully completed responses. Twenty subjects were male. There was overall agreement in the scores of 157 subjects (88.2%), providing a kappa coefficient of 0.811, with agreement in prediction of eating disorder for 167 (93.8%) and a kappa value of 0.824 (both p < 0.001). For 82 subjects administered the SCOFF verbally first followed by the written version, the kappa statistic was 0.752 (p < 0.001). For 96 subjects with SCOFF administered in reverse order (written form first), kappa was 0.862 (p < 0.001). Discussion: Results demonstrated overall good replicability of the SCOFF administered as a written questionnaire compared to oral interview. Two trends were noted. The first was towards higher scores with written versus oral delivery irrespective of order, possibly indicating enhanced disclosure via written format. The second was of less consistency where verbal preceded written responses. Altogether findings support use of the SCOFF where a concise, valid and reliable screening for eating disorders is required in written form. © 2002 by Wiley Periodicals, Inc.

DOI 10.1002/eat.10093
Citations Scopus - 56
2002 Luck AJ, Morgan JF, Reid F, O'Brien A, Brunton J, Price C, et al., 'The SCOFF questionnaire and clinical interview for eating disorders in general practice: Comparative study', British Medical Journal, 325 755-756 (2002)
Citations Scopus - 107
2001 Perry L, Love CP, 'Screening for dysphagia and aspiration in acute stroke: A systematic review', Dysphagia, 16 7-18 (2001)

Stroke is a common problem, producing a variety of neurological problems that affect eating. Dysphagia is a particular concern because of its potential for airway obstruction, mal... [more]

Stroke is a common problem, producing a variety of neurological problems that affect eating. Dysphagia is a particular concern because of its potential for airway obstruction, malnutrition, and aspiration pneumonia. With chest infection reported in up to 32% of stroke patients, this is a major clinical issue. The following research questions are raised: (1) What are the incidence and outcomes of dysphagia and aspiration in acute stroke? (2) What screening interventions are available to detect dysphagia in patients with acute stroke and what effect have they on patient outcomes? A systematic review was carried out using methods and quality criteria of the NHS Centre for Reviews and Dissemination (1996), focusing on studies of adults with acute stroke. Data were extracted, collated, and presented descriptively. Two hundred forty-eight articles were retrieved with 26 meeting inclusion and quality criteria. Clinical dysphagia is common, associated with a range of deleterious outcomes and clearly linked to development of chest infection. Interpretation of aspiration on videofluoroscopy is not as straightforward but probably also confers additional risk. Further work is required on the relationship between aspiration and pneumonia, and pneumonia prevention. This will include exploration of the effects of screening, and the further development and validation of screening methods. While studies indicate current "best practice," in this important area of patient care further work is urgently required.

DOI 10.1007/s004550000047
Citations Scopus - 200
2001 Perry L, 'Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses', Journal of Clinical Nursing, 10 463-473 (2001)

¿ Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating. ¿ Dysphag... [more]

¿ Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating. ¿ Dysphagia affects between one and two thirds of patients with acute stroke, with the potential for life-threatening airway obstruction, aspiration pneumonia and malnutrition. ¿ Whilst associated with increased impairment, dysphagia may present in isolation or accompanied by minimal disability; universal screening of swallowing function is recommended. ¿ This study describes the process undertaken to review the evidence for dysphagia screening methods in patients with acute stroke. It also identifies, implements and establishes sensitivity and specificity of a screening tool (the Standardized Swallowing Assessment, SSA) for use by nurses. ¿ Not all ward staff had completed training to use the SSA by conclusion of the patient audit. Nonetheless 123 out of 165 assessable patients (74.5%) had their swallow function screened, 64 by SSA (52%). Based on 68 completed screening episodes by independently competent nurses, a comparison with summative clinical judgement of swallow function revealed a sensitivity of 0.97 and specificity of 0.9 for detection of dysphagia, with positive and negative predictive values of 0.92 and 0.96. This was significantly better than gag reflex performance, supporting the use of the SSA by competent ward nurses. © 2001 Blackwell Science Ltd.

