Critical Reflection and Decision-Making Report Essay Example

  • Category:
    Nursing
  • Document type:
    Assignment
  • Level:
    Masters
  • Page:
    4
  • Words:
    2717

Institute

Best Practice Guidelines: Management of the Day Surgery Patient

Introduction

Day surgery is carrying out an operation procedure which occurs without overnight admission of the patient before or after the intervention as defined by (Timmins & McCabe, 2009). Among ways of ensuring that day surgeries are effective is adhering to set best practices and implementing strategies that ensure effective continuity of care is provided before, during and after the intervention (Penn, et al., 1996). This is achievable through proper planning and preparation, monitoring and holistic assessment, education, consistent follow-up and effective management of post –operative issues such as stress and pain (Allard, 2005).

There are best practices for management of day surgeries patients which ensures safety and security for the patient, commitment and competence from care staff and the management and they ensure patients are provided with quality, culturally-acceptable, accessible, available and affordable care prior to, during and after the intervention which translates to quick recovery and minimal or no post discharge complications (Williams & Wilkins, 2007). The report seeks to critically assess the Joanna Briggs Institute for Evidence Based Nursing and midwifery’s Best Practice Guidelines: Management of the Day Surgery Patient.

Critical reflection on Best Practice Guidelines: Management of the Day Surgery Patient

The Joanna Briggs Institute for Evidence Based Nursing and midwifery’s Best Practice Guidelines: Management of the Day Surgery Patient is fundamental in facilitating successful day surgery outcomes. The main objectives of the guidelines although not specified are clear which includes ensuring that there is equity of care during pre-admission assessment to post discharge care, to generate a framework that aids clinical governance such as continuous quality improvement and risk management and to ensure the medical personnel utilize evidence based care for their day surgery patients (JBI. 2003). In addition, the best practice guidelines are meant to reduce duplication of information and ensures there is no repetition in regards to patient questioning, ensure the rights, preferences and autonomy of the patient are taken into account and enhance communication among the staff groups and between the staff and the patient and their families or social support system.

The guidelines recommended by The Joanna Briggs Institute for Evidence Based Nursing and midwifery are evidence based which makes them applicable across varied types of surgeries and applicable for different types of patients such as children, the elderly and regular adult patients hence, suitable for applications in varied healthcare settings offering day surgeries (JBI. 2003). The best practice guidelines on the management of the day surgery patient seeks to answer questions on the need for continuity of care as they cover three main areas which are pre admission, post-admission procedures and staffing mix.

The guidelines advocate for preoperative assessment which has restricted time and screening of patients to help minimize unnecessary cancellations (JBI. 2003). The best practice guidelines recommends that preoperative assessment should be accompanied by pre-operative education to minimize anxiety prior to intervention and help the clinician evaluate the needs of the patient and the family and help personalize information for each patient (Allard, 2005). According to the best practice guidelines, effective pre-operative assessment equips patients with knowledge about the procedure and ensures the patient is in good physical and psychological condition to undergo the surgery.

The guidelines offers a framework for post admission to discharge care which helps cater for the physical, psychological and emotional needs of the patient through provision of distraction tools and use of alternative systems to determine time of discharge (Mitchell, 2005). In addition, they recommend appropriate time and schedule for day surgeries based on their complexity and enhances ease in transfer of patient to their homes. In relation to staffing, the best practice guideline highlights the need for adequate staffing where skilled and professionally equipped staffs are used to ensure delivery of quality care which is vital in increasing patient satisfaction and containing costs (Timmins & McCabe, 2009).

The best practice guidelines for managing a day surgery patient is meant to cover all patients including children, adults, the elderly and both male and female whose conditions and health qualifies them for day surgeries. As highlighted above, the guidelines are comprehensive in covering all the main areas of care prior to, during and after the intervention and extends to addressing staffing issues and describing a favorable health setting and environment, which plays a vital role in enhancing the competence, accountability and knowledge of nurses in handling day surgeries which ensures the anticipated day surgery outcomes are effectively and efficiently achieved (JBI. 2003). However, the guidelines fail to address issues regarding to potential post-discharge issues and complications facing day surgery patients and how they can be adequately addressed to ensure patients are able to recover.

The best practice guidelines are crucial in equipping nurses with the understanding on when the day surgery are appropriate, understanding potential risks during and after- day surgery complications thus, knowing how to minimize them, knowing how to handle and interact with day surgery patient before, during and after intervention and knowing how best to adequately support patients after they are discharged without creating overdependence on nurses or enhancing paternalism (Cambridge Media, 2009).

There are organizational barriers that impede application of the best practice guidelines which include an organizational culture that is not flexible enough to accommodate changes recommended by the guidelines such as teamwork, positive attitude, staff integration and open communication (Thomas, 2008). In addition, lack of sufficient resources to sufficiently meet additional expenses brought about by implementing the guidelines such as the need for more qualified staff and increased time allocated to individual patients during pre-assessment, lack of commitment and support to implement and monitor application of the guidelines and lack of support for the nursing staff (Timmins & McCabe, 2009).

