The effect of forced-air warming blanket position during spinal surgery on patients' intra-operative body temperature.

BACKGROUND: The use of body-warming systems is recommended by international anaesthesia societies for patients undergoing surgery. Limited research is however available on the influence of positioning of forced-air warming blankets for patients undergoing spinal surgery. This study aimed to investigate how patients' intra-operative body temperature was affected by the position of forced-air warming blankets while undergoing spinal surgery on a spinal table. DESIGN: A randomized comparative experimental study was conducted with 60 adult patients undergoing posterior spinal surgery. METHODS: Patients were randomized into full underbody (n = 30) or surgical access (n = 30) forced-air warming blanket groups. Intra-operative body temperature was recorded at regular time intervals. The student's T-test, Chi-square, and MANOVA tests were performed to determine the differences between the two groups. RESULTS: Intraoperative hypothermia was significantly lower in the full underbody group than in the surgical access group (p = 0.020). The change in body temperature differed significantly between the two groups from 15 min until 240 min, with a mean difference of 0.5 °C. CONCLUSION: The full underbody position of the forced-air warming blanket was effective for maintaining normal range core body temperature. The use of full underbody forced-air warming blanket for spinal surgery when patients are positioned on a spinal table in a prone position is recommended.

A concept analysis of person-centred handover practices: The meaning in emergency departments.

BACKGROUND: Transfer of patients from the prehospital to the in-hospital environment is a frequent occurrence requiring a handover process. Habitually, emergency care practitioners and healthcare professionals focus on patient care activities, not prioritising person-centred handover practices and not initiating person-centred care. AIM: The aim of this concept analysis was to define the concept person centred handover practices. METHODS: The eight steps for Walker and Avant's method of concept analysis. RESULTS: Thirty-one articles were included for final review including qualitative and quantitative studies, literature reviews and audits. This concept analysis guided the development of an concept definition of person-centred handover practices between emergency care practitioners and healthcare professionals in the emergency department as person- centred handover practices are those handovers being performed while including all identified defining attributes such as structure, verbal, and written information transfer, interprofessional process, inclusion of the patient and/ or family, occurs at the bedside, without interruption. CONCLUSIONS: Results suggested that person-centred handover practices involve verbal and non- verbal interprofessional communication within a specific location in the emergency department. It requires mutual respect from all professionals involved, experience and training, and the participation of the patient and / or family to improve patient outcomes and quality patient care. A definition for the concept may encourage the implementation of person-centred handover practices in emergency departments.

Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi.

AIM: To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. BACKGROUND: Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. DESIGN: A three-round online Delphi survey. METHODS: Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. RESULTS: Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. CONCLUSION: Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. REPORTING METHOD: The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. IMPACT (ADDRESSING): Improve handover practices and patient care. Improve person-centred care in emergency departments. PATIENT OR PUBLIC CONTRIBUTION: Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

Documentation of wounds in emergency departments through a forensic lens.

BACKGROUND: Nurses document wounds to direct and evaluate the care. People admitted to emergency departments with wounds should be regarded as potential forensic patients, requiring meticulous documentation for evidence purposes. AIM: To explore the documentation of wounds in emergency departments through a forensic lens and compare it between different levels of emergency departments. METHODS: In this descriptive retrospective study, we randomly sampled 515 paper-based medical files of patients who sustained wounds admitted to three selected emergency departments. The files were analysed using a structured data collection tool the data were descriptively analysed. RESULTS: All files included information on the type of wound (100%) and the site of the wound (100%) with most files including the mechanisms of injury (98.6%). Few files included information on blood loss (18.1%) and the size of the wound (15%). Only one file included information on the contents of the wound. No files included information on the wound's shape and the surrounding skin's condition. CONCLUSION: Wounds were poorly documented in emergency departments, irrespective of the level of care. Nurses in emergency departments should have strict guidelines for documenting wounds since accurate documentation protects patients' human rights and protects nurses.

Healthcare professionals and pregnant and post-natal women's perceptions of interprofessional collaboration in a maternity care facility: A qualitative study from Botswana.

