scholarly journals Nursing Qualifications needed in Municipal Emergency Inpatient Units. A qualitative study

2021 ◽  
Author(s):  
Bodil J. Landstad ◽  
Torstein Hole ◽  
Aasta Marie Sveino Strand ◽  
Marit Kvangarsnes
Keyword(s):  
Emergency Care ◽  
Hospital Admissions ◽  
Medical Knowledge ◽  
Clinical Judgement ◽  
Continuous Learning ◽  
Complex Needs ◽  
Treatment Management ◽  
Family Perspective ◽  
Holistic Understanding ◽  
Inpatient Units

Abstract Background: Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the districts. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities.The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed.Results: The physicians highlighted broad medical knowledge, clinical judgement, skills in treatment management and communication, a holistic understanding, and continuous learning as relevant professional qualifications for nurses in municipal emergency inpatient units. Taking a holistic approach requires ethical judgement and teamwork. Interpersonal skills and adopting a family perspective were considered important in facilitating care in municipal emergency inpatient units.Conclusions: Nurses have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Nurses should adopt a family perspective when managing patients in municipal emergency inpatient units. Nursing education should prepare students to treat patients with complex needs and chronic illnesses. This requires an emphasis on broad medical knowledge, clinical judgement, and skills in communication, treatment management and continuous learning.

scholarly journals Nursing qualifications needed in municipal emergency inpatient units. A qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bodil J. Landstad ◽  
Torstein Hole ◽  
Aasta-Marie Sveino Strand ◽  
Marit Kvangarsnes
Keyword(s):  
Emergency Care ◽  
Hospital Admissions ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Holistic Approach ◽  
Older Individuals ◽  
Complex Needs ◽  
Emergency Situations ◽  
Interprofessional Cooperation ◽  
Inpatient Units

Abstract Background Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the municipalities. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities. The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. Method A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed. Results We synthesised three themes from the data: (1) broad medical knowledge; (2) advanced clinical skills; and (3) ethical qualifications and a holistic approach. The first theme is about knowledge, the second is about skills, and the third conveys the need for overall competence. Conclusions Nurses working in municipal emergency inpatient units need advanced ethical qualifications, which integrate broad medical knowledge, advanced clinical skills and the ability to take a holistic approach. They have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Establishing arenas for collaborative practice between physicians and nurses on clinical issues may be a way of strengthening patient safety and nurses’ clinical judgement.

scholarly journals Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

2021 ◽  
Vol 38 (5) ◽  
pp. 371-372
Author(s):  
Rich Carden ◽  
Bill Leaning ◽  
Tony Joy
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Response Unit ◽  
Care Services ◽  
Vulnerable Patients ◽  
Palliative Care Services ◽  
Alternative Solutions ◽  
Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

Extreme Caregiving

2017 ◽  
Author(s):  
Lisa Freitag
Keyword(s):  
Identity Formation ◽  
Special Needs ◽  
Academic Research ◽  
Medical Knowledge ◽  
Term Care ◽  
Complex Needs ◽  
Social Lives ◽  
Physical Burden ◽  
Care And Support ◽  
Uncertain Future

Raising a child with multiple special needs or disabilities is a time-consuming and difficult task that exceeds the usual parameters of parenting. This book examines all the facets of that task, from the better-known physical, financial, and emotional burdens to the previously invisible moral work involved. Drawing from narratives written by parents of children with a variety of special needs, academic research in ethics and disability, and personal experience in pediatrics, this book begins to recognize the moral consequences of providing long-term care for a child with complex needs. Using a virtue ethic framework based on Joan Tronto’s phases of care, it isolates the various tasks involved and evaluates the moral demands placed on the parent performing them. Raising a child with special needs requires an excess of attentiveness, responsibility, competence, and responsiveness, and demands from the parent a reassessment of their personal and social lives. In each phase, moral work must be done to become the sort of person who can perform the necessary caregiving. Some of the consequences are predictable, such as the emotional and physical burden of constant attentiveness and numerous unexpected responsibilities. But the need for competence, which drives an acquisition of medical knowledge, has not previously been analyzed. Nor has there been recognition of the enormous moral task of encouraging identity formation in a child with intellectual delays or autism. For a child who cannot attain independence, parents must continue to provide care and support into an uncertain future.

