Pub Date : 2023-09-22DOI: 10.1016/j.auec.2023.09.003
Alice Martins Irvine , Willoughby Moloney , Stephen Jacobs , Natalie Elizabeth Anderson
Background
Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence.
Methods
A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department.
Results
Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of ‘toughness’)
Conclusion
Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.
{"title":"Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses","authors":"Alice Martins Irvine , Willoughby Moloney , Stephen Jacobs , Natalie Elizabeth Anderson","doi":"10.1016/j.auec.2023.09.003","DOIUrl":"10.1016/j.auec.2023.09.003","url":null,"abstract":"<div><h3>Background</h3><p>Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence.</p></div><div><h3>Methods</h3><p>A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department.</p></div><div><h3>Results</h3><p>Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of ‘toughness’)</p></div><div><h3>Conclusion</h3><p>Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 97-101"},"PeriodicalIF":1.8,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000714/pdfft?md5=ea3d9bc653e9265140928dea8c914c53&pid=1-s2.0-S2588994X23000714-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.1016/j.auec.2023.08.004
Claire L. Hutchinson , Kate Curtis , Andrea McCloughen
Aim
To identify common characteristics of patients who return to the ED unplanned and factors that may contribute to their decision to return.
Background
Return visits to the Emergency Department (ED) have been associated with adverse events and deficits in initial care provided. There is increasing evidence to suggest that many return visits may be preventable.
Methods
The results of primary quantitative measures (QUAN) followed by qualitative measures (qual) were integrated to build on and explain the quantitative data found in the initial phase of the research.
Results
Integration of results produced three new findings. 1) Most return visits occurred beyond 48 hrs because patients intentionally delayed going back to the ED despite their persisting symptoms; 2) Clinical urgency and deterioration were rarely evident in patients who made return visits in patients and 3) Ineffective communication between the clinician and the patient at discharge may have contributed to patients making the decision to return to the ED.
Conclusion
The decision to return unplanned to the ED is not an immediate response for most patients, and several potentially avoidable factors may influence their decision-making process. Future research should focus on strategies which contribute to the avoidance of unplanned return visits.
{"title":"Characteristics of patients who return unplanned to the ED, and factors that contribute to their decision to return: Integrated results from an explanatory sequential mixed methods inquiry","authors":"Claire L. Hutchinson , Kate Curtis , Andrea McCloughen","doi":"10.1016/j.auec.2023.08.004","DOIUrl":"10.1016/j.auec.2023.08.004","url":null,"abstract":"<div><h3>Aim</h3><p>To identify common characteristics of patients who return to the ED unplanned and factors that may contribute to their decision to return.</p></div><div><h3>Background</h3><p>Return visits to the Emergency Department (ED) have been associated with adverse events and deficits in initial care provided. There is increasing evidence to suggest that many return visits may be preventable.</p></div><div><h3>Methods</h3><p>The results of primary quantitative measures (QUAN) followed by qualitative measures (qual) were integrated to build on and explain the quantitative data found in the initial phase of the research.</p></div><div><h3>Results</h3><p>Integration of results produced three new findings. 1) Most return visits occurred beyond 48 hrs because patients intentionally delayed going back to the ED despite their persisting symptoms; 2) Clinical urgency and deterioration were rarely evident in patients who made return visits in patients and 3) Ineffective communication between the clinician and the patient at discharge may have contributed to patients making the decision to return to the ED.</p></div><div><h3>Conclusion</h3><p>The decision to return unplanned to the ED is not an immediate response for most patients, and several potentially avoidable factors may influence their decision-making process. Future research should focus on strategies which contribute to the avoidance of unplanned return visits.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 71-77"},"PeriodicalIF":1.8,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute gastroenteritis is a major cause of morbidity and mortality in children. The aim of this study was to explore assessment and management of children aged between 6 and 48 months presenting to the emergency department (ED) with acute gastroenteritis.
Methods
This retrospective cohort study included 340 children aged 6–48 months. Data were collected by medical record audit for children presenting between 1 January and 31 December 2019.
Results
General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies.