OBJECTIVE: To explore the perceptions of healthcare professionals and pregnant and post-natal women regarding interprofessional collaboration in a maternity care setting in Botswana, a low-to-middle-income country in Sub-Sahara Africa. DESIGN: A descriptive qualitative design using in-depth interviews with forty participants, including healthcare professionals and women in maternity wards. Data were transcribed and thematically analysed. SETTING: Antenatal, delivery and post-natal maternity wards in a referral hospital that provides basic and specialist care in Botswana. PARTICIPANTS: We interviewed 13 pregnant and post-natal women and 27 healthcare professionals in the maternity care wards. FINDINGS: Participants perceived several interrelated factors that influenced the delivery of interprofessional collaborative care. Interpersonal factors such as poor communication, disrespectful behaviours and inadequate teamwork practices prevented interprofessional collaboration. Other barriers to collaboration included lack of understanding of each other's roles and responsibilities, ineffective coordination of resources, hierarchical power struggles and poor collaborative leadership. KEY CONCLUSIONS: Effective interprofessional collaboration remains elusive in this maternity care setting. Healthcare systems in low-to-middle-income countries may benefit from interventions for healthcare professionals to learn and practice interprofessional collaborative care.

Considerations for promoting the implementation of work-based interprofessional education programmes: A scoping review.

BACKGROUND: Effective inter-professional collaboration may improve healthcare outcomes, including maternal and child healthcare settings where unfavourable outcomes are often due to communication and collaboration failures. OBJECTIVE: Explore the considerations for promoting the implementation of work-based interprofessional education programmes. METHODS: A scoping review guided by the methodological framework of Arksery and O'Malley was used to analyse 28 articles published between 2000 and 2020. The reporting was guided by the PRISMA extension for Scoping Reviews. RESULTS: Twenty-seven of 28 articles were studies conducted in high-income countries. The review revealed considerations which were themed as 1) mobilisation of resources, 2) helpful learning environment, 3) healthcare professional's valuation and 4) barriers prior to implementing IPE/IPC. Successful implementation of interventions triggered motivation, confidence, self-efficacy, value for IPE/IPC. CONCLUSION: Our findings demonstrate that there are specific considerations that can contribute to the uptake of IPE/IPC interventions in the clinical setting.

Second victim experiences of healthcare providers after adverse events: A cross-sectional study.

Background: Adverse events in healthcare are inevitable as most treatments and investigations have the potential to cause harm. Healthcare providers often witness or are involved in adverse events, putting them at risk of becoming second victims, which may further impact patient safety. Aim: The researchers report on the physical and psychological symptoms experienced by healthcare providers following adverse events during patient care as well as their perceptions of the quality of support received and the desired forms of support following adverse events. Setting: A single secondary public hospital in the Limpopo province, South Africa. Methods: Using total population sampling, healthcare providers were invited to anonymously participate in a cross-sectional survey using the Second Victim Experience and Support questionnaire to assess experiences after adverse events and desired forms of support. Results: Healthcare providers (N = 181) experienced more psychological distress (mean = 2.97, standard deviation [SD] = 1.33) than they experienced physical distress. Most healthcare providers relied on non-work-related support (mean = 4.08, SD = 1.19). Healthcare providers reported that adverse events influenced their perceptions of professional self-efficacy (mean = 2.71, SD = 0.94) and mostly desired support in the form of discussing the event with supervisors or managers (mean = 3.72, SD = 1.37). Conclusion: Healthcare providers in different clinical settings are at risk of suffering second victim effects. Health institutions should offer support to all victims of adverse events. Contribution: The information offered could enable healthcare management to modify existing practices to a non-punitive style, improve communication and provide better support following adverse events.

Factors affecting the implementation of a complex health intervention to improve insulin management in primary care: A SWOT analysis.

BACKGROUND:  In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention. AIM:  To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability. SETTING:  Tshwane District, Gauteng province, South Africa. METHODS:  We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13). RESULTS:  Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention. CONCLUSION:  Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions.

A process to gain access for research in the clinical setting.

