Sanders J
Research Sister, UCL Centre for Cardiovascular Genetics, London, England.
J Adv Nurs. 2000 May;31(5):1097-105. doi: 10.1046/j.1365-2648.2000.01379.x.
Increasing attendances in accident and emergency (A and E) departments in the United Kingdom have been attributed to a greater number of patients presenting with minor injuries. A and E staff believe this type of patient is suitable for primary care, and is 'inappropriate' for A and E management. Thus, A and E staff find 'inappropriate' attenders time-consuming and unrewarding, and are less motivated to help them, whilst 'inappropriate' patients believe they have attended the appropriate service for their medical needs and expectations. This review examines research into health professional and patient attitudes towards 'inappropriate' attendances in accident and emergency. It identifies a discrepancy between health professional and patient perspectives regarding 'inappropriate' attendances. However, the change in accident and emergency services with the development of minor injury units and nurse practitioners within A and E to treat minor injury patients away from the mainstream A and E service, appears to be based on the professional attitude of what constitutes an appropriate A and E attendance, and not on the patients' perspective. As negative attitude formation towards 'inappropriate' A and E attendances has occurred, there is concern that such attitudes could remain or develop again in the new units. Patients are generally not medically trained and may experience difficulty in ascertaining the severity of their own condition and attending the 'appropriate' service, as defined by trained professionals. This is exacerbated by the unclear boundaries and roles of minor injury units, nurse practitioners and general practitioners in minor injury care. Therefore research is required into current attendances in minor injury units, A and E departments and general practice, in order to develop clear roles and boundaries for these services. More importantly, research is warranted into the attitudes of all minor injury care providers towards attending patients, and into patient perceptions of the services offered.
英国急诊部门就诊人数不断增加，原因是出现轻伤的患者数量增多。急诊医护人员认为这类患者适合初级护理，而不适合在急诊进行处理。因此，急诊医护人员觉得“不适当”的就诊者既耗费时间又没有回报，因而不太愿意帮助他们，而“不适当”的患者却认为自己选择了能满足其医疗需求和期望的合适服务。本综述审视了关于医护人员和患者对急诊“不适当”就诊态度的研究。研究发现医护人员和患者对“不适当”就诊的看法存在差异。然而，随着轻伤治疗单元的发展以及急诊部门内护士从业者的出现，可在远离主流急诊服务的地方治疗轻伤患者，急诊服务的这种变化似乎是基于对何种情况属于合适的急诊就诊的专业态度，而非患者的看法。由于对急诊“不适当”就诊形成了负面态度，人们担心这种态度可能在新的单元中持续存在或再次出现。患者通常没有接受过医学培训，可能难以确定自身病情的严重程度，也难以选择由专业人员定义的“合适”服务。轻伤治疗单元、护士从业者和全科医生在轻伤护理方面界限不清、职责不明，这使情况更加糟糕。因此，需要对轻伤治疗单元、急诊部门和全科医疗当前的就诊情况进行研究，以便明确这些服务的职责和界限。更重要的是，有必要研究所有轻伤护理提供者对就诊患者的态度以及患者对所提供服务的看法。
