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Bove DG, Simonsen SS, Herling SF, Timm H. Emergency nurses' experiences of caring for brought-in-dead persons and their relatives-a qualitative study. J Adv Nurs 2024. [PMID: 39104304 DOI: 10.1111/jan.16371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024]
Abstract
AIM To explore how emergency nurses experienced caring for brought-in-dead persons and their relatives, and what hindered or facilitated this care in an emergency setting. DESIGN A qualitative study using Interpretive Description. METHODS Data were collected as individual interviews with 13 nurses at seven Danish emergency departments from February to June 2023. FINDINGS Our analysis revealed the overarching theme 'Navigating the complexities of providing holistic care in a constrained environment', covering five sub-themes: (1) An important yet not recognized nursing task; (2) Pending care needs of the living and the dead; (3) No physical or mental room for the brought-in-dead persons; (4) Utilizing personal experiences in the absence of formal education and training and (5) Navigating professionalism and empathy. CONCLUSION Emergency departments posed unique challenges in providing care to brought-in-dead persons and their relatives. IMPLICATIONS FOR THE PROFESSION The unrecognized nature of caring for brought-in-dead persons and their relatives suggests a universal undervaluation of this care in emergency departments. IMPACT Care for brought-in-dead persons and their relatives is neither recognized nor evidence-based. This study initiates a discussion of the circumstances for delivering care for persons brought-in-dead and has an impact on nurses and nursing leaders employed in emergency departments. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- D G Bove
- Centre for Nursing, University College Absalon, Roskilde, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - S S Simonsen
- Centre for Nursing, University College Absalon, Roskilde, Denmark
| | - S F Herling
- The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - H Timm
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern, Odense, Denmark
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn, Faroe Islands
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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. The work of palliative care from the perspectives of district nurses: A qualitative study. J Adv Nurs 2024; 80:3323-3332. [PMID: 38108192 DOI: 10.1111/jan.16030] [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: 05/22/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
AIM To explore the work of palliative care from the perspectives of district nurses with a focus on the strategies they use to achieve positive outcomes for patients. DESIGN An exploratory descriptive qualitative study. METHODS A combination of group and individual interviews using semi-structured interviewing were used to explore district nurses' views of providing palliative care across two large urban community nursing services. RESULTS Sixteen district nurse participants were interviewed. Three key themes were identified: "Getting what was needed" involved finding solutions, selling a story and establishing relationships. District nurses sought ways to "Stay involved" recognizing the benefit of delaying discharge for some patients. "Completing a nursing task" was a way of managing time constraints and a form of self-protection from having difficult conversations. CONCLUSION This study highlights the importance of understanding the contextual nature of the practice setting in relation to the provision of palliative care. In doing so, it has revealed the strategies district nurses use to overcome the challenges associated with providing palliative care within a generalist workload. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE District nurses experience a tension between managing high patient workloads and remaining patient centred in palliative care. Being task focused is a way of remaining safe while managing a high volume of work and is not always a negative factor in the care they provide. However, focusing on a task while at the same time addressing other unmet needs requires a set of skills that less experienced nurses may not have. IMPACT Palliative care education alone will not improve the quality of palliative care provided by generalist community district nurses. The practice context is an important factor to take into consideration when supporting the integration of palliative care in district nursing. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was made to this study. REPORTING METHOD We have adhered to the relevant EQUATOR guidelines and used the COREQ reporting method.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Rebekah Irwin
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Craston AIP, Scott-Murfitt H, Omar MT, Abeyratne R, Kirk K, Mackintosh N, Roland D, van Oppen JD. Being a patient in a crowded emergency department: a qualitative service evaluation. Emerg Med J 2024:emermed-2023-213751. [PMID: 39084692 DOI: 10.1136/emermed-2023-213751] [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: 11/09/2023] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Emergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to metrics and surveys rather than understanding perspectives. This project investigated patients' experiences and identified mitigating interventions. METHODS A qualitative service evaluation was undertaken in a large UK ED. Adults were recruited during periods of high occupancy or delayed transfers. Semi-structured interviews explored experience during these attendances. Participants shared potential mitigating interventions. Analysis was based on the interpretative phenomenological approach. Verbatim transcripts were read, checked for accuracy, re-read and discussed during interviewer debriefing. Reflections about positionality informed the interpretative process. RESULTS Seven patients and three accompanying partners participated. They were aged 24-87 with characteristics representing the catchment population. Participants' experiences were characterised by 'loss of autonomy', 'unmet expectations' and 'vulnerability'. Potential mitigating interventions centred around information provision and better identification of existing ED facilities for personal needs. CONCLUSION Participants attending a crowded ED experienced uncertainty, helplessness and discomfort. Recommendations included process and environmental orientation.
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Affiliation(s)
| | | | - Mariam T Omar
- Medical School, University of Leicester, Leicester, UK
| | - Ruw Abeyratne
- Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kate Kirk
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Damian Roland
- Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - James David van Oppen
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Centre for Urgent and Emergency Care Research (CURE), The University of Sheffield, Sheffield, UK
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Petrino R, Biondi C, Castrillo LG. Healthcare professionals' perceptions of patient safety in European emergency departments: a comparative analysis of survey results. Intern Emerg Med 2024; 19:1121-1127. [PMID: 38278968 PMCID: PMC11186879 DOI: 10.1007/s11739-023-03523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
Patient safety is a significant concern worldwide. The Emergency Departments (EDs) are vulnerable to adverse events. Europe, with its diverse healthcare systems, differs in patient safety. This study aimed to identify safety challenges through a comparative analysis of healthcare professionals' perceptions of patient safety in European EDs. In early 2023, a validated questionnaire was distributed to European ED professionals, meeting specific response rate criteria. The questionnaire included five safety domains and additional questions about infection control and team morale, with 36 ordinal scale questions. Responses ranged in five levels from "Never" to "Always," and the scores were summed to calculate the total safety score (TSS). The study examined the impact of per capita healthcare expenditure on safety perceptions using descriptive statistics, correlation assessments and SPSS 17 used for the analysis. The analysis of 1048 valid responses from 24 European countries revealed significant variability in safety perceptions. Teamwork scored highest, signifying effective collaboration. Common safety issues included overcrowding, patient flow management, understaffing, limited training and facilities for mental illnesses. TSS showed correlation with team morale and infection control, but no correlation with per capita healthcare expenditure. This comparative study underlines the disparities in patient safety perceptions across European EDs. Each country displayed unique safety concerns. Safety perceptions did not align with per capita healthcare expenditure, indicating that addressing ED safety needs multifaceted strategies. Policymakers can leverage these findings to inform strategic planning, encouraging targeted interventions to enhance patient safety at both the national and European levels.