Conclusions
ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. There was variability in the management of children with moderate dehydration and Australian Aboriginal children but it is unclear whether this is suboptimal or patient specific care. This study has highlighted areas for further research in this unique context.
{"title":"Emergency department assessment and management of children with gastroenteritis","authors":"Kimberley Robson , Stéphane Bouchoucha , Julie Considine","doi":"10.1016/j.auec.2023.09.001","DOIUrl":"10.1016/j.auec.2023.09.001","url":null,"abstract":"<div><h3>Background</h3><p>Acute gastroenteritis is a major cause of morbidity and mortality in children. The aim of this study was to explore assessment and management of children aged between 6 and 48 months presenting to the emergency department (ED) with acute gastroenteritis.</p></div><div><h3>Methods</h3><p>This retrospective cohort study included 340 children aged 6–48 months. Data were collected by medical record audit for children presenting between 1 January and 31 December 2019.</p></div><div><h3>Results</h3><p>General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies.</p></div><div><h3>Conclusions</h3><p>ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. There was variability in the management of children with moderate dehydration and Australian Aboriginal children but it is unclear whether this is suboptimal or patient specific care. This study has highlighted areas for further research in this unique context.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 81-87"},"PeriodicalIF":1.8,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000696/pdfft?md5=895a47fafd9df54a31baa597eaaaee88&pid=1-s2.0-S2588994X23000696-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1016/j.auec.2023.08.003
Penelope Dempster , Ana Hutchinson , Elizabeth Oldland , Stéphane L. Bouchoucha
Introduction
The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses’ experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice.
Methods
An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke’s framework.
Results
Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What’s the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance.
Conclusions
Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.
{"title":"Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study","authors":"Penelope Dempster , Ana Hutchinson , Elizabeth Oldland , Stéphane L. Bouchoucha","doi":"10.1016/j.auec.2023.08.003","DOIUrl":"10.1016/j.auec.2023.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses’ experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice.</p></div><div><h3>Methods</h3><p>An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (<em>n</em> = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke’s framework.</p></div><div><h3>Results</h3><p>Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) <em>What’s the go with PPE today?</em> ii) <em>In the beginning we were scrambling for masks</em>; iii) <em>Emergency is the true frontline</em>. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) <em>Facing the fear of exposure</em>; (ii) <em>By the end of the shift I am just absolutely spent</em>; iii) <em>Discomfort of wearing PPE impacts on compliance</em>.</p></div><div><h3>Conclusions</h3><p>Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 63-70"},"PeriodicalIF":1.8,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000568/pdfft?md5=e764dce4e27c7aabd86a68245a1e7c1a&pid=1-s2.0-S2588994X23000568-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10180048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04DOI: 10.1016/j.auec.2023.08.002
P.M. Alcázar Artero , R. Greif , J.J. Cerón Madrigal , D. Escribano , M.T. Pérez Rubio , M.E. Alcázar Artero , P. López Guardiola , M. Mendoza López , R. Melendreras Ruiz , M. Pardo Ríos
Background
The main functions of healthcare professionals include training and health education. In this sense, we must be able to incorporate new technologies and serious game to the teaching cardiopulmonary resuscitation.
Methods
a multicenter, comparative and cross-sectional study was carried out to assess the learning of resuscitation of a group that was trained with the use of serious gaming with virtual reality, as compared to a control group trained with conventional classroom teaching.
Results
the mean quality obtained in chest compressions for the virtual reality group was 86.1 % (SD 9.3), and 74.8 % (SD 9.5) for the control group [mean difference 11.3 % (95 % CI 6.6–16.0), p < 0.001]. Salivary Alpha-Amylase was 218.882 (SD 177.621) IU/L for the virtual reality group and 155.190 (SD 116.746) IU/L for the control group [mean difference 63.691 (95 % CI 122.998–4.385), p = 0.037].
Conclusion
using virtual reality and serious games can improve the quality parameters of chest compressions as compared to traditional training.
