www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3
ORIGINAL ARTICLE
Eme gency heal h ca e p o essionals’ expe iences o
ac o s ha in luence ca e quali y and sa e y
Ma i Salminen-Tuomaala ∗1, Päi i Leikkola2, Eija Paa ilainen3
1School o Heal h Ca e and Social Wo k, Seinäjoki Uni e si y o Applied Sciences, Finland
2Seinäjoki Cen al Hospi al, Finland
3School o Heal h Sciences, Uni e si y o Tampe e, Sou h Os obo hnia Hospi al Dis ic , Finland
Recei ed: Decembe 28, 2014 Accep ed: Ma ch 30, 2015 Online Published: Ap il 20, 2015
DOI: 10.5430/cns. 3n3p60 URL: h p://dx.doi.o g/10.5430/cns. 3n3p60
ABSTRACT
In oduc ion:
Mo e esea ch is equi ed on ca e quali y and pa ien sa e y, especially om he ca e p o ide pe spec i e. Aims
and objec i es: The s udy desc ibes ac o s ha a ec he quali y o eme gency ca e as expe ienced by nu ses, pa amedics,
hospi al and ambulance a endan s and p ac ical nu ses in ou -o -hospi al eme gency medical se ices.
Me hods:
Da a we e collec ed in Oc obe 2013 by semi-s uc u ed in e iews (n= 15) in Finland and analysed using induc i e
con en analysis.
Resul s:
High quali y eme gency ca e is pa ien -cen ed, equal, p o essional, indi idualized and holis ic. I encompasses he
ollowing a eas: p omp eme gency ca e on si e; p e en ion o pa ien de e io a ion; indi idualized holis ic ca e; a anging
sa e ollow-up ca e; suppo ing he coping o pa ien s and amilies and; secu ing he sa e y o pa ien s and s a on si e and in
ambulance. The ca e quali y ca e is a ec ed by p o essionals’ heo e ical and p ac ical compe ence and pe sonal quali ies, by he
a ailabili y o equipmen , co-ope a ion, con ex ual ac o s, pe sonnel policy and by he ou come o consul a ion wi h a doc o .
Conclusions:
Eme gency ca e s a will be expec ed o p o ide inc easingly ex ensi e, holis ic ca e on si e. All s ages o he ca e
pa hway should be e alua ed and compa a i e in e na ional s udies conduc ed o de ec de elopmen needs. Rele ance o clinical
p ac ice: Consis en p ac ices and ins uc ions a e indica ed. Managemen needs o p omo e s a coping and mo i a ion by means
o educa ion, ocusing on he ca e o olde pa ien s and clien s a ec ed by mul iple diseases, and on psychosocial and social
p oblems o people a ec ed by alcoholism o social exclusion.
Key Wo ds: Eme gency ca e, Quali y o ca e, Eme gency heal h ca e p o essional, Ou -o -hospi al eme gency ca e
1. INTRODUCTION
Eme gency medical se ices (EMS) and ou -o hospi al ca e
a e key a eas in heal h se ices, p o iding u gen ca e o
acu ely ill o inju ed pa ien s and anspo ing hem o de ini-
i e ca e uni s. De eloping he quali y o eme gency ca e is
a cu en conce n, bo h in e na ionally and na ionally. In Fin-
land, he ocus is on p omo ing pa ien sa e y, bu ew s udies
ha e so a been conduc ed on eme gency ca e speci ically.
[1]
In Finnish legisla ion,
[2]
eme gency medical se ices a e de-
ined as a combina ion o ou -o hospi al se ices p o ided
unde he adminis a ion o hospi al dis ic s, mainly o as-
sess pa ien s’ need o acu e ca e and ans e o hospi al.
The Minis y o Social A ai s and Heal h Dec ee
[3]
u he
s a es ha all isk managemen and sa e y planning in heal h
and social se ice o ganiza ions mus s a wi h pa ien s and
wi h ensu ing ha hey ecei e sa e, high quali y ca e.
∗Co espondence:
Ma i Salminen-Tuomaala; Email: [email p o ec ed]; Add ess: School o Heal h Ca e and Social Wo k, Seinäjoki
Uni e si y o Applied Sciences, Finland.
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A g ea numbe o ecommenda ions exis , di ec ed a im-
p o ing he quali y o heal h ca e. A na ional example is
p esen ed he e: A Quali y Manual published by he As-
socia ion o Finnish Local and Regional Au ho i ies lis s
ou ac o s ha a e essen ial o he quali y o heal h se -
ices; (1) quali y o se ing clien s (pa ien -cen edness and
imeliness), (2) clinical quali y (compe ence, pa ien sa e y),
(3) quali y o p ocesses (smoo h ope a ion o se ices) and
(4) e ec i eness.[4]
O hese, pa ien sa e y is a c i ical componen o quali y
in EMS.
