Experiences with and attitudes towards geriatric screening among older emergency department patients: a qualitative study

Abstract Background The patient perspective on the use of screening for high risks of adverse health outcomes in Emergency Department (ED) care is underexposed, although it is an important perspective influencing implementation in routine care. This study explores the experiences with, and attitudes towards geriatric screening in routine ED care among older people who visited the ED. Methods This was a qualitative study using individual face-to-face semi-structured interviews. Interviews were conducted in older patients (≥70 years) who completed the ‘Acutely Presenting Older Patient’ screener while visiting the ED of a Dutch academic hospital. Purposive convenience sampling was used to select a heterogeneous sample of participants regarding age, disease severity and the result from screening. Transcripts were analyzed inductively using thematic analysis. Results After 13 interviews (7 women, median age 82 years), data saturation was reached. The participants had noticed little of the screening administration during triage and screening was considered as a normal part of ED care. Most participants believed that geriatric screening contributes to assessing older patients holistically, recognizing geriatric problems early and comforting patients with communication and attention. None of the participants had a negative attitude towards screening or thought that screening is discrimination on age. Care providers should communicate respectfully with frail older patients and involve them in decision-making. Conclusions Older patients experienced geriatric screening as a normal part of ED care and had predominantly positive attitudes towards its use in the ED. This qualitative study advocates for continuing the implementation of geriatric screening in routine ED practice.

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“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BMC Health Services Research ◽

10.1186/s12913-021-06110-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anh Ly ◽

Roger Zemek ◽

Bruce Wright ◽

Jennifer Zwicker ◽

Kathryn Schneider ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Clinical Pathways ◽

Theoretical Domains Framework ◽

Local Context ◽

Emergency Department Physician ◽

Evidence Based ◽

Care Providers ◽

Structured Interviews ◽

Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918771812 ◽

2018 ◽

Vol 25 (5) ◽

pp. 249-256 ◽

Cited By ~ 1

Author(s):

Rein Ketelaars ◽

Esther Van Heumen ◽

Lambert P Baken ◽

Marja Witten ◽

Gert Jan Scheffer ◽

...

Keyword(s):

Emergency Department ◽

Qualitative Study ◽

Solid Base ◽

Emergency Physicians ◽

Structured Interviews ◽

Evaluation Program ◽

Practical Applications ◽

Assurance System ◽

Essential Insight ◽

Level 2

Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.

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Strategies to reach marginalized women for cervical cancer screening: A qualitative study of stakeholder perspectives

Current Oncology ◽

10.3747/co.25.3851 ◽

2018 ◽

Vol 25 (1) ◽

pp. 8 ◽

Cited By ~ 3

Author(s):

B. Wood ◽

A. Lofters ◽

M. Vahabi

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Qualitative Study ◽

Cervical Cancer Screening ◽

Health Care Providers ◽

Cervical Screening ◽

Primary Care Providers ◽

Care Providers ◽

Structured Interviews ◽

Primary Screening

Background Self-sampling for human papillomavirus (hpv) has the potential to reach marginalized populations that are underserved for cervical cancer screening. However, before implementing an alternative screening strategy such as self-sampling for under- and never-screened women, the key processes, facilitators, and barriers to reform need to be understood.Methods A descriptive qualitative study was conducted that involved semi-structured interviews with Canadian and international cancer screening health care providers and policy-makers. Respondents were purposively selected from a list of thirty stakeholders generated through an environmental scan. The interviews were transcribed verbatim and analyzed using directed content analysis.Results Nineteen stakeholders participated in the interviews. Most respondents thought that self-sampling was an appropriate cervical screening alternative for hard-to-reach populations, as it addressed barriers to cervical screening related to various social determinants of health. All respondents emphasized that transitioning to hpv primary screening would catalyze a policy shift towards self-sampling. Clinician respondents were less enthusiastic about self-sampling strategies since that discouraged women’s appointments with primary care providers, because cervical screening offered an opportunity to discuss other preventive health topics. There also was little consensus between respondents on whether the state of evidence was satisfactory to integrate a self-sampling option into policy, or whether more Canadian research was needed.Conclusion Canadian cervical cancer screening stakeholders should collaborate to identify the knowledge gaps that researchers should address and leverage the existing literature to implement tailored, patient-centred alternative cervical screening strategies. The transition to hpv primary screening would be a key first step in the broad implementation of hpv self-sampling in Canada.

