Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

Falchenberg, Åsa; Andersson, Ulrika; Sundström, Birgitta Wireklint; Bremer, Anders; Andersson, Henrik

doi:10.1177/20571585211006980

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…In addition to substantial knowledge and experience, working with evaluation tools requires the ability to choose the appropriate instrument. Falchenberg et al (2021) say that the basis of a properly conducted evaluation is the ability to understand the individual needs of patients, which is one of the fundamental aspects of professionalism in nursing. Kiljunen et al (2017) see education as the basis for providing high-quality and professional care in a geriatric environment, leading nurses to acquire complex and advanced competences.…”

Section: Discussionmentioning

confidence: 99%

Selected aspects of nursing practice related to the usage of evaluation tools for population aged over 60 years

Doležalová¹,

Tóthová²,

Neugebauer³

2022

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Introduction:The accuracy of evaluation tools is subject to several factors involving nurses. Two of these factors are the level of education and experience. These factors can significantly affect the instrument's objectivity. In terms of providing quality and specific geriatric care, having objective evaluation tools and applying the results are essential.Objective: The research aimed to determine how nurse education and experience affect the objectivity of evaluation tools. Another aim was to determine how education and experience affected the assessment of selected areas. Methods: The research was conducted using a quantitative survey involving 501 nurses from the South Bohemian Region. The data was obtained using a non-standardized questionnaire that focused explicitly on the use of evaluation tools. Results:The results show that nurses with higher levels of education have more experience in using evaluation tools and consider the tools to be useful and effective. The same was confirmed for nurses who have more nursing experience. Conclusions: Evaluation tools are an essential part of the nursing process, and an emphasis should be placed on learning how to use these tools during nurse training. In the context of geriatric nursing, nurses need special education for the various geriatric specialties. This is also true for the use of geriatric evaluations. In clinical practice, it is necessary to use evaluation tools systematically, logically, and, above all, to implement the results into care plans.

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Section: Discussionmentioning

confidence: 99%

Selected aspects of nursing practice related to the usage of evaluation tools for population aged over 60 years

Doležalová¹,

Tóthová²,

Neugebauer³

2022

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“…In addition to these general guidelines, there are a number of clinical practice guidelines and concepts for assessment, prioritization and treatment of specific situations and conditions. Among these can be mentioned guidelines for home-based self-care, non-conveyance of the patient, prehospital trauma life support, advanced medical life support, major incident medical management and support, prehospital medical management, and ongoing deadly violence [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Caring for older patients with reduced decision-making capacity: a deductive exploratory study of ambulance clinicians’ ethical competence

2023

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Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values.

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“…However, if an patient's symptoms is non-specific, the effects of checklists are uncertain (275). Further, guidelines are described as having a greater focus on medical needs than on gaining a comprehensive understanding of physical, psychological, social and existential needs (277). There is a tension between following guidelines to ensure patient safety and following guidelines rigidly and risking patient safety; these approaches need to be balanced (278).…”

Section: Decision Support Tools; Benefits and Limitationsmentioning

confidence: 99%

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

Forsgärde¹

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Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care. Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods. Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making. Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.

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Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

Cited by 5 publications

References 42 publications

Selected aspects of nursing practice related to the usage of evaluation tools for population aged over 60 years

Selected aspects of nursing practice related to the usage of evaluation tools for population aged over 60 years

Caring for older patients with reduced decision-making capacity: a deductive exploratory study of ambulance clinicians’ ethical competence

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

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