Patient satisfaction with outpatient hysteroscopy performed by nurse hysteroscopists

Nurse-surgeons in the Australian public health system: A descriptive quantitative survey

Background

With over five billion people worldwide lacking access to surgery, innovative solutions are vital to address the global surgical crisis. Nurse-surgeons present a promising innovation. Considering their contribution worldwide and impact on surgical care in Australia, an exploration of these advanced practice nurses is timely.

Objective

To investigate the roles, training, education, and perceptions of career prospects and support received by practicing nurse-surgeons in the Australian public health system.

Design

Non-experimental descriptive national survey.

Methods

The target population was nurse-surgeons practicing within the Australian public health system. The survey questionnaire comprised of four sections containing questions on nurse-surgeon demographics, roles, training, and perceptions of career prospects and support received. Data collection was conducted through emailing of public hospitals, crowdsourcing, and snowballing. Descriptive analysis was used to report the findings.

Results

Twenty-eight nurse-surgeons participated in the study, 22 females and six males. Most commonly, participants (n = 10) held master's degrees and trained to become nurse-surgeons for an average of 2·27 years (95 % CI [1·47,3·07]). Training programs varied but were all surgical specialty-specific, and usually included a practical component, theoretical component, and competency assessment prior to independent practice. Participants rated employment prospects for nurse-surgeons as poor to average due to limited work opportunities, politics, and strong pushbacks from Australian medical societies. The support received from nurses, surgeons and management was rated by participants as good providing reasons such as supportiveness, value recognition, jealousy, and resentment. The participants were very likely (95 % CI [7.436 - 9.364] to continue practicing due to positive job satisfaction but recommended the standardising of training and practice to ensure role futureproofing.

Conclusions

Nurse-surgeons have been practicing in Australia for decades, yet no standard training and credentialing pathway exist for them. This study identified the various roles, non-standard training, and perceptions of nurse-surgeons in the Australian public health system. The findings of this study will have an impact on policymakers and stakeholders to develop standard national credentialing pathway for nurse-surgeons in Australia to enhance clinical practices and ensure a consistent framework for recognition and development of these advanced practice nurses.

Impact of nurse-surgeons on patient-centred outcomes: A systematic review

Background

Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail.

Objective

To investigate the impact of nurse-surgeons on patient-centred outcomes.

Design

Systematic review.

Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies.

Results

Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies.

Conclusions

Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.

Advanced hysteroscopic surgery training

Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.

[Satisfaction among patients attending outpatient preventive medicine clinic]

INTRODUCTION

To evaluate satisfaction among patients attending the outpatient clinics of a Preventive Medicine Department and to identify any problems with the care they receive.

MATERIAL AND METHODS

We performed a cross-sectional study in outpatient clinics of the Preventive Medicine Department, at Hospital General Universitario in Alicante, during January 2009. A questionnaire was given to all patients after their visit. Patients were satisfied if the final score was > or = 8. Socio-demographic variables were: age, sex, educational level, marital status and type of user (external or internal). chi(2) were used to study the association between these variables and satisfaction.

RESULTS

The response rate was 84.4% (119/141), 94.1% were correctly completed (112/119), and 82.1% had a final score of > or = 8. The worst aspects were: comfort of waiting room, signs and wait time (percentage dissatisfied: 54.5%, 46.4% and 30.4%, respectively). The rest of the items obtained the following satisfaction percentages: medical treatment (97.3%), privacy of care (95.5%), information received (93.7%), easy next appointment (93.7%), visit length (92.9%), clarity of information (92.9%), to arrange the first appointment (90.2%), nursing treatment (87.5%), time to date of appointment (81.2%). Educational level was the only variable significantly associated with satisfaction.

CONCLUSIONS

General satisfaction was good, although aspects like waiting time and signs could be better, if changes were made to management of appointments and the signs in the Hospital Department were increased.