A Grounded Theory Qualitative Analysis of Interprofessional Providers' Perceptions on Caring for Critically Ill Infants and Children in Pediatric and General Emergency Departments

Gangadharan, Sandeep; Tiyyagura, Gunjan; Gawel, Marcie; Walsh, Barbara; Brown, Linda; Lavoie, Megan; Tay, Khoon‐Yen; Auerbach, Marc

doi:10.1097/pec.0000000000000906

Cited by 19 publications

(24 citation statements)

References 25 publications

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“…A prior publication focused on comparing differences in the care pediatric patients receive between pediatric only and pediatric/adult mixed EDs. This article noted that care can be quite heterogeneous with respect to adherence to clinical guidelines, in comfort with pediatric‐specific equipment and medication dosing, in approaches and the composition of care teams and in the active use of cognitive aids and algorithms during acute care . This work and that of others outline both advantages and potential limitations to pediatric acute care between settings …”

Section: Discussionmentioning

confidence: 97%

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

Goldman

Wong

Bhatnagar

et al. 2018

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 97%

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

Goldman

Wong

Bhatnagar

et al. 2018

Academic Emergency Medicine

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“…A recent study by Gangadharan et al . used qualitative methodology to identify GED provider comfort with algorithm‐based care, reliance on cognitive aids, and discomfort with pediatric‐specific equipment and medications.…”

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confidence: 99%

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

Query

Olson

Meyer

et al. 2018

Academic Emergency Medicine

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Background: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice.Methods: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis. Results:We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes.Conclusions: General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.E ach year in the United States, approximately 35 million children are evaluated in an emergency department (ED). Secondary to hospital distribution and geographic limitations, 1 the large majority (95%) of these children are seen in a general emergency department (GED), 2 as opposed to a dedicated

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“…While combining the strategies of debriefing with the use of video vignettes intended to address implicit bias is unique to this educational endeavor, the use of guided debriefing is not unique. Having an instructor guide available to nursing faculty as a strategy to guide discussions after clinical simulations improves student engagement and learning (Gangadharan et al, 2018; Sawyer et al, 2016).…”

Section: Educational Strategiesmentioning

confidence: 99%

Faculty Perceptions of Engaging Students in Active Learning to Address Implicit Bias Using Videos Exemplifying the Prenatal Visit of a Lesbian Couple

et al. 2019

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Introduction: Implicit bias affects patient–nurse interactions and care management decisions. The purpose of this educational project was to explore faculty perceptions of engaging students in active learning to address implicit bias using videos vignettes. Method: Three videos were created with a corresponding instructor guide. The vignettes depicted insensitive behaviors, best practice clinical interactions, and a reflection about bias in health care. Faculty who implemented the active learning strategy were invited to complete an online, confidential survey regarding their perceptions. Results: Most faculty (83%) agreed that students benefit from discussing implicit bias using an active learning approach. All faculty ( N = 12) believed the videos and instructor guide to be effective tools in creating meaningful discussion. Discussion: Video vignettes illustrating insensitive behaviors and demonstrating best practice enable faculty to actively engage students in addressing the impact of implicit bias. Educational strategies intended to ensure equitable care are indicated to support positive patient outcomes.

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A Grounded Theory Qualitative Analysis of Interprofessional Providers' Perceptions on Caring for Critically Ill Infants and Children in Pediatric and General Emergency Departments

Abstract: Our qualitative analysis produced several themes that help us to understand providers' perceptions in caring for critically ill children in GEDs and PEDs. These data could guide the development of targeted educational and improvement interventions.

Cited by 19 publications

References 25 publications

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

Faculty Perceptions of Engaging Students in Active Learning to Address Implicit Bias Using Videos Exemplifying the Prenatal Visit of a Lesbian Couple

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