Emergency Department Staff Attitudes Research Articles

The Impact of Coronavirus Disease 2019 Visitor Restrictions on the Attitudes of Emergency Department Staff

IntroductionDuring the first 2 years of the pandemic, visitors for patients with COVID-19 were prohibited from emergency departments in the United States with few exceptions, leaving patients without their caregivers and advocates. Little is known about emergency nurses and nursing assistive personnel beliefs regarding this issue. Therefore, this study’s purpose was to describe and assess relationships among emergency nursing and assistive personnel attitudes and perceptions regarding emergency department “no-visitor policies” for patients with COVID-19. MethodsThis institutional review board-approved observational study was conducted in a health care system in the Southwestern United States. Nursing personnel (n = 180; 21.74% response rate) working in 11 emergency departments completed the survey during the fall of 2021. Bivariate correlations and multivariable linear regression modeling were performed to explore relationships among survey questions. ResultsMost participants (61%) strongly/very strongly believed that restriction of visitors for patients with COVID-19 was necessary for the protection of staff and patients. In addition, 65% reported strongly/very strongly agreeing that it was unethical and 75% felt upset when these patients died alone. Most (81%) strongly/very strongly agreed that exemptions to the policy should be made in some cases, including imminent death. Respondents’ recognition of patients’ displeasure with visitor policy, recognition that a lack of visitors affected efficiency, and feeling upset when these patients died alone negatively predicted agreement that restriction was necessary. ConclusionAlthough most participants favored visitation restrictions for patients with coronavirus disease 2019, their beliefs were complex. Navigating stringent visitation policies and vulnerable patients’ needs can result in moral distress for ED personnel.

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department.

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

Emergency nurses’ perceptions of the health care system and how it impacts provision of care to people who self-harm

BackgroundSelf-harm is a deliberate act to cause physical harm to oneself. People who self-harm are at greater risk for suicide than people who do not self-harm. Emergency nurses are first responders to many people who present to the emergency department (ED) with self-harm. The care they provide can influence future presentations to the emergency department and long-term outcomes. AimThe aim was to explore ED nurses’ experiences of working with people who self-harm. MethodsSemi-structured interviews were conducted with 18 emergency nurses from different locations in Australia in 2019. Elo and Kyngäs’ inductive content analysis research method guided all stages of the research. ResultsThe category “health care system” emerged from the data. It comprised five subcategories: (i) Complexity of the work environment; (ii) ED staff attitudes and care provision; (iii) the mental health patient; (iv) facilitators and barriers to providing care to people who self-harm; and (v) lack of community resources. DiscussionThis study found there were several factors influencing ED nurses’ knowledge, skills and confidence in caring for people who self-harm and several factors influenced their experience. ConclusionWhile participants felt confident to manage the physical injuries associated with self-harm, they were less confident to engage with the person about their self-harm. The article provides guidance for ED nurses to assess and intervene with people who present with self-harm.

Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.

To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcriptswas carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.

The impact of educational interventions on attitudes of emergency department staff towards patients with substance-related presentations: a quantitative systematic review.

