Nursing intensity and nurse staffing in perioperative settings

The goal of this study was to design and test a nursing intensity (NI) instrument in perioperative settings to produce information concerning patients’ care needs. This information is intended to be used for knowledge-based management purposes when applying optimal nurse staffing. In Phase I, a Delphi method with two rounds (n=55) was used to define the core elements of perioperative nursing. Then those core elements were tested to evaluate NI during the pre-, intra-, and postoperative phases of the surgical patient’s care process (n=308 patients). In Phase II, the core elements were implemented in an instrument, and further testing was carried out in different perioperative settings (n=876 patients). In Phase III, an integrative review was con-ducted to find out how nurse staffing had been executed in perioperative settings. According to the results, the core elements of perioperative nursing describing patient’s safety or patient’s physiological needs were seen as the most crucial. A principal component analysis revealed that a patient’s care needs vary from the intraoperative to postoperative phases of perioperative nursing. Patients in a high ASA class more frequently had high intraoperative NI points, but patients in a low ASA class did not automatically have fewer intraoperative care needs. The length of stay in the post-anesthesia care unit (PACU) and the type of follow-up unit could be predicted with intraoperative NI. Scant evidence was found concerning nurse staffing in perioperative settings. The need to take into account patients’ care needs showed up in some papers, but these were not expressed in an assessable form. Staffing models in relation to perioperative nursing-sensitive outcomes were not found. This study offers an instrument for evaluating NI in perioperative settings. This information produced can be utilized for nurse staffing and nurse staff allocation purposes. More research is needed that focuses more on the detailed use of information based on NI. Its potential to serve as a knowledge-based management tool also needs clarifying in future studies

Delirium in a surgical context from a nursing perspective : A hybrid concept analysis

Publisher Copyright: © 2022Background: The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses’ viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed. Objective: The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective. Design: The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases. Settings: Surgical wards, surgical intensive care units, and post-anaesthesia care units. Data sources: A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase. Participants: Registered nurses and licensed practical nurses (n = 105) participated in the fieldwork phase. Methods: In the theoretical phase, the concepts’ working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses’ descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported. Results: The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients’ compliance with care may be decreased with the continuum of delirium, which might challenge both patients’ recovery from surgery and the quality of nursing care. Conclusions: In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.Peer reviewe

The Criterion Validity, Reliability, and Feasibility of an Instrument for Assessing the Nursing Intensity in Perioperative Settings

Peer reviewe

Uusi strategia vaikean kroonisen munuaistaudin hoidonohjaukseen

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Dialyysi uuteen toimintamalliin

HUS-piirin dialyysipotilaista noin joka neljäs hoidetaan yksityisen yrityksen dialyysipalveluissa. Sen ansiosta myös sairaanhoitopiirin rooli yksilöllisen dialyysihoidon järjestäjänä on terävöitynyt

Kun arkea varjostaa päihderiippuvuus - kokemuksia perhe-elämästä puolisoiden kertomana

TIIVISTELMÄ Riina Rauta & Satu Mansikka Kun arkea varjostaa päihderiippuvuus. Kokemuksia perhe-elämästä puolisoiden kertomana 45 sivua ja 1 liite. Kevät, 2019. - Diakonia-ammattikorkeakoulu, Sosiaalialan koulutusohjelma, Sosionomi (AMK) Opinnäytetyö sisältää kokemusperäistä tietoa sellaisten perheiden arjesta ja perhedynamiikasta, joissa toisen vanhemman päihteiden käyttö varjostaa arkea. Tarkastelimme teemaa päihteettömän puolison näkökulmasta, taustalla kuitenkin ajatus kokonaisesta perheestä ja siitä, minkälaisin erityispiirtein lapsiperhearki näyttäytyy silloin, kun perheessä on päihdeproblematiikkaa. Puolisolla tarkoitetaan tässä tutkimuksessa avio- ja avopuolisoita sekä seurustelukumppaneita. Opinnäytetyö toteutettiin teoriasidonnaisena laadullisena tutkimuksena, jossa aineistosta on löydettävissä teorialiitännäisyys