title: Counseling patients and family members in out-of-hospital emergency situations: a survey for emergency staff.
abstract: BACKGROUND
  Not much is known about emergency care delivered in patients' homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff's experiences of encountering and counseling patients and their family members.
  
  
  METHODS
  A descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N= 125,N= 142 reponse rate 59%, response rate 53%) and analyzed using descriptive statistics.
  
  
  RESULTS
  Respondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging.
  
  
  CONCLUSIONS
  High-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient's and family's situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.
authors.affiliation: School of Health Sciences, University of Tampere/ Hospital District of South Ostrobothnia, 33014 Tampere, Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Paavilainen
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Mikkola
authors.affiliation: School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland.
authors.forename: Mari
authors.initials: M
authors.lastname: Salminen-Tuomaala
authors.affiliation: Hospital District of South Ostrobothnia, Seinäjoki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Leikkola
keywords: Counseling; Family members; Out-of-hospital emergency care; Patients