scholarly journals “A Sustained, Productive, Constructive Relationship with Someone Who Can Help”—A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis

2021 ◽  
Vol 18 (19) ◽  
pp. 10262
Author(s):  
Demee Rheinberger ◽  
Diane Macdonald ◽  
Lauren McGillivray ◽  
Myfanwy Maple ◽  
Michelle Torok ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Times ◽  
Physical Space ◽  
Theory Approach ◽  
Structured Interviews ◽  
Support Person ◽  
Policies And Procedures ◽  
Systemic Factors ◽  
Qualitative Exploration ◽  
Suicidal Crisis

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.

scholarly journals P140: Investigating volunteer perspectives on leading patient-centred practices in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S114-S115
Author(s):  
L. Witt ◽  
T. Oyedokun ◽  
D. Goodridge ◽  
J. Stempien ◽  
T. Graham
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Care ◽  
Waiting Times ◽  
Physical Space ◽  
Cultural Safety ◽  
Wait Times ◽  
Two Phase ◽  
Survey Responses ◽  
Current Practices

Introduction: Patient satisfaction is an essential component of effective delivery of quality care in the emergency department (ED). Frequent reflection on current practices is required to detect areas in need of improvement. The Ontario Hospital Association (OHA) outlined five ‘Leading Practices’ (LPs) targeted to increase patient satisfaction in this setting. The ED volunteers are a group of individuals who have unique perspectives on ED practices that are unbiased by confounders affecting patients and staff. The goal of this study was to explore the unique perspectives of ED volunteers involving what they believe will improve the delivery of patient-centered care, as well as to examine to what extent Saskatoon EDs are embracing the principles outlined in the OHA LPs. Methods: A two-phase mixed methods approach, with a survey followed by interviews that allowed participants to expand on survey findings was used. The pool of 45 ED volunteers was extended the opportunity to participate resulting in 36 survey responses and 6 interviews. The 13 Likert-grade survey questions were generated to align to each of the LPs and allowed room for qualitative feedback. Interview questions were generated following 15 survey responses to expand on the LPs that were rated below average. Results: Analysis of responses identified inefficient ED processes leading to increased waiting times, inefficient patient location, inadequate signage, a lack of physical space, unclean environments, and a lack of staff and volunteer awareness regarding spiritual care and interpreter services, perceptions of received care by patients due to long wait times and level of cultural safety training of ED staff. Themes reduced from interviews yielded common themes such as patient frustration, disorganization, uncomfortable environment, overcrowding, prolonged wait times, and patient misconception of ED processes at Site 1. Themes common to Site 2 included organization, patient-friendly environment, patient misconception of ED processes, and prolonged wait times. Additionally, the volunteers suggested a plethora of interventions that could improve the current processes in Saskatoon's EDs to make them more patient friendly. Conclusion: Saskatoon EDs comply reasonably well to the OHA Leading practices. Surveying ED volunteers provides important insight into current practices and areas for improvement, and should be considered at other sites to improve adherence to the OHA LPs.

Abstract P177: Provider Perspectives on Improving Telestroke Usability - A Qualitative Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Elena Blaginykh ◽  
Ken Uchino ◽  
Dena R Brown ◽  
Zeshaun KHAWAJA
Keyword(s):  
Emergency Department ◽  
Systems Of Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Theory Approach ◽  
Nurse Training ◽  
Emergency Physicians ◽  
Structured Interviews ◽  
Program Managers ◽  
Provider Perspectives

Background: Telestroke is an integral part of acute stroke systems of care. To further grow telestroke and maintain quality, we surveyed telestroke stakeholders’ experience. Methods: We conducted open-ended, semi-structured interviews with stroke program managers, hub neurologists, emergency department physicians and nurses in a telestroke network in an academic medical center. The goal of the interviews was to understand stakeholders’ experience with telestroke including their perceptions of telestroke values, barriers, and solutions. The data analysis was performed using qualitative methods guided by a grounded theory approach. Results: Face-to-face interviews with 44 stakeholders, including 8 hub neurologists, 7 stroke program managers, 15 emergency physicians, and 14 emergency department nurses were completed. The values provided by telestroke were consistent: empowering emergency physicians in treatment decisions, increasing access to a comprehensive stroke care, and improving health outcomes. The stakeholders also agreed that the main utilization barriers were unmatched role expectations, technical issues, and patient-provider detachment. Other barriers were specific to certain stakeholder groups. Stroke program managers emphasized the importance of the unified criteria for telestroke activation. Hub neurologists highlighted the lack of interoperability of the electronic health records system and the variation in nurse training. Nurses reported inadequate dissemination of the telestroke updates during night-shifts. Emergency physicians were concerned about the lack of emergency department representation at telestroke meetings. The stakeholders were actively managing arising issues through developing their own strategies and reporting the problems to the telestroke program. Conclusion: Stakeholders perceive telestroke as a necessary tool that assure high quality care. However, addressing the barriers to optimal telestroke use might improve provider and patient experience.

