Hoitohenkilökunnan asenteet ja osaaminen alkoholista päihtyneen potilaan hoidossa päivystyksessä

Tiina Hakala

Research output: Book/ReportDoctoral thesisCollection of Articles

Abstract

The purpose of the study was to describe the attitudes and skills and the importance of skills of emergency department staff in the care of alcohol intoxicated patients. The study was part of the project in which has been studied among with the attitudes and skills of the nursing staff, the quality of care for patients with alcohol intoxication in the emergency department.

The study was conducted in four phases. In the first phase, an integrated literature review was conducted on the attitudes and skills of emergency nursing staff on the care of intoxicated patients and the factors associated with it. The data were collected from 2000–2015 from four databases and by manual search. After data selection and quality assessment, the data (n = 9) were analysed by content analysis. The second phase described the experiences of emergency nursing staff on the attitudes and skills related to the care of alcohol intoxicated patients. The material was collected through a thematic interview with the nursing staff of one central hospital emergency department (n = 6). The data were analysed by inductive content analysis. In the third phase, the importance of skills related to the care of alcohol intoxicated patients and the connection of background factors to it was described as assessed by Finnish university and central hospital emergency department nursing staff (N = 1,220, n = 252). The data, collected with a questionnaire developed by the researchers of this research project, were analysed by statistical methods. The fourth phase described the experiences of nurses (n = 17) who participated in the online training developed for emergency nursing staff on the attitudes and skills related to the care of alcohol intoxicated patients with essays written in connection with the training. The purpose of the online training was to strengthen the attitudes and skills of the emergency care staff in the care of alcohol intoxicated patients. The data were analysed using inductive content analysis.

The literature review indicated that the care of intoxicated patients in the emergency department is affected by the patient, the staff and the care environment. The attitudes towards intoxicated patients were fairly neutral, but some intolerance and stigmatisation was seen in the attitudes. Patient behavioural disorders, disrespectful attitudes, impaired co-operation, and a lack of commitment to receive care have importance for the attitudes of nurses. These patients consume a lot of resources, and the shortage of staff resources was a considerable barrier to considering the patient’s substance abuse problem and the provision of care. A large proportion of the nursing staff lacked skills in dealing with these patients. They had no knowledge of how to address a patient’s alcohol use. In cases where intervention equipment had been provided to the nursing staff, they did not necessarily commit to using it. The emergency nursing staff had received very little training in the use of mini intervention related to high-risk alcohol use. It has been shown that with training, it is possible to promote the identification of patients with alcohol intoxication and improve the care of their health problems.

On the interview study, five main categories were constructed: the skills to discuss the use of alcohol on arrival; teamwork skills; safety skills; the skills to organize follow-up care; and nurse’s attitudes and ethics in patients’ care. There was variation in asking about the use of alcohol and in the use of a screening tool. The subjects highlighted skills to anticipate the risk of violence and ensuring the safety of the work environment. The patient’s ability to regulate negative emotions was important for nurse’s attitude towards the patient, for the patient’s behavioural disorders and for the patient’s commitment to care. Despite concerns about negative attitudes toward patients, nursing staff considered it important to ensure ethical care for patients. The interviewees highlighted that alcohol intoxicated patients must be encountered without making them feel guilty, and they merit the same care as other patients in the emergency department. Trust is the key to patient-nurse collaboration.

In the study describing the importance of alcohol intoxication patient care skills, safety skills were considered to be the most important, but interaction skills, ethical skills, guidance and counselling skills, follow-up care skills, and team and networking skills were also considered to be at least somewhat important.

Based on the analysis of the essays written in connection with the online training, three main categories were formed: nurse’s lack of commitment to the care of an alcohol intoxicated patient, nurse’s commitment to the care of an alcohol intoxicated patient, and intervention method skills. The participants questioned the viability and effectiveness of caring for alcohol intoxicated patients. Nursing staff experienced frustration with the patient, and lack of confidence and motivation to care for an alcohol intoxicated patient. The negative emotions evoked by the patient also contributed to nurses’ attitudes towards alcohol intoxicated patients. Nursing staff lacked faith that this group of patients could be helped by health care. On the other hand, nurses have experienced the importance of respecting and treating alcohol intoxicated patient like other patients. The study highlighted the need for common rules of care and evidence-based information in addressing alcohol use. More training was desired on the mini-intervention and motivational interview. Early intervention in risky alcohol use was seen as a way to prevent substance abuse.

This study provides more information on the attitudes and skills of emergency care nurses regarding the care of alcohol intoxicated patients. From the point of view of nursing management, the results of the research can be utilised in planning and developing operating models that ensure and monitor the implementation of common practices. For nursing education, this research provides an understanding of the attitudes and skills of caring for patients with alcohol intoxication.
Original languageFinnish
Place of PublicationTampere
PublisherTampere University
ISBN (Electronic)978-952-03-1693-8
ISBN (Print)978-952-03-1692-1
Publication statusPublished - 2020
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
Volume306
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

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