Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study.
Aged
Ambulance service
Community health nurse
General practitioners
Nursing homes
Patients
Primary health care
Reflective lifeworld research
Support
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
28 09 2023
28 09 2023
Historique:
received:
30
06
2023
accepted:
19
09
2023
medline:
4
10
2023
pubmed:
29
9
2023
entrez:
28
9
2023
Statut:
epublish
Résumé
Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved. The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse. Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence. The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
Sections du résumé
BACKGROUND
Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.
METHODS
The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.
RESULTS
Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.
CONCLUSIONS
The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
Identifiants
pubmed: 37770856
doi: 10.1186/s12877-023-04331-0
pii: 10.1186/s12877-023-04331-0
pmc: PMC10537128
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
608Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Basinska K, Künzler-Heule P, Guerbaai RA, Zúñiga F, Simon M, Wellens NIH, Serdaly C, Nicca D. Residents’ and relatives’ experiences of acute situations: a qualitative study to inform a care model. Geront 2021;61(7):1041–52. https://doi.org/10.1093/geront/gnab027 .
Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011;12(5):337–43. https://doi.org/10.1016/j.jamda.2010.04.009 .
doi: 10.1016/j.jamda.2010.04.009
pubmed: 21450180
Swedish National Board of Health and Welfare. Akut omhändertagande: ett underlag för kompetensutveckling vid omhändertagande av akut sjuka och skadade (Eng. Emergency care: a document for competence development). Stockholm: Swedish National Board of Health and Welfare; 1994.
SOU 2020:19. God och nära vård: en reform för ett hållbart hälso- och sjukvårdssystem (Eng. Proper and close care: a reform for a sustainable health care). Stockholm: Norstedts juridik; 2020.
Shepperd S, Iliffe S, Doll HA, Clarke MJ, Kalra L, Wilson AD, Gonçalves-Bradley DC. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2016;9(9):CD007491. https://doi.org/10.1002/14651858 .
Forsgärde E-S, Elmqvist C, Fridlund B, Svensson A, Andersson R, Rööst M. Patients’ aged ≥ 65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study. BMJ Open. 2020;10(11):e038885.
Forsgärde E-S, Svensson A, Rööst M, Fridlund B, Elmqvist C. The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called. Int J Qual Stud Health Well-being. 2021;16(1):1970095. https://doi.org/10.1080/17482631.2021.1970095 .
doi: 10.1080/17482631.2021.1970095
pubmed: 34427535
pmcid: 8386744
Hominick K, McLeod V, Rockwood K. Characteristics of older adults admitted to hospital versus those discharged home, in emergency department patients referred to internal medicine. Can Geriatr J. 2016;19(1):9–14. https://doi.org/10.5770/cgj.19.195 .
Ivic R, Kurland L, Vicente V, Castrén M, Bohm K. Serious conditions among patients with non-specific chief complaints in the pre-hospital setting: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2020;28(1). https://doi.org/10.1186/s13049-020-00767-0 .
Ackroyd-Stolarz S, Read Guernsey J, Mackinnon NJ, Kovacs G. The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: a retrospective cohort study. BMJ Qual Saf. 2011;20(7):564–9. https://doi.org/10.1136/bmjqs.2009.034926 .
Ebben RHA, Vloet LCM, Speijers RF, Tönjes N, Loef J, Pelgrim T, Hoogeveen M, Berben SAA. A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scand J Trauma Resusc Emerg Med. 2017;25(1). https://doi.org/10.1186/s13049-017-0409-6 .
Kihlgren A, Svensson F, Lövbrand C, Gifford M, Adolfsson A. A Decision support system (DSS) for municipal nurses encountering health deterioration among older people. BMC Nurs 2016;15(1):63. https://doi.org/10.1186/s12912-016-0184-0 .
Goodridge D, Stempien J. Understanding why older adults choose to seek non-urgent care in the emergency department: the patient’s perspective. CJEM. 2019;21(2):243–8. https://doi.org/10.1017/cem.2018.378 .
Doekhie KD, Buljac-Samardzic M, Strating MMH, Paauwe J. Elderly patients’ decision-making embedded in the social context: a mixed-method analysis of subjective norms and social support. BMC Geriatr. 2020;20(1):53. https://doi.org/10.1186/s12877-020-1458-7 .
