Canadian Journal of Emergency Nursing (CJEN)
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Perceptions des professionnels de la santé face à la présence de la famille lors des manoeuvres de réanimation : une revue intégrative des écrits
Full text linkContexte : l’inclusion des familles lors d’une réanimation cardiorespiratoire constitue un défi clinique. En effet, les familles sont souvent absentes des protocoles de réanimation qui ciblent les interventions de l’équipe interprofessionnelle composée de médecins, d’infirmiers, d’inhalothérapeutes et de préposés aux bénéficiaires. La littérature scientifique existante parait peu étoffée sur la perception de l’équipe interprofessionnelle face à l’inclusion des familles durant la réanimation.
Objectif : le but de cette revue intégrative est de recenser des écrits traitant de la perception des membres de l’équipe interprofessionnelle face à la présence de la famille lors des manœuvres de réanimation.
Méthodologie : cette revue intégrative des écrits a été réalisée en consultant les bases de données Cumulative Index to Nursing Information and Allied Health Literature (CINAHL), PsycINFO, Medline, Web of Science, Cochrane et Joanna Briggs Institute (JBI). Les données ont été organisées selon les trois thèmes qu’identifient Twibell et al. (2008) dans leurs travaux : les bénéfices perçus par les professionnels de la santé, les risques perçus et le niveau de confiance en la pratique professionnelle.
Résultats : sur un total de 1910 écrits répertoriés, 23 articles scientifiques ont été retenus. Les trois thèmes identifiés dans les travaux de Twibell et al. (2008) ont servi de base à l’analyse des écrits. Cette dernière a été effectué à l’aide d’une analyse thématique. La littérature recensée aborde la perception principalement des infirmiers et des médecins, mais très peu des autres membres de l’équipe interprofessionnelle. Malgré les risques ou les appréhensions ressentis par les infirmiers et les médecins, la présence de la famille durant les manœuvres demeure bénéfique pour celle-ci.
Limites : cette revue intégrative n’a pas retenu d’article ciblant le point de vue des gestionnaires ou de décideurs politiques ni le point de vue de l’équipe interprofessionnelle œuvrant dans les urgences pédiatriques. De plus, la méthode d’analyse des données basée sur les thèmes de Twibell et al. (2008) entraîne un biais dans l’émergence d’autres thèmes. Enfin, les perceptions de l’équipe interprofessionnelle n’ont pas été rattachées au milieu d’exercice.
Conclusion : les résultats de cette revue intégrative offrent des pistes d’interventions qui permettront d’améliorer la pratique d’inclusion des familles lors des manœuvres de réanimation. Une attention particulière devrait être portée sur la formation initiale et continue des professionnels de la santé. De plus, cet article permet un début de réflexion chez les gestionnaires et décideurs afin de promouvoir une culture collaborative ainsi qu’une approche centrée sur le patient.
Mots-clés : équipe interprofessionnelle, réanimation, urgence, famille, revue intégrativ
English
No full textA better way to care for Long Term Care residents (LTC) in times of medical urgency: improving acute care for LTC residents.
Leanna Wyer, Shawna Reid, Abraham Munene, Eddy Lang, Vivian Ewa, Heather Hair, Greta Cummings, Patrick McLane, Eldon Spackman, Peter Faris, Dominic Alaazi, Marian George, Jayna Holroyd-Leduc
Background: Many LTC residents are transferred to Emergency Departments (EDs) with conditions that could be cared for in LTC, perhaps with additional support (e.g. Community Paramedics). Communication between sites and EDs has also been lacking. These lead to long lengths of stay in EDs, unnecessary use of resources, and sub-optimal health outcomes. Two INTERACT tools will support initial management of the concern at the LTC site. Then a Care and Referral Pathway will help facilitate needed conversations and optimal transfers between LTC and ED.
Implementation: Beginning in April 2019, standalone LTC sites in Calgary and Central zones have been invited to participate. Using a randomized stepped wedge design, we implement at 4-5 new sites every 3 months, with a total goal of implementing this change in 40 sites in Calgary and 9 sites in the Central zone. Early engagement with site medical directors, LTC and ED physicians, and managers at RAAPID (Referral, Access, Advice, Placement, Information and Destination) call centre and Community Paramedics was instrumental in getting the project initiated. Quarterly meetings with a project steering committee assists with ongoing project details and risk/issues. Operational leads and unit managers meet with our Senior Practice Consultant to be introduced to the project. This is followed by an implementation session at which site staff are given information about the specific tools and pathway, potential barriers are mitigated, and a site implementation plan is developed. Quarterly reports using data from a project Tableau dashboard are prepared by our Research Coordinator and distributed to LTC sites for them to monitor their performance compared to zone averages on a number of performance indicators.
