Patients' experiences of acute deterioration: A scoping review

The relationship between presenteeism among nurses and patients' experience in tertiary hospitals in China

This study aims to observe the current situation of nurses' presenteeism and the relationship between presenteeism among nurses and patient perceptions and examine its implications for nursing management. The study design was quantitative, correlational and cross-sectional. The researchers used convenience samples of nurses and patients from five hospitals who agreed to participate in an online survey distributed using Sojump Survey Software. A total of 500 in-service nurses from five tertiary hospitals in Henan Province in China were recruited as the nurse participants. Among them, 433 met the inclusion criteria and completed the general information questionnaire and the presenteeism scale. Patients who were hospitalised for three days or more and were cared for by one or more nurse participants were included in the study. In total, 435 patient participants answered the Inpatient Experience Questionnaire. The responses collected from both groups were analysed using descriptive and inferential statistics.Nurses' presenteeism was a key factor that affected patient experience. Presenteeism among nurses is a common phenomenon. Although patients' experience was overall positive, there is still room for improvement. Reducing presenteeism among nurses is crucial for improving patient experience, creating harmonious nurse-patient relationships and sharing a common mission.

Recognising and responding to acute deterioration in care home residents: a scoping review

BACKGROUND

Acute deterioration describes a rapid change in physical and/or mental health resulting from an acute illness - e.g., heart attack or infection. Older people in care homes are some of the frailest and vulnerable in society. They have complex health needs, experience multiple long-term conditions (MLTC) and have weakened immune systems due to the ageing process. They are more susceptible to acute deterioration and delayed recognition and response, is linked to poorer health outcomes, adverse events and death. Over the past five years, the need to manage acute deterioration in care homes and prevent hospital admissions has led to development and implementation of improvement projects, including the use of hospital derived practices and tools to identify and manage this condition. This is potentially problematic as care homes are different from hospitals-options to escalate care vary throughout the UK. Further, hospital tools have not been validated for use in care homes and have shown to be less sensitive in older adults living with frailty.

OBJECTIVES

To collate the available evidence on how care home workers recognise and respond to acute deterioration in residents using published primary research, non-indexed and grey literature, policies, guidelines and protocols.

METHODS

A systematic scoping review was conducted following Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted using: CINAHL (EBSCOhost), EMCARE (OVID), MEDLINE (OVID) and HMIC (OVID). Snowball searches of included studies' reference lists were conducted. Studies that featured care homes with or without nursing and provided 24/7 care to residents were included.

RESULTS

Three hundred and ninety-nine studies were identified. After reviewing all studies against inclusion criteria, n = 11 were included in the review. All studies used qualitative methods and were conducted in Australia, UK, South Korea, USA and Singapore. Four themes were generated from the review: identifying residents with acute deterioration; managing acute deterioration, care home policies and procedures, and factors affecting recognition and response to acute deterioration.

FINDINGS

Recognition and response to acute deterioration in residents is determined by multiple factors and is context sensitive. There are several interrelated factors within and external to the care home that contribute to how acute deterioration is recognised and managed.

CONCLUSIONS AND IMPLICATIONS

The available literature on how care home workers recognise and respond to acute deterioration is limited and often subtends other areas of interest. Recognising and responding to acute deterioration in care home residents is reliant on a complex and open system encompassing multiple interrelated components. The phenomenon of acute deterioration remains underexplored and further research is required to examine contextual factors that accompany identification and management of this condition in care home residents.

The patient experience of a medical emergency team review: A convergent mixed-methods study

AIMS

The aim of this study was to explore clinician-patient engagement during, and patient experience of, medical emergency team (MET) reviews.

DESIGN

This study involved a convergent mixed-methods design.

METHODS

This three-phase study was conducted at two hospitals of one Australian health service. Reviews by the MET were observed for clinician-patient engagement behaviours; medical records were audited to confirm patient demographics and clinical characteristics; and patients who received a MET review were interviewed. Quantitative data were analysed using descriptive statistics, and thematic analysis of qualitative interview data was conducted.