Sinclair J. COBUILD advanced learner’s dictionary. Glasgow: HarperCollins Publishers; 2017.
McCloskey R, Jarrett P, Stewart C. The untold story of being designated an alternate level of care patient. Health Policy. 2015;11(1):76–89. PMID:26571470.
Sadak T, Foster Zdon S, Ishado E, Zaslavsky O, Borson S. Potentially preventable hospitalizations in dementia: family caregiver experiences. Int Psychogeriatr. 2017;29(7):1201–11. https://doi.org/10.1017/S1041610217000217 .
Holmberg M, Forslund K, Wahlberg AC, Fagerberg I. The relationship with the ambulance clinicians as experienced by significant others. Nurs Critic Care. 2016;21(4):e1–8. https://doi.org/10.1111/nicc.12144 .
Kihlgren A, Sunvisson H, Ziegert K, Mamhidir A-G. Referrals to Emergency Departments— The Processes and factors that influence decision-making among community nurses. Open J Nurs. 2014;4(5):366 – 74. https://doi.org/10.4236/ojn.2014.45042 .
Kirsebom M, Hedström M, Pöder U, Wadensten B. General practitioners’ experiences as nursing home medical consultants. Scand J Caring Sci. 2017;31(1):37–44. https://doi.org/10.1111/scs.12310 .
Furåker C. Registered nurses’ views on competencies in home care. Home Health Care Manag Pract. 2012;24(5):221–7. https://doi.org/10.1177/1084822312439579 .
Widgren BR. RETTS: akutsjukvård direkt. (Eng. RETTS emergency care immediately). Lund: Studentlitteratur; 2012.
Stokoe A, Hullick C, Higgins I, Hewitt J, Armitage D, O’Dea I. Caring for acutely unwell older residents in residential aged-care facilities: Perspectives of staff and general practitioners. Australas J Ageing. 2016;35(2):127–32. https://doi.org/10.1111/ajag.12221 .
Moore A, Croxson C, McKelvie S, Lasserson D, Hayward G. General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study. Fam Pract. 2019;36(4):493–500. https://doi.org/10.1093/fampra/cmy083 .
O’Hara R, Johnson M, Siriwardena AN, Weyman A, Turner J, Shaw D, Mortimer P, Newman C, Hirst E, Storey M, Mason S, Quinn T, Shewan J. A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Serv Resear & Policy. 2014;20(1_suppl):45–53. https://doi.org/10.1177/1355819614558472 .
Wireklint Sundström B, Dahlberg K. Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions. Int Emerg Nurs. 2011;19(3):113–9. https://doi.org/10.1016/j.ienj.2010.07.005 .
Vicente V, Svensson L, Wireklint Sundström B, Sjöstrand F, Castren M. Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden. J Am Geriatr Soc. 2014;62(7):1281–7. https://doi.org/10.1111/jgs.12888 .
Murphy-Jones G, Timmons S. Paramedics’ experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors. Emerg Med J. 2016;33(10):722–6. https://doi.org/10.1136/emermed-2015-205405 .
Dahlberg K, Dahlberg H, Nyström M. Reflective lifeworld research. Lund: Studentlitteratur; 2008.
Dahlberg H, Dahlberg K. Open and Reflective Lifeworld Research: A Third Way. Qual Inq. 2019;26(5):458 – 64. https://doi.org/10.1177/1077800419836696 .
Swedish National Board of Health and Welfare. Lagstiftningen inom vården och omsorgen om äldre. Likheter och skillnader mellan socialtjänst- och hälso- och sjukvårdslagstiftningen (Eng. Legalisation in care of the elderly. Similarities and differences between social services and healthcare legalisation). Stockholm: Swedish National Board of Health and Welfare; 2006.
Statistics Sweden. Municipal Facts 2018. https://www.h5.scb.se/kommunfakta/k_frame.htm . Accessed 1 jun 2020.
Elmqvist C, Fridlund B, Ekebergh M. More than medical treatment: The patient´s first encounter with prehospital emergency care. Int Emerg Nurs 2008;16(3):185 – 92. https://doi.org/10.1016/j.ienj.2008.04.003.
Goethals S, Dierckx de Casterlé B, Gastmans C. Nurses’ decision-making process in cases of physical restraint in acute elderly care: A qualitative study. Int J Nurs Stud. 2013;50(5):603–12. https://doi.org/10.1016/j.ijnurstu.2012.10.006 .
