Browsing by Author "Sawhney, Monakshi"

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    Factors Influencing Orthopedic Nurses' Pain Management Decision Making: A Focused Ethnography
    (2016) Denness, Kayla; Carr, Eloise; Seneviratne, Cydnee; Rae, Janice; Sawhney, Monakshi
    The experience of acute pain is highly subjective, and poor pain management contributes to a multitude of harmful conditions. Examining the context in which pain management occurs is important in formulating plans for improvement. The aim of this focused ethnography was to explore the factors orthopedic surgery nurses consider when deciding whether to initiate opioid analgesia for patients who have received a nerve block following total knee arthroplasty. Ten nurses participated in semi-structured interviews using a case study vignette. The overarching factors affecting pain management decision-making in this study relate to the culture of the unit, the self-concept of nurses, and nurses’ perception of patient assessments. Nurses are challenged to provide quality patient-centered care in a fast-paced clinical environment where efficiency and a brief length of stay are prioritized. Supporting informal nursing leaders and facilitating patient-centred care while maintaining efficiency may improve the unit culture and, in turn, pain management practices.
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    Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study
    (2020-08-19) Sawhney, Monakshi; Goldstein, David H; Wei, Xuejiao; Pare, Genevieve C; Wang, Louie; VanDenKerkhof, Elizabeth G
    Abstract Background Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. However, the reason for unplanned healthcare use after ambulatory surgery in Canada is not well understood. Aims To examine unplanned healthcare use, specifically emergency department visit and hospital admissions, in the 3 days after ambulatory surgery in Ontario, Canada. Methods This population-based retrospective cohort study was conducted using de-identified administrative databases. Participants were residents in the province of Ontario, Canada; 18 years and older; and underwent common ambulatory surgical procedures between 2014 and 2018. The outcomes included emergency department (ED) visit and hospital admission. Incidence rates were calculated for the total cohort, for each patient characteristic and for surgical category. The odds ratios and 95% confidence intervals were calculated for each outcome using bivariate and multivariate logistic regression. Results 484,670 adults underwent select common surgical procedures during the study period. Patients had healthcare use in the first 3 days after surgery, with 14,950 (3.1%) ED visits and 14,236 (2.9%) admissions. The incidence of ED use was highest after tonsillectomy (8.1%), cholecystectomy (4.2%) and appendectomy (4.0%). Incidence of admissions was highest after appendectomy (21%). Acute pain (19.7%) and haemorrhage (14.2%) were the most frequent reasons for an ED visit and “convalescence following surgery” (49.2%) followed by acute pain (6.2%) and haemorrhage (4.5%) were the main reasons for admission. Conclusions These findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources.