A multi-facetted patient safety resource-A qualitative interview study on hospital managers' perception of the nurse-led Rapid Response Team.

AIM: To explore hospital managers' perceptions of the Rapid Response Team. DESIGN: An explorative qualitative study using semi-structured individual interviews. METHODS: In September 2019, a qualitative interview study including nineteen hospital managers at three managerial levels in acute care hospitals was conducted. Interview transcripts were analysed with an inductive content analysis approach, involving researcher triangulation in data collection and analysis processes. FINDINGS: One theme, 'A resource with untapped potential, enhancing patient safety, high-quality nursing, and organisational cohesion' was identified and underpinned by six categories and 30 sub-categories. CONCLUSION: The Rapid Response Team has an influence on the organization that goes beyond the team's original purpose. It strengthens the organization's dynamic cohesion by providing clinical support to nurses and facilitating learning, communication and collaboration across the hospital. Managers lack engagement in the team, including local key data to guide future quality improvement processes. IMPLICATIONS: For organizations, nursing, and patients to benefit from the team to its full potential, managerial engagement seems crucial. IMPACT: This study addressed possible challenges to using the Rapid Response Team optimally and found that hospital managers perceived this complex healthcare intervention as beneficial to patient safety and nursing quality, but lacked factual insight into the team's deliverances. The research impacts patient safety pointing at the need to re-organize managerial involvement in the function and development of the Rapid Response Team and System. REPORTING METHOD: We have adhered to the COREQ checklist when reporting this study. "No Patient or Public Contribution".

Interprofessional Collaboration Between Nurses and Physicians in the Perioperative Period.

PURPOSE: To explore nurses' and physicians' experiences of the six dimensions of interprofessional (IP) collaboration when using Goal-Directed Therapy (GDT), and to examine how existing protocols on GDT facilitate the six dimensions of IP collaboration. DESIGN: A qualitative design using individual semi-structured interviews and participant observations. METHODS: A secondary analysis of data from participant observation and semi-structured interviews with nurses (n= 23) and physicians (n=12) in three departments of anesthesiology. Observations and interviews were carried out from December 2016 to June 2017. A deductive, qualitative content analysis using the Inter-Professional Activity Classification as a categorization matrix was used to explore interprofessional collaboration as a barrier to implementation. This analysis was supplemented by a text analysis of two protocols. FINDINGS: Four dimensions were identified to influence IP collaboration: commitment, roles and responsibilities, interdependence, and integration of work practices. Negative factors included hierarchical boundaries, traditional nurse-physician relationship, unclear responsibility, and lack of shared knowledge. Positive factors included physician involvement of nurses in decisions and bedside education. The text-analysis showed a lack of clear directions of specific action and responsibility. CONCLUSIONS: Commitment and roles and responsibilities were dominant aspects of interprofessional collaboration in this context, causing problems for enhanced collaboration. Lack of clear guidance in the protocols might detract nurses' feelings of responsibility.

Nurse and Physician Perceptions of Working With Goal-Directed Therapy in the Perioperative Period.

PURPOSE: To explore nurse and physician perceptions of working with and collaborating about arterial wave analysis for goal-directed therapy to identify barriers and facilitators for use in anesthesia departments, postanesthesia care units, and intensive care units. DESIGN: A qualitative study drawing on ethnographic principles in a field study using the technique of nonparticipating observation and semistructured interviews. METHODS: Data collection occurred using semistructured interviews with nurses (n = 23) and physicians (n = 12) and field observations in three anesthetic departments. An inductive approach for content analysis was used. FINDINGS: The results showed one overarching theme Interprofessional collaboration encourage and impede based on three categories: (1) interprofessional and professional challenges; (2) obtaining competencies; and (3) understanding optimal fluid treatment. CONCLUSIONS: Several barriers identified related to interprofessional collaboration. Nurses and physicians were dependent on each other's skills and capabilities to use arterial wave analysis. Education of nurses and physicians is important to secure optimal use of goal-directed therapy.

Nurses' Indications for Administration of Perioperative Intravenous Fluid Therapy-A Prospective, Descriptive, Single-Center Cohort Study.

PURPOSE: To examine whether nurse anesthetists and postanesthesia nurses' administration of intravenous (IV) fluid therapy during surgery and in the postanesthesia care unit is based on evidence. Secondarily to investigate if providing indications for IV fluid administration changed nursing practice. DESIGN: Prospective, descriptive, single-center study in Scandinavia comparing two cohorts. METHODS: Descriptive, fluid volume, and type data were obtained in both cohorts. Cohort 1 (n = 126) was used as baseline data. In cohort 2 (n = 130), nurses recorded indications for type and volume of fluid therapy using a validated list. Analysis compared median volumes of crystalloid or colloid fluids of surgical types by cohort. Analysis compared frequency of given indication reasons for each IV fluid by surgical type. FINDINGS: Basic static variables were chosen most frequently for indications of IV fluid needed for all surgeries except high-risk abdominal surgery where dynamic variables were more frequent. Signs and symptoms of inadequate tissue perfusion were only sparsely indicated. The volume of intraoperative crystalloid fluids was statistically different for patients with hip fracture surgery in cohort 2. Volumes of both colloid and crystalloid fluids were significantly higher for high-risk abdominal surgery in cohort 2. CONCLUSIONS: Nurse anesthetists and nurses in the postanesthesia care unit rely more on basic static parameters than signs of inadequate tissue perfusion when they make decisions about fluid administration. The indications cited for fluid administered to high-risk abdominal surgery and hip fracture patients did not always fit guidelines. This indicates the need of a stronger intervention to change practice to follow evidence-based clinical guidelines.

Patients' experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis.

BACKGROUND: Being a patient in an intensive care unit (ICU) and being mechanically ventilated is a scary and unpleasant experience to many patients. Qualitative studies describe these Patients' experiences, but the findings have not yet been synthesised. AIM: The aim of this study was to gather and synthesise interpreted knowledge from qualitative studies about Patients' experiences of being mechanically ventilated in an ICU. METHOD: A qualitative metasynthesis was conducted on findings from nine qualitative studies performed in the period from 1994 to 2012. The studies were critically appraised according to the method defined by Sandelowski and Barosso, and the findings were extracted, edited, grouped and abstracted. Subsequently, the abstracted findings were analysed, using the constant comparison analysis. In the analysis, we used findings from patients with home ventilation and findings from patients admitted to an ICU, while they were not ventilated. RESULTS: Fifteen abstracted findings appeared from the metasynthesis and led to the synthesised finding: 'Being dependent on health professionals, without being able to communicate, causes experiences with anxiety, fear and loneliness. How intensively these feelings are experienced seems to depend on the health professionals' ability of being present with these patients. The presence of relatives can alleviate these experiences'. CONCLUSION: This study shows that patients being mechanically ventilated in an ICU experience an emic vulnerability, consisting of anxiety, fear and loneliness. IMPLICATIONS FOR PRACTICE: In future practice, it is expected that patients will be more awake during mechanical ventilation. It is therefore important that health professionals have the knowledge that their presence and their support of the relationship between the patient and his/her relatives are of great importance in the care of patients.