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Turcotte JJ, Chang YWW, Park AE. Patients Engaged in Losing Weight Preoperatively Experience Improved Outcomes After Hiatal Hernia Repair. Surg Innov 2024; 31:466-477. [PMID: 38907732 DOI: 10.1177/15533506241264371] [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] [Indexed: 06/24/2024]
Abstract
BACKGROUND Adherence to preoperative weight loss recommendations may serve as a surrogate for the level of engagement in hiatal hernia (HH) patients. This study aims to evaluate the relationship between achieving preoperative weight loss goals and outcomes after HH repair. METHODS A retrospective review of 235 patients undergoing laparoscopic HH repair at a single institution was performed. Patients were grouped based on the percentage of weight loss goal achieved. Low achievement was defined as the bottom quartile of goal achievement (≤75%); high achievement was defined as the top quartile (≥140%). Baseline characteristics, clinical outcomes, and patient reported outcomes (PROMs) were compared between groups. RESULTS 131/235 (55.7%) achieved their weight loss goal. No differences in baseline characteristics or clinical outcomes were observed between the low and high achievement groups. While both groups experienced improvements in PROMs postoperatively, patients in the high achievement group demonstrated significantly lower symptom burden at one-month postoperatively. Further, high-achievement patients were more likely to experience complete resolution of common HH symptoms at one-month postoperatively, including no difficulty swallowing food, no breathing difficulties or choking episodes, no choking when eating food, no choking when drinking liquid, and no regurgitation of food or liquid. CONCLUSIONS In patients undergoing laparoscopic HH repair, patients achieving their preoperative weight loss goals experienced less overall symptom burden and lower prevalence of common symptoms one-month postoperatively than those with low levels of goal achievement. These results demonstrate that patients can take an active role in improving their own surgical outcomes and health status.
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Affiliation(s)
- Justin J Turcotte
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Yu-Wei W Chang
- Department of Surgery, Penn State Health, Enola, PA, USA
| | - Adrian E Park
- Department of Surgery, Meritus Health, Hagerstown, MD, USA
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2
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Türker Ö, Şanlı D. Surgical Patients' Evaluation of Pain Management Quality and Surgical Nurses' Pain-Related Knowledge and Attitudes. Pain Manag Nurs 2024; 25:459-466. [PMID: 38600012 DOI: 10.1016/j.pmn.2024.03.012] [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: 09/04/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The present study was aimed at investigating the quality of pain management evaluated by inpatients in surgical clinics, and pain-related knowledge and attitudes of nurses working in surgical clinics, surgical units, or emergency services. METHODS The study was conducted as a descriptive and cross-sectional study. The study data were collected from inpatients in surgical clinics (N = 306), and from nurses working in surgical clinics, surgical units, or emergency services (N = 57) between January 2020 and September 2020. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) and Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) were the tools used for data collection. RESULTS The mean scores the participants obtained from the severity of worst pain, pain relief, and satisfaction with pain treatment components of the APS-POQ-R were 6.14 ± 2.59, 59.28 ± 22.26, and 8.99 ± 1.62, respectively. There were significant differences between many components of the APS-POQ-R in terms of such variables as age, sex, undergoing previous surgery, presence of pain before surgery, surgery performed, and type of anesthesia (p < .05). The mean score the participants obtained from the NKASRP was 15.35 ± 3.87. CONCLUSIONS It was concluded that the patients' pain was relieved moderately, that they were very highly satisfied with pain treatment, and that the nurses' pain-related knowledge and attitude levels were below the moderate level. CLINICAL IMPLICATIONS Nurses should support patients whose in-bed activities were prevented due to pain, involve them in pain treatment decisions, advise them about pain treatment options, and encourage them to use nonpharmacological methods.
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Affiliation(s)
- Özge Türker
- Izmir Alsancak Nevvar Salih Isgoren State Hospital, Konak, Izmir, Türkiye
| | - Deniz Şanlı
- Izmir Katip Celebi University, Faculty of Health Sciences, Nursing Department, Department of Surgical Nursing, Izmir, Türkiye.
