Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review

Psychometric properties of the Chinese version of the preoperative assessment of readiness tool among surgical patients

Background

The evaluation of the surgical readiness of patients plays an important role in clinical care. Preoperative readiness assessment is needed to identify the inadequacy among surgical patients, which provides guide for interventions to improve patients’ preoperative readiness. However, there is a paucity of high-level, quality tool that evaluate surgical readiness of patients in China. The purpose of this study is to translate the Preoperative Assessment of Readiness Tool (PART) into Chinese and determine the reliability and validity of the Chinese version in the population of surgical patients.

Methods

Using a standard translation-backward method, the original English version of PART was translated into Chinese. A convenient sampling of 210 surgical patients was recruited from 6 hospitals in Zhejiang Province to test the psychometric properties of this scale including internal consistency, split-half reliability, content validity, structure validity, and floor/ceiling effect.

Results

A total of 194 patients (92%) completed questionnaires. The Chinese version of PART achieved Cronbach’s alphas 0.948 and McDonald’s omega coefficient 0.947, respectively, for the full scale. The estimated odd-even split-half reliability was 0.959. The scale-level content validity index was 0.867, and the items content validity index ranged from 0.83 to 1.0.The output of confirmatory factor analysis (CFA) revealed a two-factor model (χ2 = 510.96; df = 86; p < 0.001; root mean square error approximation = 0.08) with no floor/ceiling effect.

Conclusion

The Chinese version of PART demonstrated acceptable reliability and validity among surgical patients. It can be used to evaluate patients’ preoperative preparation and help health professionals provide proper preoperative support.

Building the Case for Nurses' Continuous Professional Development in Ethiopia: A Qualitative Study of the Sick Kids-Ethiopia Paediatrics Perioperative Nursing Training Program

Background

This study describes the in-service training experience of perioperative nurses from the SickKids-Ethiopia Paediatrics Perioperative Nursing Training Program in Addis Ababa, Ethiopia. The study emphasizes specifically how nurses applied the knowledge and skills gained from the Paediatrics Perioperative Nursing Training program in their subsequent practice and consider the situational factors that facilitated or hindered implementing these new knowledge and skills.

Methods

The first author led qualitative in-depth interviews with nine perioperative nurses who participated in training in September 2016, and systematically developed descriptive codes and themes to analyze the data.

Results

The authors found that participants experienced improved knowledge, skills, confidence, and job retention related to perioperative nursing practice after participating in Paediatrics Perioperative Nursing Training. Participants also stressed key challenges including lack of access to ongoing perioperative in-service training and problematic staffing policies that impact perioperative nurses' ability to fully utilize and share new knowledge gained during CPD training.

Conclusion

The findings highlighted the value of specialized perioperative CPD training for Ethiopian nurses, yet also pointed to multidimensional challenges for knowledge translation and sustainability of best practices. The authors offer recommendations for individual and institutional strategies to address some of them.

Total knee replacement pre-operative education in a Singapore tertiary hospital: A best practice implementation project

OBJECTIVES

To increase the competency of specialist outpatient clinic nurses in the provision of pre-operative total knee replacement (TKR) education, and ensure that all patients scheduled for elective TKR received the pre-operative education package.

METHODS

The project was implemented in three phases. Phase 1 entailed a baseline audit that analysed 30 randomized TKR patients who received pre-operative education. In Phase 2, the gaps and barriers in the project were discussed. Using best practice recommendations from the Joanna Briggs Institute, the project team leader collated and standardized the pre-operative education tools, which consisted of a pictorial booklet, a video and home care advice. A teaching plan guided the nurses to increase their understanding and improve practice using the education tools. The usefulness of education strategies and tools was discussed and these were improved over the proposed timeline. Phase 3 entailed a post-implementation audit to evaluate the provision of pre-operative education.

RESULTS

Post implementation, nurses' competency in the provision of pre-operative TKR education increased from 18% to 91%. The number of patients who received the structured pre-operative education package increased from 27% to 50%.

CONCLUSION

Overall, there was improvement in the provision of pre-operative TKR education to patients by clinic nurses using evidence-based best practice and a standardized education package.

Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment

BACKGROUND

Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.

METHODS

We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.

RESULTS

In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.

CONCLUSION

The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context - including performance targets - promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.