Analysis of how nursing staff in Far North Queensland manage people who are victims of Irukandji syndrome

Every year in tropical areas of Australia, in addition to the people who live there, many others visit to experience nature at its best. In tropical Far North Queensland, tourists often come to holiday during the summer period when their own region of residence is cold and uninviting. As a consequence, they are keen to swim in the ocean and partake of other water activities. In these warm tropical waters, however, lurk a number of creatures which can cause unpleasant physical effects. One of these marine animals is a very small creature, the Irukandji jellyfish, which is usually invisible to the swimmer but causes a very painful systemic reaction in those who are stung. The body's response to the sting is called 'Irukandji syndrome'. However, in spite of the pervasiveness of the Irukandji and other similar animals in tropical waters during the summer months, very little is written about the nursing management of patients with Irukandji syndrome although there is some literature on the medical management. This study aimed to redress this gap in the nursing evidence-base and provide a framework for expert emergency nurses to better manage the patient with Irukandji syndrome. Objectives: The objectives of this study were to: 1. Document and analyse information gathered about the condition of patients with Irukandji syndrome; 2. Assess the nursing management of patients with Irukandji syndrome; and 3. Develop clinical practice guidelines to support the clinical management of patients with IS by advanced practice nurses working in ED settings. Framework: The overarching theoretical frameworks for the study were Pragmatism and Reflective Practice. The research design, a concurrent mixed methods approach embedded within a Case Study, was selected as the most appropriate way to conduct the study and generate relevant qualitative and quantitative data. In this study, the use of a concurrent nested design meant that I was able to use the seasonal aspects of a jellyfish 'season' to collect both quantitative and qualitative data during observational episodes or chart audit processes. This design was chosen to allow description and exploration of aspects of a quantitative study, with added depth and richness provided by the qualitative component of the study which included reflection by both participants and researcher. This study was undertaken between 2005 and 2007 over two summer seasons, in a regional hospital Emergency Department (ED) in Far North Queensland. Seventeen (17) advanced practice registered nurses were recruited into the study and agreed to participate in one or more of the twenty three (23) observational episodes within the ED. Quantitative data were analysed using SPSS version 16.0, generating both descriptive and inferential statistics. Qualitative data was managed using an Excel spreadsheet to undertake content analysis and the Delphi technique was employed to generate clinical guidelines. Findings: The participants were advanced practice ED nurses who regularly use their knowledge, skills and abilities to manage the variety of patients who transit through the ED. The participants were clinically able to manage the patients with Irukandji syndrome, but were limited in their capacity to respond quickly to the patient's needs, especially their need for pain relief, because of policy frameworks requiring the initiation of appropriate pain relief by medical officers only. Using the Delphi technique, clinical guidelines were developed and it is envisaged these will support a change in the existing policy so as to allow appropriately qualified ED nurses to initiate pain management for these patients in the future. Secondary and unexpected findings suggested that expert nurses in ED appear to provide clinical care based on decisions which are not overtly evident; that is, little documentation existed in patients' charts to show the intellectual nursing assessment processes used to arrive at a clinical decision. Conclusions: Expert ED nurses may have the capacity to use advanced clinical knowledge and skills when managing patients who had been diagnosed with Irukandji syndrome, however they have been hindered by policy frameworks which need to be addressed and amended. In this study, the nurses understood their scope of practice but did not always document all components of their clinical care in a transparent way although the care they delivered to the patients was of a very high standard.