Attitudes and beliefs of emergency department doctors towards domestic violence in Hong Kong

A questionnaire was sent to all doctors working in emergency departments in Hong Kong to survey their attitudes and beliefs towards domestic violence. Beliefs concerning privacy and traditional cultural values were found to be important factors affecting the doctor's ability to identify cases of wife abuse. Most respondents had no formal training in this area and felt inadequate in the handling of domestic violence cases. Ways to improve training and identification of at risk cases are discussed.     

Violence towards junior doctors in accident and emergency departments.

The experience and training of accident and emergency (A&E) junior doctors with regard to patient aggression was investigated by use of a telephone questionnaire. A total of 114 A&E departments in five different regions in the United Kingdom were telephoned. A total of 100 junior doctors answered the questionnaire. Verbal aggression had been experienced by 96 of them, 50 had received threats and 32 said that patients had tried to assault them. Eighteen doctors had been assaulted by patients on a total of 23 occasions. Thirty-two doctors admitted that they had been upset after a violent incident, so much so that they were preoccupied with it after work. None of those assaulted received any counselling and no police charges resulted from the assaults. Only 11 doctors had received any training on how to manage aggressive patients, although 88 believed that it would be useful. The results of this study indicate that violence towards junior doctors in A&E is a significant problem. Aspects of this problem, including training and support for staff, need to be addressed urgently.     

Professional resilience among nurses working in an overcrowded emergency department in Taiwan

PurposeProfessional resilience has become increasingly important for nurses in adverse work environments to reduce the negative results and increase the positive outcomes of stress. This study aimed to explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) and increase knowledge about what nurses identified as protective factors, which may be useful for future planning.MethodsA construction-grounded theory (CGT) approach was adopted. Purposive sampling and snowball technique were employed to recruit 13 participants, which proved sufficient to achieve theoretical saturation. In-depth interviews were conducted and audiotaped.ResultsDoubting work value and maintaining optimism were the 2 main themes in the core category of seeing and taking work difficulty and responsibility. Nurses described how their passion for their profession gradually diminished, but they assessed the situation and took responsibility for their jobs.ConclusionThis study found that nurses retain their compassion, which sustains them in their work. The issue of ED overcrowding led to pessimism among nurses. However, work rewards encouraged nurses to adopt a more proactive attitude toward work-related adversity.     

Attitudes of Dublin accident and emergency department doctors and nurses towards the services offered by local general practitioners.

Good communication at the accident and emergency (A&E)-general practice interface is important. Such communication will be affected by the attitudes of A&E staff towards local general practitioners (GPs). The objectives of this study were to establish and compare, using a questionnaire, the attitudes of Dublin A&E doctors and nurses towards the services offered by local GPs. A questionnaire was sent to all nurses and non-consultant doctors working in four of the six Dublin A&E departments. Completed questionnaires were received from 57 (61%) nurses and 35 (81%) doctors. Only two activities (being accessible to patients during normal surgery hours and providing family planning services) were rated by more than one-fifth of doctors and nurses as being performed 'well'. Six activities (being accessible to patients outside surgery hours, providing long-term care for the chronically ill and debilitated, providing appropriate care for 'difficult' patients, advising patients about the appropriate use of services and performing first aid) were rated by more than 40% of both doctors and nurses as being performed 'badly'. For all activities the nurses consistently rated the performance of the 'average GP' more critically than the doctors. These results must be interpreted cautiously. The implications of these findings and how best they can be addressed are discussed.     

Violence against doctors: 2. Effects of violence on doctors working in accident and emergency departments.

