Nursing

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Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention
(2024-05-31) Bucknall, Tracey K.; Guinane, Jessica; McCormack, Brendan; Jones, Daryl; Buist, Michael; Hutchinson, Alison M.
Aim: To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. Background: Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. Design: A narrative inquiry. Methods: Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. Results: The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. Conclusion: Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. Implications for the Profession and/or Patient Care: Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. Reporting Method: The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. Patient or Public Contribution: The consumer researcher was involved in design, data analysis and publication preparation.
New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis
(Wiley, 2018-03-24) Rhynas, Sarah J.; Garcia Garrido, Azucena; Burton, Jennifer K.; Logan, Gemma; MacArthur, Juliet
Aims and objectives: To gain an in-depth understanding of the decision- making pro-cesses involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records.Background: The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision- making.Method: A purposive sample of 10 cases was selected from a cohort of 100 individu-als admitted to hospital from home and discharged to a care home. Cases were se-lected to highlight important personal, relational and structural factors thought to affect the decision- making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making.Results: Care home discharge decision- making is a complex process involving stake-holders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient’s voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice.Implications for practice: Nurses have a critical role in the involvement of older peo-ple making discharge decisions in hospital, improved documentation of the patient’s voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs.
Advocating a person-centered care approach to drug safety [Editorial]
(Taylor & Francis, 2021-01-06) Scerri, Josianne; Churchill, Julie; Banks, David; Sultana, Janet
Stories from people living with frailty
(Cambridge University Press, 2019-08-09) Lloyd, Anna; Haraldsdottir, Erna; Kendall, Marilyn; Murray, Scott A.; McCormack, Brendan
We describe the findings of a qualitative longitudinal interview study of a group of initially community dwelling frail older people, their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those living with chronic illness. The frail older people told stories of their experiences that revealed three distinct shapes or typologies. These were either stable, unbalancing or overwhelmed and related to how the person managed to adapt to increasing challenges and losses and to reintegrate their sense of self into a cohesive narrative. Each is illustrated by an individual case story. Frailty is described as both biographically anticipated yet potentially biographically disruptive as older people may struggle to make sense of their circumstances without a clear single causative factor. Findings are discussed in relation to biographical disruption and reconstruction in chronic illness and the rhetoric around ‘successful ageing’. We conclude by drawing attention to the complex individual and social factors that contribute to the experience of living with frailty in later life.

Nursing

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