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Affiliation(s)
- Roberta Petrino
- Emergency Medicine Unit, Department of Critical Care, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Carola Biondi
- Emergency Medicine Unit, Department of Critical Care, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Luis Garcia Castrillo
- Department of Emergency Medicine, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Amritzer MA, Göransson KE, Berg LM, Nymark C. A New Perspective on Missed Nursing Care in the Emergency Department: A Descriptive Cross-Sectional Study. J Emerg Nurs 2024; 50:392-402. [PMID: 38310494 DOI: 10.1016/j.jen.2023.12.006] [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: 07/09/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. METHODS Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey-Swedish version was used for data collection. RESULTS Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. DISCUSSION The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in-hospital wards.
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Dupuy M, Dutheil F, Alvarez A, Godet T, Adeyemi OJ, Clinchamps M, Schmidt J, Lambert C, Bouillon-Minois JB. Influence of COVID-19 on Stress at Work During the First Wave of the Pandemic Among Emergency Health Care Workers. Disaster Med Public Health Prep 2023; 17:e455. [PMID: 37533367 DOI: 10.1017/dmp.2023.134] [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] [Indexed: 08/04/2023]
Abstract
OBJECTIVES For more than 2 years, coronavirus disease (COVID-19) has forced worldwide health care systems to adapt their daily practice. These adaptations add to the already stressful demands of providing timely medical care in an overcrowded health care system. Specifically, the COVID-19 pandemic added stress to an already overwhelmed emergency and critical care health care workers (HCWs) on the front lines during the first wave of the pandemic.This study assessed comparative subjective and objective stress among frontline HCWs using a visual analog scale and biometric data, specifically heart rate variability (HRV). METHODS This is a prospective, observational study using surveys and heart rate monitoring among HCWs who work in 3 frontline health care units (emergency department, mobile intensive care unit, and intensive care unit) in the University Hospital of Clermont-Ferrand, France. Two sessions were performed: 1 during the first wave of the pandemic (April 10 to May 10, 2020) and 1 after the first wave of the pandemic (June 10 to July 15, 2020).The primary outcome is the difference in stress levels between the 2 time points. Secondary objectives were the impact of overcrowding, sociodemographics, and other variables on stress levels. We also assessed the correlation between subjective and objective stress levels. RESULTS Among 199 HCWs, 98 participated in biometric monitoring, 84 had biometric and survey data, and 12 with only biometric data. Subjective stress was higher during the second time point compared to the first (4.39 ± 2.11 vs 3.16 ± 2.34, P = 0.23). There were higher objective stress levels with a decrease in HRV between the first and the second time points. Furthermore, we found higher patient volumes as a source of stress during the second time point. We did not find any significant correlation between subjective and objective stress levels. CONCLUSION HCWs had higher stress levels between the 2 waves of the pandemic. Overcrowding in the emergency department is associated with higher stress levels. We did not find any correlation between subjective and objective stress among intensive care and emergency HCWs during the first wave of the pandemic.
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Affiliation(s)
- Marie Dupuy
- Université Clermont Auvergne, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Occupational and Environmental Medicine, Clermont-Ferrand, France
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas Godet
- CHU Clermont-Ferrand, Department of Anesthesiology and Critical Care, Reproduction and Developmental Diseases (R2D2) Unit, EA 7281, Clermont-Ferrand, France
| | - Oluwaseun John Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York University Langone Health, New York, NY, USA
| | - Maëlys Clinchamps
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Céline Lambert
- CHU Clermont-Ferrand, DRCI, Biostatistics unit, Clermont-Ferrand, France
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
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Teske C, Mourad G, Milovanovic M. Mobile care - a possible future for emergency care in Sweden. BMC Emerg Med 2023; 23:80. [PMID: 37501146 PMCID: PMC10375669 DOI: 10.1186/s12873-023-00847-1] [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: 12/17/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Provision of mobile care at the home of patients appears to become necessary as the population becomes increasingly older. But there are challenges in moving emergency care from hospitals to the home of patients. The aim of the study was therefore to describe the experiences of the mobile care in Sweden. METHOD Semi structured interviews were conducted with 12 persons with experience of mobile care in Sweden, such as nurses, physicians, civil servants and politicians. Qualitative latent content analysis was used as an analysis method. RESULT The results show that cooperation is of utmost importance to achieve functioning mobile care. Cooperation both on an inter-organizational level and on a close team-work is required for all of the involved parties in mobile care to take on a joint responsibility for the patient. As mobile care is primarily provided to elderly multimorbid patients, a comprehensive view on patient care is required in which the patient and their relatives experience security. CONCLUSION Mobile care is seen as a moving care that comes to the seeking person and not the other way around. The resources are distributed where they make the most use, that is, closest to the individual. Mobile care is seen as a complement to the traditional hospital care. This means a different way of working that requires close collaboration between different categories of personnel and organizations, where there should not be any discussions about boundaries, rather, the discussion should include patient's needs and situation instead.
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Affiliation(s)
- Christofer Teske
- Department of Health, Medicine and Care (HMV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Norrköping, SE-601 74, Sweden
- Department of Emergency, Vrinnevi Hospital, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Care (HMV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Norrköping, SE-601 74, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Care (HMV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Norrköping, SE-601 74, Sweden.
- Department of Internal Medicine, Vrinnevi Hospital, Norrköping, Sweden.
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Walters C, Cope V, Hopkins MPR. Left behind: Exploring the concerns of emergency department staff when personnel are utilised for inter-hospital transfer. Int Emerg Nurs 2023; 69:101298. [PMID: 37257361 DOI: 10.1016/j.ienj.2023.101298] [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: 07/19/2022] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Inter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff. AIMS To explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT. METHOD A qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed. FINDINGS Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels. CONCLUSION IHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.
