TITLE:
Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses
AUTHORS:
Annica Kihlgren, Helena Sunvisson, Kristina Ziegert, Anna-Greta Mamhidir
KEYWORDS:
Emergency Department, Older Persons, Municipal Care, Registered Nurse, Decision Making
JOURNAL NAME:
Open Journal of Nursing,
Vol.4 No.5,
April
25,
2014
ABSTRACT: 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.