Day Surgery Patiens During the Preoperative Wait - Book Report/Review Example

Critical Appraisal of “Day surgery: patients’ felt abandoned during the preoperative wait” by Jo Gilmartin and Kerrie Wright (Student’s Name) (Student’s number) (Institution) (Course) (Module number) (Instructor’s name) (Submission date) Introduction Nursing care is one of the most delicate and sensitive subjects that demands proper attribution of practice to evidence and theory. Opinion and experience based decisions are deemed as inappropriate and may pose a risk to the health and safety of a patient (Granger 2008). It is in this regard that nurses are advised at reviewing literature extensive and intensively to gain solid understanding of various topics in the profession. Care of post-operative patients is one among them. Increased numbers of day surgery has opened up a new direction in the study of preoperative care for patients. An article by Gilmartin and Wright claim that patients felt abandoned during the pre-operative wait as shown by a study they conducted on 20 adult patients who recounted their experiences and a hermeneutic phenomenological approach was used to identify four common themes in their experiences. This paper will critically examine the information presented by Gilmartin and Wright in the articles on its acceptability, reliability, suitability and relevance to the nursing profession. Summary Population growth and need for efficiency in theatres fuels demand for day surgery implying a new set of needs for patients and new challenges for nurses. Patients have raised concerns on preparation for surgery, the material day and postoperative care. On the material day of surgery, patients need to be assessed and assured of their fitness for the operation and informed of any cancellations or possible delays. Such assessment prepares them emotionally and eases their worries. Patients also indicated that they needed procedural details beforehand and risks involved. The post operative stage is also of importance to patients, nurses and researchers alike. Research shows that postoperative issues affect recovery period and prolongs the need for nursing care. The research specifically seeks to describe and interpret patients’ experiences before and after day surgery. The research utilized unstructured interviews with the patients, whereby the patients shared their experiences and feelings that did not infringe on their privacy. A representative sample of 20 patients was carefully selected from a large preassessment clinic in a teaching hospital in Northern England. The sample age bracket was 19–85 years of age both male and female. Eighteen patients were white and 2 were from minor ethnic communities. To preserve privacy, each patient was assigned a pseudonym and informed about the purpose of the study which was duly approved. The study analyses data using a phenomenological approach and identifies four themes in patients experiences: The feeling of empowerment during preparation, apprehensions encountered, the feeling of abandonment in the preoperative waiting area and the dynamics of recovery. The study concludes that apprehensions encountered and the feeling of abandonment in the preoperative waiting area was most significant to patients and hence recommends that that nursing care be made continuous during the preoperative wait. Critical appraisal Vlayen et al (2005) identify ten general dimensions for critical appraisal of clinical practice guidelines; validity, reliability/reproducibility, clinical applicability, clinical flexibility, multidisciplinary process, clarity, scheduled review, dissemination, implementation, and evaluation. Validity is the most important dimension as it impacts on all the others. Given that the study used unstructured questions, it was imperative to make participant responses as accurate as possible. This research achieved this by paraphrasing participants’ response and verifying the written response. Gilmartin and Wright provide a nursing guideline in the care of preoperative day surgery patients based on evidence research that they conducted. Penz and Bassendowski (2006) say that “evidence-based nursing is a discipline in which nurses make clinical decisions using current “best” research evidence, which is then blended with approved policies and clinical guidelines, clinical expertise and judgment, and patient preferences” (p. 250). An evidence-based approach ensures that provision of nursing care is patient oriented and humane (Brady & Lewin 2007). However, evidence-based approach findings are not independent as they have to be blended with theory and policies. Evidence-based research has to be carried out with the aim of exploring beyond routine and the conventional ways of doing things (Penz & Bassendowski 2006; Granger 2008). In the case, of Gilmartin and Wright, their research was inspired by the need to explore the assumption that day surgery patients in their preoperative waiting rooms do not need nursing care. From their findings, the authors recommend nursing care to be provided continuously into the preoperative waiting period to avert the frequent sense of feeling