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Goode D, Ryan A, Melby V, Slater P. Care experiences of older people with mental health needs and their families in emergency medical services settings. Int J Older People Nurs 2023; 18:e12500. [PMID: 36017887 PMCID: PMC10078226 DOI: 10.1111/opn.12500] [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: 06/15/2021] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND There are challenges to person-centred care provision in Emergency Medical Services (EMS) settings. The environment is often busy and noisy which can influence the experience of older people and their carer/partners when they attend emergency departments. Older people with mental health needs are a vulnerable group of people who are at risk of not having their needs met in acute care settings. This is due to complex presentations and increased pressures on the EMS system. AIM The aim of the paper was to explore the care experience of older people with mental health needs and their carer/partners in pre-hospital and in-hospital Emergency Medical Services settings. METHOD This study used an interpretive qualitative approach incorporating in-depth, individual interviews to gather information on the experience of the older person with mental health needs and carers/partners. Data were analysed using Braun and Clarke's (2006) thematic analysis. RESULTS Fifteen individual interviews were carried out with older people with mental health needs (n = 10) and with carers/partners (n = 5). Six themes on 'Getting there, getting in and getting out', 'Seeing the person', 'Perceptions and experiences of the pre-hospital and Emergency Department (ED)', 'The effects of the experience on personal well-being', 'Older person/carer/partner perceptions and experiences of the EMS staff' and 'Making it better' emerged from the data. CONCLUSIONS The results suggest that previous experiences with the emergency care system influence the way older people with mental health needs and their carers make decisions on current and future care needs. Negative experiences can be influenced by the layout and organisation of the ED. Participants remain reluctant to discuss or disclose their diagnosis in the Emergency Medical Services setting due to a perceived stigma. Health and social care systems and services need to undergo transformations to ensure that all people who access services are treated fairly and effectively.
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Larsson G, Dagerhem A, Wihlborg J, Rantala A. Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey. BMC Emerg Med 2022; 22:100. [PMID: 35672702 PMCID: PMC9171931 DOI: 10.1186/s12873-022-00659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene. Methods The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others. Results A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information. Conclusions Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses’ interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alma Dagerhem
- Emergency Department, Halland Hospital, Halmstad, Sweden
| | - Jonas Wihlborg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Andreas Rantala
- Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden. .,Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden. .,Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
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Alnoaimi MM, Hart A, Issa F, Hertelendy A, Voskanyan A, Ciottone G. Variance Analysis of Expatriate Pre-Hospital Provider Training in Bahrain. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:99-107. [PMID: 35280843 PMCID: PMC8906849 DOI: 10.2147/oaem.s349621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The absence of local Emergency Medical Services (EMS) educational programs in Bahrain has given rise to an EMS workforce comprised predominantly of expatriate personnel with varying educational backgrounds that require further training before being licensed as EMS providers in Bahrain. Methods A qualitative variance analysis was performed comparing desired core competencies for EMS practice in neighbouring Saudi Arabia, used as a comparator for Bahrain, with core competencies extracted from national curricula of the major countries from which expatriate providers originate. Results Major core competencies not covered by the expatriate providers’ curricula were identified as follows: working in an autonomous environment, requiring different critical thinking and decision-making skills, assessment and treatment during transportation, disaster response, EMS knowledge base, and coping with the different stressors of the prehospital environment. Conclusion These results can form the basis for additional customized training programs for expatriate EMS providers working in Bahrain, with the goal of improving and standardizing EMS care in the country.
