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Leonardsen ACL, Wolf A, Nilsson U. Patient-Centerdness in the Perioperative Period-A Rapid Review of Current Research. J Perianesth Nurs 2024:S1089-9472(24)00003-0. [PMID: 38613539 DOI: 10.1016/j.jopan.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 04/15/2024]
Abstract
PURPOSE The indication of surgery is a critical moment in a person's life implying different needs, feelings, or fears. The aim of the current literature review was to elucidate the prevailing utilization of the concepts 'patient-centerdness' and 'person-centerdness' within the perioperative period. DESIGN A rapid review design. METHODS Literature searches were conducted in the databases PubMed, Scopus (Elsevier), American Psychological Association PsychInfo (Ovid), Embase (Ovid), CINAHL (Ovid), and Cochrane Library in December 2022. Rayyan software was used to assess the articles. Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of the included articles. Thematic analysis was used to identify themes across the articles. FINDINGS The electronic database searches identified 1,967 articles. A total of 12 articles were assessed in full text against the inclusion and exclusion criteria, and finally, a total of seven articles were included. The articles originated from six countries, employed disparate methodological approaches, and featured a heterogeneous array of participants representing various health care settings. Patient-centerdness held the mantle as the most prominently used concept across the seven articles, whereas person-centerdness emerged as the least frequently explored concept. One theme was identified across the articles; Preparedness. This was related to shared decision-making and information pre, peri- and postoperative. CONCLUSIONS This rapid review suggests that patient preparedness, particularly through shared decision-making and providing information, is a recurring theme in the limited studies on patient- or person-centerdness in the perioperative context. The fact that only one single study focuses on person-centered care underscores the pressing need for a comprehensive re-evaluation of modern perioperative care.
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Affiliation(s)
- Ann-Chatrin L Leonardsen
- Department of Nursing, Health and Biosciences, Ostfold University College, Faculty of Health, Welfare and Organization, Halden, Norway; Department of Nursing and Health Sciences, University of Southeastern Norway, Faculty of health and social care, Borre, Norway.
| | - Axel Wolf
- Department of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Department of Intensive Care and Anesthesiology, Institute for Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Division of Nursing, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Bur JA, Wilson NJ, Lewis PR, Missen K. Patient experiences during the planned perioperative care pathway: An integrative review. J Adv Nurs 2024. [PMID: 38294089 DOI: 10.1111/jan.16071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
AIMS This integrative review aimed to synthesize evidence about the patients' experiences during the planned perioperative care pathway. DESIGN Integrative review. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Ovid, Scopus, and American Psychological Association (APA) PsychINFO. Original, peer-reviewed studies published in English between 2012 and 2023 exploring patient experiences during the planned perioperative care pathway were reviewed. METHODS This review was guided by the Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Twenty-two articles were selected for the final study. RESULTS Three themes emerged: Sharing of information is empowering; interpersonal relationships are valued by patients, and hospital systems and care co-ordination influence the patient experience. CONCLUSIONS The quality and consistency of the information patients receive can both support and undermine patient confidence in health professionals. The quality of relationships that participants experience and effective communication with health professionals can support or compromise the quality of the patients' perioperative experience. The nature of the hospital systems and care co-ordination in hospital has implications for the quality of recovery from surgery. IMPACT This review evaluates whether national and international health services and organizations, adhering to the WHO guidelines, have developed and implemented intentionally focused perioperative care with the aims to achieving effective and sustainable surgical outcomes through increased patient satisfaction. NO PATIENT OR PUBLIC CONTRIBUTION This article is an integrative review and does not include patient or public contribution.