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Affiliation(s)
- Clare Walters
- School of Nursing, College of Health and Education, Murdoch University, 90, South Street, Murdoch, WA 6150, Australia.
| | - Vicki Cope
- School of Nursing, College of Health and Education, Murdoch University, 90, South Street, Murdoch, WA 6150, Australia
| | - Martin P R Hopkins
- School of Nursing, College of Health and Education, Murdoch University, 90, South Street, Murdoch, WA 6150, Australia
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Al-Etreby MZ, Khalil AA, Abd-Elrhman AAE. A study of the effect of some musical compositions on glucagon-like peptide 1, insulin, leptin, and body weight of crowded adult albino rats. AL-AZHAR ASSIUT MEDICAL JOURNAL 2023; 21:53-57. [DOI: 10.4103/azmj.azmj_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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10
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Alquwez N. Association between nurses' experiences of workplace incivility and the culture of safety of hospitals: A cross-sectional Study. J Clin Nurs 2023; 32:320-331. [PMID: 35098598 DOI: 10.1111/jocn.16230] [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: 08/16/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
AIM AND OBJECTIVES This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals. BACKGROUND Workplace incivility, which is characterised by low-intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace. DESIGN Cross-sectional study. METHOD This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit- and hospital-level PS culture as the dependent variables. RESULTS 'Organizational learning-continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean = 2.27, standard deviation = 0.88). Working in Hospital B (ß = 0.24, p < .001, 95%CI = 0.15, 0.33) and having a baccalaureate degree in nursing (ß = 0.13, p = .014, 95%CI = 0.03, 0.23) were associated with better perceptions of unit-level PS, whereas working in medical-surgical wards (ß = -0.16, p = .002, 95%CI = -0.26, -0.06) and in intensive care units (ß = -0.19, p = .002, 95%CI = -0.32, -0.07) and experiencing patient/visitor incivility (ß = -0.09, p = .004, 95%CI = -0.15, -0.03) were associated with poor unit-level PS culture perceptions. Experiences of general incivility (ß = -0.24, p < .001, 95%CI = -0.35, -0.13) and supervisor incivility (ß = -0.26, p = .011, 95%CI = -0.46, -0.06) were associated with poor hospital-level PS culture perceptions. CONCLUSIONS Workplace incivility from patients/visitors had a negative association with unit-level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital-level PS culture perceptions. RELEVANCE TO CLINICAL PRACTICE The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit- and hospital-level PS culture are above standards.
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Affiliation(s)
- Nahed Alquwez
- Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia
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Emergency Room Nurses’ Experiences in Person-Centred Care. NURSING REPORTS 2022; 12:472-481. [PMID: 35894035 PMCID: PMC9326738 DOI: 10.3390/nursrep12030045] [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: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
Implementing person-centred care is often considered difficult in congested emergency rooms. The purpose of this study was to understand person-centred care experienced by emergency room nurses in depth and examine the essence of emergency room nurses’ lived experience of the person- centred care. Eight nurses working in the emergency room of a large hospital in South Korea and who had over six months of experience were surveyed via semi-structured interviews in February 2019. The data were transcribed and analysed using Colaizzi’s framework. The major findings related to person-centred care experiences among emergency room nurses were: (1) feeling distanced from patients; (2) guilt and frustration; (3) accepting patients’ symptoms and emotions as they are; (4) person-centred care as a domain of nursing that cannot be replaced by machines; and (5) nursing as an art wherein the minutest details make a difference. Providing person-centred practice in the emergency room is difficult, but it will not only improve the quality of patient care but also increase the job satisfaction of nurses. Based on an in-depth understanding of person-centred care experienced by emergency nurses, it will contribute to enhancing the quality of nursing care in the emergency room.
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12
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Nazari S, Poortaghi S, Sharifi F, Gorzin S, Afshar PF. Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. BMC Health Serv Res 2022; 22:840. [PMID: 35773700 PMCID: PMC9244299 DOI: 10.1186/s12913-022-08258-x] [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: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The quality of care has a significant impact on the condition of elderly patients. Many factors affect the quality of care, including ethical considerations. Ethical considerations, such as moral sensitivity, change in times of crisis. The present study was conducted to assess the relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. METHODS This was a cross-sectional descriptive correlational study. The participants included 445 nurses that were selected by quota sampling method from hospitals admitting COVID-19 patients. The data were collected using the Moral Sensitivity Questionnaire (MSQ) and Quality Patient Care Scale (QUALPAC) as self-reports. We used the SPSS software v.16 for statistical analysis. RESULTS The total score of moral sensitivity and quality of care was 52.29 ± 16.44 and 2.83 ± 0.23, respectively. Moral sensitivity negatively correlates with psychological, social, and physical aspects (P < 0.05). Modifying autonomy, interpersonal orientation, and experiencing moral conflict predicted β = 0.10 of the psychosocial aspect of quality of care. Structural moral meaning and expressing benevolence predicted the changes in the physical dimension of quality of care (β = 0.02). CONCLUSION The quality of care had a significant inverse correlation with moral sensitivity. Multiple regression analysis showed that modifying autonomy, interpersonal orientation, and experiencing moral conflict could predict the psychosocial dimensions. Structuring moral meaning could predict the physical dimension. The communication aspects were not related to any of the dimensions of moral sensitivity.
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Affiliation(s)
- Shima Nazari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarieh Poortaghi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Science, Tehran, Iran
| | - Shaghayegh Gorzin
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Farokhnezhad Afshar
- Department of Gerontology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
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Asmoro CP, Hariyati RTS, Ayuningtyas D, Umar J, Tartila DYR. Researching nurses' adherence to patient safety guidelines in emergency departments. Emerg Nurse 2022; 30:e2129. [PMID: 35762099 DOI: 10.7748/en.2022.e2129] [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: 01/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND One of the reasons why patient safety may be put at risk during healthcare interventions is a lack of staff adherence to patient safety guidelines. There could be a relationship between staff's adherence to patient safety guidelines and their perceived level of reward for their work and/or motivation. AIM To examine the relationship between reward and adherence to patient safety guidelines, and between motivation and adherence to patient safety guidelines, among nurses working in emergency departments (EDs) in Indonesia. METHOD This was a cross-sectional study of 101 nurses working in the EDs of four hospitals in Indonesia. Self-reported questionnaires were used to collect data on the level of reward participants felt they received for their work, the level of participants' motivation for their work, and participants' adherence to patient safety guidelines. Spearman's rank correlation testing was used to determine the relationships between variables. RESULTS There was a statistically significant negative relationship between reward and adherence (P=0.019, r=-0.233), which meant that those who perceived their reward as low were more likely to adhere to patient safety guidelines than those who felt they were highly rewarded. There was a statistically significant positive relationship between motivation and adherence to patient safety guidelines (P=0.017, r=0.236), which meant that the higher the motivation, the higher participants' level of adherence to patient safety guidelines. CONCLUSION Ensuring ED nurses are motivated for their work by offering rewards - such as a decent salary, a supportive workplace environment and career progression opportunities - is important to enhance their adherence to patient safety guidelines.
