Patient experience of emergency department triage: An integrative review.

BACKGROUND: Emergency department (ED) triage is often patients' first contact with a health service and a critical point for patient experience. This review aimed to understand patient experience of ED triage and the waiting room. METHODS: A systematic six-stage approach guided the integrative review. Medline, CINAHL, EmCare, Scopus, ProQuest, Cochrane Library, and JBI database were systematically searched for primary research published between 2000-2022 that reported patient experience of ED triage and/or waiting room. Quality was assessed using established critical appraisal tools. Data were analysed for descriptive statistics and themes using the constant comparison method. RESULTS: Twenty-nine articles were included. Studies were mostly observational (n = 17), conducted at a single site (n = 23), and involved low-moderate acuity patients (n = 13). Nine interventions were identified. Five themes emerged: 'the who, what and how of triage', 'the patient as a person', 'to know or not to know', 'the waiting game', and 'to leave or not to leave'. CONCLUSION: Wait times, initiation of assessment and treatment, information provision and interactions with triage staff appeared to have the most impact on patient experience, though patients' desires for each varied. A person-centred approach to triage is recommended.

Review article: Prehospital telehealth for emergency care: A scoping review.

Telehealth has been successfully implemented in the prehospital setting to expedite emergency care, although applications are still in their infancy. With recent advances in technologies, it is not described how prehospital telehealth has evolved over the past decade. This scoping review aimed to answer the research question 'what telehealth platforms have been used to facilitate communication between prehospital healthcare providers and emergency clinicians in the past decade?'. The review was guided by Joanna Briggs Institute scoping review methodology and reported in accordance with the PRISMA checklist for scoping reviews. A systematic search of five databases and Google Scholar was undertaken using key terms 'prehospital', 'ambulance', 'emergency care' and 'telehealth', and results were limited to research articles published in English language between 2011 and 2021. Articles were included if they related to the research question and reported quantitative, qualitative, mixed-method or feasibility studies. A total of 28 articles were included in the review that reported feasibility (n = 13), intervention (n = 7) or observational studies (n = 8) involving 20 telehealth platforms. Platforms were commonly implemented to provide prehospital staff with medical support for general emergency care and involved a range of devices that were used to transmit video, audio and biomedical data. The benefits of prehospital telehealth to patients, clinicians and organisations were identified. Challenges to telehealth involved technical, clinical and organisational issues. Few facilitators of prehospital telehealth were identified. Telehealth platforms to facilitate prehospital to ED communication continue to develop but require technological advances and improved network connectivity to support implementation in the prehospital environment.

Development of patient-centred care in acute hospital settings: A meta-narrative review.

BACKGROUND: Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM: To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS: A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS: One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS: Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT: Patient-centred care in acute care settings - we have arrived! Is it sustainable?

Mental health nurses' perspectives of people who self-harm.

Self-harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self-harm. The aim of this study was to explore mental health nurses' (MHNs) experience of working with people who self-harm. Data were collected using semi-structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs' inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs' experiences of working with people who self-harm: (i) Nurses' level of preparedness to work with people who self-harm; and (ii) The healthcare system. Several sub-categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self-harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self-harm and an accurate understanding of the functions of self-harm focuses therapeutic interactions to manage psychological distress and reduce further self-harm and lessen the risk of suicide.

Perceptions of knowledge, attitude and skills about non-suicidal self-injury: A survey of emergency and mental health nurses.

Non-suicidal self-injury (NSSI) is a major public health concern and is also associated with increased risk of suicide. The type of care people with NSSI receive at the hospital impacts their health outcomes. This study explored emergency department (ED) and mental health nurses' (MHNs) understanding, attitudes, empathy and confidence to work with people presenting with NSSI. ED and MHNs who belonged to either the College of Emergency Nursing Australasia (CENA) or the Australian College of Mental Health Nurses (ACMHN) were invited to complete an online survey through a group email from their college. One hundred and one nurses (56 ED and 45 MHNs) completed the survey. The results revealed that nurses from both groups had an accurate understanding of NSSI and had positive attitudes about patients who self-injure. However, confidence was higher among MHNs. Greater knowledge of NSSI was correlated with increased confidence, positive attitudes and empathy. For mental health nurses, but not ED nurses, years of clinical practice was associated with nurses' confidence. In contrast, ED nurses with more than 10 years' experience were less confident in addressing NSSI than ED nurses with less experience. Issues that affect both ED and MHNs' knowledge, attitude, empathy and confidence to care for patients who self-injure are multifactorial. Future education and training should focus on therapeutic interactions with people at risk of repeat NSSI. Further, more research is recommended to explore patients' perspectives of nurses' attitudes in care for people who self-injure.

Emergency nurses' experience of providing care to patients who self-harm.

BACKGROUND: Individuals who self-harm may present to emergency departments (EDs) for medical care. As first responders, emergency nurses can have a significant impact on the health outcomes of people who self-harm. This research explored emergency nurses' experiences of working with patients who self-harm. METHODS: Data were collected using semi-structured interviews and analysed using Elo and Kyngäs' inductive content analysis. Researcher checks ensured consensus of identified categories. Adherence to the research method and inclusion of participant citations added to the trustworthiness of findings. RESULTS: Eighteen emergency nurses from across Australia participated in the research. The category "Nurses' level of preparedness to work with people who self-harm" emerged during data analysis with four sub-categories: (1) Nurses' level of comfort to work with people who self-harm; (2) Nursing role; (3) Barriers and facilitators to providing quality care; and (4) Education and training. CONCLUSIONS: The ED is a challenging environment to provide care to people who present with self-harm. Nurses' level of comfort and attitudes towards caring for people who self-harm improved with knowledge, support and experience. Education and training in the area were important.