[4]
P o ision o pa ien -cen ed, indi idualized ca e
can be seen as ano he cen al aspec o quali y. Fo pa ien s,
indi idualized ca e has been shown o in ol e an expe ience
o ecei ing suppo du ing ca e p ocedu es.
[5–7]
Op imally,
pa ien -cen ed, indi idualized ca e combines a en ion gi en
o a numbe o ac o s; he clinical ca e si ua ion, he pa ien ’s
eac ions, his o he indi idual li e si ua ion and po en ial
and willingness o pa icipa e in decision-making conce ning
ca e.
[6]
I has also been poin ed ou ha besides a ending o
he pa ien ’s unique needs a he igh ime, ca e p o essionals
need o pay a en ion o he po en ial o he ca e con ex in
seeking o help he pa ien .[8]
High quali y eme gency ca e is also equa ed wi h expe
se ices, which mee pa ien needs while also aking in o
conside a ion he a ious s akeholde s. Quali y is seen o
esul om he ca e p o essionals’ join commi men o e e y-
hing hey unde ake in o de o help pa ien s.
[9]
As in o he
coun ies, Finnish law equi es ha heal h ca e o ganiza ions
ollow e idence-based p ac ices o ensu e high quali y ou -
comes.
[10]
In u u e, he de elopmen o clinical eme gency
se ices will ely on eal- ime elec onic in o ma ion abou
he pa ien ’s medical his o y.
[11]
Finally, one mus also bea
in mind ha as pa o hei e o o p omo e pa ien sa e y
as an impo an quali y ac o ,
[12–15]
ca e p o ide s need o
look beyond he physical aspec o ca e. To be able o eel
sa e, pa ien s also need suppo , p o ided by means o a com-
munica i e con ac , in e aining hei iden i y and egaining
equilib ium a e he acu e inciden .[16]
The quali y o ou -o hospi al eme gency ca e canno be dis-
cussed wi hou some idea abou he challenges u u e is likely
o b ing. As in many o he coun ies, Finland’s popula ion
is ageing apidly. An inc easing numbe o eme gency ca e
pa ien s will be olde people wi h mul iple illnesses. Addi-
ionally, ewe people a e nowadays ca ed o in ins i u ions,
bu con inue li ing in hei own homes. Mo e o en han be-
o e, eme gency ca e p o essionals will encoun e people in
poo heal h. Guidelines on wha kind o ea men s o unde -
ake will be equi ed. Ca e p o essionals may occasionally
need o conside whe he o no o e ain om hea y ea -
men s, bu also, mo e commonly han ea lie , hey will be
expec ed o adminis e holis ic ca e on si e. Compe ence in
ge ia ic acu e ca e will be e y much sough a e in u u e.
Mo eo e , eme gency ca e se ices may be he only con ac
ha people a ec ed by alcoholism, social exclusion o men-
al heal h p oblems ha e wi h heal h se ices. I is c ucial
ha well- unc ioning co-ope a ion ne wo ks a e de eloped
and main ained be ween p ima y heal h ca e, eme gency so-
cial se ices, home nu sing, subs ance abuse se ices and
EMS.[1,17–19]
Besides he challenges b ough on by a skewed age py amid,
p o essionals wo king in eme gency heal h ca e se ices will
ha e o ake on a numbe o o he complex asks. Thei wo k
will ake place in an inc easingly in e na ional en i onmen ,
in which s uc u al changes a e common in heal h and social
ca e o ganiza ions. C ea ing ne wo ks o se ices will be
necessa y, al hough in Finland he e is also a co-exis ing
endency o cen alize eme gency ca e se ices. Finally and
impo an ly, in oday’s socie y, pa ien s and hei amilies
ha e lea n o expec and demand indi idualized se ices.
[11]
The exis ing esea ch on EMS in Finland, conduc ed ei he
om pa ien o ca e p o ide pe spec i e, mainly discusses
nea -misses and ad e se e en s as ac o s ha a ec he qual-
i y in eme gency medicine.
[7,20–23]
Mo e s udies a e needed
om he pe spec i e o eme gency ca e p o essionals, o
explo e hei concep ions and expe iences o ac o s ha con-
ibu e o he quali y o ou -o -hospi al ca e ha hey p o ide.
Thei expe iences will be aluable when seeking o de ec
isks and p e en human e o s.
[24,25]
S udying ca e p o es-
sionals’ expe iences o he wo k en i onmen , equipmen
and ac o s ha a ec pa ien sa e y can also help o de elop
he quali y o eme gency ca e.[26]
Aims
The pape discusses ac o s ha in luence ca e quali y and pa-
ien sa e y in ou -o -hospi al eme gency ca e as expe ienced
by eme gency ca e p o essionals. The same ac o s a e wo h
conside ing in e na ionally. The s udy e eals de elopmen
needs in he eme gency ca e pa hways ha a e in e es ing
bo h na ionally and in e na ionally.
