Background: It has been suggested that emergency care providers' decision-making competence should be strengthened regarding whether or not to transport the patient. This qualitative study describes challenges related to non-conveyance situations from emergency care providers' perspective. Methods: Data were collected by a questionnaire from emergency care providers of a hospital district in Finland in 2014. Responses to open questions were analyzed using inductive content analysis to examine the difficulty of non-conveyance decisions, reasons for non-conveyance and challenges related to the non-conveyance decision after immediate care. Results: The majority (70%) of care providers did not experienced difficulty in making non-conveyance decisions, although those working in basic emergence care found decision-making slightly more challenging than workers in advanced emergency care. Care providers' reasons for not transporting patients were most commonly connected with their assessment of care needs and the conclusion that no hospital care was required. Other reasons involved treating the patient on site, psychosocial reasons and not seeing the patient as an emergency care client. Difficulty of reaching mutual understanding with patients was considered the greatest challenge. Other challenges included worrying about the patient's coping at home and problems in inter-professional co-operation, related to hurry and the concern that doctors did not always document requests for care instructions. Conclusions: The results suggest that care providers' skills in assessing care needs and making decisions based on assessments are a decisive factor in non-conveyance situations. Reaching a mutual understanding with the patient is the greatest challenge.
Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training.
Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.
Introduction: More research is required on care quality and patient safety, especially from the care provider perspective. Aims and objectives: The study describes factors that affect the quality of emergency care as experienced by nurses, paramedics, hospital and ambulance attendants and practical nurses in out-of-hospital emergency medical services. Methods: Data were collected in October 2013 by semi-structured interviews (n = 15) in Finland and analysed using inductive content analysis.Results: High quality emergency care is patient-centred, equal, professional, individualized and holistic. It encompasses the following areas: prompt emergency care on site; prevention of patient deterioration; individualized holistic care; arranging safe follow-up care; supporting the coping of patients and families and; securing the safety of patients and staff on site and in ambulance. The care quality care is affected by professionals' theoretical and practical competence and personal qualities, by the availability of equipment, co-operation, contextual factors, personnel policy and by the outcome of consultation with a doctor. Conclusions: Emergency care staff will be expected to provide increasingly extensive, holistic care on site. All stages of the care pathway should be evaluated and comparative international studies conducted to detect development needs. Relevance to clinical practice: Consistent practices and instructions are indicated. Management needs to promote staff coping and motivation by means of education, focusing on the care of older patients and clients affected by multiple diseases, and on psychosocial and social problems of people affected by alcoholism or social exclusion.
Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.
BackgroundNot much is known about emergency care delivered in patients’ homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff’s experiences of encountering and counseling patients and their family members.MethodsA descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N = 125, N = 142 reponse rate 59%, response rate 53%) and analyzed using descriptive statistics.ResultsRespondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging.ConclusionsHigh-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient’s and family’s situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.
Nurses' role and competence are crucial in supporting the coping of patients and families.
Background: Workers' clinical skills at out-of-hospital emergency care greatly affect patient safety and care quality. The objectives of the study was to examine emergency care workers' self-perception of their clinical skills in out-of-hospital emergency care to produce new knowledge that can be used to develop basic and continuing education programmes.
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