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Bak SY, Uhm JY. A Nurse-Led App-Based Home Exercise Program After Total Knee Arthroplasty: A Quasi-Experimental Study. Rehabil Nurs 2024; 49:103-114. [PMID: 38904651 DOI: 10.1097/rnj.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
PURPOSE Reduced activity because of pain is a major health issue associated with total knee arthroplasty. This study evaluated the effectiveness of a nurse-led app-based home exercise program for patients who underwent total knee arthroplasty. METHODS A nonequivalent control group of pretest-posttest design was used. Data from 45 patients were collected. The control group received individualized face-to-face exercise education, whereas the experimental group received training on the use of app-based home exercise education, including exercise videos and app push notifications to encourage exercise after discharge. Pain, range of motion, exercise self-efficacy, and quality of life were measured at baseline and 3 and 12 weeks after surgery. Nursing care satisfaction was evaluated 12 weeks after surgery. RESULTS There were significant overall reductions in pain intensity ( p = .001), improvements in limited range of motion ( p < .001), and increases in exercise self-efficacy ( p = .034) and quality of life ( p = .033) in the experimental group ( n = 22) compared with those in the control group ( n = 23). Nursing care satisfaction was significantly higher in the experimental group than in the control group ( p < .001). CONCLUSIONS Rehabilitation nurses can offer app-based home exercise education with push notifications to alleviate pain, enhance range of motion, improve exercise self-efficacy, and increase nursing care satisfaction for patients who have had a knee arthroplasty.
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Affiliation(s)
- Song-Yi Bak
- Department of Nursing, Pukyong National University, Busan, South Korea
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Duclos A. Pragmatic trials are needed to assess the effectiveness of enhanced recovery after surgery protocols on patient safety. BMJ Qual Saf 2024; 33:348-350. [PMID: 38429103 DOI: 10.1136/bmjqs-2023-016966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Keen A, Lu Y, Oruche UM, Mazurenko O, Burke Draucker C. Patient Activation of Persons With Opioid Use Disorder in Intensive Outpatient Treatment. J Am Psychiatr Nurses Assoc 2024; 30:333-342. [PMID: 35581715 DOI: 10.1177/10783903221096473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High patient activation is associated with a variety of positive health outcomes. Although increasing patient activation in persons with opioid use disorder (OUD) in intensive outpatient treatment (IOT) programs may increase engagement and improve outcomes, little is known about how patient activation is manifested in these programs. AIMS To describe types of instances in which persons play an active role in their IOT or show self-determination in their recovery generally (patient activation) and types of instances in which they play a passive role in their IOT or have recovery directed by others (patient nonactivation). METHODS A qualitative descriptive study using data from a larger grounded theory study was conducted. Interviews were completed with 14 persons with OUD who attended an IOT program within a large health care system in the Midwest. Content analysis was used to create a typology of instances of patient activation or nonactivation in participants' IOT experiences. RESULTS Six types of instances were identified: (1) making and enacting one's own treatment decisions, (2) actively collaborating with staff, (3) self-determining one's disclosure in groups, (4) making a commitment to treatment, (5) taking responsibility for one's recovery, and (6) taking actions to avoid return to use. CONCLUSIONS Patient activation is multidimensional and plays a salient role in IOT experiences. IOT staff should engage patients as active participants in their treatment and encourage mutual goal-setting and shared-decision but should be aware that some approaches used too early in treatment may impede recovery.
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Affiliation(s)
- Alyson Keen
- Alyson Keen, MSN, RN, ACNS-BC, PhD Candidate, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Yvonne Lu
- Yvonne Lu, PhD, RN, FGSA, Associate Professor, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Ukamaka M Oruche
- Ukamaka M. Oruche, PhD, RN, FAAN, Associate Professor, Director of Global Programs, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Olena Mazurenko
- Olena Mazurenko, MD, PhD, Associate Professor, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Claire Burke Draucker
- Claire Burke Draucker, PhD, RN, FAAN, Angela Barron McBride Endowed Professor in Mental Health Nursing, Indiana University School of Nursing, Indianapolis, IN, USA
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Pritwani S, Shrivastava P, Pandey S, Kumar A, Malhotra R, Maddison R, Devasenapathy N. Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management After Knee Arthroplasty: Scoping Review. JMIR Mhealth Uhealth 2024; 12:e47843. [PMID: 38277195 PMCID: PMC10858429 DOI: 10.2196/47843] [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: 04/04/2023] [Revised: 10/10/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Successful post-knee replacement rehabilitation requires adequate access to health information, social support, and periodic monitoring by a health professional. Mobile health (mHealth) and computer-based technologies are used for rehabilitation and remote monitoring. The extent of technology use and its function in post-knee replacement rehabilitation care in low and middle-income settings are unknown. OBJECTIVE To inform future mHealth intervention development, we conducted a scoping review to map the features and functionality of existing technologies and determine users' perspectives on telerehabilitation and technology for self-management. METHODS We followed the Joanna Briggs Institute methodology for scoping reviews. We searched the Embase, Medline, PsycINFO via OVID, and Cochrane Central Register of Controlled Trials