Visits to emergency departments for substance use/abuse are common worldwide. However, emergency department health care providers perceive substance-using patients as a challenging group to manage which can lead to negative attitudes. Providing education or experience-based exercises may impact positively on behaviors towards this patient population. Whether staff attitudes are similarly impacted by knowledge acquired through educational interventions remains unknown. To synthesize available evidence on the relationship between new knowledge gained through substance use educational interventions and emergency department health care providers' attitudes towards patients with substance-related presentations. Health care providers working in urban and rural emergency departments of healthcare facilities worldwide providing care to adult patients with substance-related presentations. Quantitative papers examining the impact of substance use educational interventions on health care providers' attitudes towards substance using patients. Experimental and non-experimental study designs. Emergency department staff attitudes towards patients presenting with substance use/abuse. A three-step search strategy was conducted in August 2015 with a search update in March 2017. Studies published since 1995 in English, French or Spanish were considered for inclusion. Two reviewers assessed studies for methodological quality using critical appraisal checklists from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Reviewers agreed on JBI-MAStARI methodological criteria a study must meet in order to be included in the review (e.g. appropriate use of statistical analysis). The data extraction instrument from JBI-MAStARI was used. As statistical pooling of the data was not possible, the findings are presented in narrative form. A total of 900 articles were identified as relevant for this review. Following abstract and full text screening, four articles were selected and assessed for methodological quality. One article met methodological criteria for inclusion in the review: use of random assignment and comparable study groups and measurement outcomes in a reliable and consistent manner. The included study was a cluster randomized controlled trial. Participants were emergency medicine residents with a mean age of 30 years. The study assessed the impact of a skills-based educational intervention on residents' attitudes, knowledge and practice towards patients with alcohol problems. While knowledge and practice behaviors improved one year following the intervention, there were no significant differences between groups on attitudinal measures. Employing educational interventions to improve the attitudes of emergency department staff towards individuals with drug and alcohol related presentations is not supported by evidence.

Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management.

Patients with borderline personality disorder (BPD) are high utilizers of psychiatric emergency services and present unique challenges in that setting. Frequently advised to visit an emergency department (ED) if safety is in question, their experiences once there often do not have beneficial effects. Issues specific to patients with BPD in the ED include volatile interactions with staff, repeat visits, concerns about safety (and liability), and disposition. Emergency department staff attitudes toward these patients are frequently negative when compared to patients with other diagnoses, and can detrimentally affect outcomes and perpetuate stigma regarding BPD. These attitudes are often due to lack of education and training about how to understand, approach, and treat the patient with BPD. The limited literature regarding the treatment of BPD in the ED offers few guidelines. This article presents an approach based on Good Psychiatric Management that can reduce negative reactions by ED staff and make ED visits more effective and less harmful. Relevant principles include psychoeducation, the reinforcement of the connection between symptoms and interpersonal stressors, and employment of an active, authentic therapeutic stance. Training ED staff in these principles could lead to attitudinal changes, reduced stigma, and potentially improved outcomes.

Emergency Department Staff Attitudes Toward People Presenting in Chronic Pain: A Qualitative Study.

Patients who experience their nonmalignant chronic pain as intolerable sometimes present at Emergency Departments (EDs). However, as emergency medical services are set up to provide rapid treatment for acute injury or illness; there is potential for misunderstanding and disappointment. Literature on the topic of ED staff attitudes toward chronic pain patients is minimal, USA-based and methodologically unsatisfying. We carried out an in-depth, qualitative study identifying the attitudes and narratives of ED staff around people in chronic pain. Focus groups with ED staff; qualitative analysis of the group transcripts. Regional trauma centre in the UK. Three focus groups, 20 ED clinicians, mean ED experience 8.1 years. The clinical challenge of treating patients in the ED stemmed from a mismatch between patients' needs and what the setting can deliver. Participants reported frustration with the system and with chronic pain patients' perceived inconsistencies and requirements. However, they also highlighted good practice and acknowledged their frustration around not being able to help this group. ED staff found people presenting at ED with chronic pain to be a challenging and frustrating population to treat. Staff was constrained by the fast-paced nature of their jobs as well as the need to prioritise emergency cases, and so were unable to spend the time needed by chronic pain patients. This was seen as being bad for staff, and for the patient experience. Staff suggested that care could be improved by appropriate information, signposting and with time invested in communication with the patient.

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum.

IntroductionWhile treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design.MethodsFormal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs.ResultsOne hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training.ConclusionA structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.