Evaluation Methods: The project will be evaluated using both qualitative and quantitative measures. Key Performance Indicators include a reduction in transfers to EDs, improved satisfaction, and increased use of available resources. Residents, families and healthcare providers will participate in interviews or focus groups to assess their experiences with the interventions. Quantitative evaluation includes an economic analysis to determine how the interventions have led to cost savings within the healthcare system, as well as examination of the number transfers to ED, hospital admissions, calls to RAAPID, and visits by Community Paramedics. This will help to determine if the intervention has led to better resource utilization, increased satisfaction among residents and families, and improved patient and health system outcomes. At this stage of the project, no unintended consequences have been identified.
Results: Currently, we have implemented at 6 of 11 Cohorts (26 sites). Data from April 2019 (start of project) until December 2020 show a downward trend in number of ED visits and hospital admissions, as well as increased utilization of RAAPID. Formal evaluation will be completed when the project ends in June 2022. Given the COVID-19 pandemic, it is important to note that this may have an effect on our current trends and this will further be explored at the end of the project period. Anecdotal evidence is also beginning to indicate success of the right care being provided in the right place.
Advice and Lessons Learned:1) Firstly, partnerships with key stakeholders are vital to ensure successful utilization of theLTC-ED Care and Referral pathway. Specifically, RAAPID is key to the facilitation ofcommunication between LTC sites and the EDs, and the services provided by CommunityParamedics allow many residents to remain at their LTC homes.
2) Secondly, good engagement with Site Medical Directors and Operational leads is needed toensure LTC staff and physicians are supported to use the interventions, and to care for theirresidents on site if appropriate.
3) Finally, tailored implementation strategies for each individual LTC site (and units in somecases) help mitigate site specific barriers, leverage strengths, and work within the site culture
Éditorial sur l’examen par les pairs
Full text linkPeer review is the evaluation of written work by subject matter experts in the same field. It is quality assurance for scientific, academic and professional work ensuring that it is relevant for the journal audience, significant to the discipline, and accurate to the best knowledge of the reviewers and editors. Peer review can come in many forms including open review, single-blind, double-blind and even triple-blind.L’examen par les pairs consiste en l’évaluation du travail écrit par des experts du même domaine. C’est l’assurance de la qualité pour les travaux universitaires, scientifiques et professionnels qui a pour but de veiller à ce que les travaux soient pertinents au lectorat, valable au domaine et exact au meilleur de la connaissance des réviseurs et éditeurs. La révision par les pairs peut revêtir plusieurs formes y compris l’examen ouvert, à simple insu, à double insu et même à triple insu
Perceptions of healthcare professionals about the presence of family members during cardiopulmonary resuscitation: An integrative literature review
Full text linkContext: The inclusion of families during cardiopulmonary resuscitation procedures is a clinical challenge. Families are often overlooked in resuscitation protocols aimed at interventions by an interprofessional team, which includes physicians, nurses, respiratory therapists, and orderlies. The existing scientific literature has relatively little to say about the perception of the interprofessional team as to the inclusion of families during resuscitation
Objective: The goal of this integrative review is to explore existing papers on the perception of members of an interprofessional team with regard to the presence of family members during emergency room cardiopulmonary resuscitation procedures.
Method: This integrative review of the literature was carried out using the five-step method of Whittemore & Knafl (2005) comprising problem identification, literature search, data evaluation, data analysis, and presentation of a summary of the data. The research strategy focused on three key concepts: interprofessional, family and resuscitation. Scientific papers were found through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Medline, Web of Science, Cochrane and the Joanna Briggs Institute ( JBI). To be included
Conclusion: The results of this integrative review offer guidelines for improving the practice of inclusion of families during cardiopulmonary resuscitation procedures. Particular attention should be paid to the initial and continuing training of health professionals. Furthermore, this article allows for an initial reflection among managers and decision makers to promote a collaborative culture as well as a patient-centred approach.
Keywords: interprofessional team, resuscitation, emergency department, family, integrative revie
Initiating Buprenorphine/Naloxone for Opioid Use Disorder in the Emergency Department
Full text linkThe opioid crisis continues to affect individuals across the country, and requires a multifaceted approach to minimize the impact of this public health crisis. Through the chronic consumption of opioids, many individuals can become dependent on opioids and develop opioid use disorder. Buprenorphine/naloxone is the recommended treatment for patients living with opioid use disorder. The Emergency Strategic Clinical Network™ within Alberta Health Services is targeting the crisis through emergency departments by implementing a provincially standardized program. The Buprenorphine/Naloxone Initiation in Emergency Departments program includes screening for opioid use disorder, treatment initiation with the medication buprenorphine/naloxone, and providing rapid and reliable referrals to community clinics for titration and continuing patient care. This paper provides an overview of opioids, opioid use disorder, opioid agonist treatments such as buprenorphine/naloxone, and specifically details the program and protocol available in Alberta
Palliative home care patients’ emergency department visits near end of life: decision making and outcomes
Full text linkIntroduction & Aims
Some palliative patients have one or multiple ED visits near their end of life. People who stay home are more likely to die at home or in hospice compared to those admitted to acute care. This study was to describe decisions and outcomes of palliative home care patients who go to Emergency (ED) within the last 6 weeks of life in one metropolitan zone of Alberta Health Services.