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Affiliation(s)
| | | | | | - Jahja Umar
- Universitas Islam Negeri Syarif Hidayatullah Jakarta, South Tangerang, Indonesia
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Pavedahl V, Muntlin Å, Summer Meranius M, von Thiele Schwarz U, Holmström IK. Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses. J Adv Nurs 2022; 78:2165-2174. [PMID: 35130360 PMCID: PMC9304302 DOI: 10.1111/jan.15172] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life‐threateningly ill patients' care needs from the perspective of a person‐centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task‐oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person‐centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person‐centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life‐threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person‐centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person‐centred fundamental care and thereby avoid fundamental care being missed.
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Affiliation(s)
- Veronica Pavedahl
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Prevalence of Prolonged Length of Stay in an Emergency Department in Urban Denmark: A Retrospective Health Records Repository Review. J Emerg Nurs 2022; 48:102.e1-102.e12. [PMID: 34996571 DOI: 10.1016/j.jen.2021.08.005] [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: 02/05/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Prolonged length of stay in emergency departments is associated with increased hospitalization, hospital-acquired pressure ulcers, medication errors, and mortality. In acute admissions in Denmark in 2018, 67% of patients experienced waiting time from arrival to examination. This study aimed to estimate the prevalence of prolonged length of stay (≥6 hours) and identify risk factors related to input, throughput, and output components. METHODS A retrospective health records repository review included 4743 patients admitted to a single urban emergency department in Denmark in January 2019. Data collected from the electronic health record system repository included demographic and organizational characteristics and were analyzed using descriptive statistics and logistic regression. RESULTS Among patients admitted in the study period, 31% had a prolonged length of stay of ≥6 hours. Prolonged length of emergency department stay was associated with being female (male odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75-0.98), treatment by medical service (OR, 4.25, 95% CI, 3.63-4.98) vs surgical or injury, triage acuity of 2-Orange (OR, 1.45; 95% CI, 1.18-1.78) or 3-Yellow (OR, 1.47; 95% CI, 1.23-1.75) on a 5-level scale, evening (OR, 1.44; 95% CI, 1.24-1.66) or night (OR, 2.36; 95% CI, 1.91-2.91) arrival, ages 56 to 80 (OR, 1.79; 95% CI, 1.52-2.11) and >81 (OR, 2.40; 95% CI, 1.99-2.88) years, and hospital admission (OR, 1.19; 95% CI, 1.04-1.38) vs discharge from the emergency department to home. DISCUSSION Female, elderly, and medical patients were each identified as at-risk characteristics for ≥6-hour length of stay in the emergency department. Acute care patient pathways in the emergency department, particularly for evening and night, with guideline-based care and system level improvements in patient flow are warranted. Further research with larger populations is needed to identify and support interventions to decrease prolonged length of stay.
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Mohr NM, Wu C, Ward MJ, McNaughton CD, Faine B, Pomeranz K, Richardson K, Kaboli PJ. Transfer boarding delays care more in low-volume rural emergency departments: A cohort study. J Rural Health 2022; 38:282-292. [PMID: 33644911 PMCID: PMC8715860 DOI: 10.1111/jrh.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this study was to measure the relative impact of ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low-volume rural hospitals. METHODS A retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011 and 2014. The primary exposure was the number of patients in the ED at the time of ED registration, stratified by disposition (admit, discharge, or transfer) and mental health diagnosis. The primary outcome was time-to-provider evaluation, and secondary outcomes included time-to-EKG, time-to-laboratory testing, time-to-radiography, and total ED length-of-stay. Rurality was measured using the Rural-Urban Commuting Areas. FINDINGS A total of 5,912,368 patients were included from all 123 VHA EDs. Adjusting for acuity, new patients had longer time-to-provider when more patients were in the ED, and patients awaiting transfer for nonmental health conditions impacted time-to-provider for new patients (16.6 min delays, 95% CI: 12.3-20.7 min) more than other patient types. Rural patients saw a greater impact of crowding on care timeliness than nonrural patients (additional 5.3 min in time-to-provider per additional patient in ED, 95% CI: 4.3-6.4), and the impact of additional patients in all categories was most pronounced in the lowest-volume EDs. CONCLUSIONS Patients seen in EDs with more crowding have small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.
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Affiliation(s)
- Nicholas M. Mohr
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA;,Department of Emergency Medicine, University of Iowa Carver College of Medicine;,Department of Anesthesia, University of Iowa Carver College of Medicine
| | - Chaorong Wu
- Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, Iowa
| | - Michael J. Ward
- Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee;,Department of Emergency Medicine, Vanderbilt University Medical Center
| | - Candace D. McNaughton
- Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee;,Department of Emergency Medicine, Vanderbilt University Medical Center
| | - Brett Faine
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA;,Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Kaila Pomeranz
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Kelly Richardson
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA
| | - Peter J. Kaboli
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA;,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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17
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Rocha HMDN, do Nascimento EB, dos Santos LC, Alves GV, Farre AGMDC, de Santana-Filho VJ. Usability in the admission monitoring system of an emergency room. Rev Saude Publica 2021; 55:113. [PMID: 34932702 PMCID: PMC8664066 DOI: 10.11606/s1518-8787.2021055003475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop and evaluate the usability of the admission monitoring system in an emergency room. METHODS This applied research intends to develop a software product and evaluate its usability. The development followed four stages: systematic review, structuring of the system framework, construction of system forms, and evaluation of the information generated. In the evaluation, the experts simulated the use of the system by inserting data from a fictitious medical record. We measured usability using the System Usability Scale (SUS). Scores and scores were calculated individually and globally. We propose these evaluation standards: worst case scenario, poor, average, good, excellent, and best-case scenario. RESULTS The Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS - Information and Monitoring System for Emergency Room Admissions) monitors the epidemiological profile of admissions to the emergency room, time management, clinical deterioration, incidence of adverse events, and human resource management. The usability of SIMIPS, evaluated by 17 experts, reached the SUS Score 86.5 (best case scenario), and some suggestions for modifications were accepted. CONCLUSIONS We consider SIMIPS an easy-to-use tool, with real importance in the management of emergencies in view of overcrowding and congestion problems faced in Brazil.
