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Althobity TA, Jawhari AM, Almalki MG, Altowairqi AA, Dighriri M, Alghamdi IJ, Al Nofaiey Y. Healthcare Professional's Knowledge of the Systemic ABCDE Approach: A Cross-Sectional Study. Cureus 2024; 16:e51464. [PMID: 38298302 PMCID: PMC10829823 DOI: 10.7759/cureus.51464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Background and aim Assessing the knowledge of healthcare professionals regarding the Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is crucial since it prioritizes the initial assessment and treatment of patients who are critically ill, regardless of the underlying cause or their age. Since adherence requires knowledge, this study aimed to evaluate the knowledge level of the ABCDE approach among healthcare professionals. Methods This cross-sectional study among healthcare professionals was performed from April to August 2023 in Taif City, Saudi Arabia. The study included healthcare professionals employed in departments exposed to patients with critical illnesses and excluded those from other specialties and individuals from outside Taif City. Data was collected via Google Forms using a previously validated questionnaire designed to assess the ABCDE approach knowledge among healthcare professionals. Statistical analysis was conducted using IBM SPSS, version 26. Results The study included 242 healthcare professionals with a mean (SD) age of 35.77 (9.93) years. About half of the participants were female (52.5%) nurses (50.8%) and had been working in intensive care units (ICU) and neonate intensive care units (NICU) (41.4%). The mean (SD) of the participants' working experience was 9.28 (8.295) years. The overall mean test score was 52.94 % (SD 16.27). The mean knowledge score among males was significantly higher than females (56.37% vs. 49.85%, respectively) (p-value= 0.001). The mean knowledge score was significantly higher among medical specialists and residents (63.308% and 55.67%) than among nurses (46.34%) (p-value <0.001). Attending an advanced trauma life support course and theoretical lecture significantly impacted the total knowledge score among the participants (p-values= 0.001 and <0.001, respectively). The total knowledge significantly increased with age (r: 0.265, p-value <0.001). Years of experience correlated with total knowledge score; with increasing years of experience, the total knowledge was significantly increased (r: 0.248, p-value <0.001). Conclusion The ABCDE approach is a valuable tool for the initial examination and treatment of patients in acute medical and surgical emergencies. The findings indicate that there is a need for further awareness programs and training on the ABCDE approach, as the total knowledge score among healthcare professionals was found to be suboptimal. Further research is needed to assess the association between knowledge level and clinical performance in different healthcare settings within Saudi Arabia.
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Xu HG, Ullman AJ, Rickard CM, Johnston A. Factors impacting emergency department clinicians' peripheral intravenous catheter practice: A qualitative analysis. Int Emerg Nurs 2023; 71:101366. [PMID: 37852059 DOI: 10.1016/j.ienj.2023.101366] [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: 04/07/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are commonly used devices in emergency departments (EDs), and yet relatively little is known about factors influencing Australian clinicians' adherence to the national PIVC quality and safety Standard. AIMS To explore attitudes and experiences of ED clinicians around PIVC insertion and care processes. METHODS This study used an exploratory qualitative approach to analyse written responses to open-ended questions included in an online national (mixed data) survey. Snowballing methods were used to gather responses. Deductive analysis was used to analyse open-ended questions regarding practice and Standard adherence. RESULTS There were 340 written responses, mainly from nurses in public EDs, who reported suboptimal practices regarding idle catheters, lack of patient participation in care, antecubital fossa insertion, multiple insertion attempts, inadequate site preparation, poor documentation and insufficient review of PIVC. The main factors inhibiting ED clinicians from adhering to the Standard includes inadequate knowledge, perceptions of infeasibility, disbelief in evidence, ambiguous responsibilities, habitual practice, insufficient training, lack of recognition of good practice and inadequate engagement. CONCLUSION The factors that impact ED clinicians' PIVC Standard adherence are complex and multifactorial. Strategies and interventions are needed to facilitate the implementation of the Standard into daily practice and achieve sustainable behaviour change.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Emergency Department, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia.