背景医护人员的主要职能包括培训和健康教育。方法开展了一项多中心、横断面比较研究，以评估使用虚拟现实严肃游戏进行培训的一组与使用传统课堂教学进行培训的对照组的复苏学习情况。结果虚拟现实组胸外按压的平均质量为 86.1%（标准差 9.3），对照组为 74.8%（标准差 9.5）[平均差异为 11.3% (95 % CI 6.6-16.0), p <0.001]。虚拟现实组的唾液α-淀粉酶为 218.882 (SD 177.621) IU/L，对照组为 155.190 (SD 116.746) IU/L [平均差异为 63.691 (95 % CI 122.998-4.385)，P = 0.037]。
{"title":"Teaching cardiopulmonary resuscitation using virtual reality: A randomized study","authors":"P.M. Alcázar Artero , R. Greif , J.J. Cerón Madrigal , D. Escribano , M.T. Pérez Rubio , M.E. Alcázar Artero , P. López Guardiola , M. Mendoza López , R. Melendreras Ruiz , M. Pardo Ríos","doi":"10.1016/j.auec.2023.08.002","DOIUrl":"10.1016/j.auec.2023.08.002","url":null,"abstract":"<div><h3>Background</h3><p>The main functions of healthcare professionals include training and health education. In this sense, we must be able to incorporate new technologies and serious game to the teaching cardiopulmonary resuscitation.</p></div><div><h3>Methods</h3><p>a multicenter, comparative and cross-sectional study was carried out to assess the learning of resuscitation of a group that was trained with the use of serious gaming with virtual reality, as compared to a control group trained with conventional classroom teaching.</p></div><div><h3>Results</h3><p>the mean quality obtained in chest compressions for the virtual reality group was 86.1 % (SD 9.3), and 74.8 % (SD 9.5) for the control group [mean difference 11.3 % (95 % CI 6.6–16.0), p < 0.001]. Salivary Alpha-Amylase was 218.882 (SD 177.621) IU/L for the virtual reality group and 155.190 (SD 116.746) IU/L for the control group [mean difference 63.691 (95 % CI 122.998–4.385), p = 0.037].</p></div><div><h3>Conclusion</h3><p>using virtual reality and serious games can improve the quality parameters of chest compressions as compared to traditional training.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 57-62"},"PeriodicalIF":1.8,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10526684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.auec.2023.01.003
Katrina Witt , Gowri Rajaram , Michelle Lamblin , Jonathan Knott , Angela Dean , Matthew J. Spittal , Greg Carter , Andrew Page , Jane Pirkis , Jo Robinson
Background
Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation.
Methods
This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people.
Results
There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months).
Conclusions
Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.
{"title":"Characteristics of self-harm presentations to the emergency department of the Royal Melbourne Hospital, 2012–2019: Data from the Self-Harm Monitoring System for Victoria","authors":"Katrina Witt , Gowri Rajaram , Michelle Lamblin , Jonathan Knott , Angela Dean , Matthew J. Spittal , Greg Carter , Andrew Page , Jane Pirkis , Jo Robinson","doi":"10.1016/j.auec.2023.01.003","DOIUrl":"10.1016/j.auec.2023.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments<span> (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation.</span></p></div><div><h3>Methods</h3><p>This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people.</p></div><div><h3>Results</h3><p>There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months).</p></div><div><h3>Conclusions</h3><p>Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 230-238"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.auec.2023.02.001
Helen M. Stallman , Natalie Dodd , Matthew Warren-James , Belinda Chiera
Background
Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing.
Methods
Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being—identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics.
Results
The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing.
Conclusions
These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace.
{"title":"Workplace sense of belonging and paramedic wellbeing using network analysis: A cross-sectional study","authors":"Helen M. Stallman , Natalie Dodd , Matthew Warren-James , Belinda Chiera","doi":"10.1016/j.auec.2023.02.001","DOIUrl":"10.1016/j.auec.2023.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing.</p></div><div><h3>Methods</h3><p>Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being—identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics.</p></div><div><h3>Results</h3><p>The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing.</p></div><div><h3>Conclusions</h3><p>These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 254-263"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.auec.2022.11.002
Jason Belcher , Judith Finn , Austin Whiteside , Stephen Ball
Introduction
Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients’ conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state.
