Ambulance nurses' experiences of nursing critically ill and injured children: A difficult aspect of ambulance nursing care

Prehospital emergency nurses' experiences of caring for patients with suspected acute myocardial infarction: an interview study

OBJECTIVE

Despite the prevalence of emergency medical service assignments related to chest discomfort, limited research delves into nurses' experiences of caring for such patients. This study aimed to illuminate prehospital emergency nurses' (PENs') experiences of caring for patients with suspected acute myocardial infarction (AMI).

DESIGN

A qualitative interview study.

SETTING

Two Swedish emergency medical service organisations in two different regions.

PARTICIPANTS

Consecutive inclusion of 12 PENs.

DATA ANALYSIS

An inductive content analysis according to Elo and Kyngäs.

RESULTS

The results underline the active role of PENs in providing care for patients with AMI in the emergency medical service. They emphasise the ability to identify classic symptoms and the need for an open-minded approach to diffuse presentations. Ensuring patient security, projecting knowledge and composure are decisive for instilling a sense of safety. Healthcare providers feel profound responsibility and a fear of errors, especially in critical situations with potential patient deterioration. Prioritisation in time-sensitive cases leans towards medical interventions and immediate transportation. Continuing education is essential to enhance patient management and safety. Effective communication and trust are vital for urgent patient care, and prompt activation of the ST-elevation myocardial infarction pathway is recognised as imperative. Malfunctions result in frustration, underlining the importance of pathway functionality.

CONCLUSIONS

PENs have immense responsibility for the swift and knowledgeable management of patients with suspected AMI. Balancing patient involvement and urgent medical measures is challenging, emphasising the critical role of mental preparedness and comprehensive education. The study underlines the significance of effective communication and trust between healthcare providers, particularly in time-sensitive scenarios. Establishing feedback mechanisms for prehospital staff is important for advancing prehospital emergency care in this patient category.

Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

BACKGROUND

We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.

METHODS

We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.

RESULTS

Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.

CONCLUSIONS

This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.

REVIEW REGISTRATION

Open Science Framework; 2022. https://osf.io/vkd5h/.

The challenges of delivery in pre-hospital emergency medical services ambulances in Iran: a qualitative study

BACKGROUND

Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery.

METHODS

A qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction.

RESULTS

The analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources.

CONCLUSIONS

Several approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.

A reflexive thematic analysis of ambulance nurses' experience of facilitating child-centered care

INTRODUCTION

Ambulance nurses' (ANs) feel less confident treating children. According to the United Nations Convention on Child Rights, there is a provision to safeguard children's rights. Child-Centered Care (CCC) strives to lift children's voices in healthcare.

AIM

To describe ambulance nurses' experiences of facilitating child-friendly care.

METHOD

A qualitative approach with Reflexive Thematic Analysis was performed on seventeen individual semi-structured interviews.

RESULT

One overarching theme, caring with the child in center, and three themes were developed: adapting to follow the child's lead, being reliable by balancing the trust, stepping back and supporting.

DISCUSSION

The ANs' communication with the children was honest and straightforward. Letting the child and the parents perform the care together reduced the child's anxiety. Guided participation was used by ANs, expanding the child's initiative.

CONCLUSION

The ANs work according to CCC, but unknowingly. It is important and beneficial to elevate the CCC to a conscious level. The ANs could refer to CCC in training new colleagues, reflecting on cases, and incorporating the Child Act in their work.

An emotional journey when encountering children in prehospital care: Experiences from ambulance nurses

BACKGROUND

Care encounters with children are a challenging and important task, but opportunities for such encounters are rarely available. Therefore, ambulance nurses (ANs) face difficulties in gaining experience in properly handling children, which can lead to stress for the ANs. A deeper understanding of ANs' emotions through the course of the care encounter is needed.

AIM

To describe how ambulance nurses' feel and manage their emotions before, during and after a care encounter with a child.

METHODS

A qualitative approach was adopted, with content analysis being performed on seventeen individual interviews.

FINDINGS

Three themes were identified: Feeling worried and insecure, Emotional surge, and Mixed feelings of satisfaction and concern.

CONCLUSION

The ANs experienced a range of emotions during a care encounter with children as they had little experience with it. More training and education in paediatric care could benefit ANs. The ANs use professionalism during care encounters to create a calm and secure atmosphere for families. Their will to bring about a safe journey for the child and family through the care encounter supersedes their nervousness. Reflection after a care encounter could strengthen their confidence in their professional role and reduce emotional distress in future encounters.