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Brisbane, Australia
| | - Amy Johnston
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Emergency Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
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Xu HG, Rickard CM, Takashima M, Butterfield M, Pink E, Ullman AJ. Exploring Australian emergency department clinicians' knowledge, attitudes and adherence to the national peripheral intravenous catheter clinical care standard: A cross-sectional national survey. Emerg Med Australas 2023; 35:759-770. [PMID: 37062587 DOI: 10.1111/1742-6723.14214] [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: 11/08/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aimed to (i) capture clinicians' knowledge, attitude and adherence to the first Australian national peripheral intravenous catheter (PIVC) Clinical Care Standard, (ii) examine the instrument performance of the knowledge related questions and (iii) explore the educational needs for, and barriers to, Standard adherence among Australian ED clinicians. METHODS A cross-sectional national online survey was conducted from March to June 2022, using a snowball sampling method. The survey used 5-point Likert scales and multiple-choice questions to capture respondents' knowledge, attitude and adherence to the Standard as well as the educational needs for, and barriers to, Standard adherence. RESULTS In total, 433 ED nurses and doctors responded. Although nearly half (n = 206, 47.6%; 95% confidence interval [CI] 55.5-65.8) of respondents claimed that they were unfamiliar with the Standard, questions on PIVC knowledge yielded that most respondents had adequate knowledge of most of the key standards. Respondents' attitudes towards multiple intravenous insertion attempts and ongoing PIVC competency monitoring are not in agreement with the Standard. Self-reported practices regarding routine insertion of idle catheters (55%; 95% CI 49.9-59.9), using antecubital fossa as the first insertion site (84%; 95% CI 80-87), insertion without confidence (46%; 95% CI 41.2-51.1) and lack of routine reviewing the ongoing needs of PIVC (40%; 95% CI 35.3-45.1) were not aligned with the Standard. Unawareness of the Standard and non-practical recommendations were rated as the top barriers to Standard adherence. CONCLUSION The findings of the survey suggest that the Standard may need modification to align with the needs of ED clinicians. Future studies need to explore the applicability and relevancy of some recommendations in the ED settings as they may cause low adherence to the Standard.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Metro North Health and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Mari Takashima
- School of Medicine, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Michael Butterfield
- Emergency Department, Logan Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Edward Pink
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Schoeber NHC, Linders M, Binkhorst M, De Boode WP, Draaisma JMT, Morsink M, Nusmeier A, Pas M, van Riessen C, Turner NM, Verhage R, Fluit CRMG, Hogeveen M. Healthcare professionals' knowledge of the systematic ABCDE approach: a cross-sectional study. BMC Emerg Med 2022; 22:202. [PMID: 36510149 PMCID: PMC9743501 DOI: 10.1186/s12873-022-00753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach is a universal, priority-based approach for the assessment and treatment of critically ill patients. Although the ABCDE approach is widely recommended, adherence in practice appears to be suboptimal. The cause of this non-compliance is unknown. As knowledge is a prerequisite for adherence, the aim of this study was to assess healthcare professionals' knowledge of the ABCDE approach. METHODS A cross-sectional study was conducted at the Radboud University Medical Center, the Netherlands. A digital multiple-choice assessment tool of the ABCDE approach was developed by an expert panel through a mini-Delphi method and validated by performing test item statistics and an expert-novice comparison. The validated test was sent to healthcare professionals (nurses, residents and medical specialists) of the participating departments: Anaesthesiology, Paediatrics, Emergency Department and the Neonatal, Paediatric and Adult Intensive Care Units. Primary outcome was the test score, reflecting individual level of knowledge. Descriptive statistics, regression analysis and ANOVA were used. RESULTS Test validation showed a Cronbach's alpha of 0.71 and an expert-novice comparison of 91.9% (standard deviation (SD) 9.1) and 72.4% (15.2) respectively (p < 0.001). Of 954 eligible participants, 240 filled out the questionnaire. The mean (SD) test score (% of correct answers) was 80.1% (12.2). Nurses had significantly lower scores (74.9% (10.9)) than residents (92.3% (7.5)) and medical specialists (88.0% (8.6)) (p < 0.001). The Neonatal Intensive Care Unit (75.9% (12.6)) and Adult Intensive Care Unit (77.4% (11.2)) had significantly lower scores than Paediatric Intensive Care Unit (85.6% (10.6)), Emergency Department (85.5% (10.4)) and Anaesthesiology (85.3% (10.6)) (p < 0.05). Younger participants scored higher than older participants (-0.30% (-0.46;-0.15) in test score/year increase in age). CONCLUSION Scores of a validated knowledge test regarding the ABCDE approach vary among healthcare professionals caring for critically ill patients. Type of department, profession category and age had a significant influence on the test score. Further research should relate theoretical knowledge level to clinical practice. Tailored interventions to increase ABCDE-related knowledge are recommended.
