Research
Differences Between Emergency Nurse Perception and Patient Reported Experience With an ED HIV and Hepatitis C Virus Screening Program

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Introduction

Nontargeted human immunodeficiency virus (HIV) screening and targeted hepatitis C virus (HCV) screening for selected high-risk patients (those born between 1945 and 1965 and those who report injection drug use) was integrated into our ED triage process and carried out by nurses. Determining whether emergency nurses accurately perceive what patients experience is important to know because staff misperceptions may pose a barrier to program adherence and sustainability.

Methods

We performed a cross-sectional survey study of emergency nurses and patients to assess the accuracy of emergency nurses’ perception of patient experience with the HIV/HCV screening program. Respondents evaluated their level of agreement using a 5-item Likert scale for 9 statements across 4 domains related to the patient experience with the screening process (satisfaction, sense of autonomy, sense of privacy, and comfort level).

Results

Surveys were completed by 65 of the 153 eligible emergency nurses (42%). Of the 1040 patients approached, 610 (59%) were eligible, and 491 of the 610 eligible patients (80%) completed surveys. Across all domains, statistically significant differences were found between emergency nurse perception and patient report, P < .001. Emergency nurses perceived patients to be less satisfied with the screening program, more uncomfortable with being asked screening questions, more concerned about privacy issues, and less likely to feel that the decision to decline screening was autonomous than were patients.

Discussion

Emergency nurses not only frequently misperceive how patients experience ED-based HIV/HCV screening, but these misperceptions are skewed toward the negative, representing a type of staff bias. Further research is recommended to determine if such misperceptions adversely affect implementation of screening.

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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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.

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