Nurse's experiences of the caring encounter as single responder in prehospital emergency care

BACKGROUND

In the Swedish emergency medical services, single responder and assessment units have been implemented to meet the increasing need for ambulance assessment and care.

AIM

To describe registered nurseś experiences of care encounters as single responders in the emergency medical services.

METHOD

The study design was descriptive with a qualitative approach. Semi-structured interviews with eight single responders were used together with inductive content analysis.

RESULTS

From the theme which showed the experiences of being a single responder in the caring encounter in the ambulance care "meeting unique human care needs with conscious caution", three categories emerged: Increased risk-awareness, Lack of resource support creates vulnerability and Professional experiences and personal qualities contribute to patient safety.

CONCLUSION

The single responders was aware of their vulnerability and a consistent theme was "caution". Risk assessments had evolved and were constantly present to maintain their own and the patient's safety. In critical patients, the experience of frustration and insufficiency dominated but at the same time there was a sense of meaningfulness. The main experience among all single responders was the feeling of getting close to the patient and responding to them in their own way.

Time consumption for non-conveyed patients within emergency medical services (EMS): A one-year prospective descriptive and comparative study in a region of Sweden

INTRODUCTION

Over time, ambulance assignments have increased in number both nationally and internationally, and a substantial proportion of patients encountered by emergency medical services are assessed as not being in need of services. Non-conveying patients has become a way for emergency medical services clinicians to meet this increasing workload. It has been shown that ambulances can be made available sooner if patients are non-conveyed, but there is no previous research describing the factors that influence the non-conveyance time.

STUDY OBJECTIVE

To describe ambulance time consumption and the factors that influence time consumption when patients are non-conveyed.

METHODS

A prospective observational review of 2615 non-conveyed patients' ambulance and hospital medical records was conducted using a consecutive sample. Data were analysed with the Kruskal-Wallis test, Mann-Whitney U test and Spearman's rank correlation (rho) for linear correlations.

RESULTS

The mean NC time for all ambulance assignments during the study period was 26 minutes, with a median of 25 minutes. The shortest NC time was 4 minutes, and the longest NC time was 73 minutes. NC times were significantly faster during the day than at night.

CONCLUSIONS

This study provides new knowledge about time consumption when patients are non-conveyed. Although there are time differences when patients are non-conveyed, the differences observed in this study are small and not of clinical value. Ambulances will most often become available sooner if patients are non-conveyed. Although patients might be eligible for non-conveyance, policy-makers might have to decide when it is appropriate to non-convey patients from time, resource, patient safety and patient-centred care perspectives.

Pediatric Emergency Medical Care in Yerevan, Armenia: A Knowledge and Attitudes Survey of Out-of-hospital Emergency Nurses

BACKGROUND

Emergency Medical Services (EMS) system in Armenia follows the Franco-German model in which physician - nurse dyads staff ambulances. This study aims to evaluate the knowledge and attitudes of EMS nurses regarding pediatric rapid assessment and resuscitation.

METHODS

This is a cross-sectional, anonymous, self-administered survey study of a convenience sample of 200 out-of-hospital emergency nurses in June and July 2015.

RESULTS

Response rate was 87.5%. Half of respondents failed to achieve the pre-defined passing score of 70% on the 10-question knowledge test (sample mean 6.32 ± 1.85 SD). Test score was positively correlated with pediatric training, current pediatric continuing medical education (CME), years with EMS and female gender. Questions regarding recognition of shock and initiation of neonatal and pediatric cardiopulmonary resuscitation were most frequently missed. Nurses were least confident in their ability to care for neonates and infants. 79.4% indicated that they would benefit from further pediatric training, and 86.1% indicated that knowledge from the Anglo-American model of emergency medicine could improve pediatric emergency care (PEC) in Armenia.

CONCLUSIONS

There is a need for additional PEC training and continuing education for EMS nurses in Yerevan, Armenia. Training EMS nurses would improve first responder awareness of pediatric acute management and resuscitation and enhance the quality of emergency care of children.

Prehospital emergency nurses' experiences of care in critical incidents

INTRODUCTION

The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs' experiences of care in CIs.

METHOD

A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden.

RESULTS

PENs' experiences can be described as: "In a critical incident, personal ability based on experiential knowledge is central to patient care". Three generic categories underpinned the main category: "Clinical expertise", "Professional approach" and "Broad knowledge base".

CONCLUSIONS

The care given during a CI in the ambulance care setting depends on PENs' personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.

Parental factors predicting unnecessary ambulance use for their child with acute illness: A cross-sectional study

AIMS

To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily.

DESIGN

A cross-sectional study.