Methods
Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia. Patient conscious state at the time of paramedic arrival was compared to acuity (based on paramedic assessment and management). We determined the proportion of high-acuity patients across six levels of consciousness (Alert, Confused, Drowsy, Voice Response, Pain Response, Unresponsive) overall, and within individual protocols of the Medical Priority Dispatch System (MPDS).
Results
The proportion of high acuity patients increased with each step across the consciousness scale. Applying conscious state as a binary predictor of acuity, the largest increases occurred moving the threshold from Alert to Confused (22.0–48.6% high acuity) and Drowsy to Voice Response (61.9–89.5% high acuity). The Area Under the Curve (AUC) of the Receiver Operating Characteristic was 0.65. Within individual protocols, the highest AUC was in Cardiac Arrest (0.89), Overdose/Poisoning (0.81), Unknown Problem (0.76), Diabetic Problem, (0.74) and Convulsions/Fitting (0.73); and lowest in Heart problems (0.55), Abdominal Pain (0.55), Breathing Problems (0.55), Back Pain (0.53), and Chest Pain (0.52).
Conclusion
Based on these proportions of high acuity patients, it is reasonable to consider patients with any altered conscious state a high priority. The value of conscious state assessment for predicting acuity varies markedly between MPDS protocols. These findings could help inform secondary triage of ambulance patients during the emergency call.
{"title":"Association between initial presenting level of consciousness and patient acuity – A potential application for secondary triage in emergency ambulance calls","authors":"Jason Belcher , Judith Finn , Austin Whiteside , Stephen Ball","doi":"10.1016/j.auec.2022.11.002","DOIUrl":"10.1016/j.auec.2022.11.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients’ conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state.</p></div><div><h3>Methods</h3><p><span>Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia. Patient conscious state at the time of </span>paramedic arrival was compared to acuity (based on paramedic assessment and management). We determined the proportion of high-acuity patients across six levels of consciousness (Alert, Confused, Drowsy, Voice Response, Pain Response, Unresponsive) overall, and within individual protocols of the Medical Priority Dispatch System (MPDS).</p></div><div><h3>Results</h3><p><span><span>The proportion of high acuity patients increased with each step across the consciousness scale. Applying conscious state as a binary predictor of acuity, the largest increases occurred moving the threshold from Alert to Confused (22.0–48.6% high acuity) and Drowsy to Voice Response (61.9–89.5% high acuity). The </span>Area Under the Curve (AUC) of the Receiver Operating Characteristic was 0.65. Within individual protocols, the highest AUC was in Cardiac Arrest (0.89), Overdose/Poisoning (0.81), Unknown Problem (0.76), Diabetic Problem, (0.74) and Convulsions/Fitting (0.73); and lowest in Heart problems (0.55), Abdominal Pain (0.55), Breathing Problems (0.55), </span>Back Pain<span> (0.53), and Chest Pain (0.52).</span></p></div><div><h3>Conclusion</h3><p>Based on these proportions of high acuity patients, it is reasonable to consider patients with any altered conscious state a high priority. The value of conscious state assessment for predicting acuity varies markedly between MPDS protocols. These findings could help inform secondary triage of ambulance patients during the emergency call.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 199-204"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.auec.2023.01.005
Andreas Rantala , Anders Sterner , Catharina Frank , Elsa Heinrich , Bodil Holmberg
Background
As worldwide life expectancy increases, the Swedish Ambulance Service is likely to be affected by the demographic shift towards a larger proportion of older persons. An older population tends to increase the demand for ambulances, indicating a need to illuminate older patients’ perspective. Thus, the aim of this study was to explore older patients’ perceptions of the Swedish Ambulance Service.
Methods
This interview study employed a descriptive qualitative design with a phenomenographic approach in accordance with Dahlgren and Fallsberg.
Results
Three main descriptive categories emerged to describe the underlying conceptions in the interviews; A double-edged encounter, Trust is created by perceived competence, and Safety through accessibility in vulnerable situations.
Conclusion
Older patients described trust in ambulance clinicians as a prerequisite for feeling safe enough to share their feelings and allow a bodily examination. However, they also criticized the care provided because they questioned the need for certain actions.
