Decisions About Transfer From Nursing Home to Emergency Department

Abstract

The findings cannot be generalized to long-term care facilities across the US or to other countries, but they enhance understanding about some of the ways transfer decisions occur and the role of nurses in those transfers, especially when conflict arises.

The Institutional Practice

“…Most frequently mentioned are congestive heart failure (40 percent) and pneumonia (35 percent) (Pappas & Hadden 1997). Jablonski et al (2007) criticize the research majority's understanding of avoidable hospitalization, stating that many overemphasize occurrences because of «(…) the use of specific research designs and methods that do not include the whole «story» of the transfer decisions» (267). In short it is argued that because of the selected research designs, most commonly the use of «chart reviews» (Ibid.…”

“…The focus on the significance of nurses might also be attributed to the fact that most studies are about nurses 3 and many are carried out by nurses 4 . Nurses or registered nurses, it is argued, are central in decision-making about residents in general (Arendts & Howard 2010, Bottrell et al 2001, Carusone et al 2006a, Kayser-Jones et al 1989, Mitchell et al 2011, Shanley et al 2011, Shidler 1998, because of formal responsibility and authority (McCloskey 2011), or through indirect or subtle influences over others (Jablonski et al 2007, Lopez 2009). Although most studies highlight the benevolent role of the nurse, torn between opposing interests, the nurse can, in some instances, also influence decisions based on convenience or because of pressure from others, arguments rarely found in the other segments of the research literature:…”

“…The physician is typically presented as having varied influence on transfer decisions when discussed (Laging et al 2015). Studies point out that a lack of access to physicians influences (in the sense of increasing) rates of hospitalization (Jablonski et al 2007, McCloskey 2011, Phillips et al 2006, either in general, or at times when the physician in not physically present at the nursing homes (Mitchell et al 2011). Others emphasize challenges in communication between physicians and nurses (and families) as potentially influencing decisions of transfer (Phillips et al 2006).…”

“…Potential pressure from family to transfer or not to transfer residents (more often the former) is accentuated in several studies and is noticeably missing from other segments of the literature. Family of residents is pointed out to be generally influential, through interaction with physicians, nurses or both (Arendts & Howard 2010, Bottrell et al 2001, Hutt et al 2011, Jablonski et al 2007, Kayser-Jones et al 1989, Lamb et al 2011, Phillips et al 2006, Shanley et al 2011): or in specific cases when the resident's preferences were unknown (Lopez 2009). Staff in nursing homes experience pressure from family, it is generally argued, while the effect of pressure varies, depending on the study.…”

“…Rather than exclusively addressing the availability of treatment options (such as intravenous therapy), the literature highlights variation in utilization of available treatment options (Jablonski et al 2007, Kayser-Jones et al 1989). In addition, the relationship between availability, utilization of and having adequately trained staff, is pointed out as influential for decisions on hospitalization (Carusone et al 2006a(Carusone et al & 2006b.…”