Emergency medical service nurses’ experiences and perspectives on a protocol change of pre-hospital preventive immobilization of spinal injuries after trauma: A qualitative study

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2024-11-22 DOI:10.1016/j.ienj.2024.101533

Otto J. van de Breevaart , Nancy E.E. Van Loey , Luke P.H. Leenen , Lisette Schoonhoven , Wietske H.W. Ham

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Abstract

Objective

In 2016, a selective preventive spinal immobilization protocol for emergency medical service (EMS) nurses was introduced in the Netherlands. This protocol leaves more room for autonomous decision-making in the pre-hospital phase regarding preventive spinal immobilization (PSI), compared to the previous strict protocol. In this study, we explored the experiences and perspectives of EMS nurses on decisionmaking about PSI after the change from a strict to a selective PSI protocol. Methods: We used a qualitative design with semi-structured face-to-face interviews. Thematic analysis was applied. The capability-opportunity-motivation-behavior-model was used to interpret the experiences and perspectives. Results: Thirteen EMS nurses from three emergency medical services were interviewed. Respondents appreciated autonomous decision-making as there was more room for patient-centered informed decision-making. However, autonomous decision-making required optimized knowledge and skills and elicited the need to receive feedback on their decision not to apply PSI. When nurses anticipated resistance to selective PSI from receiving hospitals, they were doubtful to apply it. Conclusion: Nurses appreciate the increased autonomy in decision-making, encouraging them to focus on patient-centered care. Increased autonomy also places higher demands on knowledge and skills, calling for training and feedback. Anticipated resistance to receiving hospitals based on mutual protocol discrepancies could lead to PSI application by EMS nurses while not deemed necessary. Recommendations: To enhance PSI procedures, optimizing the knowledge and skills of EMS nurses that facilitate on-scene decision-making may be indicated. A learning loop for feedback between the EMS nurses and the involved hospitals may add to their professional performance. More efforts are needed to create support for the changed Emergency Medical Services strategy in PSI to prevent unnecessary PSI and practice variation.

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紧急医疗服务护士对创伤后脊柱损伤院前预防性固定协议变更的经验和观点：定性研究。

目的：2016 年，荷兰为急救医疗服务 (EMS) 护士推出了选择性预防性脊柱固定方案。与之前的严格规程相比，该规程在院前阶段为预防性脊柱固定（PSI）的自主决策留出了更多空间。在本研究中，我们探讨了从严格的 PSI 方案转变为选择性 PSI 方案后，急救护士在 PSI 决策方面的经验和观点：方法：我们采用了半结构化面对面访谈的定性设计。采用主题分析法。采用能力-机会-动机-行为模型来解释经验和观点：来自三个紧急医疗服务机构的 13 名急救护士接受了访谈。受访者对自主决策表示赞赏，因为这为以患者为中心的知情决策提供了更大的空间。然而，自主决策需要优化的知识和技能，并需要在决定不使用 PSI 时得到反馈。当护士预料到接收医院对选择性 PSI 的抵制时，她们对应用 PSI 持怀疑态度：结论：护士对决策自主权的增加表示赞赏，这鼓励她们将精力集中在以患者为中心的护理上。自主权的增加也对知识和技能提出了更高的要求，需要培训和反馈。基于双方协议的差异，预计接收医院会有抵触情绪，这可能会导致急救护士在认为没有必要的情况下应用 PSI：建议：为加强 PSI 程序，应优化急救护士的知识和技能，以促进现场决策。在急救护理人员和相关医院之间建立反馈学习回路，可提高他们的专业表现。还需要做出更多努力，为急救医疗服务在 PSI 中改变策略提供支持，以防止不必要的 PSI 和实践差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.