Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain.

AIM AND OBJECTIVES: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. BACKGROUND: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high-quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high-quality fundamental care across the acute care chain. DESIGN: Qualitative descriptive semi-structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. METHODS: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro- and macrolevels across the acute care chain. RESULTS: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. CONCLUSIONS: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. RELEVANCE TO CLINICAL PRACTICE: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence-based and high-quality care.

Engagement under difficult conditions: Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study.

BACKGROUND: Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain. AIM: To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care. METHOD: Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed. RESULTS: Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain. CONCLUSION: This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.