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Affiliation(s)
- Moza M Alnoaimi
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
- Department of Emergency Medicine, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Bahrain
- Correspondence: Moza M Alnoaimi, Fellow, Beth Israel Deaconess Medical Centre (BIDMC) Disaster Medicine fellowship, Department of Emergency Medicine, BIDMC, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA, Email ;
| | - Alexander Hart
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
- Department of Emergency Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT, USA
| | - Fadi Issa
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Attila Hertelendy
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - Amalia Voskanyan
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
| | - Gregory Ciottone
- Department of Emergency Medicine, Disaster Medicine Fellowship, Beth Israel Deaconess Medical Centre (BIDMC), Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
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Svensson A, Bremer A, Rantala A, Andersson H, Devenish S, Williams J, Holmberg M. Ambulance clinicians' attitudes to older patients' self-determination when the patient has impaired decision-making ability: A Delphi study. Int J Older People Nurs 2021; 17:e12423. [PMID: 34510764 DOI: 10.1111/opn.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients' self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care. MATERIALS AND METHODS An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2-4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. RESULTS Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2-4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. CONCLUSIONS The findings highlight the complexity of ACs' attitudes towards older patients' self-determination. The respect of older patients' self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs' moral abilities within their professional practice. IMPLICATIONS FOR PRACTICE Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.
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Affiliation(s)
- Anders Svensson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Växjö, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Kalmar, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden.,Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden
| | - Henrik Andersson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Scott Devenish
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julia Williams
- Paramedic Clinical Research Unit (ParaCRU), University of Hertfordshire, Hatfield, UK
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
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Holmberg M, Hammarbäck S, Andersson H. Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/2057158520941753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.
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Affiliation(s)
- Mats Holmberg
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Staffan Hammarbäck
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Wallin K, Hörberg U, Harstäde CW, Elmqvist C, Bremer A. Preceptors´ experiences of student supervision in the emergency medical services: A qualitative interview study. NURSE EDUCATION TODAY 2020; 84:104223. [PMID: 31726285 DOI: 10.1016/j.nedt.2019.104223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/30/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research. OBJECTIVES To describe preceptors' experiences of student supervision in the EMS during clinical placements. DESIGN A descriptive qualitative design was used. Twenty specialist nurses were recruited among EMS staff from all parts of Sweden. METHODS Data were collected using individual interviews and analyzed with latent qualitative content analysis. FINDINGS EMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse. CONCLUSIONS Preceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.
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Affiliation(s)
- Kim Wallin
- Centre of Interprofessional Cooperation within Emergency care (CICE), Sweden; Faculty of Health and Life sciences, Linnaeus University, 351 95 Växjö, Sweden.
| | - Ulrica Hörberg
- Faculty of Health and Life sciences, Linnaeus University, 351 95 Växjö, Sweden.
| | | | - Carina Elmqvist
- Centre of Interprofessional Cooperation within Emergency care (CICE), Sweden; Faculty of Health and Life sciences, Linnaeus University, 351 95 Växjö, Sweden.
| | - Anders Bremer
- Centre of Interprofessional Cooperation within Emergency care (CICE), Sweden; Faculty of Health and Life sciences, Linnaeus University, 351 95 Växjö, Sweden.
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Common core content in education for nurses in ambulance care in Sweden, Finland and Belgium. Nurse Educ Pract 2019; 38:34-39. [PMID: 31176241 DOI: 10.1016/j.nepr.2019.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/13/2018] [Accepted: 05/27/2019] [Indexed: 11/20/2022]
Abstract
There is no consensus regarding the required education content and competence needed for professionals working in the emergency medical services and only a few countries in Europe staff ambulances with registered nurses. This study aimed to identify common core content in Swedish, Finnish and Belgian university curricula in the education on advanced level for registered nurses in ambulance care and to describe the teachers' perception of the necessary content for the profession as a registered nurse in ambulance care. A deductive research design was used. Three Universities, one from each country; Sweden, Finland and Belgium, participated. Data was generated from curricula and interviews with teachers and analyzed with different approaches of qualitative content analysis. The results showed commonness with respect to core content; the emphasis was mainly on medical knowledge but the content concerning contextual subjects differed between the three universities. The teachers, however, aimed for the students' to acquire a broad competence in clinical reasoning by implementing theory into practice, as well as developing the students' personal aptitude and instilling a scientific awareness. The results suggest that it is possible to create a common curriculum for training of RNs for working in ambulance care.