Citations Scopus - 57
2001 Perry L, 'Screening swallowing function of patients with acute stroke. Part two: Detailed evaluation of the tool used by nurses', Journal of Clinical Nursing, 10 474-481 (2001)

¿ Stroke is a common problem and a major consumer of health and social care budgets in the UK. ¿ Dysphagia is a frequent accompaniment and its management has the potential to ex... [more]

¿ Stroke is a common problem and a major consumer of health and social care budgets in the UK. ¿ Dysphagia is a frequent accompaniment and its management has the potential to exert significant influence within the rehabilitation process. ¿ This study explores in detail the performance of a screening tool (based on the Standardized Swallowing Assessment) used by nurses. ¿ Based on 68 complete screening episodes by independently competent nurses, with the effects of chance removed, the tool demonstrated good agreement with summative clinical judgement of swallow function (K = 0.88). The accuracy of results supported the full training and education programme for nurses. ¿ Not all components of the tool were required; analyses suggested elimination of three variables but further exploration is warranted. ¿ As a component of evidence-based guidelines for nutritional support in acute stroke, the screening initiative contributed to improved patient outcomes. © 2001 Blackwell Science Ltd.

Citations Scopus - 45
2001 Perry L, 'Dysphagia: the management and detection of a disabling problem.', British journal of nursing (Mark Allen Publishing), 10 837-844 (2001)

Dysphagia represents a varying group of swallowing difficulties commonly encountered in patients in both acute and community settings. It accompanies a variety of disease states, ... [more]

Dysphagia represents a varying group of swallowing difficulties commonly encountered in patients in both acute and community settings. It accompanies a variety of disease states, can be neuromuscular or mechanical/obstructive in origin and encompasses varied prognoses and outcomes. Its consequences include dehydration, malnutrition, bronchospasm, airways obstruction, aspiration pneumonia and chronic chest infection, social isolation, depression and detrimental psychosocial effects. Current "best evidence" in screening, assessment and management is of variable quality but demonstrates that nurses have an important role to play in interventions entailing multiprofessional collaboration within individually tailored programmes. Clear benefits for patients have been indicated. There are gaps in the knowledge base, especially in relation to psychosocial effects and treatment strategies and the nursing contribution in this area.

Citations Scopus - 10
2001 Perry L, McLaren S, 'Eating disabilities and dietary intake after stroke', Clinical Effectiveness in Nursing, 5 88-92 (2001)

Aim: to explore eating disabilities persisting at 6 months post stroke, and relationship with dietary intake. Design: prospective survey of a cohort of stroke survivors in South L... [more]

Aim: to explore eating disabilities persisting at 6 months post stroke, and relationship with dietary intake. Design: prospective survey of a cohort of stroke survivors in South London. Participants: consecutive admissions to a District General Hospital in South London with a clinical diagnosis of acute stroke during the period March 1998 to February 1999 were interviewed at discharge from hospital. If the patient was English-speaking, with a Mental Status Questionnaire score =7 and Frenchay Aphasia Screening Test scores indicating adequate comprehension and communication skills, or a live-in carer met these conditions, follow up was sought via interview in their own home at 6 months post stroke. Main outcome measures: the Barthel Index, the Eating Disabilities Assessment Scale (EDAS) and a 24-hour recall of food intake. Results: a range of enduring stroke-related eating disabilities was revealed, most commonly arm movement, chewing and swallowing impairment, visual/perceptual and communication deficits. Substantial dietary inadequacy was also revealed, although in this group (which excluded the most disabled stroke survivors) there was no significant relationship between EDAS score and dietary intake. Conclusion: Further work is required to explore the relationship between eating disabilities and representative groups of stroke survivors, and to explore factors related to inadequate intake in less-disabled subjects. © 2001 Harcourt Publishers Ltd.