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Affiliation(s)
- Nino H. C. Schoeber
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Marjolein Linders
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Mathijs Binkhorst
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Willem-Pieter De Boode
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Jos M. T. Draaisma
- grid.10417.330000 0004 0444 9382Department of Paediatrics, Radboud University Medical Center Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Marlies Morsink
- grid.10417.330000 0004 0444 9382Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anneliese Nusmeier
- grid.10417.330000 0004 0444 9382Paediatric Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn Pas
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Christine van Riessen
- grid.10417.330000 0004 0444 9382Department of Anaesthesia and Pain, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nigel M. Turner
- grid.7692.a0000000090126352Division of Vital Functions, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger Verhage
- grid.10417.330000 0004 0444 9382Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelia R. M. G. Fluit
- grid.10417.330000 0004 0444 9382Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marije Hogeveen
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
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Ulrich Hansen M, Vejzovic V, Zdravkovic S, Axelsson M. Ambulance nurses' experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study. Int Emerg Nurs 2022; 63:101195. [PMID: 35802956 DOI: 10.1016/j.ienj.2022.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/29/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain. AIM To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome. METHOD A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis. RESULTS Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines. CONCLUSIONS The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.
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Affiliation(s)
- Michael Ulrich Hansen
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden.
| | - Vedrana Vejzovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Slobodan Zdravkovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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Mastenbrook J, Emrick D, Bauler LD, Markman J, Koedam T, Fales W. Evaluation of Basic Life Support First Responder Naloxone Administration Protocol Adherence. Cureus 2021; 13:e18932. [PMID: 34812316 PMCID: PMC8604552 DOI: 10.7759/cureus.18932] [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] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Opioid overdoses have become a significant problem across the United States resulting in respiratory depression and risk of death. Basic Life Support (BLS) first responders have had the option to treat respiratory depression using a bag-valve-mask device, however naloxone, an opioid antagonist, has been shown to quickly restore normal respiration. Since the introduction of naloxone and recent mandates across many states for BLS personnel to carry and administer naloxone, investigation into the adherence of naloxone use standing protocols is warranted. Methods: This preliminary study examined 100 initial cases of BLS first responder administration of naloxone for appropriate indications and protocol adherence. Results: This study found that n=22/100 naloxone administrations were inappropriate, often given to patients who were not suffering from respiratory depression (n=11/22). Positive pressure ventilation (PPV) was not administered prior to naloxone in n=56/100 cases, of which n=42/100 had an inadequate respiratory effort documented. For patients with a known history of substance use disorder, there was a significant increase in administration of naloxone prior to PPV (60%; n=33/55) compared to patients without a known history (30%; n=9/30). Conclusion: Overall these preliminary data suggest that during BLS naloxone administration, the majority of cases did not follow at least one component of the standard protocol for patients with respiratory depression. This study suggests that further education and more research are needed to better understand the decision-making processes of prehospital providers to ensure adherence to standard protocols.
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Affiliation(s)
- Joshua Mastenbrook
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Daniel Emrick
- Student Affairs, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Laura D Bauler
- Biomedical Sciences, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - James Markman
- General Surgery, Mount Carmel Graduate Medical Education, Grove City, USA
| | - Tyler Koedam
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - William Fales
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
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Magnusson C, Carlström M, Lidman N, Herlitz J, Wennberg P, Axelsson C. Evaluation and treatment of pain in the pre-hospital setting. A comparison between patients with a hip injury, chest pain and abdominal pain. Int Emerg Nurs 2021; 56:100999. [PMID: 33765527 DOI: 10.1016/j.ienj.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of patients who call 112 in Sweden do so because of pain. The purpose of this study was to compare three of the most common types of pain presented by the patients: chest pain, abdominal pain and hip injury, in terms of initial assessment, intensity, treatment and effect of treatment. The overall rationale was to evaluate whether the early assessment and treatment of pain in the pre-hospital setting is optimal or whether there is room for improvement. METHODS Observational study during 2016 including 1234 patients triaged to chest pain, abdominal pain and hip injury by the Emergency Medical Services (EMS) in Gothenburg, Sweden. RESULTS Severe pain on the arrival of the EMS was described by 39% of patients with a hip injury, 27% with abdominal pain and 15% with chest pain. Analgesics were given to 58% of patients with a hip injury, 35% with chest pain and 34% with abdominal pain. A lower intensity of pain at re-evaluation was observed in 80% of patients with a hip injury, 57% with chest pain and 43% with abdominal pain. Administration of analgesics increased with the duration of pre-hospital care time in all three groups. CONCLUSIONS Patients with a hip injury had the most severe pain and they received most pain-relieving medication. Overall, a relatively small proportion of patients with pain received pain-relieving medication and there appears to be an extensive room for improvement.