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–21. https://doi.org/10.1136/bmj.327.7425.1219 .
Ljungholm L, Klinga C, Edin-Liljegren A, Ekstedt M. What matters in care continuity on the chronic care trajectory for patients and family carers?—A conceptual model. J Clinic Nurs. 2022;31(9–10):1327–38. https://doi.org/10.1111/jocn.15989 .
Kohnke H, Zielinski A. Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study. Scand J Prim Health Care. 2017;35(2):113–9. https://doi.org/10.1080/02813432.2017.1333303 .
Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8(6):e021161. https://doi.org/10.1136/bmjopen-2017-021161 .
Rhodes P, Sanders C, Campbell S. Relationship continuity: when and why do primary care patients think it is safer? Br J Gen Pract. 2014;64(629):e758–64. https://doi.org/10.3399/bjgp14X682825 .
Vård och omsorgsanalys 2021:4 (Eng. Care and care services analysis 2021:4). Vården ur befolkningens perspektiv 2020 (Eng. Care from the population’s perspective 2020). Swedish Agency for Health and Care Services Analysis; 2021. https://www.vardanalys.se/rapporter/varden-ur-befolkningens-perspektiv-2020/ . Accessed 1 Apr 2021.
Husserl E, Carr D. The crisis of European sciences and transcendental phenomenology: an introduction to phenomenological philosophy. Evanston: Northwestern U.P; 1978[1970].
Merleau-Ponty M, Smith C. Phenomenology of Perception. London: Routledge; 2002[1962].
Jarling A, Rydström I, Ernsth Bravell M, Nyström M, Dalheim-Englund AC. Perceptions of professional responsibility when caring for older people in home care in Sweden. J Community Health Nurs. 2020;37(3):141–52. https://doi.org/10.1080/07370016.2020.1780044 .
Langford CP, Bowsher J, Maloney JP, Lillis PP. Social support: a conceptual analysis. J Adv Nurs. 1997;25(1):95–100. https://doi.org/10.1046/j.1365-2648.1997.1997025095.x .
House JS. Work stress and social support. 1981, Addison-Wesley, Reading, Mass.
Panesar SS, deSilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, et al. How safe is primary care? A systematic review. BMJ Quality & Safety. 2016;25(7):544–53. https://doi.org/10.1136/bmjqs-2015-004178 .
Hays R, Daker-White G, Esmail A, Barlow W, Minor B, Brown B, Blakeman T, Sanders C, Bower P. Threats to patient safety in primary care reported by older people with multimorbidity: baseline findings from a longitudinal qualitative study and implications for intervention. BMC Health Serv Res. 2017;17(1):754. https://doi.org/10.1186/s12913-017-2727-9 .
Bayliss EA, Balasubramianian BA, Gill JM, Stange KC. Perspectives in primary care: implementing patient-centered care coordination for individuals with multiple chronic medical conditions. Ann Fam Med. 2014;12(6):500–3. https://doi.org/10.1370/afm.1725 .
Holmberg M. The EXPAND-model: A hermeneutical application of a lifeworld-led prehospital emergency nursing care. Nurs Sci Q. 2021;34(3):287–93. https://doi.org/10.1177/08943184211010456 .
Abrashkin KA, Poku A, Ramjit A, Washko J, Zhang J, Guttenberg M, Smith KL. Community paramedics treat high acuity conditions in the home: A prospective observational study. BMJ Support Palliat Care 2019:4:BMJspacare-2018-001746. https://doi.org/10.1136/bmjspcare-2018-001746 .
Svensson A, Fridlund B. Experiences of and actions towards worries among ambulance nurses in their professional life: a critical incident study. Int Emerg Nurs. 2008;16(1):35–42. https://doi.org/10.1016/j.ienj.2007.10.002 .
van Wijngaarden E, Meide HV, Dahlberg K. Researching health care as a meaningful practice: toward a nondualistic view on evidence for qualitative research. Qual health res. 2017;27(11):1738–47. https://doi.org/10.1177/1049732317711133 .
World Medical Association, WMA. Declaration of Helsinki- ethical principles for medical research involving human subjects. 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ . Accessed 1 Jan 2016.