The handover process and triage of ambulance‐borne patients: the experiences of emergency nurses

Abstract

One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function. The aim of the study was to explore the experiences of nurses receiving patients who were brought into hospital as emergencies by ambulance crews through an analysis of the handover and triage process. A qualitative descriptive interview study inspired by the phenomenological method was used with six emergency nurses. There are three elements to a handover: a verbal report, handing over documented accounts and the final symbolic handover when a patient is transferred from the ambulance stretcher onto the hospital stretcher. The study identified that the verbal communication between ambulance and emergency nurses was often very structured. The ideal handovers often involved patients with very distinct medical problems. The difficult handover or the 'non-ideal' one was characterized by a significantly more complicated care situation. The handover function was pivotal in ensuring that the patient received the correct care and that care was provided at the appropriate level. The most seriously afflicted patients arrived by ambulance; therefore, the interplay between pre-hospital and hospital personnel was vital in conveying this important information. To some extent, this functioned well, but this research has identified areas where this care can be improved.

The non-verbal communication in handover situations are the spice between the lines, to understand the severity of the patient’s condition

“…The understanding of the situation and preparedness of how it can evolve is a very strong patient safety issue, as misunderstandings and erroneous reactions occur in situations where verbal communication is transmitted without any nonverbal communication involved, it is not just what is said but also how it is said that is important. [26,27] Bruce and Suserud [28] argues that the verbal reporting could be key for a deeper understanding about the patient as it contains information and provides a comprehensive picture of the patient's situation and accordingly saves time for the recipient nurse and thereby streamlines nursing care. Verbal handover situations are a prerequisite for dialogue, where empathy and mutual understanding can be formed.…”

“…If the patient's condition were of a less acute matter, the patient might be handed over by another paramedic than the one that cared for the patient during transport. Studies show [28,32] that patients who needed medical treatment got handed over in a more sufficient way, since patient with less medical needs were seen less engaging which influenced the handover situation negatively. [28,32] This results uncover a lack of professionalism from the paramedics which can cause the staff in the emergency room to be negatively affected by the attitude and approach the patient in an insufficient way.…”

Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety

“…Significant amount of customization may be required, with patient safety and hemodynamic stability being among top priorities throughout the entire process. Each patient should be transported under the care of specially trained healthcare professionals, which can include physicians, nurses, advanced life support (ALS)-trained or basic life support (BLS)-trained personnel, respiratory therapists, and others as required, in order to ensure that the transfer is safe and that continuity of care occurs seamlessly both during the IPT and after the arrival at the destination facility [25,26].…”

Aci̇l Hemşi̇reli̇ği̇ni̇n Görünmeyen Yüzü: İnsan Olarak Ben Neler Yaşiyorum?

“…Öncelikleri belirleyerek hastaların ilgili tedavi ve bakımı almasını sağlamak açısından triyajın doğru, zamanında ve çabuk yapılmasını sağlamak acil hemşirelerinin önemli sorumluluklarından biridir (Bruce and Suserud 2005). Ancak bu konuda yeterince deneyimi bulunmayan hemşire için triyaj yapmanın yükümlülüğü hemşire üzerinde baskı oluşturarak stres yaşamasını tetikleyebilir.…”

“…Bunun için hemşire hastalıkların belirti ve bulguları, etyolojik faktörleri ve fizyopatolojik sürecine ilişkin bilgiye sahip olmalı;; ilaçların farmakolojik özelliklerini ve hasta üzerindeki etkilerini bilmeli;; fizik tanılama konusunda yeteri olmalı;; dinleme, gözlem yapma, hızlı ve kritik düşünme, analiz sentez etme, problem çözme, karar verme gibi becerileri geliştirmelidir (Schriver, Talmadge, Chuong and Hedges 2003). Ancak bu şekilde acil hemşireliği güçlendirilebilir (Bruce and Suserud 2005;; Wolf 2008;Wolf and Everson 2010).…”