Abstract
Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.
Highlights
The professional foundation of nursing care values and responsibilities includes the registered nurse’s (RN) stance, approach, and actions
The results show that no Clinical practice guidelines (CPGs) outlined a comprehensive patient assessment covering all five activity areas of interest
The findings of this study demonstrate that there are currently no Swedish CPGs in use that support Emergency care nurses (ECNs) in performing comprehensive patient assessments in emergency care
Summary
The professional foundation of nursing care values and responsibilities includes the registered nurse’s (RN) stance, approach, and actions. Based on a humanistic and caring perspective in which the human being is viewed as an entity consisting of body, soul, and spirit with varying nursing needs, the RN’s task is to alleviate patients’ suffering and promote well-being.[1] In emergency medical services (EMS) and emergency departments (ED) ( ‘emergency care’), which involve lifethreatening, urgent, and non-urgent care situations, patients are more exposed, dependent, and vulnerable than in other care situations.[2,3,4,5,6] This constitutes a challenge for RNs to address issues related to patient assessment, participation, and influence over care.[7,8,9] In emergency care, RNs and specialist nurses ( ‘emergency care nurses’, ECNs) face challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs.[10,11,12]. Assessing patients, determining whether their conditions are stable or unstable, and defining care needs are important tasks for ECNs.[10] Failure to assess patients according to their individual care needs may lead to undesired consequences, such as incomplete nursing care and adverse health events.[13] In Sweden, patient assessment
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