RESULTS

In total, 26 MET reviews were observed for 22 patients (median age = 81.5 years and 68.2% females). Between 8 and 13 clinicians and other staff members were present during each review, with a total of 209 clinicians present during the 26 reviews. Clinicians were not observed to speak directly or indirectly to the patient about their care in 38.5% (n = 10/26) of the MET reviews, and 58.3% (n = 56/96) of interventions were performed without explanation. Four themes were identified from the interviews: An unexpected event; A lack of understanding; In good hands, and What happens next?

CONCLUSION

Clinician-patient engagement was infrequent during and after MET reviews. Patients experienced surprise from the sudden arrival of clinicians in their room and had poor levels of understanding about the review. However, most patients felt supported and safe. MET reviews are frequent safety-critical events, and this study identified the patient experience of these events. Clinicians should be aware that patients expressed they were surprised and shocked by the review and that an explanation of what was being done by the clinical team was rarely offered. These findings can be used to inform strategies to improve their patient-engagement behaviours and patient-centred care.

Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter: A grounded theory study

AIM

This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter.

BACKGROUND

Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective.

DESIGN

Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter.

METHODS

Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes.

FINDINGS

Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional-patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status.

CONCLUSION

Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors.

IMPACT

The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration.

Acute Kidney Injury and Covid-19: A Scoping Review and Meta-Analysis

Acute kidney injury (AKI) is a fatal complication of the new severe acute respiratory syndrome coronavirus (SARS-CoV-2) which causes COVID-19 disease. Here, we performed a scoping review and meta-analysis including clinical studies on patients with SARS-CoV-2 infection with data on AKI assessment and characteristics, and the overall prevalence of AKI was estimated using a random-effects model. We identified 21 articles which passed the search criteria. All were quantitative observational studies which used a cross-sectional, retrospective, case report, or cohort methodology. This showed that aging, diabetes, cardiovascular disease, previous chronic disease, and other comorbidities were risk factors of AKI. Although the prevalence of proteinuria, hematuria, and increased serum creatinine was reported for up to 60% of the patients with COVID-19, the overall prevalence of AKI was estimated to be 8%. We conclude that although approximately two-thirds of patients with COVID-19 had symptoms of kidney damage, most of these did not meet the diagnostic criteria for AKI. Further studies should be performed to validate biomarkers for improved AKI diagnosis in COVID-19 patients and new treatment options are required to reduce the rate of mortality.

Acute Respiratory Distress Syndrome and COVID-19: A Scoping Review and Meta-analysis

Acute respiratory distress syndrome (ARDS) is a fatal complication of the new severe acute respiratory syndrome coronavirus (SARS-CoV-2), which causes COVID-19 disease. This scoping review was carried out with international, peer-reviewed research studies and gray literature published up to July 2020 in Persian and English languages. Using keywords derived from MESH, databases including Magiran, IranMedex, SID, Web of Sciences, PubMed, Embase via Ovid, Science Direct, and Google Scholar were searched. After screening titles and abstracts, the full texts of selected articles were evaluated, and those which passed the criteria were analyzed and synthesized with inductive thematic analysis. Study quality was also evaluated using a standard tool. The overall prevalence of ARDS was estimated using a random-effects model. This led to identification of 23 primary studies involving 2880 COVID-19 patients. All articles were observational with a cross-sectional, retrospective, case report, and cohort design with moderate to strong quality. The main findings showed that COVID-19-related ARDS has a high prevalence and is different to ARDS due to other etiologies. Elderly and patients with comorbidities and organ failure should be closely surveyed for respiratory organ indications for several weeks after the onset of respiratory symptoms. There is currently no definitive treatment for ARDS in COVID-19 disease, and supportive therapies and their effects are somewhat controversial.