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Affiliation(s)
- Hertaline Menezes do Nascimento Rocha
- Universidade Federal de SergipePrograma de Pós-Graduação em Ciências da SaúdeAracajuSEBrasilUniversidade Federal de Sergipe. Programa de Pós-Graduação em Ciências da Saúde. Aracaju, SE, Brasil
- Universidade Federal de SergipeDepartamento de EnfermagemLagartoSEBrasilUniversidade Federal de Sergipe. Departamento de Enfermagem. Lagarto, SE, Brasil
| | - Ester Batista do Nascimento
- Universidade Federal de SergipeDepartamento de EnfermagemLagartoSEBrasilUniversidade Federal de Sergipe. Departamento de Enfermagem. Lagarto, SE, Brasil
| | - Laryssa Carvalho dos Santos
- Universidade Federal de SergipeDepartamento de EnfermagemLagartoSEBrasilUniversidade Federal de Sergipe. Departamento de Enfermagem. Lagarto, SE, Brasil
| | - Guilherme Viturino Alves
- Universidade Federal de SergipePrograma de Pós-Graduação em Ciência da ComputaçãoSão CristóvãoSEBrasilUniversidade Federal de Sergipe. Programa de Pós-Graduação em Ciência da Computação. São Cristóvão, SE, Brasil
| | - Anny Giselly Milhome da Costa Farre
- Universidade Federal de SergipeDepartamento de EnfermagemLagartoSEBrasilUniversidade Federal de Sergipe. Departamento de Enfermagem. Lagarto, SE, Brasil
| | - Valter Joviniano de Santana-Filho
- Universidade Federal de SergipePrograma de Pós-Graduação em Ciências da SaúdeAracajuSEBrasilUniversidade Federal de Sergipe. Programa de Pós-Graduação em Ciências da Saúde. Aracaju, SE, Brasil
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18
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Stathopoulos D, Ekvall Hansson E, Stigmar K. Exploring the Environment behind In-Patient Falls and Their Relation to Hospital Overcrowdedness-A Register-Based Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10742. [PMID: 34682482 PMCID: PMC8535502 DOI: 10.3390/ijerph182010742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Inpatient falls are a serious threat to patients' safety and their extrinsic factors are, at present, insufficiently described. Additionally, hospital overcrowdedness is known for its malicious effects but its relation to the inpatient falls is currently underexplored. The aim of this study was to explore the distribution of falls and their extrinsic characteristics amongst a range of different clinics, and to explore the correlation and predictive ability of hospital overcrowding in relation to inpatient falls. (2) Methods: An observational, cross-sectional, registry-based study was conducted using retrospective data from an incidence registry of a hospital organization in Sweden during 2018. The registry provided data regarding the extrinsic factors of inpatient falls, including the clinics' overcrowdedness. Simple descriptive statistics, correlation analysis and simple linear regression analysis were used. (3) Results: Twelve clinics were included. A total of 870 inpatient falls were registered during 2018. Overcrowdedness and total amount of falls were positively and very strongly correlated (r = 0.875, p < 0.001). Overcrowdedness was a significant predictor of the total amount of inpatient falls (p < 0.001, α = 0.05). (4) Conclusions: The characteristics regarding inpatient falls vary among the clinics. Inpatient overcrowding might have a significant role in the prevalence of inpatient falls, but further high-evidence-level studies are required.
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Affiliation(s)
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, 22100 Lund, Sweden; (D.S.); (K.S.)
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19
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Rabelo SK, de Lima SBS, Dos Santos JLG, Dos Santos TM, Reisdorfer E, Hoffmann DR. Care management instruments used by nurses in the emergency hospital services. Rev Esc Enferm USP 2021; 55:e20200514. [PMID: 34460895 DOI: 10.1590/1980-220x-reeusp-2020-0514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the instruments used by nurses for the management of care in face of the demands of the emergency hospital service. METHOD This is a qualitative study, with triangulation of data from interviews, focus groups, and documents, conducted with nurses from an Emergency Hospital Service in a state in southern Brazil. Data were subjected to thematic content analysis. RESULTS Seventeen nurses participated in the study. The categories emerging from this study were view of the whole picture, definition of priorities, and physical instruments. These instruments are used by nurses to manage multiple tasks and provide adequate care to patients with different levels of complexity, in the face of an intense and unpredictable work process due to the constant demand for care. CONCLUSION The instruments used by nurses in their work process are mainly skills and attitudes developed as a coping strategy at an intense and complex work environment.
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Affiliation(s)
- Simone Kroll Rabelo
- Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem, Santa Maria, RS, Brazil
| | | | | | - Tanise Martins Dos Santos
- Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem, Santa Maria, RS, Brazil
| | - Emilene Reisdorfer
- MacEwan University, Faculty of Nursing, Department of Professional Nursing and Allied Health Edmonton, Alberta, Canada
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20
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GEDİK MS, HAKKOYMAZ H, BASAN NM, SAFİ Y, AKSAY E. 112 Ambulans Çalışanlarının Hizmet ve Sosyal Durumlarının Değerlendirilmesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.900466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: 112 Emergency Health Services (EHS) is crucial for preventing deaths and injuries with early intervention and has significant impacts on survival. Many factors like shift working, occupational dissatisfaction, safety concern, and stress adversely affect 112 EHS workers. This study aimed to evaluate working conditions, expectations, job satisfaction, service and social conditions of 112 EHS staff working in the city of XX, to determine the difficulties they face and to provide suggestions for more efficient working condition.
Method: This study was conducted with health workers working at 112 EHS in the city of XX. A survey form was developed to investigate their service and social conditions. It was converted into an electronic survey consisting of 29 questions via Google Forms. 252 health workers participated in study by filling the electronic survey.
Results: The most important factors affecting the job performance of workers were job satisfaction/respect and the level of salary. Workers reported the majority of the cases encountered during a 24-hour shift were green zone patients.The average arrival time to the cases and the delivery time of the patients to the hospital are mostly within 0-10 minutes. Emergency room physician's approach and the lack of allied health personnel were the most common problems during patients' delivery to hospital. Most workers stated that protective measures on occupational safety in the EHS were insufficient and that they were subjected to physical assault.