BPI19-010: Febrile Neutropenia Induced by Chemotherapy: Impact of Risk Re-Stratification

2019 ◽  
Vol 17 (3.5) ◽  
pp. BPI19-010
Author(s):  
David da Silva Dias ◽  
Catarina Jorge ◽  
Mafalda Baptista ◽  
Ana Júlia Arede ◽  
Paulo Luz ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Febrile Neutropenia ◽  
Hospital Admissions ◽  
Stage Iv ◽  
Low Risk ◽  
Severe Neutropenia ◽  
Clinical Judgement ◽  
Extended Spectrum Beta Lactamase ◽  
Focal Infection ◽  
Stage Iv Cancer

Introduction: Febrile neutropenia (FN) induced by chemotherapy (ChT) arises until 6 weeks after the last cycle, usually between 5 and 10 days post-ChT. Infection risk is 20%–30%. It is difficult to stratify patients with low risk of complications due to FN. MASCC index is useful but has limitations. This correlates with unnecessary hospital admissions, complications, and costs. Methods: Retrospective study of patients with diagnosis of FN induced by ChT, admitted to our center between 2012 and 2016. Primary goal was to describe this population. Secondary goal was to re-stratify the risk of FN using MASCC and CISNE indexes, clinical judgement, and social/logistic factors. SPSS v23 was used for statistical analysis. Results: 211 patients were included; median age, 66 years. Median hospital stay was 6 days (1–89). 25% were nosocomial admissions. At admission 46% of patients presented with stage IV cancer. 75% were solid neoplasms and 25% were hematologic. Profound neutropenia was observed in 43% and severe neutropenia in 36%. Overall mortality rate was 13%. Sepsis was diagnosed in 24 patients (11%), with a mortality rate of 54%. Only 12.3% of patients had prophylaxis with granulocyte-colony stimulating factor. At admission, 64% of patients had no obvious focal infection; 20% had probable focus; and in 16% a microorganism was identified, most commonly gram-negative Enterobacteriaceae. Most used antibiotics were piperacillin/tazobactam (44%) and its combination with aminoglycoside (34%). This combination showed benefit against some extended-spectrum beta-lactamase (ESBL)–producing strains and multiresistant (MR) Pseudomonas aeruginosa (2.8%). MASCC index identified 31% of patients with low risk FN. After applying the CISNE index, clinical judgement, and social/logistic factors, only 11% were identified as low-risk FN and did not benefit from admission. This translates to an avoidable cost of €48,000 according to the center’s annual report. Conclusion: The combination of β-lactam and aminoglycoside is overused in our practice. It is not recommended in hemodynamically stable patients and contradictory in unstable ones; still it shows some effect versus MR and ESBL strains. A study to evaluate their incidence in our center is now in progress. Low risk FN was observed in 11% of admitted patients. Our center has an internal protocol and has been able to provide a good overall response.

scholarly journals Nursing diagnoses and interventions in mental health used in hospital admissions units: integrative Review

2020 ◽  
pp. 1165-1171
Author(s):  
Nathália Duarte Bard ◽  
Isadora Olizsewski Feijó ◽  
Jaqueline Ramires Ipuchima ◽  
Adriana Aparecida Paz ◽  
Graciele Fernanda da Costa Linch
Keyword(s):  
Mental Health ◽  
Family Relationships ◽  
Hospital Admissions ◽  
Active Listening ◽  
Hospital Inpatient ◽  
Mental Health Nursing ◽  
Appropriate Behavior ◽  
Health Nursing ◽  
Inpatient Units ◽  
Nursing Diagnoses

Objective: The study’s purpose has been to identify nursing diagnoses and interventions used in hospital inpatient units related to mental health care. Methods: It is an integrative literature review that was performed in the PubMed, Scopus, and Web of Science databases, over the period from 2014 to 2018. Nine articles make up the study sample. Results: Mental health nursing diagnoses were grouped into related feelings: anxiety, fear, sadness, aggression, stress, denial, and family relationships. The interventions were related to cares as follows: clarify the treatment, be aware of physical and emotional risks, stimulate leaving the room, provide guidance on sleep hygiene, include family members in the treatment, promote and allow choices when possible, avoid physical and mental exhaustion of the patient, provide positive feedback on coping, provide emotional support, promote cognitive stimuli, guide appropriate behavior, perform active listening and mediate interpersonal conflicts. Conclusion: There was a shortage of studies addressing this matter.