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Affiliation(s)
- J A Bur
- School of Nursing and Midwifery, Western Sydney University, Richmond, New South Wales, Australia
| | - N J Wilson
- School of Nursing and Midwifery, Western Sydney University, Richmond, New South Wales, Australia
| | - P R Lewis
- School of Nursing and Midwifery, Western Sydney University, Richmond, New South Wales, Australia
| | - K Missen
- School of Healthcare, Federation University, Churchill, Victoria, Australia
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3
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Larsson F, Strömbäck U, Rysst Gustafsson S, Engström Å. Perception of feeling safe perioperatively: a concept analysis. Int J Qual Stud Health Well-being 2023; 18:2216018. [PMID: 37210740 DOI: 10.1080/17482631.2023.2216018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/16/2023] [Indexed: 05/23/2023] Open
Abstract
PURPOSE The purpose of this study was to explore the concept of feeling safe, from the patient perspective, in a perioperative context. METHOD The eight-step concept analysis approach proposed by Walker and Avant was utilized to examine the attributes of feeling safe. Uses of the concept, defining attributes as well as antecedents, consequences and empirical referents are presented to describe the concept. Case examples are provided in order to assist the understanding of the defining attributes. RESULTS Feeling safe is defined as: a person that does not feel worried or threatened. Three attributes were identified: Participation, Control and Presence. Knowledge and Relationship are the antecedents of feeling safe, while Feeling Acknowledged and Trust are the consequences. Empirical referents are explored in order to find a way to measuring the perceived feeling of safety. CONCLUSION This concept analysis underscores the importance of including patients' perceptions in traditional patient safety work. Patients who feel safe perceive that they participate in their care, that they are in control, and that they feel the presence of both healthcare staff and relatives. The perceived feeling of security could, by extension, promote the postoperative recovery of patients undergoing surgery by positively affect the process of recovery.
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Affiliation(s)
- Fanny Larsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Ulrica Strömbäck
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Silje Rysst Gustafsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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4
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Ngaledzani RI, Ndou-Mammbona AA, Mavhandu-Mudzusi AH. The Effect on Theatre Nurses for Rendering Perioperative Care to Patients Living with HIV in a South African Tertiary Hospital. AIDS Res Treat 2023; 2023:1889208. [PMID: 37750059 PMCID: PMC10518239 DOI: 10.1155/2023/1889208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose The study aimed to gain an in-depth understanding of how theatre nurses are being affected when they render perioperative care to patients living with HIV in a South African tertiary hospital. Background There is a scarcity of studies that focus solely on the wellbeing of theatre nurses who render perioperative care to HIV patient due to the ramifications of the nurses' fear of contracting HIV. Patients living with HIV often receive substandard care. Objectives To establish how theatre nurses are being impacted when rendering perioperative care to patient living with HIV, the study followed a qualitative approach using an interpretative phenomenological analysis design. Data were collected through in-depth individual interviews from ten theatre nurses who were purposively selected according to specific criteria. They voluntarily agreed to participate. An interpretive phenomenological analysis framework was used to analyse the data. Two main themes emerged from the data analysis, namely, the negative effect on nurses' wellbeing and the impact that it had on them professionally. Results The study revealed that the perioperative care of patients living with HIV had a negative impact on physical, mental, and social wellbeing of theatre nurses. Their compromised wellbeing in turn led to poor patient care, which put nurses at risk of losing their jobs and even potentially having to face litigation. The study further indicated that nurses did not receive psychological support from the management which further affected their health and professional performance. Conclusion The study proposes that theatre nurses rendering perioperative care to people living with HIV should receive proper training and support; staff shortages should also be addressed. There is also an urgent need for appropriate and sufficient protective equipment. Such changes will be essential in order to mitigate the negative impact that their jobs have on their wellbeing and on them in their professional capacity.
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Ingstad K, Pedersen MK, Uhrenfeldt L, Pedersen PU. Patients' expectations of and experiences with psychosocial care needs in perioperative nursing: a descriptive study. BMC Nurs 2023; 22:304. [PMID: 37670261 PMCID: PMC10478291 DOI: 10.1186/s12912-023-01451-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Meeting inpatients' psychosocial care needs is essential for their wellbeing, recovery, and positive experiences. This study aimed to describe and compare surgical inpatients' subjective perceptions of the importance of fundamental psychosocial and overall care received. METHODS A descriptive study with a convenient sample was conducted from September 2019 to April 2020. A total of 194 surgical inpatients from Norway and Denmark answered a perioperative user participation questionnaire on the day of discharge. The questionnaire was previously face- and content validated. The questionnaire assessed patients' sociodemographic characteristics and four dimensions of fundamental care domains: Psychosocial, Relational, Physical, and System level. This study reports the results from the psychosocial domain. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to analyze background information variables. The congruency between participants' expectations of and experiences with psychosocial care is presented. RESULTS The inpatients expected (and experienced) the healthcare personnel to treat them with respect and dignity, and to be involved and informed throughout their perioperative care. The average ratings regarding these aspects of psychosocial care needs were 72.1-93.8%. There was congruency between patients' perceptions of the subjective importance (SI) of psychosocial fundamental care and their perceived reality (PR) of care. Congruency between high SI and high PR ranged from 59.1 to 92.2%, and congruency between low SI and low PR ranged from 0 to 6.6%. Incongruency between SI and PR varied between 5.9 and 39.6% and was mainly related to higher PR than SI. We found no association between education level, sex, length of stay, age, and patient expectations of or experiences with psychosocial care needs. CONCLUSIONS Surgical inpatients in Norway and Denmark experience respectful and dignified treatment, and they feel involved and informed in their perioperative care. It is important to include patient perspectives in further research to avoid missed care and disconnection between what patients prefer and what healthcare personnel plan to do. Understanding patient preferences might also lead to less stress and workload for healthcare personnel.