Description
In the 2017-2018 fiscal year, there were 1874 palliative home care patients in the Edmonton Zone, of whom 646 (34.4 %) patients went to ED in the last 6 weeks of life. Of these, home care and emergency charts were reviewed for 194 deceased patients, selected by CTAS score, urban and suburban/rural, and unusual events: died in the ED, left the ED, admitted to critical care.
Key Findings Patients who went to ED were more likely to be male (59%) and older than 65 years (65 %). Most had cancer as a primary diagnosis (82.6%). More than 50 % went to ED more than once. For the majority (74.3%), the final ED visit was within 2 weeks of death; almost half were within 7 days (49.2%). Primary presenting concerns were pain (24.9%) and dyspnea (21.5%). There was no known goal of care reported or documented in either chart for 28.2%. In ED 85% had documentation that their goals or wishes for care were reviewed or discussed, of whom 9% had their first order written and 47.8% had their order changed to align care with their wishes and illness. 44.6% spent 8 hours or less in ED; 21 patients died in the ED. Most patients (73.8%) identified a preference to die at home or hospice; some wishes were unknown (7.2 %), others had not been discussed (17%); 77.5% died in hospital.
Conclusions and Implications
This study highlights the ongoing opportunity to meet palliative care needs, including communication and collaboration between ED and home care. Some patients presented urgently to home care near end of life; others were diagnosed in ED and then referred. Additional anticipatory guidance may benefit those who present to the ED near end of life but prefer to die at home or hospice
Examining the use of geriatric assessment teams and comprehensive geriatric assessment in emergency departments
Full text linkHelping kids and youth in times of emotional crisis
Full text linkBackground
In 2017 the Emergency Strategic Clinical Network (ESCN) and Addiction and Mental Health Strategic Clinical Network (AMH SCN) of Alberta Health Services (AHS) launched a survey to understand the experience of young people seeking help in an Emergency Department (ED) for a mental health concern. Over 1500 surveys were completed, and qualitative results were analyzed thematically and interpreted in partnership with focus groups. A major theme of the responses was the feeling of being stigmatized when seeking help for a mental health concern, and that health care professionals’ understanding, empathy, and competencies with youth mental health needs to be improved. In response to this finding, a nurse education workshop has been developed and is being piloted and evaluated.
Implementation
The ESCN and the AMH SCN are working together to develop, pilot, and evaluate new training for ED nurses. The education will debunk common misperceptions and associated stigma about the causes of mental illness and addictions by presenting the medical paradigm of a physical illness with a complex etiology including genetic and environmental influences. The objective of these workshops is that nurses receive training to increase knowledge of the science and determinants of addiction and mental health issues to enable them to provide care that is compassionate and trauma informed. Pilot workshops have been delivered to a lived-experience advisory committee, as well as four cohorts of ED nurses. The impact of the workshops is being evaluated to inform further implementation.
Evaluation Methods
Nurses participating in the pilots will complete a 10 question survey to establish a baseline of their knowledge, compassion, and confidence. This survey has been adapted from the Mental Health Commission of Canada Healthcare Providers Questionnaire, and the Attitudes Towards Child Mental Health Questionnaire. Upon completion of the workshop nurses are be asked to complete a second brief survey reflecting on how this training will impact their clinical practice, and the barriers to practice change. Finally, 90-days post-training nurses will be re-administered the 10 question baseline survey. In addition, they will be asked if their goals for clinical practice change have been achieved.
Results
Four cohorts consisting of 39 emergency department nurses have completed the workshop. All 39 nurses completed the baseline survey and the workshop survey.
The baseline survey results were that 90% of respondents agreed that mental illness and addiction deserves as much attention as physical illness, and 92% agreed that healthcare providers need to advocate for people with mental illness and addiction. However, 79% of respondents reported that they were more comfortable treating physical illness than mental illness or addiction. Further, while 95% of respondents disagreed that mental illness was the result of a weak personality, only 74% disagreed that substance abusers have no self-control. Finally, when asked if adverse social circumstances can result in mental illness or addiction 8% of respondents disagreed and 49% were unsure.
Following the workshop 100% of respondents agreed that the workshop was applicable to their clinical practice, and 92% agreed that they understood better how to support these patients. Important themes arising from the qualitative questions were the need to show more empathy and compassion, and the realization that although an ED nurse cannot resolve an underlying mental illness or addiction they do have an important role to play in stabilizing an acute crisis.
Advice and Lessons Learned
Youth and their caregivers often do not know where to go in a time of emotional crisis. Their experience in the emergency department can be a source of further distress, and presents an opportunity to provide compassionate and trauma informed care.
Approaching the topic of improving care in the ED requires the involvement of multiple stakeholders, including emergency operational and strategic leadership, addiction and mental health specialists, front line clinicians, and the youth and caregivers receiving care.
A major barrier to providing higher quality care for youth experiencing an emotional crisis is knowledge of how to assess these patients and communicate them, as well as knowledge of and access to appropriate resources that can be leveraged in patient care
