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de Lange S, Heyns T, Filmalter C. A concept analysis of person-centred handover practices: The meaning in emergency departments. Int Emerg Nurs 2024; 74:101446. [PMID: 38677057 DOI: 10.1016/j.ienj.2024.101446] [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: 07/29/2023] [Revised: 02/22/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Transfer of patients from the prehospital to the in-hospital environment is a frequent occurrence requiring a handover process. Habitually, emergency care practitioners and healthcare professionals focus on patient care activities, not prioritising person-centred handover practices and not initiating person-centred care. AIM The aim of this concept analysis was to define the concept person centred handover practices. METHODS The eight steps for Walker and Avant's method of concept analysis. RESULTS Thirty-one articles were included for final review including qualitative and quantitative studies, literature reviews and audits. This concept analysis guided the development of an concept definition of person-centred handover practices between emergency care practitioners and healthcare professionals in the emergency department as person- centred handover practices are those handovers being performed while including all identified defining attributes such as structure, verbal, and written information transfer, interprofessional process, inclusion of the patient and/ or family, occurs at the bedside, without interruption. CONCLUSIONS Results suggested that person-centred handover practices involve verbal and non- verbal interprofessional communication within a specific location in the emergency department. It requires mutual respect from all professionals involved, experience and training, and the participation of the patient and / or family to improve patient outcomes and quality patient care. A definition for the concept may encourage the implementation of person-centred handover practices in emergency departments.
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Affiliation(s)
- Santel de Lange
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Celia Filmalter
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Serrano-Guerrero J, Bani-Doumi M, Chiclana F, Romero FP, Olivas JA. How satisfied are patients with nursing care and why? A comprehensive study based on social media and opinion mining. Inform Health Soc Care 2024; 49:14-27. [PMID: 38178275 DOI: 10.1080/17538157.2023.2297307] [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: 01/06/2024]
Abstract
To assess the overall experience of a patient in a hospital, many factors must be analyzed; nonetheless, one of the key aspects is the performance of nurses as they closely interact with patients on many occasions. Nurses carry out many tasks that could be assessed to understand the patient's satisfaction and consequently, the effectiveness of the offered services. To assess their performance, traditionally, expensive, and time-consuming methods such as questionnaires and interviews have been used; nevertheless, the development of social networks has allowed the patients to convey their opinions in a free and public manner. For that reason, in this study, a comprehensive analysis has been performed based on patients' opinions collected from a feedback platform for health and care services, to discover the topics about nurses the patients are more interested in. To do so, a topic modeling technique has been proposed. After this, sentiment analysis has been applied to classify the topics as satisfactory or unsatisfactory. Finally, the results have been compared with what the patients think about doctors. The results highlight what topics are most relevant to assess the patient satisfaction and to what extent. The results remark that the opinion about nurses is, in general, more positive than about doctors.
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Affiliation(s)
- Jesus Serrano-Guerrero
- Department of Information Technologies and Systems, University of Castilla-La Mancha, Escuela Superior de Informatica, Ciudad Real, Spain
| | - Mohammad Bani-Doumi
- Department of Information Technologies and Systems, University of Castilla-La Mancha, Escuela Superior de Informatica, Ciudad Real, Spain
| | - Francisco Chiclana
- School of Computer Science and Informatics, De Montfort University, Institute of Artificial Intelligence, Leicester, UK
| | - Francisco P Romero
- Department of Information Technologies and Systems, University of Castilla-La Mancha, Escuela Superior de Informatica, Ciudad Real, Spain
| | - Jose A Olivas
- Department of Information Technologies and Systems, University of Castilla-La Mancha, Escuela Superior de Informatica, Ciudad Real, Spain
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Niyonsaba M, Nkeshimana M, Uwitonze JM, Davies J, Maine R, Nyinawankusi JD, Hunt M, Rickard R, Jayaraman S, Watt MH. Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda. Afr J Emerg Med 2023; 13:250-257. [PMID: 37767314 PMCID: PMC10520315 DOI: 10.1016/j.afjem.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants' perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.
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Affiliation(s)
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), Rwanda
| | | | - Justine Davies
- University of Birmingham, Institute of Applied Health Research, United Kingdom
- Stellenbosch University, Centre for Global Surgery, Department of Global Health, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, South Africa
| | - Rebecca Maine
- University of Washington, Department of Surgery, United States
| | | | - McKenna Hunt
- University of Utah, Honors College, United States
| | - Rob Rickard
- Rwanda Build Program, Common World Inc., Rwanda
| | | | - Melissa H. Watt
- University of Utah, Department of Population Health Sciences, United States
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Müller F, Schröder D, Schäning J, Schmid S, Noack EM. Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany. BMC Pediatr 2023; 23:312. [PMID: 37344777 DOI: 10.1186/s12887-023-04121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers. METHODS We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS). RESULTS Data from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results. CONCLUSION Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies. TRIAL REGISTRATION This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany.
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Jennifer Schäning
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Sybille Schmid
- Fire Department, City of Braunschweig, Brunswick, DE, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
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Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients. Pediatr Qual Saf 2022; 8:e624. [PMID: 36601629 PMCID: PMC9799169 DOI: 10.1097/pq9.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Accurate inpatient placement at the level of care needed for incoming transported patients can present challenges that may result in a rapid escalation in care following admission to the general inpatient unit. The Pediatric Early Warning System (PEWS) score is useful for early recognition of clinical deterioration. Therefore, we aimed to reduce rapid escalations in care for incoming transported patients via the implementation of an escalation algorithm with a goal of 80% PEWS score completion rate during transport within 6 months. Methods We created an escalation algorithm utilizing PEWS scores and direct lines of communication between emergency medical technicians and receiving physicians. Audit and feedback increased the adoption of the process. We defined rapid escalations as transfer to a higher level of care within 6 hours of admission. Results PEWS score completion increased from a mean of 48% to 70%. This result varied by emergency medical technician crew level of care. Eleven percent (n = 114) of PEWS scores required physician notification, 20% (n = 23) of which resulted in interventions en route. There were no differences in rapid escalation rates over time, but it remained low at <2% of all incoming transported patients. Some crew members report improved communication with hospital providers and feel more empowered to speak up when a patient's assessment is not as expected following algorithm implementation. Conclusions This project improved PEWS score completion and maintained a low rate of rapid escalations of care among incoming transfers.
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