DOI 10.1054/cein.2001.0198
Citations Scopus - 10
2000 Perry L, McLaren SM, 'Dysphagia screening, assessment and outcomes in stroke patients: Phase 1 of an evidence-based practice project', Journal of Clinical Excellence, 1 201-208 (2000)

Objectives: To (1) survey and audit documentation of patients admitted with acute stroke for screening and assessment of dysphagia in relation to professional standards; (2) inves... [more]

Objectives: To (1) survey and audit documentation of patients admitted with acute stroke for screening and assessment of dysphagia in relation to professional standards; (2) investigate associations between screening, patient characteristics and outcomes; and (3) make recommendations for future practice. Setting: Acute trust hospital of 640 beds in South London. Subjects: Documentation of 200 patients consecutively admitted with clinical diagnosis of acute stroke (ICD-10 codes 160-164) between March and August 1998. Main outcome measures: (1) Adherence to Royal Colleges of Physicians and Speech and Language Therapists' standards for dysphagia screening, referral and assessment; and (2) patient admission characteristics and rehabilitation, infective complications and discharge destination in relation to swallow screening and function. Results: Screening for dysphagia was recorded for 53% of stroke patients, citing a variety of methods, most commonly checking gag reflex. Swallowing problems were documented for 38.5%, predominantly amongst screened patients. Where assessment was required this took place within 72 h of admission for 39% and 2 working days of referral in 87% of cases. Delays derived from both screening and referral processes. Whilst dysphagia was strongly associated with increased morbidity and mortality, the dysphagic group was significantly older, more impaired and disabled than those with intact swallow. Unscreened dysphagic patients were significantly less disabled than screened dysphagic patients. Although a significant proportion of swallowing problems were detected, screening and assessment did not appear to achieve the improved outcomes found in other studies. Conclusions: The audit revealed variability, delay points, scope to bring practice closer in line with research evidence and opportunities to explore the impact of evidence-based standards on patient outcomes.

Citations Scopus - 2
2000 Perry L, McLaren SM, 'An evaluation of implementation of evidence-based guidelines for dysphagia screening and assessment following acute stroke: Phase 2 of an evidence-based practice project', Journal of Clinical Excellence, 2 147-156 (2000)

Objectives: To (1) evaluate the impact of implementing evidence based guidelines on dysphagia screening, assessment and patient outcomes; and (2) make recommendations for future p... [more]

Objectives: To (1) evaluate the impact of implementing evidence based guidelines on dysphagia screening, assessment and patient outcomes; and (2) make recommendations for future practice. Setting: Acute trust hospital of 670 beds in south London. Subjects and methods: Quasi-experimental study design. Documentation of two groups of 200 patients consecutively admitted with clinical diagnosis of acute stroke (ICD 10 codes 160-164) was audited before and after guideline implementation. A multifaceted approach to guideline implementation combined the use of a project leader, and education programme for nursing and medical staff with an audit framework. Main outcome measures: (1) Adherence to Royal Colleges of Physicians and Speech and Language Therapists' standards for dysphagia screening, referral and assessment; and (2) patient characteristics and rehabilitation, infective complications and discharge destination in relation to swallow screening and function. Results: Whilst 100% compliance with guidelines was not achived, following implementation significantly more patients were screened on admission for swallowing dysfunction (pre-test 57.3% vs post-test 74.5%, P < 0.001). Length of time waiting for swallowing assessment was significantly reduced (pre-test range 1-25, median 4 days vs post-test range 1-14, median 3 days, P < 0.001). The time dysphagic patients spent nil orally prior to receiving nutritional support was significantly reduced (pre-test mean 9 days vs post-test mean 3.7 days, P < 0.001). The incidence of chest infections and sepsis of unknown origin was significantly reduced in dysphagic patients (pre-test 35% vs post-test 15%, P < 0.005). Conclusion: Implementation of evidence-based guidelines using an approach combining a project leader, educational programme and audit framework led to significant improvements in multi-professional management and patient outcomes.