abandoned. The research did not hypothesize on the ‘feeling abandoned’ issue at the onset of the study but realized it as a finding from patients’ experiences which facilitates subjectivity in research (Brady & Lewin 2007). By calling this finding as one of the four main themes in the research, the authors skip informing the audience on the formula used to describe patient response as ‘feeling abandoned’ given that, the study used unstructured interviews. A number of researchers recommend that questions posed to patients be classified using the PICO format which calls for grouping of questions as “P-for the patient or problem”, “I-for the intervention of interest” “C-for comparison”, and “O-for outcome” (Moyer 2008; Brady & Lewin 2007; Schlosser, Kaul & Costello 2006; Engberg & Schlenk 2007). Nowhere in the paper that the authors give a sample of the questions posed to the respondents. Failing to follow this format as recommended by Moyer (2008) would make it almost impossible for the research to be replicated as there are no guidelines to the questions. This also exposes the study to irrelevant responses from participants and irrelevant questions by researchers seeking to replicate this research (Holloway and Wheeler 2002, cited in Gilmartin & Wright 2007; Engberg & Schlenk 2007). However, some data collection situations are very dependent on situations and circumstance that replication of research or use of structured questions might be problematic (Penz & Bassendowski 2006). Irrelevance of some responses would have been averted using an appropriate data analysis and presentation method. Marshall recommends use of t-test for descriptive data such as this study. A t-test helps users to better understand the data presented (Marshall & Jonker 2009), and also assesses the reliability/confidence levels of the data (Vlayen et al (2005). Schlosser, Kaul & Costello (2006) assert that the formulation of questions in evidence based practice is critical and researchers should utilize the PICO format. The formulation of the right questions directs the research and helps in identifying the gap in knowledge that the study seeks to fill (Engberg & Schlenk 2007). The study sought to provide evidence based knowledge cutting across the nursing field given that the sample was all inclusive and did not specialize on patients waiting for a particular form of surgery. However, this research used a relatively small sample to gain high confidence level which was not tested. However, the sample was enough to address the research question. Again, the researchers made all the important ethical consideration such as authorization and using pseudonyms to conceal participants’ identity. Fundamental research component The title of the article “Day surgery: patients’ felt abandoned during the preoperative wait” is self explanatory and contains the articles key words; abandoned and preoperative wait, which is imperative in grabbing the attention of potential audience. The title should somehow provide an overview of the article by telling the reader what content to expect in the article and encourage them to read on (CASP 2006). In evidence based approach practice in nursing the, the delivery of care has to be patient oriented and hence his claim that the feeling of abandonment is evidence based is quite critical in drawing readers interest especially the nursing profession due to growing popularity of evidence based nursing practices. The authors consign their work in context by analyzing existing literature on preoperative patient issues and notes that not much research has been carried out on day surgery patients thus the research has a conceptual framework based on an observation. To capture the nature of the data being collected, the researchers had to use descriptive statistics because the data is qualitative in nature. The patients had to narrate their experiences. Unstructured interviews were used in order to allow free flow of expression and feelings by the participants. In the case if structured interviews, the participants’ responses and answers would have been guided by the questions and in the process some information would have been left out since participants would only restrict their responses to the question. Tong, Sainsbury and Craig (2010) support the use of interviews in collection of descriptive data in healthcare. They say that the responses from the interviews not only provide answers to the research’s question but also provide alternative means and suggestion relevant in the provision of nursing care as per the participants’ views. Unfortunately, this method is exposed to loss of focus as participants tend to steer away from the focus of the study. Again, by allowing participants to freely express their views and experiences, they are vulnerable to being emotionally carried away which may lead to biased responses. To gain a balanced response on experiences during the preoperative wait, the researchers chose to use a purposively selected sample made up of participants undergoing different forms of day surgery in preoperative clinic in a large hospital located North of England. Purposive selection