Patient-Centerdness in the Perioperative Period-A Rapid Review of Current Research

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.

The MeSH heading "Call Center" is due for an update: why we recommend the more precise heading "Emergency Medical Communication Center"

Call centers can be found in various industries. However as a Medical Subject Heading (MeSH) the term "Call centers" does not reflect the critical purpose of handling emergency calls. We recommend "emergency medical communication center(s)", as this provides clarity and precision regarding the primary function and purpose of the center.

Moral Courage: Student Registered Nurse Anesthetist Experiences on the Operating Team

Lack of moral courage may lead to moral stress for healthcare personnel and to unethical behavior or adverse events for patients. Hospital operating room (OR) teams include surgeons, OR nurses, Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, and student registered nurse anesthetists (SRNAs). Due to the multidisciplinary work in a stressful, high-technology and high-risk environment, the OR is the context for most of the unethical behavior reported in hospitals. The purpose of this study was to explore SRNA experiences of moral courage in the OR. We used a critical incident technique, utilizing 40 SRNA narratives of situations including moral courage/lack of moral courage. The narratives were analyzed using thematic analysis. Findings indicate that unethical behavior potentially leading to patient safety or work environment issues could be avoided when OR personnel showed moral courage by speaking up for patients or for colleagues. Lack of moral courage was indicated by tacit acceptance of unethical behavior or lack of collaboration. SRNAs need not only to learn about the CRNAs' professional obligations and tasks but also to develop moral courage to be able to respond to unethical behavior or communication in the OR. Hence, students should be introduced to such issues during their education.

Anesthesia Personnel's Experiences With Digital Anesthesia Information Management Systems: A Literature Review

Traditionally, anesthetic records were in paper format. An increasing volume of complex data, legislation, and quality improvement initiatives related to clinical documentation have promoted the transition to digital records. Anesthesia information management systems (AIMS) have been designed to directly extract patient information from the anesthesia workstation and transmit the data into documentation systems and databases. The purpose of this review was to explore existing literature on anesthesia personnel's experiences with digital AIMS. Literature searches were conducted in PubMed, Cumulative Index to Nursing & Allied Health Literature, Embase, and The Cochrane Database of Systematic Reviews. A total of 473 records were identified, of which 40 records were read in full-text. Seven records underwent quality appraisal, representing research from 1991 to 2018, all with a quantitative design. In total, 379 anesthesia personnel were included. Five studies were conducted in the United States; 1, in Korea; and 1, in Germany. Results were collated into the themes user satisfaction, technical aspects, physical placement of the system, paper-based vs electronic data entry, quality of care, and suggestions for improvement. Findings indicate both positive and negative effects of AIMS. Anesthesia personnel's experiences should be included in the planning, development, and implementation of digital data entry systems.

Nursing supervisors' perspectives on student preparedness before clinical placements- a focus group study

Clinical placements and supervision is an integral part of nursing education internationally. There are significant differences between students’ expectations of clinical learning and their fulfillment. Few studies have focused on supervisors’ perspectives on clinical placements. The objective of this study was to explore nursing supervisors’ perspectives on students’ preparedness for clinical placements.

Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy

BACKGROUND

Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancy.

METHODS

The study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire.

RESULTS

The expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach's alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts' test of sphericity was greater than the critical value for chi-square, and significant (p < .0001).

CONCLUSIONS

Findings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

General practitioners' perspectives on referring patients to decentralized acute health care

BACKGROUND

Municipality acute wards (MAWs) have recently been introduced in Norway. Their mandate is to provide treatment for patients who otherwise would have been hospitalized. Even though GPs are key stakeholders, little is known about how they perceive referring patients to these wards. The aim of this study was to investigate GPs' perspectives on factors relevant for their decision-making when referring patients to MAWs.

METHODS

We used a qualitative approach, conducting semi-structured interviews with 23 GPs from five different MAW catchment areas in the southeastern part of Norway. The data were analysed using thematic analysis.

RESULTS

The GPs experienced challenges in deciding which patients were suitable for treatment at a MAW, including whether patients could be regarded as medically clarified, and whether these services were sufficient and safe. GPs were also under pressure from several other stakeholders when deciding where to refer their patients. Moreover, the MAWs were viewed not merely as an alternative to hospitals, but also as a service in addition to hospitals.

CONCLUSION

This study improves our understanding of how GPs experience decentralized acute health care services, by identifying factors that influence and challenge their referral decisions. For these services to be used as intended in the collaboration reform, integrating the perspectives of GPs in the development and implementation of these services may be beneficial.