METHODS

From 2016 - 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents' characteristics, including health literacy scales and the Parents' Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents' Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis.

RESULTS

Analysed data were from 171 participants. The cut-off score was 59 for the Parents' Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances.

CONCLUSION

Publicizing available resources regarding child health information, social healthcare activities to raise parents' health literacy and providing explanations in accordance with parents' uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use.

IMPACT

Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.

Caring science research in the ambulance services: an integrative systematic review

BACKGROUND

The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

AIM

This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

DATA SOURCES

Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

REVIEW METHODS

The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale.

RESULTS

After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values.

CONCLUSION

Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.

Specialist ambulance nurses' experiences of births before arrival

BACKGROUND

Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards.

AIM

This study describes the experiences of specialist ambulance nurses with BBA.

METHOD

A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis.

FINDINGS

The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education.

CONCLUSION

Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.

Nurses' experiences of prehospital care encounters with children in pain

BACKGROUND

Pain relief in children is a complex issue, partly an ethical dilemma and due to a lack of nursing competence. There are few studies regarding prehospital care encounters with children in pain.

AIM

The aim of this study was to describe nurses' experiences in prehospital care encounters with children in pain and the specific related challenges.

METHOD

This study has a qualitative design. Eighteen Swedish nurses participated in three focus group interviews analysed using qualitative content analysis.

FINDINGS

The findings consist of a theme, "A challenge to shift focus and adjust to the child", and three categories describing prehospital care encounters with children in pain: "Being receptive and focusing on care," "Developing a trusting relationship," and "Providing professional nursing care." Caring for children in pain was stressful for the nurses. The nurses described how they had to shift focus and used different methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials.

CONCLUSION

Nurses has to be practically, mentally, and theoretically prepared to care for children with prehospital pain. It is essential to evaluate the administration of adequate pain relief to children, and more evidence-based knowledge is necessary concerning the different modes of administering pain-relieving drugs to prehospital children.

We need support! A Delphi study about desirable support during the first year in the emergency medical service

Background

New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS.

Methods

A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12–48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded items which were developed into a questionnaire. The experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75%. Items which reached consensus were removed from questionnaires used in subsequent rounds.

Results

Desirable support was categorized into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organization and other support. The experts agree on the level of importance on 64 of a total of 70 items regarding desirable support. One item was considered not important, graded 1 or 2, 63 items were considered important, graded 4 or 5.

Conclusion

Even with extensive formal competence the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented.

Validating a questionnaire - prehospital preparedness for pediatric trauma patients

In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients.

OBJECTIVE

The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting.

METHODS

Questionnaire development included face and content validity tests resulting in 38 questions. Eighteen of these questions were analyzed by test-retest. The content of the questionnaire was statistically analyzed.

RESULTS

Fifteen questions were considered valid after reliability and validity tests. Three questions did not fulfill the stability criteria. The content analyses show a low degree of experience with pediatric trauma patients and half of the participants reported stress symptoms when responding to such alarms.

CONCLUSION

The questionnaire assessing PENs preparedness caring for pediatric trauma patients in Sweden is considered to be suitable for research and clinical practice to improve the care of pediatric trauma patients and the health of PENs, although further testing of the questionnaire is required.

Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group training. Conclusions: There appears to be both a need and an opportunity for education initiatives regarding paediatric traumatic stress in the pre-hospital context.

Experiences of nursing patients suffering from trauma - preparing for the unexpected: A qualitative study

SETTINGS AND OBJECTIVES

A midsize hospital in the north of Sweden with a high-tech intensive care unit and space for up to 10 patients, with an attached postoperative ward for up to 15 patients. The wards are manned by critical care nurses who are also responsible for carrying a trauma pager. When the alarm goes off, the critical care nurse leaves her/his duties and joins a trauma team. The aim of the study was to describe critical care nurse's experiences of nursing patients suffering from trauma.

METHOD

A qualitative descriptive design was used. Data were collected through four focus group discussions with 15 critical care nurses analysed using qualitative content analysis.

FINDINGS

One theme: Preparing for the unexpected with four subthemes: (1) Feeling competent, but sometimes inadequate; (2) Feeling unsatisfied with the care environment; (3) Feeling satisfied with well-functioning communication; and (4) Feeling a need to reflect when affected.

CONCLUSIONS

Nursing trauma patients require critical care nurses to be prepared for the unexpected. Two aspects of trauma care must be improved in order to fully address the challenges it poses: First, formal preparation and adequate resources must be invested to ensure delivery of quality trauma care. Secondly, follow-ups are needed to evaluate care measures and to give members of the trauma team the opportunity to address feelings of distress or concern.