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To describe how the potential presence of cognitive biases in emergency nurses may influence the triage process in people experiencing homelessness compared to those who were not.
Qualitative descriptive design using observations and interviews.
Twelve emergency department nurses participated in interviews after being observed for over 128 triage patient interactions. Qualitative content analysis was used for observation data and thematic analysis was used for interview data. Findings were compared to identify differences and similarities between the observed presence of bias and nurses' described experiences.
Observation findings included two themes: (1) Emergency medical services (EMS) presentation: Words matter and (2) Nurse response: Taking action. Interview findings identified four themes: (1) Objective interpretation, (2) Subjective interpretation, (3) Resulting disparities, and (4) Busy environment. Differences included nurses' observed actions of often disregarding people experiencing homelessness compared to perceptions of remaining impartial. Similarities included the presence of bias in observation and interviews and reflected how personal labels and assumptions can influence nurse response.
Findings provide evidence about how cognitive biases can influence the type of nurse response when triaging people experiencing homelessness and suggest an opportunity for future research to investigate strategies to mitigate bias during triage.
Emergency nurses may require additional bias awareness education specific to vulnerable populations.
Evidence from this research added knowledge about how bias in emergency nurses may influence nurse response when triaging people experiencing homelessness.
COREG.
Patient contribution included presence and behaviour within the observed nurse/patient interactions, providing data for the descriptive statistics. Patients were not actively involved in data collection or analysis in a participatory sense.
The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.
Quasi-experimental research design.
The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.
A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.
In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.
Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.
What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.
What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.
Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.
This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.
No patient or public contribution.
This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.
No protocol.
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