2. METHODS
2.1 Design
The pu pose o he esea ch was o desc ibe ac o s ha
in luence he quali y and sa e y o pa ien ca e as expe i-
enced by eme gency heal h ca e p o essionals, ha is nu ses,
pa amedics, hospi al and ambulance a endan s and p ac ical
nu ses wo king in ou -o -hospi al eme gency medical se -
ices. The e ms eme gency heal h ca e p o essional and
eme gency heal h ca e p o ide will be used h oughou he
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s udy o e e o his g oup o p o essionals. The esea ch
aims a p oducing new knowledge o be used in de eloping
sa e, high quali y eme gency ca e o pa ien s u he .
This s udy is a pa o a la ge p ojec on he quali y and
sa e y o eme gency medical se ices in one hospi al dis ic
se ing 200,000 inhabi an s. The p ojec aims a p oducing
quan i a i e and quali a i e esea ch knowledge o ac o s
ha a e associa ed wi h quali y and pa ien sa e y in ou -o -
hospi al eme gency ca e. This a icle ocuses on he ca e
p o ide pe spec i e. E en ually, he pe spec i es o pa ien s,
amilies and ca e p o ide s will be inco po a ed. The o e all
quali y p ojec sp ings om a s uc u al change in Finland
in 2013, when he du y o o ganizing eme gency medical
se ices was ans e ed om indi idual municipali ies o
hospi al dis ic s un by join municipal au ho i ies.
A quali a i e app oach based on semi-s uc u ed in e iews
was selec ed o his s udy, because li le ea lie esea ch ex-
is s on he quali y o eme gency medical se ices in Finland,
especially om he ca e p o ide pe spec i e.
The esea ch asks we e: (1) Wha is high quali y eme gency
ca e like as expe ienced by hospi al eme gency heal h ca e
p o essionals? (2) Wha ac o s a ec he quali y o pa ien ’s
eme gency ca e as expe ienced by eme gency heal h ca e
p o essionals?
2.2 Da a collec ion
Da a we e collec ed by semi-s uc u ed in e iews (n= 15) in
Oc obe 2013 wi hin a single hospi al dis ic in Finland. The
hemes add essed in he in e iews in ol ed he quali y o
ou -o hospi al eme gency ca e and sa e y, as expe ienced by
he eme gency heal h ca e p o essionals. All he in e iewees
we e asked he same ques ions. They we e eques ed o de-
sc ibe (1) wha good quali y is in ou -o hospi al eme gency
ca e, (2) wha i consis s o , and (3) wha ac o s in luence i .
The olun a y pa icipan s, selec ed by disc e iona y sam-
pling ou o a o al o 200 employees wo king in ou -o -
hospi al eme gency se ices o he hospi al dis ic , consis ed
o i e pa amedics, i e nu ses, h ee hospi al and ambulance
a endan s and wo p ac ical nu ses. In Finland, nu ses hold
a Bachelo ’s deg ee o equi alen , whe eas p ac ical nu ses
and hospi al and ambulance a endan s (phased ou as a ce -
i ica e bu s ill used in job desc ip ions) ha e comple ed a
oca ional uppe seconda y quali ica ion. Pa amedics a e
ei he nu ses o p ac ical nu ses specialised in eme gency
ca e.
Ten ou o hese p o essionals wo k in he so-called ad anced
and i e in he basic le el o eme gency ca e. In Finland,
eme gency ca e p o essionals can each he ad anced le el by
aking a es o demons a e hei abili y o anspo pa ien s
while main aining pa ien s’ i al unc ions and o ini ia e ad-
anced ca e ( o example eme gency medica ion, 12 channel
ECG, managemen o esusci a ion, in uba ion using ligh
anaes he ic, ex e nal de ib illa ion). Ad anced le el eme -
gency ca e p o essionals a e compe en in eaching a wo king
diagnosis o choose app op ia e ac ion based on examina ions
and in e iew. They mus also be able o manage medical
escue ope a ions in ol ing mul iple pa ien s. Basic le el
eme gency ca e p o essionals, on he o he hand, a e compe-
en in ini ia ing basic li e-sa ing p ocedu es and in ensu ing
ha he pa ien is no de e io a ed du ing anspo a ion.
Eligible pa icipan s had a minimum o wo yea s’ wo k expe-
ience in ou -o -hospi al eme gency se ices. The in e iews
we e conduc ed indi idually in a peace ul se ing and aped
wi h he pa icipan s’ consen . The leng h o he in e iews
a ied om 60 o 80 minu es.
2.3 Da a analysis
The da a we e analysed using induc i e con en analysis.