The best practice guidelines are generated based on evidence based research and through use of systematic research approach to ensure validity, relevance, reliability and accuracy. In addition, they were informed by distinctly defined levels of evidence that is, level I, level II, level III.1, level III.2, level III.3 and level IV as discussed by (JBI. 2003). The procedures utilized to generate the guidelines and recommendations are succinctly described which takes into account the risks and health benefits to the patient. Where additional research and reviews are required, the guidelines does not however, state so explicitly.

The best practice guidelines compares greatly with findings from varied studies on day surgeries in regards to selection of patient and pre-operative assessment for day surgeries. Effective selection of patients minimizes the rate of cancellations by patients and failure to attend which assist in achieving quality and efficient day surgery (Mitchell, 2005). Suitable patient selection allows patients to make informed choices, it enhances holistic and family-centered patient care which forms that basis of patient satisfaction and success for day surgeries and it facilitate overall effectiveness of day unit. Regarding after care, the guidelines implies a need for family engagement in consultations. (Hodge, 1999) notes that this is achievable through effective communication and professional interrelationships where the rights and decisions of the patient and the family are considered.

Conclusion

This report has critically assessed The Joanna Briggs Institute for Evidence Based Nursing and midwifery Best Practice Guidelines: Management of the Day Surgery Patient. The guidelines are evidence based and are significantly effective in ensuring day surgery patients receive holistic and individually centered care throughout the intervention process pre, during and post discharge.

PROFORMA

DOMAIN: SCOPE AND PURPOSE

Aspect 1 The overall objectives of the guidelines are specifically and adequately described

  • ensuring that there is equity of care during pre-admission assessment to post discharge care

  • generate a framework that aids clinical governance such as continuous quality improvement and risk management

  • ensure the medical personnel utilize evidence based care for their day surgery patients

Aspect 2 The clinical questions covered by the guidelines are specifically described

  • What is the significance of continuity of care

  • What constitutes to effective day surgeries

  • What are the activities that should be carried out during pre and post admission

  • What are the significant impact of staffing mix

Aspect 3 The patients to whom the guideline is meant to apply are specifically described

  • Children

  • the elderly

  • both male and female whose conditions and health meets the inclusion criteria which qualifies them for day surgeries

DOMAIN: RIGOUR OF DEVELOPMENT

Aspect 8 Systematic methods were used to search for the evidence

  • Randomized controlled trials

  • Case control analytical studies with more than one research centre or group

  • Quantitative data from descriptive studies and reports from expert committees

Aspect 9 The criteria for selecting the evidence are clearly described

  • Level I Evidence obtained from a systematic review of all relevant randomized controlled trials.

  • Level II Evidence obtained from at least one properly designed randomized controlled trial.

  • Level III.1 Evidence obtained from well-designed controlled trials without randomization.

  • Level III.2 Evidence obtained from well- designed cohort or case-control analytical studies preferably from more than one centre or research group.

  • Level III.3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments.

  • Level IV Opinion of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Aspect 10 The methods used for formulating the recommendations are clearly described

  • Three systematic reviews conducted by the Nursing Practice Unit, La Trobe University and the Day Surgery Special Interest Group, ANF, Victorian Branch.

Aspect 11 The health benefits, side effects and risks have been considered in formulating the recommendations

According to the best practice guidelines “The procedures described in Best Practice

must only be used by people who have appropriate expertise in the field to which the procedure relates. The applicability of any information must be established before relying on it. While care has been taken to ensure that this edition of Best Practice summarizes available research and expert consensus, any loss, damage, cost, expense or liability suffered or incurred as a result of reliance on these procedures (whether arising in contract, negligence or otherwise) is, to the extent permitted by law, excluded” (JBI, 2003).

Therefore, all recommendations in the guidelines are to be applied based on

  • availability of resources

  • applicable local context such as policies and protocols

  • wishes and condition of the patient

  • understanding of recent evidence based findings

Aspect 12 There is an explicit link between the recommendations and the supporting evidence

  • Every recommendation given by the guideline is backed by evidence of empirical research conducted on the highlighted issue either pre admission, during the procedure and post discharge and on staffing mix. For example,

-Pre-operative telephone screening or questionnaires were found in one study to be effective in reducing the rate of cancellations/postponements supporting the need for assessment and screening recommended by the guideline.

— Screening criteria guidelines by the Association of Anesthetists of Great Britain and Ireland indicate that the patient’s willingness to have day surgery should be factored in, which correlates with the recommendations given by the guideline

Aspect 14 A procedure for updating the guideline is provided

There is no explicit procedure highlighted in the guideline which can be used for updating the guideline. Nevertheless, the guideline highlights that the best practices are evidence based and has been generated by an array of empirical studies and under the guidance of a panel of clinical experts who were consultants during the review process on the three areas namely pre admission, post admission and staff mix.