Conclusion: As a result of our study, it was determined that 112 employees experienced job dissatisfaction.The reasons for this situation are the level of salary, lack of dignity, fear of security.However, there are some deficiencies regarding the use and organization of 112 emergency health services. It is necessary to immediately improve 112 EHS workers’ working conditions and the coordination of EHS.
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Affiliation(s)
| | | | | | - Yılmaz SAFİ
- ŞANLIURFA MEHMET AKİF İNAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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21
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do Nascimento Rocha HM, da Costa Farre AGM, de Santana Filho VJ. Adverse Events in Emergency Department Boarding: A Systematic Review. J Nurs Scholarsh 2021; 53:458-467. [PMID: 33792131 DOI: 10.1111/jnu.12653] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overcrowding in emergency departments (EDs) is a worldwide challenge. As a result of the increased demand for EDs, slow internal patient flow, and unavailability of hospital beds, patients are kept in the corridors, causing a boarding effect. Studies have associated boarding in EDs with unfavorable clinical outcomes and adverse events. Thus, the purpose of this systematic review was to describe the effects of ED boarding on the occurrence of adverse events. DESIGN We followed the Meta-Analysis of Observational Studies in Epidemiology checklist and registered this systematic review with PROSPERO (CRD42020117915). METHODS Literature searches were performed using the databases PubMed, Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, as well as Google Scholar, OpenThesis, and the Brazilian Digital Library of Theses and Dissertations from September to November 2019. Cohort or case control studies that evaluated the occurrence of adverse events in patients who remained in an ED, waiting for a hospital bed, were included in the review. RESULTS Seven studies met our eligibility criteria. Boarding in EDs may be related to a reduction in the quality of care, resulting in unfavorable clinical outcomes and adverse events. CONCLUSIONS Boarding in EDs may be related to increases in adverse incidents and events. CLINICAL RELEVANCE The evidence in this review suggests that ED boarding increases the occurrence of unfavorable outcomes and identifies important considerations for future research.
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22
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Wagner JIJ, MacPhee M, Udod S, Berry L, Perchie G, Conway A. Surveys conducted pre- and post-implementation of a synergy tool: Giving voice to emergency teams. J Nurs Manag 2021; 29:1771-1777. [PMID: 33772912 DOI: 10.1111/jonm.13317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/01/2023]
Abstract
AIM To investigate the impact of a patients' needs assessment (synergy tool) on emergency department nurses' perceptions of quality, safe care delivery and morale. BACKGROUND The synergy tool provides real-time data on types of patients, their arrival, management and discharge. This tool was introduced to two urban emergency departments in response to government priorities to reduce emergency department wait times and improve patient flow. METHOD This survey, a component of participatory action research, measures perceptions of 158 nurses pre-introduction and 91 nurses post-introduction of the synergy tool. RESULT Responses were consistent regarding intent to leave, workload/staffing, spirit at work and quality/safety. One question describing staff as working in 'crisis mode' indicated a significant improvement. CONCLUSION Critical patient care may be missed during periods of overload, placing patients and staff at risk, leading to an increase in intent to leave. The synergy tool provides an objective means in real time for staff to identify their patients' care needs, assisting management with staffing decisions. Ongoing staff and management communication using tools such as the synergy tool may reduce perceptions of working in 'crisis mode'. IMPLICATIONS FOR NURSING MANAGEMENT This research suggests that when managers employ a collaborative process and use evidence-based tools and approaches to addressing nurses' workload concerns, nurses' perceptions of working in 'crisis mode' diminish.
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Affiliation(s)
- Joan I J Wagner
- Faculty of Nursing, University of Regina, Regina, SK, Canada
| | - Maura MacPhee
- UBC School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Sonia Udod
- Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Lois Berry
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Glen Perchie
- Emergency Medicine Services for Southern Saskatchewan, Regina, SK, Canada.,Emergency, Saskatchewan Health Authority, Regina, SK, Canada
| | - Aidan Conway
- Saskatchewan Union of Nurses, Saskatoon, SK, Canada
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af Ugglas B, Lindmarker P, Ekelund U, Djärv T, Holzmann MJ. Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR). PLoS One 2021; 16:e0247881. [PMID: 33690653 PMCID: PMC7946203 DOI: 10.1371/journal.pone.0247881] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. Methods This was an observational cohort study including visits from 14 EDs in Sweden 2015–2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. Results 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01–1.12) in the moderate crowding category, and 1.11 (1.01–1.22) in the high category. Conclusions The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role.
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Affiliation(s)
- Björn af Ugglas
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Per Lindmarker
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Ekelund
- Faculty of Medicine, Department of Clinical Sciences Lund, Emergency Medicine, Lund University, Lund, Sweden
| | - Therese Djärv
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Martin J. Holzmann
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
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Chastonay OJ, Lemoine M, Grazioli VS, Canepa Allen M, Kasztura M, Moullin JC, Daeppen JB, Hugli O, Bodenmann P. Health care providers' perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland. BMC Emerg Med 2021; 21:4. [PMID: 33413163 PMCID: PMC7792123 DOI: 10.1186/s12873-020-00397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. Objectives The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. Methods Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. Results The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. Conclusions The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00397-w.
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Affiliation(s)
- Oriane J Chastonay
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.
| | - Melissa Lemoine
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Marina Canepa Allen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | | | | | - Olivier Hugli
- Emergency Department, University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
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af Ugglas B, Djärv T, Ljungman PL, Holzmann MJ. Emergency department crowding associated with increased 30-day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016. J Am Coll Emerg Physicians Open 2020; 1:1312-1319. [PMID: 33392538 PMCID: PMC7771779 DOI: 10.1002/emp2.12243] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Emergency department (ED) crowding is a major problem across the world. Studies investigating the association between crowding and mortality are many, but the quality is inconsistent and there are very few large, high-quality multicenter studies that are properly designed to deal with confounding due to case mix. The aim of this study is to investigate the association between ED crowding and 30-day mortality. METHODS We conducted an observational cohort study at all 7 EDs in Stockholm Region, Sweden 2012-2016. The crowding exposure was defined as the mean hourly ED census during the shift that the exposed patient arrived, divided with the expected ED census for this shift. The expected ED census was estimated using a separate linear model for each hospital with year and shift as predictors. The exposure was categorized in 3 groups: reference (lowest 75% of observations), moderate (75%-95% of observations), and high (highest 5% of observations). Hazard ratios (HR) for all-cause mortality within 30 days were estimated with a Cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode, chief complaint, number of prior hospital admissions, and comorbidities. RESULTS 884,228 patients who visited the ED 2,252,656 times were included in the analysis. The estimated HR (95% confidence interval) for death within 30-days was 1.00 (0.97-1.03) in crowding category 75%-95% and 1.08 (1.03-1.14) in the 95%-100% category. CONCLUSIONS In a large cohort study including 7 EDs in Stockholm Region, Sweden we identified a significant association between high levels of ED crowding and increased 30-day mortality.