Researchers and clinical nurses need to collaborate to develop the clinical setting. Negotiating access to do research in the clinical setting can be challenging. The task of gaining access is often omitted and scarcely described in the literature. The aim of this article is to describe a process to gain access based on the authors' individual and collective experience through reflective conversations. The process consists of four key components: researcher, review board, gatekeepers and participants. Each component is linked and a crucial step to gain access to the clinical setting and ultimately to the participants. The gaining access process may prepare novice researchers for the specific considerations, time and effort required to initiate research in the clinical setting.

The accuracy of nurse-led triage of adult patients in the emergency centre of urban private hospitals.

Background: : Triage is applied in emergency centres (ECs) to assign degrees of urgency to illnesses or injuries to decide in which order to treat patients, especially when there are many patients or casualties, facilitating the allocation of scarce medical resources. A triage nurse determines triage priority by assessing patients using an established triage tool with specific criteria. The South African Triage Scale is widely used in South African ECs. Although the South African Triage Scale has been adopted and implemented in both private and public healthcare ECs in South Africa, few studies have assessed the accuracy of nurse-led triage in private ECs. Aim: : To determine the accuracy of nurse-led triage in ECs in urban, private hospitals. Methods: : A quantitative, descriptive, retrospective study was done. Three private hospitals with similar average patient volumes were purposively selected. We sampled the nursing notes as follows: 1) we stratified nursing notes by nurse qualification and then 2) for each category of nurse we stratified nursing notes according to triage priority level and 3) then systematically randomly selected the recommended number of notes from each triage priority level for each nurse category. We retrospectively audited 389 EC nursing notes to determine the accuracy of nurse-led triage. For each note, we independently applied the South African Triage Scale, and then determined agreement between our score and the score determined by the triage nurse. Results: : We recorded 342 triage errors, consisting of triage early warning scores (TEWS) errors (n = 168), discriminator errors (n = 97) and additional investigation errors (n = 77). Overall agreement between the triage nurses and our scores was 71.7% (n = 279). Triage errors (n = 110) consisted of 3.9% (n = 15) over-triage errors and 24.4% (n = 95) under-triage errors. The highest level of agreement was between our scores and the scores of the emergency trained registered nurses (85%) and enrolled nursing assistants (78%). Conclusion: : In South African ECs, the South African Triage Scale is not always correctly applied, which can lead to almost a quarter (24.4%) of cases being under-triaged and not receiving timeous care. Our results suggest that emergency trained registered nurses are well equipped to be triage nurses, and that this skill should be developed in South African nursing curricula.

Stakeholders' perceptions of family-centred care in the intensive care unit: An associative group analysis.

AIM: To explore different stakeholders' including nurses, health care professionals and family member's perceptions of ideal family-centred care in an intensive care unit. RESEARCH DESIGN AND METHODS: We used a mixed method approach to identify perceptions of family-centred care with 60 stakeholders of equal numbers who voluntarily participated in the study. Data were collected over one month using an associative group analysis method. The responses were ranked, scored, thematically themed and weighted. SETTING: A 23 bed adult intensive care unit in an urban private hospital in South Africa. FINDINGS: According to the stakeholders' responses, ideal family-centred care should be built around communication based on expectations and engagement. In addition, the physical environment should allow for overall comfort and spiritual care must be incorporated. CONCLUSION: Stakeholders had similar perceptions on the main themes however; nuances of different perspectives were identified showing some of the complexities related to family-centred care. Spiritual care was highlighted by the family members, revealing the need to broaden the care perspectives of healthcare providers.

Integrative therapies in intensive care units: A scoping review.

AIM: We reviewed literature describing the incorporation of integrative therapies in intensive care units. We aimed to elicit an overall picture of research and find existing knowledge gaps on this topic. DESIGN: We conducted a scoping review guided by Arksey and O'Malley's methodological framework and were guided by the PRISMA-ScR Checklist. METHODS: Various databases were searched for relevant literature. English language articles published between 1999 and 2019 were retrieved. Data were extracted based on sample, sample size, methodology, findings and implications for practice. RESULTS: From 275 studies retrieved, 30 were included, based on the inclusion criteria. Three key themes related to integrative therapies in intensive care units emerged from the literature: 1) general information on integrative therapies; 2) interventions using integrative therapies; and 3) perceptions and attitudes of nurses on integrative therapies. Positive outcomes were observed in ICUs, and nurses showed positive attitudes towards using integrative therapies.