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Wireklint Sundström B, Bremer A, Lindström V, Vicente V. Caring science research in the ambulance services: an integrative systematic review. Scand J Caring Sci 2019; 33:3-33. [PMID: 30252151 PMCID: PMC7432173 DOI: 10.1111/scs.12607] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Birgitta Wireklint Sundström
- PreHospen – Centre for Prehospital ResearchUniversity of BoråsBoråsSweden
- Faculty of Caring Science, Work Life and Social WelfareUniversity of BoråsBoråsSweden
| | - Anders Bremer
- PreHospen – Centre for Prehospital ResearchUniversity of BoråsBoråsSweden
- Faculty of Caring Science, Work Life and Social WelfareUniversity of BoråsBoråsSweden
- Faculty of Health and Life SciencesLinnaeus UniversityVäxjöSweden
- Division of Emergency Medical ServicesKalmar County HospitalKalmarSweden
| | - Veronica Lindström
- Division of NursingDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic EMSStockholmSweden
| | - Veronica Vicente
- Academic EMSStockholmSweden
- The Ambulance Medical Service in Stockholm (AISAB)StockholmSweden
- Department of Clinical Science and EducationKarolinska InstitutetSödersjukhusetStockholmSweden
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Larsson G, Strömberg U, Rogmark C, Nilsdotter A. Patient satisfaction with prehospital emergency care following a hip fracture: a prospective questionnaire-based study. BMC Nurs 2018; 17:38. [PMID: 30127665 PMCID: PMC6097315 DOI: 10.1186/s12912-018-0307-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
Background Older patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met. The aim of this study was to investigate patient satisfaction with prehospital emergency care following a hip fracture by comparing two similar emergency care contexts. Methods The study was conducted using the Consumer Emergency Care Satisfaction Scale (CECSS) on patients treated for hip fracture in prehospital emergency care. The data were collected within a randomized controlled study for the purpose of comparing prehospital fast track care (PFTC) and the traditional type of transport to an accident and emergency department (A&E). Results Questionnaire data from 287 patients, 188 women (66%) and 99 men (34%) with a mean age of 80.9 years, were analysed. More than 80% of the patients selected the most positive response alternatives, but 16% were dissatisfied with the nursing information provided. Patients in PFTC responded more positively on specific caring behaviour than those transported to the A&E department in the traditional way. Conclusion Patient satisfaction with prehospital emergency care following a hip fracture is an important outcome and this study highlights the fact that patients expressed a high level of satisfaction with the prehospital emergency care provided by ambulance nurses in both care contexts under study. However, some areas need to be improved in terms of nursing information.
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Affiliation(s)
- Glenn Larsson
- Department of Ambulance and Prehospital Care, Region Halland, Health Centre Nyhem, 302 49 Halmstad, Sweden.,2Department of Orthopaedics, Lund University, Lund, Sweden
| | - Ulf Strömberg
- 4Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Cecilia Rogmark
- 2Department of Orthopaedics, Lund University, Lund, Sweden.,3Skane University Hospital, Malmö, Sweden
| | - Anna Nilsdotter
- 2Department of Orthopaedics, Lund University, Lund, Sweden.,4Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
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Bölenius K, Vestin C, Saveman BI, Gyllencreutz L. Validating a questionnaire - prehospital preparedness for pediatric trauma patients. Int Emerg Nurs 2017; 34:2-6. [PMID: 28545931 DOI: 10.1016/j.ienj.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
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.
