Competencies in Swedish emergency departments – The practitioners’ and managers’ perspective

The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs.MethodsThis study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis.ResultsThe competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs.ConclusionsThe study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.     

Endostatin predicts mortality in patients with acute dyspnea – A cohort study of patients seeking care in emergency departments

BackgroundIncreased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported.AimOur main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea.DesignCirculating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System–Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age.ResultsEach one standard deviation increment of endostatin was associated with a HR of 2.12 (95% CI 1.31–3.44 p < 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p < 0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin.ConclusionsIn an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3%.     

Emergency departments and the inappropriate attender--is it time for a reconceptualisation of the role of primary care in emergency facilities?

The appropriateness of Emergency Department (ED) usage is often questioned, with recognition at an international level of the growing prevalence of 'inappropriate attenders'. This term is used to describe individuals who present for treatment that could more appropriately be provided in the primary health care setting. This is an issue of concern for staff working in New Zealand Emergency Departments. The present article offers a review of currently identified issues concerning ED attendance, and examines the core question of the role of primary care in the Emergency Department. It asks whether this is an appropriate use of ED resources, and if so, what are the implications for the role of the emergency nurse?     

Physicians’ and nurses’ perceptions of patient safety risks in the emergency department

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians’ perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians’ experiences with regard to patient safety risks.MethodSemi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.ResultsThe experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.ConclusionThe results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.     

Patient participation in emergency care – A phenomenographic study based on patients’ lived experience

International guidelines promote patient participation in health care. When patients participate in their care they experience greater satisfaction. Studies have shown that patients in emergency departments express dissatisfaction with their care, and it was therefore important to study how patients understand and conceptualize their participation. The aim of this study was to describe patients’ qualitatively different conceptions of patient participation in their care in an emergency department. Based on a lifeworld perspective, nine interviews were performed with patients in an emergency department. The phenomenographic analysis shows that participation by patients means contact with the emergency department staff in three categories of conceptions: being acknowledged; struggling to become involved; and having a clear space. The different conceptions of patient participation give us a deeper understanding of how patients may experience their care, and this result may provide a foundation for developing nursing practice and the quality of health care in line with international guidelines.     

The effects of interprofessional education – Self-reported professional competence among prehospital emergency care nursing students on the point of graduation – A cross-sectional study

The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses’ (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n = 19, Swedish n = 22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p < 0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students’ self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs.     

The wave of very old people in the intensive care unit–A challenge in decision-making

In this paper the authors express the opinion that there is much to be learned about the 80+ year old age group as it relates to critical care and end-of-life matters. We need to learn how to better predict outcome, we need to learn our limitations and deal with uncertainties, we need to better communicate with our elderly patients and their caregivers and we need to engage with our colleagues in Geriatrics. There is a wave of very old people arriving in the intensive care unit and we have much to do to prepare for it and for the ethical, fair and appropriate care of these critically ill, but elderly, patients.     

Design and initial evaluation of a virtual pediatric primary care clinic in Second Life®

Purpose: To present an example of an innovative educational strategy using a theoretical framework for the design and evaluation of a virtual world simulation for family nurse practitioner (FNP) students. Data sources: The example arises from a primary care pediatric clinic developed for FNP students in Second Life? to supplement experiences in clinical practice sites. The simulation uses a case-based interactive format. The educational strategy is based on constructivist learning theory and experiential learning principles. Report of initial prototype testing of faculty and FNP students is reported. Conclusions: Virtual-world simulations have the potential to provide a safe environment for students to practice clinical decision making for pediatric patients. However, attention to the context, pedagogy, learner, and the capabilities of the technology is essential to provide a quality educational experience. Implications for practice: Preparation of FNP students can include quality educational experiences in a virtual world when guided by a theoretical framework.     

The emergency department “carousel”: An ethnographically-derived model of the dynamics of patient flow

Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year’s worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED “carousel”. Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding.     

The effectiveness of educational interventions on trauma intensive care unit nurses’ competence: A systematic review and meta-analysis

ObjectivesTo examine the current evidence on the effect of education on intensive care unit nurses’ knowledge and skills competence in caring for adult major trauma patients.MethodologyA systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality.ResultsFive eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses’ knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29–47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84–38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up.ConclusionThis review demonstrated the significant effects of trauma education on improving intensive care nurses’ knowledge and practices. Further research should develop valid competencies and policies to drive nurses’ practice and potentially improve the safety and quality of care.