title: Stakeholder perspectives on transitions of nursing home residents to hospital emergency departments and back in two Canadian provinces.
abstract: Major gaps exist in our understanding of transitions in care for older persons living in nursing homes. The purpose of the study was to identify key elements, from multiple stakeholder perspectives, that influence the success of transitions experienced by nursing home residents when they required transfer to a hospital emergency department. This interpretive descriptive study was conducted in two cities in the Canadian provinces of British Columbia and Alberta. Data were collected from 71 participants via focus groups and individual interviews with nursing home residents, family members, and professional healthcare providers working in nursing homes, emergency departments, and emergency medical services. Transcripts were analyzed using constant comparison. The elements contributing to the success of transitions reflected a patient- and family-centered approach to care. Transitions were influenced by the complex interplay of multiple elements that included: knowing the resident; critical geriatric knowledge and skilled assessment; positive relationships; effective communication; and timeliness. When one or more of the elements was absent or compromised, the success of the transition was also compromised. There was consistency about the importance of all the identified elements across all stakeholder groups whether they are residents, family members, or health professionals in nursing homes, emergency departments or emergency medical services. Aspects of many of these elements are modifiable and suggest viable targets for interventions aimed at improving the success of transitions for this vulnerable population.
authors.affiliation: School of Nursing, Faculty of Health and Social Development, University of British Columbia, 3333 University Way, Kelowna, BC, Canada. Carole.Robinson@ubc.ca
authors.forename: C A
authors.initials: CA
authors.lastname: Robinson
authors.forename: J L
authors.initials: JL
authors.lastname: Bottorff
authors.forename: M B
authors.initials: MB
authors.lastname: Lilly
authors.forename: C
authors.initials: C
authors.lastname: Reid
authors.forename: S
authors.initials: S
authors.lastname: Abel
authors.forename: M
authors.initials: M
authors.lastname: Lo
authors.forename: G G
authors.initials: GG
authors.lastname: Cummings
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D001955:British Columbia; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease / Q000451:nursing* / Q000523:psychology*; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006707:Homes for the Aged; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008487:Medical History Taking; D009735:Nursing Homes; D010348:Patient Care Team; D010360:Patient Transfer / Q000379:methods*; D011368:Professional-Family Relations