Jamsahar Maryam, Ahmadi Fazlollah, Khoobi Mitra, Vaismoradi Mojtaba
Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
Nurs Open. 2025 Jul;12(7):e70190. doi: 10.1002/nop2.70190.
The transfer of patients from a pre-hospital emergency environment to a qualified healthcare centre is a critical aspect of emergency care. Due to the unpredictable and uncontrolled nature of pre-hospital environments, emergency care providers often encounter multiple challenges during the patient transfer process.
AIM/OBJECTIVE: This study aimed to explore the patient transfer process from pre-hospital to the hospital emergency department, identify the areas of main concern, strategies that emergency care providers used to address these concerns and generate a coherent underlying theory.
A qualitative research method using a grounded theory approach was carried out to develop a comprehensive theoretical framework based on the experiences of emergency care providers, patients and their relatives in pre-hospital settings and hospital emergency departments. This study, conducted from September 2022 to January 2024, involved 24 participants: 18 emergency care providers, four patients' relatives and two patients with transfer experience. Sampling began purposefully and transitioned to theoretical sampling to ensure diversity and enrich the emerging theory. Data were collected through in-depth, individual, semi-structured interviews, along with note-taking, observation and document review. The Corbin-Strauss 5-step analysis approach was used to develop a coherent theory capturing the essence of the study phenomenon. The steps included open coding to identify concepts, developing concepts based on their features and dimensions, analysing data for context, incorporating processes into the analysis and integrating categories.
The main category as the main concern of the participants was 'the tension of delay in safe transfer and patient survival threat'. The central variable was 'diligent avoidance of tense confrontation', which was used as a conscious, deliberate and purposeful effort to prevent the escalation of tensions in various situations and included a set of different strategies such as situational resourcefulness, persuasive communication and forbearance. Ultimately, the emergency care providers' efforts caused different outcomes, from successful persuasion and safe transfer of the patient to unsuccessful persuasion, surrendering, escaping from responsibility and long-lasting hidden tensions.
Emergency care providers use different strategies to manage the tension of delay in safe transfer and patient survival threat as their main concern. While successful strategies can inform practical guidelines, negative consequences highlight the need for more efficient and effective approaches. A prescriptive model based on the contextual theory from this study can be designed. This model should take a comprehensive, multifaceted view of the underlying causes of tension, support emergency care providers and improve their experience of delays during patient transfers in pre-hospital emergency settings, ultimately leading to safe care.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Emergency care providers should balance the urgency of transfer with patient safety and the patient's relative concerns.
This study underscores the need for patient-centred care, effective communication and practical strategies to improve patient transfer processes.
This article has been presented based on the COnsolidated Criteria for REporting Qualitative Research (COREQ) checklist.
No Patient or Public Contribution.
将患者从院前急救环境转移至合格的医疗保健中心是急救护理的关键环节。由于院前环境具有不可预测和无法控制的性质，急救护理人员在患者转运过程中常常面临多重挑战。
本研究旨在探讨从院前到医院急诊科的患者转运过程，确定主要关注领域、急救护理人员用以应对这些问题的策略，并生成一个连贯的基础理论。
采用基于扎根理论方法的定性研究方法，根据急救护理人员、患者及其亲属在院前环境和医院急诊科的经历，构建一个全面的理论框架。本研究于2022年9月至2024年1月进行，涉及24名参与者：18名急救护理人员、4名患者亲属和2名有转运经历的患者。抽样开始时采用目的抽样，之后过渡到理论抽样，以确保多样性并丰富新出现的理论。通过深入的个人半结构化访谈、笔记记录、观察和文件审查收集数据。采用Corbin-Strauss五步分析方法来构建一个连贯的理论，以捕捉研究现象的本质。这些步骤包括开放编码以识别概念、根据概念的特征和维度发展概念、分析上下文数据、将过程纳入分析以及整合类别。
作为参与者主要关注的主要类别是“安全转运延迟的紧张局势与患者生存威胁”。核心变量是“努力避免紧张对峙”，这是一种有意识、蓄意且有目的的努力，旨在防止各种情况下紧张局势的升级，包括一系列不同的策略，如随机应变、有说服力的沟通和忍耐。最终，急救护理人员的努力导致了不同的结果，从成功说服并安全转运患者到说服失败、放弃、逃避责任以及长期隐藏的紧张局势。
急救护理人员采用不同策略来应对安全转运延迟的紧张局势和患者生存威胁这一主要问题。虽然成功的策略可为实践指南提供参考，但负面后果凸显了需要更高效和有效的方法。可以设计一个基于本研究情境理论的规范性模型。该模型应全面、多方面地看待紧张局势的根本原因，支持急救护理人员，并改善他们在院前急救环境中患者转运期间的延迟体验，最终实现安全护理。
对专业和/或患者护理的启示：急救护理人员应在转运的紧迫性与患者安全及患者亲属的关切之间取得平衡。
本研究强调了以患者为中心的护理、有效沟通和实用策略对于改善患者转运过程的必要性。
本文已根据定性研究报告统一标准（COREQ）清单进行呈现。
无患者或公众贡献。
