Mabood Neelam, Ali Samina, Dong Kathryn A, Wild T Cameron, Newton Amanda S
From the Departments of *Pediatrics and †Emergency Medicine, Faculty of Medicine & Dentistry, ‡School of Public Health, and §Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Pediatr Emerg Care. 2013 Dec;29(12):1260-5. doi: 10.1097/PEC.0000000000000024.
The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents.
Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures.
Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects.
Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.
急诊科是识别和管理酒精相关就诊患者的关键临床护理场所。我们探讨了急诊医生为青少年提供酒精相关护理的经历。
采用目的抽样法，从加拿大各地的儿科急诊科中确定至少有1年经验的儿科急诊医生（n = 12）。通过电话使用半结构化访谈指南收集数据。采用诠释现象学，运用穆斯塔卡斯的沉浸/结晶程序，识别受访者之间的共同和独特经历。
医生们对醉酒患者的行为表示沮丧，并将提供护理描述为一场斗争；建立有效的治疗联盟具有挑战性。医生们认为，醉酒的青少年患者需要的临床时间和资源超出了他们的能力范围。尽管医生们认为急诊科不适合确保护理的连续性以及解决与饮酒相关的更广泛社会问题，但他们确实将急诊科视为一个在医学上稳定患者病情并就饮酒及其有害影响展开讨论的场所。
儿科急诊科医生在护理过程中感到困难，并且怀疑在他们主要负责提供医学稳定治疗的临床环境中，能否有效处理通常与青少年酒精滥用相关的更广泛、更长期的社会问题。医生们确实认为急诊科是确保患者医学稳定并随后就饮酒及其有害影响展开对话的合适场所。