helps in ensuring that only participants with rich, relevant and diverse information pertinent to the research (Tong et al 2010). The sample was collected on one day thereby ignoring the influence of the hospitals programs and schedules pertaining to surgery. For instance, it could be possible that the hospital prepares schedules on which days to perform which types of surgery. Moher et al (2010) recommend that evidence based studies and trials should recruit participants over long periods of time. Therefore, it is possible that the sample missed on very crucial contribution from patients who undergo different circumstances in the preoperative waiting rooming depending on their type of surgery. The researchers consulted with relevant authorities and the hospital before commencing the research. This gives the research credibility and authority. Again seeking authority from the hospital and liaising with the nursing and surgical staff in the hospital was imperative in selecting the sample purposively. The researchers complied with ethical considerations by preserving the privacy of the respondents by use of pseudonyms. However, though the researchers do not explicitly state how they went around convincing participants about the purpose of the study in order to have an informed consent to the study. Relevant information about the purpose of the study encourages participants to be more honest and open in their responses. The presentation of the findings in the research is very wanting. Although the research groups the responses into four main themes, there is data support for ‘feeling abandoned’ as the main theme from the participants’ responses. Failure to use an appropriate data analysis technique erodes on the credibility of the research findings and makes it almost to replicate the research. Relevance The provision of nursing care should be adequately provided in the preoperative waiting room. From the research, it is evident that there is a gap in nursing care provision between preparation for surgery and surgery itself. From some of the responses sampled in the study, some nurses perceived patients in the preoperative waiting room as not their responsibility. Again, hospitals should enact polices and introduce practices that will reduce the preoperative waiting period which at times lasts up to six hours. The longer the waiting period, the more the participants felt abandoned. Again, nurses should treat patients as active participants in the delivery of nursing care rather than passive ones. This involves informing and explaining to the patients in the preoperative waiting room of possible delays and cancellations in time. Conclusion Provision of nursing care has many faces and stages that should all be connected and integrated into one satisfying experience for patients. Simple mistakes by nurses add up to the stress caused by illnesses and hence nurses should be there to manage these and avoid all situations that may aggravate this. The research by Gilmartin and Wright indicates one instance that nursing practices aggravate the problems of patients by causing emotional pain particularly in day surgery patients in preoperative waiting rooms. The research points out a relevant issue in delivery nursing care which nursing professions should manage and increase patient satisfaction and emotional wellbeing. References Brady, N. & Lewin, L. (2007). “Evidence-based practice in nursing: bridging the gap between research and practice.” Journal of pediatric health care. 21, 53-56 Critical Appraisal Skills Programme (CASP) (2006). 10 questions to help you make sense of qualitative research. Public Health Resource Unit, England Engberg, S. & Schlenk, E. (2007). “Asking the right question.” Journal of emergency nursing. 33 (6) 571-573 Gilmartin, J & Wright, K. (2008). “Day surgery: patients’ felt abandoned during the preoperative wait.” Journal of clinical nursing. 17, 2418–2425 Granger, B. B. (2008). “Practical Steps for Evidence-Based Practice.” Journal of advanced critical care. 19 (3) 314-324 Marshall, G. & Jonker, L. (2009). “An introduction to inferential statistics: A review and practical guide.” Journal of radiography. 10 (16) 1-7 Moher, D. et al (2010). “Research methods & reporting.” British medical journal. 340 (869) 1-28 Moyer, V. (2008).Weighing the Evidence: PICO Questions: what are they, and why bother? American academy of pediatrics. Retrieved online from http://aapgrandrounds.aappublications.org Penz, K., Bassendowski, S.L. (2006). “Evidence-Based Nursing in Clinical Practice: Implications for Nurse Educators.” The Journal of Continuing Education in Nursing. 37 (6) 250-254 Schlosser, R.W., Kou, R. & Costello, J. (2007). “Asking well-built questions for evidence- based practice in augmentative and alternative communication.” Journal of communication disorders. 40, 225–238 Tong, A., Sainsbury, P. Craig, J. (2007). “Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.” International journal for quality in health care.19 (6) 349–357 Vlayen, J. et al (2005). “A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit.” International Journal for Quality in Health Care. 17(3) 235–242 Read More