Matters of concern: a qualitative study of emergency care from the perspective of patients.
OBJECTIVE
A key to improving the quality of emergency care is improvement of the contact between patient and emergency department (ED) staff. We investigate what patients actually experience during their ED visit to better understand the patterns of relationships among patients and health care professionals.


METHODS
This was an ethnographic study. We conducted observations at the ED of a large general teaching hospital. Patients were enrolled in the study on the basis of convenience sampling. We thoroughly analyzed 16 cases in a grounded theory approach, using the constant comparative methods (ie, starting the analysis with the collection of data). This approach enabled us to conceptualize the experiences of patients step by step, using the ethnographic data to refine and test the theoretical categories that emerged.


RESULTS
Our data show that patients at the ED continuously and actively labor to deal with their disorder, its consequences, and the situation they are in. Characteristics of these "patient concerns" indicate a certain trouble, have a personal character, impose themselves with a certain urgency, and require patient effort. We have established a qualitative taxonomy of 5 categories of patient concerns: anxiety, expectations, care provision, endurance, and recognition.


CONCLUSIONS
Diligence for patient concerns enables ED staff to have a fruitful insight into patients' actual experience. It offers significant clues to improving relationship building in emergency care practice between patients and health care professionals.
Tilburg School of Humanities, Tilburg University, Tilburg, the Netherlands. Electronic address: g.j.olthuis@uvt.nl.
Gert
G
Olthuis
University of Humanistic Studies, Utrecht, the Netherlands.
Carolien
C
Prins
ZorgEssentie: Consultancy, Training and Research, Hertogenbosch, the Netherlands.
Marie-Josée
MJ
Smits
St. Elisabeth Hospital, Tilburg, the Netherlands.
Harm
H
van de Pas
Vught, the Netherlands.
Joost
J
Bierens
University of Humanistic Studies, Utrecht, the Netherlands.
Andries
A
Baart
D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards; D055815:Young Adult