scholarly journals P102: Perspectives surrounding paediatric procedural sedation using intranasal ketamine administration: a qualitative study of emergency nurses

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S100-S101
Author(s):  
D. Wonnacott ◽  
S. Scott ◽  
R. Flynn ◽  
S. Ali ◽  
N. Poonai
Keyword(s):  
Health Care Providers ◽  
Resistance To Change ◽  
Implementation Strategies ◽  
Structured Interview ◽  
Pediatric Emergency ◽  
Procedural Sedation ◽  
Care Providers ◽  
Emergency Nurses ◽  
Nursing Experience ◽  
Physician Resistance

Introduction: Intranasal ketamine (INK) has an emerging role for procedural sedation (PSA) in children in the emergency department (ED). While INK is less invasive and requires fewer personnel than IV ketamine, widespread adoption in the paediatric ED would require strong nursing acceptance. To inform INK implementation strategies, we explored nursing perspectives surrounding INK, including perceived barriers to its adoption. Methods: Nurses in the paediatric ED of London Health Sciences Centre, London, Ontario were recruited by email. Two, one-hour, in-person focus groups were conducted on January 26 and February 2, 2018 using a semi-structured interview format. Transcription was performed by a professional medical transcription service and analyzed using an inductive qualitative approach involving code words corresponding to recurring topics. Thematic analysis was used to group similar codes into themes. The analytic process was managed using the NVivo 11 software package. Results: Results: Eight nurses participated. All nurses were female and had a mean of 8.9 (range: 2.5 - 26) years of pediatric emergency nursing experience. Seven nurses had experience monitoring and administering INK to children for PSA. Five themes emerged: 1) attributes of INK, 2) INK effects on patients and families, 3) INK effects on health care providers, 4) INK effects on the ED environment, and 5) uncertainty regarding INK's effectiveness, predictability, and fit into institutional sedation protocols. Subthemes included 1) perceptions that INK produced a relatively shallower, slower-onset, and/or less titratable sedation, 2) the importance of patient cooperation (i.e. INK may be preferred by providers for older patients undergoing relatively painful or long procedures), 3) belief that INK was an effective anxiolytic and sedative with the potential to improve nursing resource utilization, and 4) belief that physician resistance to change and lack of personal familiarity were barriers to adoption. Conclusion: Conclusions: We identified clinical advantages to using INK in children, the importance of selecting appropriate patients, and barriers to widespread INK adoption. Importantly, our findings highlighted uncertainty about INK's effectiveness and incorporation into sedation protocols. Our findings will inform future knowledge translation strategies when implementing INK in the clinical setting.

scholarly journals Fenomenologi : Caring Perawat Terhadap Klien Dengan Kondisi Kritis Di Instalasi Gawat Darurat – Rumah Sakit Dr. Saiful Anwar Malang

2017 ◽  
Vol 2 (1) ◽  
pp. 17
Author(s):  
Janes Jainurakhma ◽  
Indah Winarni ◽  
Setyoadi Setyoadi
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Critical Condition ◽  
Care Providers ◽  
Emergency Nurses ◽  
Nursing Experience ◽  
Nursing Services ◽  
Nurse Caring ◽  
Critical Patients

Caring is an important part of nursing process that difficult to be apart. Emergency nursing is a profession that required health care providers with fast performance, accurate, and quality of complicated and holistic problems. A lot of patients with critical condition at emergency department, they ask a quality of nursing services and it is affected by the quality of a nurse caring. Without caring passion, a nurse vulnerable to act that violate ethical of nursing, no exception nursing profession at emergency installations of RSSA Malang. The purpose of this study is to explore the experience of nurse caring for clients with critical condition at emergency installations of RSSA Malang. This study used a qualitative approach, with interpretive phenomenological method. Purposive sampling is a method used in this study, the criteria of experience as nurse in the emergency installations of RSSA Malang at least 5 years, still working in the emergency installations of RSSA Malang, and willing as participant. Using semi-structure interviews technique, and analyzed by Miles and Huberman model approach. The results led to three themes, namely: the resque of critically ill patients, improve patient and family confidence,  desire to do the best for crical patients. Based on the results of the study are expected to follow up with the theme of the next study of emergency nurses caring of the perpective of patient and families, and needs to be improved further for the training of emergency skill of nurses in the emergency department, so thet skills and knowledge of nurses in handling critical patients better.; Key words: caring, nursing experience, critical patient.

scholarly journals Brazil’s Community Health Workers Practicing Narrative Medicine: Patients’ Perspectives

2021 ◽  
Author(s):  
Rogério Meireles Pinto ◽  
Rahbel Rahman ◽  
Margareth Santos Zanchetta ◽  
W. Galhego-Garcia
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Providers ◽  
Health Workers ◽  
Hybrid Approach ◽  
Narrative Medicine ◽  
Structured Interview ◽  
Patient Perspectives ◽  
Care Providers

Abstract Background Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective To document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System. Design We used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results Sample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.

