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Baykal D, Çömlekçi N, Can G. "I don't Want to Die Alone" Nurses' Perception of Ageism: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:812-827. [PMID: 37210657 DOI: 10.1177/00302228231177761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The aim of the study was to learn the perceptions and thoughts of nurses with whom older patients interact constantly. In this research, semi-structured interview was used. In a research hospital in Istanbul between March-June 2019, 16 volunteers were included in the study. Researchers led individual semi-structured interviews regarding nurses' perceptions, how they overcame those challenges, and need and expectations aging care (dying patients). All interviews were analysed using thematic analysis methods and synthesized into major themes. The research was planned based on the 32-item checklist (COREQ) guideline. Nurses (N = 16) reported three themes: (i) ageing perceptions (ii) care for dying patients, (iii) expectations and five subthemes emerged in this study. It is understood that nurses have a positive perception of ageing. In addition, nurses have expectations from the state (financial support, gerontology service etc.) and society (respectful, understanding etc.) to reduce the difficulties they experience while caring for dying patient.
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Affiliation(s)
- Dilek Baykal
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Türkiye
| | - Necmiye Çömlekçi
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Türkiye
| | - Gülbeyaz Can
- Faculty of Nursing, Istanbul University-Cerrahpasa Florence Nightingale Istanbul, Istanbul, Türkiye
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Conroy S, Brailsford S, Burton C, England T, Lalseta J, Martin G, Mason S, Maynou-Pujolras L, Phelps K, Preston L, Regen E, Riley P, Street A, van Oppen J. Identifying models of care to improve outcomes for older people with urgent care needs: a mixed methods approach to develop a system dynamics model. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-183. [PMID: 37830206 DOI: 10.3310/nlct5104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Background We aimed to understand urgent and emergency care pathways for older people and develop a decision support tool using a mixed methods study design. Objective(s), study design, settings and participants Work package 1 identified best practice through a review of reviews, patient, carer and professional interviews. Work package 2 involved qualitative case studies of selected urgent and emergency care pathways in the Yorkshire and Humber region. Work package 3 analysed linked databases describing urgent and emergency care pathways identifying patient, provider and pathway factors that explain differences in outcomes and costs. Work package 4 developed a system dynamics tool to compare emergency interventions. Results A total of 18 reviews summarising 128 primary studies found that integrated social and medical care, screening and assessment, follow-up and monitoring of service outcomes were important. Forty patient/carer participants described emergency department attendances; most reported a reluctance to attend. Participants emphasised the importance of being treated with dignity, timely and accurate information provision and involvement in decision-making. Receiving care in a calm environment with attention to personal comfort and basic physical needs were key. Patient goals included diagnosis and resolution, well-planned discharge home and retaining physical function. Participants perceived many of these goals of care were not attained. A total of 21 professional participants were interviewed and 23 participated in focus groups, largely confirming the review evidence. Implementation challenges identified included the urgent and emergency care environment, organisational approaches to service development, staff skills and resources. Work package 2 involved 45 interviews and 30 hours of observation in four contrasting emergency departments. Key themes relating to implementation included: intervention-related staff: frailty mindset and behaviours resources: workforce, space, and physical environment operational influences: referral criteria, frailty assessment, operating hours, transport. context-related links with community, social and primary care organisation and management support COVID-19 pandemic. approaches to implementation service/quality improvement networks engaging staff and building relationships education about frailty evidence. The linked databases in work package 3 comprised 359,945 older people and 1,035,045 observations. The most powerful predictors of four-hour wait and transfer to hospital were age, previous attendance, out-of-hours attendance and call handler designation of urgency. Drawing upon the previous work packages and working closely with a wide range of patient and professional stakeholders, we developed an system dynamics tool that modelled five evidence-based urgent and emergency care interventions and their impact on the whole system in terms of reducing admissions, readmissions, and hospital related mortality. Limitations Across the reviews there was incomplete reporting of interventions. People living with severe frailty and from ethnic minorities were under-represented in the patient/carer interviews. The linked databases did not include patient reported outcomes. The system dynamics model was limited to evidence-based interventions, which could not be modelled conjointly. Conclusions We have reaffirmed the poor outcomes frequently experienced by many older people living with urgent care needs. We have identified interventions that could improve patient and service outcomes, as well as implementation tools and strategies to help including clinicians, service managers and commissioners improve emergency care for older people. Future work Future work will focus on refining the system dynamics model, specifically including patient-reported outcome measures and pre-hospital services for older people living with frailty who have urgent care needs. Study registrations This study is registered as PROSPERO CRD42018111461. WP 1.2: University of Leicester ethics: 17525-spc3-ls:healthsciences, WP 2: IRAS 262143, CAG 19/CAG/0194, WP 3: IRAS 215818, REC 17/YH/0024, CAG 17/CAG/0024. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme [project number 17/05/96 (Emergency Care for Older People)] and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Simon Conroy
