Welcoming Josh Allen to the Department of Nursing

“I’m excited to join the Master of Nursing Science Team in the Department of Nursing and complete my PhD on patient deterioration”. “I was previously a lecturer for an undergraduate nursing program, but it’s time for a new challenge.” Josh said. “I hope my subject will be an engaging student experience, one they find challenging and stimulating in a positive way, where they can see it will be hard work but also valuable”. Likewise, he wishes to learn more about the current courses available and what he can take away to practice clinically. “I look forward to meeting many people from different fields in our diverse faculty and collaborating with them in the future.”

Josh Allen is a critical care nurse in the final stages of his PhD, working on a publication on deteriorating patients. He has recently joined Department of Nursing team as a Senior Lecturer. His interests lie in identifying factors that help hospitals determine patients' risk to deterioration (transition from acute/ hospital care to emergency/ critical care). Since patient outcomes are poor once deterioration occurs, identifying those at risk has been a big focus of clinical practice for the past almost 20 years, and is becoming increasingly important with the rise in patient numbers seen by medical emergency teams.

Josh identified a gap in the literature – a disconnect between the patient transition from acute care to critical care and what hospitals do to identify susceptible patients. With nurses having such an important role in identifying signs and symptoms of patient to prevent deterioration, it is critical that this knowledge gap was filled to improve patient outcomes.

Having been in academia for a few years and doing an honours research project, Josh knew he wanted to do a PhD. Once he knew he wanted to research patient deterioration and had a good team of supervisors he commenced his PhD. He utilised both quantitative data and qualitative data in his study. Quantitative information from pre-existing hospital database was used to develop a statistical predictive tool. Qualitative data was collected by interviewing registered nurses on their observations of patients entering hospitals. Through regression processing, Josh used statistical analysis programming to weed out non-important factors determining patient deterioration risk. For example, age was surprisingly insignificant in predicting deterioration despite previous literature hypothesising that it was.  Factors like the health status of admitted patients, particularly their comorbidity with heart failure and respiratory disease, played a more significant role in deterioration risk. The variables were reduced to nine predictors, which were used as a calculator: by answering yes or no questions, the calculator generates a score for risk of needing critical review in the next 48 hours.

In post doctorate studies, Josh will focus on the translation of this calculator in a clinical setting; through carrying out prospective trials on patients in real time, he aims to test the calculator as a screening tool. If the trials are successful, this could become an effective predicting tool to identify patients at risk of deterioration. Next steps involve what hospitals should do once these patients have been identified. Nurses already have strategies and interventions in place; hence it is important to partner with nurses in developing interventions and managing high-risk patients.

“I initially thought the process would be linear.” Josh reflected. “However, many things came up throughout my PhD journey and I had to learn to adapt and be flexible.”

Juggling study with personal life and work as “a battle that required perseverance to follow through”.

With novel research, another struggle is managing a project without having an idea of what the process would look like from start to end. “I didn’t know what to expect, how long each step would take, when to anticipate what types of challenges.”

Despite this, he enjoyed his research journey. “I learned to take responsibility and control of my project, and that I can trust my supervisors to keep me on track”.

Currently, Josh is finalising his PhD and is pleased to have his research published in the top critical nursing journal in the world. You can follow Josh’s future work through his LinkedIn.