Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study

Abstract

BackgroundStudies on hospital violence have emphasized the importance of staff- service recipient interaction in leading to violent incidents. These incidents are the extreme result of service recipients’ frustration and anger in their interaction with staff.The aim of this study was to analyze factors related to negative experiences of emergency department (ED) patients and accompanying persons in Israeli hospitals.MethodsStructured interviews with 692 participants in seven major general Israeli hospitals: 322 patients and 370 accompanying persons.ResultsNegative feelings while in the ED were reported by 23.6% of patients and 20.5% of accompanying persons. Eight aggregate variables relating to staff-patients/accompanying persons interaction were identified: 1. General attitudes of staff and quality of ED experience; 2. Staff attitudes towards patients; 3. Staff attitudes towards accompanying persons; 4. Waiting; 5. Quality of perceived medical care; 6. Information provided to patients and accompanying persons; 7. Information provided to patients, as reported by accompanying persons; and 8. Severity of medical problem. Among patients, the only significant aggregate variable related to anger and frustration was perceived quality of care. Among accompanying persons, the three significant contributors to negative feelings were: 1. Staff’s general attitudes; 2. Attitudes towards patients; and 3. Severity of patients’ medical problem. Analysis of specific items within the variables revealed that, whereas patients’ negative feelings were related to nurses’ perceived negative attitudes those of accompanying persons were related to the doctors’ perceived negative attitudes. In addition, patients’ negative feelings were related to low severity of medical problem, whereas accompanying persons’ negative feelings were related to patients’ low severity of pain.ConclusionsThe study reveals the importance of including both patients and accompanying persons in the analysis of staff-service recipient interactions in EDs. The results are discussed in terms of patients’ and accompanying persons’ different perspectives. Three practical implications of the results are put forward, aiming at reducing patients/accompanying persons-staff frictions in the EDs, thus decreasing the potential of violent outbursts against ED staff: (1) implementing a framework based on “patient-centeredness” for the restoration of patient’s sense of agency and empowerment; (2) broadening the scope of laws concerning patient’s rights to include their families and other accompanying persons; and (3) implementing courses on interpersonal and human service skills, as well as teaching skills of handling emotional stressors experienced by both the staff and service recipients.

A case study of the patient wait experience in an emergency department with therapy dogs

“…There has been emerging attention to the patient experience in healthcare research in Canada, the United States and elsewhere over the past decade or so. 21,31,81 For example, in 2011 the Canadian Institutes of Health Research, a major health research funding body, developed a national strategy for patient-oriented research, including the goal of "enhancing patients' health care experience". 82,p.iii The Beryl Institute defines the patient experience as "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions, across the continuum of care".…”

“…29 Patient and family dissatisfaction with wait times is likewise a primary cause of assault on ED nurses and other personnel. 30,31 In other words, long wait times negatively influence how patients feel during their ED experience.…”

“…Prolonged ED wait times are commonly associated with negative emotions and feelings among patients. 31 Emotions are physiological states that result from an intense experience, whereas feelings are subjective reactions to emotions. That is, a "feeling is a mental portrayal of what is going on in your body when you have an emotion and is the byproduct of your brain perceiving and assigning meaning to the emotion".…”

“…Contributors include uncertain diagnoses, overcrowding and long wait times. 31 A recent study of Israeli emergency departments concluded that one in four patients expressed negative feelings, including those associated with a long wait time. 31 A systematic review of qualitative literature concluded that patient experience in the ED is impacted primarily by the emotional needs of patients.…”

“…31 A recent study of Israeli emergency departments concluded that one in four patients expressed negative feelings, including those associated with a long wait time. 31 A systematic review of qualitative literature concluded that patient experience in the ED is impacted primarily by the emotional needs of patients. 24 Negative feelings, particularly anxiety and stress, can also be intensified when patients encounter uncertainty regarding their pain, 42 which is the primary reason individuals attend a hospital ED in Canada.…”