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Curtin University
W.A. Centre for Evidence Informed Healthcare Practice

Systematic Reviews

Systematic Reviews Completed

Portable Document Format File Type Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A systematic review.

Clean intermittent self-catheterisation is the gold standard in the management of neurogenic/neuropathic bladder disorders, providing independence, alleviating symptoms and complications of the urinary tract.

The objective of this systematic review was to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic/neuropathic bladders.

The review considered qualitative and quantitative studies, mixed methods and case studies. Interventions, programs and strategies preparing adults to self-catheterise included education, suitability for self-catheterisation and interventions promoting compliance and continuity. Outcomes of interest were the quality of life and depression, long-term compliance, advantages/disadvantages of urethral self-catheterisation and limitations to self-catheterisation.

From the 18 studies reviewed, three interventions (education and preparation, suitability to self-catheterise, and interventions promoting compliance/continuity), and three outcomes (effect of self-catheterisation on quality of life and depression, and long-term compliance) were addressed with multiple studies in each intervention and outcome. The results are discussed under four headings: (i) education essentials for self-catheterisation (ii) factors promoting compliance and continuity with self-catheterisation, (iii) factors influencing quality of life and (IV) diagnostic sub-groups of people with a neurogenic bladder.

The narrative and synthesised data from the 18 included studies identified findings to provide a basis for strategies to promote clean intermittent self-catheterisation in adults. These include an extended education program with a pre-education component, on-going support and skills training. All aspects of education should reflect sound research findings related to quality of life issues.

The implications for clinical practice are the development of a comprehensive standardised education program that includes background information, skills training and follow-up support.

The review highlights the need for further experimental research to confirm factors that will promote self-catheterisation in adults with neurogenic/neuropathic bladders, with particular reference specific sub-groups.

The full report is available on the JBI Library of Systematic Reviews (JBL 000232) 2011 Volume 9(34): 1393-1446

For information and enquiries about this review contact Jillian Adams:
Telephone: +61 8 9224 2976

The effect of nurse staffing on clinical outcomes of children in hospital: a systematic review

The objective of this systematic review was to identify any associations between nurse staffing and clinical outcomes in hospitalised children.

The review considered quantitative studies that evaluated the effect of nurse staffing such as nursing hours per patient day, nurse-to-patient ratio, skill mix, and nurse characteristics such as level of education and years of experience on clinical outcomes of hospitalised children aged from 0-18 years. The clinical outcomes were those believed to be potentially sensitive to nursing care. Specifically, where the provision, or lack, of competent nursing care had made a difference to the outcome for the child (a nursing-sensitive outcome). Examples included mortality, healthcare-associated infections, failure to rescue, medication administration errors, postoperative complications and pressure ulcers.

Following quality assessment eight studies were included (six cohort, one case-control and one cross-sectional) which reported associations between ten different measures of nurse staffing and twenty four clinical outcomes. Fourteen of the outcomes reported were healthcare-associated infections and a further eight were other adverse events. Meta-analysis was not undertaken as predictor and outcome measures varied indicating that pooling of results was not appropriate. Therefore, results have been reported in narrative form.

A decrease in nursing hours per patient day by Registered Nurses was associated with increased healthcare-associated infections in five studies. However, there appears to be a level where increasing Registered Nurse hours no longer has a significant association with decreased adverse events. Similarly, positive associations were found between measures of nurse staffing and three clinical outcomes in children (children’s length of hospital stay, parent/family complaints and postoperative cardiopulmonary complications). Mixed results were reported for mortality and medication administration errors. No associations were found between measures of nurse staffing and peripheral intravenous infiltrates, pressure ulcers, fluid overload and failure to rescue.

The exact numbers, ratios and skill mix to reduce adverse outcomes in hospitalised children are unclear. However, a high proportion of registered nurses within the skill mix is recommended for all wards and units caring for children.

The report has been published in the International Journal of Evidence-Based Healthcare (2011) at

For information and enquiries about this review contact Sally Wilson:
Email: or

The effectiveness of educational strategies in improving parental/caregiver management of fever in their child: a systematic review

The objective of this review was to determine what educational interventions are effective in influencing parents to provide effective care for their febrile child.

The review considered quantitative studies that evaluated the effect of any educational activities, both formal and informal, including written, verbal, interactive and audiovisual material on parental knowledge, confidence, satisfaction and behaviour when their child had a fever.