databases for manuscripts published from 2001 onward. We included original research articles reporting the use of mobile or computer-based technologies by patients, health care providers, researchers, or family members. Studies were divided into the following 3 categories based on the purpose: validation studies, clinical evaluation, and end user feedback. We extracted general information on study design, technology features, proposed function, and perspectives of health care providers and patients. The protocol for this review is accessible in the Open Science Framework. RESULTS Of the 5960 articles, 158 that reported from high-income settings contributed to the qualitative summary (64 studies on mHealth or telerehabilitation programs, 28 validation studies, 38 studies describing users' perceptions). The highest numbers of studies were from Europe or the United Kingdom and North America regarding the use of a mobile app with or without wearables and reported mainly in the last decade. No studies were from low and middle-income settings. The primary functions of technology for remote rehabilitation were education to aid recovery and enable regular, appropriate exercises; monitoring progress of pain (n=19), activity (n=20), and exercise adherence (n=30); 1 or 2-way communication with health care professionals to facilitate the continuum of care (n=51); and goal setting (n=23). Assessment of range of motion (n=16) and gait analysis (n=10) were the commonly validated technologies developed to incorporate into a future rehabilitation program. Few studies (n=14) reported end user involvement during the development stage. We summarized the reasons for satisfaction and dissatisfaction among users across various technologies. CONCLUSIONS Several existing mobile and computer-based technologies facilitate post-knee replacement rehabilitation care for patients and health care providers. However, they are limited to high-income settings and may not be extrapolated to low-income settings. A systematic needs assessment of patients undergoing knee replacement and health care providers involved in rehabilitation, involving end users at all stages of development and evaluation, with clear reporting of the development and clinical evaluation can make post-knee replacement rehabilitation care in resource-poor settings accessible and cost-effective.
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Affiliation(s)
- Sabhya Pritwani
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Purnima Shrivastava
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Shruti Pandey
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Ajit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
| | - Ralph Maddison
- Department of School of Exercise & Nutrition, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Niveditha Devasenapathy
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
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McNaughton MA, Quinlan-Colwell A, Lyons MT, Arkin LC. Acute Perioperative Pain Management of the Orthopaedic Patient: Guidance for Operationalizing Evidence Into Practice. Orthop Nurs 2024; 43:10-22. [PMID: 38266259 DOI: 10.1097/nor.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.
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Affiliation(s)
- Molly A McNaughton
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Ann Quinlan-Colwell
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Mary T Lyons
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Laura C Arkin
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
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Kinsey D, Febrey S, Briscoe S, Kneale D, Thompson Coon J, Carrieri D, Lovegrove C, McGrath J, Hemsley A, Melendez-Torres GJ, Shaw L, Nunns M. Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-164. [PMID: 38140881 DOI: 10.3310/ghty5117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Objectives To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: • understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation • understand the experiences of patients, carers and staff involved in the delivery of interventions • understand how different aspects of the content and delivery of interventions may influence patient outcomes. Review methods We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Results Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Overarching synthesis: Intervention components which trigger successful interventions represent individualised approaches that allow patients to understand their treatment, ask questions and build supportive relationships and strategies to help patients monitor their progress and challenge themselves through early mobilisation. Discussion Interventions to reduce hospital length of stay for older adults following planned surgery are effective, without detriment to other patient outcomes. Findings highlight the need to reconsider how to evaluate patient recovery from the perspective of the patient. Trials did not routinely evaluate patient mid- to long-term outcomes. Furthermore, when they did evaluate patient outcomes, reporting is often incomplete or conducted using a narrow range of patient-reported outcome measures or limited through asking the wrong people the wrong questions, with lack of longer-term evaluation. Findings from the qualitative and overarching synthesis will inform policy-making regarding commissioning and delivering services to support patients, carers and families before, during and after planned admission to hospital. Study registration This trial is registered as PROSPERO registration number CRD42021230620. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 130576) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 23. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Debbie Kinsey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Samantha Febrey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christopher Lovegrove
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - John McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Liz Shaw