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Affiliation(s)
- Kari Ingstad
- Faculty of Nursing and Health Science, Nord University, Pb. 93, Levanger, 7601, Norway.
| | - Mona K Pedersen
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
- Department for Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lisbeth Uhrenfeldt
- Nord University Faculty of Nursing and Health Science, Nord University, Bodø, Norway
- Institute of Regional Health Research, Southern Danish University, Ortopedic dep., Lillebaelt University Hospital, Kolding, Denmark
| | - Preben U Pedersen
- Centre of Clinical Guidelines, Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
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Cardoso MM, Baixinho CL, Silva GTR, Ferreira Ó. Nursing Interventions in the Perioperative Pathway of the Patient with Breast Cancer: A Scoping Review. Healthcare (Basel) 2023; 11:1717. [PMID: 37372835 DOI: 10.3390/healthcare11121717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
The decrease in average hospitalisation time and the increase in outpatient surgery in some types of breast cancer represent gains for the reduction of the negative impact of hospitalisation in women with breast cancer but are also a challenge for the organisation of nursing care to prepare women for surgery, reduce anxiety about the interventions, and ensure continuity of care in the postoperative period. The aim of this study is to identify nursing interventions present in the care provided to patients with breast cancer during the perioperative period. A scoping review was the method chosen to answer the research question: What are the specialised nursing interventions in the perioperative pathway of the patient with breast cancer? Inclusion and exclusion criteria were defined for the articles that were identified in the CINAHL and MEDLINE databases; later, additional sources were identified from the list of bibliographic references for each selected study. The final bibliographical sample consisted of seven articles, which allowed the identification of three key moments of nursing interventions in the perioperative period of patients with breast cancer: the preoperative consultation, the reception of the patient in the operating room, and the postoperative consultation. Factors such as psychological, emotional, and spiritual support, communication and patient-centred care, health education and surgical safety, and the definition of a perioperative pathway for these patients contribute significantly to patients' satisfaction and the improvement of their quality of life. The results of this study make it possible to establish recommendations for practise and for research, increasing the range of nurses' actions.
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Affiliation(s)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, 1600-190 Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
| | - Gilberto Tadeu Reis Silva
- Stricto-Sensu Graduate Program at the School of Nursing, Federal University of Bahia, Salvador 40170-110, Brazil
| | - Óscar Ferreira
- Nursing School of Lisbon, 1600-190 Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
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7
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Joymangul JS, Sekhari A, Grasset O, Moalla N. Homecare interventions as a Service model for Obstructive sleep Apnea: Delivering personalised phone call using patient profiling and adherence predictions. Int J Med Inform 2023; 170:104935. [PMID: 36473408 DOI: 10.1016/j.ijmedinf.2022.104935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive Sleep Apnea (OSA) is a sleep disorder that leads to different pathologies like depression and cardiovascular problems. The first-line medical treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy. However, this therapy has the lowest adherence level when compared to other homecare therapies. Consequently, the main objective of this paper is to increase this adherence level with methods that can be replicated in a large number of patients. METHODS The Homecare Intervention as a Service model can build, verify, and deliver per-sonalised home care interventions. With the Homecare Intervention as a Service model, we build and provide on-demand personalised interventions according to the patient's needs. The 2 core components of this model are patient clustering and CPAP adherence predictions. To define the patient profiles and predict the adherence level, we apply the K-means and the Logistic Regression algorithm respectively. To support these algorithms, we use the CPAP monitoring data and qualitative data on the patients. RESULTS We demonstrate that there are 3 patient profiles (non-adherent, attempter, and adherent). We draw a comparison with multiple machine learning algorithms to predict CPAP adherence at 30, 60 and 90 days. In this case, the Logistic Regression gives the best results with a f1-score of 0.84 for30 days, 0.79 for 60 days and 0.76 for 90 days. These newly build profiles were to be used to deliver personalised phone call interventions. The phone call intervention shows an increase in adherence by 1.02 h/night for non-adherent patients and 0.69 h/night for attempter patients. CONCLUSIONS This is the first study in CPAP therapy that formalises the process of transforming raw data into effective home care interventions that can be delivered directly to the patients. In fact,it is the first time that both patient characterisation and predictions based on data are used to provide personalised patient management for CPAP therapy. Our model is flexible to be extended to new types of interventions and other homecare therapies.