[27]
The ansc ibed ma e ial amoun ed o 124 pages using Times
New Roman, on size 12 and single spacing. Fi s , he ma-
e ial was ead h ough se e al imes. All he sen ences and
uni s o hough ha seemed o ep esen an answe o he
esea ch asks we e picked ou and w i en down as educed
exp essions, e aining he o iginal o m as a as possible.
Exp essions wi h he same o simila con en s we e g ouped
unde he same sub-ca ego y. Sub-ca ego ies wi h simila
con en s we e hen combined in o gene ic ca ego ies, which
we e u he combined o o m main ca ego ies. Du ing he
analysis, he in es iga o e u ned o he o iginal da a se e al
imes o ensu e plausible in e p e a ion.[28]
2.4 T us wo hiness and e hical conside a ions
The us wo hiness o he s udy will be discussed in e ms
o he ollowing c i e ia sugges ed o he e alua ion o qual-
i a i e esea ch: c edibili y, ans e abili y, dependabili y
and con i mabili y.
[29]
Fi s , he c edibili y o he esul s
is ensu ed by ample, ecen ly acqui ed in e iew ma e ial.
C edibili y is u he inc eased by he ac ha in o man s ep-
esen ed ou p o essions; nu ses, pa amedics, hospi al and
ambulance a endan s and p ac ical nu ses, who had a g ea
deal o expe ience o eme gency se ices and who could be
ega ded as expe s in hei ield. Second, he ans e abili y
o he esul s is enhanced by he desc ip ion o he in o man s’
p o essional backg ound and by a s ep-by-s ep desc ip ion
o he induc i e con en analysis. Thi d, o s eng hen he de-
pendabili y o he s udy, wo o he in es iga o s we e asked
o e alua e he p og ess o he analysis om sub o gene ic
o main ca ego ies. Fou h, he con i mabili y o he esul s
is based on he illus a ion o con en s by means o o iginal
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exp essions. The exce p s p o ide a conc e e illus a ion o
he plausibili y o he esul s. Finally, s udy us wo hiness
is enhanced by he in es iga o ’s expe ience o wo king in
acu e nu sing ca e, e en hough he p econcep ions may also
ha e a ec ed us wo hiness nega i ely. Le i also be added
ha ecen legal e o ms and o ganiza ional change in eme -
gency heal h ca e se ices may ha e shaped he eme gency
ca e p o essionals’ expe iences.
Resea ch e hical guidelines we e obse ed h oughou he
s udy.
[30]
Pa icipa ion was olun a y and in o man s we e
asked o hei consen , including he use o eco de . Be-
o e he onse o he s udy, pa icipan s we e in o med bo h
o ally and in w i ing abou he pu pose o he s udy, s o -
age o apes, ansc ip ion and he app op ia e elimina ion o
apes and w i en ma e ial. Pa icipan s we e awa e ha hei
anonymi y was ensu ed and ha hey could wi hd aw a any
ime.
3. RESULTS
3.1 High quali y eme gency ca e
Eme gency heal h ca e p o essionals wo king in ou -o -
hospi al se ices desc ibe high quali y eme gency ca e in
he ollowing e ms: I is pa ien -cen ed, equal, p o essional
and indi idualized; i means encoun e ing pa ien s holis i-
cally and esponding o hei ca e needs; i p ese es li es,
p o ec s pa ien s and seeks o p omo e he sa e y and con i-
nui y o he pa ien s’ ca e.
3.2 Cons i uen s o high quali y eme gency ca e
Acco ding o eme gency heal h ca e p o essionals, high qual-
i y eme gency ca e encompasses he ollowing a eas o con-
s i uen s: p o iding p omp eme gency ca e on si e; p e en -
ing pa ien de e io a ion; p o iding indi idualized holis ic
ca e; a anging sa e ollow-up ca e; suppo ing he coping
o pa ien s and amilies and secu ing he sa e y o pa ien s
and s a on si e as well as in he ambulance. The i s a ea,
p omp eme gency ca e on si e en ails apid assessmen using
he ABCDE P o ocol and unde aking app op ia e li e-sa ing
measu es.
“Good eme gency ca e esponds o he pa ien ’s
needs, so ha he pa ien ge s he igh kind o
help a he igh ime.”
The second cons i uen o high quali y ca e, p e en ing pa-
ien de e io a ion, equi es in ensi e pa ien obse a ion o
de ec signs and symp oms o de e io a ing s a us. The aim
is o p e en complica ions and u he b eakdown o i al
unc ions.
“Good eme gency ca e ensu es ha he pa ien ’s
condi ion ne e , in any ci cums ances, de e io-
a es.”
