Healthcare workers' experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework.

IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY BMC Geriatrics Pub Date : 2024-10-28 DOI:10.1186/s12877-024-05410-6
Louise Barry, Aoife Leahy, Margaret O'Connor, Damien Ryan, Gillian Corey, Sylvia Murphy Tighe, Rose Galvin, Pauline Meskell
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Abstract

Background: In emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.

Methods: This study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These findings will directly inform implementation strategies.

Results: Three themes were identified; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices.

Conclusions: Screening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED.

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医护人员在急诊环境中筛查老年人的经验:使用理论领域框架进行的定性描述性研究。
背景:在急诊护理环境中,对老年人的疾病或不良健康后果的风险因素进行筛查,可以识别出那些需要专家及早干预的老年人。本研究旨在确定在爱尔兰中西部的急诊护理机构中实施以老年人为中心的筛查的障碍和促进因素:本研究采用了以理论领域框架(TDF)为基础的定性描述设计。这种设计通过为重点目标建立理论基础,为实施策略提供信息。研究人员有目的性地对医护人员(HCWs)进行了一对一半结构式访谈,以探讨他们在急诊护理环境中对老年人进行筛查的经验。在计算样本大小时,以信息功率为指导。在数据分析过程中,逐字记录的访谈记录被演绎映射到 TDF 结构,形成元主题,揭示了以人为本的老年人筛查的具体障碍和促进因素。这些发现将直接为实施策略提供参考:结果:确定了三个主题:实施以老年人为中心的筛查的先决条件;实施以老年人为中心的筛查所需的知识和技能;实施以老年人为中心的筛查的动机。总体而言,急诊护理环境中的筛查是一个复杂的过程,最好由知识丰富、技能娴熟、对团队动态和急诊护理环境中的环境挑战有敏锐认识的从业人员来进行。这些从业人员是专业知识和实践的倡导者和来源。经验较少的临床医生则应寻求监督和支持,以胜任并自信地开展筛查工作。关于虚弱和老年相关综合征的教育有助于筛查的开展。对筛查价值的认可是一个明确的激励因素,而领导力对于维持筛查实践至关重要:结论:筛查是专家干预的切入点,需要专业的多学科团队(MDT)方法才能在急诊环境中有效实施。加强对急诊环境中老年人的筛查工作包括审计、监督和有针对性的支持。技术娴熟、经验丰富的从业人员在指导和支持更广泛的 MDT 参与筛查方面发挥着关键作用。长期和可持续的实施有赖于利用现有的管理、实践发展和教育资源来支持筛查实践。急诊科(ED)工作人员、专家团队和更广泛的老年医学团队之间的沟通对于确保在急诊科提供以老年人为中心的护理服务至关重要。
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来源期刊
BMC Geriatrics
BMC Geriatrics GERIATRICS & GERONTOLOGY-
CiteScore
5.70
自引率
7.30%
发文量
873
审稿时长
20 weeks
期刊介绍: BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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