Wachter, Katrina L

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTInteractions in the ED: Training for Proper Care ofPatients with a DisabilityKatrina L. WachterUSF MCOM- LVHN, Katrina.Wachter@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWachter, K. (2016, July 29). Interactions in the ED: Training for Proper Care of Patients with a Disability. Poster presented at: ThePrologue II Presentation Day, University of South Florida, Tampa, FL.Katrina L. WachterUsniversity of South Florida Morsani College of Medicine and Lehigh Valley Health NetworkInteractions in the ED: Training for Proper Care of Patients with a DisabilityED Staff Survey ResultsCaregiver Interview ResultsConclusions/Future DirectionsLiterature CitedAcknowledgementsMethodsIntroductionProblem• Patients with disabilities bring an extra level of complication to an emergency department (ED) visit, and there is little knowledge given to staff to proficiently treat these patients.Importance• Emergency department staff feel ill-prepared to provide care to those with intellectual disabilities when the ED is used due to a lack of knowledge on all specific disabilities they encounter.1• Interviews of children with autism and their parents identified issues that negatively affected care experiences, including communication issues and lack of autism knowledge by staff.2• Patients with disabilities have had increasingly negative experiences in the ED.3Main Questions• Where is the disconnect between patients with disabilities (and their caregivers) and ED staff occurring and what are the needs to correct it?• How can ED staff use values-based patient centered care to better improve experiences of and interactions with individuals with disabilities?Emergency Department Staff Survey• Created 10 question survey including questions on:• Comfort with various disabilities• Opinion on usefulness of training• Known resources for patients with disabilities• Distributed survey email to ED staff May 26, 2016• Sent two follow-up emails (June 15, July 17) with end date of July 22Caregiver Interviews of Children with Autism• Interviewed six caregivers of children aged 16-24 with autism • Created a semi-structured interview guide• Experiences in the Emergency Room• Ideas on improving interactions• Scheduled/conducted interviews May 26-June 8,• Transcribed recordings of interviews and separated positive and negative experiencesNegative Experiences in the ED• “Pushing pills” even when the parent was not comfortable with it• Separation of the child for 45 minutes and placement in an adult emergency psychiatric department room• Dismissing the caregiver’s concerns and comments about the issue• Lack of sensitivity to patient needsI would like to thank the following people/organizations for assistance with this project:Dr. Sweety Jain, Dr. Bryan Kane, Arch of the Lehigh Valley, Lehigh Valley Health Network Emergency Departments, Melanie Johnson, Trieste Kennedy, Ellen Hunt, and the Lehigh Valley Center for Independent Living.Identified Issues in the ED• Sub-par knowledge of needs of children with autism when in the ED• Poor communication between ED staff and primary care provider when patient with a disability is admitted Separation of patient from caregiver, especially in the case of children with disabilities• Missed acknowledgement of disability diagnosis when reviewing patient chart• Unfamiliarity of proper interaction procedures for different disabilities• Little familiarity with resources for patients with disabilitiesProposed Improvements• Make entertainment devices for children with disabilities during caregiver admission to the ED available (i.e. iPad, coloring books, etc.)• Create/conduct a short, 3 hour training for all current and incoming ED staff, to include• Practice scenarios• Processing procedures for disabilities• Children and adult interaction differences• Rights of patients with disabilities• Communication tips/skills• Compile a comprehensive and dynamic list of resources to use when interacting with patients with different disabilitiesPositive Experiences in the ED• Patience with child and willingness to repeatedly explain the situation • Honesty in what the situation/test will be like (i.e. no “sugar-coating” the pain or other associatedsymptoms)• Speaking to the patient directly, not ignoring them and speaking to the caregiver Do you have knowledge of any local resources to assist patients with disabilities as well as their families?Would a list of resources benefit you?Would a short training make you more comfortable interacting with patients with disabilities?Yes21.09%No78.91%Yes93.75%No6.25%Yes65.63%No34.37%Responses: 128• 60 nurses, 27 physicians, 11 residents, 2 APCs, 28 other/did not respond• 39 males, 83 females, 6 did not respond• Ages from 21 to > 45 years old• 99.22% of respondents have interacted with a patient with a disability in the pastHow comfortable are you taking care of patients with different disabilities (1 being not comfortable at all and 5 being extremely comfortable)?1. Lunsky, Y., Gracey, C., & Gelfand, S. (2008). Emergency psychiatric services for individuals with intellectual disabilities: Perspectives of hospital staff. Intellectual and Developmental Disabilities, 46:446–455. 2. Nicholas, D.B., Zwaigenbaum, L., Muskat, B. et al. (2016). Experiences of emergency department carre from the perspective of families in which a child has autism spectrum disorder. Social Work Health Care. 55(6):409-426.3. Sowney, M., & Barr, O. (2006). Caring for adults with intellectual disabilities: Perceived challenges for nurses in accident and emergency units. Journal of Advanced Nursing, 55: 36–45. 

Interactions in the ED: Training for Proper Care of Patients with a Disability

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Interactions in the ED: Training for Proper Care of Patients with a Disability

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Lehigh Valley Health Network: LVHN Scholarly Works