A meta‐synthesis of factors influencing nursing home staff decisions to transfer residents to hospital

Abstract

There is a lack of consensus regarding the role of the nursing home when a resident's health deteriorates. Nursing home staff would benefit from a clear prescription of their expected minimum clinical skill set; a staffing capacity that allows for the increased requirements to manage residents on-site, greater consistency in access to outside resources and further confidence and skills to optimize their role in resident advocacy.

The Institutional Practice

“…«Qualitative research» is a vague and wide-ranging term, as is the application of the term for research on hospitalization from nursing homes, most notably in two recent literature reviews (Arendts et al 2013, Laging et al 2015, including research using observation, interviews, focus groups and questionnaires as primary methodological approaches. This segment of the research literature is distinguishable from other segments not only by approach, but also by time of publication.…”

“…In the most recent review (Laging et al 2015), which included findings from the former (where, for some reason, observational studies were excluded, Arendts et al 2013: 826), the qualitative research literature on hospitalization from nursing homes is described as varied and having a «(…) lack of consensus regarding the role of the nursing home when a resident's health deteriorates» (Laging et al 2015: 1). Upon further analysis of the respective studies one by one, such a sentiment is accentuated, in addition to revealing that many studies do not, at least explicitly, actually cover the topic of hospitalization from nursing homes.…”

“…Of the 14 studies utilizing interviews and/or focus groups (Laging et al 2015), 11 did so with nurses, either exclusively (seven studies) or in combination with administrators and/or assistants (four studies). The remaining three studies interviewed administrators exclusively.…”

“…Seven of the 17 studies are first authored by registered nurses (Laging et al 2015), five by other professional groups. The remaining five did not disclose professional background of first author.…”

“…The physician is typically presented as having varied influence on transfer decisions when discussed (Laging et al 2015). Studies point out that a lack of access to physicians influences (in the sense of increasing) rates of hospitalization (Jablonski et al 2007, McCloskey 2011, Phillips et al 2006, either in general, or at times when the physician in not physically present at the nursing homes (Mitchell et al 2011).…”