PERIPHERAL BRAIN

1995 ◽  
Vol 16 (6) ◽  
pp. 229-238
Author(s):  
Jill M. Baren ◽  
James S. Seidel
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Providers ◽  
Cardiopulmonary Arrest ◽  
Pediatric Emergency ◽  
Care Providers ◽  
Loss Of Life ◽  
Policies And Procedures ◽  
Emergency Drugs ◽  
Emergency Equipment

This section of Pediatrics in Review is designed to be clipped or duplicated and filed in a handy place in the office, clinic, or emergency department, providing a convenient and concise reference. All offices in which children are examined should have pediatric emergency equipment, supplies, drugs, policies, and procedures. The equipment, supplies, and drugs kept in the office will depend on the spectrum of ill or injured children seen in the practice. However, a source of oxygen, basic resuscitation drugs (suited to the patient population and experience of the health-care providers), and a dosage chart or weight-based dosing tape (Figure 1) should be available in all offices. The following list of drugs is fairly comprehensive and is organized according to sign or symptom needing treatment. Health-care providers should become familiar with the information regarding specific drugs that they use commonly, eg, choose a short-acting benzodiazepine such as diazepam or lorazepam for treating status epilepticus. The intraosseous (IO) route of drug administration can be used for the majority of emergency drugs listed in the chart that suggest administration by the intramuscular (IM) or intravenous (IV) routes. The IO route is appropriate for children age 6 years and younger and should be reserved for those circumstances where failure to achieve vascular access might result in loss of life or limb (ie, anaphylaxis, cardiopulmonary arrest).

Prescribing an App? Oncology Providers’ Views on Mobile Health Apps for Cancer Care

2017 ◽  
pp. 1-7 ◽  
Author(s):  
Callie M. Berkowitz ◽  
Leah L. Zullig ◽  
Bridget F. Koontz ◽  
Sophia K. Smith
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Mobile Health ◽  
Cancer Care ◽  
Structured Interview ◽  
Mobile App ◽  
Care Providers ◽  
Supportive Services ◽  
Wide Range ◽  
Oncology Providers

Introduction Although there are over 500 mobile health (mHealth) applications (apps) available for download in the field of oncology, little research has addressed their acceptability among health care providers. In addition, the providers’ perspectives regarding patient app use has been largely unexamined. We conducted a qualitative study to explore opportunities and barriers for mHealth app use for oncology care. Methods We developed a structured interview guide focusing on acceptability, appropriateness, feasibility, and sustainability of the use of apps in cancer care. We interviewed 15 oncology providers about their attitudes and preferences. De-identified audio recordings were transcribed and coded for emerging themes. Results Providers interviewed included physicians (n = 8) and advanced practice (n = 3) and supportive services (n = 4) providers who care for a wide range of cancer types; ages ranged from 32 to 68 years. Interviews lasted approximately 30 minutes. Oncology providers reported limited exposure to mHealth apps in patient care, but were generally open to recommending or prescribing apps in the future. Key themes included opportunities for mobile app use (including general health promotion, tracking symptoms, and engaging patients) and barriers to implementation (including access to technology, responsibility, workflow, and the source of the app itself). Conclusion Our results show openness among oncology providers to using mHealth technology as part of patient care, but concerns regarding implementation. Designing acceptable apps may be challenging and require involvement of key stakeholders, partnering with trustworthy institutions, and outcome-based research.

scholarly journals Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

CJEM ◽  
2011 ◽  
Vol 13 (05) ◽  
pp. 333-338 ◽  
Author(s):  
Shawn K. Dowling ◽  
Ian Wishart
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Pediatric Emergency ◽  
Ankle Fractures ◽  
Care Providers ◽  
Emergency Physicians ◽  
Ottawa Ankle Rules ◽  
Clinically Significant

ABSTRACT: Introduction: A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear. Objectives: The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant. Methods: A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research. Results: Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon. Conclusions: The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.

scholarly journals Case Report of Severe Lactic Acidosis and Persistent Diastolic Hypotension After Standard Dose Intermittent Salbutamol Nebulization in a Child: Rare Adverse Effects for Common Treatment.