Thi d, indi idualized holis ic ca e means encoun e ing peo-
ple in a pa ien -cen ed and p o essional manne . Acco ding
o he in e iewees, he essen ial ask is o assess he pa ien ’s
li e si ua ion and o espond o he o his physical, psycholog-
ical and social ca e needs. Physical illness may no always
be he p oblem; he pa ien may need com o and help in
acing loneliness o in dealing wi h ea s. The in e iewees
s ess ha social and inancial p oblems seem o be on he
inc ease. Especially aged people, immig an s and people a -
ec ed by alcoholism and social exclusion may ha e special
psychosocial needs ha need o be add essed u gen ly.
The ou h a ea men ioned by in e iewees in his s udy is
a anging sa e ollow-up ca e. This ques ion needs o be
add essed al eady on si e, since no all pa ien s need o be
anspo ed o hospi al. In his con ex , eme gency heal h
ca e p o essionals ind i necessa y o assess isks o pa ien ’s
coping and wellbeing and o examine he pa ien ’s and am-
ily’s social si ua ion. The isks may be connec ed ei he wi h
he pa ien ’s physical o psychological heal h o wi h his
o he li ing en i onmen . Bo h psychosocial ac o s and
he conc e e en i onmen need o be conside ed be o e i is
possible o decide whe he o no he pa ien can be sa ely
le a home.
“Some g anny o example, i he e is a decline
in he gene al condi ion, when she is aken away
o u he ca e, she does no need o be alone
a home and po en ial alls o wo se hings a e
a oided.”
The i h a ea b ough up by eme gency heal h ca e p o es-
sionals is suppo ing he coping o pa ien s and amilies.
This in ol es app op ia e counselling and suppo , based on
he ca e p o essional’s assessmen o he si ua ion. Besides
counselling, emo ional and conc e e suppo a e equen ly
equi ed. O al counselling is no always su icien . I he
pa ien and amily membe s a e e y dis essed, i becomes
necessa y o w i e down ins uc ions on he app op ia e ca e
o m o ensu e sa e y o ca e.
“You should be able o ake in o conside a ion
he whole si ua ion, i is no jus abou he po-
en ial auma o symp om o illness, i is he
whole li ing en i onmen and social si ua ion o
he pa ien and o he hings ha a ec his abili y
o deal wi h i and manage a home, be o e you
can e en conside i he will cope a home.”
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The las cons i uen o high quali y eme gency ca e ha
eme ged in his s udy is secu ing he sa e y o pa ien s and
ca e p o essionals, bo h on si e and in he ambulance. When-
e e possible, po en ial isks and h ea s o sa e y need o
be an icipa ed. Ca e p o essionals may also need o eques
assis ance om he police o ensu e bo h pa ien s’ and hei
own sa e y. Occasionally, he pa ien ’s ca e may be delayed
due o denied access o si e be o e he a i al o police, i e o
escue uni s. Si ua ional sensi i i y and logical, consequen
decision-making a e hus impo an quali ies in p o essionals
p o iding high quali y eme gency ca e. These skills can be
de eloped h ough expe ience and hey ha e a majo impac
on he sa e y o pa ien ca e.
“One has o wai , ha also a ec s he quali y
o eme gency ca e in a way, how soon you ge
he e, he e may be some he oin use , who has
ches pain, and he e may be weapons o some-
hing, and you canno jus go and s a helping
immedia ely.”
Table 1 depic s he cons i uen s o high quali y eme gency
ca e as expe ienced by eme gency heal h ca e p o essionals
wo king in ou -o -hospi al eme gency se ices.
Table 1. Cons i uen s o high quali y eme gency ca e
Sub-ca ego y Gene ic ca ego y Main ca ego y
Unde aking li e-sa ing measu es
P omp eme gency ca e on si e Cons i uen s o high
quali y eme gency ca e
P omp assessmen o he pa ien ’s condi ion
E ec i e use o he ABCDE P o ocol
De ec ing signs o de e io a ion
P e en ing b eakdown o i al unc ions P e en ing he de e io a ion o pa ien s
P e en ing complica ions
Encoun e ing pa ien s in a p o essional, pa ien -cen ed manne
P o iding indi idualized holis ic ca e
Mee ing he pa ien ’s indi idual needs
Assessing he pa ien ’s li e si ua ion
De ec ing isks o pa ien ’s heal h and wellbeing
Taking he pa ien ’s and amily’s social si ua ion in o conside a ion A anging sa e ollow-up ca e
Assessing and suppo ing coping a home
P o iding su icien counselling o pa ien s and amily membe s Suppo ing he coping o pa ien s and
amilies
P o iding emo ional and conc e e suppo o pa ien s and amily membe s
De ec ing po en ial isks and h ea s on si e Secu ing he sa e y o pa ien s and ca e
p o essionals on si e and in he ambulance
Op imum use o assis ance om o he au ho i ies
Consequen and logical decision-making
3.3 Fac o s ha a ec he quali y o eme gency ca e
The analysis o he in e iews u he e ealed ha acco d-
ing o eme gency heal h ca e p o essionals, he quali y o
eme gency ca e is a ec ed by he ollowing ac o s: he
eme gency ca e p o essional’s knowledge and skills; he p o-
essional’s pe sonal quali ies; he a ailabili y o eme gency
ca e equipmen ; he e ec i eness o co-ope a ion; con ex-
ual ac o s; pe sonnel policy and he deg ee o success in
consul ing a doc o .