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Ross L, Jennings PA, Smith K, Williams B. Paramedic Attendance to Older Patients in Australia, and the Prevalence and Implications of Psychosocial Issues. PREHOSP EMERG CARE 2016; 21:32-38. [PMID: 27439109 DOI: 10.1080/10903127.2016.1204037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to determine the number and reasons for emergency paramedic attendances to older adults in Victoria, Australia. A second aim is to investigate the prevalence of psychosocial factors that may contribute to older patients requiring emergency paramedic attendance. METHODS This descriptive retrospective study analyzed all emergency paramedic attendances to patients aged 65 or older between July 1, 2011 and June 30, 2014 in Victoria, Australia. Fully de-identified data were extracted from the Ambulance Victoria Data Warehouse. Data included demographic and clinical variables such as age, gender, case nature (cause), past history, management and transportation, paramedic final assessment (diagnosis), social situation, past history; as well as free text case descriptions. RESULTS A total of 596,579 patients 65 years or older were attended by emergency paramedics during the study period. This accounted for 24.1% of Ambulance Victoria workload during that period. The mean (SD) age of patients was 79.8(8.2). The majority (70.7%) of cases involved patients at private residences. The most common final assessments were pain (18.7%), cardiac problem (7.2%), infection (6.9%), trauma (6.7%), other/unknown (6.4%), and respiratory problem (5.7%). The vast majority of patients were transported to hospital (82.8%). Psychosocial issues were evident in the free text case descriptions of more than 91,000 cases. CONCLUSION Paramedics attended almost 600,000 patients 65 years and older during the study period. Patients suffered from conditions including, pain, trauma, infections, cardiac complaints, and respiratory problems. Free text case descriptions provided more detail and insight into the reasons for emergency paramedic attendance. Psychosocial problems were far more prevalent than indicated by the "final assessment" field. Further research is required to determine the reasons and implications of this.
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12
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Rantala A, Ekwall A, Forsberg A. The meaning of being triaged to non-emergency ambulance care as experienced by patients. Int Emerg Nurs 2016; 25:65-70. [DOI: 10.1016/j.ienj.2015.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/30/2015] [Accepted: 08/03/2015] [Indexed: 11/25/2022]
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13
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Gonsaga RAT, Silva EMD, Brugugnolli ID, Cabral JL, Thomé Neto O. Padrão e necessidades de atendimento pré-hospitalar a idosos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As principais doenças que atingem os idosos são as crônico-degenerativas, que somadas às frequentes comorbidades desse grupo, demandam maior preocupação por parte das instituições de saúde e, consequentemente, maior utilização de serviços de alta complexidade. O objetivo do estudo foi descrever os atendimentos de idosos pelo Serviço de Atendimento Móvel de Urgência SAMU no município de Catanduva-SP, com base em registros de atendimentos aos indivíduos com idade superior a 59 anos lá realizados. Foram analisados dados demográficos, sinais vitais, tipos de atendimento segundo gênero, nível de atenção à saúde indicado para resolução da ocorrência, horários das ocorrências e relação entre os grupos etários e ocorrências de clínica médica e traumáticas. Foram atendidos 42.629 pacientes, a maioria do sexo feminino 55%; a média de idade foi de 74,2 anos. Houve significância estatística nos sinais vitais quando comparados os gêneros. As ocorrências de maior frequência foram as classificadas como enfermidades clínicas, seguidas por solicitações sociais e transferências intra-hospitalares. Houve aumento dos agravos agudos clínicos e traumáticos nas faixas etárias de maior idade, e 77,9% dos atendimentos necessitaram de uma unidade fixa de atendimento para continuidade do tratamento. Encontrou-se, ainda, predomínio de atendimento nos horários de vigília dos pacientes. Observam-se maiores taxas de ocorrências com o aumento da faixa etária e utilização mais frequente de atendimento hospitalar terciário pós-ocorrências, fato que caracteriza, de maneira geral, o modelo hospitalocêntrico.