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Affiliation(s)
- Carl Magnusson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Prehospen - Centre for Prehospital Research, University of Borås, Sweden; Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Carlström
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nathalie Lidman
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Prehospen - Centre for Prehospital Research, University of Borås, Sweden.
| | - Pär Wennberg
- Prehospen - Centre for Prehospital Research, University of Borås, Sweden; Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Christer Axelsson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Prehospen - Centre for Prehospital Research, University of Borås, Sweden; Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Clavijo-Chamorro MZ, Sanz-Martos S, Gómez-Luque A, Romero-Zarallo G, López-Medina IM. Context as a Facilitator of the Implementation of Evidence-based Nursing: A Meta-synthesis. West J Nurs Res 2020; 43:60-72. [PMID: 32321372 DOI: 10.1177/0193945920914397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurses have numerous difficulties in implementing science due to obstacles related to the work context. The aim is to explore the work-context-related facilitators of the application of evidence in clinical practice by nursing professionals. Qualitative meta-synthesis of primary studies on nurses' experiences of work-context-related facilitators, as defined by the Promoting Action on Research Implementation in Health Services model. Using the Qualitative Appraisal and Review Instrument of the Joanna Briggs Institute. Of the total 57 primary research articles included, an explanatory model of the facilitating factors related to the work context was generated on the basis of four general categories: institutional support (leadership), multidisciplinary support (teamwork and communication), culture of improving quality of care (nursing professionals' attitudes towards change) and use of research (valuing research). Action can be taken on the facilitating factors of the evidence-based practice application in nursing clinical environments, providing resources and motivation from the organization.
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Affiliation(s)
- María Zoraida Clavijo-Chamorro
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Sebastián Sanz-Martos
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Andalusia, Spain
| | - Adela Gómez-Luque
- Department of Nursing, Faculty of Nursing, University of Extremadura, Plasencia, Extremadura, Spain
| | - Gema Romero-Zarallo
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Isabel M López-Medina
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Andalusia, Spain
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Schweitzer G, Nascimento ERPD, Malfussi LBHD, Hermida PMV, Nascimento KCD, Moreira AR. Implementation of the protocol of nursing care in trauma in aeromedical service. Rev Bras Enferm 2020; 73:e20180516. [DOI: 10.1590/0034-7167-2018-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 05/11/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the implementation of a nursing care protocol for trauma patients before, during and after the flight. Method: A cross-sectional quantitative study carried out in an aeromedical service, using a checklist with 106 care: 79 before flight, 25 during, and 2 after flight. 97 patients were included in the study. Results: Most care (n = 59; 55.7%) was implemented, totaling 4,435, 1,480 and 192 cares performed before, during and after the flight, respectively. They stood out as unrealized care: protect ears with ear muffler (n = 55) and avoid leaving the pulse oximeter exposed to the sun’s rays (n = 22). The main reason for the non-performance was lack of appeal (n = 94). Conclusion: Although most protocol care has been implemented, unrealized care compromises the quality of care, which requires the management of the service to provide more incentive to nurses and adequate resources for its implementation.