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Affiliation(s)
- Björn af Ugglas
- Theme of Emergency and Reparative MedicineKarolinska University HospitalStockholmSweden
- Department of MedicineSolnaKarolinska InstitutetStockholmSweden
| | - Therese Djärv
- Theme of Emergency and Reparative MedicineKarolinska University HospitalStockholmSweden
- Department of MedicineSolnaKarolinska InstitutetStockholmSweden
| | - Petter L.S. Ljungman
- Department of CardiologyDanderyd HospitalStockholmSweden
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Martin J. Holzmann
- Theme of Emergency and Reparative MedicineKarolinska University HospitalStockholmSweden
- Department of MedicineSolnaKarolinska InstitutetStockholmSweden
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Andersson J, Nordgren L, Cheng I, Nilsson U, Kurland L. Long emergency department length of stay: A concept analysis. Int Emerg Nurs 2020; 53:100930. [PMID: 33035877 DOI: 10.1016/j.ienj.2020.100930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency Department (ED) Length of stay (LOS) has been associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. The cut-offs defining long EDLOS varies across settings and seem to be arbitrarily chosen. This study aimed to clarify the meaning of long EDLOS. METHODS A concept analysis using the Walker and Avant approach was conducted. It included a literature search aiming to identify all uses of the concept, resulting in a set of defining attributes and a way of measuring the concept empirically. RESULTS Long EDLOS was primarily used as proxy for other phenomena, e.g. boarding or crowding. The definitions had cut-offs ranging between 4 and 48 h. The attributes defining long EDLOS was waiting, a crowded ED environment and an inefficient organization. DISCUSSION Time targets are probably more suitable when directed towards and tailored for specific sub-groups of the ED population.
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Affiliation(s)
- Jonas Andersson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Centre for Clinical Research Sörmland/Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden.
| | - Lena Nordgren
- Centre for Clinical Research Sörmland/Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ivy Cheng
- School of Medical Sciences, Örebro University, Örebro, Sweden; University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
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Babatabar-Darzi H, Jafari-Iraqi I, Mahmoudi H, Ebadi A. Overcrowding Management and Patient Safety: An Application of the Stabilization Model. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:382-386. [PMID: 33344208 PMCID: PMC7737840 DOI: 10.4103/ijnmr.ijnmr_254_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 01/10/2023]
Abstract
Background: Emergency department is among the most crowded hospital units. The function of this department considerably affects the functions of other hospital units as well as patient satisfaction. The Stabilization Model is a strategy with potential effectiveness in managing overcrowding in emergency department. This study aimed to determine the effects of overcrowding management based on the stabilization model on patient safety in emergency department. Materials and Methods: This pretest-posttest quasi-experimental was conducted in 2015 in the emergency department of a teaching hospital located in Tehran, Iran. Primarily, the perceived safety of 35 patients was assessed using the Patient Safety Assessment Questionnaire. Then, an overcrowding management intervention was implemented based on the stabilization model. Finally, the perceived safety of 35 newly recruited patients was assessed after the intervention. The SPSS software (v. 16.0) was employed for data analysis through the Chi-square, the Kolmogorov-Smirnov, and the independent-sample t tests. Results: The mean (SD) score of patient safety was 27.45 (8.43) in the control group and 34.45 (4.04) in the intervention group and the between-group difference was statistically significant (t34 = 50.37, p < 0.001). The rate of patient safety increased from 65% at baseline to 82% after the intervention. Conclusions: Overcrowding management based on the stabilization model can significantly enhance patients' perceived safety. Therefore, this strategy can be used to ease emergency department overcrowding and enhance patient safety and care quality.
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Affiliation(s)
- Hosein Babatabar-Darzi
- Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Iman Jafari-Iraqi
- Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hosein Mahmoudi
- Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Jacobsson A, Kurland L, Höglund E. Direct in-hospital admission via ambulance (DIVA): A retrospective observational study. Int Emerg Nurs 2020; 52:100906. [PMID: 32827937 DOI: 10.1016/j.ienj.2020.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prolonged stays in emergency departments increase the risk of adverse events in elderly patients. To optimize care for nonurgent patients who need in-hospital admission, a patient-focused improvement project named Direct In-hospital admission Via Ambulance (DIVA) was launched at Örebro University Hospital. PURPOSE This study describes the effects of DIVA. The primary outcome was time to in-hospital admission. Secondary outcomes were the in-hospital admission rate, the in-hospital length of stay and patient characteristics. METHOD This was a retrospective observational study. Descriptive and comparative statistics were used. All patients identified by the ambulance nurse as nonurgent but with an apparent need for in-hospital admission were candidates for direct in-hospital admission. The results were compared with those of a reference group. RESULT In total, 127 patients were included, with 45 patients in the DIVA group and 82 patients in the reference group. In the DIVA group, 24 patients were directly admitted. The median time to in-hospital admisson was 49.5 min for direct admitted patients and 278.5 min for the reference group. There was a statistical significant difference between the groups (p < 0.01). CONCLUSION The current study indicates that time to in-hospital admission could be reduced by DIVA.
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Affiliation(s)
- Andreas Jacobsson
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden.
| | - Lisa Kurland
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
| | - Erik Höglund
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
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Han JH, Roh YS. Teamwork, psychological safety, and patient safety competency among emergency nurses. Int Emerg Nurs 2020; 51:100892. [PMID: 32659674 DOI: 10.1016/j.ienj.2020.100892] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/04/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The patient safety competency of emergency nurses is critical because the emergency department is a complex and dynamic setting in which patient safety incidents are likely to occur owing to difficulties in controlling and predicting situations. PURPOSE This study aimed to identify factors that predict the patient safety competency of emergency nurses. METHODS A descriptive correlational study using cross-sectional survey methodology was conducted with a convenience sample of 200 emergency nurses. Teamwork, psychological safety, and patient safety competency were measured using a self-administered questionnaire. Data were analyzed using descriptive statistics, Pearson's correlation, and stepwise multiple regression. RESULTS Multiple regression analysis revealed that situation monitoring, reporting of patient safety adverse events, number of night shifts per month, and psychological safety were significant factors affecting patient safety competency, accounting for 27.1% of the variance. CONCLUSIONS A training program targeting emergency nurses with vulnerable factors is needed to improve their patient safety competency. As situation monitoring and psychological safety were found to be influential factors for patient safety competency, multi-level intervention is needed to improve nurses' situation monitoring ability and psychological safety.
