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Fogh Kasum CV, Skjøt-Arkil H, Sparre Hansen JM, Overgaard H, Specht K. Experience of admission and readmission to the emergency department for patients with acute abdominal pain: A qualitative study. Int Emerg Nurs 2024; 76:101503. [PMID: 39126885 DOI: 10.1016/j.ienj.2024.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Abdominal pain is one of the most common complaints when patients are admitted to emergency departments (ED). Unfortunately, many of these patients are readmitted to the ED shortly after initial discharge. The perspectives of these patients have not yet been explored. PURPOSE The study aimed to explore how patients readmitted with acute abdominal pain in the ED experienced their initial admission, the time after discharge, and the cause of readmission. METHODS The study had a qualitative explorative design with a phenomenological-hermeneutic approach. Semi-structured individual telephone interviews were conducted with 14 patients readmitted with acute abdominal pain. RESULTS The analysis showed four themes: 1) being vulnerable during hospitalisation, 2) the meaning of information during hospitalisation, 3) discharged without being diagnosed, and 4) readmitted in the pursuit of relief. The patients wanted more knowledge and better communication despite their vulnerable condition. Patients were discharged whilst still in pain, and uncertainty of the situation at home contributed to mistrust of the health professionals. CONCLUSION Patients' experience of the first ED admission due to acute abdominal pain was loneliness, minimal contact with healthcare professionals, and lack of information and involvement in pain management. Discharge was associated with feelings of insignificance and contributed to a fear of death. Pain was the main reason for readmission. Patients described how multiple readmissions contributed to being taken seriously by healthcare professionals.
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Affiliation(s)
| | - Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark.
| | | | - Helle Overgaard
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Kirsten Specht
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark; Center for COPD, City of Copenhagen, Denmark
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Skoglund K, Bescher M, Ekwall S, Hammar LM. Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences. Nurs Crit Care 2024; 29:1142-1150. [PMID: 38391114 DOI: 10.1111/nicc.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice. AIM This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses. STUDY DESIGN This study adopted a mixed-methods approach. METHODS Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics. RESULTS Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training). CONCLUSION IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care. RELEVANCE FOR CLINICAL PRACTICE The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT.
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Affiliation(s)
- Karin Skoglund
- School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
| | - Milo Bescher
- Cardiothoracic Surgery Intensive Care Unit (CTSICU), New York, New York, USA
| | - Savannah Ekwall
- The Nordic Clinic, Postoperative Care within Plastic Surgery, Stockholm, Sweden
| | - Lena Marmstål Hammar
- School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden
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Tikkanen V, Sundberg K. Care relationship and interaction between patients and ambulance clinicians: A qualitative meta-synthesis from a person-centred perspective. Scand J Caring Sci 2024; 38:24-34. [PMID: 37997183 DOI: 10.1111/scs.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Ambulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care, whereas interpersonal interaction between patients and ambulance clinicians appears less prioritised. A patient within ambulance care needs to be listened to, be taken seriously, be treated with empathy and be seen as a unique person. These are fundamental to delivering Person-centred care. AIM The purpose is to describe how the care relationship and interaction between patients and ambulance clinicians in prehospital emergency care are described in the literature and how they can be interpreted from a person-centred perspective. DATA SOURCES AND REVIEW METHODS A qualitative meta-synthesis was used. Data collection was carried out with PubMed, CINAHL Plus and Web of Science in September-October 2022 and in August-September 2023. The first article searching applied a timeline 1990-2022 and the second applied a timeline 2022-2023. A total of 13 studies employing a qualitative approach were evaluated and included in the interpretive analysis. RESULTS Three themes were identified: A good care relationship, Decision-making and Hindrances to practising person-centred care in ambulance care. Trust, good communication and respect for patients' dignity were the most important parts of the good care relationship between patients and ambulance clinicians. Decision-making regarding the examination of patients, medical treatment and transport to the receiving care unit was one of the tasks that ambulance clinicians do independently but in cooperation with patients and family members. Person-centred care within ambulance care may be hindered due to environmental factors, attitudes and behaviour of ambulance clinicians and patient-related factors. CONCLUSION Many ambulance clinicians have already adopted Person-centred care, but several factors can hinder Person-centred care in interactions with patients. Although the results build on a limited number of studies, they indicate that person-centred care needs to be further developed and studied for high-quality ambulance care.
