2.50
Hdl Handle:
http://hdl.handle.net/10755/211536
Type:
Research Study
Title:
A PERFECT STORM: CONTEXTUAL FACTORS IN THE ED WHEN CARING FOR OLDER ADULTS
Abstract:
Background: Emergency departments (ED) are a frequent source of care for older adults who often present with complex, specialized and time consuming care needs. Older adults seen in the ED are at greater risk for repeat visits, functional decline, increased complications and death. Randomized clinical trials providing a transitional model of care for older adults in the ED have proved ineffective at reducing subsequent service use. This suggests while there is an understanding of the challenges and poor outcomes for the care of older adults in the ED there is not a sufficient understanding of the origins of these problems. Purpose: The purpose of this qualitative descriptive study is to expand on previous analysis on the care of older adults in the ED, and describe from the perspective of ED health professionals factors that influence the way in which they provide care to older adults. Sample: Nurses who spoke English and had worked in the ED of a large urban hospital in Los Angeles for at least 6 months were eligible to participate.  The final sample included nurses with a range of ED experience from 1-33 years as well as physicians and ancillary staff, and included representatives from all three shifts. Methods: A qualitative, descriptive methodology was used. After receiving IRB approval, nine focus groups were conducted with nurses physicians and ancillary staff employed at a large urban ED. A semi-structured interview guide consisting of open ended questions was used to elicit experiences of providing care to older adults in the ED. Focus group data were analyzed using constant comparative analysis. Results: Staff described contextual factors which affect their care delivery to older adults. Tensions in care for older adults emerged from five areas: system constraints, perceived expectations, knowledge, image of role as an ED professional and the ED model of care. These areas contributed to a clash with the geriatric model of care creating tensions in the ED care environment of older adults. For example, staff described how older adults often had needs which they felt fell outside the specific role functions for the ED professional such as toileting and preventative turning. These five contextual factors created barriers to providing comprehensive geriatric care in the ED. Implications: The intersection of increased demand of ED services by older adults versus the tensions in the ED care environment of older adults creates a perfect storm for which poor outcomes can occur raising issues of quality, safety and use of resources. Interventions aimed at improving care of older adults in the ED need to be a system-wide approach targeting direct care staff, ED leadership and hospital administrators.
Keywords:
Older adult care; Emergency departments
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5395
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleA PERFECT STORM: CONTEXTUAL FACTORS IN THE ED WHEN CARING FOR OLDER ADULTSen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211536-
dc.description.abstractBackground: Emergency departments (ED) are a frequent source of care for older adults who often present with complex, specialized and time consuming care needs. Older adults seen in the ED are at greater risk for repeat visits, functional decline, increased complications and death. Randomized clinical trials providing a transitional model of care for older adults in the ED have proved ineffective at reducing subsequent service use. This suggests while there is an understanding of the challenges and poor outcomes for the care of older adults in the ED there is not a sufficient understanding of the origins of these problems. Purpose: The purpose of this qualitative descriptive study is to expand on previous analysis on the care of older adults in the ED, and describe from the perspective of ED health professionals factors that influence the way in which they provide care to older adults. Sample: Nurses who spoke English and had worked in the ED of a large urban hospital in Los Angeles for at least 6 months were eligible to participate.  The final sample included nurses with a range of ED experience from 1-33 years as well as physicians and ancillary staff, and included representatives from all three shifts. Methods: A qualitative, descriptive methodology was used. After receiving IRB approval, nine focus groups were conducted with nurses physicians and ancillary staff employed at a large urban ED. A semi-structured interview guide consisting of open ended questions was used to elicit experiences of providing care to older adults in the ED. Focus group data were analyzed using constant comparative analysis. Results: Staff described contextual factors which affect their care delivery to older adults. Tensions in care for older adults emerged from five areas: system constraints, perceived expectations, knowledge, image of role as an ED professional and the ED model of care. These areas contributed to a clash with the geriatric model of care creating tensions in the ED care environment of older adults. For example, staff described how older adults often had needs which they felt fell outside the specific role functions for the ED professional such as toileting and preventative turning. These five contextual factors created barriers to providing comprehensive geriatric care in the ED. Implications: The intersection of increased demand of ED services by older adults versus the tensions in the ED care environment of older adults creates a perfect storm for which poor outcomes can occur raising issues of quality, safety and use of resources. Interventions aimed at improving care of older adults in the ED need to be a system-wide approach targeting direct care staff, ED leadership and hospital administrators.en_GB
dc.subjectOlder adult careen_GB
dc.subjectEmergency departmentsen_GB
dc.date.available2012-02-20T12:00:53Z-
dc.date.issued2012-02-20T12:00:53Z-
dc.date.accessioned2012-02-20T12:00:53Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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