Nurse escorts' perceptions of nurse-led inter-hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study.

Abstract

The Western Australia (WA) Country Health Service (WACHS) requires the ward or emergency department (ED) registered nurse (RN) to assume the responsibility of conducting nurse-led interhospital patient road ambulance transfers, in the absence of an available registered paramedic (RP). The generalist nurse escort with no specialised training is allocated to the patient transport from their rostered shifts when the need arises, and, in some instances, this nurse may not have been in an ambulance before. Patients requiring transfer are usually prioritised over hospital patient care because of the life-threatening nature of these situations and the urgency to get them to tertiary care facilities. This study explored nurses' perceptions about caring for a patient during road ambulance transfer, with an aim of supporting future policy formulation and decision-making to guide nurses' training, induction and ongoing education on interhospital transfers. To examine the perceptions of hospital-employed registered nurses caring for a patient during road ambulance transfer from rural Western Australia. A descriptive survey design included 23 questions to clarify the level of experience and training, the prevalence of clinical deterioration and the confidence to manage patient care. Findings from the surveys indicated that nurses often felt overwhelmed by the responsibility of the patient transfer, unclear guidelines, limited preparation and handover, lack of orientation to the ambulance environment, difficulty escalating care during transfer and no insight into the return to base process. To explore how the RN who normally works within a well-organised and accessible multidisciplinary team manages caring for a patient in an unfamiliar mobile environment, the study was conducted within WACHS in the Wheatbelt Region of WA involving 27 health care sites. Participating nurses were asked several broad questions to explore their perceptions on how well-equipped they are in managing clinical care and deterioration during transfer; what are the challenges that they face while doing so and how confident they are about their knowledge, skill level and scope of clinical practice in supporting patients during interhospital transfer? Wheatbelt nurse escorts were capable, generalist nurses with a demonstrated skill set in managing patient care during transfer when needed. The 'back of the ambulance' was a challenging environment for nurses to engage in the type of care usually provided in the hospital setting, which come with a high level of uncertainty and anxiety for both patient outcome and own well-being.