Citations Scopus - 11
1999 Perry L, 'Nurse-teacher roles--2. Balancing provision of education and service needs--is there a way?', NT learning curve, 3 4-6 (1999)
1999 Perry L, 'Nurse-teacher roles--1. Nurse teachers' dilemma on how to manage their split role.', NT learning curve, 3 8-9 (1999)
Citations Scopus - 1
1997 Perry L, 'Fishing for understanding : Nurses knowledge and attitudes in relation to nutritional care', International Journal of Nursing Studies, 34 395-404 (1997)

Many studies have demonstrated that malnutrition is a significant problem amongst hospital patients, but little is known about what nurses actually do, and what factors influence ... [more]

Many studies have demonstrated that malnutrition is a significant problem amongst hospital patients, but little is known about what nurses actually do, and what factors influence this. This study aimed to explore the nutritional attitudes, knowledge base and nursing care of qualified nurses in an acute hospital. A survey of nurses' records for documented nutrition related activities was carried out for all (141) patients from five wards for two weeks, followed by a questionnaire, focused on nutrition-related attitudes, activities and knowledge, to all qualified nurses of these and a further four wards (110 nurses). Results revealed evidence of some knowledgeable and pro-active attitudes and nursing care; however, there was little association between knowledge, stated attitudes and behaviour and discrepancies were observed between questionnaire responses and documented activities. Ajzen and Fishbein's (1980) theory relating beliefs, attitudes, intentions and behaviour was not supported although this might be attributed, in part at least, to nurses not regarding weighing patients as nutritional assessment. Behaviour appeared to have been influenced by a variety of factors and relationships between attitudes, knowledge and activities seemed far from straightforward. © 1997 Elsevier Science Ltd. All rights reserved.

Citations Scopus - 12
1997 Perry L, 'Assessing nutritional status.', Nursing times, 93 51 (1997)
Citations Scopus - 1
1997 Perry L, 'Nutrition: A hard nut to crack. An exploration of the knowledge, attitudes and activities of qualified nurses in relation to nutritional nursing care', Journal of Clinical Nursing, 6 315-324 (1997)

¿ Provision of adequate nutrition is recognized as essential, yet malnutrition continues to be reported in patients admitted to hospital. ¿ The effects of malnutrition in hospit... [more]

¿ Provision of adequate nutrition is recognized as essential, yet malnutrition continues to be reported in patients admitted to hospital. ¿ The effects of malnutrition in hospital patients have been well documented; however, most work relating to nutritional management has been produced by members of Nutrition Support Teams, nurse specialists and interested clinicians, whilst the majority of hospitals are still without such specialist posts. ¿ This study used two data collection methods to gain information about the attitudes, nutritional knowledge base and nutrition-related nursing care in a large trust hospital in the South of England. ¿ A survey of care plans for documentation of nutrition-related nursing activities, carried out on the day of discharge for all patients from five wards over a period of a fortnight (totalling 141 sets of documentation), was followed by a questionnaire to all qualified nurses on these and a further four wards (110 nurses). ¿ Results demonstrated that nurses generally felt that nutritional assessment was primarily their responsibility. ¿ Whilst there was evidence of knowledgeable and proactive nursing care, it also appeared that there were fairly widespread deficiencies in the knowledge, communication and co-ordination required to ensure consistent good practice. © 1997 Blackwell Science Ltd.

Citations Scopus - 30
1995 Perry L, 'Continuing professional education: luxury or necessity?', Journal of Advanced Nursing, 21 766-771 (1995)

The author sets out to define what is meant by continuing professional education, the implications of the terminology and the contribution that it makes to nursing She then moves ... [more]

The author sets out to define what is meant by continuing professional education, the implications of the terminology and the contribution that it makes to nursing She then moves on to discuss the distinction between education and learning, and the importance of ¿life-long learning¿ to nursing The relative merits of voluntary and compulsory education are considered and the attitudes and expectations of both nurses and their managers are examined. Obstacles to the up-take of educational opportunities are outlined, and some of the issues behind this are explored The assessment of educational requirements and the evaluation of educational offerings are reviewed, along with the importance of assuring quality, not only in the context of proposals for post-registration education and the current market ethos in the United Kingdom, but also with regard to the potential benefits to be gained in the health care of the general public Copyright © 1995, Wiley Blackwell. All rights reserved