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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A Quality Initiative Incorporating iPads to Improve Nonpharmacologic Pain Management in the Hospital. Pain Manag Nurs 2022; 23:655-662. [DOI: 10.1016/j.pmn.2022.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/09/2022] [Accepted: 02/26/2022] [Indexed: 11/22/2022]
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Kang E, Chaboyer W, Tobiano G, Gillespie B. Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients' postdischarge recovery: a pilot randomised controlled trial. BMJ Open 2022; 12:e054038. [PMID: 35140156 PMCID: PMC8830258 DOI: 10.1136/bmjopen-2021-054038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the feasibility of implementing a web-based discharge education programme for general surgery patients both prior to and after hospital discharge. DESIGN, SETTING AND PARTICIPANTS This is a prospective, two-arm, pilot randomised controlled trial. Patients who had a general surgery procedure were recruited from a tertiary hospital between October 2020 and January 2021. Patients were randomly assigned to either the standard education or the web-based education intervention. INTERVENTION The web-based education comprised of three components designed to enhance patients' knowledge, skills and confidence to improve their engagement with self-care, and the ability to detect any postoperative issues that can arise during the postdischarge period. MAIN OUTCOMES AND MEASURES The primary outcome was feasibility in terms of recruitment, randomisation, retention and treatment fidelity related to intervention delivery, adherence and satisfaction. Secondary outcomes were patient activation, self-care ability and unplanned healthcare utilisation. RESULTS Eighty-five patients were recruited and randomised (42 control; 43 intervention). Twenty-three (27%) were lost to follow-up. All patients received their group allocation as randomised and all patients in the intervention group received the web-based education prior to discharge. Postdischarge, patients accessed the education an average of 3 times (SD 3.14), with 4 minutes (SD 16) spent on the website. 28 (97%) of the intervention patients found the content easy to understand, 25 (86%) found it useful and 24 (83%) were satisfied with its content. There was a significant association between the intervention and patient activation (F(1,60)=9.347, p=0.003), but not for self-care ability and unplanned healthcare utilisations. CONCLUSION This pilot study demonstrated the feasibility of implementing a web-based education programme. There was a high number of participants lost to follow-up, requiring additional attention in the design and implementation of a larger trial. TRIAL REGISTRATION NUMBER ACTRN12620000389909p.
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Affiliation(s)
- Evelyn Kang
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Georgia Tobiano
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brigid Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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11
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McDonall J, Redley B, Livingston P, Hutchinson A, de Steiger R, Botti M. Implementation of a nurse-led multimedia intervention to increase patient participation in recovery following knee arthroplasty: Implementation study (Preprint). JMIR Hum Factors 2022; 9:e36959. [PMID: 35588363 PMCID: PMC9164095 DOI: 10.2196/36959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses’ views on who was responsible for facilitating this intervention. Conclusions The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639
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Affiliation(s)
- Jo McDonall
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Deakin University, Geelong, Australia
| | - Patricia Livingston
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Ana Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Geelong, Australia
| | - Richard de Steiger
- Epworth HealthCare, Epworth Victor Smorgon Chair of Surgery, Department of Surgery, Richmond, Australia
- The University of Melbourne, Melbourne, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Geelong, Australia
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Lockwood I, Walker RM, Latimer S, Chaboyer W, Cooke M, Gillespie BM. Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review. Contemp Clin Trials Commun 2022; 26:100894. [PMID: 36684693 PMCID: PMC9846456 DOI: 10.1016/j.conctc.2022.100894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 01/25/2023] Open
Abstract
Background There is increasing recognition of the importance of undertaking process evaluations alongside implementation of health interventions by examining mechanisms of impact and contextual factors. However, a comprehensive synthesis of process evaluations undertaken alongside clinical trials in hospital settings is lacking. We undertook a scoping review to address this gap. Methods This review was guided by the methodological framework for scoping studies. Studies were identified using four databases; Ovid Medline, EBSCO CINAHL, EMBASE and Scopus. Two authors independently screened all titles and available abstracts, with a third author available to adjudicate. Studies were eligible for inclusion if they described a process evaluation undertaken alongside a randomised controlled trial in the hospital setting. Data were abstracted by one author and checked by two others and analysed both descriptively and using inductive content analysis. Results Data were extracted from 30 articles reporting on 15 trials, most of which were cluster randomised trials (c-RTs) (n = 12). The most common data collection methods used in process evaluations were interviews, questionnaires or surveys, and records or logs. Data analysis revealed three themes relative to how authors: use process data to interpret, understand and explain trial outcomes; evaluate responses to the intervention; and consider the implementation context. Conclusions Findings from this review demonstrate the complex nature of intervention implementation in the hospital setting. Overall, there is need for standardised reporting of process evaluations and more explicit descriptions of how authors use frameworks to guide their evaluation.