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Affiliation(s)
- Jee Hye Han
- Graduate School of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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Rabelo SK, Lima SBSD, Santos JLGD, Costa VZD, Reisdorfer E, Santos TMD, Gracioli JC. Nurses' work process in an emergency hospital service. Rev Bras Enferm 2020; 73:e20180923. [PMID: 32638926 DOI: 10.1590/0034-7167-2018-0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 12/19/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the nurses' work process in an Emergency Hospital Service. METHODS a qualitative, exploratory and descriptive research conducted with 17 nurses from the emergency service of a high complexity hospital in southern Brazil. Data were collected through interviews, focus group and document analysis. Data analysis followed the thematic content analysis framework. RESULTS four categories emerged: Work environment characteristics; Assistance dimension; Management dimension; Care management. Final Considerations: the nurses' work process in Emergency Hospital Service is characterized by the peculiarities of the setting, with centrality in care and care management aiming at quality care and safety to patients.
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Leonard-Roberts V, Currey J, Considine J. Emergency nurses' perceptions of their role in responding to escalations of care for clinical deterioration. Australas Emerg Care 2020; 23:233-239. [PMID: 32561394 DOI: 10.1016/j.auec.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge' perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients. METHODS A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis. RESULTS Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management. CONCLUSIONS Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.
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Affiliation(s)
- Vanessa Leonard-Roberts
- Goulburn Valley Health, Shepparton, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
| | - Judy Currey
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Julie Considine
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Australia
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Frank C, Elmqvist C. Staff strategies for dealing with care situations at an emergency department. Scand J Caring Sci 2019; 34:1038-1044. [PMID: 31865626 DOI: 10.1111/scs.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/28/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff's strategies of dealing with this caring situation is limited. AIM The aim of the present study was thus to describe staffs' strategies to deal with the caring situations at an emergency department. METHOD Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. FINDINGS The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach. CONCLUSION In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it. IMPLICATION The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.
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Affiliation(s)
- Catharina Frank
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Wang PY, Fang PH, Wu CL, Hsu HC, Lin CH. Workplace Violence in Asian Emergency Medical Services: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203936. [PMID: 31623179 PMCID: PMC6843119 DOI: 10.3390/ijerph16203936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 01/01/2023]
Abstract
Workplace violence among Asian emergency medical services (EMS) has rarely been examined. A cross-sectional, mainly descriptive study using a standardized, paper-based, self-reported questionnaire survey was conducted between August and October 2018 among emergency medical technicians (EMTs) in the Tainan City Fire Bureau, Taiwan. A total of 152 EMT-paramedics responded to the questionnaire survey, constituting an overall response rate of 96.2%. The participants were predominantly male (96.1%), college-educated (4-year bachelor’s degree) (49.3%), and middle-aged (35–44 years old) (63.8%). Among them, 113 (74.3%) and 75 (49.3%) participants had experienced verbal and physical assaults at work, respectively. Only 12 (7.9%) participants were familiar with relevant regulations or codes. The assaults predominantly occurred during evening shifts (16:00–24:00) and at the scene of the emergency. The most predominant violence perpetrators included patients, patients’ families, or patients’ friends. Nearly 10% of participants had experienced verbal assaults from hospital personnel. EMTs who encountered workplace violence rarely completed a paper report, filed for a lawsuit, or sought a psychiatric consultation. Fifty-eight (38.2%) and 16 (10.5%) participants were victims of frequent (at least once every 3 months) verbal and physical forms of violence, respectively; however, no statistically significant association was observed in terms of EMT gender, age, working years, education level, or the number of EMS deployments per month. The prevalence of workplace violence among Asian EMS is considerable and is comparable to that in Western countries. Strategies to prevent workplace violence should be tailored to local practice and effectively implemented.
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Affiliation(s)
- Pei-Yu Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Chen-Long Wu
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Hsiang-Chin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
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Bae KS, Roh YS. Training needs analysis of Korean nurses' neurological assessment competency. Nurs Health Sci 2019; 22:99-107. [PMID: 31609541 DOI: 10.1111/nhs.12654] [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: 05/20/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022]
Abstract
Despite the importance of neurological assessment, there is a lack of research directed at nurses' competency in performing these assessments. We aimed to identify nurses' competency levels in performing neurological assessments and prioritize their related training needs using importance-performance analysis. This survey research was conducted and reported based on the enhancing the quality and transparency of health research (EQUATOR) guidelines. A total of 213 nurses participated in a descriptive, cross-sectional survey study. Exploratory factor analysis identified seven factors that together accounted for 70.34% of the variance: cerebral function, signs and symptoms, pathologic reflexes, motor strength, assessment of an unconscious patient, reporting and documentation, and neurological assessment scales. [Correction added on 10 February 2020, after first online publication: the value of the variance has been corrected from '7.34%' to '70.34%' in the preceding sentence.] There were significant gaps between importance and performance for all seven factors. The importance-performance matrix identified the neurological assessment scales factor as a high priority for continuing education. Emergency department nurses reported lower neurological assessment competency when compared with ward and intensive care unit nurses. The analysis of training needs is beneficial for developing programs to enhance neurological assessment competency. Training in neurological assessment scales is a priority for nurses, and they prefer simulation- and practicum-based methods.
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Affiliation(s)
- Ki Sook Bae
- Department of Nursing, Graduate School, Chung-Ang University, Seoul, Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Berg LM, Ehrenberg A, Florin J, Östergren J, Discacciati A, Göransson KE. Associations Between Crowding and Ten-Day Mortality Among Patients Allocated Lower Triage Acuity Levels Without Need of Acute Hospital Care on Departure From the Emergency Department. Ann Emerg Med 2019; 74:345-356. [DOI: 10.1016/j.annemergmed.2019.04.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/16/2019] [Accepted: 04/11/2019] [Indexed: 11/28/2022]
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