三级甲等医院急诊护士工作沉浸体验的现象学研究

目的探索三级甲等综合性医院急诊科护士的工作沉浸体验,形成三级甲等综合性医院急诊科护士工作沉浸体验的诠释性描述。方法运用质性研究的现象学研究方法,在自然情景下对12名三级甲等综合性医院急诊科护士进行半结构式深度访谈,采用Giorgi分析方法分析收集的资料。结果急诊科护士工作沉浸体验的5个主题：专注于当前的工作任务忘却自我;自己能控制工作任务并有清晰的目标;行动与意识的融合,了解工作的进程;时间感的改变;体验能激发自身的工作动力。结论激励急诊科护士工作的是一种责任,包括对家庭的责任和工作责任感;急诊科护士的工作需要得到领导、同行和社会的认可,同时需要得到理解和尊重。     

Information and communication in the emergency department

BackgroundEffective communication between healthcare providers and patients represents an important caveat in healthcare, both nationally and internationally. Providing information to patients about their care and condition can be challenging, particularly in demanding, time-pressured environments such as the Emergency Department (ED). Understanding the process of communication and information between patients and staff in the ED is essential to ensuring patients are satisfied with their treatment and care.AimThis study aimed to develop a holistic understanding of the informational and communicational requirements of patients and staff in the ED.MethodsAction Research involving patient qualitative interviews and a staff focus group were used.ResultsFifteen patient and family interviews identified four main themes associated with information and communication in the ED. Six ED staff participated in the focus group, which identified three emergent themes echoing some findings from the patient qualitative interviews.DiscussionMeaningful and informative interactions between patients and healthcare providers are an imperative and pragmatic component of a positive patient experience. Establishing communicative procedures that are practical, functional and reflective of the service can improve communications between patients and staff and have implications for practice on a local, national and international level.     

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition.     

Acute care needs in an Indian emergency department: A retrospective analysis

BACKGROUND: Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35% (n=662) were male and 44.7% (n=534) were female. The majority (67.14%, n=803) were adults, while only 3.85% (n=46) were infants. The most common chief complaints were fever (21.5%, n=257), renal colic (7.3%, n=87), and dyspnea (6.9%, n=82). The most common ED diagnoses were gastrointestinal (15.5%, n=185), pulmonary (12.3%, n=147), tropical (11.1%, n=133), infectious disease and sepsis (9.9%, n=118), and trauma (8.4%, n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identified by this study can help guide and shape Indian EM training programs and faculty development to more accurately reflect the burden of acute disease in India.     

Models of care for frail older persons who present to the emergency department: A scoping review of the literature

BackgroundPeople aged ≥65 years comprise approximately 20 % of all emergency department (ED) presentations. Frailty amongst this cohort is common yet can go undetected.ObjectiveTo summarise the evidence regarding models of care for frail older people in the ED.MethodsThe Joanna Briggs Institute scoping review framework was used. Literature searches were conducted in five electronic databases published from 2009 to 2022. Original research that met the criteria: frail older people aged ≥65 years, models of care and ED were included.ResultsA total of thirteen articles met the criteria for inclusion in this review. These comprised four studies of frailty care models and nine studies of care models using different assessment tools to identify frail older people. Care models were comprised of various specialist team members (e.g., geriatrician/ED physician and nurse). Processes underpinning these models included tools to support clinicians in the assessment of frail older adults, particularly around functional status, comorbidities, symptom distress, quality of life, cognition/delirium, and social aspects. Outcomes of care models for frail older people included: shorter ED length of stay, lower hospital admission rates, cost savings and increased patient satisfaction rates.ConclusionA variety of models, supported by a variety of assessment tools, exist to identify and guide care delivery for frail older people in the ED. Careful consideration of existing policies, guidelines and models is required before implementing new service models.     

