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Sümen A, Adibelli D. The effect of case-based teaching method on professional competence and clinical decision-making levels of public health nursing students: A sequential explanatory mixed-methods study. Public Health Nurs 2024; 41:446-457. [PMID: 38450824 DOI: 10.1111/phn.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/04/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To evaluate the effect of case-based teaching method applied to fourth year nursing students on their professional competence and clinical decision-making levels. DESIGN A quasi-experimental design study with a sequential-exploratory mixed-method approach. SAMPLE 64 nursing students enrolled in the Public Health Nursing course. METHODS A case-based teaching program was applied to the students that cover the topics of the Public Health Nursing course. Quantitative phase data were collected with the Clinical Decision Making in Nursing Scale and Nursing Students' Competence Scale. For the qualitative part, focus group interviews were conducted with a Structured Interview Form. RESULTS It was determined that the total and subscale posttest scores of the students increased significantly compared to their pretest scores (p < .001). A moderate positive correlation was found between the total scores received from the scale and a significant positive correlation was found between researching information and adopting new information impartially and all sub-dimensions except care (p < .05). Three main themes emerged from the focus group interviews conducted after the case-based teaching method experience: usefulness, limitations, and improvement. CONCLUSIONS Case-based teaching method is effective on students' professional competence and clinical decision-making scores. Students' professional competence levels positively affect their clinical decision-making levels.
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Affiliation(s)
- Adem Sümen
- Department of Public Health Nursing, Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Derya Adibelli
- Department of Public Health Nursing, Faculty of Health Sciences, Antalya Bilim University, Antalya, Turkey
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2
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Bulls HW, Hamm M, Wasilewski J, Olejniczak D, Bell SG, Liebschutz JM. "To prescribe or not to prescribe, that is the question": Perspectives on opioid prescribing for chronic, cancer-related pain from clinicians who treat pain in survivorship. Cancer 2024. [PMID: 38567685 DOI: 10.1002/cncr.35299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Opioid pain management in cancer survivorship is a complex and understudied topic. METHODS The authors conducted in-depth, qualitative interviews to understand clinician approaches to opioid pain management in chronic cancer pain and to generate ideas for improvement. They used a rigorous, inductive, qualitative, descriptive approach to examine clinician (n = 20) perspectives about opioid pain management in survivorship, including oncologists (n = 5), palliative care clinicians (n = 8), primary care clinicians (n = 5), and pain management specialists (n = 2). RESULTS The findings indicated that no consistent medical home exists for chronic pain management in cancer survivors and that there are fundamental differences in how each subspecialty approaches chronic pain management in survivorship (e.g., "Do we think of this as noncancer pain or cancer pain?… This is in this limbo zone-this gray zone-because it's cancer-related pain, right?"). Simultaneously, clinicians are influenced by their peers' perceptions of their opioid prescribing decisions, sparking intraprofessional tension when disagreement occurs. In these instances, clinicians described overthinking and doubting their clinical decision-making as well as a sense of judgment, pressure, and/or shame. Finally, clinicians acknowledged a fear of consequences for opioid prescribing decisions. Specifically, participants cited conflict with patients, sometimes escalating to aggression and threats of violence, as well as potential disciplinary actions and/or legal consequences. CONCLUSIONS Participants suggested that opportunities to improve chronic cancer pain care include developing clear, systematic guidance for chronic cancer pain management, facilitating clinician communication and consultation, creating tailored survivorship care plans in partnership with patients, and developing accessible, evidence-based, complementary pain treatments.
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Affiliation(s)
- Hailey W Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan Hamm
- Qualitative, Evaluation, and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia Wasilewski
- Qualitative, Evaluation, and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donna Olejniczak
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Wood L, Giles E, Cunningham L, Le H, Zientara N, Short M. Proton radiation therapy patient selection and impacts of COVID-19: A scoping review. J Med Radiat Sci 2024; 71 Suppl 2:37-46. [PMID: 37431794 PMCID: PMC11011594 DOI: 10.1002/jmrs.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023] Open
Abstract
This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines. A literature search was performed in Medline, Embase, Web of Science and Scopus, as well as grey literature. Keywords such as "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 11 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Six of 11 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Few publications detailed changes to patient selection or workflow methods during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in PT, collecting this data could aid in future planning for PT in Australia.
