Mari Salminen-Tuomaala

Coping With the Effects of Myocardial Infarction From the Viewpoint of Patients’ Spouses:

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient’s hospitalization but there is a lack of knowledge regarding spouses’ coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient’s hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category “Seeking balance” included the spouses’ emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses’ coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

Coping — Seeking lost control

Background: Acute myocardial infarction threatens patients’ psychological balance and causes varied coping needs. Aim: The aim was to describe factors that influence patients’ coping with acute MI during hospitalization. Methods: The data were obtained by theme interviews from 28 myocardial infarction patients and analyzed by the grounded theory method. Results: The core category “Coping with myocardial infarction: Seeking lost control” was found to include two main categories: factors supporting coping and factors interfering with coping. The factors were related to patients, conditions and interaction. Conclusion: Nurses need to become aware of their patients’ needs to maintain a sense of control over their situation. They also need to focus on empowering counselling and mental support, and assist in patient–family interaction. Updating education on the recognition of depression and on the factors that affect coping is indicated. Relevance to clinical practice: The findings of this study can be used in health care education and in nursing practice when organizing counselling and support interventions for MI patients.

Web-based Learning for Continuing Nursing Education of Emergency Unit Staff

The authors describe a Web-based continuing education course focusing on patient counseling in an emergency department. Course materials were developed based on data collected from the departments patients and their family members and on earlier findings on counseling. Web-based education is an appropriate method for continuing education in a specific hospital department. This puts special demands for nurse managers in arranging, designing, and implementing the education together with educators.

Spouses’ coping alongside myocardial infarction patients

Background: The purpose of the research was to develop a substantive theory to describe the coping of myocardial infarction (MI) patients’ spouses. The theory describes spousal coping experiences at 4 and 12 months after the patient’s MI. Methods: The data were collected by means of theme interviews from 28 spouses in the years 2006 and 2007 and analysed using Strauss and Corbin’s grounded theory method. Results: The substantive theory describes four main categories of spousal coping. The categories are: serene and balanced coping; action-centred coping; illness-centred coping; and coping based on denial of illness. Conclusions: The theory can be useful when developing support and counselling interventions for the spouses of MI patients. The study provides new knowledge about the spouses’ coping experiences and about the factors that influence their coping over a longer period of time. The theory also discusses causal, contextual, and concurrent factors, which affect the coping experience and whose identification is important when seeking to support the spouses. Another application of the theory can be found in nursing education.

Patient and Staff Safety Incidents and Near Misses in Out-Of-Hospital Emergency Care

Objectives: The purpose of this qualitative study is to describe patient and staff safety incidents and near misses in out-of-hospital emergency care with the aim of providing new knowledge that can be useful in preventing and decreasing risks in emergency care. Research Methodology and setting: The data consisted of voluntary, anonymous reports collected online from emergency care staff in 2013 in one hospital district that serves a population of 200,000 in Finland. A total of 45 incident descriptions of adverse incidents, risks and near misses were accrued, all of which were analyzed using inductive content analysis. Results: The results reveal that threats to patient safety are associated with the patient’s psychological and physical status, medication, care equipment and context. In occupational safety of emergency care providers, the patient’s mental ill-being and aggression, the context, care equipment and emergency driving constitute potential sources of risks. Conclusion: As only a limited number of incidents were reported, staff should be encouraged to use the reporting system as an essential part of quality management in emergency services. More attention needs to be paid to assessing the overall emergency situation from the viewpoint of safety and the level and reliability of information before starting diagnostic procedures and treatment. Education and study of earlier safety incidents can help prevent risks.

Challenges and factors likely to promote coping as anticipated by nurses preparing for a merger of intensive and intermediate care units

OBJECTIVE To describe challenges and factors that support coping as anticipated by nursing staff preparing for a merger of intensive and intermediate care units. RESEARCH METHODOLOGY The method of empathy-based stories was employed to collect data from staff. The stories (n=20) were analysed using inductive content analysis. SETTING Nursing staff from the cardiac observation and evaluation, intensive care and surgical observation units in a central hospital in Finland. FINDINGS Participants anticipated challenges related to personal factors that affect coping at work, challenges in co-operation among nursing staff and problems associated with the new work context. Participants expected to need informational, concrete and social support from colleagues in future clinical nursing situations. CONCLUSION Fostering peer support and team spirit is important to ensure staff co-operation and smooth care processes following restructuring.

Counseling patients and family members in out-of-hospital emergency situations: a survey for emergency staff

BackgroundNot much is known about emergency care delivered in patients’ homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff’s experiences of encountering and counseling patients and their family members.MethodsA descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N = 142 reponse rate 59%) and analyzed using descriptive statistics.ResultsRespondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging.ConclusionsHigh-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient’s and family’s situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.

774 Factors that improve the safety of patient care as experienced by emergency medical care providers

Background An increasing number of acutely ill patients are not transported to hospital but treated in their homes or another location. Special attention should be paid to factors that affect patient safety (Ministry of Social Affairs and Health 2014.) Methods The study describes factors that promote the safety of patient care in out-of-hospital emergency medical care, as experienced by care providers. The data were collected by semi-structured interviews (n = 15) with care providers selected by discretionary sampling. The material was analysed using inductive content analysis. Results Patient safety improves with successful consultation with the emergency physician and with holistic consideration of all factors that affect the patient’s coping. Safety is further promoted by the emergency care provider’s theoretical, practical and attitudinal competencies and co-operation skills. Situational sensitivity is an important factor intertwined with the care provider’s personality, emotional intelligence and discretion. Moreover, safety can be improved by making certain that individual procedures are carried out safely and by ensuring continuity of care and coping with home care. Finally, management practices that aim at workers’ wellbeing at work increase patient safety. Conclusions A study of factors that improve or impair patient safety can help care providers anticipate threats and prevent risks.

Factors that Influence the Counselling of Family Members in Out-of-HospitalEmergency Medical Care

Background: Counselling family members of acutely ill patients has not been studied from the perspective of out-of-hospital emergency care. The purpose of this study was to fill the research gap by describing care providers’ experiences of factors that influence counselling and supporting family members in out-of-hospital emergency care. Methods: The data were collected by semi-structured interviews of emergency care providers (N=15) in Finland in 2014 and analysed using content analysis. Results: Factors that influence the counselling aimed at family members in out-of-hospital emergency care can depend on the patient, family member, emergency care provider or context. Patient-dependent factors involve the patient’s personality, severity of physical and psychological symptoms, criticality of the situation, the patient’s memory, responses, behaviour and cognitive abilities and emotional resources. Family member-dependent factors include the family members’ needs and responses, fears, anxiety, feelings of not having control, needs for support, cognitive and emotional preparedness to commit themselves to help and support the patient and willingness to engage in supporting the patient. Care provider-dependent factors include the care provider’s personality, clinical expertise, theoretical and practical competence, work and life experience and attitudes. Context-dependent factors include time, degree of urgency, safety of the environment and the circumstances. Conclusions: Care providers must gain an overall idea of the family’s function and their ability to endure stress in acute situations, so that counselling can be founded on the family’s strengths and limitations regarding the patient’s follow-up care and coping at home. Ability to differentiate between various factors in counselling situations helps care providers concentrate on factors that they can affect. The results can be used in the education of health carestudents and professionals and in developing the quality of counselling.