Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses.

AIM: To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. DESIGN: A descriptive, qualitative interview study. METHOD: Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. RESULTS: Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. CONCLUSION: From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. IMPACT: To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.

Fundamentals of care in the emergency room - An ethnographic observational study.

BACKGROUND: There is a strong biomedical focus within emergency care. However, while failure to meet patients' fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. AIM: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. METHODS: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. RESULTS: Observations showed that registered nurses (RN) identified patients' fundamental care needs and provided nursing care. However, the RNs' focus on the patient decreased over time. When the RN communicated with the patient, the patients' physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs' ability to meet patients' fundamental care needs. CONCLUSION: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient-nurse relationship to meet the patient's physical, psychosocial, and relational needs.