Accident and emergency nursing
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The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals' and caregivers' perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients' existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients' experiences related to the decision to call an ambulance and the wait for it to arrive. ⋯ Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals' point of view but also take account of the patients' reactions when they experience a threat to their life and health.
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Review Case Reports
A moral dilemma in the emergency room: confidentiality and domestic violence.
A professional colleague presents for treatment at an Emergency Department. Investigations reveal signs that indicate the possibility of domestic violence. This is subsequently confirmed in confidence. Personal reflections identify and explore the dilemmas and the ethical issues involved.
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The study aimed to assess if accident and emergency (A&E) nurses have positive or negative attitudes towards patients with deliberate self-harm, and to assess if nurses' age, length of A&E experience, or in-service education influence their attitudes towards these patients. An adapted version of the Suicide Opinion Questionnaire was used to assess attitudes towards patients with deliberate self-harm. Data were collected from 43 Registered Nurses in the A&E department of a major city hospital in Australia. ⋯ Older and more experienced nurses had more supportive attitudes than younger and less experienced nurses. Nurses who had attended in-service education on DSH had more positive attitudes than non-attendees. Overall, the findings have implications for improving the educational preparation of A&E nurses, improving awareness and adoption of practice guidelines, mentoring nurses, and improving attitudes towards patients who self-harm.
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Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. ⋯ We used Leape's model for assessing the reporting system as a whole and found the system in the department to be relatively safe, fairly easy to use and moderately effective. Recommendations as a result of this study include the introduction of an electronic reporting system, limiting the number of staff who categorise the incidents--using clear definitions for classifications including a structured framework for contributory factors, and a process that allows incidents to be updated on the database locally after the discussion. This research may have implications for the incident reporting process in other specialities as well as in other hospitals.
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This paper aims to explore the concept of the breach avoidance facilitator (BAF) within the Accident & Emergency (A&E) department. This is a role that has been introduced utilising Senior Nursing staff on a supernumerary basis to predominantly provide a trouble-shooting role to manage the A&E 4-hour target. ⋯ The associated benefits of the role including monitoring of the 4-hour target, co-ordination of resources, increased communication with a variety of staff members, and the completion of a real time electronic hand-over form will be explored. The paper will also discuss how the role will evolve to provide support and clinical supervision for junior and ancillary staff.