scholarly journals The impact of closing emergency departments on mortality in emergencies: an observational study

2019 ◽  
Vol 36 (11) ◽  
pp. 645-651 ◽  
Author(s):  
Emma Knowles ◽  
Neil Shephard ◽  
Tony Stone ◽  
Suzanne M Mason ◽  
Jon Nicholl
Keyword(s):  
Emergency Care ◽  
Emergency Departments ◽  
Hospital Admissions ◽  
Geographical Area ◽  
Case Fatality ◽  
Urgent Care ◽  
Mortality Data ◽  
Risk Of Death ◽  
Population Mortality ◽  
The Impact

BackgroundIn England the demand for emergency care is increasing, while there is also a staffing shortage. This has implications for quality of care and patient safety. One solution may be to concentrate resources on fewer sites by closing or downgrading emergency departments (EDs). Our aim was to quantify the impact of such reorganisation on population mortality.MethodsWe undertook a controlled interrupted time series analysis to detect the impact of closing or downgrading five EDs, which occurred due to concerns regarding sustainability. We obtained mortality data from 2007 to 2014 using national databases. To establish ED resident catchment populations, estimated journey times by road were supplied by the Department for Transport. Other major changes in the emergency and urgent care system were determined by analysis of annual NHS Trust reports in each geographical area studied. Our main outcome measures were mortality and case fatality for a set of 16 serious emergency conditions.ResultsFor residents in the areas affected by closure, journey time to the nearest ED increased (median change 9 min, range 0–25 min). We found no statistically reliable evidence of a change in overall mortality following reorganisation of ED care in any of the five areas or overall (+2.5% more deaths per month on average; 95% CI −5.2% to +10.2%; p=0.52). There was some evidence to suggest that, on average across the five areas, there was a small increase in case fatality, an indicator of the ‘risk of death’ (+2.3%, 95% CI +0.9% to+3.6%; p<0.001), but this may have arisen due to changes in hospital admissions.ConclusionsWe found no evidence that reorganisation of emergency care was associated with a change in population mortality in the five areas studied. Further research should establish the economic consequences and impact on patient experience and neighbouring hospitals.

scholarly journals 34 Geriatricians in Intermediate Care Settings: A Modern Approach to Geriatric Medicine

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i9-i10
Author(s):  
P Enwere ◽  
R Mahmood ◽  
A Aranda-Martinez ◽  
A Manzoor ◽  
E Wilkinson ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Care Delivery ◽  
Geriatric Medicine ◽  
Care Needs ◽  
Older Population ◽  
Modern Approach ◽  
North West ◽  
Complex Needs ◽  
Acute Hospitals ◽  
Hub Model

Abstract Introduction Due to growing older population with increasing medical complexity and care needs, over-reliance on acute hospitals for care delivery, disconnect between social and medicalised care and challenging national health services (NHS) financial climate, it is essential to provide much of this care to our older patients outside the acute hospital before they reach crisis point. This prevents unnecessary hospital admissions and outpatient referrals especially to our geriatric services. Therefore, newer and innovative care models are required to cater the needs of our aging population especially within the community settings. The North West Surrey clinical commissioning group (CCG) catchment area is divided into three localities, namely SASSE Locality in Spelthorne, Thames Medical Locality in Runnymede/West Elmbridge, and the Woking Locality (Bedser hub) in Woking. Locality hub model of integrated care led by GP with multidisciplinary (MDT) input along with wellbeing coordinators was introduced to address above issue. Objectives Our mission was to find a way to manage the challenges we face from a growing older population within an integrated GP-led community service and in a manner that promotes independence, reduce social isolation, improve patient experience and safely deliver appropriate acute care in the community whilst reducing dependency on regional acute hospitals. A fully qualified geriatrician input was introduced within the hub model at Bedser hub. Results Total savings: £16,484, Geriatricians input cost: £16,500 Cost neutral intervention Conclusions Newer models of collaborative healthcare within the community dwellings with GP and geriatrician input along with multidisciplinary approach are essential to deliver safe and high quality care to our older population, thus reducing reliance on our ever so stretched local acute NHS hospitals. Our intervention has resulted in reduction of referrals to geriatric outpatient clinic and enabled us to provide the required care to our older population closer to home. It has also led GPs to build their skills in managing the very frail patients with complex needs safely and effectively. In the long run, the intervention will be cost effective with further projected reduction in referrals.

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