title: Almost 'like family': emergency nurses and 'frequent flyers'.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Observational and narrative data were collected during ethnographic fieldwork in two inner-city trauma center emergency departments. Data were interpreted using interpretive phenomenological strategies.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: R E
authors.initials: RE
authors.lastname: Malone
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology*