Supporting older people following out of hours discharge from the Emergency Department: An integrative review of the literature

Background

For many older people the emergency department (ED) is an important but sometimes difficult step in their healthcare journey. They often attend the ED with co and multi morbidities. Discharge home at evenings and weekends when post-discharge support services are limited can result in a delay or failure to follow through on their discharge plan leading to adverse health outcomes and in some cases, readmission to ED.

Objective

The aim of this integrative review was to identify and appraise the support available to older people following discharge from the ED out of hours (OOH).

Methods

For this review, out of hours referred to those times after 17.30 until 08.00 a.m. on Mondays to Fridays, all hours on weekends and public holidays. Whittemore and Knafl's (Journal of Advanced Nursing, 2005;52:546), framework was used to guide all stages of the review process. Articles were retrieved following a rigorous search of published works using various databases, the grey literature and hand search of the reference lists of the studies included.

Results

In total 31 articles were included in the review. These comprised systematic reviews, randomised control studies, cohort studies and surveys. Main themes identified included processes that enable support, support provision by health and social care professionals and telephone follow-up. Results identified a significant dearth of out of hours discharge research and a strong recommendation for more concise and thorough research in this important area of care transition.

Conclusion

Older person discharge home from the ED presents an associated risk as previous research has identified frequent readmission and periods of ill health and dependency. Out of hours discharge can be even more problematic when it may be difficult to arrange support services and ensure continuity of care. Further work in this area is required, taking cognisance of the findings and recommendations identified in this review.     

Exploratory study of nursing in an operating department: preliminary findings on the role of the nurse

This study was exploratory and describes how nursing was viewed and practised by nurses who worked in an operating department. It also highlighted factors that might influence the role performance of operating department nurses. The research involved interviews with a sample of 6 nurses working in an operating department, observation of 32 hours of nursing work over 6 operating sessions, in addition to the analysis of various documents, including the nursing care plans of 22 patients. Data were triangulated and analysed by constant comparison. Findings indicated that nurses had difficulty in articulating exactly what it was that operating department nursing entailed, but rather viewed their role in terms of the functions they performed. Observations indicated that the nursing role was primarily orientated toward the physical rather than the psychological aspects of care-giving. Furthermore, it appeared that the medical profession, nursing philosophy/leadership and the characteristics of patients all influenced the manner in which nurses enacted their role. These findings suggest that further research into the role of the nurse within the operating department environment is warranted. Key factors from this study were developed into a framework suitable for guiding future study of the nursing role in this environment.     

Fathers' experiences of living with cancer: a phenomenological study

There is a paucity of knowledge about fathers' experiences of cancer. This study explored the experiences of fathers diagnosed and living with cancer while also having parental responsibility for children. A hermeneutic phenomenological approach guided the study. Data were generated through 22 in‐depth interviews with 10 fathers throughout Northern Ireland. The findings evidenced that fathers' identities are challenged and frequently re‐shaped by the cancer experience, in many cases leading to an improved lifestyle behaviour. Heightened engagement with their children can provide a protective effect from the illness. On the other hand a lack of involvement led to frustration and low mood. The findings also demonstrated that father/child relationships were adversely affected by the social complexities that exist in the variances and diversity of fathers parenting roles and status. This knowledge contributes to our understanding of the complex relationships of fathers in non‐traditional roles. It extends our understanding of how, when stereotyped gendered roles are ascribed to fathers it can impact on a fathers' ability to fulfil the traditional breadwinner's role. This is knowledge that will inform health care professionals and enable them to provide gendered‐sensitive care that takes account of the masculine psychological responses that can shape the cancer experience.     

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate-non-graduate status, a comparative study

A review of the literature suggests people with learning disabilities are viewed negatively by others in society Such negative views have also been found among many health care professionals, including nurses This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n=31) towards people with learning disabilities The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire Two comparisons between subjects in the study were undertaken—a comparison of the attitudes of graduate nurses and those who were non-graduates, a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified
Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities     

Fatherhood and cancer: a commentary on the literature

When a parent is diagnosed with cancer it may create a multitude of concerns and worries, which can be enormously challenging. Despite the increase in research pertaining to parental cancer, there is a paucity of knowledge addressing the impact of cancer on fathers. Fathers' roles are evolving, becoming increasingly diverse and multidimensional. This paper aims to uncover some issues that may be relevant for fathers with cancer. A cancer diagnosis may not solely impact on a man's identity but also on the lives of his children given the contemporary shift from patriarch to more diverse roles. Men and women may share commonalities when diagnosed with cancer but they also experience differences emphasising the need for gender‐sensitive care. This paper highlights the significant role and function that fathers have in their children's lives. It is important that healthcare professionals are aware and pay attention to how gendered responses shape fathers' masculinity and consequently the cancer experience and parenting role. Furthermore this paper highlights the need to gather additional evidence on fathers' experiences when diagnosed and living with cancer. This knowledge can then be used to inform healthcare policy to target fathers, which will benefit both fathers and their children.     

Life after prostate cancer: A systematic literature review and thematic synthesis of the post‐treatment experiences of Black African and Black Caribbean men

Evidence shows that there are significant ethnic variations in prostate cancer prevalence and outcomes. Specifically, Black African and Black Caribbean men may encounter different post‐treatment experiences than Caucasian men due to their disproportionately higher risk of being diagnosed with advanced prostate cancer. But to date, no review of these experiences has been undertaken. This review synthesised findings from existing literature on the post‐treatment experiences of Black African and Black Caribbean men with prostate cancer and identified pertinent issues which may be useful to inform practice and future research. Seven databases were systematically searched using developed search terms. Four qualitative studies were identified and critically appraised. Findings are summarised under four main themes: symptom experience, healthcare experience, marital and social relationships and coping strategies. Cultural definitions of masculinity influenced the meanings men gave to their post‐treatment experiences. While men's experiences of healthcare varied, the provision of professional support to address their post‐treatment distress was lacking. Men derived most support from wives, peers and church communities. A culturally sensitive approach which recognises diversity among Black African and Black Caribbean populations and treats individuals within their religious and socio‐cultural contexts could potentially improve men's post‐treatment experiences. Areas for further research were also identified.     

Older UK sheltered housing tenants' perceptions of well‐being and their usage of hospital services

The aim of this study was to examine sheltered housing tenants' views of health and well‐being, the strategies they adopted to support their well‐being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service‐integrated housing for people, predominantly over 60. The study used a parallel, three‐strand mixed method approach to encompass the tenants' perceptions of health and well‐being (n = 96 participants), analysis of the service's health and well‐being database, and analysis of emergency and elective hospital admissions (n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well‐being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self‐reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi‐professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.