There is abundant evidence to suggest that doctors are increasingly being exposed to violent incidents at their workplace. The possible effects of aggression on an individual are varied and likely to depend on the severity and frequency of episodes and the perceived vulnerability to further episodes. The reported sequaelae of violent incidents towards doctors include varied psychological disturbances, and changes in behaviour, such as increasing prescribing, ongoing fear of violence at work, and poor staff morale. We investigated the effects of violence against doctors in the accident and emergency departments in Kuwait. Seventy-five (86%) out of 87 doctors exposed to violent incidents reported one or more of the symptoms consisting of: depression, reliving experience (flashbacks), insomnia, and taking 'time off'. The effects lasted for more than 4 weeks in 25, for 3-4 weeks in 17, and for 2-3 weeks in 21. The duration of symptoms was longer in doctors exposed to verbal insults or threats of imminent violence coupled with incidents involving single acts of violence. Out of a total of 101 doctors; 90 (89%) remained worried about violence at work and 72 (71%) thought training to deal with potentially violent situations would be useful.     

What should doctors wear in the accident and emergency department? Patients' perception.

In many accident and emergency (A&E) departments doctors still wear white coats or their ordinary clothes, rather than a type of uniform, which, should it become contaminated, can be changed easily for a clean uniform. Before a change of clothing to a uniform could be considered in an inner-city A&E department, a study was carried out to assess the public's perception towards different styles of dress. Three hundred and twenty-nine questionnaires were returned by minor injury patients requiring a radiograph. The study was carried out over 3 weeks in January 1993. Each week a different style of dress was worn: week 1--white coats, week 2--normal clothing and week 3--theatre greens. The majority of patients thought that style of dress was important but did not alter their attitude towards the A&E medical staff. Therefore, there is no reason why doctors should not wear a more appropriate uniform that can be changed easily when contaminated.     

A study of depression and anxiety among doctors working in emergency units in Denizli, Turkey

Background

Major work has been carried out on the psychological well‐being of emergency room doctors in the US, Canada and in other developed countries, but little has been published regarding the same in the countries in economic transition.

Objective

To determine the level of, and the factors related to, depression and anxiety among doctors working in emergency units in Denizli, Turkey.

Methods

This cross‐sectional study was conducted in May 2004, using a sample of 192 doctors employed in emergency units in Pamukkale University Hospital, the City Hospital, the Social Security Hospital, private hospitals, citywide primary healthcare centres and 112 emergency services in Denizli, Turkey. Data were obtained using a self‐administered questionnaire, including questions on sociodemographic characteristics and two instruments determining the level of depressive symptoms and anxiety. Logistic regression was the method chosen for multivariate statistical analysis.

Results

The mean (standard deviation (SD)) depression score was 10.6 (6.5) and the frequency (%) of depression was 29 (15.1). Not having any hobby and having high anxiety scores were salient factors among doctors experiencing depressive symptomatology in bivariate comparisons. Logistic regression analysis showed that not having any hobby (p = 0.07) and having increased anxiety scores (p<0.001) were positive contributors to depression scores. The mean (SD) anxiety score was 8.7 (8.2) and the frequency (%) of anxiety was 28 (14.6). Being a woman, having a low monthly income and having high depression scores contributed considerably to the anxiety of doctors in bivariate comparisons. Low monthly income (<1000 v 1000–2000 YTL) (p = 0.03), the number of years spent in emergency units (p = 0.03) and having high depression scores (p<0.001) were the factors that contributed significantly to the anxiety of doctors in the multivariate regression analysis.

Conclusion

The considerable amount of depression and anxiety found among doctors in this study should trigger further work. Studies using more powerful designs would help to illuminate the factors leading to depression and anxiety, which result in attrition among doctors from emergency units.Several occupational hazards have put the physical and psychological well‐being of doctors working in emergency units in jeopardy.¹ The likelihood of being exposed to infectious agents seems to be higher in emergency units than in other medical settings.^1,2 The increased risk of workplace violence, of having coronary artery disease and of having impaired reproductive health are other problematic conditions worth mentioning.^2,3,4 Traditionally, it has also been recognised that the emergency unit environment exposes doctors to stress, which causes burnout, frustration and, eventually, a shortened career span.^{5,6,7,8,9,10,11} Several studies have shown that a considerable number of emergency doctors experience depersonalisation and depression.^12,13 Important work on depression and anxiety has been carried out on doctors working in emergency units in the US, Canada and in other developed countries, but little has been published regarding the same in the countries in economic transition.We have serious concerns in Turkey about the attrition rate of doctors working in emergency units, which is currently unknown. The Turkish healthcare system has been experiencing major changes since early 2000.¹⁴ Attempts to regionalise the healthcare system have created new challenges. Opportunities for improvement exist in the current environment; however, there is also a risk of insufficient emergency healthcare services being provided to the community. Progress in working conditions and improvement in the psychological health of doctors are predicted to be the determining factors for the success or failure of the latest changes. Current findings on the psychological well‐being of doctors in the field are especially expected to be valuable to doctors working in emergency units, healthcare planners and managers who seek to provide optimal emergency healthcare for people in the countries in economic transition. Our study aimed to determine the level of depression and anxiety, together with their associated factors, which cause burnout among doctors working in emergency units in Denizli, Turkey.     