- Geriatrician, George Davies Centre, University of Leicester, Leichester, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Christopher Burton
- Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
| | - Tracey England
- Health Sciences, University of Southampton, Southampton, UK
| | - Jagruti Lalseta
- Leicester Older Peoples' Research Forum, University of Leicester, Leicester, UK
| | - Graham Martin
- Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Kay Phelps
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Louise Preston
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Regen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Peter Riley
- Leicester older peoples' research forum, University of Leicester, Leicester, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics, London, UK
| | - James van Oppen
- Department of Health Sciences, University of Leicester, Leicester, UK
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Peguero-Rodriguez G, Polomeno V, Backman C, Chartrand J, Lalonde M. The Experience of Families Accompanying a Senior to the Emergency Department: A Scoping Review. J Emerg Nurs 2023:S0099-1767(23)00062-4. [PMID: 37178091 DOI: 10.1016/j.jen.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Seniors are often accompanied by a family member to the emergency department. Families advocate for their needs and contribute to the continuity of care. However, they often feel excluded from care. To improve the quality and safety of care for seniors, it is necessary to consider the experience of families in the emergency department. The aim was to identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department. To identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department. METHODS A scoping review was conducted using the Arksey and O'Malley framework. Six databases were targeted. A description of the identified scientific literature and an inductive content analysis were performed. RESULTS Of the 3082 articles retrieved, 19 met the inclusion criteria. Most articles (89%) were published since 2010, were from nursing (63%), and used a qualitative research design (79%). The content analysis identified 4 main categories related to the experience of families accompanying a senior to the emergency department: (1) process leading to the emergency department, families feel uncertainty and ambiguity with the decision to go to the emergency department; (2) staying in the emergency department, families' experiences are influenced by the triage, the ED environment, and the interactions with ED personnel; (3) discharge from the emergency department, families consider that they should be part of the discharge planning; and (4) recommendations and possible solutions, there is a paucity of recommendations specifically focused on families. DISCUSSION The experience of families of seniors in the emergency department is multifactorial and part of a trajectory of care and health services.
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Venema D, Vervoort SCJM, de Man-van Ginkel JM, Bleijenberg N, Schoonhoven L, Ham WHW. What are the needs of frail older patients in the emergency department? A qualitative study. Int Emerg Nurs 2023; 67:101263. [PMID: 36773515 DOI: 10.1016/j.ienj.2023.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission. METHOD A qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed. RESULTS The analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences. CONCLUSION Frail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.
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Affiliation(s)
- Dorien Venema
- University of Applied Sciences, Institute of Nursing Studies, PO Box 12011, 3501 AA Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Sigrid C J M Vervoort
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Academic Nursing, Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Nienke Bleijenberg
- University of Applied Sciences, Research Group for Older People Living at Home, PO Box 12011, 3501 AA Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southhampton S017 1BJ, United Kingdom.
| | - Wietske H W Ham
- University of Applied Sciences, Research Group for Older People Living at Home, PO Box 12011, 3501 AA Utrecht, the Netherlands.
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Regen E, Phelps K, van Oppen JD, Riley P, Lalseta J, Martin G, Mason SM, Conroy S. Emergency care for older people living with frailty: patient and carer perspectives. J Accid Emerg Med 2022. [PMCID: PMC9510405 DOI: 10.1136/emermed-2022-212420] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Little is known about how frailty impacts on older people’s experiences of emergency care, despite patient experience being essential to providing person-centred care. This qualitative study reports on the experiences of older people with frailty in the ED and their and their carers’ preferences for emergency care. Methods Older people (aged 75+ years) who were at least mildly frail and/or their carers, with current or recent experience of emergency care, were recruited from three EDs in England between January and June 2019. Data were collected via semi-structured in-depth interviews which explored participants’ views on their recent experience of emergency care and their priorities and preferred outcomes. Interviews were audio-recorded, transcribed verbatim and analysed following the principles of the Framework approach. Results Forty participants were interviewed: 24 patients and 16 carers who, between them, described ED attendances for 28 patients across the three sites. Often informed by previous negative experiences, there was a strong desire to avoid conveyance to EDs, and a sense of helplessness or acquiescence to attend. Although staff attitudes were on the whole seen as positive, the ED experience was dominated by negative experiences relating to very basic issues such as a lack of help with eating, drinking, toileting and discomfort from long waits on hard trolleys. Participants reported that communication and involvement in decision making could be improved, including involving next of kin, who were viewed as critical to supporting vulnerable older people during sometimes very protracted waits. Conclusion Frailty reflects a vulnerability and a need for support in basic activities of daily living, which EDs in this study, and perhaps more widely, are not set up to provide. Changes at the levels of clinical practice and service design are required to deliver even the most basic care for older people with frailty in the ED environment.