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Holmberg M, Forslund K, Wahlberg AC, Fagerberg I. The relationship with the ambulance clinicians as experienced by significant others. Nurs Crit Care 2015; 21:e1-8. [DOI: 10.1111/nicc.12144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/04/2014] [Accepted: 10/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Mats Holmberg
- Department of Neurobiology; Care Sciences and Society, Karolinska Institutet; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
| | - Kerstin Forslund
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology; Care Sciences and Society, Karolinska Institutet; Stockholm Sweden
| | - Ingegerd Fagerberg
- Department of Neurobiology; Care Sciences and Society, Karolinska Institutet; Stockholm Sweden
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
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Wihlborg J, Edgren G, Johansson A, Sivberg B. The desired competence of the Swedish ambulance nurse according to the professionals - a Delphi study. Int Emerg Nurs 2013; 22:127-33. [PMID: 24210954 DOI: 10.1016/j.ienj.2013.10.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/08/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
Nursing is evolving into new fields of health care including ambulance care, where a branch of specialist nursing is growing. Various views exist on the desired competence for the ambulance nurse and valid guidelines are lacking in Sweden. To increase knowledge of the field, professionals were asked to describe what competences an ambulance nurse should possess. The aim of this study was therefore to elucidate the desired professional competence of the specialist ambulance nurse, according to the professionals. A modified Delphi technique was used, where a panel of professional experts expressed their views on the desired competence of the ambulance nurse. This study reports, at a high level of agreement among the panel experts, that the desired competence of the specialist ambulance nurse consist of forty-four separate competences creating ten areas of competences: execute leadership, generic abilities, interpersonal communication, institutional collaboration, pedagogic skills, possession of relevant knowledge, professional judgement, professional skills, research activities, and technical skills. The high level of agreement among the professionals as well as the large number of competences reflects the high demands placed on the ambulance nurse by the professionals themselves.
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Affiliation(s)
- Jonas Wihlborg
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden.
| | - Gudrun Edgren
- Centre for Teaching and Learning, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
| | - Anders Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden
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Holmberg M, Forslund K, Wahlberg AC, Fagerberg I. To surrender in dependence of another: the relationship with the ambulance clinicians as experienced by patients. Scand J Caring Sci 2013; 28:544-51. [DOI: 10.1111/scs.12079] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/17/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Mats Holmberg
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
| | - Kerstin Forslund
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Ingegerd Fagerberg
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
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Wallin K, Fridlund B, Thorén AB. Prehospital Emergency Nursing students’ experiences of learning during prehospital clinical placements. Int Emerg Nurs 2013; 21:197-203. [DOI: 10.1016/j.ienj.2012.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/24/2012] [Accepted: 09/29/2012] [Indexed: 10/27/2022]
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Vicente V, Castren M, Sjöstrand F, Sundström BW. Elderly patients' participation in emergency medical services when offered an alternative care pathway. Int J Qual Stud Health Well-being 2013; 8:20014. [PMID: 23445898 PMCID: PMC3584033 DOI: 10.3402/qhw.v8i0.20014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/14/2022] Open
Abstract
As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients' experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients' lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as "There was a ray of hope about a caring encounter and about being treated like a unique human being". Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.
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Affiliation(s)
- Veronica Vicente
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Maaret Castren
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Sjöstrand
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Wireklint Sundström
- School of Health Sciences, Research Centre PreHospen, The Prehospital Research Centre of Western Sweden, University of Borås, Borås, Sweden
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Wennman I, Klittermark P, Herlitz J, Lernfelt B, Kihlgren M, Gustafsson C, Hansson PO. The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study. Scand J Trauma Resusc Emerg Med 2012; 20:48. [PMID: 22781159 PMCID: PMC3477056 DOI: 10.1186/1757-7241-20-48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 06/06/2012] [Indexed: 11/26/2022] Open
Abstract
Background There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke. The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit. Methods Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created. Results In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p < 0.0001). In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS). Conclusions In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.