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Blöndal K, Sveinsdóttir H, Ingadottir B. Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study. Nurs Open 2022; 9:2495-2505. [PMID: 35666048 PMCID: PMC9374389 DOI: 10.1002/nop2.1270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/08/2022] Open
Abstract
Aims The aim of this study was to explore the educational expectations and experiences of surgical patients. Design Prospective, longitudinal, descriptive and two‐centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery. Methods Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre‐operative and pre‐discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected. Results Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face‐to‐face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.
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Affiliation(s)
- Katrín Blöndal
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Herdís Sveinsdóttir
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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9
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Cheng JYJ, Wong BWZ, Chin YH, Ong ZH, Ng CH, Tham HY, Samarasekera DD, Devi KM, Chong CS. Preoperative concerns of patients undergoing general surgery. PATIENT EDUCATION AND COUNSELING 2021; 104:1467-1473. [PMID: 33303283 DOI: 10.1016/j.pec.2020.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period. METHODS Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden's methodology. RESULTS 27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients' trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs' credibility and capabilities. CONCLUSION Patients' preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered. PRACTICE IMPLICATIONS Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.
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Affiliation(s)
| | - Bryan Wei Zhi Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Zhi Hao Ong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Hui Yu Tham
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala M Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore.
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10
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Viftrup A, Dreyer P, Nikolajsen L, Holm A. Surgery cancellation: A scoping review of patients' experiences. J Clin Nurs 2020; 30:357-371. [PMID: 33258277 DOI: 10.1111/jocn.15582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To review the literature on patients' experiences of surgery cancellation to gain knowledge of nursing care needs and identify gaps in evidence. BACKGROUND Surgery cancellations are an ongoing challenge in healthcare systems with negative impacts on healthcare costs, hospital staff and patients. Most research addresses the reasons for cancellation and implementation of preventive interventions, but limited knowledge exists about patients' experiences of cancellation. DESIGN The scoping review was undertaken using the methodology recommended by the Joanna Briggs Institute for Scoping Reviews and the Reporting Cheklist for Scoping Reviews (PRISMA-ScR). METHODS A systematic search was conducted by two independent researchers in Cochrane Library, CINAHL, PubMed and PsycINFO. A forward and backward citation search was performed in Scopus, and references in relevant studies were explored. The tool Covidence was applied to select, compare and discuss relevant articles. The Mixed Methods Appraisal Tool was used for critical appraisal. RESULTS Surgery cancellation is emotionally harmful with negative effects on patients. Four themes were identified: 'Initial reactions to cancellation', 'Reactions during a new waiting period at home and during readmission to hospital', 'Information about cancellation' and 'The experience of new practical arrangements'. Patients whose surgery was cancelled experienced initial feelings such as anger, rejection and anxiety and physical/psychosomatic symptoms in the extended waiting period. Patients prefered early sufficient information about cancellation from the surgeon. The practical arrangements were stressfull for the patients. CONCLUSION Nursing care and identification of vulnerable patients are essential to prevent negative effects in the extended waiting period. Provision of timely, sufficient and professional information about cancellation from the surgeon is important. Further research assessing consequences of cancellation is needed. RELEVANCE TO CLINICAL PRACTICE Patients would benefit if hospitals find systems to minimise cancellation, and healthcare professionals could systematically develop professional supportive interventions tailored to patients' individual needs.