Violence towards emergency department nurses by patients

Emergency department (ED) violence is a significant problem in many hospitals. This study identified the incidence of violence by patients towards nurses in two EDs. Patient factors related to violence were identified and the circumstances surrounding the violent incident were described. Of the 71 ED nurses who participated, 50 (70%) reported 110 episodes of violence in a five-months period. That is approximately five violent incidents per week. Violence was reported most often on evening shifts (n=41, 37%). The nurses' perceived that the perpetrators of violence were under the influence of alcohol (n=30, 27%) and drugs (n=27, 25%) and displayed behaviours associated with mental illness (n=42, 38%). Nurses in this study were sworn at (n=67, 61%), pushed (n=11, 10%), hit (n=3, 3%), and kicked (n=3, 3%). Identification of trends and patterns of violence is necessary so that better health care planning and service provision as well as effective preventative and safe strategies for nurses in the workplace can be implemented.     

Attitudes towards suicide among nurses and doctors working with children and young people who self-harm

This paper presents a study investigating the attitudes towards suicide in nurses and doctors who work with children and young people who self-harm. The effect of basic demographic factors on attitudes towards suicide in the staff group is explored. The Suicide Opinion Questionnaire was implemented to collect data on attitudes towards suicide. A 5-point Likert Scale was used to score responses and attitudes were measured on eight clinical scales. Participants were 179 nurses and doctors working in three clinical areas: accident and emergency; paediatric medicine and adolescent inpatient mental health services. Nurses and doctors indicated agreement on the Mental Illness, Cry for Help, Right to Die, Impulsivity, Normality and Aggression scales, and less agreement on the Religion and Moral Evil scale. Only the scores for Mental Illness were statistically different in relation to professional group. There were no other significant differences on the other clinical scales in relation to gender, age clinical speciality and length of experience in current post. It is argued that complex attitudes need to be taken into account in training for healthcare professionals and in the development of contemporary suicide prevention policy.     

Perceptions of nurse practitioners by emergency department doctors in Australia

Background

The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs).

Aims

The purpose of this study was to determine the perception of NPs by medical staff working in Australian EDs.

Methods

Semi-structured telephone interviews were conducted with closed and open-ended questions. Participants were drawn from a representative stratified sample of two city, two metropolitan and two provincial hospitals of each State/Territory.

Results

A total of 95 doctors from 35 EDs participated in this study including 36 Departmental Directors; 36% of participating Directors indicated having an NP on staff. Doctors were strongly opposed to the statement that NPs could replace either nurses or other prevocational doctors; 71 interviewees commented on the role of NPs in the ED. Thematic analyses revealed polarised views held by doctors. Eight major themes were identified, the most common being that there is a lack of clarity of the NP role definition, their scope of practice and differentiation from the medical role.

Conclusion

Although ED NPs represent a highly skilled professional group their role is poorly understood by ED doctors. Opposition to the NP role is a significant barrier to the introduction of great numbers of ED NPs as a strategy to overcome the medical workforce shortage.     