Following quality assessment ten studies were included (six clinical trials, two cohort studies, and two surveys) and involved 1977 participants. Meta-analysis was not undertaken as pooling of results was not appropriate therefore, results have been reported in narrative form.

Formal educational interventions involving mixed methods of written, verbal and interactive material found a statistically significant improvement on parental knowledge of fever management of their child. This improvement was found by one study to be sustained until six months. Semiformal methods of education, such as written and audiovisual materials, also showed a statistically significant improvement in parental knowledge of fever management of their child however, the effects did not appear to be long lasting. Studies using informal methods of education, which were largely parent dependent, were not found to be effective in improving parental knowledge. Parental knowledge, attitudes, confidence and satisfaction did not necessarily equate with improved behaviours.

Formal education involving mixed methods of written, visual, interactive and verbal material in a structured or repeated session was effective in significantly improving parental knowledge about fever management in children. One-dimensional methods such as written material alone did not appear to be statistically significant in affecting behaviours, however did decrease anxiety and improve parental satisfaction of care. Therefore, strategies delivered by health care providers, which are formal in structure, relevant to current situations, i.e. in close proximity to the time of fever, with multidimensional methods, and reinforced, are recommended to improve parental management of fever in their child.

The full report is available on the JBI Library of Systematic Reviews (JBL000399) 2010: 8 (21):826-868

This systematic review was funded by a Princess Margaret Hospital Foundation Seeding Grant

For information and enquiries about this review contact:
Melisa Young
Email: or

Impact of the Physical Environment in Paediatric Hospitals on Health Outcomes: a Systematic Review

The objective of this review was to determine from the available evidence the impact of the physical paediatric hospital environment on health outcomes of children and adolescents.

The review considered studies using either quantitative or qualitative methodologies or mixed methods that assessed the impact of physical design elements of a paediatric hospital environment including architectural, interior design, ambient features and /or features that supported patient and family centred care. The primary outcomes of interest were clinical or psychological, with other outcomes of interest being patient – family perceptions, including safety and security.

Following a quality assessment review, eight studies were included in the review with five elements of physical design addressed. In the sub-topic of physical building structures, single room design for paediatric intensive care units significantly reduced nosocomial infections as did the addition of negative pressure ventilation to single rooms in an isolation unit. The one study on the effect of specially designed gardens found very low usage rates but children who did visit them were actively engaged with both natural and structural features. On the same theme of active engagement a play centre designed to encourage symbolic play generated statistically significantly more total play and less unoccupied time or wandering as well as the type of play it was designed to encourage. The one study on art did not demonstrate that nature art was effective in reducing stress in hospitalised children. In regard to adolescents, the two themes that emerged in regard to physical facilities from the two qualitative studies were ways of maximising normal life and ways of supporting coping with the illness through ward design.

Given the small number of studies addressing five sub-topics, no firm conclusions can be drawn from the review. However the results suggest positive elements of physical design that could be considered for implementation to support a healing environment within paediatric hospitals or paediatric wards in general hospitals.

The full report is available on the JBI Library of Systematic Reviews (JBL 000155) 2009: 7 (20); 908-941

The bibliography of articles identified in the literature search for this systematic review is available on request to

The Effectiveness of Non-invasive Complementary Therapies in Reducing Postoperative Nausea and Vomiting Following Abdominal Laparoscopic Surgery in Women: A Systematic Review

The objective of this review was to determine from the available evidence the most effective non-invasive complementary therapies for reducing the incidence and/or severity of postoperative nausea and vomiting in women undergoing abdominal laparoscopies. Randomised controlled trials and quasi-experimental studies investigating the effects of non-invasive complementary interventions on postoperative nausea and/or vomiting, and the need for rescue medication following abdominal laparoscopic surgery in women were considered for inclusion in the review. Trials with only a 'no-treatment' control group were not included.

Following a quality assessment, twenty-one studies involving a total of 2286 participants were included in the review. Thirteen studies investigated the effect of four interventions on PONV following gynaecological laparoscopy: ginger, acupressure, guided imagery and music. Eight studies examined the effect of two interventions on PONV following laparoscopic cholecystectomy: stimulation of acupoints by various means and oral carbohydrate rich beverage.

