scholarly journals Nurses’ workarounds in acute healthcare settings: a scoping review

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Deborah S Debono ◽  
David Greenfield ◽  
Joanne F Travaglia ◽  
Janet C Long ◽  
Deborah Black ◽  
...  
Author(s):  
Alexander Micallef ◽  
Sandra C. Buttigieg ◽  
Gianpaolo Tomaselli ◽  
Lalit Garg

Background: With the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings. Methods: An extensive literature search yielded a total of 26 248 records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January 2017 and March 2020 and covered literature ranging from 1990 to 2019. Results were reviewed by authors for duplicates and filtered using the inclusion/ exclusion criteria. Tables were created to classify the chosen articles (n = 64), allowing us to organise findings and results. Results: Conceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&E (Accident & Emergency) overcrowding, and financial implications. The main interventions included ‘discharge before noon’ initiative, ‘discharge facilitation tools,’ ‘discharge delay tracking’ mechanisms, and the role of general practitioners and social care staff. Conclusion: This paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a researchbased perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.


2021 ◽  
pp. 096973302098830
Author(s):  
Amara Sundus ◽  
Sharoon Shahzad ◽  
Ahtisham Younas

Background: Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. Ethical considerations: No formal ethical approval was required. Aim: To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. Design: A Scoping Review Literature Search: Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as “transgender,” “gender non-conforming,” “ethically sensitive care,” and “culturally sensitive care.” In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. Findings: Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. Conclusions: The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.


2008 ◽  
Vol 23 (6) ◽  
pp. 526-529 ◽  
Author(s):  
Brett Williams ◽  
Mal Boyle ◽  
Bill Lord

AbstractIntroduction:Correct identification of the J-Point and ST-segment on an electrocardiograph (ECG) is an important clinical skill for paramedics working in acute healthcare settings. The skill of ECG analysis and interpretation is known to be challenging to learn and often is a difficult concept to teach.Objectives:The objective of the study was to determine if undergraduate paramedic students could accurately identify ECG ST-segment elevation and J-Point location.Methods:A convenience sample of undergraduate paramedic students (n = 148) was provided with four enlarged ECGs (ECG1–4) that illustrated different levels, patterns, and characteristics of ST-segment elevation. Participants were asked to identify whether ST-elevation was present, and if so, height in millimeters (mm) and the correct location of the J-Point.Results:There were significant variations in students'accuracy with both J-Point and ST-segment determination. Eleven (10%) students correctly identified the ST-segment being present in all ECGs. Also, ECG 2 reflected 6 mm of ST-elevation; however, only one student correctly identified this. Overall the students were 0.55 mm (95% CI = 0.29–0.81 mm, range = -6.5–5.8 mm) from the J-point on the horizontal and -0.18 mm (95% CI = -0.31–0.04 mm, range = -2.8–2.3 mm) on the vertical axis.Conclusions:Undergraduate paramedic students recognize ST-segment elevation. However, inaccuracies occurred with measurements of ST-segment and precise location of J-Points. Errors in ECG analysis may reflect weaknesses in teaching this skill. Consideration should be given to the design of an educational program that can reliably improve performance of this skill.


2021 ◽  
Author(s):  
Minerva Rivas Velarde ◽  
Caroline Jagoe ◽  
Jess Cuculick

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.


2020 ◽  
Vol 18 (1) ◽  
Author(s):  
L. Lennox ◽  
A. Linwood-Amor ◽  
L. Maher ◽  
J. Reed

Abstract Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.


2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Chloe L. Brown ◽  
Danyaal Raza ◽  
Andrew D. Pinto

PLoS ONE ◽  
2012 ◽  
Vol 7 (8) ◽  
pp. e41911 ◽  
Author(s):  
Duncan Chambers ◽  
Paul Wilson ◽  
Carl Thompson ◽  
Melissa Harden

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024588 ◽  
Author(s):  
Kirsten Marchand ◽  
Scott Beaumont ◽  
Jordan Westfall ◽  
Scott MacDonald ◽  
Scott Harrison ◽  
...  

IntroductionSubstance use disorders are chronic conditions that require a multidimensional treatment approach. Despite ongoing efforts to diversify such treatments, evidence continues to illuminate modest rates of treatment engagement and perceived barriers to treatment. Patient-centred care (PCC) is one approach that may strengthen the responsiveness of treatments for people with problematic substance use. The aim of this scoping review is to explore how the principles of PCC have been implemented and operationalised in healthcare settings for people with problematic substance use.Methods and analysisThis scoping review follows the iterative stages of the Arksey and O’Malley framework. Both empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references will be considered if they focused on populations with problematic substance use and described or measured PCC or one of its principles in a health-oriented context. Two reviewers will independently screen references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria. A descriptive overview, tabular and/or graphical summaries, and a directed content analysis will be carried out on extracted data. This scoping review has been registered with Open Science Framework (https://osf.io/5swvd/).Ethics and disseminationThis review will systematically examine the extent and nature of existing evidence of PCC in addiction research and clinical practice. Such evidence will contribute to the operationalisation of PCC for people with problematic substance use. A multidisciplinary team has been gathered to represent the needs of people with problematic substance use, healthcare providers and decision-makers. The team’s knowledge users will be engaged throughout this review and will participate in dissemination activities (eg, workshops, presentations, publications, reports).


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hanna Augustsson ◽  
Kate Churruca ◽  
Jeffrey Braithwaite

Abstract Introduction Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders’ differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated. Aim This scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings. Method The review was based on Arksey and O’Malley’s framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker’s Quality Assessment Tool. Result A total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland’s original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements. Conclusion SSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare.


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