scholarly journals The unheard voice: a qualitative exploration of companions' experiences of liaison psychiatry and mental health crises in the emergency department

2019 ◽  
Vol 43 (5) ◽  
pp. 204-209
Author(s):  
Jennifer Collom ◽  
Emma Patterson ◽  
Geoff Lawrence-Smith ◽  
Derek K. Tracy
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Clinical Practice ◽  
Current Understanding ◽  
Clinical Implications ◽  
Structured Interviews ◽  
Liaison Psychiatry ◽  
Purposive Sampling ◽  
London Hospital ◽  
Qualitative Exploration

Aims and methodTo understand the experience of companions of patients seen in the emergency department by liaison psychiatry teams. Participants were recruited via purposive sampling following a recent visit to the emergency department of an inner- or outer-London hospital. Semi-structured interviews were administered to all participants.ResultsTwo major themes were generated. The first concerned the appropriateness of the clinical space, in which ‘noise’, ‘privacy’ and the ‘waiting area’ were subthemes. The second was communication with staff, including subthemes of ‘wanting more information’ and a ‘desire to be more involved’.Clinical implicationsLiaison psychiatry services should consider appropriateness of the clinical space, promoting improved communication between staff and patients' companions, and a review of the information provided to companions in the emergency department. This research offers a novel perspective on liaison psychiatry and will enhance current understanding and clinical practice.

Attitudes of emergency department physicians and nurses toward implementation of an early warning score to identify critically ill patients: qualitative explanations for failed implementation

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 269-273 ◽  
Author(s):  
Blair L. Bigham ◽  
Teresa Chan ◽  
Steven Skitch ◽  
Alison Fox-Robichaud
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Early Warning ◽  
Critically Ill Patients ◽  
Cultural Barriers ◽  
Constructivist Grounded Theory ◽  
Early Warning Score ◽  
Theory Approach ◽  
Structured Interviews ◽  
Common Time

AbstractBackgroundSepsis, a common, time-sensitive condition, is sometimes not identified at emergency department (ED) triage. The use of early warning scores has been shown to improve sepsis-related screening in other settings.ObjectivesOur objective was to elucidate nurse and physician perceptions with the Hamilton Early Warning Score (HEWS) in combination with the Canadian Triage Acuity Scale.MethodSemi-structured interviews were conducted with nurses, resident physicians and attending physicians to explore perceived feasibility, utility, comfort, barriers, successes, opportunities and accuracy. A constructivist grounded theory approach was used. Transcripts were coded into thematic coding trees.ResultsThe twelve participants did not value the HEWS in the ED because they felt it was not helpful in identifying critically ill patients. We identified five themes; knowledge of sepsis and HEWS, utility of HEWS in emergency triage, utility of HEWS at the bedside, utility in communicating acuity and deterioration, and feasibility and accuracy of data collection. We also found 9 barriers and 7 enablers to the use of early warning score in the ED.ConclusionsIn our emergency departments, we identified potential barriers to implementation of an early warning score. A pre-existing expertise and lexicon related to critically ill patients lessens the perceived utility of an EWS in the ED. Understanding these cultural barriers needs to be addressed through change theory and implementation science.

scholarly journals Male autistic youth experiences of belonging in integrated physical education

Autism ◽  
2021 ◽  
pp. 136236132110186
Author(s):  
Justin A Haegele ◽  
Anthony J Maher
Keyword(s):  
Physical Education ◽  
Peer Relationships ◽  
Peer Interactions ◽  
Physical Space ◽  
The United States ◽  
Educational Needs ◽  
Subjective Experiences ◽  
Structured Interviews ◽  
Autistic People ◽  
Locker Room