The impact of knowledge on attitudes of emergency department staff towards patients with substance related presentations: a quantitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE The overall objective of this systematic review is to synthesize the available evidence on the relationship between new knowledge (gained through educational interventions about substance use/abuse) and health care providers’ attitudes (measured by well validated instruments such as the Drug and Drug Problems Perceptions Questionnaire, the Short Alcohol and Alcohol Problems Perception Questionnaire, etc.) towards patients with substance-related presentations to emergency departments. The specific review question is: Among emergency department staff, does the acquisition of knowledge (on educational interventions about substance use) impact attitudes in relation to their therapeutic role towards patients with substance-related presentations? INCLUSION CRITERIA Types of participants This review will consider studies that include health care providers (nurses, physicians, social workers, psychologists, psychiatrists and other mental health care professionals), working in urban and rural emergency departments (emergency rooms, accident and emergency rooms) of healthcare facilities worldwide, and providing care to adult patients who indicate some level of substance use. Substance-related presentation phenomena will include hazardous alcohol use, alcohol misuse, use of legal and restricted pharmacological agents, and illicit drug use. Studies that address patient presentations to emergency departments for traumatic injury, motor vehicle crashes, traumatic presentations secondary to violence, and drug and alcohol overdoses or physical health conditions related to substance usage (such as heart and liver failure, pancreatitis and gastric problems) will be included. Types of intervention(s) Quantitative papers examining the impact of educational interventions about substance use/abuse on health care providers’ attitudes towards substance using patients will be included. TRUNCATED AT 250 WORDS

Client satisfaction with nursing-led sexual assault and domestic violence services in Ontario.

There is still little known about survivors' experiences of and satisfaction with comprehensive nursing-led hospital-based sexual assault and domestic violence treatment programs. To address this gap, we surveyed and collected information from clients/guardians presenting to 30 of 35 of Ontario's Sexual Assault/Domestic Violence Treatment Centres across seven domains: presentation characteristics, client characteristics, assailant characteristics, assault characteristics, health consequences, service use, and satisfaction with services. One thousand four hundred eighty-four clients participated in the study, 96% of whom were women/girls. Most were White (75.3%), 12-44 years old (87.8%), and living with family (69.6%); 97.9% of clients used at least one service. The most commonly used service was assessment and/or documentation of injury (84.8%), followed by on-site follow-up care (73.6%). Almost all clients/guardians reported that they received the care needed (98.6%), rated the overall care as excellent or good (98.8%), and stated that the care had been provided in a sensitive manner (95.4%). Concerns and recommendations to improve care expressed by a small proportion of clients/guardians focused on long wait times, negative emergency department staff attitudes, issues of privacy and confidentiality, and difficulty with accessing services. The high uptake and positive evaluation of services provided by Ontario's Sexual Assault/Domestic Violence Treatment Centre programs confirms the value of nursing-led, hospital-based care in the aftermath of sexual assault and domestic violence. Ongoing evaluation of such services will ensure the best care possible for this patient population.

Emergency department staff attitudes towards mental health consumers: A literature review and thematic content analysis

Visits to the emergency department (ED) for mental health reasons account for 10-15% of all visits. Consumers of mental health ED services, however, report that they often feel sent to the back of the queue and that their mental health concerns are not taken seriously, suggesting that societal stigma has impacted their care in the ED. In this study, we systematically explore the research concerning the attitudes of ED professional staff towards those who present with issues related to mental health. Four themes emerge from the literature: consumer perspectives, whose tenor is generally one of negativity; staff-reported attitudes and influencing factors, such as age, experience, and confidence in working with mental health presentations; the environmental climate of the ED, which might not be conducive to good mental health care; and interventions that have been used to evaluate changes in attitudes.

Emergency Department Staff Attitudes Toward People Who Self-Harm

Patients who self-harm report negative staff attitudes toward them on presentation to an emergency department. Applying a thematic framework analysis to interviews with 10 staff members from one emergency department, the present research explored staff attitudes and behaviors (their own and the perception of others') and the impact of these attitudes on behavior, and the role of team identification and norms. Located within an overarching theme of balancing difference and diversity in relation to patients who self-harm, analysis identified themes related to beliefs about self-harm, the perceived barriers and facilitators to working effectively with patients, and the importance of identity, culture, and roles. Analysis also revealed the presence of pluralistic ignorance, whereby individuals perceive that others' (negative) actions reflect stable (negative) attitudes but do not perceive this for themselves. Thus, increasing knowledge and awareness of pluralistic ignorance may be a useful addition to training to minimize feelings of failure and frustration and increase understanding and improve patient care.

