Prehospital Emergency Care Nurses Research Articles

Alfentanil for Pain Relief in a Swedish Emergency Medical Service – An Eleven-Year Follow-up on Safety and Effect

Objectives Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care. Methods This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE) – were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients’ medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care. Results During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was −4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period. Conclusions This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.

Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey.

Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.

Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital.

BackgroundPre-hospital emergency care is a medical care given to patients before arrival in the hospital after activation of the emergency team. Poor knowledge and practice about pre-hospital emergency care hurt the health outcomes of the patients.ObjectiveThis study aimed to assess knowledge and practice nurses at the University of Gondar Compressive Specialized Hospital, Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted from March 20 to April 10, 2020. A stratified sampling technique was used to select the study participants. Data were collected using a pretested structured self-administered questionnaire. Data were analyzed using SPSS version 20. To explain study variables, frequency tables and percentages were used. Logistic regression analysis was used to see the association between independent and dependent variables.ResultsOut of the total 378 respondents, less than half (42.9%) had good knowledge; similarly, 49.5% of them had good practice about pre-hospital emergency care. Male sex and attend formal training were significant associations with both knowledge and practice of pre-hospital emergency nursing care. Male participants (adjusted odds ratio (AOR) = 6.57, 95% confidence interval (CI) (3.79–11.36)) and having training (AOR=1.74, 95% CI (1.83–3.66)) were significantly associated with knowledge of pre-hospital emergency care, whereas male sex (AOR=1.73, 95% CI (1.09–2.73)) and having training (AOR=6.16, 95% CI (2.69–14.10)) were significantly associated with the practice of pre-hospital emergency care.ConclusionKnowledge and practice of nurses regarding pre-hospital emergency care was found to be inadequate as compared to previous studies. Male sex and attend formal training showed a positive and significant association with both knowledge and practice of pre-hospital emergency nursing care. The responsible body ought to allow professional development and attending formal training for nurses.

Prehospital emergency nurses’ experiences of care in critical incidents

IntroductionThe ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs’ experiences of care in CIs. MethodA qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden. ResultsPENs’ experiences can be described as: “In a critical incident, personal ability based on experiential knowledge is central to patient care”. Three generic categories underpinned the main category: “Clinical expertise”, “Professional approach” and “Broad knowledge base”. ConclusionsThe care given during a CI in the ambulance care setting depends on PENs’ personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.

Iranian Nurses' Experiences of Workplace Violence in Prehospital Emergency Care

Prehospital emergency care nurses experience severe workplace violence. However, despite the widespread violence they experience, this phenomenon has not been well studied among these nurses. Therefore, the purpose of this study was to explore the experiences of Iranian nurses working in prehospital setting regarding workplace violence with a focus on the factors leading to such violence. In this qualitative descriptive study, 23 prehospital nurses participated purposefully. The data were collected by individual face-to-face semistructured interviews and analyzed using content analysis methodology. Data analysis led to the identification of 4 main themes, including job competency mismatch, inadequate resources, criticality of the situation and circumstances, and inadequate awareness and misplaced expectations of society. These nurses have not completed specialized training courses, work in a system that is in a critical situation, and face many barriers and deficiencies in terms of intra- and interorganizational coordination. On the other hand, people in the community do not have sufficient awareness about the duties and services provided by prehospital nurses and thus have unrealistic expectations to receive services. The results showed that there was a deep gap between the prehospital emergency realities and public expectations, leading to workplace violence. Therefore, efforts to improve the working conditions of nurses with an emphasis on teaching specialized prehospital emergency courses, especially violence control courses, promoting intra- and interorganizational coordination, and increasing the equipment and personnel of ambulances for special missions, as well as raising the public awareness and outlining more realistic expectations, may reduce the prevalence of violence against prehospital nurses.

Parents' experiences of the caring encounter in the ambulance service-A qualitative study.

