Nursing home residents in emergency departments: a Foucauldian analysis.
OBJECTIVE
This paper is a critical review of current knowledge about use of emergency departments by nursing home residents.


BACKGROUND
A great deal of literature focuses on the challenges presented by older adults in acute care environments. Nursing home residents who transfer to emergency departments have been identified as being particularly problematic because they use considerable resources and their needs are not always amenable to acute interventions.


METHODS
A literature search was conducted in May 2006 using the CINAHL, Medline and Cochrane databases and Google Scholar with the keywords 'nursing home resident', 'long-term care resident', 'hospital transfer', and 'acute illness and emergency room'. No date restrictions were imposed. Foucault's concept of subjectivity was used to demonstrate how power derived from medical knowledge is used by emergency department personnel to construct nursing home residents as problematic.


RESULTS
Knowledge about the use of emergency departments by nursing home residents has been derived mainly from retrospective record reviews, while the events in nursing homes that lead to transfers have been virtually ignored. Moreover, the primary focus of these investigations has been the effect of residents on emergency departments, rather than how residents themselves were affected.


CONCLUSIONS
Current understanding of the care of nursing home residents in emergency departments is embedded in a complex web of social, historical and political factors. Research is needed that considers multiple perspectives, including those of both emergency department and nursing home staff, residents and ambulance personnel who act as mediators between the two settings.
McCloskey
Rose
R
Department of Nursing, University of New Brunswick, Saint John, New Brunswick, Canada. rmcclosk@unbsj.ca
van den Hoonaard
Deborah
D
D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005851:Geriatric Nursing / Q000458:organization & administration*; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D009735:Nursing Homes; D010360:Patient Transfer / Q000458:organization & administration*