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Affiliation(s)
- Anette Viftrup
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Bergen University, Bergen, Norway
| | - Lone Nikolajsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Holm
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Nallani R, Fox CC, Sykes KJ, Surprise JK, Fox CE, Reschke AD, Simpson MH, Polivka BJ, Villwock JA. Pain Management and Education for Ambulatory Surgery: A Qualitative Study of Perioperative Nurses. J Surg Res 2020; 260:419-427. [PMID: 33256986 PMCID: PMC10165861 DOI: 10.1016/j.jss.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ambulatory surgery presents unique challenges regarding adequate pain management and education. Studies have documented issues with transfer of information and patient comfort. Our objective was to explore perioperative nurses' perspectives of current practices and challenges with pain management and education. MATERIALS AND METHODS We used a qualitative descriptive design and conducted four focus group interviews, with 24 total participants from two perioperative areas of an academic medical center, using a standardized script. Using qualitative analysis software, two investigators reviewed the data and coded major themes and subthemes. The consolidated criteria for reporting qualitative studies guidelines were followed for reporting the data. RESULTS We identified four major themes impacting current perioperative pain management and education practices: communication among the perioperative care team, sources of nurses' frustrations in the perioperative setting, patient expectations for pain, and nurse-driven pain management and education. Nurses highlighted their work became easier with adequate information transfer and trust from physicians. Frustrations stemmed from surgeon, system, and patient factors. Nurses often use their clinical experience and judgment in managing patients throughout the perioperative period. Furthermore, nurses felt patients have limited pain education and stressed education throughout the surgical care pathway could improve overall care. CONCLUSIONS Perioperative pain management, assessment, and education practices are inconsistent, incomplete, and sources of frustrations according to participants. Participant experiences highlight the need for improved and standardized models. Patient pain education should use a multidisciplinary approach, beginning at the point of surgery scheduling and continuing through postoperative follow-up.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
| | - Cameron C Fox
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer K Surprise
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Clare E Fox
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Alan D Reschke
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Melanie H Simpson
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Barbara J Polivka
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer A Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
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12
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Sandelin A, Gustafsson BÅ, Kalman S. Congruency Between Planned and Performed Procedures and Adherence to Recommended Perioperative Practices: A Chart Audit of High-Risk Surgical Patients. AORN J 2020; 112:663-673. [PMID: 33252792 DOI: 10.1002/aorn.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/31/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022]
Abstract
Documentation in an electronic health record system helps ensure that perioperative personnel provide appropriate treatment and care to surgical patients. A retrospective chart review performed with an audit instrument sought to describe the extent to which the documented preoperative plan for a surgery corresponded to the procedure performed. The secondary aim was to describe to what extent perioperative nurses' and physicians' documented care was in accordance with national and international guidelines. Extracted data consisted of physicians' and nurses' documentation of 24 high-risk surgical patients who died within 30 days after a procedure at two hospitals within a single health system. Surgeons documented a planned surgical method for 23 of the 24 patients and the surgical team performed 20 surgeries as planned. Perioperative nurses' and anesthesia professionals' documentation showed a lack of adherence to recommended practices: compliance with guidelines concerning antibiotic prophylaxis and preoperative hygiene preparation were low.
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13
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Tobiano G, Jerofke‐Owen T, Marshall AP. Promoting patient engagement: a scoping review of actions that align with the interactive care model. Scand J Caring Sci 2020; 35:722-741. [DOI: 10.1111/scs.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Georgia Tobiano
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
| | | | - Andrea P. Marshall
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
- School of Nursing and Midwifery, Griffith University Southport Qld Australia
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Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: What does the patient experience? PLoS One 2019; 14:e0224899. [PMID: 31805061 PMCID: PMC6894823 DOI: 10.1371/journal.pone.0224899] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey. METHODS A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed. RESULTS Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey. CONCLUSIONS Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.
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Affiliation(s)
- Raffaella Gualandi
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
- * E-mail:
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Daniela Viglione
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniela Tartaglini
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
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