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Affiliation(s)
- Ishtar Lockwood
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Rachel M. Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia,Corresponding author. Building L05, Room 3.44, Griffith University, Logan, Queensland, 4131, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Marie Cooke
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Brigid M. Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia
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13
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Redley B, Douglas T, Hoon L, White K, Hutchinson A. Nursing guidelines for comprehensive harm prevention strategies for adult patients in acute hospitals: An integrative review and synthesis. Int J Nurs Stud 2022; 127:104178. [DOI: 10.1016/j.ijnurstu.2022.104178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/05/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
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Keast M, Hutchinson AF, Khaw D, McDonall J. Impact of Pain on Postoperative Recovery and Participation in Care Following Knee Arthroplasty Surgery: A Qualitative Descriptive Study. Pain Manag Nurs 2021; 23:541-547. [PMID: 34972657 DOI: 10.1016/j.pmn.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient participation in care is key to optimising postsurgical outcomes and the quality of acute care delivery. AIMS This study explored patient perceptions of the impact of pain on acute recovery following Total Knee Arthroplasty (TKA), and barriers and facilitators to participating in pain management. DESIGN An exploratory-descriptive qualitative study involving semi-structured interviews. SETTINGS A private-sector health service. PARTICIPANTS/SUBJECTS Participants were adults undergoing TKA allocated to the control ward of a cluster randomised controlled trial who received standard care. METHODS To allow adequate opportunity for participation in their care, interview and pain data were collected on postoperative Day 3. Acute pain was assessed using an 11-point Numerical Rating Scale (NRS). Interviews were analysed using combined qualitative thematic analysis and quantitative content analysis. RESULTS Overall, 120 patients, 69 females (50.4%) and 68 males, were interviewed (mean age = 66.8 years, stadard deviation [SD] = 8.5). Most reported severe (NRS 7-10), day 3 pain (n = 76, 63.3%). Two themes emerged from interviews: (1) participants' postoperative pain experience; and (2) participation in postoperative pain management was limited. Pain experience was characterised by variation in pain and its qualities, having uncontrolled pain and distress, and influence from preoperative expectations. Patient participation was characterized by reliance upon prior staff instruction, barriers from limited knowledge, inconsistent promotion of non-pharmacologic strategies, and suboptimal clinician-patient communication. Regular analgesia was identified to facilitate participation. CONCLUSIONS Despite the known benefits of patient participation in pain management, gaps remain in providing patients with the knowledge and opportunity to take an active role in their recovery. Interventions to overcome identified barriers need to be developed and evaluated.
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Affiliation(s)
- Mirella Keast
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia
| | - Anastasia F Hutchinson
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia; Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia
| | - Damien Khaw
- Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia
| | - Joanne McDonall
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia; Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia.
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15
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Keen A, Lu Y, Oruche UM, Mazurenko O, Draucker CB. Activation in persons with mental health disorders: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:873-899. [PMID: 34311508 DOI: 10.1111/jpm.12789] [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: 04/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Evidence indicates a strong relationship between patient activation (i.e. confidence, knowledge and skills to self-manage health) and positive health behaviours and outcomes in a variety of clinical populations. Because persons with mental health disorders experience significant disease burden but often underutilize mental health treatment or experience poor treatment outcomes, they would likely benefit from increases in activation. No systematic reviews have been conducted to summarize and synthesize research on patient activation in persons with mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, this is the first comprehensive review to identify factors associated with activation and interventions that have shown to be effective in persons with mental health disorders. This integrative review indicates that better health status, less depression, positive health attitudes and behaviours, and higher quality therapeutic relationships may be associated with higher levels of activation in persons with mental health disorders. This review also indicates that a variety of interventions, most notably educational programs, are effective in increasing levels of patient activation in persons with mental health disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric mental health nurses and other clinicians should consider routine assessment of patient activation to inform individualized treatment plans for their clients. Clinicians should aim to form high-quality therapeutic relationships with clients as a way to promote higher levels of activation. Interventions that have been found to be effective in improving activation could be offered in a variety of mental health settings. ABSTRACT: Introduction Patient activation is understanding one's role in the healthcare process and having confidence, knowledge, and skills to self-manage one's health and health care. Researchers have begun to investigate patient activation in persons with mental health disorders, but no systematic reviews have been conducted to summarize and synthesize this research. For psychiatric mental health nurses and other clinicians to develop strategies to increase patient activation in this population, more information is needed about factors associated with activation and interventions that increase activation. Review Questions (1) What factors are associated with levels of activation in persons diagnosed with mental health disorders? (2) What interventions have shown to be effective at increasing levels of activation in persons diagnosed with mental health disorders? Method A 5-stage integrative review as described by Whittemore & Knafl. Results Twenty-nine articles were included in the review. Ten provided correlations between activation and other factors, and 20 examined the effects of interventions on activation. Some studies revealed significant correlations between a variety of health and treatment-related factors, and others revealed that some interventions, most notably educational programs, were shown to increase activation. Discussion The findings of this comprehensive review can inform psychiatric mental health nurses and other clinicians in developing strategies to increase activation in the patients with whom they work. More research is needed to provide a deeper understanding of the role of activation in the recovery and treatment of persons with mental health disorders. Implications for Practice Psychiatric nurses and other clinicians should assess for patient activation and incorporate strategies to increase levels of activation in patients in their practice. Positive therapeutic relationships likely enhance activation in persons with mental health disorders.
