Autor(es): Cunha, Lara Daniela Matos ; Santos, Márcia Noélia Pestana dos ; Lomba, Maria de Lurdes Lopes de Freitas ; Santos, Margarida Reis
Data: 2022
Origem: Repositório Científico da Escola Superior de Enfermagem de Coimbra
Assunto(s): Clinical Reasoning; Postanesthesia Nursing; Uncertainty
Introduction or background Accurate nursing clinical reasoning makes postoperative care safer. The diagnostic process in complex clinical environments can be involved in uncertainty, which can bias clinical reasoning and, consequently, the safety of healthcare. Aim of the study The aim is to contribute to uncertainty management in clinical reasoning of nurses in post-anesthesia care units. Four studies will be undertaken. Study I a) to identify available evidence related to uncertainty in postanesthesia nursing clinical reasoning, b) to analyze the results from the perspective of the Model of Uncertainty in Complex Healthcare Settings (MUCH-S); study II a) to describe and analyze experiences of uncertainty in nursing clinical reasoning at recovery room; study III a) to validate the Postanesthesia Nursing Script Concordance Test (PaNSCT); study IV a) to design a decision guide and recommendation of strategies to improve uncertainty management in clinical reasoning of nurses in the recovery room. Methods/Design The study I consisted of an integrative literature review. The study II will consist of a descriptive exploratory study with a qualitative paradigm carried out with nurses in the recovery room setting through semi-structured interviews followed by thematic analysis and data analysis by MAXQDA. The study III will be a cross-sectional study. The data will be collected through soSci Survey and analyzed using SPSS. The fourth study is a Delphi-type technique. Results Three main themes were identified: nurses' intuition to reason, feelings of uncertainty related to lack of nursing knowledge and clinical (in)experience to deal with uncertainty. These findings of study I are embedded with the MUCH-S taxonomy: personal, scientific and practical. Communicating uncertainty in clinical pain assessment, dealing with patient's behaviors, articulating professional practice with intuition are all associated with personal uncertainty. Related with scientific uncertainty, nurses struggle with balancing personal beliefs, lack of scientific knowledge and limited clinical experience with clinical practice. The challenging relationship with patients impacts the recognition of causal explanations. Allied with practical uncertainty, the variability of individual anesthesia providers' practices induces nurse's confusion. Discussion and conclusions Despite the benefits of understanding uncertainty, it cannot be considered a guarantee of absolute security. However, evidence suggests that it can contribute to improving safety by defining strategies to manage it. Practical and/or academic/research implications This research may provide insights invaluable for healthcare providers and policy makers representing a starting point for the development of organizational strategies that allow nurses to know how to direct supported practices to building a safer postoperative care.
