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Referrals to Emergency Departments: The Process and Factors That Influence Decision-Making among Community Nurses
School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsofrämjande processer.
Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden & Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
2014 (engelsk)Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, nr 5, s. 366-374Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

sted, utgiver, år, opplag, sider
Irvine, CA: Scientific Research Publishing, 2014. Vol. 4, nr 5, s. 366-374
Emneord [en]
Emergency Department, Older Persons, Municipal Care, Registered Nurse, Decision Making
HSV kategori
Identifikatorer
URN: urn:nbn:se:hh:diva-25943DOI: 10.4236/ojn.2014.45042OAI: oai:DiVA.org:hh-25943DiVA, id: diva2:730280
Merknad

Article ID: 45320. The authors wish to express their gratitude to the Ministry of Health and Social Affairs and the Swedish Association of Local Authorities in Gävleborg for grants.

Tilgjengelig fra: 2014-06-27 Laget: 2014-06-27 Sist oppdatert: 2018-10-24bibliografisk kontrollert

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