{"title":"Older patients’ perceptions of the Swedish ambulance service: A qualitative exploratory study","authors":"Andreas Rantala , Anders Sterner , Catharina Frank , Elsa Heinrich , Bodil Holmberg","doi":"10.1016/j.auec.2023.01.005","DOIUrl":"10.1016/j.auec.2023.01.005","url":null,"abstract":"<div><h3>Background</h3><p>As worldwide life expectancy increases, the Swedish Ambulance Service is likely to be affected by the demographic shift towards a larger proportion of older persons. An older population tends to increase the demand for ambulances, indicating a need to illuminate older patients’ perspective. Thus, the aim of this study was to explore older patients’ perceptions of the Swedish Ambulance Service.</p></div><div><h3>Methods</h3><p>This interview study employed a descriptive qualitative design with a phenomenographic approach in accordance with Dahlgren and Fallsberg.</p></div><div><h3>Results</h3><p>Three main descriptive categories emerged to describe the underlying conceptions in the interviews; <em>A double-edged encounter, Trust is created by perceived competence</em>, and <em>Safety through accessibility in vulnerable situations.</em></p></div><div><h3>Conclusion</h3><p>Older patients described trust in ambulance clinicians as a prerequisite for feeling safe enough to share their feelings and allow a bodily examination. However, they also criticized the care provided because they questioned the need for certain actions.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 249-253"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.auec.2023.01.001
Brendan V. Schultz , Kerrianne Watt , Stephen Rashford , James Wylie , Emma Bosley
Background
Open limb fractures are a time-critical orthopaedic emergency that present to jurisdictional ambulance services. This study describes the demographic characteristics and epidemiological profile of these patients
Methods
We undertook a retrospective analysis of all patients that presented to Queensland Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna, tibia/fibula or femur) over a two-year period (January 2018 – December 2019).
Results
Overall, 1020 patients were included. Patients were mainly male (65.9%) and middle-aged (age 41 years, IQR 22–59). Fractures predominately occurred in the lower extremities (64.9%) with transport crashes the primary mechanism of injury (47.8%). The location of the fracture varied depending on the cause of injury, with femur fractures associated with motorcycle crashes, and fractures to the radius/ulna attributed to falls of greater than one metre (p = 0.001). The median prehospital episode of care was 83 min (IQR 62–144) with aeromedical air ambulance involvement and the attendance of a critical care paramedic or emergency physician, both independent factors that increased this time interval.
Conclusion
Open limb fractures are a relatively infrequent injury presentation encountered by ambulance clinicians. The characteristics of these patients is consistent with previously described national and international out-of-hospital trauma cohorts
{"title":"Epidemiology of open limb fractures attended by ambulance clinicians in the out-of-hospital setting: A retrospective analysis","authors":"Brendan V. Schultz , Kerrianne Watt , Stephen Rashford , James Wylie , Emma Bosley","doi":"10.1016/j.auec.2023.01.001","DOIUrl":"10.1016/j.auec.2023.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Open limb fractures<span> are a time-critical orthopaedic emergency that present to jurisdictional ambulance services. This study describes the demographic characteristics and epidemiological profile of these patients</span></p></div><div><h3>Methods</h3><p>We undertook a retrospective analysis of all patients that presented to Queensland Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna, tibia/fibula or femur) over a two-year period (January 2018 – December 2019).</p></div><div><h3>Results</h3><p><span>Overall, 1020 patients were included. Patients were mainly male (65.9%) and middle-aged (age 41 years, IQR 22–59). Fractures predominately occurred in the lower extremities (64.9%) with transport crashes the primary mechanism of injury (47.8%). The location of the fracture varied depending on the cause of injury, with femur fractures associated with motorcycle crashes, and fractures to the radius/ulna attributed to falls of greater than one metre (</span><em>p</em><span><span> = 0.001). The median prehospital episode of care was 83 min (IQR 62–144) with aeromedical air ambulance involvement and the attendance of a critical care </span>paramedic or emergency physician, both independent factors that increased this time interval.</span></p></div><div><h3>Conclusion</h3><p>Open limb fractures are a relatively infrequent injury presentation encountered by ambulance clinicians. The characteristics of these patients is consistent with previously described national and international out-of-hospital trauma cohorts</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 216-220"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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