Eme gency ca e p o essionals’ knowledge and skills depend
on hei educa ion and amoun o wo k expe ience. Skilled
use o he eme gency ca e equipmen and applica ion o nu s-
ing knowledge o p ac ice a e men ioned by he in e iewees
as impo an componen s o he ca e p o essionals’ compe-
ence. E ec i e o ien a ion o new employees is emphasized
in his con ex . Second, ca e p o essionals’ pe sonal quali ies
a e also seen o a ec ca e quali y and pa ien sa is ac ion.
Ca e p o essionals’ cha ac e and pe sonali y in luence pa-
ien s’ expe ience o he ca e. Thei wo k mo i a ion and
ale ness le el also di ec ly a ec he quali y o ca e. Oc-
casionally, a ious human ac o s and ca e p o essionals’
pe sonal p oblems may de e io a e he quali y o ca e.
The hi d ac o ha eme ged om he analysis, he a ailabil-
i y o eme gency ca e equipmen , depends on esponsible
ca e and main enance o he equipmen . I is essen ial ha
a e i s use, he equipmen is e u ned o i s place as com-
monly ag eed upon. This p ac ice p omo es he quali y o
ca e by sa ing ime.
“We now ha e uni o m equipmen , which makes
i easie o people, who mo e om one eme -
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www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3
gency ca e uni o ano he , some imes in he
middle o a p ocedu e. You jump in o ano he
ambulance o help ou . I is an impo an pa ien
sa e y issue, no only ha he equipmen is o
high quali y, bu also ha hey a e simila , and
each bag and cabine is equipped he same way,
so you know whe e o ind hings.”
In his s udy, he ou h ac o ound o con ibu e o high
quali y eme gency ca e was he e ec i eness o co-ope a ion
be ween eme gency heal h ca e p o essionals, pa ien s, ami-
lies and o he pa ne s. When wo king wi h pa ien s and hei
amilies, success ul co-ope a ion is especially buil on he
ca e p o essional’s communica ion skills. Good co-ope a ion
in ol es encoun e ing and counselling pa ien s and amilies
on si e in a manne ha c ea es sa e y and encou ages amily
membe s’ pa icipa ion in pa ien ’s ca e a home. The ca e
p o essional’s abili y o communica e e ec i ely wi h he
pa ne a wo k as well as wi h police and escue au ho i ies
a e also c ucial o lexible and e ec i e ca e. Si ua ional
sensi i i y is equi ed o smoo h co-ope a ion.
“The e a e so many mo ing pa s because he e
a e a lo o people in ol ed. E e y si ua ion is
di e en .”
Fi h, ac o s associa ed wi h he eme gency ca e con ex and
si e may ha e a g ea in luence on he quali y o he ca e p o-
ided. The e a e always si ua ion-speci ic ac o s ha equi e
a en ion. Con ex ual ac o s, o example da kness, slippe y
oads o o he wise haza dous en i onmen may jeopa dize
he sa e y o he si ua ion. Mul iple people may be a isk
and in dis ess.
“When you hink o ca ing o an indi idual pa-
ien , some imes ac o s in he en i onmen a -
ec he quali y, o example he e is an anxious
amily membe who in e enes, so i is mo e
di icul o concen a e on he si ua ion and you
ha e o spend some ime on i be o e you ha e
space o ca e o he pa ien , so some imes a
well-meaning amily membe may complica e
he si ua ion a li le.”
“When you go o a la whe e he e a e a lo o
in oxica ed people, he e a e g ea occupa ional
sa e y isks and you mus concen a e on e e y-
body, so ha no hing happens, so he e a e g ea
isks in he en i onmen and ha a ec s how
well you can ake ca e o an indi idual pa ien .”
Acco ding o he eme gency heal h ca e p o essionals in-
e iewed o his s udy, pe sonnel policy is an especially
signi ican ac o ha a ec s he quali y o eme gency ca e.
The ca e p o essionals eel ha suppo and encou agemen
om he managemen enhances he wo k a mosphe e and
p omo es hei wo k mo i a ion and coping a wo k. They
also ind i impo an ha employe s main ain su icien hu-
man esou ces and encou age con inuing educa ion. The
managemen ’s in e es in ge ing o know he s a and in
looking a e hei wellbeing and coping a wo k a e app eci-
a ed. In con as , ca e p o essionals’ coping a wo k is ound
o be unde mined by ans e s o o he posi ions and by o he
o ganiza ional changes, which c ea e insecu i y, diminish
he s a ’s coping esou ces and impai he unc ion o he
whole uni . In Finland, he mos ecen challenge esul s
om he ac ha eme gency ca e uni s, ea lie un by p i a e
companies o by municipal escue au ho i ies, we e aken
o e by hospi al dis ic s.