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Magnusson C, Herlitz J, Karlsson T, Jiménez-Herrera M, Axelsson C. The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years. BMC Pediatr 2019; 19:500. [PMID: 31842832 PMCID: PMC6912993 DOI: 10.1186/s12887-019-1857-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 11/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christer Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Thorvaldsen NØ, Flingtorp LD, Wisborg T, Jeppesen E. Implementation of new guidelines in the prehospital services: a nationwide survey of Norway. Scand J Trauma Resusc Emerg Med 2019; 27:83. [PMID: 31464620 PMCID: PMC6716817 DOI: 10.1186/s13049-019-0660-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline. Electronic supplementary material The online version of this article (10.1186/s13049-019-0660-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina Øye Thorvaldsen
- Emergency Medical Services, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Lars Didrik Flingtorp
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
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Chong V, Schultz TJ, Donnelly F. Clinical protocols for adults with acute abdominal pain in Australian emergency departments. J Eval Clin Pract 2019; 25:412-419. [PMID: 30714279 DOI: 10.1111/jep.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patients with acute abdominal pain are a common presentation in hospital emergency departments; however, international studies have demonstrated that hospitals often lack clinical protocols to guide care. This study aimed to investigate whether Australian hospital emergency departments have acute abdominal pain clinical protocols, identify hospital-level predictors of the presence of these clinical protocols, and assess the quality of protocols. METHODS A survey was sent to all Australian hospitals with emergency departments, collecting data on hospital characteristics and the presence of acute abdominal pain clinical protocols. Participating hospitals (n = 73, 26% response rate) were also asked to provide a copy of these protocols. The quality of these protocols was assessed using Appraisal of Guidelines for REsearch & Evaluation (AGREE) II. RESULTS Slightly more than half (n = 40) of the hospitals surveyed had acute abdominal pain clinical protocols, while 16 had a general pain protocol. In binomial logistic regression, two independent variables were related to the presence of a protocol, geographic region (P = 0.008) and advanced practice nurses/nurse practitioners' presence on staff (P = 0.024). The mean score for the overall quality assessment of these protocols was 4.2 on a seven-point Likert scale; in terms of the six domains of quality, "Clarity of presentation" and "Scope and purpose" were highest. The overall quality of clinical protocols increased with remoteness, χ2 (3) = 8.341, P = 0.039, and was lower in hospitals with medical staff on site (U = 2.5, P = 0.007). CONCLUSION There is a documented standard for pain management of acute abdominal pain in about three quarters of participating Australian emergency departments. The use and quality of clinical protocols is influenced by the physical location of hospitals and staff and skill mix of clinicians.
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Affiliation(s)
- Vivienne Chong
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Frank Donnelly
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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Ebben RHA, Siqeca F, Madsen UR, Vloet LCM, van Achterberg T. Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open 2018; 8:e017572. [PMID: 30478101 PMCID: PMC6254419 DOI: 10.1136/bmjopen-2017-017572] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Guideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings. DESIGN Systematic review. DATA SOURCES PubMed (including MEDLINE), CINAHL, EMBASE and Cochrane. METHODS We selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care. Pairs of two independent reviewers performed the selection process, quality assessment and data extraction. RESULTS Eleven studies were included, nine of which were performed in the ED setting and two studies were performed in a combined prehospital and ED setting. For the ED setting, the studies indicated that educational strategies as sole intervention, and educational strategies in combination with audit and feedback, are probably effective in improving guideline adherence. Sole use of reminders in the ED setting also showed positive effects. The two studies in the combined prehospital and ED setting showed similar results for the sole use of educational interventions. CONCLUSIONS Our review does not allow firm conclusion on how to promote guideline and protocol adherence in prehospital emergency care, or the combination of prehospital and ED care. For ED settings, the sole use of reminders or educational interventions and the use of multifaceted strategies of education combined with audit and feedback are all likely to be effective in improving guideline adherence.
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Affiliation(s)
- Remco H A Ebben
- Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Flaka Siqeca
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Erasmus Scholar from the University of Prishtina, Kosovo at the KU Leuven, Leuven, Belgium
| | | | - Lilian C M Vloet
- Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
- Department of Public Health and Primary Care, Uppsala University, Uppsala, Sweden
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The role of emergency medical service providers in the decision-making process of prehospital trauma triage. Eur J Trauma Emerg Surg 2018; 46:131-146. [PMID: 30238385 PMCID: PMC7026224 DOI: 10.1007/s00068-018-1006-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/11/2018] [Indexed: 10/29/2022]
Abstract
PURPOSE Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. METHODS All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. RESULTS For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. CONCLUSION The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.