DOMAIN: CLARITY AND PRESENTATION

Aspect 15 The recommendations are specific and unambiguous

  • Collaborative approach to delivering care to patients

  • Continuous improvement of care from pre admission to post discharge

  • Effective assessment and screening of patient

  • Patient preoperative education

  • Integrated approach to management of day surgery patient

  • Adequate staff training

Aspect 16 The different options for management of the condition are clearly presented

  • Availability of alternative to ambulatory (day) surgeries for patients

  • Effective assessment and screening to ensure all other options of management of the condition are utilized and to ensure that day surgeries are the only best and last option/ resort

Aspect 17 Key recommendations are easily identifiable

  • Person-centered health care

  • Continuous quality improvement(pre admission, during operation and post admission)

  • Suitable staffing levels and skill mix reflecting needs of day surgery patients

  • Adequate assessment, screening and education of day surgery patient

Aspect 18 The guideline is supported with tools for application

Every activity recommended for management of day surgery patient is specifically indicated in what aspect and time of the procedure it should be applied either pre or post operative. In addition, the how and by whom and for whom

Briefly determine the quality of the Guideline and analyze whether nursing knowledge is increased as a result of it

  • The guidelines are comprehensive in covering all the main areas of day surgery care prior to, during and after the intervention and extends to addressing staffing issues and describing a favorable health setting and environment, which plays a vital role in enhancing the competence, accountability and knowledge of nurses in handling day surgeries which ensures the anticipated day surgery outcomes are effectively and efficiently achieved.

  • The best practice guidelines are crucial in equipping nurses with the understanding on when the day surgery are appropriate, understanding potential risks during and after- day surgery complications thus, knowing how to minimize them, knowing how to handle and interact with day surgery patient before, during and after intervention and knowing how best to adequately support patients after they are discharged

  • Nevertheless, the guideline fails to indicate the grading of the recommendations and does not indicate if it has any limitations

Discuss the application of the Best Practice Guideline relating to potential organizations barriers and cost to an organization at a unit level

  • Among organizations barriers include organizational culture that is not flexible enough to accommodate changes recommended by the guidelines such as teamwork, positive attitude, staff integration and open communication.

  • lack of sufficient resources to sufficiently meet additional expenses brought about by implementing the guidelines such as the need for more qualified staff and increased time allocated to individual patients during pre-assessment

  • lack of commitment and support to implement and monitor application of the guidelines

  • lack of support for the nursing staff

Apply your clinical experience and relevant literature to discuss the feasibility of implementation as evidence based

The best practices for management of day surgeries patients based on evidence ensures

  • safety and security for the patient

  • commitment and competence from care staff and the management

  • Patients are provided with quality, culturally-acceptable, accessible, available and affordable care prior to, during and after the intervention which translates to patient satisfaction and minimal or no post discharge complications as supported by (Williams & Wilkins, 2007).

Care for patients should be based on evidence and comply with internationally set guidelines to ensure health and clinical standards are continuously and consistently being maintained. As highlighted by the best practice guidelines on management of day surgery patient, using evidence based information to provide care ensures health risks are minimized and patient receives the best care which satisfies their health needs. Evidence based care enhances good health outcomes and it ensures that care given is continuously improved and focused on the needs of the patient by generating the right health environment and health resources as supported by(Timmins & McCabe, 2009).

Through evidence based care, health care providers are able to understand and know what strategies work and those that do not and in so doing limit health risks which may harm their clients or lead to non-attainment of anticipated health outcomes.

References

Allard, N. (2005). Day surgery and recovery in women with a suspicious breast lesion: Evaluation of a psycho educational nursing intervention. Toronto: University of Toronto.

Cambridge Media. (2009). Australian Day Surgery Nurses Association Best Practice Guidelines for Ambulatory Surgery & Procedures 2009. Cambridge: Cambridge Media.

Hodge, D. (1999). Day surgery: a nursing approach. Sidney: Elsevier Health Sciences.

JBI. (2003). Management of the Day Surgery Patient. Best Practice Supplement 1, p1-4

Mitchell, M. (2005). Anxiety management in adult day surgery: a nursing perspective. New York: John Wiley and Sons.

Penn, S., Davenport, H.T., Carrington, S. & Edmondson, M. (1996). Principles of day surgery nursing. Oxford: Blackwell Science.

Thomas, W.E.G. (2008). Short stay surgery. Melbourne: Springer.

Timmins, F. & McCabe, C. (2009). Day Surgery: Contemporary Approaches to Nursing Care. New York: John Wiley and Sons.

Williams, L. & Wilkins. (2007). Best practices: evidence-based nursing procedures. London: Lippincott Williams & Wilkins.