Finally, one mo e ac o ha a ec s he quali y o eme gency
ca e is consul a ion wi h a doc o . Eme gency heal h ca e
p o essionals ind he consul a ion challenging, i he doc o
on call is no amilia wi h eme gency ca e, does no know
wha medicines and equipmen ambulances ca y o is no
awa e o wha possibili ies he e a e o ea pa ien s on si e
o in he ambulance. Consul ing a doc o who is no a na-
i e speake o he Finnish language occasionally p esen s a
isk o misunde s anding. On he o he hand, consul a ion is
ound o succeed especially well i he ca e p o essional has
ca e ully assessed he pa ien ’s condi ion be o e calling and
i ins uc ions a e p o ided by an expe ienced expe eme -
gency ca e physician. The quali y o ca e is also p omo ed by
s anda dized ca e models and clea ins uc ions p o ided by
physicians o long- e m use. Table 2 summa izes he ac o s
ha a ec he quali y o eme gency ca e as expe ienced by
he ca e p o essionals in e iewed o his s udy.
4. DISCUSSION
This s udy accesses expe iences o nu ses, pa amedics, hospi-
al and ambulance a endan s and p ac ical nu ses wo king in
ou -o -hospi al eme gency medical se ices. Lea ning abou
eme gency heal h ca e p o essionals’ expe iences is aluable,
because hei desc ip ions o high quali y eme gency ca e
and ac o s ha in luence he quali y o he ca e depic a
pic u e o he eme gency medical se ices cu en ly p o ided
in Finland. In his s udy, he quali y o eme gency ca e was
ound o be associa ed wi h he ca e p o essional’s heo e i-
cal and p ac ical compe ence, co-ope a ion, pe sonnel policy
and con ex ual ac o s.
Pa o he ac o s ha a ec he quali y o eme gency ca e
a e si ua ion-speci ic and canno be con olled. Pe sonnel
policy, howe e , is an a ea wi h po en ial o con ibu e o
he quali y and sa e y o eme gency ca e. In o de o p o-
Published by Sciedu P ess 65
www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3
mo e s a coping and wo k mo i a ion, pe sonnel policy
mus be encou aging and suppo i e o con inuing educa ion.
Knox, e al.
[31]
oo, emphasize he impo ance o con inu-
ing educa ion in eme gency ca e. This s udy con i ms ha
good communica ion be ween eme gency ca e p o essionals,
pa ien s and amilies essen ially imp o es he quali y and
sa e y o he ca e deli e ed. Fo example, consul a ion wi h
non-specialis doc o s o immig an doc o s is po en ially
challenging, as he ounda ion o common unde s anding is
lacking. Close co-ope a ion be ween eme gency ca e p o es-
sionals and doc o s p omo es pa ien sa is ac ion and quali y
o ca e.
[21]
Mo ey, e al.
[32]
and Kilne and Sheppa d
[33]
sugges aining and p ac ising eam wo k o enhance com-
munica ion and o minimize e o s in ou -o -hospi al eme -
gency ca e. Fu he mo e, heal h ca e manage s can p omo e
eme gency heal h ca e p o essionals’ wo k mo i a ion by
inc easing oppo uni ies o pa icipa e in decision-making
and in de eloping ca e quali y. Imp o ed mo i a ion is con-
nec ed o highe quali y o ca e.[34] Wo king wi h a amilia
pa ne in a wo k a mosphe e ha p omo es coping c ea es
u he sa e y and dec eases he isk o aul y assessmen . I
is also essen ial ha all eam membe s become commi ed
o e alua ing and de eloping he quali y o hei wo k and
ha he managemen demons a e an encou aging a i ude o
p omo e he pe manency o s a .[35]
Table 2. Fac o s ha a ec he quali y o eme gency ca e as expe ienced by/acco ding o eme gency heal h ca e
p o essionals
Sub-ca ego y Gene ic ca ego y Main ca ego y
The ca e p o essional’s educa ion Fac o s ha a ec he quali y
o eme gency ca e
Skilled use o he eme gency ca e equipmen The ca e p o essional’s knowledge and skills
The ca e p o essional’s wo k expe ience
The ca e p o essional’s wo k mo i a ion
The ca e p o essional’s pe sonal quali ies
The ca e p o essional’s pe sonali y
The ca e p o essional’s ale ness le el
Human ac o s
The condi ion o he eme gency ca e equipmen The a ailabili y o eme gency ca e equipmen
Easy- o- ind eme gency ca e equipmen
The ca e p o essional’s communica ion skills wi h
pa ien s and amilies
The e ec i eness o co-ope a ion
The ca e p o essional’s communica ion skills wi h
he pa ne a wo k
Co-ope a ion wi h o he au ho i ies
Eme gency ca e en i onmen