DOI 10.1046/j.1365-2648.1995.21040766.x
Citations Scopus - 24
1993 Perry L, 'Gut feelings about gut feeding: enteral feeding for ventilated patients in a district general hospital', Intensive and Critical Care Nursing, 9 171-176 (1993)

This article looks at the role that nutrition plays in the maintenance of gut integrity and function in the critically ill patient. It refers to previous studies that have highlig... [more]

This article looks at the role that nutrition plays in the maintenance of gut integrity and function in the critically ill patient. It refers to previous studies that have highlighted the relevance of facilitating the bacteriocidal function of gastric secretions as a means to minimise the development of nosocomial pneumonias in ventilated patients. A small trial was set up to investigate the merits and difficulties associated with two different enteral feeding regimes for ventilated patients in the intensive therapy unit (ITU) of a district general hospital. This project and its results are described and evaluated; conclusions and issues for practice are highlighted. © 1993.

DOI 10.1016/0964-3397(93)90023-Q
Citations Scopus - 2
Show 97 more journal articles

Conference (11 outputs)

Year Citation Altmetrics Link
2015 Rowe C, Wynne K, Luu J, Quach T, Jackel D, Perry L, Acharya S, 'Emergency Department (ED) utilisation in young adults with type 1 diabetes (T1D) under care of a tertiary clinic.' (2015)
Co-authors Christopher W Rowe Uon
2011 Dunbabin JS, Perry L, Lowe J, Steinbeck K, Phelan H, 'A new model of care for young adults with type 1 diabetes living in rural areas', 2011 PHC Research Conference Abstracts (2011) [E3]
2010 Moxey AJ, Byles JE, Perry L, Parkinson L, Bellchambers H, Capra S, 'Implementing best practice in nutrition and hydration support in residential aged care: residents' perspectives on the meals and the dining experience', 2010 AAG Rural Conference - Ageing at Home: Sustainable Housing and Communities for Older People. Program & Abstracts (2010) [E3]
Co-authors Julie Byles, L Parkinson
2009 Perry L, Bellchambers HL, Howie A, Moxey AJ, Parkinson L, Capra SM, Byles JE, 'Does the PARIHS framework 'work for aged care?', 2009 National Australian Conference on Evidence-Based Practice. Program (2009) [E3]
Co-authors Helen Bellchambers, Julie Byles, L Parkinson
2009 Dunbabin JS, Perry L, Lowe J, Steinbeck K, 'Young adults with type 1 diabetes: What they think about their local services', 3rd Rural Health Research Colloquium: Building a Healthier Future Through Research: Program and Abstract Book (2009) [E3]
2009 Dunbabin JS, Perry L, Steinbeck K, Lowe J, 'Young adults with type 1 diabetes: Audit of service usage', 3rd Rural Health Research Colloquium: Building a Healthier Future Through Research: Program and Abstract Book (2009) [E3]
2009 Perry L, Lowe J, Steinbeck K, Dunbabin JS, 'Engaging youg adults with type 1 diabetes: A model of care', NSW Rural Allied Health Conference 2009: Program Book (2009) [E3]
2009 Byles JE, Parkinson L, Perry L, Capra SM, Moxey AJ, Bellchambers HL, 'Implementing best practice in nutrition and hydration support in residential aged care: Change in resident nutrition status', Proceedings of the Nutrition Society of Australia (2009) [E3]
Co-authors Helen Bellchambers, L Parkinson, Julie Byles
2009 Parkinson L, Perry L, Capra S, Bellchambers HL, Moxey AJ, Howie A, Byles JE, 'Implementing best practice in nutrition and hydration support in residential aged care: Staff perceptions of contextual influences on practice change', Australasian Journal on Ageing (2009) [E3]
DOI 10.1111/j.1741-6612.2009.00398.x
Co-authors Julie Byles, L Parkinson, Helen Bellchambers
2009 Parkinson L, Perry L, Capra S, Bellchambers HL, Moxey AJ, Howie A, Byles JE, 'Implementing best practice in nutrition and hydration support in residential aged care: Staff experiences of participatory action research and sustainability of practice change', Australasian Journal on Ageing (2009) [E3]
DOI 10.1111/j.1741-6612.2009.00398.x
Co-authors L Parkinson, Julie Byles, Helen Bellchambers
2009 Parkinson L, Perry L, Bellchambers HL, Moxey AJ, Brookes JA, Leigh L, et al., 'Implementing best practice in nutrition and hydration support in residential aged care: Change in a resident quality of life score', Australasian Journal on Ageing (2009) [E3]
DOI 10.1111/j.1741-6612.2009.00397.x
Co-authors L Parkinson, Julie Byles, Helen Bellchambers
Show 8 more conferences
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Grants and Funding