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Affiliation(s)
- Emma Regen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kay Phelps
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James David van Oppen
- Department of Health Sciences, University of Leicester, Leicester, UK
- Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Peter Riley
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jagruti Lalseta
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Suzanne M Mason
- University of Sheffield, School of Health and Related Research, Sheffield, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Cornelius T, Birk JL, Shechter A. The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath. Behav Med 2022; 48:230-237. [PMID: 33750268 PMCID: PMC8455716 DOI: 10.1080/08964289.2020.1870431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
After hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients' partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (yes/no), spouse hospitalized ≥ two times (yes/no), and spouse spent ≥ eight nights in-hospital (yes/no). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one's own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one's own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients' partners.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
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Mwakilasa MT, Foley C, O'Carroll T, Flynn R, Rohde D. Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study. J Patient Exp 2021; 8:23743735211065267. [PMID: 34917753 PMCID: PMC8669876 DOI: 10.1177/23743735211065267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.
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Affiliation(s)
- Magreth Thadei Mwakilasa
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Muhimbili University of Health and Allied Sciences, Ilala, Tanzania
| | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
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Schouten B, Driesen BEJM, Merten H, Burger BHCM, Hartjes MG, Nanayakkara PWB, Wagner C. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping. Eur Geriatr Med 2021; 13:339-350. [PMID: 34761369 PMCID: PMC9018642 DOI: 10.1007/s41999-021-00581-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022]
Abstract
Aim To achieve patient-centered care for older patients at the emergency department (ED) it is important to include their perspective and experience, and this can be done through the patient journey method. Findings By mapping the patient journey, we found that waiting times and suboptimal discharge communication are almost always related to a negative experience for older patients. Message The novelty of this study lies within the qualitative patient journey method, which allowed us to include the voice of the patient in issues that have been previously described (i.e. waiting times and discharge communication). We believe this can guide towards patient-centered improvement initiatives that can contribute to a positive ED experience in the future, for example a time-out at the ED and a discharge check list Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6. Purpose Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey. Methods We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding. Results Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an ‘experience’ theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience. Conclusions This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6.
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Affiliation(s)
- Bo Schouten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Babiche E J M Driesen
- Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Brigitte H C M Burger
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mariëlle G Hartjes
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Fry M, Elliott R, Murphy S, Curtis K. The role and contribution of family carers accompanying community-living older people with cognitive impairment to the emergency department: An interview study. J Clin Nurs 2021; 31:975-984. [PMID: 34254383 DOI: 10.1111/jocn.15954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older people with cognitive impairment may have lack of understanding of their health and ability to co-ordinate care needs. Family carers play a key role in supporting older people but the role of family carers in emergency discharge has not been explored well. OBJECTIVE To explore and describe the role and contribution of family carers accompanying the older person with cognitive impairment to the emergency department. DESIGN A exploratory descriptive study was conducted in which telephone interviews were performed. SETTING Three emergency departments located in metropolitan Sydney, Australia; two major tertiary referral centres and one district hospital. The EQUATOR research checklist (COnsolidated criteria for REporting Qualitative research) (COREQ) was used to report the qualitative study. SUBJECTS Participants were family carers accompanying people aged ≥64 years with cognitive impairment; with non-urgent triage classifications; English speaking and eligible for discharge home. Semi-structured telephone interviews were conducted 2 to 4 weeks after the older person was discharged. Data were reflexively thematically analysed in NVIVO independently by three researchers. RESULTS Twenty-eight interviews were conducted. Three key themes were evident: (1) 'communicating knowledge of the older person's health status and usual behaviour'; (2) 'providing advocacy, translation, surrogacy and care co-ordination'; and (3) 'ensuring safe transition from the emergency department to home'. CONCLUSIONS Study findings detailed how family carers created an important safety net while the older person was in emergency, through advocacy and the communication of vital health information. More importantly, their knowledge influenced the healthcare management of the older person and ensured safe discharge and co-ordination of care in the community. RELEVANCE TO CLINICAL PRACTICE The study identified for older persons with cognitive impairment a safe stay in the ED and transition home from hospital was supported by family carers and assisted to ensure that discharge information was understood and adhered to optimise wellbeing and prevent adverse outcomes. The findings of this study can inform discharge processes for nurses, nurse practitioners and doctors. Additionally, processes to support family carer engagement would optimise older person compliance and better inform healthcare decision-making and choice for older peoples, family carers. The findings of the study should inform discharge processes to minimise risk of readmission, financial burden and harm.