Important factors for planning nurse staffing in the emergency department: A consensus study.

INTRODUCTION: Planning adequate nurse staffing in the emergency department (ED) is challenging. Although there are models to determine nurse staffing in EDs, these models do not consider all the factors. Inadequate nurse staffing causes overcrowding, poor quality of patient care, increased hospital costs, poor patient outcomes and high levels of burnout amongst nurses. In this paper, we report stakeholders' perceptions of important factors to be considered when planning ED nursing ratios. METHODS: We applied a consensus research design. The data was generated from modified nominal group techniques followed by an e-Delphi with two rounds. The factors were generated during two nominal groups by 19 stakeholders which included management and healthcare professionals working in EDs. The generated factors were then put on a survey format for use in an e-Delphi. Using purposive and snowball sampling the survey was distributed to 74 national and international experts for consensus. RESULTS: Ultimately, 43 experts agreed (a validity index of ≥ 80%) on four categories namely: hospital, staff, patient and additional categories which included 17 related factors. CONCLUSION: Ideal nurse staffing ratios are influenced by the complexity of the environment and interactions between multiple factors. The categories and factors identified emphasised the need for extensive further research to ensure a financially viable model that will be accepted by both staff and patient, and thus promote optimal outcomes.

Length of stay and contributing factors in elderly patients who have undergone hip fracture surgery in a tertiary hospital in South Africa.

BACKGROUND: Length of stay and factors that contribute to length of stay in elderly patients who have undergone hip fracture surgery is under researched in developing countries, including South Africa. The purpose of this study was to describe the factors that increase length of stay (LOS) among elderly patients who have had hip fracture surgery. METHODS: A retrospective review of patient records of elderly (>65 years) patients who had hip fracture surgery in a public hospital in South Africa. Descriptive statistics were used to report demographic data, LOS and frequency distributions of individual factors relating to LOS. Two sample t-tests were used to compare the LOS in patients with and without main complications reported. RESULTS: The mean total length of stay was 33 (19) days. Patients presented with numerous comorbidities, with hypertension (n = 93) being the most prevalent. The most frequently occurring complications included anaemia (n = 42) and wound infection (n = 21). The LOS was significantly lower for patients not presenting with wound infections compared to those who sustained a wound infection (p = 0.041). Social factors delayed departure from the hospital for 48 patients. CONCLUSION: Elderly patients who had hip fracture surgery and developed wound infections had an increased LOS. However social issues also contributed to the increase in length of stay that could be addressed by proper planning and involvement of families and care givers. The factors identified could be used as a starting point for planning services aimed at decreasing the hospital stay of elderly patients.

Forensic patients in the emergency department: Who are they and how should we care for them?

BACKGROUND: Patients who suffer violent, crime related injuries are likely to seek medical assistance in emergency departments. Forensic patients may not disclose the cause of their injuries leading to the impairment of evidence. We explored healthcare providers' perceptions of forensic patients and how they should be cared for. METHOD: The perceptions of physicians and nurses regarding the profiles and care of forensic patients were explored in three urban emergency departments. The data were collected through a talking wall and analysed collaboratively, with the participants, using content analysis. RESULTS: Healthcare providers in emergency departments differentiated between living and deceased forensic patients. Healthcare providers identified living forensic patients as victims of sexual assault, assault, gunshots and stab wounds, and abused children. Deceased patients included patients that were dead on arrival or died in the emergency departments. Healthcare providers acknowledged that evidence should be collected, preserved and documented. CONCLUSION: Every trauma patient in the emergency department should be treated asa forensic patient until otherwise proven. If healthcare providers are unable to identify forensic patients and collect the evidence present, the patients' human right to justice will be violated.

Requirements for reflection in the critical care environment.

BACKGROUND: Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear. OBJECTIVES: To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses. METHOD: A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment. RESULTS: The themes that emerged from the focus group were buy-in from stakeholders -management, facilitators and critical care nurses, and the need to create an environment where reflection can occur. CONCLUSION: Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatory practice development.