Emergency department waiting room nurses in practice: An observational study

Characterizing Spanish-speaking patients' patient-centered care experiences in the emergency department

BACKGROUND

Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care.

METHODS

We conducted a single-center qualitative study using semistructured interviews with adult, Spanish-speaking patients who had been discharged home from the ED. Interviews were conducted using an interview guide, recorded, transcribed, and analyzed iteratively in Spanish using inductive and deductive thematic analysis.

RESULTS

We conducted 19 interviews with participants from 24 to 72 years old. Participants were born in seven different Spanish-speaking countries. Participants identified three domains of PCC: patient, medical team's skills, and system. Several of the identified themes such as shared decision making, open communication, compassionate care, and coordination of follow-up care are often incorporated into PCC definitions. However, other themes, including uncertainty leading to fear, use of professional interpreters to promote understanding, receiving equitable care, technical proficiency, and efficiency of care expand upon existing domains in PCC definitions.

CONCLUSIONS

We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.

Predicting Workplace Violence in the Emergency Department Based on Electronic Health Record Data

INTRODUCTION

Emergency departments are extremely vulnerable to workplace violence, and emergency nurses are frequently exposed to workplace violence. We developed workplace violence prediction models using machine learning methods based on data from electronic health records.

METHODS

This study was conducted using electronic health record data collected between January 1, 2016 and December 31, 2021. Workplace violence cases were identified based on violence-related mentions in nursing records. Workplace violence was predicted using various factors related to emergency department visit and stay.

RESULTS

The dataset included 1215 workplace violence cases and 6044 nonviolence cases. Random Forest showed the best performance among the algorithms adopted in this study. Workplace violence was predicted with higher accuracy when both ED visit and ED stay factors were used as predictors (0.90, 95% confidence interval 0.898-0.912) than when only ED visit factors were used. When both ED visit and ED stay factors were included for prediction, the strongest predictor of risk of WPV was patient dissatisfaction, followed by high average daily length of stay, high daily number of patients, and symptoms of psychiatric disorders.

DISCUSSION

This study showed that workplace violence could be predicted with previous data regarding ED visits and stays documented in electronic health records. Timely prediction and mitigation of workplace violence could improve the safety of emergency nurses and the quality of nursing care. To prevent workplace violence, emergency nurses must recognize and continuously observe the risk factors for workplace violence from admission to discharge.

Emotions and lung cancer screening: Prioritising a humanistic approach to care

Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.

Patient-centered care in the emergency department: a systematic review and meta-ethnographic synthesis

BACKGROUND

Patient-centered care (PCC) is an emerging priority in many healthcare settings but lacks clarity in the emergency department (ED). It is of interest to know what PCC practices are most important to patients to better their experience. The objective of this study was to conduct a mixed-methods systematic review of PCC in the ED.

METHODS

We used stakeholder and patient engagement to consult with clinicians, subject-matter experts, patient partners, and community organizations to determine patient needs. We examined all articles in the ED context with PCC as the intervention. Two independent reviewers screened 3136 articles and 13 were included. A meta-ethnographic analysis was conducted to determine common themes of PCC.

RESULTS

Themes included emotional support, communication, education, involvement of patient/family in information sharing and decision making, comfort of environment, respect and trust, continuity, and transition of care. Challenges in the ED reflected a lack of PCC. Moreover, implementation of PCC had many benefits including higher patient satisfaction with their care. Though there were commonalities of PCC components, there was no consistently used definition for PCC in the ED.

CONCLUSION

The findings of this review support the evidence that PCC is of high value to the ED setting and should be standardized in practice.

A scoping review of barriers, facilitators and tools to escalation of care processes in the emergency department

INTRODUCTION

Escalation of care is the timely recognition and communication of deterioration in a previously stable patient. Delays in escalating care may lead to unnecessary patient morbidity and mortality. There is currently a paucity of synthesis of work focused on the initiation of escalation of care in the emergency department (ED), where unique challenges may be present. We sought to complete a scoping review to investigate: (1) factors (barriers and/or facilitators) affecting clinicians in escalating care in the ED; and (2) tools that support clinicians in ED escalation of care processes.