Emergency department staff's attitudes toward narcotics and drug-seeking patients who fabricate symptoms: A multicenter survey

Recently, there has been an increase in the amount of prescription narcotics used in Taiwan. Despite the possibility that patients suspected of abusing opioids are visiting emergency departments (EDs) to collect drugs, only few studies have assessed the attitudes of ED staff toward these fabricating drug seekers and narcotics prescription. Both issues are crucial in identifying fabricating drug seekers and for pain management. The aims of this study were to investigate the attitudes of ED staff toward fabricating drug seekers and narcotics prescription, and to understand the characteristics of patients suspected to be fabricating drug seekers. From January 1, 2008 to December 31, 2008, 174 staff members of four EDs completed questionnaires to review their perceptions for patients with fabricated drug-seeking behaviors and their attitudes toward prescribing narcotics. The staff members were also requested to report the characteristics of those patients suspected of fabricating a need for narcotics. According to the ED staff's clinical practice, the three most commonly fabricated drug-seeking behaviors were insistence on specific medications, frequent ED visits, and over-reporting of symptoms. Most medical personnel would choose non-narcotic analgesics as their first-line remedy. A total of 14 patients were reported as fabricating drug seekers. The fabricated drug-seeking behavior patterns described by the ED staff were similar to the descriptions mentioned in the literature and their attitudes toward prescribing narcotics were conservative. However, more interventions to overcome staff's opiophobia are needed to improve pain management. Reported fabricating drug seekers usually complain of abdominal pain, while parenteral meperidine was the most sought-after drug.

Attitudes of Emergency Department Staff towards the Role of Clinical Pharmacists in a Region of Saudi Arabia - A Pilot Study

Purpose: To evaluate the attitudes and perceptions of medical doctors and nurses in the Emergency Department ED towards the role of clinical pharmacists.Methods: A pilot study was conducted among the medical and paramedical staff of the ED of Public Hospital, Eastern Region, Saudi Arabia, Al-Ahsa, using a 24-item questionnaire on Doctor of Pharmacy (Pharm-D) program as well as clinical pharmacist and medical staff attitudes toward the availability and possible role of clinical pharmacist in EDs. The data analysed statistically.Results: Sixteen of the 20 respondents expressed a willingness to participate in the study. Six (37.5 %) of the respondents were doctors while the rest were nursing staff. Ten (62.5 %) of the ED staff were aware of the professional degree held by clinical pharmacists (i.e., Pharm-D), and a majority, 12 (75.0 %) had heard of a health care professional called a clinical pharmacist. While exploring medical staff attitude toward the availability of a full-time pharmacist in EDs, 13 (81.3 %) of the respondents viewed this favorably while that regarding the role of pharmacists in drug adherence and patient care was viewed less favorably. Fourteen (87.5%) disagreed with giving prescription rights to clinical pharmacists for minor ailments.Conclusion: These findings highlight the need to enhance the interaction between the medical and paramedical staff on the one hand, and the clinical pharmacist on the other. Clinical pharmacists need to be given an opportunity to prove their capabilities in direct patient care in order to facilitate the full participation of future Pharm-D graduates in direct patient care in the Saudi health care system.

What factors influence emergency department staff attitudes towards using information technology?

ObjectivesInformation technology (IT) has an important role in the emergency department (ED) functioning, but staff attitudes can influence the way IT is used. Qualitative research into the perceptions of the...

