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Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room: An interview study with registered nurses
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (COMCARE)ORCID iD: 0000-0003-2084-6284
Uppsala Univ Hosp, Dept Emergency Care & Internal Med, Uppsala, Sweden.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (COMCARE)ORCID iD: 0000-0002-0407-9831
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Med Management Ctr, LIME, Stockholm, Sweden. (HAL)ORCID iD: 0000-0002-4771-8349
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2022 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, no 7, p. 2165-2174Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022. Vol. 78, no 7, p. 2165-2174
Keywords [en]
emergency nursing, emergency room, fundamentals of care, interview study, person-centred care, PERCEPTIONS
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-57622DOI: 10.1111/jan.15172ISI: 000763102200001Scopus ID: 2-s2.0-85124513937OAI: oai:DiVA.org:mdh-57622DiVA, id: diva2:1645021
Available from: 2022-03-16 Created: 2022-03-16 Last updated: 2023-10-09Bibliographically approved
In thesis
1. Person-centered fundamental care in the emergency room: Patient and registered nurse perspectives
Open this publication in new window or tab >>Person-centered fundamental care in the emergency room: Patient and registered nurse perspectives
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients who suffer from life-threatening illness or injury – experiencing conditions such as cardiac arrest, breathing problems, or trauma – are cared for at designated emergency rooms within the emergency department. In the emergency room, the registered nurse is responsible for those who are exposed and vulnerable and have complex needs. In these rooms, the biomedical focus may reinforce a culture that values the medical-technical aspects of nursing. Meeting patients’ fundamental care needs, such as respect, information, and toileting, in a person-centered way seems challenging in emergency rooms. When care is not provided correctly, the consequences for the patient’s health can be serious, for instance resulting in physical complications in the form of pressure injuries from breathing masks and spine boards or psychological complications such as worry, anxiety, or post-traumatic stress syndrome. Little is known about how person-centered fundamental care is made visible and valued both for and by patients in emergency rooms. In this thesis the understanding of fundamental care is guided by the Fundamentals of Care framework, in order  to maintain an optimal person-centered care that considers the patient’s fundamental care needs with a holistic view of the patient. The overall aim of this thesis is to explore how person-centered fundamental care needs are met for life-threateningly ill patients in emergency rooms, from both patient and registered nurse perspectives.

Study I explored how fundamental care needs of life-threateningly ill or injured patients were met by observing the daily activities of registered nurses in the emergency room, through 108 observations. The results showed that registered nurses were initially engaged and active in meeting patients’ needs, but that this decreased over the duration of the care. Registered nurses met the patients’ physical needs to a greater extent than their psychosocial and relational ones. The environment affected the registered nurses’ ability to meet the patients’ fundamental care needs.

To describe fundamental care needs in the emergency room, based on life-threateningly ill patients’ experiences, an interview study (Study II) was conducted with 15 persons who had been cared for in an emergency room. The interviews were analyzed using deductive content analysis based on the Fundamentals of Care framework. The results showed that relationship, timely and personalized information, and existential needs were identified as essential fundamental care needs, which were not (or only partly) met. The physical environment limited patients in having their fundamental care needs met, and they adopted a “patient role” to avoid adding to healthcare professionals’ stress.

Study III described registered nurses’ work approach and prerequisites for meeting life-threateningly ill patients’ care needs from the perspective of a person-centered fundamental care framework, through 14 interviews. The results revealed that registered nurses structure their work approach in meeting patients’ fundamental care needs based on prevailing organizational and personal prerequisites.

In Study IV the content of guidelines governing the registered nurses’ work in the emergency room was investigated. The results revealed that the registered nurses’ work in Swedish emergency rooms was guided by an instrumental and task-oriented approach to care. The guidelines lacked guidance in providing for patients’ fundamental care needs, and did not support the registered nurses in conducting holistic, comprehensive patient assessments and interventions.

The organizational prerequisites contribute to a task-oriented and instrumental way of working, and patients are not having their fundamental care needs fully met. Fundamental care is not being promoted or prioritized, as the organization and responsibilities for providing person-centered fundamental care are unclear, unspecified, and lacking in direction for how it is to be performed – neither the organization nor the culture supports the registered nurses’ work and profession.

Place, publisher, year, edition, pages
Västerås: Mälardalens universitet, 2023. p. 98
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 393
Keywords
emergency care; emergency nursing; emergency room; fundamental care; person-centered care; life-threatening illness or injury
National Category
Medical and Health Sciences Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-64489 (URN)978-91-7485-614-9 (ISBN)
Public defence
2023-12-08, Omega och digitalt via Zoom, Mälardalens Universitet, Västerås, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2023-10-11 Created: 2023-10-09 Last updated: 2023-11-17Bibliographically approved

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Pavedahl, VeronicaSummer Meranius, Martinavon Thiele Schwarz, UlricaHolmström, Inger

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