Mari Helena Salminen-Tuomaala, Päivi Leikkola, Riitta Mikkola, Eija Paavilainen

Abstract

IntroductionEmergency medical services and out-of-hospital care are important areas in health services, providing urgent care for acutely ill patients and supporting their family members on site. In previous studies, the quality of emergency care has been mainly approached from the patient perspective [1][2][3][4][5] and some studies have discussed the counselling provided for family members of acutely ill patients in emergency departments as an important contributor to quality [6][7][8]. The perspective of care providers working in out-of hospital care, however, has not been studied much, so this paper will contribute to filling this research gap by a qualitative approach based on semistructured interviews.The purpose of this study is to describe emergency care providers' experiences of factors that affect counselling and support for family members in out-of-hospital emergency medical care. The study aims at producing new research knowledge that can be used to develop the counselling and support for family members in out-of-hospital emergency medical care. This study is a part of larger project on the quality and safety of emergency medical services in one hospital district serving 200, 000 inhabitants in Finland. Counselling is defined as goaloriented, research and evidence-based support and advice, whose purpose is to enhance the coping of patients and their family members during follow-up care at home [9,10].Earlier studies have primarily focused on family counselling interventions for chronic illness [11][12][13][14]. Three general goals that familyfocused interventions have been found to involve are: helping families cope with the challenges of chronic illness management, mobilizing family support and reducing intrafamilial suffering [15]. A number of studies have also discussed the usefulness of family interventions that examine the influence of each family member's illness experiences on other family members [16][17][18]. Besides the usefulness of the family interventions, their effectiveness in the treatment of physical illness has been examined in 2 integrative reviews [19,20]. Support was found for the effectiveness of interventions directed to the family rather than just the individual diagnosed with the illness.Support from care providers has been found to be a significant contributor the coping of patient and families [21,22]. However, a study revealed that family members received very little support in how to become involved in the patient's care [23]. Counselling and support are required to strengthen the family's resources, so that they can trust their ability to care for patients at home [24]. This is especially important in acute home care situations, which do not require hospitalization.According to some previous studies, the most important needs in family members of patients experiencing a critical illness involve assurance, information, communication, proximity, support and comfort [25][26][27]. Good communication between care providers and families can reduce the family members' experience...