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Affiliation(s)
- Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Sandra Murphy
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kate Curtis
- Faculty of Medicine and Health, University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
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Sagoo SN, Grytnes R. Involvement un-enabled? An ethnographic study of the challenges and potentials of involving relatives in the acute ambulatory clinical pathway. BMC Health Serv Res 2020; 20:1086. [PMID: 33243218 PMCID: PMC7690026 DOI: 10.1186/s12913-020-05923-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/15/2020] [Indexed: 03/28/2023] Open
Abstract
Background Involving a patient’s relatives is a complex endeavour, especially in emergency departments (EDs). Generally, relatives are recognized as vital partners in health care, but in-depth knowledge on how these family involvement processes take place in the everyday practices of EDs is sparse. The aim of this study is to explore the practice of involving relatives in the acute ambulatory clinical pathway in the ED, as seen from the perspectives of patients and relatives. Methods The study was conducted as ethnographic fieldwork in an ED at a Danish Regional Hospital. Two months of participant-observation were carried out focusing on 43 patients. Of these, 18 patients and/or relatives were selected for telephone interviews after 1 week, and of these 11 were selected for in-depth interviews 3 weeks later. Results Unpredictability is a basic condition of any ED. For the patients and relatives, who are unfamiliar with the routines in the ED, unpredictability translates to a sense of temporal and existential unpredictability, reinforced by a sense of not knowing when the examinations will be completed or if/when they will be sent home. Relatives’ involvement in the ED is affected by this sense of unpredictability and by the existing relations between patients and their relatives prior to entering the ED. The stay in the ED is only one ‘stop’ in the complete acute ambulatory clinical pathway but relatives’ involvement also concerns the time before and after the stay in the ED. Practices of involving relatives leave (some) relatives invisible in the clinical pathway. As a consequence, they are often not addressed, which un-enables their involvement. Conclusion Involvement of relatives presupposes recognizing the relatives as participants if they are to be involved in the patient’s clinical pathway in the ED. As a start, it is advisable that the medical staff ask the patients on arrival who has accompanied them in the ED, and if and in what way they want their companions involved in the ED. There is a need for a more integrated and contextualized understanding of relatives’ involvement, as it takes place along an extended acute ambulatory clinical pathway. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05923-x.
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Affiliation(s)
- Susanne Nissen Sagoo
- Department. of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, Herning, Denmark.
| | - Regine Grytnes
- Department. of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, Herning, Denmark
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Rance S, Westlake D, Brant H, Holme I, Endacott R, Pinkney J, Byng R. Admission Decision-Making in Hospital Emergency Departments: The Role of the Accompanying Person. Glob Qual Nurs Res 2020; 7:2333393620930024. [PMID: 32596418 PMCID: PMC7303774 DOI: 10.1177/2333393620930024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/15/2022] Open
Abstract
In resource-stretched emergency departments, people accompanying patients
play key roles in patients’ care. This article presents analysis of
the ways health professionals and accompanying persons talked about
admission decisions and caring roles. The authors used an ethnographic
case study design involving participant observation and
semi-structured interviews with 13 patients, 17 accompanying persons
and 26 health care professionals in four National Health Service
hospitals in south-west England. Focused analysis of interactional
data revealed that professionals’ standardization of the patient–carer
relationship contrasted with accompanying persons’ varied connections
with patients. Accompanying persons could directly or obliquely
express willingness, ambivalence and resistance to supporting
patients’ care. The drive to avoid admissions can lead health
professionals to deploy conversational skills to enlist accompanying
persons for discharge care without exploring the meanings of their
particular relationship with the patients. Taking a
relationship-centered approach could improve the attention to
accompanying persons as co-producers of health care and participants
in decision-making.
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Affiliation(s)
| | | | - Heather Brant
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Ruth Endacott
- University of Plymouth, Plymouth, United Kingdom.,Monash University, Frankston, Victoria, Australia
| | | | - Richard Byng
- University of Plymouth, Plymouth, United Kingdom
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12
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Parke B, Hunter KF. The dementia-friendly emergency department: An innovation to reducing incompatibilities at the local level. Healthc Manage Forum 2019; 30:26-31. [PMID: 28929901 DOI: 10.1177/0840470416664532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emergency Departments (EDs) are an integral part of the Canadian healthcare system. Older people living with dementia challenge EDs. They have complex health profiles that pose multiple challenges for staff. The current one-size-fits-all approach that aids efficiency in a technologically dependent hospital setting may not always serve older people living with dementia, their caregivers, or staff well. The premise that older people living with dementia are a problem for Canadian EDs must be reconsidered. Understanding the complexity of the situation is aided by the dementia-friendly ED framework. We propose one way to enhance communication between those living with dementia who receive ED services and those providing the service.
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Affiliation(s)
- Belinda Parke
- 1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- 1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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13
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Fontova-Almató A, Suñer‐Soler R, Juvinyà‐Canal D. Factors associated with patients' and companions' satisfaction with a hospital emergency department: A descriptive, cross-sectional study. Nurs Open 2019; 6:834-841. [PMID: 31367406 PMCID: PMC6650685 DOI: 10.1002/nop2.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 12/30/2022] Open
Abstract
AIM The aim was to study the level of satisfaction with an emergency department and to identify the factors associated with satisfaction. DESIGN This research consisted of a descriptive, cross-sectional study. METHODS The study population was composed of patients and companions who visited the emergency department during a three-month period. The patients were selected randomly from the register of visits to the emergency department during the period of study. Sociodemographic variables and variables related to the attention received were studied through questionnaires (response rate 33%). RESULTS Older age was associated with greater satisfaction (p = 0.002), as was female sex (p = 0.013) and greater optimism (p < 0.001). Greater control of pain was a factor associated with satisfaction (p = 0.033), as was the perception of a shorter waiting time before the medical visit (p < 0.001).
