2.50
Hdl Handle:
http://hdl.handle.net/10755/162603
Type:
Presentation
Title:
The Almshouse Revisited: Heavy Users of Emergency Services
Abstract:
The Almshouse Revisited: Heavy Users of Emergency Services
Conference Sponsor:Emergency Nurses Association
Conference Year:1995
Author:Malone, Ruth E.
P.I. Institution Name:University of California, San Francisco School of Nursing
Contact Address:San Francisco School of Nursing N319X, San Francisco, CA, 94143, USA
Purpose: A small subgroup of emergency department (ED) patients is responsible for a disproportionate amount of ED visits and costs. This subgroup, heavy users of ED services, is identified as a medically and socially vulnerable population. Interventions aimed at reducing this group's use of ED services have not proven effective, for reasons which remain unclear. The broad objective of this study was to improve understanding of the phenomenon of heavy ED use. The primary aims were to: Describe the context in which heavy ED use occurs and explore the meanings of such use to patients who are heavy ED users; uncover the dimensions of the "problem" by examining it from several perspectives, and explicate the findings within a policy perspective. The study was grounded in Heideggerian interpretive phenomenology.

Design: Interpretive ethnography utilizing multiple data points.

Setting: Two inner-city trauma center, teaching hospital EDs in separate cities.

Sample: Patients identified by nurses as frequent visitors were interviewed by the researcher. Forty-six patients participated in taped unstructured interviews. Approximately 50-60 nurses and other hospital staff participated in taped, informal, break-room discussions of their experiences with frequent ED visitors. Other staff and patients were observed during fieldwork. Medical records of a subsample of the patient sample were also reviewed.

Methodology: Transcribed interviews, observational notes, and medical records data were treated as text analogues for interpretive analysis. Data analysis used the interrelated processes of thematic analysis, analysis of exemplars, and search for paradigm cases. Second-level analysis examined findings from the data and compared them for "fit" with policy assumptions.

Results: Patients identified as heavy ED users shared two commonalities: They all had social or medical problems not readily "fixable" by standard medical treatment, and their problems raised issues of legitimacy and helplessness for both providers and patients. Many of these patients are viewed as "hopeless cases," yet some "former" heavy ED users were found to be making significant contributions. Issues of legitimacy, recognition, vulnerability, possibility for change, and community were common themes in the discourse of both patients and providers.

Conclusions: Deficit-focused views of these patients leave out their commonality with ourselves, the meaningful context within which their behaviors make sense, their values, fears, and concerns, and their contributions. Breakdowns of family and community and the changes within healthcare mean that caregivers in "safety net" settings such as the ED are asked to assume greater burdens. Institutional and social policies based on narrowly-focused medical-economic models of care render more basic needs invisible and contribute to the medicalization of social problems and the objectification of patients. [Research Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Almshouse Revisited: Heavy Users of Emergency Servicesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162603-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Almshouse Revisited: Heavy Users of Emergency Services</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1995</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Malone, Ruth E.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of California, San Francisco School of Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">San Francisco School of Nursing N319X, San Francisco, CA, 94143, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">res@ena.org</td></tr><tr><td colspan="2" class="item-abstract">Purpose: A small subgroup of emergency department (ED) patients is responsible for a disproportionate amount of ED visits and costs. This subgroup, heavy users of ED services, is identified as a medically and socially vulnerable population. Interventions aimed at reducing this group's use of ED services have not proven effective, for reasons which remain unclear. The broad objective of this study was to improve understanding of the phenomenon of heavy ED use. The primary aims were to: Describe the context in which heavy ED use occurs and explore the meanings of such use to patients who are heavy ED users; uncover the dimensions of the &quot;problem&quot; by examining it from several perspectives, and explicate the findings within a policy perspective. The study was grounded in Heideggerian interpretive phenomenology.<br/><br/>Design: Interpretive ethnography utilizing multiple data points.<br/><br/>Setting: Two inner-city trauma center, teaching hospital EDs in separate cities.<br/><br/>Sample: Patients identified by nurses as frequent visitors were interviewed by the researcher. Forty-six patients participated in taped unstructured interviews. Approximately 50-60 nurses and other hospital staff participated in taped, informal, break-room discussions of their experiences with frequent ED visitors. Other staff and patients were observed during fieldwork. Medical records of a subsample of the patient sample were also reviewed.<br/><br/>Methodology: Transcribed interviews, observational notes, and medical records data were treated as text analogues for interpretive analysis. Data analysis used the interrelated processes of thematic analysis, analysis of exemplars, and search for paradigm cases. Second-level analysis examined findings from the data and compared them for &quot;fit&quot; with policy assumptions.<br/><br/>Results: Patients identified as heavy ED users shared two commonalities: They all had social or medical problems not readily &quot;fixable&quot; by standard medical treatment, and their problems raised issues of legitimacy and helplessness for both providers and patients. Many of these patients are viewed as &quot;hopeless cases,&quot; yet some &quot;former&quot; heavy ED users were found to be making significant contributions. Issues of legitimacy, recognition, vulnerability, possibility for change, and community were common themes in the discourse of both patients and providers.<br/><br/>Conclusions: Deficit-focused views of these patients leave out their commonality with ourselves, the meaningful context within which their behaviors make sense, their values, fears, and concerns, and their contributions. Breakdowns of family and community and the changes within healthcare mean that caregivers in &quot;safety net&quot; settings such as the ED are asked to assume greater burdens. Institutional and social policies based on narrowly-focused medical-economic models of care render more basic needs invisible and contribute to the medicalization of social problems and the objectification of patients. [Research Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:30:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:58Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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