title: The organizational culture of emergency departments and the effect on care of older adults: a modified scoping study.
abstract: How does the organizational micro culture in emergency departments (EDs) impact the care of older adults presenting with a complaint or condition perceived as non-acute? This scoping study reviews the literature and maps three levels of ED culture (artifacts, values and beliefs, and assumptions). Findings on the artifact level indicate that EDs are poorly designed for the needs of older adults. Findings on the ED value and belief level indicate that EDs are for urgent cases (not geriatric care), that older adults do not receive the care and respect they should be given, that older adults require too much time, and that the basic nursing needs of older adults are not a priority for ED nurses. Finally, finding on the assumptions level underpinning ED behaviors suggest that older adults do not belong in the ED, most older adults in the ED are not critically ill and therefore can wait, and staff need to be available for acute cases at all times. A systematic review on the effect of ED micro culture on the quality of geriatric care is warranted.
authors.affiliation: School of Nursing, University of Victoria, Victoria, British Columbia, Canada. Electronic address: pskar@uvic.ca.
authors.forename: Pål
authors.initials: P
authors.lastname: Skar
authors.affiliation: School of Nursing, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Bruce
authors.affiliation: School of Nursing, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Sheets
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015279:Organizational Culture; D063868:Patient Outcome Assessment
keywords: Aged; Culture; Elderly; Emergency department; Frail elderly; Frail older adult; Hospital emergency service; Organizational culture; Schein; Seniors