Kristiina Junttila

Perioperative documentation in Finland.

In Finland, research studies about perioperative documentation are few, and there are no professional recommendations for perioperative documentation, such as AORN s Standards, Recommended Practices, and Guidelines. Exploring current documentation practices and contents used in Finland is the first step to establishing a standard for perioperative documentation. The need for this type of exploration resulted in a study that found that the aim of nursing documentation is not always clear, and current documentation practice does not necessarily reveal the decision making that directs patient care, demonstrate nursing resources needed, or provide data for evaluating and developing perioperative practice. Education, motivation, and computerization generally were mentioned as a means to develop documentation.

The Validation of AORN Recommended Practices in Finnish Perioperative Nursing Documentation

In Finland, there are no common guidelines or recommended practices for perioperative documentation. Thus, perioperative nursing documentation varies from one operating department to another. To create minimum criteria for nursing documentation in Finland, we conducted an investigation in a university hospital district in 2006. Purposive sampling was used to invite experts in perioperative nursing documentation (N = 42) to serve as a Delphi panel. The final criteria are 120 items, 71% of which are based on the AORN standards and recommended practices. These criteria may be used to educate students and new perioperative personnel and to enhance the quality of nursing practice. To ensure relevance and usability, the criteria should be tested in various perioperative settings with a variety of surgical patients.

Evaluating Perioperative Nursing in Finland: An Initial Validation of Perioperative Nursing Data Set Outcomes

The current Finnish version of AORNs Perioperative Nursing Data Set consists of nursing diagnoses and interventions but not outcomes. During the early Finnish validation phase, researchers determined that almost half of the outcomes listed in the AORN version were impossible to measure in Finland. We conducted this study to determine the applicability of the nursing outcomes identified in the Perioperative Nursing Data Set, 2nd ed Rev, and to test the use of the outcomes by exploring the relevance of the outcome indicators for eight selected outcomes. We collected the data by using two surveys with structured questionnaires that were provided to an expert panel of nurses and physicians. Panel members found that most of the outcomes were acceptable for use in Finnish perioperative care; however, further validation of the outcome indicators is needed to develop tools to support nurses in their attempts to reach desirable nursing-sensitive outcomes for patients.

Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale

BackgroundDelirium is a common clinical problem with acute and fluctuating onset. Early notification of its symptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required for successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the Neecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care, utilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale.MethodsThis randomized, blinded, instrument testing study was conducted at one university hospital in one surgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI) and a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales were calculated and face validity and usability evaluated.ResultsInternal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was .87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and NEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and Nu-DESC was .91, in the RN’s group .42. Nu-DESC was evaluated as the most usable scale.ConclusionThe findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and Nu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing patients’ delirium in surgical wards but more validity testing is needed.