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Affiliation(s)
- Aurora Fontova-Almató
- Emergency DepartmentFundació Salut EmpordàGironaSpain
- Faculty of NursingUniversity of GironaGironaSpain
| | - Rosa Suñer‐Soler
- Faculty of NursingUniversity of GironaGironaSpain
- Health and Healthcare Research GroupUniversity of GironaGironaSpain
| | - Dolors Juvinyà‐Canal
- Faculty of NursingUniversity of GironaGironaSpain
- Health and Healthcare Research GroupUniversity of GironaGironaSpain
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14
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Cetin-Sahin D, Ducharme F, McCusker J, Veillette N, Cossette S, Vu TTM, Vadeboncoeur A, Lachance PA, Mah R, Berthelot S. Experiences of an Emergency Department Visit Among Older Adults and Their Families: Qualitative Findings From a Mixed-Methods Study. J Patient Exp 2019; 7:346-356. [PMID: 32821794 PMCID: PMC7410141 DOI: 10.1177/2374373519837238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective To explore experiences of an ED visit among patients aged 75 and older. Methods In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.
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Affiliation(s)
- Deniz Cetin-Sahin
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada.,Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Quebec, Canada
| | - Francine Ducharme
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Jane McCusker
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Nathalie Veillette
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Sylvie Cossette
- University of Montreal, Montreal, Quebec, Canada.,Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - T T Minh Vu
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Centre hospitalier de l'université de Montréal, Montreal, Quebec, Canada
| | - Alain Vadeboncoeur
- University of Montreal, Montreal, Quebec, Canada.,Emergency Medicine Services, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul-André Lachance
- University of Montreal, Montreal, Quebec, Canada.,Hôpital de la Cité-de-la-Santé, Laval, Quebec, Canada
| | - Rick Mah
- St. Mary's Hospital Center, Montreal, Quebec, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Canada
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15
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Goodridge D, Martyniuk S, Stempien J. At Risk for Emotional Harm in the Emergency Department: Older Adult Patients' and Caregivers' Experiences, Strategies, and Recommendations. Gerontol Geriatr Med 2018; 4:2333721418801373. [PMID: 30263907 PMCID: PMC6149014 DOI: 10.1177/2333721418801373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Emergency departments (ED) serve a critical role in addressing the health care needs of older adults, although organizational and provider characteristics can result in unintended negative outcomes for this population, such as emotional harm. This study aimed to describe the patient experience of older adults in the ED and generate recommendations for enhancing their experience. Methods: Data from focus groups and individual interviews of older adults and caregivers who had visited the ED were thematically analyzed. Results: Ten focus groups and individual interviews of 41 older adults and 15 caregivers were conducted. Health system and provider factors affecting the patient experience were identified. Participants negotiated their experience using diverse strategies. Recommendations for improving the ED experience were generated. Conclusions: Older adults attending the ED are at risk for health care-related emotional harm unrelated to their entrance complaint, which could be mitigated by addressing organizational and attitudinal factors.
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16
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Parke B, Boltz M, Hunter KF, Chambers T, Wolf-Ostermann K, Adi MN, Feldman F, Gutman G. A Scoping Literature Review of Dementia-Friendly Hospital Design. THE GERONTOLOGIST 2018; 57:e62-e74. [PMID: 27831481 DOI: 10.1093/geront/gnw128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/31/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and Methods Exploratory iterative design utilizing scoping literature review methodology. Results A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | | | - Thane Chambers
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | | | - Mohamad Nadim Adi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Surrey, British Columbia, Canada.,Seniors Fall and Injury Prevention, Primary Care, Chronic Disease Management and Specialized Seniors, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Gloria Gutman
- Gerontology Department and Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Fernández-Sola C, Granero-Molina J, Díaz-Cortés MDM, Jiménez-López FR, Roman-López P, Saez-Molina E, Aranda-Torres CJ, Muñoz-Terrón JM, García-Caro MP, Hernández-Padilla JM. Characterization, conservation and loss of dignity at the end-of- life in the emergency department. A qualitative protocol. J Adv Nurs 2018; 74:1392-1401. [PMID: 29421848 DOI: 10.1111/jan.13536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Abstract
AIMS To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end-of-life care in the emergency department. BACKGROUND The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. DESIGN A phenomenological qualitative study. METHODS The protocol was approved in December 2016 and will be carried out from December 2016-December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the emergency department, in-depth interviews with terminally ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. DISCUSSION Emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the emergency department are expected to be found. This study's results could have important implications in the implementation of new interventions in emergency departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment and assumption (takeover) of dignified actions and attitudes (respect for human rights).
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Affiliation(s)
- Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - José Granero-Molina
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - María Del Mar Díaz-Cortés
- Emergency Department, Hospital Torrecárdenas, Almería, Spain.,Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almería, Spain
| | - Francisca Rosa Jiménez-López
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain
| | - Pablo Roman-López
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almería, Spain.,Department of Nursing, Universitat Jaume I, Castellon, Spain
| | | | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
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18
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Nyborg I, Danbolt LJ, Kirkevold M. Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members. BMC Health Serv Res 2017; 17:619. [PMID: 28859659 PMCID: PMC5579919 DOI: 10.1186/s12913-017-2563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age. METHODS This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. RESULTS The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals. CONCLUSIONS Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.