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Affiliation(s)
- Viivi Tikkanen
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- FALCK Ambulance Stockholm, Hägersten, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Avallin T, Muntlin Å, Kitson A, Jangland E. Testing a model for person-centred pain management: A systematic review and synthesis guided by the Fundamentals of Care framework. J Clin Nurs 2023; 32:6811-6831. [PMID: 37245067 DOI: 10.1111/jocn.16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023]
Abstract
AIMS To test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results. DESIGN A qualitative systematic review with thematic synthesis using the Fundamentals of Care framework. METHODS AND DATA SOURCES A literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence. RESULTS The model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions. CONCLUSIONS The strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support our recommendation for empirical evaluation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The model links the knowledge of pain management elements from individual studies together into actions to be performed in clinical practice. It also outlines the organizational support needed to make this happen. Nurses and nursing leaders are suggested to test the model to implement person-centred pain management in clinical practice. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT What Problem Did the Study Address? There is a need to transfer available evidence of person-centred pain management into practice to relieve the patient from pain. What Were the Main Findings? Person-centred pain management is of high priority for patients and nurses around the world and can be performed in a holistic care process including patient-nurse trust and communication, supported by contextual conditions to deliver timely pharmacological and non-pharmacological pain management addressing the patient's physical, psychosocial and relational care needs. Where and on Whom will the Research Have an Impact? The model is to be tested and evaluated in clinical practice to guide the providers to relieve the patient from pain. REPORTING METHOD Relevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Åsa Muntlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
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Wilson C, Janes G, Lawton R, Benn J. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. BMJ Qual Saf 2023; 32:573-588. [PMID: 37028937 PMCID: PMC10512001 DOI: 10.1136/bmjqs-2022-015634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development. METHODS A systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses. RESULTS The search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity. CONCLUSION This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS. PROSPERO REGISTRATION NUMBER CRD42020162600.
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Affiliation(s)
- Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, UK
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Gillian Janes
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jonathan Benn
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
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Whitley GA, Wijegoonewardene N, Nelson D, Curtis F, Ortega M, Siriwardena AN. Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta-synthesis. J Am Coll Emerg Physicians Open 2023; 4:e12940. [PMID: 37056718 PMCID: PMC10086522 DOI: 10.1002/emp2.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. Methods A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Results Twenty-five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient-clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Conclusion Interventions and guidelines that strengthen the patient-clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.
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Affiliation(s)
- Gregory Adam Whitley
- Community and Health Research UnitUniversity of LincolnLincolnUK
- Clinical Audit and Research UnitEast Midlands Ambulance Service NHS TrustLincolnUK
| | - Nimali Wijegoonewardene
- Community and Health Research UnitUniversity of LincolnLincolnUK
- Healthcare Quality and SafetyMinistry of HealthColomboSri Lanka
| | - David Nelson
- Lincoln International Institute for Rural HealthUniversity of LincolnLincolnUK
| | - Ffion Curtis
- Centre for Ethnic Health ResearchEast Midlands Applied Research CollaborationUniversity of LeicesterLeicesterUK
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Teoh SE, Loh CYL, Chong RIH, Yaow CYL, Masuda Y, Han MX, Lin DJ, Lim YL, Ng JCH, Ng QX. A scoping review of qualitative studies on pre-hospital analgesia administration and practice. Am J Emerg Med 2022; 57:81-90. [PMID: 35526405 DOI: 10.1016/j.ajem.2022.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023] Open
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Pavedahl V, Muntlin Å, Summer Meranius M, von Thiele Schwarz U, Holmström IK. Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses. J Adv Nurs 2022; 78:2165-2174. [PMID: 35130360 PMCID: PMC9304302 DOI: 10.1111/jan.15172] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life‐threateningly ill patients' care needs from the perspective of a person‐centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task‐oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person‐centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person‐centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life‐threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person‐centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person‐centred fundamental care and thereby avoid fundamental care being missed.
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Affiliation(s)
- Veronica Pavedahl
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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