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OBJECTIVE: This review will explore the literature on contemporary incident analysis methods used in acute hospital settings, identifying types and characteristics of these methods and how they are used to minimize, prevent, or learn from errors and improve patient safety. INTRODUCTION: Safety is a major focus in health care; however, despite best efforts, errors and incidents still occur, leading to harm or potential harm to patients, families, carers, staff, or the organization. Incident analysis methods aim to reduce risk of harm. Traditional methods have been criticized for failing to consider the complexity of health care and the dynamic nature of acute care settings. Alternative methodologies are being sought to achieve higher levels of patient safety and care quality care in hospitals. Learning from errors and communicating with those involved in incidents are key requirements in contemporary incident analysis. INCLUSION CRITERIA: This review will consider empirical research published since 2013, reporting on the use of clinical incident analysis methods within acute care settings. The review will explore ways in which consumers or stakeholders (eg, clinicians or other hospital workers, patients, families, carers, visitors) have been included in these analysis methods and how data have been used to support changes in the service or organization. METHODS: Following JBI methods and PRISMA-ScR reporting guidance, we will search PubMed, CINAHL (EBSCOhost), Embase, Scopus, the Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. Studies will be reviewed independently, with results presented in tables, figures, and narrative summaries according to the concepts of interest.
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Erros Médicos , Segurança do Paciente , Literatura de Revisão como Assunto , Humanos , Erros Médicos/prevenção & controle , Gestão de Riscos/métodosRESUMO
OBJECTIVES: To develop a consensus on evidence-based principles and recommendations for perioperative hypothermia prevention in the Australian context. DESIGN: This study was informed by CAN-IMPLEMENT using the ADAPTE process: (1) formation of a multidisciplinary development team; (2) systematic search process identifying existing guidance for perioperative hypothermia prevention; (3) appraisal using the AGREE II Rigor of Development domain; (4) extraction of recommendations from guidelines meeting a quality threshold using the AGREE-REX tool; (5) review of draft principles and recommendations by multidisciplinary clinicians nationally and (6) subsequent round of discussion, drafting, reflection and revision by the original panel member team. SETTING: Australian perioperative departments. PARTICIPANTS: Registered nurses, anaesthetists, surgeons and anaesthetic allied health practitioners. RESULTS: A total of 23 papers (12 guidelines, 6 evidence summaries, 3 standards, 1 best practice sheet and 1 evidence-based bundle) formed the evidence base. After evidence synthesis and development of draft recommendations, 219 perioperative clinicians provided feedback. Following refinement, three simple principles for perioperative hypothermia prevention were developed with supporting practice recommendations: (1) actively monitor core temperature for all patients at all times; (2) warm actively to keep body temperature above 36°C and patients comfortable and (3) minimise exposure to cold at all stages of perioperative care. CONCLUSION: This consensus process has generated principles and practice recommendations for hypothermia prevention that are ready for implementation with local adaptation. Further evaluation will be undertaken in a large-scale implementation trial across Australian hospitals.
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Hipotermia , Humanos , Hipotermia/prevenção & controle , Consenso , Austrália , Temperatura Corporal , Assistência PerioperatóriaRESUMO
Objective: Dignity therapy is a short-term psychotherapy used to help patients at end of life through addressing distress and enhancing dignity. The objective of this study was to assess the effectiveness and feasibility of introducing dignity therapy into a hospital-based cancer care service. Methods: A feasibility study was undertaken using a randomised controlled trial design. Participants were adult patients receiving systemic treatment for cancer or haematological malignancy with palliative intent, within an Australian ambulatory cancer treatment centre. Outcomes of interest were patient distress levels and feasibility of intervention delivery. Participants completed two self-reported distress scales at recruitment and four weeks following (control group) or one month after intervention delivery (intervention group). Patients receiving the intervention also completed the dignity therapy patient feedback questionnaire. Feasibility was measured by collecting data on time required to implement the intervention with subsequent crude cost estimates calculated. Study procedures are reported according to CONSORT guidance. Results: Fifteen patients were recruited for the study. Participants in the intervention group reported small but significantly different lower distress scores than those in the control group at 4 weeks. The time taken to deliver the intervention ranged from 5.5 to 11â h with subsequent cost dependent on the remuneration of the dignity therapy therapist. Conclusions: Findings support other studies on the benefit to patients from delivering a dignity therapy intervention at end of life. Feasibility is influenced by multidisciplinary team support, resource availability and the designated therapist delivering the intervention. Larger sample sizes are needed to ascertain effect.