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Affiliation(s)
- Ingrid Nyborg
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
- Innlandet Hospital Trust, Kyrre Grepps gate 11, NO-2819 Gjøvik, Norway
| | - Lars Johan Danbolt
- Norwegian School of Theology, Majorstuen, P.O. Box 5144, NO-0302 Oslo, Norway
- Director of The Center for the Psychology of Religion, Innlandet Hospital Trust, P.O. Box 68, NO-2312 Ottestad, Norway
| | - Marit Kirkevold
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
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19
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Paavilainen E, Mikkola R, Salminen-Tuomaala M, Leikkola P. Counseling patients and family members in out-of-hospital emergency situations: a survey for emergency staff. BMC Nurs 2017; 16:11. [PMID: 28250716 PMCID: PMC5324227 DOI: 10.1186/s12912-017-0205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/16/2017] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Eija Paavilainen
- School of Health Sciences, University of Tampere/ Hospital District of South Ostrobothnia, 33014 Tampere, Finland
| | - Riitta Mikkola
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mari Salminen-Tuomaala
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Päivi Leikkola
- Hospital District of South Ostrobothnia, Seinäjoki, Finland
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20
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Sucu Dağ G, Dicle A, Firat MZ. Psychometric properties of the critical care family needs inventory-emergency department. Appl Nurs Res 2017; 33:113-120. [DOI: 10.1016/j.apnr.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 10/08/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Barreto MDS, Marcon SS, Garcia-Vivar C. Patterns of behaviour in families of critically ill patients in the emergency room: a focused ethnography. J Adv Nurs 2016; 73:633-642. [PMID: 27653638 DOI: 10.1111/jan.13156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to understand the patterns of behaviour from relatives of critically ill patients admitted to the emergency room. BACKGROUND Admission of a critically ill family member to an accident and emergency department is often a sudden and unexpected experience for the family. This stressful event often creates feelings of instability and intense suffering in relatives. Understanding the experiences of these families is essential for the provision of comprehensive health care in the emergency room. DESIGN A focused ethnography design was applied to the study. METHODS Peripheral participant observation and informal conversations were conducted in an emergency room in southern Brazil during January 2015. Analysis of data was based on Leininger. FINDINGS Suffering was recurrent among family members of critically ill patients admitted to the emergency room. The environment, which was conditioned by the patient's life-threatening situation and professionals' attitudes, resulted in relatives experiencing a range of feelings from suffering to calm. A distant approach and poor communication of professionals made relatives confused and silent. Factors that seemed to foster feelings of calm in families were the establishment of a continuous and close communication with professionals and the possibility to remain with the patient outside the established visiting hours. CONCLUSION The findings of this study challenge emergency department providers and managers to promote comprehensive care in the emergency room by inviting family members to be with the patient and by engaging in family-centred care.
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Affiliation(s)
- Mayckel da Silva Barreto
- Department of Nursing, State University of Maringá, Maringá, Paraná, Brazil.,Faculty of Philosophy Sciences and Languages of Mandaguari, Mandaguari Paraná, Brazil.,Faculty Intermunicipal Northwest of Paraná, Loanda, Paraná, Brazil
| | - Sonia Silva Marcon
- Department of Nursing, State University of Maringá, Maringá, Paraná, Brazil
| | - Cristina Garcia-Vivar
- School of Nursing, University of Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
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22
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Ferorelli D, Zotti F, Tafuri S, Pezzolla A, Dell’Erba A. Patient Safety Walkaround: a communication tool for the reallocation of health service resources: An Italian experience of safety healthcare implementation. Medicine (Baltimore) 2016; 95:e4956. [PMID: 27741109 PMCID: PMC5072936 DOI: 10.1097/md.0000000000004956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study aims to evaluate the use of Patient Safety Walkaround (SWR) execution model in an Italian Hospital, through the adoption of parametric indices, survey tools, and process indicators.In the 1st meeting an interview was conducted to verify the knowledge of concepts of clinical risk management (process indicators). One month after, the questions provided by Frankel (survey tool) were administered.Each month after, an SWR has been carried trying to assist the healthcare professionals and collecting suggestions and solutions.Results have been classified according to Vincent model and analyzed to define an action plan. The amount of risk was quantified by the risk priority index (RPI).An organizational deficit concerns the management of the operating theatre.A state of intolerance was noticed of queuing patients for outpatient visits. The lack of scheduling of the operating rooms is often the cause of sudden displacements. A consequence is the conflict between patients and caregivers. Other causes of the increase of waiting times are the presence in the ward of a single trolley for medications and the presence of a single room for admission and preadmission of patients.Patients victims of allergic reactions have attributed such reactions to the presence of other patients in the process of acceptance and collection of medical history.All health professionals have reported the problem of n high number of relatives of the patients in the wards.Our study indicated the consistency of SWR as instrument to improve the quality of the care.