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Affiliation(s)
- Alyson Keen
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Yvonne Lu
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Ukamaka M Oruche
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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Alokozai A, Bernstein DN, Samuel LT, Kamath AF. Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades. J Patient Exp 2021; 8:23743735211036525. [PMID: 34435090 PMCID: PMC8381413 DOI: 10.1177/23743735211036525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Patient engagement is a comprehensive approach to health care where the physician
inspires confidence in the patient to be involved in their own care. Most
research studies of patient engagement in total joint arthroplasty (TJA) have
come in the past 5 years (2015-2020), with no reviews investigating the
different patient engagement methods in TJA. The primary purpose of this review
is to examine patient engagement methods in TJA. The search identified 31
studies aimed at patient engagement methods in TJA. Based on our review, the
conclusions therein strongly suggest that patient engagement methods in TJA
demonstrate benefits throughout care delivery through tools focused on promoting
involvement in decision making and accessible care delivery (eg, virtual
rehabilitation, remote monitoring). Future work should understand the influence
of social determinants on patient involvement in care, and overall cost (or
savings) of engagement methods to patients and society.
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Affiliation(s)
- Aaron Alokozai
- Tulane University School of
Medicine, New Orleans, LA, USA
| | | | | | - Atul F. Kamath
- Cleveland Clinic Foundation, Cleveland, OH, USA
- Atul F. Kamath, Center for Hip
Preservation, Orthopedic and Rheumatologic Institute, Cleveland Clinic, 9500
Euclid Avenue, Mailcode A41, Cleveland, OH 44195, USA.
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17
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Yao F, Zheng M, Wang X, Ji S, Li S, Xu G, Zheng Z. Patient activation level and its associated factors in adults with chronic pain: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e25929. [PMID: 34106661 PMCID: PMC8133271 DOI: 10.1097/md.0000000000025929] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Patients’ capacity to manage their own health can be graded by levels of activation. Highly activated patients tend to have better health outcomes. However, little is known about the activation levels of chronic pain patients in China. This study aimed to identify: (1).. the activation levels within this population; and (2).. demographic and pain factors associated with the level of activation. METHODS: In this cross-sectional survey, patients completed a sociodemographic questionnaire, Brief Pain Inventory and Patient Activation Measure (PAM) 13. Patient activation was measured and categorized into Levels 1–4. Its associations with sociodemographic, patient-reported diseases and pain variables were explored using Wilcoxon rank sum test and Kruskal-Wallis H test. RESULTS: Of 338 patients, 84 were excluded. Of the 254 remaining, 51.6% of patients were at lower activation levels (PAM Levels 1 and 2). Higher activation levels (PAM Levels 3 and 4) were recorded in patients with younger age (P = .00005), higher education (P = .0018), non-laboring occupations (P = .0239), and fewer co-morbidities (P = .00615). Intensities of the worst pain (P = .000627), average pain (P = .0213), and current pain (P = .0353), as well as the impact of pain on relationships with others (P = 0.00529), mood (P = .00391), sleep (P = .0132), and interest in life (P = .0248), were negatively correlated with activation levels. CONCLUSION: Half of the chronic pain patients in this population displayed lower activation levels. Older age, less education, manual labor, more co-morbidities, more intense pain and greater impact of pain on life were associated with lower activation levels. Pain education programs need to target the individual's PAM level. REGISTRATION: This trial was registered in Chinese Clinical Trial Registry. Number: ChiECRCT-20180170
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Affiliation(s)
- Fengzhen Yao
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Man Zheng
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xiaoqing Wang
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Shujuan Ji
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Sha Li
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Gang Xu
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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18
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McDonall J, Heynsbergh N, Oxley S, Botti M, Hutchinson A. Opportunities for patients to engage in postoperative recovery following cardiac surgery: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2020; 103:2095-2106. [PMID: 32381287 DOI: 10.1016/j.pec.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery. METHODS A systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English. RESULTS A total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery. CONCLUSIONS Gaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed. PRACTICE IMPLICATIONS Nurses are key drivers in facilitating patient participation in postoperative recovery.