北京地区三级甲等医院急诊科医生工作及身心压力调查分析

目的 通过对北京市区三级甲等医院急诊科医生工作压力状况的调查,探讨急诊医生工作压力对身心健康的影响.方法 采用整群抽样方法抽取北京市区三级甲等医院120名急诊科医生和80名普通内科医生,分别进行问卷调查其工作压力源、心理健康状况.结果 三级甲等医院急诊科与普通内科医生在专业信心和医疗自我满意度方面比较差异无统计学意义(P＞0.05),在工作量和工作环境方面比较差异有统计学意义(P＜0.05),在人际关系、情感及思维方式等方面比较差异亦有统计学意义(P＜0.05).结论 三级甲等医院急诊科医生工作压力大,建议医院管理者采取有效的措施,改善工作环境和人际关系,维护急诊科医生的健康.     

Complaints against doctors in an accident and emergency department: a 10-year analysis.

We carried out an analysis of complaints against doctors in our Accident and Emergency Department received from 1 January 1979 to 31 December 1988. There were 66 complainants in all, comprising 37 relatives, 21 patients and eight persons acting in a professional capacity. The majority of complaints (80 out of 125) were about poor communication and dissatisfaction with diagnosis and treatment. A small number of complainants had unrealistic expectations of the Accident and Emergency service. A total of 83.3% of complaints were against Senior House Officers who saw 61.3% of all patients. We concluded that an improvement in the communicative, diagnostic and therapeutic skills of doctors would minimize justified complaints.     

Survey of attitudes of senior emergency physicians towards the introduction of emergency department ultrasound

Introduction: Emergency department ultrasound (EDU) is widely practised in the USA, Australia, parts of Europe, and Asia. EDU has been used in the UK since the late 1990s but as yet, few areas have established a practice. Objectives: To assess the current climate of opinion with respect to the practice, constraints, and establishment of EDU among emergency department (ED) consultants on the island of Ireland. Methods: A postal questionnaire was formulated, piloted, and assessed for ambiguity by a sample of ED consultants and an independent non-ED consultant, prior to being mailed to all ED consultants in Ireland. Results: Of the 58 consultants canvassed 46 (79%) responded. Of the respondents, 40 (87%) strongly agreed/agreed that EDU is appropriate and should be performed in the ED. Of these, 3 (7%) are currently performing EDU; 37 (80%) have not had formal training in EDU, however 42 (91%) support the establishment of national guidelines for training in focused ultrasound in the ED. Problems instituting EDU were often multifactorial. Commonly highlighted difficulties included financial issues (24 respondents, 52%) and radiology department support (16 respondents, 34%). Other cited problems include varying interdepartmental practices (15 respondents, 33%) and (for some EDs) low numbers of patients requiring EDU, with projected difficulties in skills maintenance. Conclusion: Despite the vast majority of ED consultants being in favour of EDU, very few actually perform it on a regular basis or have had any formal training. Highlighted difficulties in EDU implementation included financial constraints, lack of support from radiology departments, and lack of formal training.     

Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department.

OBJECTIVE: To assess whether accident and emergency (A&E) nurses using the Ottawa Ankle Rules could detect all ankle fractures. DESIGN: Prospective observational study. SETTING: A&E department of a university teaching hospital. SUBJECTS: All patients who presented with ankle injuries who were initially assessed by a nurse taught the Ottawa Ankle Rules. OUTCOME MEASURES: (1) The numbers of patients referred by the nurse for ankle radiography; (2) of these, the number with ankle fractures; (3) of those not sent for radiography initially by the nurse, the number who subsequently had x rays (ordered by the doctor) and had a fracture; (4) of those having no x rays, the number who reattended later. RESULTS: 324 patients were eligible; 238 had x rays at the request of the nurse (73%); 48 of these (20%) were diagnosed as having a fracture. Of those 86 patients not sent for radiography by the nurse, 19 subsequently had x ray examinations at the request of a doctor and no fracture was detected. Of the 67 not sent for radiography, none returned within the subsequent eight weeks. CONCLUSIONS: Nurses can apply the Ottawa Ankle Rules safely without missing acute fractures; that is, of those who were not sent for radiography by nurses, none subsequently reattended the A&E department or the trauma service of the Bristol Royal Infirmary during the following two months.