METHODS

We conducted a scoping review guided by the Arksey & O'Malley framework, and in accordance with PRISMA Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in MEDLINE, EMBASE and CINAHL on November 30th, 2020. Extracted data was analyzed via qualitative content analysis. Review and data abstraction were completed by two independent reviewers. Discrepancies were resolved via consensus meetings with a third reviewer.

RESULTS

Of the 4527 unique records identified, 13 studies met our inclusion criteria. Studies described standard escalation practices including detection, reporting, and response. Factors influencing escalation of care were described on individual (confidence, comfort, and expertise), interpersonal (communication and the nurse-physician relationship), organizational (workload and staffing), and environmental (distractions and layout) levels. Four ED-specific tools for escalation of care were also identified.

CONCLUSION

This scoping review identified 13 studies that contained information on processes, factors influencing and/or tools used to facilitate escalation of care in the ED. They may serve as valuable starting points for ED clinicians and administrators who are building or reforming local escalation of care processes.

Exploration and model development for emergency department waiting room nurse role: Synthesis of a three-phase sequential mixed methods study

BACKGROUND

To improve flow and care in waiting rooms, some emergency departments introduced a specific nursing role to care for this patient cohort with the aim of commencing interventions early, improving patient safety by reassessing and enhancing communication. The objective of the research was to explore to what extent does qualitative interviews and quantitative survey contribute to describing emergency department waiting room nurses, through integration and synthesis of findings from a multiphase mixed methods study.

METHODS

Multiphase mixed methods exploratory sequential design with integration of findings. Data integration occurred during the phases and when assimilating all findings.

FINDINGS

Experienced emergency nurses, preferably with graduate qualifications, who are autonomous practitioners with highly developed communication skills, clinical decision making and proficiency in assessment and monitoring are required to perform the role. The waiting room nurse provides patient-centered care and ensures safe, timely care is delivered to those in the waiting room. A standardised approach and high risk of exposure to occupational stressors need to be considered.

CONCLUSIONS

This mixed methods sequential design explored the waiting room nurse role from the perspective of emergency nurses generating new knowledge into the role. This advanced practice nursing role contributes to patient safety and delivery of patient centred care in the emergency department waiting room.

The influence of engaging authentically on nurse-patient relationships: A scoping review

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Mental Health Nursing: waiting room intervention in integral health care

OBJECTIVE

To describe and to analyze the proposal for intervention in the waiting room as a possibility for Nursing in mental health in group context.

METHOD

Descriptive study with a qualitative approach, convergent care type, developed in a Psychosocial Care Center for Alcohol and Drugs in the interior of the state of Goiás.

RESULTS

The service in the waiting room provided moments of reflection, knowledge, learning, listening and exchanging experiences. Final considerations: The meetings in the waiting room favored the articulation between theoretical knowledge and the practice of nursing care in groups, constituting a space with a valuable locus for the development of educational and support actions in health services, to be undertaken by the nurse and, also, by other professionals of the health team.

Accountability issues in an English emergency department: A nursing perspective

INTRODUCTION

Nurses confront doubts about their accountability and how it affects their clinical practice daily in the complex environment of an emergency department. Therefore, nurses' experiences can provide vital information about the decisions and dilemmas in clinical practice that affect both healthcare professionals and patients alike.

AIM

The aim of this study was to explore the perceptions of nursing staff in an English emergency department in relation to their ethical, legal and professional accountability.

METHODS

Ethnographic content analysis was used to analyse 34 semi-structured interviews from registered nurses working in an emergency department.

RESULTS

There were five categories found during the coding process: nursing care, staff interactions, legal and professional accountability, decision-making process and ethics and values.

CONCLUSION

Several issues related to nursing accountability were found, including the effects of nursing shortages and the reasoning behind multidiscipinary team conflicts. Different approaches of individual and institutional accountability, the evolution of Benner's nursing model and nursing value progression was also identified as key issues. All these phenomena affect nursing accountability in different ways, so their comprehension is paramount to understand and influence them to benefit both patients and nurses.

A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions

BACKGROUND

In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role.

AIM

To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions.

METHODS

Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively.

RESULTS

Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported.

CONCLUSIONS

The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.