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Affiliation(s)
- Lucy Wood
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Eileen Giles
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Lisa Cunningham
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Hien Le
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Nicole Zientara
- Liverpool Cancer Therapy CentreLiverpool HospitalSydneyNew South WalesAustralia
- Macarthur Cancer Therapy CentreCampbelltown HospitalSydneyNew South WalesAustralia
| | - Michala Short
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Litschi MA, Lancaster SL, Linkh DJ, Renno S, Neal-Walden TA, Lawless CE, Breetz AA. Evaluating Suicide Risk Stratification in Outpatient Settings: A Vignette-Based Approach. Clin Psychol Psychother 2024; 31:e2965. [PMID: 38572772 DOI: 10.1002/cpp.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
Suicide risk assessment and stratification are a key suicide prevention strategy in mental health care systems that treat military service members and veterans. The aim of the current mixed-method project was to address a gap in our knowledge as to how therapists make these important clinical decisions. This manuscript reports the results of a project during which six vignettes were developed reflecting varying levels of risk according to the Rocky Mountain MIRECC Risk Stratification Table. Mental health therapists were asked to evaluate the risk level of each vignette, determine a treatment disposition, and provide justification for their ratings. The results of the study indicate that therapists can reliably evaluate risk, but that treatment planning tended to be based more on vignette-specific factors than essential features of the risk model. The qualitative findings revealed variations in the definition and perception of foundational concepts, suggesting a need for further research and training in these domains. Overall, the results support the use of vignettes as a method to assess clinical decision-making and provide several areas for further training and research.
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Affiliation(s)
- Melissa A Litschi
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
| | - Steven L Lancaster
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
| | - David J Linkh
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
| | - Stephanie Renno
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
| | | | - Claire E Lawless
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
| | - Alisa A Breetz
- Institute for Quality, Cohen Veterans Network, Stamford, Connecticut, USA
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Eubank BHF, Martyn J, Schneider GM, McMorland G, Lackey SW, Zhao XR, Slomp M, Werle JR, Robert J, Thomas KC. Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada. J Evid Based Med 2024; 17:224-234. [PMID: 38270389 DOI: 10.1111/jebm.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management. METHODS A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI). RESULTS A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management. CONCLUSIONS This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.
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Affiliation(s)
- Breda H F Eubank
- Faculty of Health, Community, & Education, Department of Health & Physical Education, Mount Royal University, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jason Martyn
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
| | - Geoff M Schneider
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gord McMorland
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
- National Spine and Wellness Clinic, Calgary, Alberta, Canada
| | | | - Xu Rong Zhao
- Knowledge Resource Service, Alberta Health Services, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mel Slomp
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
| | - Jason R Werle
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
| | - Kenneth C Thomas
- Bone & Joint Health Strategic Clinic Network, Alberta Health Services Corporate Office, Seventh Street Plaza, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Aïdoud A, Gana W, Poitau F, Debacq C, Leroy V, Nkodo J, Poupin P, Angoulvant D, Fougère B. High Prevalence of Geriatric Conditions Among Older Adults With Cardiovascular Disease. J Am Heart Assoc 2023; 12:e026850. [PMID: 36628962 PMCID: PMC9939057 DOI: 10.1161/jaha.122.026850] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
As the population ages, the global cardiovascular disease burden will continue to increase, particularly among older adults. Increases in life expectancy and better cardiovascular care have significantly reshaped the epidemiology of cardiovascular disease and have created new patient profiles. The combination of older age, multiple comorbidities, polypharmacy, frailty, and adverse noncardiovascular outcomes is challenging our routine clinical practice in this field. In this review, we examine noncardiovascular factors that statistically interact in a relevant way with health status and quality of life in older people with cardiovascular disease. We focused on specific geriatric conditions (multimorbidity, polypharmacy, geriatric syndromes, and frailty) that are responsible for a major risk of functional decline and have an important impact on the overall prognosis in this patient population.
