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Hedlund J, Blomberg K, Hjelmqvist H, Jaensson M. Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room: An Integrative Review. J Perianesth Nurs 2024; 39:303-310.e8. [PMID: 37906248 DOI: 10.1016/j.jopan.2023.07.023] [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: 01/30/2023] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives. DESIGN An integrative review. METHODS Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method. FINDINGS Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment. CONCLUSIONS SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.
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Affiliation(s)
- Jakob Hedlund
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Starmer AJ, Michael MM, Spector ND, Riesenberg LA. Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00130-7. [PMID: 37423813 DOI: 10.1016/j.jcjq.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events. CONCEPTUAL FRAMEWORK The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ. IMPLICATIONS Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.
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Meneses M, Muthusamy N, Vetter MJ, Schwarzkopf R. Utilizing a Standardized Handoff Initiative Incorporating Both Medical Clearance Postoperative Recommendations and Orthopaedic-Specific Context to Improve Information Transfer. Orthop Nurs 2022; 41:282-286. [PMID: 35869915 DOI: 10.1097/nor.0000000000000863] [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: 11/27/2022] Open
Abstract
Patients undergoing total joint arthroplasty (TJA) with multiple comorbidities require medical clearance recommendations from their primary care provider, which if not adhered to can lead to adverse postoperative complications. In this quality improvement initiative, we explore the impact of a standardized handoff process incorporating medical clearance postoperative recommendations and orthopaedic-specific context on information transfer in TJA. A systematic review of quantitative and qualitative studies from 2014 to 2019 was completed to draw a conclusion about the best practice methods for the development of a standardized handoff process. Prior to implementation, evidence was reviewed to inform activities such as baseline chart audits, attainment of stakeholder input regarding handoff, exploration of wound closure equipment utilization, and standardization of a structured "smart phase" that incorporates medical clearance recommendations and orthopaedic-specific context information. After provider education was completed and the new handoff approach initiated, data were collected to compare postintervention outcomes such as transfer of information and wound kit distribution cost analysis. At baseline, 42% of patients had medical clearance postoperative recommendations handed off when they were provided. At completion, the new handoff smart phrase was used 97% for the first handoff and 100% for the second handoff. Medical clearance postoperative recommendations were captured in the electronic health record 83% of the time when they were provided. When the new smart phrases were utilized, wound closure, precautions, and postoperative void status were always handed off. Once wound closure technique was specified, bedside nurses were able to provide the appropriate wound closure removal equipment at discharge, projecting cost savings of $0.69 per case (∼234 cases per month). The use of a standardized handoff smart phrase that includes specialty specific context and postoperative medical management requirements successfully improved the information transfer between providers in a large academic orthopaedic medical center.
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Affiliation(s)
- Michelle Meneses
- Michelle Meneses, DNP, MS, AGPCNP-BC , Department of Nursing, NYU Langone Orthopedic Hospital, New York, NY; and NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Nishanth Muthusamy, BA , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Mary Jo Vetter, DNP, RN, AGPCNP-BC , NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Ran Schwarzkopf, MD, MSc , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Nishanth Muthusamy
- Michelle Meneses, DNP, MS, AGPCNP-BC , Department of Nursing, NYU Langone Orthopedic Hospital, New York, NY; and NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Nishanth Muthusamy, BA , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Mary Jo Vetter, DNP, RN, AGPCNP-BC , NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Ran Schwarzkopf, MD, MSc , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Mary Jo Vetter
- Michelle Meneses, DNP, MS, AGPCNP-BC , Department of Nursing, NYU Langone Orthopedic Hospital, New York, NY; and NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Nishanth Muthusamy, BA , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Mary Jo Vetter, DNP, RN, AGPCNP-BC , NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Ran Schwarzkopf, MD, MSc , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Michelle Meneses, DNP, MS, AGPCNP-BC , Department of Nursing, NYU Langone Orthopedic Hospital, New York, NY; and NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Nishanth Muthusamy, BA , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Mary Jo Vetter, DNP, RN, AGPCNP-BC , NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY
- Ran Schwarzkopf, MD, MSc , Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Reine E, Aase K, Raeder J, Thorud A, Aarsnes RM, Rustøen T. Exploring postoperative handover quality in relation to patient condition: A mixed methods study. J Clin Nurs 2021; 30:1046-1059. [PMID: 33434381 DOI: 10.1111/jocn.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. BACKGROUND High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. DESIGN Observational mixed methods convergent design. METHODS Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. RESULTS Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. CONCLUSIONS The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. RELEVANCE TO CLINICAL PRACTICE It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.
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Affiliation(s)
- Elizabeth Reine
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Johan Raeder
- Department of Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Thorud
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Reidunn M Aarsnes
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Nallani R, Fox CC, Sykes KJ, Surprise JK, Fox CE, Reschke AD, Simpson MH, Polivka BJ, Villwock JA. Pain Management and Education for Ambulatory Surgery: A Qualitative Study of Perioperative Nurses. J Surg Res 2020; 260:419-427. [PMID: 33256986 PMCID: PMC10165861 DOI: 10.1016/j.jss.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ambulatory surgery presents unique challenges regarding adequate pain management and education. Studies have documented issues with transfer of information and patient comfort. Our objective was to explore perioperative nurses' perspectives of current practices and challenges with pain management and education. MATERIALS AND METHODS We used a qualitative descriptive design and conducted four focus group interviews, with 24 total participants from two perioperative areas of an academic medical center, using a standardized script. Using qualitative analysis software, two investigators reviewed the data and coded major themes and subthemes. The consolidated criteria for reporting qualitative studies guidelines were followed for reporting the data. RESULTS We identified four major themes impacting current perioperative pain management and education practices: communication among the perioperative care team, sources of nurses' frustrations in the perioperative setting, patient expectations for pain, and nurse-driven pain management and education. Nurses highlighted their work became easier with adequate information transfer and trust from physicians. Frustrations stemmed from surgeon, system, and patient factors. Nurses often use their clinical experience and judgment in managing patients throughout the perioperative period. Furthermore, nurses felt patients have limited pain education and stressed education throughout the surgical care pathway could improve overall care. CONCLUSIONS Perioperative pain management, assessment, and education practices are inconsistent, incomplete, and sources of frustrations according to participants. Participant experiences highlight the need for improved and standardized models. Patient pain education should use a multidisciplinary approach, beginning at the point of surgery scheduling and continuing through postoperative follow-up.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
| | - Cameron C Fox
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer K Surprise
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Clare E Fox
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Alan D Reschke
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Melanie H Simpson
- Inpatient Pain Management Nurses, University of Kansas Hospital, Kansas City, Kansas
| | - Barbara J Polivka
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer A Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Eithun B, Brazelton T, Ross J, Kohler JE, Kelly MM, Dean SM, Rusy D, Gurses AP. Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. APPLIED ERGONOMICS 2020; 85:103059. [PMID: 32174347 PMCID: PMC7309517 DOI: 10.1016/j.apergo.2020.103059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/13/2019] [Accepted: 01/13/2020] [Indexed: 06/02/2023]
Abstract
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU. We applied the Systems Engineering Initiative for Patient Safety (SEIPS) process modeling method and identified nine dimensions of barriers and facilitators - anticipation, ED decision making, interacting with family, physical environment, role ambiguity, staffing/resources, team cognition, technology and characteristic of trauma care. For example, handoffs involving all healthcare professionals in the OR to PICU transition created a shared understanding of the patient, but sometimes included distractions. Understanding barriers and facilitators can guide future improvements, e.g., designing a team display to support team cognition of healthcare professionals in the care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M Kelly
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA; Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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