Dunnion Mary E, Kelly Billy
Nursing Department, Letterkenny Institute of Technology, Letterkenny, Co. Donegal, Ireland.
J Clin Nurs. 2005 Jul;14(6):776-85. doi: 10.1111/j.1365-2702.2005.01129.x.
The purpose of this study was to explore dimensions of the management of the older person following care in an emergency department in preparation for discharge home by identifying perceptions and attitudes of staff in both emergency department and primary care sectors.
It is recognized that older people discharged home directly from the emergency department are a vulnerable group. Effective communication and liaison are seen to be keys to the provision of high quality care for older people in the emergency department and in ensuring a seamless care between sectors.
A purposeful sample was collected that comprised the total population (n = 222) of all grades of medical and nursing staff in both the emergency department and all nursing (Public Health Nurses & Practice nurses) and medical staff (General Practitioners) in the primary care area.
Methodology used was that of a survey approach of nursing and medical staff in both the emergency department and primary care services. Standardized questionnaires were employed which comprised both open and closed questioning style. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were content analysed for themes.
Many staff in the primary care area reported the level of communication between the emergency department and the primary care area as unsatisfactory with confusion regarding follow-up care and a lack of support for older people on discharge. Hospital staff reported the level of communication to be much greater than that perceived by their colleagues in primary care. There was agreement of staff in both sectors in relation to the perceived usefulness of a discharge liaison nurse in the emergency department.
Previous research highlights communication difficulties when patients are discharged from hospital. Findings from this study indicate that this problem can also be applied to the emergency department.
Implications for practice include a need for a multidisciplinary approach to developing referral guidelines, staff training and a comprehensive dissemination of information between sectors ultimately to improve quality and continuity of care for the older person.
本研究旨在通过识别急诊科和初级保健部门工作人员的看法和态度，探索在急诊科护理后准备出院回家的老年人管理的维度。
人们认识到，直接从急诊科出院回家的老年人是弱势群体。有效的沟通和联络被视为在急诊科为老年人提供高质量护理以及确保各部门之间无缝护理的关键。
收集了一个有目的的样本，包括急诊科所有级别医护人员的全部人群（n = 222）以及初级保健领域的所有护理人员（公共卫生护士和执业护士）和医务人员（全科医生）。
采用的方法是对急诊科和初级保健服务中的医护人员进行调查。使用了标准化问卷，包括开放式和封闭式提问方式。使用SPSS for Windows对原始统计数据进行分析，同时对开放式问题产生的定性数据进行主题内容分析。
许多初级保健领域的工作人员报告说，急诊科和初级保健领域之间沟通水平不尽人意，后续护理存在混乱，老年人出院时缺乏支持。医院工作人员报告说沟通水平比初级保健领域的同事所认为的要高得多。两个部门的工作人员都认同急诊科出院联络护士的有用性。
先前的研究强调了患者出院时的沟通困难。本研究结果表明，这个问题也适用于急诊科。
对实践的启示包括需要采取多学科方法来制定转诊指南、进行工作人员培训以及在各部门之间全面传播信息，最终提高对老年人护理的质量和连续性。
