Institutional ethnography: A methodology for exploring complex problems in healthcare systems.

Healthcare professionals experiencing barriers in the delivery of care are often unaware of factors within complex institutions that create and perpetuate those problems. Institutional ethnography in healthcare is a research methodology that starts from the perspective of a problem that clinicians or people receiving care experience and seeks to identify how those negative experiences are coordinated by institutional structures. This paper describes and advocates for the use of institutional ethnography as a powerful tool to investigate problems experienced by individuals or groups in the complex systems of healthcare design and delivery. It is a research methodology that has been adopted across settings in North America, although it has the potential to be utilized more broadly across other settings by clinicians and researchers. This echoes calls from other authors for its use across a wider range of healthcare disciplines and settings. Institutional ethnography is an underutilized research methodology that has potential to address a wide range of challenges experienced in contemporary healthcare. It offers healthcare clinicians the opportunity to better understand and resolve issues affecting their practice within complex healthcare systems.

How social media data are being used to research the experience of mourning: A scoping review.

BACKGROUND: Increasingly, people are using social media (SM) to express grief, and researchers are using this data to investigate the phenomenon of mourning. As this research progresses, it is important to understand how studies are being conducted and how authors are approaching ethical challenges related to SM data. OBJECTIVE: The aim of this review was to explore how SM data are being used to research experiences of mourning through the following questions: a) 'Which topics related to mourning are being studied?'; b) 'What study designs have been used to analyse SM data'; c) 'What type of data (natural or generated) have been used?'; and d) 'How are ethical decisions being considered?'. METHODS: The JBI Scoping Review methodology guided this review. Eligibility criteria were determined using the PCC framework, and relevant key words and phrases derived from these criteria were used to search eight databases in September 2021 (CINAHL, Embase, LILACS, OpenGrey, ProQuest, PsycINFO, PubMed and Scopus). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results of this review. RESULTS: Database searches resulted in 3418 records, of which, 89 met eligibility criteria. Four categories of grief and mourning were identified. Most records were qualitative in nature and used natural data. Only 20% of records reported ethics approval by an Institutional Review Board, with several including measures to protect participants, for example, using pseudonyms. CONCLUSIONS: This unique review mapped the diverse range of mourning-related topics that have been investigated using SM data and highlighted the variability in approaches to data analysis. Ethical concerns relating to SM data collection are identified and discussed. This is an emerging and rapidly changing field of research that offers new opportunities and challenges for exploring the phenomenon of mourning.

Using 360° Video to Enable Affective Learning in Nursing Education.

BACKGROUND: The affective domain describes learning associated with feelings, values, and emotions. Although this domain was first described in the late 1960s, a significant emphasis on skills and knowledge still remains. This prominence is evident despite global concerns about standards of practice and the place for empathy and care in nursing education. The emergence of newer technologies, such as 360° video, provides an opportunity to revisit the design and delivery of affective learning. METHOD: Using the taxonomy of the affective domain, a 360° video viewed through a virtual reality headset was developed to give nursing and medical students insight on the patient experience and an orientation to the operating room. RESULTS: Careful planning and consideration of how the affective domain can inform design of learning and teaching materials resulted in an engaging and informative learning experience. Being aware of how each level of the domain informs the next is essential to develop effective affective teaching plans. CONCLUSION: Affective learning traditionally has been difficult to deliver and assess. Technology such as 360° video provides an engaging, reproducible, and consistent platform for delivering a domain of education. [J Nurs Educ. 2020;59(7):409-412.].

Does an orthopaedic workshop improve the confidence of nurses transitioning into the specialty of orthopaedics?