Homeless patients tend to have greater psychiatric needs when presenting to the emergency department,

IntroductionHomeless patients tend to visit Emergency Departments (EDs) more frequently than the non-homeless population. The goal of this study was to assess differences in chief complaint, medical conditions, and disposition between homeless patients compared to non-homeless patients presenting to an urban ED.MethodsThis was a retrospective cohort of homeless patients ages ≥18 years compared to non-homeless controls from January 1, 2017 to December 31, 2017. Exclusion criteria were as follows: direct admission to hospital floor, repeat visits, or leaving without being seen. The primary endpoint of this study was to assess differences in chief complaint of homeless versus non-homeless patients upon presentation to the ED. Our secondary endpoints included differences in ED utilization between the two groups, in terms of length of stay, ambulance use, diagnosis, and disposition.ResultsHomeless patients were more likely present to the ED for a psychiatric evaluation (homeless group 34% vs. non-homeless group 4%, p < 0.01) and have a history of a psychiatric diagnosis (56% vs. 10%, p < 0.01) compared to non-homeless controls. Homeless patients also tended to require more ambulance transport (46% vs. 16%, p < 0.01). More homeless patients were transferred to a psychiatric facility (40% vs. 1%, p < 0.01), while the majority of non-homeless patients were discharged home (50% vs. 93%, p < 0.01).ConclusionThis study found that homeless patients had a significantly higher association with psychiatric diagnoses and greater ED utilization than non-homeless. This suggests the importance of increased access to consistent psychiatric care and follow up within the homeless population.     

A double-blind comparison of granisetron and placebo for the treatment of acute migraine in the emergency department

Three hundred and ninety-seven patients who presented to the emergency department were screened for a randomized, double-blind, placebo-controlled study of iv granisetron (40 micrograms/kg or 80 micrograms/kg) in acute migraine. Twenty-eight patients fulfilled the stringent eligibility criteria and completed the study. Rescue medication was required 2 h post-infusion in 8 of 10 patients receiving granisetron 40 micrograms/kg, 5 of 10 patients receiving granisetron 80 micrograms/kg, and 6 of 8 patients receiving placebo. Significant improvement (p less than 0.05) in headache pain (on a visual analogue scale and categorical scale) was observed in the 80-micrograms/kg group. Headache pain evaluated with the Hunter headache scale indicated improvement for the sensory and affective components of headache pain in both granisetron groups. Except for more nausea at 30 min in the placebo group, no significant differences were noted between treatments. All three treatments were well tolerated. Granisetron may be effective for acute migraine headache; however, further studies with increased patient numbers are required.     

A brief assessment of capacity to consent instrument in acutely intoxicated emergency department patients

Objective

The aim of this study was to determine to what extent acute alcohol intoxication effects capacity to assent, consent, or refuse research participation.

呼吸科老年住院患者心理状态的质性研究

目的深入了解和研究在呼吸科住院的老年患者住院期间的心理状态。方法采用质性研究EdmundHusserl观点构成的现象学方法为指导,采用个人访谈法,深入访问在某三甲医院呼吸科住院的8例老年患者。结果呼吸科住院的老年患者心理状态包括5个主题：焦虑和忧郁心理;对疾病和治疗的恐惧;猜疑和依赖;自尊心强;孤独和失落心理。结论通过提出针对性的护理干预措施,确保呼吸科老年住院患者的健康心理状态,以配合治疗、检查、手术、护理的顺利进行,并且在痊愈出院后保持健康、积极向上的生活方式和高质量的老年生活。     

Giving a voice to the community: A qualitative study of consumer expectations for the emergency department

Objective: To identify consumer expectations with respect to the ED. Methods: Semi‐structured focus groups comprising representatives from a wide range of community groups. Data was analysed using a qualitative analytical approach. Results: The major themes of the groups were communication, triage, waiting area, cultural issues and carers. Consumers expressed the need to be informed about how the ED functions, particularly with regard to the triage process, patient assessment and admissions procedure. Privacy at the triage desk, comfort and safety of the waiting area, provision of facilities for children, cultural awareness of staff, access interpreter services and recognition of the needs of carers were identified as key issues. Conclusion: The recognition of consumer needs provides the opportunity for the ED to develop strategies to match patient needs to service delivery.     