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Affiliation(s)
- Davide Ferorelli
- Interdisciplinary Department of Medicine, Section of Legal Medicine
- Correspondence to Davide Ferorelli, Interdisciplinary Department of Medicine, Section of Legal Medicine, Universita degli Studi di Bari Aldo Moro, Bari, Italy (e-mail: )
| | - Fiorenza Zotti
- Interdisciplinary Department of Medicine, Section of Legal Medicine
| | | | - Angela Pezzolla
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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23
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Palonen M, Kaunonen M, Åstedt-Kurki P. Family involvement in emergency department discharge education for older people. J Clin Nurs 2016; 25:3333-3344. [PMID: 27218600 DOI: 10.1111/jocn.13399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To report findings concerning family involvement in emergency department discharge education for older people. BACKGROUND The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education. DESIGN A descriptive qualitative design was used. METHODS Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis. RESULTS Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement. CONCLUSIONS Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels. RELEVANCE TO CLINICAL PRACTICE The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction.
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Affiliation(s)
- Mira Palonen
- School of Health Sciences, University of Tampere, Tampere, Finland.
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, General Administration, Tampere, Finland
| | - Päivi Åstedt-Kurki
- School of Health Sciences, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, General Administration, Tampere, Finland
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Abstract
Background: Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. Objective: The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. Research design: A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013–2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). Findings: The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Discussion: Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Conclusion: Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.
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Rubio Soares J, Martin AR, Rabelo JF, Barreto MDS, Marcon SS. Presença da família durante o atendimento emergencial: percepção do paciente vítima de trauma. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.2.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: aprehender cómo pacientes víctimas de trauma perciben la presencia de la familia durante la atención de emergencia. Métodos: estudio descriptivo, de naturaleza cualitativa, realizado con 29 pacientes asistidos en una unidad de urgencias en el sur de Brasil. Los datos, recolectados en octubre de 2013, por medio de entrevista abierta, se sometieron a análisis de contenido, modalidad temática. Resultados: los pacientes víctimas de trauma percibían como positiva la presencia de la familia durante la atención de emergencia y la deseaban; creían que a sus familiares también les gustaría estar presentes. La motivación principal para desear la presencia de la familia en urgencias era la posibilidad de que esta proporcionara confianza y comodidad al paciente y, al mismo tiempo, tranquilizar a los familiares en la medida en que pueden obtener más informaciones acerca de la evolución del estado clínico y acompañar la atención. Conclusión: profesionales del área de salud que actúan en urgencias deben considerar la posibilidad de integrar la familia al espacio de cuidado a las víctimas de trauma, ya que los pacientes consideraron esta práctica beneficiosa para ellos y sus familiares.
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Fassier T, Valour E, Colin C, Danet F. Who Am I to Decide Whether This Person Is to Die Today? Physicians' Life-or-Death Decisions for Elderly Critically Ill Patients at the Emergency Department-ICU Interface: A Qualitative Study. Ann Emerg Med 2015; 68:28-39.e3. [PMID: 26619758 DOI: 10.1016/j.annemergmed.2015.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/19/2015] [Accepted: 09/29/2015] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE We explored physicians' perceptions of and attitudes toward triage and end-of-life decisions for elderly critically ill patients at the emergency department (ED)-ICU interface. METHODS This was a qualitative study with thematic analysis of data collected through semistructured interviews (15 emergency physicians and 9 ICU physicians) and nonparticipant observations (324 hours, 8 units, in 2 hospitals in France). RESULTS Six themes emerged: (1) Physicians revealed a representation of elderly patients that comprised both negative and positive stereotypes, and expressed the concept of physiologic age. (2) These age-related factors influenced physicians' decisionmaking in resuscitate/not resuscitate situations. (3) Three main communication patterns framed the decisions: interdisciplinary decisions, decisions by 2 physicians on their own, and unilateral decisions by 1 physician; however, some physicians avoided decisions, facing uncertainty and conflicts. (4) Conflicts and communication gaps occurred at the ED-ICU interface and upstream of the ED-ICU interface. (5) End-of-life decisions were perceived as more complex in the ED, in the absence of family or of information about elderly patients' end-of-life preferences, and when there was conflict with relatives, time pressure, and a lack of training in end-of-life decisionmaking. (6) During decisionmaking, patients' safety and quality of care were potentially compromised by delayed or denied intensive care and lack of palliative care. CONCLUSION These qualitative findings highlight the cognitive heuristics and biases, interphysician conflicts, and communication gaps influencing physicians' triage and end-of-life decisions for elderly critically ill patients at the ED-ICU interface and suggest strategies to improve these decisions.