BACKGROUND: Nurses transitioning into the specialty of orthopaedics gradually develop the skills required to provide care for patients with musculoskeletal conditions or injuries, but during the early stages this can be challenging and lead to a lack of confidence. Strategies aimed at developing confidence in these nurses to make sound decisions and clinical judgements in their professional practice will assist in strengthening their practice and delivery of quality care. AIMS: This study aimed to investigat if the delivery of an orthopaedic workshop improved the ongoing confidence of advanced beginner nurses, as recognised in Benner's exploration of skill acquisition, to undertake skills required to assess and manage patients with musculoskeletal injuries or conditions and assist in their decision making to achieve optimal patient outcomes. METHODOLOGY: A quasi experimental pre-test, post-test study was chosen to measure nurses' confidence to undertake the scope of practice in orthopaedics at the advanced beginner level of expertise. METHODS: A questionnaire was designed and administered to measure the level of confidence pre-intervention, immediately post intervention and twelve weeks following participation at an orthopaedic workshop. The workshop was designed specifically for nurses transitioning into the specialty of orthopaedics. FINDINGS: The intervention had a positive impact on the confidence of advanced beginner nurses. The measurement prior to participation at the workshop indicated confidence levels were generally low. Immediately post participation the level of confidence had increased for all participants. When measured again at twelve weeks' post intervention the level of confidence had been maintained or continued to increase in the majority of orthopaedic practice areas. The overall level of confidence between pre-interven tion to twelve weeks post intervention demonstrated a clear improvement in all areas of practice. CONCLUSION: It was evident that nurses transitioning into the speciality of orthopaedics had lower confidence levels in relation to specialty-specific skills and knowledge. The use of an education workshop improved the confidence of nurses, not only immediately post intervention, but also in the longer term. Supporting a pathway to transition in the specialty which includes specific education delivered at key times is recommended as it could beneficial to advanced beginner nurses, the specialty, patients and the profession.

Nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status: A phenomenological study.

BACKGROUND: A major goal of care for orthopaedic surgical patients is the achievement of their pre-morbid functional level or at least an improvement of their functional ability. However, patients with altered mental status can significantly impact this and other outcomes and influence the delivery of care. Patient mobilisation is a role shared by both nurses and physiotherapists. AIMS: To enhance the understanding of nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status. METHOD: Three nurses and three physiotherapists were recruited using purposive sampling. Data was collected through interviews and analysed using Burnard's 14 stages of thematic content analysis. RESULTS: Four main categories emerged from the study: altruism, interprofessional specialist practice, patient dynamics and challenges. Nurses and physiotherapists' experience have more similarities than differences under the four categories. CONCLUSION: Nurses and physiotherapists experience numerous challenges from both patient and resources related factors such as environment, staffing and time limitations; safety risks to patient and staff; and communication barriers due to patient's altered mental state. While tensions and variations in priorities of care delivery exist between the two groups, interdisciplinary collaboration of both professional groups was clearly evident and enabled optimisation of mobilisation goals for this patient population and revealed more similarities than differences in their experience. Patient and staff safety takes precedence over mobilisation and safety risks in this patient group can be mitigated by adequate resources, competence, and teamwork.

Orthopaedic nursing in developing nations: A collaboration between the Republic of the Union of Myanmar (Burma) and Australia.

This paper describes a collaboration between orthopaedic nurses in Myanmar (Burma) and Australia. It aims to explores how that collaboration began and how it can grow and has grown. The unique needs and challenges of healthcare delivery in developing nations are discussed. Understanding these unique needs and challenges is vital in tailoring strategies to provide orthopaedic nurses in those countries with resources that are suitable to assist them in providing the highest level of quality care to their patients. The authors hope that this example may inspire other orthopaedic nurses and organisations around the globe to participate in this type of activity with the understanding that it benefits all those involved, nurses from both developed and developing countries, as well as improving patient care.

Identifying and reducing the incidence of post discharge Venous Thromboembolism (VTE) in orthopaedic patients: a systematic review.

