Patient experience in the emergency department: inconsistencies in the ethic and duty of care.
OBJECTIVE
To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care.


BACKGROUND
People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care.


METHODS
Qualitative description of interview data (stage 3 of a multimethod study).


METHODS
The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences.


RESULTS
Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'.


CONCLUSIONS
People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed.


CONCLUSIONS
Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care.
Faculty of Medicine, Nursing & Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Vic., Australia.
Cheryle
C
Moss
Katherine
K
Nelson
Margaret
M
Connor
Cynthia
C
Wensley
Eileen
E
McKinlay
Amohia
A
Boulton
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001364:Awareness; D002755:Choice Behavior; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000941:ethics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D028681:Moral Obligations; D010342:Patient Acceptance of Health Care; D055815:Young Adult
chronic illness; duty of care; emergency department; ethic of care; ethical framework; frequent attendance; health professionals; moral comportment; patient experience; usage