To explore the experiences of the caring encounter in the ambulance service among parents to children aged 0-14 years. The care provided by the ambulance team is often associated with emergency medicine, traumatology and disaster medicine. But to develop care in the ambulance service, it is imperative to understand what the parents want and value in the care for their child. A qualitative study design was used. Interviews was used for data collection, 16 caring encounters described by 14 parents were analysed using qualitative content analysis. Reporting of this research adheres to the COREQ guidelines. The parents described the importance of giving the family enough time in the situation, creating a safe environment and involving the parents in the care. In cases where the parents felt insecure, there had been lack of communication and lack of sensitivity, and the ambulance team did not invite the parents to be participate in the care. There is a need to strengthen the family-centred care in the ambulance service. Not inviting the parents in the care and use of equipment that was nonfunctioning or not adjustable for the children's age caused lack of trust and increased the level of stress among the parents. The parents had a positive experience and felt included when the team were calm, responsive and gave them the chance to be participants in their child's care. The prehospital emergency care nurses need to be prepared for caring of children and their parents. The ambulance team also need to understand their role in providing care of children. Lack of confidence in treating children may be perceived as nonfamily-centred care. There is need of further training concerning family-centred care in the ambulance service.

Primary amenorrea in obese patient

The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs’ experiences of care in CIs.A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden.PENs’ experiences can be described as: “In a critical incident, personal ability based on experiential knowledge is central to patient care”. Three generic categories underpinned the main category: “Clinical expertise”, “Professional approach” and “Broad knowledge base”.The care given during a CI in the ambulance care setting depends on PENs’ personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.

Technical feasibility and ambulance nurses’ view of a digital telemedicine system in pre-hospital stroke care – A pilot study

BackgroundHigh-quality telemedicine in cases of suspected stroke has comparable precision with on-site medical examinations. A novel technical concept was developed in order to deliver a video/audio system to achieve more efficient patient assessment and diagnostic support. Aims and objectivesThe aim of the present pilot-study was to evaluate in a clinical setting the quality of a linked image and sound transmission in the prehospital assessment of patients with suspected stroke. In addition, we wanted to elucidate how ambulance nurses experienced the use of this innovative technology. DesignThe study used a quantitative method using questionnaires with fixed response options, combined with a qualitative approach to assess complementary statements of prehospital emergency care nurses (PEN) that had used the system. MethodsThe study was conducted in one ambulance care office and one hospital in southern Sweden. Six PEN and one neurological specialist (Dr) expressed their perceptions based on 11 cases with suspected stroke. Responses were assessed in the dimensions of the technology (Dr – image quality/sound quality; Dr and PEN), safety, sense of increased control and uniform assessment. A questionnaire technique was used, complemented with a qualitative part of the content analysis (PEN views). ResultsIn the technology dimension, the Dr evaluated the image quality as Very good to Good (100%) while 75% of PEN answered that the digital stroke concept felt reliable to use and the digital stroke assessment is believed to increase uniform assessment. Asked if the present digital concept should be further developed and if further digital systems should be developed in general, the PEN were split in their responses (50 vs 50%), which could be related to a conception of unclear efficacy of the concept. Descriptions of the decisive comments emerged in three categories; Minor operating interference, Physician’s competence crucial and Unclear efficacy. ConclusionAll respondents seem to have confidence in the assessed digital stroke concept. The image quality is perceived suitable in the assessment situation but the nurses expressed ambiguity about the efficiency of the entire concept. The ambulance nurses also highlighted the physician’s skills and personality as important factors for further development of the concept.

Prehospital emergency care nurses' strategies while caring for patients with limited Swedish-English proficiency.

To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency. Communication difficulties due to lack of mutual language is a challenge in healthcare systems around the world. Little is known about nurses' strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service. A qualitative study design based on interviews was used, and a purposeful sample and snowball technique were used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency. Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department as they had not found a secure way of assessing and caring for the patients in the ambulance. The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker. The nurses need to be prepared for how to assess and care for patients when there is a lack of mutual language; otherwise, there is a risk of increased unequal care in the ambulance service. To further explore and learn about this field of research, studies exploring the patients' perspective are needed.

Ambulance Nurses' Competence and Perception of Competence in Prehospital Trauma Care.