BACKGROUND: The risk of venous thromboembolism for orthopaedic patients is often high due to the length of surgery, damage from trauma to bone and soft tissues and lengthy periods of immobility or reduced mobility. Although venous thromboembolism occurs mainly in inpatients a significant number of patients develop venous thromboembolism post discharge OBJECTIVES: To synthesise the best available evidence on strategies that effectively reduce post discharge venous thromboembolism in orthopaedic patients. INCLUSION CRITERIA: Patients regardless of age, gender or co-morbidities that have been admitted with an acute orthopaedic injury (unplanned) or a planned orthopaedic surgery/procedure and then followed up after discharge. Only papers describing the incidence and prophylaxis treatment used in non-Asian patients were considered for inclusion. Any interventions of combinations of chemoprophylaxis and/or mechanical prophylaxis to prevent venous thromboembolism incidence extending beyond hospital admission. Outcomes included diagnosis of venous thromboembolism following an orthopaedic admission/surgery for up to 6 months post discharge and the incidence of any significant bleeding or death related to venous thromboembolism or haemorrhage.The review considered any randomised controlled trials; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered SEARCH STRATEGY: Search strategy considered only papers in English from 2000 to March 2012. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION: Data was extracted from the studies using the standardised Johanna Briggs Institute data extraction form. DATA SYNTHESIS: Of the included studies none matched methodology, treatment or comparator that allowed meta-analysis. The results were therefore presented in a narrative form and were structured using patient population, then intervention and then analysis of results. RESULTS: 20 articles were included in the systematic review. The overall incidence of post discharge venous thromboembolism in orthopaedic patients is not possible to determine due to the variability in reporting criteria and poor follow-up. Use of Low Molecular Weight Heparins was generally shown to be effective in preventing venous thromboembolism. The new generation Factor Xa inhibitors were shown to improve venous thromboembolism prevention however had a slightly higher risk of bleeding. There was limited high level research presented to allow effective assessment of aspirin and/or mechanical compression devices. CONCLUSIONS: Prevention of post discharge venous thromboembolism is complex due to the number of variables that can influence its occurrence. The risk of post discharge venous thromboembolism varies among different patient populations so consideration must be given to matching the risk for each of those groups with available interventions.For higher risk orthopaedic patient groups such as those with large joint replacements and femoral fractures low molecular weight heparins should be considered and continued where possible post discharge for thirty days however the risk profile for venous thromboembolism and bleeding must be considered for both populations and individuals.Consideration in future research design must be given to factors such as: adequate follow-up time, and standardised criteria to measure the incidence of post discharge venous thromboembolism. • Save items Add to Favorites View more options Similar articles Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review. [JBI Libr Syst Rev. 2010] The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review. [JBI Libr Syst Rev. 2009] Review The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review. [JBI Database System Rev Implem...] Continuous Subcutaneous Insulin Infusion (CSII) Pumps for Type 1 and Type 2 Adult Diabetic Populations: An Evidence-Based Analysis. [Ont Health Technol Assess Ser....] Review The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review. [JBI Database System Rev Implem...] See reviews... See all... Cited by 1 PubMed Central article A systematic scoping review on the consequences of stress-related hyperglycaemia. [PLoS One. 2018] Related information Cited in PMC Search details 27820532[uid] Search See more... Recent Activity ClearTurn Off Effectiveness of tight glycemic control in the medical Intensive Care Unit: a sy... PubMed 27820532[uid] (1) PubMed 27820349[uid] (1) PubMed Effectiveness of Tight Glycemic Control in the Medical Intensive Care Unit: A Sy... PubMed

Are we providing the best possible pain management for our elderly patients in the acute-care setting?

BACKGROUND: During 2008 seven practice improvement projects were conducted in an acute-care hospital under the banner of The Older Person and Improving Care (TOPIC 7). Each project team examined a discrete aspect of care of the elderly and this project focus was on pain management and in particular assessment of the older person with communication difficulties. AIMS: The project intended to assess current practice and implement changes to match best practice in the management of pain in the older person within an acute-care setting. METHODS: A multidisciplinary team was recruited to conduct the project. The pain team with the other six TOPIC 7 teams was facilitated by a coordinating team. The project was divided into four phases. Phase one was designated as Describing, where the clinical issue was identified and focused to priority areas. It was decided to focus on the elderly who were unable to verbally communicate their pain management needs. Standards of practice relevant to the area of practice were sourced to guide practice improvement. Phase two was Measuring activity where clinical audits were used to measure current practice and compare this with the appropriate standards. Phase three was Taking action where a range of practice improvement activities were implemented including the introduction of the Abbey Pain Scale. The final phase was designated as Review and share where the impact of the project activities was measured with a follow-up audit and the results were disseminated. RESULTS: Initial results showed a need for increased awareness of the difficulties in the pain assessment and management of older persons who cannot verbally communicate their needs. Seventy-eight per cent of patients had a documented pain assessment in the previous 24 h on audit. However, 83% of these assessments were only a general comment in the patient records. No tools were available for completing a systematic assessment that was reliable and reproducible. Sixty-two per cent of patients did not have analgesia administered 1 h before mobilising or having a significant dressing completed. Reaudit, posteducation sessions, showed an increase in the awareness in the complexities involved in caring for this group of patients. An alternate, specific tool (Abbey Pain Scale) was utilised well by staff and acted as a prompt in reminding staff to assess the pain levels of their elderly patients. CONCLUSIONS: Globally, pain in the older person is poorly managed. Pain in older persons who are unable to communicate or who have difficulty in communicating their needs is even more poorly managed. However, the availability of an appropriate tool and an increased awareness of this issue can have a significant and real impact on the pain management of this group of patients.