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Neoplasias , Assistência Terminal , Adulto , Humanos , Estudos de Viabilidade , Respeito , Austrália , Assistência Terminal/métodos , Neoplasias/terapia , MorteRESUMO
OBJECTIVE: The objective of this scoping review is to map the available literature on the role of specialist lung cancer nurses. INTRODUCTION: The international literature acknowledges the importance of specialist cancer nurses who provide supportive care to patients. Historically, however, there has been a lack of consistent evidence to inform development and implementation of the role. INCLUSION CRITERIA: This review will consider quantitative and qualitative studies of any design or methodology that report on role characteristics or behaviors, practices, or activities, or other aspects of specialist lung cancer nurses in the acute care setting. Systematic reviews, professional body reports, as well as unpublished or published studies and reports will also be considered for inclusion. Textual or opinion papers will be excluded. METHODS: This review will follow the JBI methodology for scoping reviews. Relevant papers from 2006 to 2022, in any language, will be searched for in the following databases and registries: MEDLINE (PubMed), CINAHL (EBSCO), Web of Science, Embase, and the Cochrane Register of Controlled Trials. Websites to be searched will include the World Health Organization, International Council of Nurses, and Agency for Healthcare Research and Quality. ProQuest Dissertations and Theses (ProQuest) and Grey Matters (CADTH) will be searched for unpublished literature. Results will be presented in tabular and narrative format and mapped according to the specified concepts of interest, as well as to the domains of practice for specialist nursing roles.
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Neoplasias Pulmonares , Enfermeiras e Enfermeiros , Humanos , Cuidados Críticos , Pesquisa Qualitativa , Literatura de Revisão como AssuntoRESUMO
OBJECTIVE: The objective of this review is to determine the effectiveness of behavioral economic interventions for promoting uptake of and adherence to cancer screening recommended by guidelines. INTRODUCTION: Cancer screening has been found to help reduce incidence of and mortality from advanced cancer. However, adherence to recommended cancer screening services is low in asymptomatic adults with average risk, possibly due to systematic decision biases. The findings of this review will demonstrate whether interventions informed by behavioral economic insights can help improve uptake of and adherence to cancer screening. INCLUSION CRITERIA: This review will consider experimental, quasi-experimental, and analytical observational studies that i) evaluate the effects of behavioral economic interventions in adults eligible for guideline-recommended cancer screening; and ii) report the number/percentage of individuals who used screening services; number/percentage of individuals who completed screening recommended by guidelines; participant self-reported intentions, choice, and satisfaction regarding the use of screening services; detection rates of early-stage cancers; use of early intervention for cancers; and cancer-related mortality. METHODS: A systematic literature search will be performed by one reviewer. After removing duplicates, two reviewers will independently screen and appraise eligible studies according to the JBI methodology for systematic reviews of effectiveness. Five databases will be searched: CINAHL, the Cochrane Library, PsyclNFO, PubMed, and Web of Science. Sources of gray literature and registered clinical trials will also be searched for potential studies. There will be no limits on publication date or language. Data synthesis will be conducted using meta-analysis and narrative synthesis where appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021258370.