2020 ◽  
Author(s):  
Marco Colombo ◽  
Anna Plebani ◽  
Annalisa Bosco ◽  
Massimo Agosti
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Lactic Acidosis ◽  
Health Care Providers ◽  
Standard Dose ◽  
Airflow Obstruction ◽  
Pediatric Emergency ◽  
Intermittent Therapy ◽  
Care Providers ◽  
Nebulized Salbutamol

Abstract BackgroundSalbutamol is a selective β2 receptor agonist widely used to treat asthma and other conditions and it often represents the treatment of choice for reversing airflow obstruction both in emergency and domiciliary settings. However, it can be associated to a broad spectrum of side effects and even paradox effects, if administered intravenously, at high doses continuous nebulized treatment and even at standard doses intermittent nebulized treatment, the latter being the most hazardous due to its infrequency. Lactic acidosis and persistent diastolic hypotension secondary to intermittent salbutamol nebulization are rare in children, moreover at standard therapeutic doses during asthma exacerbations.Case presentation We present a case of a 12 year-old boy, 34 Kg, who experienced a serious drug reaction during a moderate asthma attack, after intermittent inhaled (0.2 mg in 3 hours interval – overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg in 20 minutes interval in 60 minutes, overall 11.25 mg in our ED). He began experiencing symptoms of toxicity (tremor) in the emergency department few minutes after administration of the second dose of nebulized salbutamol, without reporting that to health care providers. Few minutes after the end of the third nebulized dose, clinical conditions worsened showing hyperglycemia (highest value 222 mg/dl), hypokalemia (lowest value 2.6 mEq/L), electrocardiogram alterations, decreased blood pressure (lowest value 87/33 mm/Hg), increased lactate serum level (highest value 8.1 mmol/L). The patient fully recovered after discontinuation of salbutamol and was discharged after 24 hours of staying in the intensive brief observation unit of our pediatric emergency department.ConclusionsWe reinforce the message that not only intravenous administration or continuous nebulization of salbutamol can lead to severe complication in children, but also intermittent therapy given at standard doses. Then, health care providers should pay attention not only in emergency settings in order to achieve prompt recognition and proper management of this adverse reaction.

scholarly journals Breast feeding knowledge, attitude and perspective in immediate postnatal mothers

2019 ◽  
Vol 8 (6) ◽  
pp. 2482
Author(s):  
Vishma H. Shetty
Keyword(s):  
Breast Feeding ◽  
Health Care Providers ◽  
Maternity Leave ◽  
Feeding Practices ◽  
Structured Interview ◽  
Care Providers ◽  
Medical College ◽  
Skin Contact ◽  
Attitude And Practice ◽  
Postnatal Mothers

Background: The aim of the study is to understand the knowledge, attitude and practice of breastfeeding among postnatal mothers and optimize the breast feeding practices and overcome various factors that hinder and influence the full realization of benefits of breast feeding.Methods: The study was conducted in the postnatal ward of Rajarajeswari medical college and hospital, Bangalore. 500 postnatal mothers were included. A structured interview schedule was prepared to collect sociodemographic data, perceptions, knowledge, attitude and practices of mothers regarding breastfeeding. Data was collected by interviewing mothers (in their own language) using proforma.Results: About 100% of mothers and newborn infant have skin to skin contact within one hour of an uncomplicated vaginal delivery. Majority of the mothers knew about the importance of breast feeding for babies and herself. Only 17% of the mothers were working in our study and majority of them had resigned from their work as there was no option of maternity leave and baby friendly work environment at their working places. 69% intended to breastfeed up to 6 months. 23% mothers discarded colostrum and 11% gave prelacteal feeds to their babies.Conclusions: The mothers should be encouraged and reinforced about the benefits of breastfeeding for both baby and herself. The workplace condition has to be improved and make it more breast feeding friendly. The study also will assist the health care providers and community workers to understand the attitude and practice in the area and help them to prioritize and focus on these aspects and decrease the incidence of suboptimal feeding practices.

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