Malone R E
J Emerg Nurs. 1996 Jun;22(3):176-83. doi: 10.1016/s0099-1767(96)80102-4.
Heavy users (HUs) of emergency services ("repeaters" or "frequent flyers") are often regarded by emergency nurses as "problem patients." Yet, these patients also solicit deeper clinician involvement because of their familiarity and their often intractable medical and social problems. The primary objective of this study was to contribute to improved understanding of the phenomenon of heavy ED use by describing the context within which such use occurs and its meanings to patients and to clinicians.
Observational and narrative data were collected during ethnographic fieldwork in two inner-city trauma center emergency departments. Data were interpreted using interpretive phenomenological strategies.
Relationships between ED clinicians and HU patients in the study hospitals were characterized by complexity and ambivalence, but thematic analysis of interviews revealed commonalities. Recognition practices, discussed in this article, were central to both centers.
Frustration with a system that focuses on control but often leaves ED clinicians feeling like failures as they try to pick up the pieces for failing or absent families, communities, and social programs can contribute to stigmatization of HU patients, missed clinical diagnoses, and reduced nurse morale. Acknowledging the reasonable limits of control, and engaging in simple recognition and inclusion practices, may be more meaningful in furthering changes in HU patients behavior than biomedically oriented interventions.
急诊服务的频繁使用者（“重复就诊者”或“常客”）常被急诊护士视为“问题患者”。然而，由于他们与医护人员较为熟悉，且往往存在棘手的医疗和社会问题，这些患者也会寻求临床医生更深入的介入。本研究的主要目的是通过描述频繁使用急诊这一现象发生的背景及其对患者和临床医生的意义，来增进对这一现象的理解。
在两个市中心创伤中心急诊科的人种志实地调查期间收集观察性和叙述性数据。使用解释性现象学策略对数据进行解读。
研究医院中急诊临床医生与频繁就诊患者之间的关系具有复杂性和矛盾性，但访谈的主题分析揭示了一些共性。本文所讨论的识别行为对两个中心都至关重要。
对于一个侧重于控制但往往让急诊临床医生在试图为失败或缺失的家庭、社区和社会项目收拾残局时感到挫败的系统，可能会导致对频繁就诊患者的污名化、漏诊以及护士士气低落。认识到控制的合理限度，并采取简单的识别和接纳行为，可能比以生物医学为导向的干预措施更有助于改变频繁就诊患者的行为。