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Affiliation(s)
- Ingela Wennman
- Department of Ambulance and Pre-hospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions. Int Emerg Nurs 2011; 19:113-9. [DOI: 10.1016/j.ienj.2010.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/30/2010] [Accepted: 07/18/2010] [Indexed: 11/18/2022]
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Melby V, Gillespie M, Martin S. Emergency nurse practitioners: the views of patients and hospital staff at a major acute trust in the UK. J Clin Nurs 2010; 20:236-46. [DOI: 10.1111/j.1365-2702.2010.03333.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Holmberg M, Fagerberg I. The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service. Int J Qual Stud Health Well-being 2010; 5:5098. [PMID: 20640018 PMCID: PMC2875973 DOI: 10.3402/qhw.v5i2.5098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Indexed: 11/14/2022] Open
Abstract
Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.
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Affiliation(s)
- Mats Holmberg
- Ambulance Service Department, Sörmland County Council, Katrineholm, Sweden
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Abstract
In this paper we report the role that a sense of significance plays in the experiences of older patients in urgent care settings, and explore the factors that influence these experiences. The paper draws on findings from a UK study in which 69 patients and 27 relatives from 31 English NHS Trusts were interviewed about their urgent care experiences using semi-structured qualitative interviews. Key among the findings was that older patients experienced a diminished sense of their individual significance. Some questioned the legitimacy of their presence in the urgent care setting and believed that they mattered little in relation to other patients and the other tasks which health professionals were undertaking. The three key features of this diminished sense of significance were: the primacy of technical, medical care; an imbalance of power; and the subordination of patients’ non-medical needs. These features suggest that interventions to enhance care delivery that promotes a sense of significance will need to target practitioners and the wider organisational culture.
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Affiliation(s)
- Jackie Bridges
- School of Community and Health Sciences, City University London, UK,
| | - Peter Nugus
- Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Keskinoglu P, Sofuoglu T, Ozmen O, Gündüz M, Ozkan M. Older people's use of pre-hospital emergency medical services in Izmir, Turkey. Arch Gerontol Geriatr 2009; 50:356-60. [PMID: 19573934 DOI: 10.1016/j.archger.2009.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/27/2009] [Accepted: 05/29/2009] [Indexed: 11/28/2022]
Abstract
The aim of this study is to determine the use of pre-hospital emergency medical services (EMS) in elderly people aged 65 years and over in Izmir, Turkey. In this descriptive study, older patients admitted to pre-hospital EMS of Izmir Province Health Directorate between 2004 and 2005 years was evaluated through the review of Emergency Call Registry Forms. The study data included socioeconomic characteristics, reasons of calling, distribution of calling times in the day, distribution of ambulance callers and preclinical diagnosis. A total of 34% of the subjects admitted to pre-hospital EMS were 65 years old and over. The rate of the use of ambulance services was 68.9/1000 population/year. The rate of pre-hospital EMS use for older persons living in urban areas was significantly higher than that of those living in rural areas. The most frequent pre-hospital EMS caller were persons in family (70.7%), and utilization of ambulance services was the highest in winter. Medically related incidents accounted for 89.1% of all emergency ambulance calls and cardiovascular diseases accounted for most common cause (32.6%) of calls. The utilization rate of pre-hospital EMS among older persons was approximately four times higher than that of the younger age groups.
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Affiliation(s)
- Pembe Keskinoglu
- Izmir Provincial Health Directorate, Department of Emergency Medical Services, Hurriyet Bulvari, No. 1, 35210, Alsancak-Izmir, Turkey.
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McFetridge B, Gillespie M, Goode D, Melby V. An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. Nurs Crit Care 2007; 12:261-9. [PMID: 17983360 DOI: 10.1111/j.1478-5153.2007.00244.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations.
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Affiliation(s)
- Brian McFetridge
- School of Nursing, University of Ulster, Magee Campus, Londonderry, UK.
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Nurses and paramedics in partnership: Perceptions of a new response to low-priority ambulance calls. ACTA ACUST UNITED AC 2007; 15:185-92. [DOI: 10.1016/j.aaen.2007.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 08/08/2007] [Accepted: 09/01/2007] [Indexed: 11/18/2022]
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