Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study.
Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study.
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DOI：
10.1136/bmjopen-2016-014057
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发表时间：
2017-02-28
期刊：
影响因子：
2.9
通讯作者：
Jui J
中科院分区：
文献类型：
--
作者：
Guise JM;Hansen M;O'Brien K;Dickinson C;Meckler G;Engle P;Lambert W;Jui J
院前紧急医疗服务 (EMS) 提供者表示，焦虑是导致儿科患者安全事件的第二大常见因素。本研究的目的是了解 EMS 提供者如何看待压力和焦虑对儿科院外患者安全的影响。这是一项针对美国 50 个州中的 44 个州 (88%) 的 EMS 提供商的全国性研究。共有 753 名符合资格的 EMS 专业人员，包括参与院外转运的急救医疗技术人员、急诊科医生和护士（普通科和儿科）以及呼吸治疗师。结果包括对以下方面的反应：(1) 压力或焦虑加剧可能导致安全事件的临床情况，(2) 这些临床情况引起压力或焦虑的方面，以及 (3) 压力或焦虑如何导致儿科安全事件。 EMS 提供者报告说，压力和焦虑更有可能导致儿科患者安全事件的临床情况是创伤、呼吸窘迫和心脏问题。关键主题是：(1) 提供者对儿童的同情或认同，(2) 难以看到无辜儿童受到伤害以及儿童的内在价值，以及 (3) 没有充分接触儿科紧急情况。儿科紧急情况的护理给医疗服务提供者带来了独特的压力，可能会影响患者的安全。据报道，许多导致提供者压力和焦虑的因素都是儿童的固有属性，因此无法改变。在压力条件下支持护理的工具（例如认知辅助工具）可能有助于减轻儿童院前护理中的焦虑。需要进一步研究来确定干预措施的机会和属性。
Prehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety. This was a nationwide study of EMS providers from 44 of 50 (88%) US states. A total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports. Outcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events. EMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies. Caring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions.