Discharge of the older person from the emergency department - the perceptions of health professionals

Aims of study. This study aimed to examine the management of the older person in preparation for discharge home from an emergency department by exploring the perceptions of health professionals on procedures undertaken particularly in relation to the planned support, supply of medications, dressings, and contact information given to patients. An additional aim related to the perceived satisfaction levels of older patients and their carers. Background. It is imperative that older patients are adequately prepared for discharge home from the emergency department so as to avoid unnecessary anxiety, increase in health problems and possible re‐attendance or admission to hospital. Design. The sample in this study comprised the total population (n = 222) of all medical and nursing staff in both the emergency department and the primary care area. Methods. The method adopted was a survey approach which employed the use of standardized questionnaires comprising both open and closed questioning styles. Results. The data obtained identified results similar to previous research in that a discrepancy exists between hospital and community staff in relation to the procedures undertaken when discharging older people from the emergency department, such as arranging follow‐up care and appointments and giving the patient relevant contact numbers and dressings. Conclusion. The findings of this study support previous research in that there is a need to provide patients with planned support, aids and appliances, clear instructions and relevant contact numbers on discharge from the emergency department. Relevance to clinical practice. Good quality discharge planning is essential for a continuum of care for older people discharged from the emergency department. While patient education is often difficult in the busy emergency department, the provision of relevant information to older patients prior to discharge is essential particularly in relation to prescribed medications and wound care.     

Exploring participation: older people on discharge from hospital

BACKGROUND AND AIM: User participation has been a widely researched and debated phenomenon in the formulation and implementation of health and social care policy and indeed wider public sector policy in the United Kingdom (UK), yet there remains a vast array of definitions of the term and great variety in the findings of empirical studies. The aim of this paper is to discuss the main findings of an empirical study in order to build upon existing evidence and interpretation relating to user participation in health and social care. METHOD: The study reported here was carried out in the UK and explored the extent to which older people were able and willing to assume an active role in the process of using health and social care. Hospital discharge and the period shortly afterwards was the process under investigation. This study used a multi-method approach incorporating both quantitative and qualitative approaches; data from 260 questionnaires and 30 interviews were included. FINDINGS: The majority of respondents felt that they had been involved in decisions regarding their discharge from hospital. All welcomed advice from professionals and some preferred service providers to make decisions on their behalf. DISCUSSION: Arnstein's ladder of citizen participation is drawn upon in analysing the findings and notions of 'partnership', 'relationship', 'communication' and 'paternalism' are discussed.     

Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review

AimThe aim of this integrative literature review was to explore the quality of the dying and death experience in the Emergency Department from the perspective of staff and carers.BackgroundDeath in the Emergency Department is common. Understanding the quality of the death and dying experience of patients and their family members is crucial to building knowledge and improving care.DesignSystematic integrative literature review reported following the PRISMA guidelines.Data sourcesPubmed, Cumulative Index to Nursing and Allied Health Literature, Magonline (internurse), and the Cochrane library. Articles used were published in English during 1990- 2017.Review methodAppraisal and thematic analysis.ResultsSixteen articles are included. Eight themes emerged from the literature: care in the Emergency Department is about living not dying, staff perceive that death is a failure, staff feel underprepared to care for the dying patient and family in this environment, there is limited time for safe standards of care, staff stress and distress, staff use of distancing behaviours, the care of the dying role is devolved from medics to nurses at the end of life, and patients and staff perceive that the Emergency Department is not the preferred place of deathConclusionThere are areas of concern about end of life care in the Emergency Department. To improve practice and to ensure that a good death occurs, further research is needed. There is a need to understand more about the experience of caregivers when a relative or friend dies in the Emergency Department.     

Sources of support for older people after discharge from hospital: 10 years on

AIMS OF THE STUDY: The aim of this research was to find out who supports older people at home after discharge from hospital and if sources of support have changed between the 1980s and the 1990s. BACKGROUND: More and more older people are being discharged from hospital earlier and this creates additional pressures on families, community health and social services and the independent care sector. The research was concerned with how sources of support may have changed in a 10-year period. METHODS: A comparison is made of two separate nonrandom samples, taken 10 years apart, of older people following discharge from hospital. Interviews were conducted in participants' homes to establish levels of dependence and the source of support given in response to the need for help with personal and domestic activities of daily living. RESULTS: Although limited by the use of relatively small, nonrandom samples, the research found that proportions needing help with domestic activities were higher than those needing help with personal activities of daily living. Although dependence for help with bathing had declined between the 1980s and 1990s, help was still needed with bathing and dressing. Unmet need for help with bathing remained a problem in the 1990s. A growing role for home helps was identified, especially in personal care (bathing and dressing), where support from district nurses had declined. By the 1990s, home helps were doing less cooking and housework, including heavy laundry. Relatives were doing more of most domestic activities except shopping, which was being carried out by home helps. CONCLUSIONS: The paper concludes by arguing that hospitals should consider if pressures to discharge older people more quickly might hinder the discharge planning process and communication between hospital and community sectors.     

Alcoholism in the Emergency Department: An Epidemiologic Study

OBJECTIVE: To describe the epidemiology of alcoholism in ED patients. METHODS: Over a two-month period, every adult patient brought by ambulance to the ED of a large municipal hospital was prospectively enrolled by questionnaire. Data collected included demographics, previous ED use, triage complaint-related diagnoses, hospital admission rates, and ethanol levels (if determined). The CAGE alcoholism questions were administered to all patients by trained assistants. The only exclusion criterion was the inability to communicate while in the ED. A chi-square analysis was used to compare categorical variables. RESULTS: A total of 2,658 patients were enrolled in the study; 226 were unable to respond to the CAGE questions. Five hundred eighty-eight of the remaining 2,432 patients (24%) were defined as being alcoholic by an affirmative response to at least two of the CAGE questions. All four questions were answered affirmatively by 17% of the total patients. Alcoholic patients were more likely to be male (88% vs 60%), unemployed (87% vs 71%), undomiciled (46% vs 20%), polysubstance users (52% vs 25%), and tobacco users (77% vs 41%), and to have had an ED visit in the previous six months (51% vs 35%) (p < 0.001 for all tests). Ethanol levels ranged from zero to 573 mg/dL. Whereas no positive response to a single CAGE question was predictive of a final diagnosis of alcoholism, a blood ethanol level more than 300 mg/dL predicted an affirmative response to at least two CAGE questions in 97% of cases. CONCLUSIONS: Alcoholism should be presumed to be present in a substantial number of patients who present to urban EDs by ambulance.     

Supportive care for older people with frailty in hospital: An integrative review

BackgroundGrowing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care.AimTo identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation.DesignAn integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term ‘supportive care’. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken.Data sourcesLiterature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n = 52) were integrated using synthesis of themes.ResultsRelevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings.ConclusionThe findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.     

The experiences of older people on discharge from hospital following assessment by the public health nurse

Aims and objectives. The aim of the study was to explore the experiences of older people on discharge from hospital following assessment by the public health nurse. The objectives of the study were to: (i) identify needs as perceived by older people, (ii) examine if older people felt that these needs were met, (iii) examine the support/care/services received by older people, and (iv) explore any unmet needs of older people. Background. A review of the literature revealed that discharge from hospital remains an area of concern as older people had varying degrees of met and unmet need following discharge from acute hospital. Design/methods. A qualitative study using a phenomenological approach was undertaken. The researcher carried out interviews with a purposive sample of 11 older people in their homes two weeks following discharge from acute hospital. Data were analysed using Colaizzi's method. Results. Older people experienced a wide variety of difficulties in managing aspects of their own care. A reassuring finding of this study is that older people received assistance in this initial discharge period, i.e. they experienced significant informal support complemented by statutory and voluntary support. Even though these older people were assessed by the public health nurse, their need to access services, for statutory service provision, social aspects of their lives and safety measures in their environment were not met. Older people expressed the wish to remain in their own homes. Conclusion. Assessment of older people by the public health nurse is meaningful to identify the needs of older people and provide for the needs of older people though this does not necessarily mean that all the needs of older people can be met by the public health nurse. This study supports the findings of other studies of the problems after discharge and provides an understanding of the experiences of older people on discharge from hospital following assessment by the public health nurse from their perspective. Relevance to clinical practice. The study will provide information that will contribute to current public health nurse practice and will contribute to the understanding of public health nurse practice.