Con ex ual ac o s
The dis ess o people in ol ed in he si ua ion
The numbe o people in ol ed in he si ua ion
Suppo om managemen
Pe sonnel managemen
Su icien esou ces Pe sonnel policy
Encou aging aining and educa ion
Wo k a mosphe e
The consul ing doc o ’s expe ise and expe ience
The deg ee o success in consul ing a doc o
The consul ing doc o ’s Finnish language skills
S anda dized ca e models and ins uc ions
p o ided by an eme gency ca e physician
The a ailabili y o high quali y equipmen is ano he c i ical
cons i uen o quali y in eme gency ca e. The pa icipan s o
his s udy gene ally ind he quali y o he equipmen sa is-
ac o y bu hey would app ecia e mo e aining on how o
use i . Ca e p o essionals also indica e ha clea pe manen
ins uc ions om expe ienced doc o s specialised in eme -
gency ca e would inc ease pa ien sa e y. Simila ly, ea lie
s udies ha e shown ha ca e p o essionals’ wo k expe ience
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www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3
combined wi h clea ins uc ions con ibu e o high quali y
eme gency ca e.
[13,15,25]
Ins uc ions signi ican ly in luence
he success o he ini ial assessmen and o he en i e eme -
gency ca e pa hway.
[36]
They can also help in he e o o
each e idence-based, good p ac ices.
[37]
The wo k in eme -
gency ca e, wi h i s cons an ly changing ca e si ua ions and
encoun e s na u ally en ails s ess and s ain, which makes
i all he mo e impo an ha ca e con inui y is ensu ed and
sa e ins uc ions p o ided.[35]
The inc easing sha e o olde popula ion and he g owing
numbe o people a isk o social exclusion pose special
challenges o pa ien sa e y in ou -o -hospi al eme gency
ca e. P o essionals wo king in eme gency se ices will e-
qui e mo e p o ound heo e cal and p ac ical compe ence
in iden i ying he co e p oblem in olde pa ien s, who a e
o en a ec ed by mul iple diseases and memo y impai men .
Eme gency ca e p o ide s will also need o add ess a ious
psychosocial and social p oblems ha indi iduals a ec ed
by alcoholism o a isk o social exclusion su e om.
5. CONCLUSION
The esul s o his s udy conduc ed in Finland highligh he
need o pay a en ion o eme gency ca e p o essionals’ con-
inuing educa ion needs. I is ad isable ha se e al p o-
essionals sha e he esponsibili y o de eloping p ac ical
o ien a ion p og ammes and o o ien ing new s a o he
use o equipmen . The mo e expe ienced ca e p o essionals,
oo, would bene i om a new app oach o con inuing educa-
ion; as an inc easing numbe o pa ien s will be ea ed on
si e, mo e ex ensi e and holis ic compe ence will be equi ed.
Speci ic con en s o educa ion will mos p obably in ol e
he acu e ca e o ge ia ic pa ien s, encoun e ing social p ob-
lems and on-si e ca e o pa ien s a ec ed by men al heal h
p oblems and in oxican abuse. Special a en ion should be
paid o he de elopmen o si ua ional sensi i i y, commu-
nica ion and consul a ion skills, which ha e a majo impac
on ca e quali y and sa e y. Desc ibing all s ages o he ca e
pa hway - he ca e on si e, in he ambulance and in hospi al
eme gency depa men – would make all ac ion isible and
help de ec needs o u he de elopmen .
Rele ance o clinical p ac ice
The ole o con inuing educa ion is essen ial in ensu ing
ha ca e p o essionals possess he inc easingly holis ic and
ex ensi e heo e ical and p ac ical compe ences equi ed as
he sha e o pa ien s ea ed on si e only g ows. I seems
ha p o essionals migh bene i om psychological aining,
case s udies and simula ion educa ion, designed o p ac ice
in e ac ion and communica ion skills. A na ional, e en in-
e na ional consul a ion p o ocol migh p e en p oblems in
communica ion wi h doc o s. Consul ing doc o s also need o
be in o med o wha ac ion eme gency p o essionals wo king
on si e a e able and allowed o unde ake.
Secondly, he ocus o u u e con inuing educa ion should
be on he acu e ca e o ge ia ic pa ien s, on encoun e ing
social p oblems and on he ca e o pa ien s a ec ed by men-
al heal h p oblems and in oxican abuse. An inc easingly
indi idualized, holis ic app oach o he pa ien ’s si ua ion
will be equi ed.
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