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Affiliation(s)
- Amal Aïdoud
- Division of Geriatric MedicineTours University HospitalToursFrance,EA4245 Transplantation, Immunologie, InflammationTours UniversityToursFrance
| | - Wassim Gana
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Fanny Poitau
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Camille Debacq
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Victoire Leroy
- Division of Geriatric MedicineTours University HospitalToursFrance,EA 7505 Education, Ethics, HealthTours UniversityToursFrance
| | | | - Pierre Poupin
- INSERM CIC 1415Tours University HospitalToursFrance,INSERM, SPHERE U1246Tours University, Nantes UniversityToursFrance
| | - Denis Angoulvant
- EA4245 Transplantation, Immunologie, InflammationTours UniversityToursFrance,Cardiology UnitTrousseau Hospital, Tours University HospitalToursFrance
| | - Bertrand Fougère
- Division of Geriatric MedicineTours University HospitalToursFrance,EA 7505 Education, Ethics, HealthTours UniversityToursFrance
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Ghodsi Astan P, Goli R, Hemmati Maslakpak M, Rasouli J, Alilu L. The effect of evidence-based nursing education on nurses' clinical decision making: A randomized controlled trial. Health Sci Rep 2022; 5:e837. [PMID: 36189417 PMCID: PMC9488901 DOI: 10.1002/hsr2.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Nurses are the largest group of health-care providers and their clinical decisions have an essential role in patients' clinical condition. Evidence-based nursing has been proposed as a health-care method based on the latest findings and evidence. Therefore, we aimed to determine the effect of evidence-based nursing education on dialysis nurses' clinical decision-making. Material and Methods This single-blind experimental study conducted in 2021 at dialysis wards of teaching hospitals affiliated to Urmia University of Medical Sciences. In this study, a total of 60 dialysis nurses were recruited using convenience sampling and allocated to two groups of intervention (n = 30) and control (n = 30). Data were collected at three time points of before, 1 week after, and 1 month after the intervention using a demographic questionnaire and the Lauri and Salantera Clinical Decision-Making Questionnaire (LSCD-MQ). Nurses in the intervention group received 12 sessions of evidence-based nursing education, while nurses in the control group received no intervention. Results The results showed the mean score of clinical decision-making had a significant decreasing trend over time (p < 0.001) so that it decreased significantly 1 week after the intervention (72.83 ± 4.90) compared with before the intervention (69.5 ± 67.34) in the intervention group. Moreover, participants' decision-making moved toward analytical decision-making. The results also indicated there was a significant difference between the baseline mean score of clinical decision-making and the postintervention mean scores obtained 1 week (p = 0.025) and 1 month (p = 0.001) after the intervention. However, this difference was not found to be significant in the control group (p = 1.000). Conclusions The study results indicate the positive effect of evidence-based education on nurses' clinical decision-making. Therefore, nurses are recommended to apply evidence-based education methods to improve their level of clinical decision-making. Health officials are also recommended to hold in-service evidence-based workshops to update nurses' knowledge.