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Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia
| | - Natalie Heynsbergh
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia.
| | | | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
| | - Anastasia Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
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19
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Howren MB, Vander Weg MW, Christensen AJ, Kaboli PJ. Association of patient preferences on medication discussion in hypertension: Results from a randomized clinical trial. Soc Sci Med 2020; 262:113244. [PMID: 32750626 DOI: 10.1016/j.socscimed.2020.113244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/26/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
Patient-centered care has received significant attention and is an integral component of high-quality healthcare. While it is often assumed that most prefer a patient-centered role orientation, such preferences exist along a continuum with some patients preferring a more provider-centered role. The present study examines patient preference data from a randomized clinical trial designed to test the efficacy of a patient activation intervention to promote thiazide prescribing for veteran patients with uncontrolled hypertension. Patient preferences for involvement in healthcare were assessed using the 9-item Sharing subscale of the Patient-Practitioner Orientation Scale (PPOS). The primary aim was to examine differences in discussion of thiazide use in the clinical encounter by those scoring high versus low on the PPOS. Five hundred ninety-five veteran patients were randomized to either one of three intervention groups or a usual care control group. The adjusted odds ratios (OR) for the three intervention groups relative to the control group indicated that thiazide discussion increased as a function of intervention intensity across both high and low PPOS groups. ORs for the most intensive intervention group were 3.72 (95% CI = 1.61-8.65, p < .01) for high PPOS patients and 6.71 (95% CI = 2.59-10.67, p < .001) for low PPOS patients. Results suggest that this patient activation intervention is effective for veteran patients representing a range of preferred involvement. Consideration of such preferences may be useful in tailoring future interventions in the healthcare context.
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Affiliation(s)
- M Bryant Howren
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | - Mark W Vander Weg
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Division of General Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological & Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - Peter J Kaboli
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Division of General Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
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20
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Analgesic Outcomes in a Danish Acute Care Hospital Following Electronic Prescribing and Analgesic Self-Administration. Pain Manag Nurs 2020; 21:345-353. [PMID: 32063502 DOI: 10.1016/j.pmn.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/10/2019] [Accepted: 12/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the long-term consequences of poorly controlled postoperative pain, inadequate pain control remains a problem. AIMS To improve the quality of postoperative pain management, the study site, an acute care hospital in Denmark, introduced electronic prescribing with standard order-sets, and allowed patients to self-administer analgesia. This study aimed to describe analgesic prescribing, prescriptions for multimodal analgesia, analgesic administration, and patients' pain experience, in this context. DESIGN Point-prevalence survey. SETTINGS One Danish regional hospital. PARTICIPANTS Consecutive sample of 286 surgical inpatients comprising 65 orthopaedic, 41 gynaecological, 57 urology and 123 gastrointestinal patients. METHODS We evaluated the quality of postoperative pain management on four postoperative surgical wards using: (1) the Revised American Pain Society Patient Outcome Questionnaire; and (2) patient chart audit. RESULTS Overall, 89.2% of patients were prescribed a fixed analgesic and 71.7% were prescribed fixed analgesics in multimodal combination. Patterns of multimodal prescribing and administration varied significantly across surgical groups. Patients received 87.7% of available fixed prescriptions and 22.5% of available analgesics prescribed 'as needed'. However, patients' worst pain intensity was high (mean = 5.8/10, SD = 2) and 73.4% reported moderate-to-severe worst pain during the previous 24-hours. Patients who self-administered medications used significantly more fixed-schedule paracetamol (p = .018), non-steroidal anti-inflammatory drugs (p = .001), weak (p = .035) and strong (p < .001) opioids. CONCLUSIONS The availability of multimodal analgesia was high following the introduction of electronic prescribing. However, gaps remain in the administration of both fixed and 'as needed' analgesics for postoperative patients. Findings suggested that allowing patients to self-administer analgesia may increase compliance with fixed schedule prescriptions.