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Oosterwold J, Sagel D, Berben S, Roodbol P, Broekhuis M. Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review. BMJ Open 2018; 8:e021732. [PMID: 30166299 PMCID: PMC6119414 DOI: 10.1136/bmjopen-2018-021732] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital's emergency department (ED). This is especially important with the elderly, for whom the likelihood and frequency of adverse events are greatest. OBJECTIVE To provide a structured overview of factors influencing the conveyance decision of elderly people to the ED after emergency ambulance attendance, and the outcomes of these decisions. DATA SOURCES A mixed studies review of empirical studies was performed based on systematic searches, without date restrictions, in PubMed, CINAHL and Embase (April 2018). Twenty-nine studies were included. STUDY ELIGIBILITY CRITERIA Only studies with evidence gathered after an emergency medical service (EMS) response in a prehospital setting that focused on factors that influence the decision whether to convey an elderly patient were included. SETTING Prehospital, EMS setting; participants to include EMS staff and/or elderly patients after emergency ambulance attendance. STUDY APPRAISAL AND SYNTHESIS METHODS The Mixed Methods Appraisal Tool was used in appraising the included articles. Data were assessed using a 'best fit' framework synthesis approach. RESULTS ED referral by EMS staff is determined by many factors, and not only the acuteness of the medical emergency. Factors that increase the likelihood of non-conveyance are: non-conveyance guidelines, use of feedback loop, the experience, confidence, educational background and composition (male-female) of the EMS staff attending and consulting a physician, EMS colleague or other healthcare provider. Factors that boost the likelihood of conveyance are: being held liable, a lack of organisational support, of confidence and/or of baseline health information, and situational circumstances. Findings are presented in an overarching framework that includes the impact of these factors on the decision's outcomes. CONCLUSION Many non-medical factors influence the ED conveyance decision after emergency ambulance attendance, and this makes it a complex issue to manage.
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Affiliation(s)
- Johan Oosterwold
- Department of Health Sciences - Nursing Research, UMC Groningen, Groningen, The Netherlands
- NHL Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
| | - Dennis Sagel
- Ambulance Department, University Medical Center Groningen, Roden, The Netherlands
| | - Sivera Berben
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands
- Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petrie Roodbol
- Department of Health Sciences - Nursing Research, UMC Groningen, Groningen, The Netherlands
| | - Manda Broekhuis
- Operations Department, Faculty of Economics and Business, Groningen, The Netherlands
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van Rein EAJ, van der Sluijs R, Raaijmaakers AMR, Leenen LPH, van Heijl M. Compliance to prehospital trauma triage protocols worldwide: A systematic review. Injury 2018; 49:1373-1380. [PMID: 30135040 DOI: 10.1016/j.injury.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Emergency medical services (EMS) providers must determine the injury severity on-scene, using a prehospital trauma triage protocol, and decide on the most appropriate hospital destination for the patient. Many severely injured patients are not transported to higher-level trauma centres. An accurate triage protocol is the base of prehospital trauma triage; however, ultimately the quality is dependent on the destination decision by the EMS provider. The aim of this systematic review is to describe compliance to triage protocols and evaluate compliance to the different categories of triage protocols. METHODS An extensive search of MEDLINE/Pubmed, Embase, CINAHL and Cochrane library was performed to identify all studies, published before May 2018, describing compliance to triage protocols in a trauma system. The search terms were a combination of synonyms for 'compliance,' 'trauma,' and 'triage'. RESULTS After selection, 11 articles were included. The studies showed a variety in compliance rates, ranging from 21% to 93% for triage protocols, and 41% to 94% for the different categories. The compliance rate was highest for the criterion: penetrating injury. The category of the protocol with the lowest compliance rate was: vital signs. Compliance rates were lower for elderly patients, compared to adults under the age of 55. The methodological quality of most studies was poor. One study with good methodological quality showed that the triage protocol identified only a minority of severely injured patients, but many of whom were transported to higher-level trauma centres. CONCLUSIONS The compliance rate ranged from 21% to 94%. Prehospital trauma triage effectiveness could be increased with an accurate triage protocol and improved compliance rates. EMS provider judgment could lower the undertriage rate, especially for severely injured patients meeting none of the criteria. Future research should focus on the improvement of triage protocols and the compliance rate.
