This study has several limitations. The first is related to the study design. This was a cross-sectional design, therefore causal interpretations cannot be directly drawn from the results obtained (Polit & Beck 2010). The second limitation is associated with the survey data which were obtained from a convenience sample of children and their parents who visited the EDs and were recruited by
The third limitation may be that the study was conducted in Finland where the health care system is publicly funded, therefore the use of findings
internationally in health care organizations funded in other ways should be conducted with caution.
The strength of this study was the importance of this topic to nursing (Brown et al. 2009) due to a limited number of previous studies and a large number of pediatric patients in EDs (Doan et al. 2014). Another strength might be that the study used multiple data sources to achieve representative findings on pediatric emergency care quality. In particular, the use of administrative data combined with survey data produced new knowledge about pediatric care quality in Finland. Among other new findings, the summary provided new knowledge about differences in the evaluation of care quality by comparing the assessments of children, parents, and nursing staff. In addition, this study’s strength was the sufficient sample size being ensured by power analysis to be adequate for the statistical analysis methods which were used in this study (Grove et al. 2012).
7 CONCLUSIONS
7.1 CONCLUSIONS FROM MAIN FINDINGS
The study provides new knowledge about pediatric emergency care quality from the view of children, parents, nursing staff, and administrative data. The
findings of this study allowed the following conclusions to be drawn:
According to this and previous studies, from the view of nursing staff, pediatric care quality appears to be declining in general EDs. In particular, in this study general EDs’ addressing of areas relating to children’s information and involvement in care as well as pain and apprehension management were of a lower level than in PEDs. However, in both types of ED, the sub-area of nurse staffing was described as being low-level by emergency nurses.
Overall, children and parents are mostly satisfied with emergency care.
In this study, both of their satisfaction increased with parents’ vocational education and fewer previous ED visits. However, children’s perceptions about care quality differed from those of their parents.
There is a bidirectional relationship between care process factors and children and parents’ satisfaction. Children's high acuity and the greater number of procedures increased children and parents’ satisfaction with care. However, ED LOS or hospital admission has no relationship with either children’s and parents’ satisfaction or their assessments of care quality.
Combining administrative data and daily nurse staffing data has great potential to bring new knowledge for ED staffing allocation. This study addressed a relationship between nurse staffing and the pediatric emergency care process factors LOS and LBTC.
The perceived quality of pediatric care differs between emergency care professionals and patients or parents. There were significantly lower assessments among nursing staff than from children and parents.
7.2 RECOMMENDATIONS FOR FUTURE RESEARCH,
CLINICAL PRACTICE, LEADERSHIP, AND EDUCATION
Recommendations for future research:
1. In the future, Finnish researchers should collect and analyze pediatric emergency care measurements to develop national nursing quality indicators for pediatric emergency care that are comparable with international indicators.
2. Future studies can deepen the knowledge of nursing by researching the topic using mixed methods, which would provide deeper and more integrated knowledge.
3. A longitudinal statistical analysis of nurse staffing and patient volumes based on historical averages on weekdays and at varying hours could create a predictive staffing model for EDs.
Recommendations for the clinical practice:
1. The nursing staff in PEDs perceived the quality of care to be higher than in EDs. In general EDs, to achieve more exposure to pediatric patients, common pediatric facilities should be developed (space, staff) for the care of pediatric patients from all ED specialties.
2. According to the findings, children assessed ability to participate in planning their care and the possibility to talk privately with staff lower than their parents. Therefore in clinical practice, the child’s need for a conversation with a professional should be identified and the child should be allowed to meet with a professional without a parent present.
3. To achieve high-quality care as well as child and parent satisfaction, the pediatric care process should include multiple interactions with staff members. In the practice of nursing, this means each family is encountered several times during the visit, inquiring about the child’s well-being or sharing information about the current state of care.
Recommendations for nursing leadership:
1. Especially in general EDs, nursing staff should be trained in pediatric nursing and especially aspects relating to pediatric patients’ and parents’
information and involvement in care as well as pain and apprehension management.
2. According to the findings, unit-level shift-based nurse-patient ratios can provide insights into nurse staffing requirements and indications of optimal staff allocation patterns. Therefore EDs’ nurse staffing should be measured against the number of pediatric patients and patient acuity regularly and these measures should follow ad hoc.
3. Assessments of received emergency care quality should be collected from both children and parents as well from the staff. As it was found that assessments of care quality differ, this should be done during the same periods, which allows a comprehensive assessment of the quality of care, and means development measures can be proportioned on that basis.
Recommendations for nursing education:
1. In nursing education as well as in the training of nursing staff, pediatric emergency teamwork training and clinical pediatric nursing skills should be emphasized, because those areas were addressed as being related to nurses’ higher assessments of the quality of pediatric emergency care.
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APPENDICES
APPENDIX 1. Characteristics of a literature review of pediatric emergency care quality (n=28).
Study and
country Aim Study design and
data their child to revisit
the ED.
Survey of parents who brought their child to the ED within 72 hours of
ED discharge;
Canada To describe the
trend of PED use A cohort study with administrative data
(patient volume and acuity) and find the
degree of overcrowding of PED by measuring LOS and the number
of LWBS.
from the PED from
2002 to 2011. 10/12 JBI critical appraisal checklist for included a total of 119,782 visits.
Gaucher et al. 2011 Canada
Goldman et al. 2018 USA
To search for factors related to prolonged
Hudgins et al. 2017 USA
To compare pediatric patients’
severity in the PED and general ED 169 million visits in
a general ED. the year 2010; data from N=30 million
and to determine if the staffing and
Kubicek et al. 2012 USA
To develop a descriptive profile of
parents/caregivers who bring their children to EDs for non-urgent reasons. were classified in an ED triage for a
non-urgent level.
call are related to high satisfaction of survey study of 300
caregivers of
patient flow in the
RVs and RVs leading to admission in EDs.
Multicenter
To describe ED staff members’ nursing staff and 8 members of the
medical staff.
9/10 JBI Critical appraisal checklist for
qualitative research
Robinson & Green
Shefrin et al. 2012 Canada
Schroder et al. 2016 USA
ORIGINAL PUBLICATIONS (I – IV)
I
Nursing Staff's Perceptions of Quality of Care for Children in Emergency Departments—High Respect, Low Resources.
Janhunen Katja, Kankkunen Päivi & Kvist Tarja
Journal of Pediatric Nursing e37, e10-e15O, 2017
Nursing Staff's Perceptions of Quality of Care for Children in Emergency Departments—High Respect, Low Resources
Katja Janhunen, MSc, RN⁎, Päivi Kankkunen, PhD, RN, Docent, Tarja Kvist, PhD, RN, Docent
aUniversity of Eastern Finland, Department of Nursing Science, Kuopio, Finland
a b s t r a c t
Purpose:To describe the quality of care for children in emergency departments (ED) as perceived by the nursing staff, and to compare the quality of care for children in a pediatric ED and in a general ED and to identify care qual-ity factors that predict nursing staff's satisfaction with pediatric care in an ED.
Design and Methods:A cross-sectional survey study was performed using the 41-item Children Revised Humane Caring Scale (CRHCS) to collect data (n = 147) from acute hospitals' pediatric EDs and general EDs in November 2015. The data were analyzed using descriptive statistics and multiple linear regression.
Results:Nurses evaluated the quality of professional practice to be high. Children were treated in a respectful and friendly fashion, and received help when needed. The nurses perceived a lack of human resources in the studied
Results:Nurses evaluated the quality of professional practice to be high. Children were treated in a respectful and friendly fashion, and received help when needed. The nurses perceived a lack of human resources in the studied