Summary

Number of grants 6
Total funding $1,951,907

Click on a grant title below to expand the full details for that specific grant.


20111 grants / $769,833

Implementation and Evaluation of a Systems Navigation Model of Transition and Care for Non-Metropolitan Young Adults with Type 1 Diabetes: Youth OutReach for Diabetes (YOuR-Diabetes) Cluster-Randomise$769,833

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Lin Perry, Conjoint Associate Professor Julia Lowe, Professor Katharine Steinbeck, Doctor Patrick McElduff, Professor Dimity Pond
Scheme Partnership Projects
Role Lead
Funding Start 2011
Funding Finish 2015
GNo G1000536
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20101 grants / $46,142

Insulin pump therapy for young people with Type 1 diabetes in rural areas: scoping and preparing for new opportunities. $46,142

Funding body: NSW Ministry of Health

Funding body NSW Ministry of Health
Project Team Conjoint Professor Lin Perry
Scheme NSW Institute of Rural Clinical Services and Teaching
Role Lead
Funding Start 2010
Funding Finish 2010
GNo G1000075
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

20082 grants / $10,884

HACC Services with a respite effect$9,500

Funding body: The Sax Institute

Funding body The Sax Institute
Project Team Conjoint Professor Lin Perry, Professor Julie Byles, Conjoint Associate Professor Lynne Parkinson
Scheme Project Grant
Role Lead
Funding Start 2008
Funding Finish 2008
GNo G0189263
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Australian Association of Gerontology 41st National Conference, Freemantle, 19/11/2008- 21/11/2008$1,384

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Lin Perry
Scheme Travel Grant
Role Lead
Funding Start 2008
Funding Finish 2008
GNo G0189592
Type Of Funding Internal
Category INTE
UON Y

20072 grants / $1,125,048

Implementing best practice nutrition and hydration support in Residential aged care.$885,648

Funding body: Department of Health

Funding body Department of Health
Project Team Professor Julie Byles, Professor Sandra Capra, Conjoint Associate Professor Lynne Parkinson, Ms Julie Brookes, Conjoint Professor Lin Perry, Dr Zumin Shi
Scheme Encouraging Best Practice in Residential Aged Care
Role Investigator
Funding Start 2007
Funding Finish 2009
GNo G0187288
Type Of Funding Other Public Sector - Commonwealth
Category 2OPC
UON Y

A Young adult Outreach Service for Type 1 Diabetes Mellitus in Rural NSW$239,400

Funding body: NSW Ministry of Health

Funding body NSW Ministry of Health
Project Team Conjoint Professor Lin Perry, Conjoint Associate Professor Julia Lowe
Scheme Project Grant
Role Lead
Funding Start 2007
Funding Finish 2009
GNo G0187333
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y
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Conjoint Professor Lin Perry

Position

Conjoint Professor
School of Nursing and Midwifery
Faculty of Health and Medicine

Contact Details

Email lin.perry@newcastle.edu.au
Phone 0401771644
Mobile 0401771644

Office

Room RW
Building RW
Location Callaghan
University Drive
Callaghan, NSW 2308
Australia
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