Nursing home residents in emergency departments: a Foucauldian analysis

Abstract

Current understanding of the care of nursing home residents in emergency departments is embedded in a complex web of social, historical and political factors. Research is needed that considers multiple perspectives, including those of both emergency department and nursing home staff, residents and ambulance personnel who act as mediators between the two settings.

The Institutional Practice

“…A similar argument was made in a thought-provoking theoretical review of research on nursing home residents in emergency departments (McCloskey & Hoonaard 2007), which argued that «(…) power derived from medical knowledge is used by emergency department personnel to construct nursing home residents as problematic» (186). It is further argued that the research literature is severely limited regarding the effects of transfers on nursing homes (as opposed to the emergency wards), events in nursing homes leading to transfers and accounts provided by nursing homes staff or residents (Ibid.).…”

“…In short it is argued that because of the selected research designs, most commonly the use of «chart reviews» (Ibid. ), or «retrospective record reviews» (McCloskey & Hoonaard 2007), the analysis of the actual decision making process is not taken into account.…”

Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses

“…Several studies have claimed that most referrals to EDs from nursing homes are inappropriate [27] [28] as they contribute to overcrowding, longer waiting times, and consume a great deal of resources [29]. In the review by McCloskey [18], most of the ED referral literature is based on ED staff members' and primarily physicians' accounts, and not on nursing home health care personnel, which may say something about the prevailing hierarchy within the health care system. However, our results reveal that RNs and their co-workers requested more education in order to deal with the deterioration in the health status and multiple illnesses of older persons so that they could assume responsibility and reduce feelings of uncertainty.…”

“…Although ED documentation and the opinions of ED staff have been examined, the other parties directly involved have not been considered, nor have the circumstances that contributed to the referral decisions, the NH staff members', the older persons' or their relatives' perspectives been illuminated [18]. The RNs expressed concerns about older persons with multiple illnesses, their vulnerability in exposed situations, and struggled to decide the best course of action in the changed circumstances-to refer or not to refer to the ED.…”

“…In a literature review, McCloskey and Hoonaard [18] reported that knowledge about referrals to EDs of persons living in nursing homes has mainly been based on retrospective record reviews, while the events that led to the referrals were sparsely examined. Recently, McCloskey [8] investigated older persons' entire referral situation from a nursing home to an ED and highlighted its complexity.…”