Emergency medical service nurses' experiences and perspectives on a protocol change of pre-hospital preventive immobilization of spinal injuries after trauma: A qualitative study.
International Emergency Nursing · 2024-11-22 · Qualitative study
Abstract
OBJECTIVE: In 2016, a selective preventive spinal immobilization protocol for emergency medical service (EMS) nurses was introduced in the Netherlands. This protocol leaves more room for autonomous decision-making in the pre-hospital phase regarding preventive spinal immobilization (PSI), compared to the previous strict protocol. In this study, we explored the experiences and perspectives of EMS nurses on decisionmaking about PSI after the change from a strict to a selective PSI protocol. METHODS: We used a qualitative design with semi-structured face-to-face interviews. Thematic analysis was applied. The capability-opportunity-motivation-behavior-model was used to interpret the experiences and perspectives. RESULTS: Thirteen EMS nurses from three emergency medical services were interviewed. Respondents appreciated autonomous decision-making as there was more room for patient-centered informed decision-making. However, autonomous decision-making required optimized knowledge and skills and elicited the need to receive feedback on their decision not to apply PSI. When nurses anticipated resistance to selective PSI from receiving hospitals, they were doubtful to apply it. CONCLUSION: Nurses appreciate the increased autonomy in decision-making, encouraging them to focus on patient-centered care. Increased autonomy also places higher demands on knowledge and skills, calling for training and feedback. Anticipated resistance to receiving hospitals based on mutual protocol discrepancies could lead to PSI application by EMS nurses while not deemed necessary. RECOMMENDATIONS: To enhance PSI procedures, optimizing the knowledge and skills of EMS nurses that facilitate on-scene decision-making may be indicated. A learning loop for feedback between the EMS nurses and the involved hospitals may add to their professional performance. More efforts are needed to create support for the changed Emergency Medical Services strategy in PSI to prevent unnecessary PSI and practice variation.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Ambulance & prehospital nurses · Clinician perspective · Communication & handover · Implementation · Spinal motion restriction
Related articles
- To collar or not to collar. Views of pre-hospital emergency care providers on immobilisation without cervical collars: a focus group study. (Br Paramed J, 2021)
- Cluster-randomised-controlled trial evaluating the impact of implementing the Canadian C-Spine Rule in prehospital cervical spine trauma care by the French Emergency Medical Call Center: IPSTRAUC study - a protocol. (BMJ Open, 2026)
- Nurses' perspectives on providing analgesia in the Italian prehospital emergency setting: A phenomenological study. (Int Emerg Nurs, 2025)
- Balancing care needs - a qualitative study on prehospital emergency nurses' experiences of providing self-care advice and home referrals for frail older patients. (BMC Emerg Med, 2025)
- Clinicians' experience of barriers and facilitators to care delivery of an extracorporeal cardiopulmonary resuscitation service for out-of-hospital cardiac arrest: a qualitative survey. (Scand J Trauma Resusc Emerg Med, 2024)
- Prehospital emergency nurses' experiences of caring for patients with suspected acute myocardial infarction: an interview study. (BMJ Open, 2024)