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Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study

BMC Psychiatry ◽

10.1186/s12888-020-02889-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Azizeh Alizadeh ◽

Hamid Reza Khankeh ◽

Mohammad Barati ◽

Yazdan Ahmadi ◽

Arash Hadian ◽

...

Keyword(s):

Health Care ◽

Content Analysis ◽

Psychological Distress ◽

Qualitative Study ◽

Health Care Providers ◽

Care Providers ◽

Structured Interviews ◽

Personal Support ◽

Corona Virus ◽

Organizational Demands

Abstract Background Novel corona virus, named COVID-19, has spread rapidly to other countries like Italy, Iran and South Korea and affected all people, especially health-care providers. Therefore, due to the rapid spread of the disease in Iran, the aim of the present study was to explore psychological distress experienced by Iranian health-care providers in the first few weeks of the corona virus outbreak. Methods The present qualitative study was conducted on 18 Iranian health-care providers exposed to COVID − 19 using a content analysis method. Purposeful sampling was used to select the participants and continued until data saturation was reached. Data were collected using semi-structured interviews and then the qualitative data were analyzed through direct content analysis. Results By analyzing 236 primary codes, two main categories were extracted from the experiences of health-care providers during corona virus outbreak. The first category included Occupational demands with three sub-categories: nature of illness, Organizational demands and social demands. The second category was Supportive resources included personal support and social support. Conclusions The results of this study found that there were some barriers and challenges to medical personnel exposed to COVID-19 that caused psychological distress. Some of these problems related to the nature of illness, others related to social and organizational demands and some of supportive resources buffer the relationship between occupational demands and psychological distress.

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Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

10.21203/rs.3.rs-80117/v1 ◽

2020 ◽

Author(s):

Daisy Kolk ◽

Anton F. Kruiswijk ◽

Janet L. MacNeil-Vroomen ◽

Milan L. Ridderikhof ◽

Bianca M. Buurman

Keyword(s):

Emergency Department ◽

Acute Care ◽

Older Patients ◽

Structured Interviews ◽

Post Discharge ◽

Qualitative Interview Study ◽

Before And After ◽

Ed Visits ◽

The Relationship

Abstract Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

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Psychological Distress among Iranian Health-Care Providers Exposed to Coronavirus Disease 2019 (COVID-19): A Qualitative Study

10.21203/rs.3.rs-29738/v1 ◽

2020 ◽

Author(s):

Azizeh Alizadeh ◽

Hamid Reza Khankeh ◽

Mohammad Barati ◽

Yazdan Ahmadi ◽

Arash Hadian ◽

...

Keyword(s):

Health Care ◽

Content Analysis ◽

Psychological Distress ◽

Qualitative Study ◽

Health Care Providers ◽

Care Providers ◽

Structured Interviews ◽

Corona Virus ◽

Data Saturation ◽

Health Demands

Abstract Background Novel corona virus pneumonia, named COVID-19, has spread rapidly to other countries like Italy, Iran and South Korea and affected all people, especially health-care providers. Therefore, due to the rapid spread of the disease in Iran, the aim of the present study was to explore psychological distress experienced by Iranian health-care providers in the first few weeks of the corona virus outbreak. Methods The present qualitative study was conducted on 18 Iranian health-care providers exposed to COVID − 19 using a content analysis method. Purposeful sampling was used to select the participants and continued until data saturation was reached. Data were collected using semi-structured interviews and then the qualitative data were analyzed through direct content analysis. Results By analyzing 236 primary codes, three main categories, including demands, job resources and individual resources were extracted from the experiences of health-care providers during corona virus outbreak. These categories each included several sub-categories, which were classified according to their significant characteristics. Conclusions .Psychological protection of health care workers is an important component in addressing the COVID-19 epidemic. Understanding the health care providers’ experiences and their mental health demands during public health emergency might help medical workers and managers to response better to a disaster.

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Factors to Improve Quality for Older Patients in the Emergency Department: A Qualitative Study of Patient Trajectory

10.21203/rs.3.rs-155870/v1 ◽

2021 ◽

Author(s):

Isabelle De Brauwer ◽

Pascale Cornette ◽

William D’Hoore ◽

Vincent Lorant ◽

Franck Verschuren ◽

...

