ResearchDifferences Between Emergency Nurse Perception and Patient Reported Experience With an ED HIV and Hepatitis C Virus Screening Program
Section snippets
Study Design
We performed a cross-sectional survey study of ED patient and emergency nurse experience with HIV and HCV screening. This study was approved by the hospital’s Institutional Review Board. Patients provided written informed consent and staff consent was inferred by survey participation.
Study Setting and Population
This study took place in an urban California teaching hospital with an accredited 4-year emergency medicine residency program. The annual ED volume is approximately 90,000 patients per year; 45% of patients are
Results
Of the 1040 patients approached for survey administration, 610 (59%) were eligible, and surveys were completed for 491 of the 610 eligible patients (80%). The surveyed patient mean age was 44 years (SD = 15 years); 227 (46%) were female; 248 (51%) were black, 104 (21%) were Hispanic, 76 (15%) were white, and 32 (7%) were Asian; and 426 (87%) were English speaking. Three hundred ninety three (80%) were Medicaid recipients, and 43 (9%) were Medicare recipients; 32 (7%) were uninsured, and 19 (4%)
Discussion
Experts believe that ED screening programs, such as those that screen for HIV and HCV, must take advantage of the emergency nursing staff workforce and be integrated into up-front, preexisting procedures such as triage in order to be feasible and sustainable.10, 11 If nurse-driven, triage-based screening is to be the model, then it is critical to understand the experience of emergency nurses, as well as their perception of the patient experience.
Staff support for ED HIV screening is mixed, with
Limitations
The generalizability of our estimate of staff misperception of what patients experience is limited by the extent to which our sample represents the entire ED staff and patient population. Furthermore, the unique nature of the dual HIV and HCV triage-based screening program and the urban, academic setting may not be generalizable to other emergency departments. Survey data were also subject to recall and response bias. For staff, work E-mails were used for recruitment, and our response rate was
Implications for Emergency Nurses
Our findings may be used as a teaching aid when educating front-line emergency nurses to be aware of their possible bias and to recognize that patients are more accepting and accommodating than we presume regarding HIV and HCV screening. Dissemination of these findings may be helpful in staff development sessions and when answering provider questions and concerns regarding perceived barriers to screening program implementation.
Conclusion
Our study demonstrates a broad range of misperception between emergency nurse presumptions and actual patient experience and highlights specific examples of this misalignment. Overall, emergency nurses perceived patients to have more concerns and dissatisfaction with ED-based HIV and HCV screening than we found in our sample. These results may be applicable to other emergency nurse–patient interactions where the nursing staff is challenged to ask sensitive questions or step out of their comfort
Douglas A.E. White is Associate Clinical Professor of Emergency Medicine, University of California–San Francisco, and Director of Emergency Department HIV and HCV Screening and Director of Resident Education, Department of Emergency Medicine, Alameda Health System–Highland Hospital, Oakland, CA.
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2017, CMAJCitation Excerpt :Findings were highly variable in terms of patient preferences related to screening and there was a high level of uncertainty about the value that patients place on the clinical outcomes considered in the review. Concerns related to stigma and to access to care were reported as important factors for decision-making.67–74 A survey of 15 patients commissioned by the task force generally reinforced these findings and found that participants placed equal value on the benefits and harms of screening.20
Variation in participation in nurse-driven emergency department hepatitis C screening
2021, Advanced Emergency Nursing Journal
Douglas A.E. White is Associate Clinical Professor of Emergency Medicine, University of California–San Francisco, and Director of Emergency Department HIV and HCV Screening and Director of Resident Education, Department of Emergency Medicine, Alameda Health System–Highland Hospital, Oakland, CA.
Erik S. Anderson is Clinical Instructor, Department of Emergency Medicine, Highland Hospital–Alameda Health System, Oakland, CA and Fellow in Social Emergency Medicine and Population Health, Department of Emergency Medicine, Stanford University, Palo Alto, CA.
Sarah K. Pfeil is Research Coordinator, Department of Emergency Medicine, Highland Hospital–Alameda Health System, Oakland, CA.
Sarah E. Graffman is Registered Nurse, Department of Emergency Medicine, Highland Hospital–Alameda Health System, Oakland, CA.
Tarak K. Trivedi is Resident Physician, Department of Emergency Medicine, Highland Hospital–Alameda Health System, Oakland, CA.
Earn Up to 9.5 CE Hours. See page 188.
The principal investigator (DAEW) and research coordinator (SKP) received funding through an HIV FOCUS grant from Gilead Sciences, Foster City, CA.