Transferring dying nursing home residents to the hospital: DON perspectives on the nurse’s role in transfer decisions

The Institutional Practice

“…Such an emphasis is a contrast to other segments of the research literature, in which the role of the physician is primary: «Despite this central role, most studies of transfer decision-making focus on the physician» (Bottrell et al 2001). It would seem that when changing the perspective from the decision itself, or the outcome of a decision, to what leads to the decision, nurses are increasingly at center stage.…”

“…Nursing homes might, for instance, be incentivized to seek treatment elsewhere for their residents if reimbursement schemes are unfavorable for treatment in-house, as pointed out in a study of nursing home directors (Bottrell et al 2001). For similar reasons, emergency departments might be incentivized to return residents to nursing homes (McCloskey & Hoonaard 2007).…”

“…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:…”

“…Families of residents are important for the practices of caring staff, particularly when residents become acutely or severely ill (Bottrell et al 2001, see also Chapter 4). Caring staff relate to families, explicitly and implicitly, and formally and informally.…”

“…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.…”