Keyword(s):

Emergency Department ◽

Qualitative Study ◽

Older People ◽

Older Patients ◽

Inductive Reasoning ◽

Basic Needs ◽

Organizational Factors ◽

Care Quality ◽

Process Of Care ◽

Patient Centered

Abstract BackgroundManaging older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, in order to fine-tune future interventions for older people, taking into account the naturalistic context of the ED.Methods. This is a qualitative study of some 450 hours of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes.Results Four themes emerged: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients: unwelcome in EDs? ConclusionsThe overall process of care was based on an organ- and flow-centered paradigm, which ignored older people’s specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.

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Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden

10.1101/2021.06.20.21259197 ◽

2021 ◽

Author(s):

Reza Rasti ◽

Johanna Brannstrom ◽

Andreas Martensson ◽

Ingela Zenk ◽

Jesper Gantelius ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Qualitative Study ◽

Health Care Providers ◽

Point Of Care ◽

High Income ◽

Care Providers ◽

Clinical Patient ◽

Paediatric Emergency Department ◽

Paediatric Emergency

ABSTRACT Objectives In many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite their having greater laboratory accessibility. Although also part of the clinical routine in HICs, the utility of POCTs is relatively unknown in such settings as compared to others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterize health care providers perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to compare such experiences to those reported in other settings; and finally, to gather requests for ideal novel POCTs. Design Qualitative study using focus group discussions. A data-driven content analysis approach was used for analysis. Setting The PED of a secondary paediatric hospital in Stockholm, Sweden. Participants Twenty-four health care providers clinically active at the PED were enrolled in six focus groups. Results A range of POCTs was routinely used. The emerging theme "Utility of POCTs is double-edged" illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local testing practice was named to distract from the care for patients. Requests were made for novel POCTs and their implementation. Conclusion Despite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.

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Challenges of Obtaining Informed Consent in Emergency Ward: A Qualitative Study in One Iranian Hospital

The Open Nursing Journal ◽

10.2174/1874434601711010263 ◽

2017 ◽

Vol 11 (1) ◽

pp. 263-276 ◽

Cited By ~ 3

Author(s):

Nayyereh Davoudi ◽

Nahid Dehghan Nayeri ◽

Mohammad Saeed Zokaei ◽

Nematallah Fazeli

Keyword(s):

Informed Consent ◽

Qualitative Study ◽

Health Care Providers ◽

Participant Observation ◽

Research Field ◽

Public Hospitals ◽

Consent Process ◽

Care Providers ◽

Structured Interviews ◽

Emergency Ward

Background and Objective:Regarding the fact that emergency ward has unique characteristics, whose uniqueness affects informed consent processes by creating specific challenges. Hence, it seems necessary to identify the process and challenges of informed consent in the emergency ward through a qualitative study to understand actual patients’ and health care providers’ experiences, beliefs, values, and feelings about the informed consent in the emergency ward. Through such studies, new insight can be gained on the process of informed consent and its challenges with the hope that the resulting knowledge will enable the promotion of ethical, legal as well as effective health services to the patients in the emergency ward.Method:In this qualitative study, research field was one of the emergency wards of educational and public hospitals in Iran. Field work and participant observation were carried out for 515 hours from June 2014 to March 2016. Also, conversations and semi-structured interviews based on the observations were conducted. The participants of the study were nurses and physicians working in the emergency ward, as well as patients and their attendants who were involved in the process of obtaining informed consent.Results:Three main categories were extracted from the data: a sense of frustration; reverse protection; and culture of paternalism in consent process.Conclusion:Findings of this study can be utilized in correcting the structures and processes of obtaining informed consent together with promotion of patients' ethical and legal care in emergency ward. In this way, the approaches in consent process will be changed from paternalistic approach to patient-centered care which concomitantly protects patient’s autonomy.

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Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04022-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rodrigo Garcia-Cerde ◽

Pilar Torres-Pereda ◽

Marisela Olvera-Garcia ◽

Jennifer Hulme

Keyword(s):

Health Care ◽

Qualitative Study ◽

Training Program ◽

Health Care Providers ◽

Preventive Measure ◽

Respectful Maternity Care ◽

Care Providers ◽

Structured Interviews ◽

Post Intervention ◽

General Physician

Abstract Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. Methods This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.

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