A mixed method study to determine the attitude of Australian emergency health professionals towards patients who present with deliberate self-poisoning

IntroductionDeliberate self-poisoning is one of the frequent presentation types to emergency departments. It has been reported that attitudes of emergency staff may have negative consequences for the wellbeing of the self-poisoning patient.AimDetermine the attitude of nursing and medical staff towards patients who present with deliberate self-poisoning and to identify if differences exist between the two groups.DesignMixed-method.MethodologyThe “Attitudes towards Deliberate Self-Harm Questionnaire” was distributed to all nursing and medical staff who had direct patient contact at three emergency departments (N = 410). Total and factor scores were generated and analysed against variables age, gender, length of experience working in the emergency department, level of education and by profession. Two open ended questions asked staff to write their perceptions and stories about patients who deliberate self-poison and were analysed using qualitative data analysis.ResultsForty-five percent of staff returned the questionnaire. The attitude of emergency nurses and doctors was positive towards patients who deliberately self-poison. Doctors had significantly higher total and Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ scores than nurses. After adjusting for length of time working in the emergency department only Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ remained statistically significant. Staff reported high levels of frustration, in particular to patients who represent.Conclusion/relevance to practiceThis information may be used to develop and implement educational strategies for staff to improve the experiences of and better support patients presenting to the emergency department who deliberately self-poison.     

急诊留观患者的特点与护理人力资源的管理

目的 了解急诊留观患者的疾病谱和时间分布规律,提高急诊留观护理管理质量.方法 对2010年9361例急诊留观患者资料进行回顾性调查,分析患者的一般资料、留观月份和各时间段内留观人数分布、疾病种类分布,并进行统计分析.结果 急诊留观患者以上呼吸道感染、头晕、腹痛查因的人数最多,位居前3位,女性多于男性,平均留观时间中位数为3.0h,3、8月留观人数最多,患者留观时间集中于8:00～22:00,8:00～12:00为全天高峰.结论 应根据患者留观的疾病谱和时间规律,科学合理地分配护理人力资源和加强业务培训,以提高急诊留观室的护理质量.     

持续不卧床腹膜透析患者需要状况的质性研究

目的:了解持续不卧床腹膜透析患者的需要状况,为临床护理措施实施提供依据.方法:运用现象学的方法,对13例实施持续性不卧床腹膜透析3个月以上患者进行深入访谈.采用类属分析法将收集到的资料依据马斯洛人类基本需要层次论进行整理、归类和分析.结果:持续性不卧床腹膜透析患者存在各种需要无法满足的状况,随着透析时间的延长这种状况更加突出.结论:护理人员应针对持续性不卧床腹膜透析患者不同阶段实施个性化护理,以最大限度地满足患者的各种需要,提高其生活质量.     

Review article: A primer for clinical researchers in the emergency department: Part X. Understanding economic evaluation alongside emergency medicine research

In this series we address research topics in emergency medicine. While traditionally there was an almost exclusive focus on the efficacy and effectiveness of interventions in emergency research, analysis of the costs and the societal impact of different approaches and pathways have become increasingly important. In this paper we will address what health economics means and discuss the different types and key features of economic evaluation relevant for clinical researchers.     

Patient and caregiver expectations of emergency department care: A scoping literature review

BackgroundCommunication between health care providers (HCPs) and patients and/or their caregivers in the chaotic emergency department (ED) context can be challenging and potentially impact health outcomes and patient satisfaction. Studies examining strategies to improve communication of patient and caregivers expectations of care in an ED are widely dispersed.MethodsWe conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research evidence regarding strategies to enhance communication of patient and caregiver expectations of care in an ED.ResultsOf the 599 articles retrieved, 24 met the inclusion criteria. Most of the studies identified included patients (n = 9) or caregivers (n = 8) as the population of interest, while the remainder examined the expectations of a mix of patients, parents/caregivers, and/or HCPs (n = 7). The majority (n = 21) of the studies did not communicate patient/caregiver expectations to HCPs.ConclusionThis scoping review highlights the paucity of available research literature evaluating strategies to communicate patient and caregiver ED expectations. Our findings identify the need for experimental designs in future studies to evaluate implementation strategies for ED expectation tools with a particular emphasis on measuring the impact of sharing patient expectations with HCPs.