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Detecção Precoce de Câncer , Neoplasias , Adulto , Economia Comportamental , Humanos , Programas de Rastreamento , Metanálise como Assunto , Neoplasias/diagnóstico , Literatura de Revisão como Assunto , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Women with genetic mutations including BRCA1, BRCA2 and Lynch syndrome are at increased risk of developing gynaecological cancers with management options including surveillance and/or risk reduction surgery. Little is known about the information women require to inform their decisions around having risk reduction surgery, the implication this surgery has for them and the timing preferences to receive this information. AIMS: To identify the information needs of women who are considering or who have had risk reduction surgery due to having a diagnosed or suspected genetic mutation with subsequent increased risk of developing gynaecological cancer. MATERIALS AND METHODS: A pilot survey was undertaken in a tertiary, metropolitan hospital as part of a service improvement project. Women referred to the gynaecology-oncology service for gynaecological risk reduction surgery between January to December 2018 were invited to participate through completing either online or hard copy versions of a 12-item survey. RESULTS: A response rate of 60% (n = 32) was obtained from women between 27 and 77 years of age. Key information topics included sexuality and intimacy (90.6%; n = 29), the surgery itself (87.5%; n = 28) and surgical menopause (87.5%; n = 28). Over 90% (n = 31) of respondents stated they preferred to receive information about surgery pre-operatively and in written format (81.3%; n = 26). The importance of a multidisciplinary approach was recognised with women wanting information from allied health practitioners such as physiotherapists and social workers. CONCLUSIONS: Findings have enabled a better understanding of the type, timing and content of information desired by women making complex decisions about risk reduction surgery. Results have contributed to developing an information resource which will more adequately assist women to meet their information needs when considering gynaecological risk reduction surgery in our hospital.
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Neoplasias dos Genitais Femininos , Ginecologia , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Medidas de Resultados Relatados pelo Paciente , Comportamento de Redução do RiscoRESUMO
OBJECTIVE: The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature. INTRODUCTION: A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs. INCLUSION CRITERIA: This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included. METHODS: Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs. RESULTS: The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision. CONCLUSIONS: The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.
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Atenção à Saúde/organização & administração , Família/psicologia , Hospitalização , Comportamento de Busca de Informação , Pacientes Internados/psicologia , Saúde Global , Pessoal de Saúde , Humanos , Fatores de TempoRESUMO
BACKGROUND: Chemotherapy-related cognitive dysfunction (CRCD) refers to problems with memory, attention span, or concentration, experienced by patients with cancer who have had chemotherapy. CRCD can have a significant negative effect on a patient's quality of life. The exact cause of CRCD is unknown but is presumed to be multifactorial. OBJECTIVE: To conduct a systematic review of the effectiveness of psychosocial interventions designed to treat CRCD. METHODS: Participants of interest to the review were over 18 years of age, diagnosed with cancer, and receiving chemotherapy or had received chemotherapy in the past. Interventions of interest were methods to improve cognitive function. Included study designs were randomized controlled trials, quasi-experimental trials, and quantitative observational studies. The primary outcome of interest was level of cognitive function. A three-step search strategy was utilized to identify studies published from 1985 to 2011 from a wide range of databases. Joanna Briggs Institute systematic review methods were used but findings were analyzed using the Cochrane Collaboration Review Manager 5.1 program. Weighted mean differences with 95% confidence intervals were calculated from the continuous data. RESULTS: Searching identified 3,109 potentially relevant articles and 120 full-text articles were retrieved. Two further papers were sourced from reference lists of retrieved articles. From 122 papers, six were suitable for critical appraisal and six were included in the analysis. Meta-analysis was conducted on two cognitive behavioral therapy (CBT) trials for the outcome of inability to concentrate. Significant effect was seen for one CBT intervention at 20 weeks (p = .004). Significant effect from CBT on quality of life was seen at 6-month follow-up (p < .05). CONCLUSIONS: Despite some evidence of an effect, there is insufficient evidence at this stage to strongly recommend any of the interventions to assist in decreasing the effects of CRCD, except in terms of improving quality of life.
