Hospitals--Emergency services

A preliminary list of ten competency and forty-six sub-competency statements derived from literature and consultation with experts and based on the general areas of clinical performance defined by the National Board of Medical Examiners were the concern of Phase I of this study. Forty-eight experts in nuclear medicine, radiology, radiotherapy, health physics, medical physics, radiation biology, public and occupational health, surgery, and emergency medicine and nursing considered this preliminary list of competencies and sub-competencies to determine which were essential for health professionals who may be caring for radiation accident victims in hospital emergency departments. These experts responded to a questionnaire on which they rated each competency and sub-competency as Essential, Supplemental, or Non-essential for emergency care of the radiation accident victim. A scoring system was utilized that facilitated consideration of each consultant's rating. Eight competencies and thirty-three sub-competencies were rated as Essential competencies. Competencies dealing with establishing priorities in patient care and initiating treatment, assessment, contamination control, and decontamination were highly rated. They were followed closely by competencies in referral, psychological care and legal, ethical and public health responsibilities. Competencies in health physics vocabulary and background knowledge of radiation biology were given lower ratings and were placed on a list of Supplemental competencies. In the second part of this study, the Essential competencies were utilized in the development of an original evaluation instrument designed to identify deficiencies and continuing education needs during radiation accident drills or exercises. Evaluation criteria based on the Essential competencies were divided into three time frames: the preparatory period, the treatment period, and the post-emergency period. Criteria adaptations were used to evaluate competence during the treatment period in order to facilitate a more objective evaluation. The instrument was designed for use in sixteen possible patient care situations in which the radiation accident victims have varying medical and radiological conditions. Development of the evaluation instrument was described.

Patients and nurses have been found to perceive support differently. This exploratory study was undertaken to: (a) identify those nursing behaviors perceived by emergency department patients as supportive, and (b) to identify the importance emergency room patients give to various nursing behaviors on a checklist. A sample of 30 emergency department patients completed a guided interview and the Supportive Nursing Behavior Checklist. The perceived attitude of the nurse toward the patient and the availability of the nurse to the patient were the most important factors influencing patients' perceptions of support. The nurse being friendly and cheerful were the most important behaviors. The study has implications for nursing practice, nursing administration and nursing education. Suggestions are also given for further research.