title: Managements' perception of community nurses' decision-making processes when referring older adults to an emergency department.
abstract: In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nurses' exposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them.
authors.affiliation: Centre for Nursing Science, Orebro University Hospital, Orebro, Sweden. annica.larsson-kihlgren@orebroll.se
authors.forename: A
authors.initials: A
authors.lastname: Kihlgren
authors.forename: K
authors.initials: K
authors.lastname: Forslund
authors.forename: I
authors.initials: I
authors.lastname: Fagerberg
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003152:Community Health Nursing / Q000458:organization & administration*; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006270:Health Facility Administrators / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D008503:Medical Staff / Q000523:psychology; D033262:Narration; D009718:Nurse Administrators / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009736:Nursing Process; D009740:Nursing Staff / Q000458:organization & administration / Q000523:psychology; D015279:Organizational Culture; D012017:Referral and Consultation / Q000458:organization & administration*; D012944:Social Support; D011795:Surveys and Questionnaires; D013548:Sweden; D035502:Trust