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Transtornos Cognitivos/enfermagem , Transtornos Cognitivos/psicologia , Neoplasias/enfermagem , Neoplasias/psicologia , Enfermagem Oncológica/métodos , Apoio Social , Antineoplásicos/uso terapêutico , Enfermagem Baseada em Evidências/métodos , Humanos , Neoplasias/tratamento farmacológicoRESUMO
BACKGROUND: Chemotherapy related cognitive dysfunction is a condition experienced by patients with cancer who have had chemotherapy. It may cause problems with memory, attention span and/or concentration, which can have a significant negative effect on the patient's quality of life. The exact cause of chemotherapy related cognitive dysfunction is unknown but is presumed to be multifactorial. To date, there is limited research available testing the effectiveness of non-pharmacological treatments for chemotherapy related cognitive dysfunction, despite widespread acceptance that the phenomenon exists, and as yet no meta-analysis has been conducted. OBJECTIVES: To assess the effectiveness of psychosocial interventions designed to treat chemotherapy related cognitive dysfunction. INCLUSION CRITERIA: Participants were over 18, diagnosed with cancer and either currently receiving chemotherapy or had received chemotherapy as part of their treatment.The interventions of interest were methods to improve cognitive function and included cognitive behavioural therapy, psychological counselling and/or education on compensatory mechanisms for managing chemotherapy related cognitive dysfunction.Randomised controlled trials, clinical trials, quasi-experimental and other quantitative research designs were considered for inclusion.The primary outcome of interest was level of cognitive dysfunction, as measured by any reliable and validated scale. Secondary outcome was quality of life, again measured by a valid and reliable tool. SEARCH STRATEGY: A three-step search strategy was utilised to identify published and non-published studies, dated between January 1985 to May, 2011. METHODOLOGICAL QUALITY: All studies meeting the criteria were retrieved. Two reviewers critically appraised the studies using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION: Data was extracted from the included papers using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument data extraction form. Two authors were contacted to provide further data. DATA SYNTHESIS: Findings were analysed using the Cochrane Collaboration Review Manager 5.1 program. RESULTS: The search process identified 3109 potentially relevant articles. From this, 120 full articles were retrieved. Two further papers were identified from the reference lists of retrieved articles. From 122 papers, 6 were suitable for critical appraisal. Meta-analysis was conducted on two trials for the outcome of inability to concentrate. CONCLUSIONS: The available evidence on psychosocial interventions for chemotherapy related cognitive dysfunction is incomplete. There is some weak evidence to suggest some of the tested interventions may reduce memory and attention problems for some people. A significant positive effect on some Quality of Life measures was shown. IMPLICATIONS FOR PRACTICE: Symptoms of chemotherapy related cognitive dysfunction can be distressing and limiting to patients and must therefore be acknowledged and validated in a clinical context. There is insufficient strong evidence at this stage to recommend any of the interventions for use in clinical practice. IMPLICATIONS FOR RESEARCH: There is abundant research identifying that the phenomena of chemotherapy related cognitive dysfunction exists, but little research on interventions to improve symptoms. Further good quality research is required to target specific non-pharmacological interventions which will improve patients' quality of life and functional ability.
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BACKGROUND: The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. OBJECTIVES: The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. INCLUSION CRITERIA: Types of participants The review considered studies that included adult or paediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient.Types of interventions The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic.Types of outcomes This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and reducing the number of overnight stays for day or ambulatory surgery patients.Types of studies The review considered any randomised controlled trials published after 1999; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. EXCLUSION CRITERIA: This review excluded studies of preoperative education as this has been the subject of a previous review. We also excluded studies of emergency admissions. Additionally, studies comparing nurse-led with physician-led preadmission assessments were excluded as that has also been the subject of a previous systematic review. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilised in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for congruence to the review's inclusion criteria, using a tool developed for the purpose. Methodological validity was assessed by two reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA COLLECTION/EXTRACTION: Data were extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Due to the methodological heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. RESULTS: Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service. CONCLUSIONS: While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed. IMPLICATIONS FOR PRACTICE: Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low. IMPLICATIONS FOR RESEARCH: Currently the overall level of evidence regarding nurse-led preadmission services is low and further more rigorous studies are required for all the examined outcomes. There is little evidence regarding the effect of this intervention on length of stay, mortality rates and morbidity, and therefore more research is needed on the effect of nurse-led preadmission services on these important outcomes.