There is sufficient evidence to suggest that several of the interventions assessed could play a role in a multimodal approach to minimise PONV following abdominal laparoscopic surgery, albeit requiring further research to confirm that promise. The two interventions of note are the use of the Korean Hand acupoints for prophylactic purposes, particularly acupressure applied to the acupoint K-K9, and the use of impregnated pads for the inhalation of 70% isopropyl alcohol to treat established nausea in females. There is also some evidence to suggest that acupressure or acustimulation at P6 may be effective in reducing nausea and vomiting in patients (females and males) having a laparoscopic cholecystectomy.

The full report is available on the JBI Library of Systematic Reviews (JBL 000081) 2009: 7(19):850-907

The Nursing Management of Fever in Children - A Systematic Review – currently being updated

The Effectiveness of a Pelvic Floor Muscle Exercise Program on Urinary Incontinence Following Childbirth: A Systematic Review

The primary objective of this review was to determine from the available evidence the effectiveness of Pelvic Floor Muscle Exercises (PFME) compared with usual care for urinary incontinence (stress, urge, mixed) following childbirth. Secondary objectives were included to examine the effectiveness of a PFME program on pelvic floor muscle strength and encouraging exercising compliance.

Participants included women who experienced a spontaneous onset of labour and who subsequently delivered at more than 20 weeks gestation either vaginally, both spontaneous and assisted, or by non-elective caesarean section.

The results of this systematic review indicate that antenatal PFME and postnatal PFME are effective in reducing or resolving urinary incontinence following childbirth. A subgroup analysis showed that postnatal PFME also have a significant effect on reducing or resolving urinary incontinence in women with existing postpartum urinary incontinence.

Findings of the studies included in the review suggest a PFME program will improve the frequency with which women perform PFME. Two studies found that women receiving the intervention (a PFME program) and who were performing PFME regularly in the month before data collection were significantly less likely to have any incontinence. The review’s results support previous findings showing there is little evidence that a high-intensity PFME program is more effective than a low intensity PFME regimen of exercising. No conclusions about the effectiveness of feedback to a woman about pelvic floor muscle strength, for example perineometer measures, as part of a PFME program can be reached. The mixed results of this review mean that no conclusions can be reached about the effectiveness of a PFME program, antenatal or postnatal, on improving pelvic floor muscle strength.

Implications for Practice: In terms of the effectiveness of PFME programs, the results of this review indicate that urinary incontinence following childbirth can be improved by performing PFME and that any form of a specific PFME program appears to improve exercising frequency. However, the value of individual components of PFME programs, such as take home materials, reminder telephone calls, and feedback of exercising effectiveness are less clear.

The report has been published in the International Journal of Evidence-Based Healthcare 2005: 3(5):103-146 and a Best Practice Information Sheet is also available (see BPIS tab for URL).

For information and enquiries about this review please contact:

Nursing and Midwifery Management of Hypoglycaemia in Healthy Term Neonates: A Systematic Review

The objective of this systematic review was to determine the best available evidence for maintenance of normal blood glucose values in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. All interventions that fell within the scope of practice of a midwife or nurse were included in the review: the type of feed (breast or breast milk substitutes) and the initiation and frequency of feeding; regulation of body temperature; and monitoring and screening of neonates for signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review.

Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention – type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol – prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breastfeeding success.

Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is not a common event and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at one hour in normal term babies. In healthy breast-fed term infants the initiation and timing of feeds in the first 6 hours of life has no significant influence on plasma glucose levels or birth weight. The colostrum of primiparous mothers provides sufficient nutrition to tide the infant over the first 24 hours after birth, and supplemental feeds or extra water are unnecessary.

Skin-to-skin contact appears to provide an optimal environment for foetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours.

Implications for Practice: The seven studies analysed in this review confirm the WHO’s first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely:

  1. Early and exclusive breastfeeding is safe to meet the nutritional needs of healthy term newborns worldwide.
  2. Healthy term newborns that are breastfed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids.
  3. Healthy term newborns do not develop "symptomatic" hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia …look for an underlying condition. Detection and treatment of the cause is as important as correction of the blood glucose level.

If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin to skin contact should be promoted and “kangaroo care” encouraged in the first 24 hours after birth. Whilst it is important to main the infant’s body temperature care should be taken to ensure that the child does not become overheated.

The report has been published in the International Journal of Evidence-Based Healthcare 2005: 3(7):169-205 and a Best Practice Information Sheet is also available (see BPIS Tab for URL).

Email enquiries to:

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