The study examined the subjective experiences of autistic youth regarding the role of peer interactions and relationships in feelings of belonging in integrated physical education classes. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. Eight autistic youth (all male, aged 13–18 years) who had received most of their physical education in integrated classes acted as participants. Semi-structured interviews were used to generate qualitative data, which were analyzed using a reflexive thematic approach. Findings are presented in three themes: (a) bullying can lead to self-harm and self-isolation, (b) peer interactions and relationships in the locker room, and (c) peer relationships are based on shared interests and take time to develop. Even though autistic students were educated in the same spaces as their non-autistic peers, feelings of belonging were largely unavailable to them. Lay abstract Recent years have seen calls to amplify the voices of autistic people in research about their subjective experiences. Despite this, we know little about how autistic youth experience integrated physical education, particularly in the United States. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. In this study, we sought to explore the perspectives of autistic youth toward their experiences in integrated physical education, and the roles of social interactions and relationships with peers in those experiences. Findings noted that several factors influenced the ways and extent to which our participants interacted with their peers during physical education. Unfortunately, most of our participants recalled experiencing bullying, and that physical education offered an environment where bullying was most frequent and comparatively unique compared to other contexts throughout the school day. The locker room, a space linked to physical education, was of particular concern because of a lack of teacher presence. Despite the negative views of and experiences in physical education, there was evidence of participants actively pursuing to connect with peers in this context. However, most instances where participants recalled pursuing friendship were not welcomed from others, which stunted their sense of belonging in this space. Given the role that belonging plays in what it means “to be included,” our research supports emerging ideas that even though autistic students were educated in the same physical spaces as their non-autistic peers, feelings of inclusion were largely absent.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Can Watching Online Videos Be Addictive? A Qualitative Exploration of Online Video Watching among Chinese Young Adults

2021 ◽  
Vol 18 (14) ◽  
pp. 7247
Author(s):  
Zeyang Yang ◽  
Mark Griffiths ◽  
Zhihao Yan ◽  
Wenting Xu
Keyword(s):  
Social Interaction ◽  
Short Form ◽  
Leisure Activity ◽  
Online Video ◽  
Video Content ◽  
Structured Interviews ◽  
Negative Effects ◽  
Online Videos ◽  
Chinese Young Adults ◽  
Qualitative Exploration

Watching online videos (including short-form videos) has become the most popular leisure activity in China. However, a few studies have reported the potential negative effects of online video watching behaviors (including the potential for ‘addiction’) among a minority of individuals. The present study investigated online video watching behaviors, motivational factors for watching online videos, and potentially addictive indicators of watching online videos. Semi-structured interviews were conducted among 20 young Chinese adults. Qualitative data were analyzed using thematic analysis. Eight themes were identified comprising: (i) content is key; (ii) types of online video watching; (iii) platform function hooks; (iv) personal interests; (v) watching becoming habitual; (vi) social interaction needs; (vii) reassurance needs; and (viii) addiction-like symptoms. Specific video content (e.g., mukbang, pornography), platform-driven continuous watching, and short-form videos were perceived by some participants as being potentially addictive. Specific features or content on Chinese online video platforms (e.g., ‘Danmu’ scrolling comments) need further investigation. Future studies should explore users’ addictive-like behaviors in relation to specific types of online video content and their social interaction on these platforms.

scholarly journals Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication

2021 ◽  
Vol 11 ◽  
pp. 204512532198913
Author(s):  
Miriam Larsen-Barr ◽  
Fred Seymour
Keyword(s):  
Antipsychotic Medication ◽  
Online Survey ◽  
Structured Interviews ◽  
Obsessive Compulsive ◽  
Convenience Sample ◽  
Internal Resources ◽  
Compulsive Disorder ◽  
What Works ◽  
Systemic Factors ◽  
The Impact

Background: It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. Methods: A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. Results: Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25–25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by ‘understanding myself and my needs’, ‘finding what works for me’ and ‘connecting with support’. Sub-themes expand on the way in which they did this. For example, ‘finding what works for me’ included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. Conclusion: This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.

scholarly journals “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

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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