Dyadic teams and nursing care: A critical incident study of nurses in the emergency medical service

Abstract

Aim and objectives The aim of the study was to describe Emergency Medical Services (EMS) nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team. Background Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering. Design The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist. Methods A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories. Results The experiences of critical incidents emerged to form two main areas: “Functional co‐operation” and “Dysfunctional co‐operation,” comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas: “Adapting oneself” and “Adapting nursing care and the colleague,” comprising four categories and eight sub‐categories. Conclusions Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles. Relevance to clinical practice This study underlines the importance of strengthening the dyadic EMS team's ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

Ambulance clinicians’ attitudes to older patients’ self‐determination when the patient has impaired decision‐making ability: A Delphi study

“…As stated in the result, 'there are colleagues who, even when making their way out to a patient, decide that the patient should remain at home, regardless of the patient's wishes' (category 4, item 4), surrogate decision-making can be complicated. Holmberg et al (2020) found this to be especially challenging within the AS, relating to the colleague's lack of competence disrespectful approach and common goals. However, having a competent colleague, together with consensus regarding the goal of the care, promotes functional co-operation within the dyadic AC team.…”

Caring approach for patients with chest pain – Swedish registered nurses’ lived experiences in Emergency Medical Services

“…A dysfunctional and confidence-lacking collegial team is described as a cause of worry in RNs, thus having a negative impact on caring (Svensson & Fridlund, 2008). This is confirmed in a recent study by Holmberg et al (2020) stressing the importance of reflections as a part of daily practice to develop both nursing care and to strengthen the dyadic team in EMS. The importance of communication relates to our findings of how RNs regain confidence in the situation using verbal and nonverbal communication with colleagues as well as patients.…”

“…Aside from own competence and experience, the RNs in this study emphasize the importance of being part of a well-functioning collegial team as a foundation for the caring approach in stressful situations while encountering patients with chest pain. The importance of a well-functional team was stressed while providing care in EMS (Holmberg et al, 2020;Patterson et al, 2011). A dysfunctional and confidence-lacking collegial team is described as a cause of worry in RNs, thus having a negative impact on caring (Svensson & Fridlund, 2008).…”

Driving the ambulance: an essential component of emergency medical services: an integrative review

“…Ambulance personnel may consist of voluntary workers, firefighters, paramedics, nurses, or medical doctors [ 1 ]. Regardless of their formal titles, ambulance personnel need to assess, load, and move the patient safely and maintain a professional relationship with the patient and significant others [ 2 ]. In some countries, the duties of driving the ambulance and providing medical care are held by separate individuals.…”

“…In some countries, the duties of driving the ambulance and providing medical care are held by separate individuals. In other settings, a team of individuals is trained to fulfil either role [ 2 ]. Despite how the service is organized, being the patient of an ambulance service entails being dependent on the caregivers and their competence through all phases of prehospital care, including the alarm call, the pick-up scene, the transportation process, and finally, the arrival and handover to the hospital or other destination.…”