385 Emergency Department Staff Attitudes and Satisfaction With Live-Feed Video Interpreting for Limited English Proficient Patients: Pre- and Post- Training

385 Emergency Department Staff Attitudes and Satisfaction With Live-Feed Video Interpreting for Limited English Proficient Patients: Pre- and Post- Training

32 Just Give It Some Time: Emergency Department Staff's Attitudes Towards Computerized Physician Order Entry at Five and Seventeen Months

32 Just Give It Some Time: Emergency Department Staff's Attitudes Towards Computerized Physician Order Entry at Five and Seventeen Months

Emergency Department Tobacco Cessation Program: Staff Participation and Intervention Success Among Patients

The emergency department (ED) is often the primary source of healthcare for uninsured and underinsured patients. To evaluate ED staff attitudes toward and participation in referring patients to a tobacco cessation program, and to assess the program's effectiveness. A nonvalidated survey on smoking cessation and preventative services for ED patients was mailed to ED staff at a suburban hospital. After survey completion, ED staff was encouraged to refer smokers with diagnoses substantially worsened by tobacco use to a brief intervention delivered in the ED. An incentive was provided to staff beginning in the second month of the 3-month period. Referred patients were briefly counseled by a hospital social worker or an ED physician or nurse. Follow-up telephone interviews with patients occurred 1 to 3 months postintervention. Of the 70 ED staff contacted, 63 (90%) responded to the survey. Most staff members (81%) agreed that they should facilitate clinical prevention. Fewer staff (60%) were comfortable advising patients to quit tobacco use (P<.03), and fewer still (51%) agreed that ED staff should assist patients in tobacco cessation (P<.001). Tobacco users were more likely to favor implementing patient education in the ED (P=.01) and were less comfortable advising patients to quit (P=.06). Staff referrals increased with program incentives (P=.008), with a total of 150 interventions occurring in the 3-month span. Of the 36 patients (24%) reached for follow-up, 13 (36%) attempted to quit and 6 (17%) succeeded. Overall, 45% of the patients reached for follow-up either cut down or quit tobacco use. Staff members' attitudes toward tobacco cessation are not a firm barrier to the successful implementation of an ED tobacco cessation program. In addition, the ED provides an important opportunity to encourage patients to quit or cut down tobacco use.

Knowledge and attitudes of ED staff before and after implementation of the emergency Nurse Practitioner role

Summary Introduction The Emergency Nurse Practitioner (ENP) role was implemented in the Emergency Department (ED) at The Northern Hospital (TNH) in April 2004. Implementation of the ENP role occurred as part of a Department of Human Services funded project to establish the ENP model as an effective and sustainable model of care delivery in Victorian EDs. Aim The aim of this study was to examine the attitudes and knowledge of ED medical and nursing staff prior to, and following, implementation of the ENP role. Methods The design was a pre-test/post-test design and the Northern Emergency Nurse Practitioner Staff Survey was used for data collection. A total of 104 ED staff completed the pre-test survey and the post-test survey was completed by 79 ED staff. Results The attitudes and knowledge of ED medical and nursing staff changed significantly during implementation of the ENP role. Pre-test data indicated that staff were generally supportive of the role but had a poor understanding of the requirements for endorsement and how the role would function in clinical practice. Post-test data showed significant increases in support for the ENP role, a greater understanding of the requirements to become an ENP and increased understanding of the logistics and functions of an ENP. Conclusion The implementation of the Nurse Practitioner role within the emergency department of The Northern Hospital, Victoria Australia has been a positive experience for both medical and nursing staff.

The quality of psychiatric services provided by an Australian tertiary hospital emergency department: a client perspective

The mainstreaming of psychiatric services within the general health care system has created fundamental changes to the manner in which clients access acute psychiatric services. A review of the literature suggests that this process has been problematic. The current study involved the conduct of telephone interviews with psychiatric clients ( n=136) to ascertain their level of satisfaction with the services received in the emergency department of a Melbourne Metropolitan Hospital. The results were analysed using descriptive statistics. The study participants indicated a high level of satisfaction. Particular emphasis was placed upon the availability of staff with psychiatric qualifications and experience to provide treatment, support and care. Dissatisfaction was noted by some clients regarding lengthy waiting times, lack of privacy in the triage area and negative attitudes of emergency department staff. These findings support the value of psychiatric consultancy services in the emergency department, and further identify the need for triage guidelines to be tailored to the needs of mental health clients.