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21
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McDonall J, Hutchinson AF, Redley B, Livingston PM, Botti M. Usability and feasibility of multimedia interventions for engaging patients in their care in the context of acute recovery: A narrative review. Health Expect 2019; 22:1187-1198. [PMID: 31778023 PMCID: PMC6882257 DOI: 10.1111/hex.12957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this narrative review was to examine the usability and feasibility of multimedia intervention as a platform to enable patient participation in the context of acute recovery and to discover what outcomes have been measured. DATA SOURCES A narrative review of primary research articles identified through a search of four electronic databases (MEDLINE, CINAHL, EMBASE and PsycInfo) identified peer-reviewed research evidence published in English language with no limitation placed on time period or publication type. Two authors independently assessed articles for inclusion. From the 277 articles identified through the search, 10 papers reporting the outcomes of seven studies were included in this review. REVIEW METHODS Articles were independently assessed for quality and relevance by two authors. The most appropriate method for data synthesis for this review was a narrative synthesis. RESULTS From the narrative synthesis of study outcomes, two findings emerged as follows: (a) multimedia interventions are feasible and usable in the context of acute care, and (b) multimedia interventions can improve patients' perception of care-related knowledge. Identified gaps included a lack of evidence in relation to the effect of interventions on enhancing patients' ability to participate in their care and the impact on patients' health-related outcomes. CONCLUSIONS In conclusion, there is some evidence of the feasibility and usability of multimedia interventions in acute care. That is, patients can use these types of platforms in this context and are satisfied with doing so. Multimedia platforms have a role in the delivery of information for patients during acute recovery; however, the effectiveness of these platforms to engage and enhance patients' capability to participate in their recovery and the impact on outcomes needs to be rigorously evaluated.
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Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Anastasia F. Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Bernice Redley
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Patricia M. Livingston
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
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22
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Value-based Healthcare: Improving Outcomes through Patient Activation and Risk Factor Modification. Clin Orthop Relat Res 2019; 477:2418-2420. [PMID: 31567580 PMCID: PMC6903833 DOI: 10.1097/corr.0000000000000985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Bangdiwala SI. Studying the effect of interventions in injury research: experimental design options. Int J Inj Contr Saf Promot 2019; 26:442-447. [PMID: 31591932 DOI: 10.1080/17457300.2019.1672923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Shrikant I Bangdiwala
- Population Health Research Institute and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa.,Violence, Injury & Peace Research Unit, South Africa Medical Research Council, Tygerberg, South Africa
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24
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Aldekhyyel RN, Bakker CJ, Pitt MB, Melton GB. The Impact of Patient Interactive Systems on the Management of Pain in an Inpatient Hospital Setting: A Systematic Review. Appl Clin Inform 2019; 10:580-596. [PMID: 31412381 PMCID: PMC6693998 DOI: 10.1055/s-0039-1694002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While some published literature exists on the use of interactive patient care systems, the effectiveness of these systems on the management of pain is unclear. To fill this gap in knowledge, we aimed to understand the impact and outcomes of pain management patient interactive systems in an inpatient setting. METHODS A systematic literature review was conducted across seven databases, and results were independently screened by two researchers. To extract relevant data, critical appraisal forms were developed and each paper was examined by two experts. Information included patient interactive system category, patient population and number of participants/samples, experiment type, and specific outcome measures. RESULTS Out of 58 full-text articles assessed for eligibility, 18 were eligible and included in the final qualitative synthesis. Overall, there were two main types of pain management interactive systems within the inpatient setting (standalone systems and integrated platform systems). While systems were diverse especially for integrated platforms, most reported systems were entertainment distraction systems. Reports examined a variety of outcome measures, including changes in patient-reported pain levels, patient engagement, user satisfaction, changes in clinical workflow, and changes in documentation. In the 13 systems measuring pain scores, 12 demonstrated a positive impact on pain level scores. CONCLUSION Pain management systems appear to be effective in lowering patient level scores, but research comparing the effectiveness and efficacy of one type of interactive system versus another in the management of pain is needed. While not conclusive, pain management systems integrated with other technology platforms show potentially promising effects with improving patient communication, education, and self-reporting.
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Affiliation(s)
- Raniah N. Aldekhyyel
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
- Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Caitlin J. Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, Minnesota, United States
| | - Michael B. Pitt
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Genevieve B. Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
- University of Minnesota Physicians, University of Minnesota, Minneapolis, Minnesota, United States
- Fairview Health Services, Minneapolis, Minnesota, United States
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25
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Wolfstadt JI, Soong C, Ward SE. Improving patient outcomes following total joint arthroplasty: is there an app for that? BMJ Qual Saf 2019; 28:775-777. [PMID: 31110141 DOI: 10.1136/bmjqs-2019-009571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada .,Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | - Sarah E Ward
- Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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