Trauma patients’ encounters with the team in the emergency department—A qualitative study

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Abstract

Background

Encounters in emergency departments have been described from different perspective and with different research approaches. On reviewing the literature, along with medical skills, interpersonal skills such as the ability to create a relationship with the patient was considered significant. Patients exposed to high-energy violence arrive at the emergency department in a vulnerable condition. Apart from their physical condition, they might be in shock and frightened by the experiences of the injury. The team at the emergency department is responsible for a complex situation and has to quickly establish rapport, gather information, assess the physical condition, and design a treatment plan.

Aim

The aim of this study was to explore trauma patients’ conceptions of the encounter with the trauma team.

Design and method

A qualitative inductive design was used and data were collected by semi-structured interviews. The interviews were transcribed verbatim and analysed according to contextual analysis.

Participants

Twenty-three trauma patients with minor injuries, 17 from a university hospital and six from a county hospital with minor injuries, were included in the study.

Findings

The main findings were three main categories, labelled modes of being with the patients: the instrumental, the attentive and the uncommitted mode. All encounters contained the instrumental mode and mostly there were a combination of instrumental mode and attentive mode. The patients were satisfied with these modes, which created emotions of confidence, comfort and satisfaction. The uncommitted mode occurred in some encounters together and generated emotions of abandonment, dissatisfaction.

Conclusion

The main conclusion is that a high-quality encounter in trauma care is likely to be received from caregivers who can shift their mode of being with the patient between the instrumental and the attentive mode as the patient/situation demands. That is, flexibility between the physical and psycho-social care.

Section snippets

What is already known about this topic?

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    Patient satisfaction in emergency medicine is related to interpersonal skills/staff attitude, provision of information, and waiting times.

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    ED patients’ complaints are related to communication problems, treatment, diagnosis and discharge arrangements.

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    Communication skills are a prerequisite for a good relationship between nurses and patients.

What this paper adds

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    More varied view of trauma victims’ encounter with the ED team concerning the team's behaviour throughout the care.

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    The team members changed their behaviour towards the patients whereupon the care activities advanced and they showed three modes of being with the trauma patient: instrumental, attentive and uncommitted.

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    A high-quality encounter in the ED requires team members who have the ability to vary their mode between the instrumental and the attentive modes of being.

Aim

The aim of this study was to explore trauma patients’ conceptions of their encounter with the ED team.

Phenomenographic research tradition

A qualitative study that takes a phenomenographic approach was designed. During the early 1970s, phenomenography was developed in Sweden in the area of pedagogic research. Phenomenography describes a distinction between the first-order perspective, explaining how things are, and the second-order perspective, describing how people perceive the world (Marton, 1981). Phenomenography uses the

Discussion

By relating the discerned aspects and components, the categories emerged as three definite modes of being with the trauma patients. The modes that emerged, instrumental, attentive and uncommitted, vary in content. There are close points of similarity between the instrumental mode and the attentive mode with regard to the outcome for the patients. These two modes of being generated positive feelings, whereas the uncommitted mode gave rise to negative feelings. It was interesting to observe how

Conclusion

One prerequisite for a high-quality encounter in the ED is team members who can change their mode of being with the patient between the instrumental and the attentive mode. Thus, flexibility with regard to the timing of physical and psychosocial care is necessary.

Implications

The quality of care can be improved by developing proper routines at discharge. The nurse must check the patients’ understanding of advice and prescriptions, etc., and make a note about this in the patient record. If such work assignments are not practicable for the responsible nurse, a post for a discharge coordinator could be created.

Recurrent measurement of patient satisfaction could help caregivers become aware of the patient perspective on trauma care. Instruments measuring patient

Acknowledgements

The study received financial support from The Health Research Council in south-east of Sweden (FORSS).

References (28)

  • K.N. Huggins et al.

    Emergency department patients’ perception of nurse caring behaviours

    Heart and Lung

    (1993)
  • A.M. Kärner et al.

    Rehabilitation after coronary heart disease: spouses’ views of support

    Journal of Advanced Nursing

    (2004)
  • S. Kvale

    Den kvalitativa Forskningsintervjun (The Qualitative Research Interview

    (1997)
  • S. Larsson

    Kvalitativ Analys—Exemplet Fenomenografi. (Qualitative Analysis—The Example Phenomenography)

    (1986)

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    Copyright © 2006 Published by Elsevier Ltd.