Publicação
Can uncertainty impact the safety of healthcare? A review about uncertainty in clinical reasoning in post-anesthesia nursing
| Resumo: | Background - Postanesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anesthesia and the effectiveness of postoperative care is highly dependent on the accurate analysis and synthesis of clinical 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 jeopardize diagnostic accuracy and consequently quality and safety of the health care. Therefore, it is essential to find strategies to manage it. Aims and objectives - It is intended to contribute to uncertainty management in postanesthesia nursing clinical reasoning. To achieve the main goal, four studies will be undertaken. The purposes of each study are: study I a) to map existing knowledge about the uncertainty in nursing clinical reasoning; study II a) to describe the postanesthesia nurses perceptions about uncertainty in clinical reasoning at recovery room, b) to characterize the patterns of uncertainty in postanesthesia nursing clinical reasoning, c) to outline the perspectives and strategies/coping tools of postanesthesia nurses capable to improve the management of uncertain in clinical reasoning; study III a) to develop, apply and validate the Postanesthesia Nursing Script Concordance Test (PaNSCT), b) to estimate the psychometric properties of PaNSCT, c) to evaluate the clinical reasoning of panel members (Medical Surgical Nurse Practitioner), registered nurses and nursing students, d) to correlate clinical reasoning and sociodemographic, clinical expertise, academic degree variables, e) to determine predictive factors about uncertainty related to postanesthesia nursing clinical reasoning; study IV a) to design a decision guide and recommendation of strategies to improve uncertainty management in postanesthesia clinical reasoning. The Ernestine Wiedenbach Prescriptive Theory, will be the foundation and guide to enhance the understanding of the phenomenon. Design and Methods- The study I will consist of a systematic literature review based on the principles recommended by the Joanna Briggs Institute. The study II will consist of a descriptive exploratory study with a qualitative paradigm carried out with postanesthesia nurses who provide postoperative care in the recovery room setting through semi-structured interviews followed by the content analysis technique and data analysis by MAXQDA. The study III will be a cross-sectional study with a quantitative paradigm. The data will be collected through online survey by soSci Survey and analyzed using SPSS. Finally, the fourth study refers to a Delphi-type technique. Expected Results - Increasing the understanding of this phenomenon by helping postanesthesia nurses to manage uncertainty in clinical reasoning, will potentially enhance a safer and higher quality nursing care delivery. This research may provide insights invaluable for health care providers and policy makers representing a starting point for the development of organizational strategies that allow nurses to know how to direct supported and targeted practices regarding the phenomenon to building a safer postoperative care. |
|---|---|
| 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 Mixed Methods Patient Safety Postanesthesia Nursing Postoperative Care 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: | Background - Postanesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anesthesia and the effectiveness of postoperative care is highly dependent on the accurate analysis and synthesis of clinical 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 jeopardize diagnostic accuracy and consequently quality and safety of the health care. Therefore, it is essential to find strategies to manage it. Aims and objectives - It is intended to contribute to uncertainty management in postanesthesia nursing clinical reasoning. To achieve the main goal, four studies will be undertaken. The purposes of each study are: study I a) to map existing knowledge about the uncertainty in nursing clinical reasoning; study II a) to describe the postanesthesia nurses perceptions about uncertainty in clinical reasoning at recovery room, b) to characterize the patterns of uncertainty in postanesthesia nursing clinical reasoning, c) to outline the perspectives and strategies/coping tools of postanesthesia nurses capable to improve the management of uncertain in clinical reasoning; study III a) to develop, apply and validate the Postanesthesia Nursing Script Concordance Test (PaNSCT), b) to estimate the psychometric properties of PaNSCT, c) to evaluate the clinical reasoning of panel members (Medical Surgical Nurse Practitioner), registered nurses and nursing students, d) to correlate clinical reasoning and sociodemographic, clinical expertise, academic degree variables, e) to determine predictive factors about uncertainty related to postanesthesia nursing clinical reasoning; study IV a) to design a decision guide and recommendation of strategies to improve uncertainty management in postanesthesia clinical reasoning. The Ernestine Wiedenbach Prescriptive Theory, will be the foundation and guide to enhance the understanding of the phenomenon. Design and Methods- The study I will consist of a systematic literature review based on the principles recommended by the Joanna Briggs Institute. The study II will consist of a descriptive exploratory study with a qualitative paradigm carried out with postanesthesia nurses who provide postoperative care in the recovery room setting through semi-structured interviews followed by the content analysis technique and data analysis by MAXQDA. The study III will be a cross-sectional study with a quantitative paradigm. The data will be collected through online survey by soSci Survey and analyzed using SPSS. Finally, the fourth study refers to a Delphi-type technique. Expected Results - Increasing the understanding of this phenomenon by helping postanesthesia nurses to manage uncertainty in clinical reasoning, will potentially enhance a safer and higher quality nursing care delivery. This research may provide insights invaluable for health care providers and policy makers representing a starting point for the development of organizational strategies that allow nurses to know how to direct supported and targeted practices regarding the phenomenon to building a safer postoperative care. |
|---|