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Affiliation(s)
- Thomas Fassier
- Research Unit EAM 4129 Health, Individual, Society, Lyon University, Lyon, France.
| | - Elizabeth Valour
- Research Unit EAM 4129 Health, Individual, Society, Lyon University, Lyon, France
| | - Cyrille Colin
- Research Unit EAM 4129 Health, Individual, Society, Lyon University, Lyon, France; Medical Information, Evaluation and Research Unit, Hospices Civils de Lyon, Lyon, France
| | - François Danet
- Research Unit EAM 4129 Health, Individual, Society, Lyon University, Lyon, France
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Morphet J, Decker K, Crawford K, Innes K, Williams AF, Griffiths D. Aged care residents in the emergency department: the experiences of relatives. J Clin Nurs 2015; 24:3647-53. [DOI: 10.1111/jocn.12954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Morphet
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | - Kelly Decker
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | | | - Kelli Innes
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | | | - Debra Griffiths
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
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Fry M, Chenoweth L, MacGregor C, Arendts G. Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: A descriptive qualitative study. Int J Nurs Stud 2015; 52:1323-31. [DOI: 10.1016/j.ijnurstu.2015.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
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Stein-Parbury J, Gallagher R, Fry M, Chenoweth L, Gallagher P. Expectations and experiences of older people and their carers in relation to emergency department arrival and care: A qualitative study in Australia. Nurs Health Sci 2015; 17:476-82. [DOI: 10.1111/nhs.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/04/2015] [Accepted: 02/24/2015] [Indexed: 12/30/2022]
Affiliation(s)
| | - Robyn Gallagher
- Sydney Nursing School and Charles Perkins Centre; University of Sydney; New South Wales Australia
| | - Margaret Fry
- Faculty of Health; University of Technology; New South Wales Australia
- Nursing and Midwifery; Northern Sydney Local Health District; New South Wales Australia
| | - Lynn Chenoweth
- Faculty of Health; University of Technology; New South Wales Australia
| | - Patrick Gallagher
- Faculty of Health; University of Technology; New South Wales Australia
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Hunter JL, Glenn LL. Positive experiences of family members in emergency departments: A commentary. Int Emerg Nurs 2015; 23:207. [DOI: 10.1016/j.ienj.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/21/2013] [Accepted: 11/22/2013] [Indexed: 10/24/2022]
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Elmqvist C, Frank C. Patients' strategies to deal with their situation at an emergency department. Scand J Caring Sci 2014; 29:145-51. [PMID: 24750520 DOI: 10.1111/scs.12143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/21/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The care in the emergency department (ED) is often characterised by high standards of efficiency and rapid treatment and the encounter between patient and staff can be described as both short and fragmented. Research within this field has mostly been performed with quantitative measurements and patients are both satisfied and vulnerable in their care at an ED. There is a lack of qualitative studies about patient's strategies to deal with their situation. AIM The aim was to describe patient's strategies for dealing with their situation at an ED. METHODS Secondary analysis has been made of 13 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. RESULTS The results showed that patients' strategies to deal with the situation at the ED are passive or active. The passive strategy is being patient and the active strategies varied in terms of having hidden tactics, using visible tactics and using families as support. CONCLUSION These findings increase the importance of gaining knowledge about these strategies so that the staff at the ED can support the patients so they do not have to use them.
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Affiliation(s)
- Carina Elmqvist
- Centre for Acute & Critical Care, Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Gallagher R, Fry M, Chenoweth L, Gallagher P, Stein-Parbury J. Emergency department nurses' perceptions and experiences of providing care for older people. Nurs Health Sci 2014; 16:449-53. [PMID: 24645872 DOI: 10.1111/nhs.12137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/20/2014] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
Abstract
Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses' perceptions of their role and experiences are seldom investigated. This focus-group study investigated emergency department nurses' perceptions and experiences of caring for older people, using four focus groups of nurses with a minimum three months' experience in the emergency department and a demographic survey. Data were thematically analyzed. Two themes emerged. The first was the clash of expectations between nurses and family/carers related to safety and quality of nursing care. Older people were perceived to be vulnerable in the emergency department, and nurses were frustrated that competing priorities decreased their ability to ensure them safe and quality care. Nurses felt family/carers were disappointed with care provided, and might not empathize with or understand their predicament. The second theme concerned nurses' perception that family/carers could provide a safety net for the older person in the emergency department in times of high workload. Nurses need support to care for older people in the emergency department to ensure safe and optimal care, and a shared understanding of care provision between nurses and family needs development.
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Affiliation(s)
- Robyn Gallagher
- Faculty of Health, University of Technology, Sydney, Australia
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Fry M, Gallagher R, Chenoweth L, Stein-Parbury J. Nurses’ experiences and expectations of family and carers of older patients in the emergency department. Int Emerg Nurs 2014; 22:31-6. [DOI: 10.1016/j.ienj.2013.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/24/2022]
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Hunter JL, Lee Glenn L. WITHDRAWN: Positive experience of family members in emergency departments: A commentary. Int Emerg Nurs 2013:S1755-599X(13)00100-6. [PMID: 24457209 DOI: 10.1016/j.ienj.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/21/2013] [Accepted: 11/22/2013] [Indexed: 11/23/2022]
Abstract
This article has been withdrawn at the request of editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Jessica L Hunter
- College of Nursing, East Tennessee State University, P.O. Box 70676, Johnson City, TN 37604, USA
| | - L Lee Glenn
- College of Nursing, East Tennessee State University, P.O. Box 70676, Johnson City, TN 37604, USA.
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