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Affiliation(s)
| | - Rogier van der Sluijs
- Department of Traumatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Luke P H Leenen
- Department of Traumatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Mark van Heijl
- Department of Traumatology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, The Netherlands.
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Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis. Int J Nurs Stud 2017. [PMID: 28622531 DOI: 10.1016/j.ijnurstu.2017.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. OBJECTIVE To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. DESIGN This research project employed a classic grounded theory analysis of qualitative data. PARTICIPANTS Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. METHODS Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. RESULTS The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome; Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and; Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.
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Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands. Eur J Emerg Med 2016; 22:199-205. [PMID: 24595355 PMCID: PMC4410961 DOI: 10.1097/mej.0000000000000133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objectives Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses’ adherence to a National Protocol Ambulance Care (NPAC). Methods A questionnaire was developed using the literature, a questionnaire and expert opinion. Ambulance nurses (n=452) from four geographically spread emergency medical services (EMSs) in the Netherlands were invited to fill out the questionnaire. The questionnaire included questions on influencing factors and self-reported adherence. Results Questionnaires were returned by 248 (55%) of the ambulance nurses. These ambulance nurses’ adherence to the NPAC was 83.4% (95% confidence interval 81.9–85.0). Bivariate correlations showed 23 influencing factors that could be related to the individual professional, organization, protocol characteristics and social context. Multilevel regression analysis showed that 21% of the variation in adherence (R2=0.208) was explained by protocol characteristics and social influences. Conclusion Ambulance nurses’ self-reported adherence to the NPAC seems high. To improve adherence, protocol characteristics (complexity, the degree of support for diagnosis and treatment, the relationship of the protocol with patient outcomes) and social influences (expectance of colleagues to work with the national protocol) should be addressed.
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Dantas RAN, Torres GDV, Salvetti MDG, Dantas DV, Mendonça AEOD. [Instrument for assessing the quality of mobile emergency pre-hospital care: content validation]. Rev Esc Enferm USP 2015; 49:381-7. [PMID: 26107697 DOI: 10.1590/s0080-623420150000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/10/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.
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Ellensen EN, Hunskaar S, Wisborg T, Zakariassen E. Variations in contact patterns and dispatch guideline adherence between Norwegian emergency medical communication centres--a cross-sectional study. Scand J Trauma Resusc Emerg Med 2014; 22:2. [PMID: 24398290 PMCID: PMC3892008 DOI: 10.1186/1757-7241-22-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/31/2013] [Indexed: 11/13/2022] Open
Abstract
Background The 19 Norwegian Emergency medical communication centres (EMCCs) use Norwegian Index for medical emergency assistance (Index) as dispatch guidelines. Little is known about the use of Index, nor its validity. We aimed to document the epidemiology of contacts made to the public emergency medical phone number and the operators’ self-reported use of Index as a first step towards a validation study. Methods We registered all medical emergency calls to the EMCCs during a 72 h period in a national cross sectional study. We subsequently sent a questionnaire to all EMCC operators in Norway, asking how they use Index. A combined outcome variable “use of Index” was computed through a Likert scale, range 1–5. Regression models were used to examine factors influencing use. Results 2 298 contacts were included. National contact rate was 56/1 000 inhabitants per year, range between EMCCs 34 – 119. Acute contact (life-threatening situations) rate was 21/1 000 per year, range between EMCCs 5 – 31. Index criteria 6 – ’Unresolved problem’ accounts for 20% of the 113 contacts, range between EMCCs 10 – 42%. The mean use of Index was 3.95 (SD 0.39), corresponding to “more than 75% of emergency calls”. There were differences in use of Index on EMCC level, range 3.7 – 4.4, and a multi regression model explained 23.4% of the variation in use. Operators working rotation with ground ambulance services reported reduced use of Index compared to operators not working in rotation, while distinct EMCC focus on Index increased use of Index compared to EMCCs with no focus on Index. Use of electronic records and operators experience were the main reasons given for not using Index. Conclusions There is a large variation between the EMCCs with regard to both contact patterns and use of Index. There is a relatively high overall self-reported use of Index by the operators, with variations on both individual and EMCC level.
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Affiliation(s)
- Eirin N Ellensen
- Department of Research, Norwegian Air Ambulance Foundation, P,O, Box 94, N-1441, Drøbak, Norway.
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