Publicação
Uncertainty in postanesthesia nursing clinical reasoning: An integrative review
| Resumo: | Introduction Postanesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anaesthesia. Concomitantly, the effectiveness of postoperative care is highly dependent on the accurate analysis, synthesis of patient data and the quality of diagnostic decisions through clinical reasoning. Given the dynamic processes required to come to a diagnosis, uncertainty is common in clinical reasoning and expected during practice. Nevertheless, uncertainty may permeate the foundations of clinical reasoning, which can jeopardise diagnostic accuracy and consequently quality and safety of the health care. Aim including research question The aims of this review are to identify available evidence related to uncertainty in postanesthesia nursing clinical reasoning and to analyse the results from the perspective of the Model of Uncertainty in Complex Healthcare Settings (MUCH-S). The research questions are: What is the available evidence related to uncertainty in postanesthesia nursing clinical reasoning? How does available evidence related to uncertainty in postanesthesia nursing clinical reasoning fit with the MUCH-S? Methods A comprehensive search strategy using CINAHL (EBSCO), Cochrane Library (EBSCO), Medline (PubMed), ProQuest and Google Scholar databases was used to find published and unpublished relevant studies. Studies published in English and Portuguese were included. There was no temporal restriction, nor geographical or cultural limitation for the studies included. All papers were reviewed by the authors to extract key information around purpose, sample and setting, research design and method, key findings and limitations. The literature search identified a total of 248 studies, 22 of which were retrieved for full read. A total of four articles were included in this review. 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 are encompassed with the MUCH-S taxonomy: personal, scientific and practical. Discussion For nurses, communicating uncertainty in clinical pain assessment, dealing with patient's behaviours, 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' practises induces nurse's confusion. Conclusions and Implications for practice Despite the great benefits of the uncertainty analysis and its application can bring in certain contexts, it should not be considered as a panacea to guarantee absolute security. Notwithstanding, evidence suggests that uncertainty comprehension has in its favour the very positive fact that it places uncertain consequences or effects at the centre of decisions, thus being able to contribute to the improvement of safety in postanesthesia healthcare. |
|---|---|
| Autores principais: | Cunha, Lara Daniela Matos |
| Outros Autores: | Santos, Márcia Noélia Pestana dos; Lomba, Maria de Lurdes Lopes de Freitas; Santos, Margarida Reis |
| Assunto: | clinical reasoning patient safety post-anesthesia nursing uncertainty |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | outro |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Escola Superior de Enfermagem de Coimbra |
| Idioma: | inglês |
| Origem: | Repositório Científico da Escola Superior de Enfermagem de Coimbra |
| Resumo: | Introduction Postanesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anaesthesia. Concomitantly, the effectiveness of postoperative care is highly dependent on the accurate analysis, synthesis of patient data and the quality of diagnostic decisions through clinical reasoning. Given the dynamic processes required to come to a diagnosis, uncertainty is common in clinical reasoning and expected during practice. Nevertheless, uncertainty may permeate the foundations of clinical reasoning, which can jeopardise diagnostic accuracy and consequently quality and safety of the health care. Aim including research question The aims of this review are to identify available evidence related to uncertainty in postanesthesia nursing clinical reasoning and to analyse the results from the perspective of the Model of Uncertainty in Complex Healthcare Settings (MUCH-S). The research questions are: What is the available evidence related to uncertainty in postanesthesia nursing clinical reasoning? How does available evidence related to uncertainty in postanesthesia nursing clinical reasoning fit with the MUCH-S? Methods A comprehensive search strategy using CINAHL (EBSCO), Cochrane Library (EBSCO), Medline (PubMed), ProQuest and Google Scholar databases was used to find published and unpublished relevant studies. Studies published in English and Portuguese were included. There was no temporal restriction, nor geographical or cultural limitation for the studies included. All papers were reviewed by the authors to extract key information around purpose, sample and setting, research design and method, key findings and limitations. The literature search identified a total of 248 studies, 22 of which were retrieved for full read. A total of four articles were included in this review. 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 are encompassed with the MUCH-S taxonomy: personal, scientific and practical. Discussion For nurses, communicating uncertainty in clinical pain assessment, dealing with patient's behaviours, 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' practises induces nurse's confusion. Conclusions and Implications for practice Despite the great benefits of the uncertainty analysis and its application can bring in certain contexts, it should not be considered as a panacea to guarantee absolute security. Notwithstanding, evidence suggests that uncertainty comprehension has in its favour the very positive fact that it places uncertain consequences or effects at the centre of decisions, thus being able to contribute to the improvement of safety in postanesthesia healthcare. |
|---|