Uncertainty in post-anaesthesia nursing clinical reasoning: An integrative review in the light of the model of uncertainty in complex health care settings

Abstract

Problem identification: Post-anaesthesia nursing plays an important role in the early detection and treatment of clinical deterioration a ter surgery and/or anaesthesia. Concomitantly, the e ectiveness of post-operative care is highly dependent on the accurate analysis, synthesis of patient data and quality of diagnostic decisions through clinical reasoning. Given the dynamic processes required to come to a diagnosis, uncertainty is common in clinical reasoning and expected during practice. Nevertheless, uncertainty may permeate the foundations of clinical reasoning, which can jeopardise diagnostic accuracy and consequently the quality and safety of health care.Literature search: The objectives of this review are to identify available evidence related to uncertainty in post-anaesthesia nursing clinical reasoning and to analyse the results from the perspective of the Model of Uncertainty in Complex Healthcare Settings (MUCH-S). A comprehensive search strategy using CINAHL (EBSCO), Cochrane Library (EBSCO), Medline (PubMed), ProQuest and Google Scholar databases was used to find published and unpublished relevant studies. Studies published in English and Portuguese were included. There was no temporal restriction, nor geographical or cultural limitation for the studies included.Data evaluation synthesis: All papers were reviewed by the authors to extract key information about purpose, sample and setting, research design and method, key findings and limitations. The literature search identified a total of 248 studies, 22 of which were retrieved for full reading. A total of four articles were included in this review.Implications for practice: Three main themes were identified: nurses' intuition to reason, feelings of uncertainty related to lack of nursing knowledge and clinical (in)experience to deal with uncertainty. These findings are encompassed within the MUCH-S taxonomy: personal, scientific and practical. This review o ers post-anaesthesia nurses' greater levels of understanding of this phenomenon and may support more informed and reflexive clinical reasoning.

Barriers and facilitators to managing uncertainty in nurses’ clinical reasoning in post-anaesthesia care units: a qualitative thematic analysis

“…A review explored uncertainty in nurses' clinical reasoning under uncertainty in Post-Anaesthesia Care Units (PACU) from a personal, practical, and scientific perspective using the Model of Uncertainty in Complex Healthcare Settings (MUCH-S) taxonomy. 7,8 Another study offered archetypes applicable to various health ecosystems and proposed an overarching model of different types of uncertainty that demonstrated their interrelatedness in health systems. 9 Moreover, Kalke and colleagues underscored the necessity for a more in-depth exploration of healthcare providers' encounters with uncertainty and highlighted challenges in researching uncertainty communication, particularly emphasizing probability, scientific issues, and patient experiences.…”

“…The semi-structured interview guide (Table 1) was developed based on the results of a previous literature review. 7 Field notes were taken immediately after the interview to clarify speech pauses and write reflective memos throughout the research. Since the interview was conducted in European Portuguese, the interview excerpts were translated and back translated to ensure the original meaning was preserved.…”

Nurses' management of older patients with post-anesthesia delirium: A Q methodology approach

“…Concomitantly, the effectiveness of post-operative care is highly dependent on the accurate analysis and synthesis of patient data and on the quality of diagnostic decisions arrived at through clinical reasoning. Intuition based on clinical experience plays an important role in overcoming uncertainty about a patient's prognosis in the clinical reasoning of anesthesia nurses [12].…”