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Affiliation(s)
- Parisa Ghodsi Astan
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyUrmia University of Medical SciencesUrmiaWest AzerbaijanIran
| | - Rasoul Goli
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyUrmia University of Medical SciencesUrmiaWest AzerbaijanIran
| | - Masumeh Hemmati Maslakpak
- Department of Nursing, School of Nursing and MidwiferyUrmia University of Medical SciencesUrmiaWest AzerbaijanIran
| | - Javad Rasouli
- Biostatistics and Epidemiology Department, School of MedicineUrmia University of Medical SciencesUrmiaWest AzerbaijanIran
| | - Leyla Alilu
- Department of Nursing, School of Nursing and MidwiferyUrmia University of Medical SciencesUrmiaWest AzerbaijanIran
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Mboineki JF, Chen C, Gerald DD, Boateng CA. The current status of nurses-doctors collaboration in clinical decision and its outcome in Tanzania. Nurs Open 2019; 6:1354-1362. [PMID: 31660162 PMCID: PMC6805315 DOI: 10.1002/nop2.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 05/13/2019] [Accepted: 06/10/2019] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study was to establish the current level of collaboration between nurses and medical doctors (MDs) in the making of clinical decisions. DESIGN Descriptive qualitative design was applied in this study. METHODS Semi-structured interviews were conducted to collect qualitative data. Contents were arranged according to their similarities, whereas content analysis was used to identify explanatory themes. RESULTS Nurses feel disrespected when medical doctors (MDs) ignore their opinions. The impression of lower level of education of nurses is seen as a cause to their opinions been ignored by the medical doctors. Nurses sometimes adhere to the instructions of MDs, but on other times, they carry on with their own proposed treatment. IMPLICATIONS FOR NURSING PRACTICES Involvement of nurses in clinical decisions will enable nurses to effectively advocate for patients.
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Affiliation(s)
- Joanes Faustine Mboineki
- School of NursingZhengzhou UniversityZhengzhouChina
- School of Nursing and Public Health, College of Health SciencesThe University of DodomaDodomaTanzania
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Backman T, Juuso P, Borg R, Engström Å. Ambulance nurses' experiences of deciding a patient does not require ambulance care. Nurs Open 2019; 6:783-789. [PMID: 31367400 PMCID: PMC6650689 DOI: 10.1002/nop2.255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
AIM To describe ambulance nurses' experience of deciding a patient does not require ambulance care. DESIGN An inductive, empirical study with a qualitative approach. METHODS Data collection was conducted through semi-structured interviews, and collected data were analysed with qualitative manifest content analysis. Data were collected during the spring 2017, and eight ambulance nurses participated. RESULTS The findings are presented in one main category, which is "Not very ill but a difficult decision" with totally three subcategories. The ambulance nurse's experience of making the assessment when the patient has no need for ambulance care is like walking the balance of slack line. This means that the assessment can be both easy and very difficult but something that definitely requires experience, knowledge and dedication.
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Affiliation(s)
| | - Päivi Juuso
- Division of Nursing, Department of Health ScienceLuleå University of TechnologyLuleåSweden
| | - Ronja Borg
- Västerås HospitalRegion of VästmanlandVästeråsSweden
| | - Åsa Engström
- Division of Nursing, Department of Health ScienceLuleå University of TechnologyLuleåSweden
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Berntzen H, Bjørk IT, Wøien H. "Having the compass-drawing the map": Exploring nurses' management of pain and other discomforts during use of analgosedation in intensive care. Nurs Open 2019; 6:453-462. [PMID: 30918696 PMCID: PMC6419128 DOI: 10.1002/nop2.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/10/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
AIM To explore the deliberation and enactment processes of nurses in relation to pain and other discomforts in the critically ill patients after the implementation of an analgosedation protocol. BACKGROUND Nurses in intensive care units (ICU) face great challenges when managing pain and other discomforts and distinguishing between patients' needs for analgesics and sedatives. An analgosedation protocol favouring pain management, light sedation and early mobilization was implemented in a university hospital ICU in Norway in 2014. Changing sedation paradigms resulting in an increasing number of awake patients during critical illness is expected to affect nursing practice. DESIGN Exploratory, single-unit study in a mixed adult ICU. METHODS Data collection with participant observation and semi-structured interviews in sixteen clinical situations in 2014 and 2015. Thirteen experienced certified critical care nurses were included. Thematic content analysis was conducted. RESULTS An overall theme "Having the compass-drawing the map" emerged from the analysis. The protocol or strategy of analgosedation appeared to provide a direction for treatment and care, although requiring extensive interpretation of needs and individualization of care, often in challenging situations. The overall theme was abstracted from three themes: "Interpreting a complex whole," "Balancing conflicting goals" and "Experiencing strain from acting across ideals." CONCLUSION Nurses seem to attend adequately to patient pain, but the approach to discomforts other than pain appears unsystematic and haphazard. More explicit goals of care and strategies to handle discomfort as distinct from pain are needed. More research is needed to identify effective comfort measures for ICU patients.