Introduction We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. Results Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. Discussion This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Patients with head trauma: A study on initial prehospital assessment and care

BackgroundBest evidence guidelines are intended to standardise assessment and treatment of patients with head trauma and improve outcomes for TBI patients. The primary aim was to explore pre-hospital emergency care nurses’ (PECNs’) documented assessment and care of patients with head trauma and the secondary aim to study gender differences in the documented care and interventions given by the PECNs. MethodsA retrospective observational study was conducted by evaluating 2750 prehospital medical records. ResultsThe results showed that 25.2% of the patients were assessed according to all four core-elements in the guidelines and 78.6% of the patients underwent at least one intervention by the PECNs. Male patients were to a higher extent assessed according to guidelines and were given higher transport priority while females were more often assessed for vital parameters and received significantly more analgesics. The assessment documented by the PECNs was not optimal concerning documentation using the Glasgow Coma Scale, but the documented assessment of circulation and, especially, respiratory rate was high (77.2%) compared to previous studies. ConclusionThe findings of this study showed a low degree of documented assessment of parameters related to head trauma and might also indicate some gender differences in the assessment and management.

The effects of interprofessional education – Self-reported professional competence among prehospital emergency care nursing students on the point of graduation – A cross-sectional study

The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses’ (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n=19, Swedish n=22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p<0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students’ self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs.

Caring for older people in prehospital emergency care: can nurses make a difference?

The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.

Nursing Records With Standardized Nursing Language in Prehospital Emergency Care: From Utopia to Reality

PURPOSETo design a record containing “traditional” and nursing process–related data, adapted to prehospital emergency care.METHODSIn the course of conducting a research project about nursing process implementation strategies in prehospital emergency care, a pilot electronic patient record was designed by expert critical care nurses. A prehospital emergency service of a leading city in the Andalusian region in Spain was chosen to test the initial implementation of the record using a qualitative approach that included semistructured interviews and record evaluation, plus a 1‐week education program about clinical use of nursing process. The record included assessment parameters, NANDA, NIC, and NOC standardized nursing terminologies as the main focus of clinical reasoning, care planning, and delineating outcomes and interventions.FINDINGSTwelve prehospital emergency care nurses were trained with a specific nursing process program. They all applied the electronic record during their clinical perfomance and related high satisfaction with it in their interviews, although they reported some initial difficulties with terminology. After this pilot phase, the record was extended to the other seven leading cities in the region following a presentation by two expert nurses. The record has been included as a formal component of the hospital information system and the NOC labels will be used as criteria when evaluating the prehospital emergency nurses. A copy of each record is deposited at the admission hospital.DISCUSSIONThe enrichment of an information system with nurse‐sensitive data is crucial for emergency services where the nurse offers complex but often neverdocumented services. The difficulties of combining easily recordable forms and exhaustive data gathering can be overcome with qualitative techniques and education activities that highlight the benefits of standardized nursing language and critical paths prior to implementation.CONCLUSIONSThe aim of developing a nursing recording system based on standardized nursing language must be balanced against a lack of a nurse‐oriented conceptual framework among emergency nurses and their unfamiliarity with nurse terminology.

Nurse competence: Advantageous in pre-hospital emergency care?

Aspects of the organization and function of pre-hospital emergency care services in western Sweden were assessed by interviewing physicians (n = 20) with administrative (n = 10) or/and active (n = 10) roles in the pre-hospital emergency care field. The data obtained indicate that although the present standard of care is acceptable, there is an obvious need for a more effective organization and the personnel involved should have a higher competence level. Ambulance personnel were not considered to have a high enough competence level. Therefore, a need for more nurses, preferably anaesthesia or intensive care nurses, was expressed. An awareness of the importance of research was noted among the physicians responsible for the services, and the research capability of nurses, along with their general competence in emergency medical service related problems, was considered an important argument for involving more nurses in pre-hospital emergency care. It was thought that by such an approach, a more scientific basis for assessing the efficacy of pre-hospital emergency care could be achieved.

Role of nurses in pre-hospital emergency care

In order to increase the quality of pre-hospital emergency care services, the Swedish National Board of Health and Welfare advocates a switch to clinically better educated professionals. The aim of this study is to assess the attitudes of ambulancemen, paramedics and nurses to each others' professional roles in prehospital emergency care. Ambulancemen and paramedics appreciate nurses' experience in anaesthesia, intensive care and cardiology, but do not see the nurse's role as being ‘team leader’. Both groups of professionals acknowledge the advantage of ambulance crew members having complementing skills, in order to improve the service. There is some rivalry between nurses and ambulancemen and paramedics. However, the increasing number of nurses in pre-hospital emergency care is contributing to the quality of the service by raising the competence level of the team as a whole.