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Affiliation(s)
- Helene Berntzen
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing ScienceUniversity of OsloOsloNorway
| | | | - Hilde Wøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing ScienceUniversity of OsloOsloNorway
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Abstract
Aim In Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR‐related issues, and improve the application of DNAR. Methods A questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out. Results The results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in‐hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home. Conclusion It is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.
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Affiliation(s)
- Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan
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Alper BS, Fedorowicz Z, van Zuuren EJ. Limitations in conduct and reporting of cochrane reviews rarely inhibit the determination of the validity of evidence for clinical decision-making. J Evid Based Med 2015; 8:154-60. [PMID: 26107648 DOI: 10.1111/jebm.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/23/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine how often clinical conclusions derived from Cochrane Reviews have uncertain validity due to review conduct and reporting deficiencies. METHODS We evaluated 5142 clinical conclusions in DynaMed (an evidence-based point-of-care clinical reference) based on 4743 Cochrane Reviews. Clinical conclusions with level 2 evidence due to shortcomings in the review's conduct or reporting (rather than deficiencies in the underlying evidence) were confirmed by a DynaMed editor and two Cochrane Review authors. RESULTS Thirty-one Cochrane Reviews (0.65%) had confirmed deficiencies in conduct and reporting as the reason for classifying 37 assessed clinical conclusions (0.72%) as level 2 evidence. In all cases, it was not feasible for the assessors to specify a clear criticism of the studies included in the reviews. The deficiencies were specific to not accounting for dropouts (2) or inadequate assessment and reporting of allocation concealment (11), other specific trial quality criteria (14), or all trial quality criteria (4). CONCLUSIONS Cochrane Reviews provide high-quality assessment and synthesis of evidence, with fewer than 1% of Cochrane Reviews having limitations which hinder the summary of best current evidence for clinical decision-making. We expect this will further decrease following recent Cochrane quality initiatives.
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Affiliation(s)
- Brian S Alper
- DynaMed, EBSCO Health, EBSCO Information Services, Ipswich, MA, USA
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Esther J van Zuuren
- Department of Dermatology Leiden, University Medical Centre, Leiden, the Netherlands
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Abstract
This paper develops a framework to compare clinical decision making in relation to chronic and acute medical conditions. Much of the literature on patient-physician decision making has focused on acute and often life-threatening medical situations in which the patient is highly dependent upon the expertise of the physician in providing the therapeutic options. Decision making is often constrained and driven by the overwhelming impact of the acute medical problem on all aspects of the individual's life. With chronic conditions, patients are increasingly knowledgeable, not only about their medical conditions, but also about traditional, complementary, and alternative therapeutic options. They must make multiple and repetitive decisions, with variable outcomes, about how they will live with their chronic condition. Consequently, they often know more than attending treatment personnel about their own situations, including symptoms, responses to previous treatment, and lifestyle preferences. This paper compares the nature of the illness, the characteristics of the decisions themselves, the role of the patient, the decision-making relationship, and the decision-making environment in acute and chronic illnesses. The author argues for a different understanding of the decision-making relationships and processes characteristic in chronic conditions that take into account the role of trade-offs between medical regimens and lifestyle choices in shaping both the process and outcomes of clinical decision-making. The paper addresses the concerns of a range of professional providers and consumers.
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Affiliation(s)
- Susan Watt
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
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